Jess Spear (40) and her partner, People Before Profit-Solidarity TD Paul Murphy (38), are in the midst of their second “cycle” of fertility treatment.
Describing the gruelling process of undergoing IVF (in vitro fertilisation) treatment – the twice daily injections of follicle-stimulating hormones to encourage egg production, the resultant “wild mood swings”, “extreme fatigue”, progesterone injections, invasive vaginal scans, egg harvesting under general anaesthetic, the implantation itself, the hope, anxiety, and the “hugely upsetting” disappointment when pregnancy fails – she says this is only worsened by the stress of huge costs.
In the absence of publicly-funded IVF services, the couple have so far spent about €12,000 accessing private treatment. “Your chances of having a kid are dependent on how much you can afford to spend. It’s quite shameful that the Government treats people with fertility problems like this,” says Spear.
Ireland, along with Poland, has the worst public provision of fertility services in the European Union, according to a report published in December by Frances Fitzgerald MEP.
It is a definite medical condition and it needs to be funded the way we fund every medical condition. The fact it is not publicly funded is creating a huge social injustice
The European Atlas of Fertility Treatment reports just five other countries, out of 43, in Europe have no public provision of IVF: Armenia, Albania, Belarus, Georgia and Switzerland. Only Armenia and Albania have worse public fertility services overall than Ireland.
It is a situation, says Prof Mary Wingfield, medical director of the Merrion Fertility Clinic – the only not-for-profit clinic in the State – that makes Ireland “a total disgrace”.
Describing infertility as “one of the most distressing things you can go through”, affecting one in six couples, she says it causes as much mental distress as a cancer diagnosis and yet the Government “turns its back” on the thousands of families impacted.
The World Health Organisation defines infertility as a “disease of the reproductive system” which “results in disability”.
“There is a feeling it’s a luxury or a lifestyle choice and maybe the fact there is no public funding promotes that,” says Prof Wingfield. “It is a definite medical condition and it needs to be funded the way we fund every medical condition. The fact it is not publicly funded is creating a huge social injustice [as only those who can afford to pay can access treatment]”.
Spear and Murphy are speaking to The Irish Times following Murphy’s contribution in the Dáil last month, during a debate on the Government’s Health (Assisted Human Reproduction) Bill which will finally regulate fertility treatment, practice and research, and establish an assisted human reproduction (AHR) regulatory authority.
Welcoming the Bill’s regulatory purpose, Murphy said, however, it failed to tackle the “key issue” of public funding. It is not mentioned once in the 136-page Bill.
The impact of zero public provision, was “immense”, he said. The costs couples faced were “astronomical”, placing huge stress on relationships.
“This isn’t a new issue. . . IVF was included in the list of universal healthcare entitlements to be introduced under Sláintecare in the 2017 report,” he said.
“Since 2016, when Leo Varadkar first promised public funding for IVF, we have heard repeated promises. . . but nothing has happened.”
The IVF process was a “huge burden” on his partner, he told the Dáil, who faced twice-daily injections by him as part of treatment, as well as dealing most acutely with the “the disappointment when it doesn’t work”.
Spear, a climate scientist specialising in paleoceanography – the study of oceans – is from Seattle. She tells how she and Murphy met at an international socialist summer school in Belgium in 2015. Having “dated” for two years between the two continents, they “took a leap of faith” and married in her home city in March 2017. She moved to Ireland the following month.
In 2019, “having a very good relationship together and thinking what life would be like in the future with kids, or without kids, we decided to have kids,” says Murphy.
After about six months, and not becoming pregnant, Spear went first to the Well Woman where tests found she had heightened levels of the thyroid hormone, TSH, which can negatively impact pregnancy. Her hypothyroidism took about a year to regulate.
The [fertility] issue could be something that means IVF is not going to work either. But you just have to take a chance
The couple’s GP referred them to the Merrion Fertility Centre Clinic last year where they underwent tests, including bloods, scans, semen analysis – which came to about €600 – before IVF was recommended.
“We knew it would be a bit of shot in the dark, as to whether IVF would work,” says Murphy. “The [fertility] issue could be something that means IVF is not going to work either. But you just have to take a chance, knowing it’s going to cost a lot of money,” says Murphy. The price per IVF cycle at the clinic is €4,500 though additional, necessary costs bring the total to about €6,000 per cycle.
It was recommended they undergo a “short cycle” – involving two weeks of twice-daily injections to encourage egg development. It resulted in just one high-quality embryo, “meaning we had just one chance”, says Spear. Pregnancy was unsuccessful. “It was upsetting, particularly as we didn’t have any other embryos. So we knew that to have another chance we would have to do it all again.”
Last October, they began a second cycle, involving a month of twice-daily injections, further progesterone shots and scans. This time they got three high-quality embryos. One has been implanted unsuccessfully, and the first of their two frozen embryos will be implanted this month. Freezing embryos costs €800.
She is “trying to be numb emotionally” because “you know what it took emotionally the first times. But you just can’t be numb because it’s your body and you’re hoping and you’ve invested all this effort and time and money. You are feeling lots.”
They would not have been able to meet the costs so far of €12,000, if it were not for some money left to Spear by a great aunt. Unable to get work in Ireland in her field she has worked as a cleaner, a museum and school-tour guide, and is now national organiser with the socialist Rise organisation.
The couple each bring home less than the average industrial wage (€40,280 per year), with Murphy on less than €30,000 per year, donating most of his TD salary (€96,189) to the party, as per party policy.
“If we hadn’t had that money, we would have borrowed possibly. Even being able to borrow that is quite a privilege. You don’t have the time to save up for this because you’re older. Every year you are losing opportunity and as the woman you feel that very acutely,” says Spear.
The Department of Health told The Irish Times a commitment to “introduce a publicly funded model of care for fertility treatment” was in the programme for government. The AHR Bill must be enacted first, however, to ensure “robust” oversight of services.
Prof Wingfield is sceptical of this explanation as to why even one cycle per couple cannot be publicly funded.
I think for a time we would mourn the loss of that vision for our lives, but over time I hope it would open up another path
“Even within the legislation, funding is not in the remit of that regulatory authority. So I think in some ways it’s an excuse to say we have to wait for the legislation.” It will be a “complex service to fund”, involving criteria such as the woman’s age, body mass index, whether she smokes, whether she has children already. Whatever model is provided, it “is likely to be unpopular among some cohorts. No one has put their hand up to make the difficult political decisions.”
Couples and single women will “do anything” to raise the funds, she says. “They will remortgage their houses if they have houses, they’ll borrow. It includes people on medical cards, on very low incomes, but even people with very good incomes such as doctors, solicitors, nurses, teachers, accountants – all really struggle to find the money, particularly when, for medical reasons, they are not successful on the first cycle.”
A department spokesperson said a model of care for infertility was being rolled out, phase one of which was the establishment of regional fertility hubs offering investigations and diagnostics.
Four opened last year – in the Rotunda, the National Maternity, the Coombe and Cork University hospitals. A fifth opened at Nenagh hospital recently and a sixth and final one is expected to open in University Hospital Galway “in the coming weeks”.
While phase two “will see the introduction of tertiary infertility services in the public health system”, this “will not commence until such time as infertility services at secondary level have been developed across the country, required resources have been allocated and the AHR legislation commenced, which will allow for a robust regulatory framework to be put in place”.
Spear and Murphy have had to put a “cap” on what they will spend. If neither of their embryos results in pregnancy, they will not try again and “will be okay” having given it their “best shot”.
“It is hard to know what the absence of something will feel like over time,” says Spear. “I think for a time we would mourn the loss of that vision for our lives, but over time I hope it would open up another path.”