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Should the state really be financing IVF?

An interesting, and obviously emotive, topic:

Minister for Health Stephen Donnelly has confirmed that his department plans to fund IVF fertility treatment for public patients in 2023.

Ireland is currently the only country in the EU that does not offer any State funding for assisted human reproduction.

The cost of IVF varies between each case but one cycle costs around €6,000. That can increase quickly depending on what treatment is needed, she added.

“Studies show that it’s as stressful as having cancer, so to compound that by adding in the financial stress just really makes it so hard for people.”

There is no doubt whatsoever that for those who desire children, and cannot seem to conceive a child naturally, the psychological distress is huge. This is a function of nature – we are, after all, mammals, evolved with a reproductive instinct. It is that instinct that ensures the continuation of our species, and therefore it is extremely powerful.

IVF, though, is a very expensive treatment. As the report above notes, a single course of treatment – with no guarantee of success – can cost up to €6,000. Many couples require multiple courses of treatment, and even at that, there is no guarantee of success.

Which poses an uncomfortable policy question: How many courses of treatment should the state fund for one couple? Two? Three? Twenty?

And it poses another uncomfortable question: How many times should the state fund IVF for a couple? Is there a right to one state-funded pregnancy? Or two? Or four? How many children is a couple entitled to have on the state scheme? Is it a one-child policy, or do we recognise that some people want more children?

In an ideal world, these would not be questions at all, of course. We would just wave our hands and give everybody as much treatment, as many times, as they need. Having children is a good thing, and the state should encourage it. But is this really the best or most cost-efficient way to go about it?

One of the reasons for rising infertility, at the end of the day, is that people feel compelled to have their children later and later in life. When you reach your mid-30s, your chances of conceiving, as a couple, start to fall. Most of us know that instinctively – it is a fact of biology. But more of us are leaving it late regardless.

Wouldn’t it perhaps be more cost-effective, then, to adopt policies that encourage people to have their children slightly earlier?

The much-maligned Government of Hungary, for example, has a policy where women who have children benefit from significant income tax breaks to help them with the costs. In an earlier era, before tax individualisation, Ireland allowed couples to be jointly taxed, which again provided a financial benefit to those with young children.

And then there is a final thorny question: Is there, in any case, a right to have children? This is a question with wider implications beyond simply IVF being state funded. It also applies to issues like surrogacy, adoption, same-sex parenting, and so on. Many (not all) of these issues are also a result of cultural shifts towards attempts to conceive happening later in life. And all of them raise thorny questions in their own way. My own view, for example, is that surrogacy involves actively severing a child from its biological mother, and that this is deeply wrong. Some people feel understandably uncomfortable about taking dairy calves from their mothers, but not as uncomfortable about taking human children from theirs. There’s a problem there.

IVF poses fewer ethical issues to somebody like me, but the ethical issues around discarded embryos are still there, and they do bother some voters.

I will not write here that state funding of IVF is wrong, because I have not come to that conclusion. But we should probably think about it a little longer, and a little harder, than we apparently are. This is a lot of money to spend on a problem that we could probably solve, over the longer term, in more family-friendly ways.

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