Recently I attended a "summit meeting" in Washington to discuss means of improving access to fertility treatment globally for those who need it.
Delegates had to apply to attend this conference and my raison d'etre was that I work in Ireland, one of only three countries in the EU where fertility treatments such as IUI or IVF are not funded by the State.
In comparison to the US (which hosted this meeting), Ireland has a socialised model of health care. All Irish citizens are entitled to State-funded medical treatment. Surgery (whether emergency or elective) is covered for all, as is in-patient care for any medical condition.
Pregnancy care is available to all in the public system, as is gynaecological care. For men, surgery for testicular problems, ejaculation problems and testosterone treatments are all available publicly as is Viagra for medical cardholders.
Plastic surgery is covered by the public system as are treatments for obesity, smoking and other lifestyle-related health problems.
Drug-related and alcohol-related illnesses are covered.
Mental health problems are treated in the public health system. And all that is as it should be in a country where we believe in social justice and universal health care. But how has it happened that fertility treatment is not provided by our State health system?
Infertility is defined as a disease by the World Health Organisation. Like many other medical conditions, infertility can be caused by infection, surgery, hormone disturbances, drug treatments, cancer or birth defects. Some cases are unexplained and lifestyle can also be contributory.
There is undisputed evidence showing the inability to conceive has a devastating effect on physical and mental health. It is a significant cause of depression, marriage breakdown and general unhappiness.
Clinical depression
Some 30-40 per cent of those with fertility problems suffer clinical depression and anxiety because of their inability to have children. Other studies show fertility patients have similar stress levels to those with cancer. Infertility is a “disease” and those afflicted need treatment. So what is our problem? At the summit in Washington, many delegates assumed Ireland did not fund fertility treatment such as IVF because we are a Catholic country. I argued that we have an increasingly pluralist and tolerant society.
With 20 years experience of working in infertility in Ireland, I know the vast majority of Irish people with fertility problems do not have ethical objections to assisted reproduction treatments.
Fertility clinics
At my public fertility clinics in Holles Street I meet couples every week who walk away, unable to afford their treatment. The refusal by successive ministers for health to refuse to consider funding fertility treatment is not just unfair – it is also shortsighted.
As the results of IVF treatment improve (and Ireland has excellent success rates), it is becoming obvious that it is the optimal treatment for many of those with fertility problems.
By failing to fund treatment, patients and their doctors are forced to waste precious resources on excessive investigation and inadequate, ineffective treatments.
We know female fertility declines with age and, all too often, if patients can eventually afford treatment it is too late and their chance of success is at least half what it would have been if they had received assistance five years earlier. This breaks my heart.
Another wasteful and medically indefensible consequence of the lack of funding is that more and more Irish patients are being forced to access fertility treatment in other countries. A worrying number of these patients return to Ireland with twin and triplet pregnancies.
It has been shown conclusively that multiple pregnancies are high risk, for the mother and especially for the babies. Our larger maternity hospitals with neonatal intensive care units are struggling to cope with these high-risk pregnancies, so many of them a consequence of multiple embryo transfer abroad.
Multiple pregnancies are also extremely costly pregnancies. A twin pregnancy costs at least six times more than a singleton and a triplet 18 times more for the delivery and first year of life. Countries such as Belgium have successfully funded IVF treatment by insisting on single embryo transfer. The money saved by avoiding multiple pregnancy helps fund the cost of the IVF treatment. Unfortunately, successive Irish ministers for health have refused to acknowledge this.
Ireland's fertility rate is declining. In time we may well have no choice but to actively promote fertility treatments such as IVF as a means of survival. However, that is cold comfort for our sons, daughters, brothers, sisters and friends who currently need fertility treatment but who can't afford it. As another election looms, can any health minister "do the right thing"? Mary Wingfield is consultant obstetrician gynaecologist at Holles Street and director of Merrion Fertility Clinic, a not-for-profit fertility/IVF clinic