# Taxpayer to pay for IVF for those who can't afford it.



## Brendan Burgess

According to the RTE News, the Minister for Health is bringing a bill to cabinet today so that those who want IVF but can't afford it will have it paid for by the taxpayer. 

_Meanwhile, Minister for Health Simon Harris will bring proposals to Government to provide State funding for fertility treatment for couples who could not otherwise afford it, before the end of the year Mr Harris. 


He will ask the Cabinet this morning to approve the drafting of a bill to enable people in need of assisted human reproduction to access these services.


The bill will also seek to regulate this area and will set down clear rules around the health of women and the welfare of the child._

Brendan


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## Brendan Burgess

I fee sorry for couples who can't have kids or who can't afford to have kids, but...

If they can't afford IVF, then they can't afford to have children. 

The taxpayer will not just be paying for the IVF, we will be paying for providing for them throughout their childhood because the parents presumably wont' be able to afford that either. And they won't be able to continue living in their one bed apartment, so we will have to provide them with "decent housing" as well. And it won't pay them to work and pay for childcare, so we will have to provide social welfare to the parents as well. 

Brendan


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## Early Riser

Brendan Burgess said:


> The taxpayer will not just be paying for the IVF, we will be paying for providing for them throughout their childhood because the parents presumably wont' be able to afford that either. And they won't be able to continue living in their one bed apartment, so we will have to provide them with "decent housing" as well. And it won't pay them to work and pay for childcare, so we will have to provide social welfare to the parents as well.



That's not all.The children will fail at school and go on to become either delinquents or Social Welfare scroungers. They won't support their parents in old age, leaving it to the taxpayer to provide medical and nursing care. They won't be able to bury them either so a taxpayer funded pauper's grave will be required. Then they will go on to have more children who will have to be supported by our children who will by then carry the tax burden. Presumably.


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## odyssey06

They should provide IVF to all or none. This is just creating more poverty traps.


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## Delboy

I think this is all very harsh and I had to read BB's 2nd post twice to make sure it wasn't a spoof.

Thankfully, I've not had to go the IVF route to have a family but my understanding of the process is that it is very expensive and could take a couple of attempts before it works. In the UK they pay for the first 2 treatments and your on your own after that.
I've seen lots of couples tell their stories who seemed like very loving people, responsible members of society, held downs jobs etc but just needed a bit of help starting a family as they couldn't get the money together up front now for the treatments. As a parent, you'd have to feel very sorry for them. And if they can be helped, then why not?

Don't get me wrong, I'm more right wing than most. But we are a society and people need help from time to time. Ideally, I'd like to see restrictions on this as to who could claim it etc but being Ireland, it'll be a free for all. And yes, there may be people who go for it who can't afford children and may even be using this route to get access to better social welfare/housing/way of life. But I'd hope they'd be in the minority and that a scheme like this would be for the greater good.

I agree with Odyssey - it should be free for all however or not available at all.


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## rob oyle

Our fertility rates are already high enough that we're adding an extra 110 to our population every day, before migration(an extra Longford to provide for every year, if you will). And we strain to provide housing, health care and education for those already here. If there are limited resources, why are they not put towards making adoption and fostering more available/affordable?


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## qwerty5

The article says they'll examine proposals for the state to provide funding for IVF treatments.

With that little information I don't know if I'm for or against. If they provide funding of a percentage of the funding so it doesn't cripple a working couple,then why not. If the percentage is 100% then I wouldn't be mad about it.

If you're a couple that are currently contributing to society and can't have kids then the small amount the state would provide to help in that situation is probably a drop in the ocean compared to what that kid / adult will provide in the long term.

I doubt the state will be providing funding for people who just have the perpetual hand out. You never know with some of our nutjob politicians though.

Idiocracy comes to mind. If you haven't seen that movie, look for it. It's comedy and a bit science fiction but the way I see the world going we'll probably look back at it as a documentary.


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## RedOnion

Brendan Burgess said:


> I fee sorry for couples who can't have kids or who can't afford to have kids, but...
> 
> If they can't afford IVF, then they can't afford to have children.



This is one of the most insensitive posts I've ever seen on AAM. 

Luckily I didn't have to use IVF, but I've several friends who have. I know people who've remortgaged their homes to have children.

On average, you're looking at direct costs of about 15,000 for IVF in Ireland, with no guarantee of success.

I have 2 children who I'm well able to provide for, but there's no way I'd have been able to come up with 30,000 upfront to have them.

I think financial assistance to people who need it, and really want a family and can provide for them, would be a far better use of tax payers money than providing social welfare and housing benefits to those who have never worked and have children simply to game the system.

I don't believe it should be 100% paid for by the state, but we're light on details as to what might be proposed.


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## gnf_ireland

Thankfully we never had to go down this route, but we do know a few who had to and it is a very difficult journey for all



odyssey06 said:


> They should provide IVF to all or none.


Agree 100% with this statement. IVF is expensive and there are very few people who can afford to fork out for a number of IVF treatments in the hope of having a child. The majority of people who go down this route today have to be the professional classes - as others simply cannot afford it. 



RedOnion said:


> On average, you're looking at direct costs of about 15,000 for IVF in Ireland, with no guarantee of success.


I thought they were a bit lower than that at the moment, at around 10k. Please see sample costs from Rotunda as an example. But its definitely not cheap by any means.
[broken link removed]


I would have concerns around eligibility and a few other aspects of it:
1. I would like to see it discounted rather than free. Personally I don't believe in free anything, and there should always be a charge for people to value it
2. I would also like it to be linked to PRSI stamps, so a minimum number of stamps paid before people are eligible. Would the partners stamps make a woman eligible - no idea !
3. Does the person have to be in a co-habitation couple or married to avail of it? Should the state pay for IVF followed by single mother allowance for the life of the child? This is a damned if you do, damned if you don't scenario
4. How many rounds of IVR should the state support? UK limits it to 2 per lifetime - seems reasonable enough to be. 
5. Success rates are not very high in general - would there need to be medical qualifying criteria to be able to avail of the scheme. Would it need to be referred to from a GP or other once all other avenues have been exhausted
6. Should there be limits on age - so should an 18 year old be allowed to avail of it; what about a 60 year old?
7. What if the couple already have 4 children - should the state pay for IVF if they want a 5th ?
8. What about other forms of intervention - surrogacy etc?

Like everything, the devil is in the detail of the proposal. I am in favour of support here, as long as it is reasonable, minimises abuse and is based on medical evidence. IVF is not an easy journey to take, and given the failure rates can be very hard emotionally on the couples, but the female in particular.  

This is a very difficult event for a large amount of people, probably not helped by the professional classes in particular getting married older and trying to have kids older. I am sure there is some interesting reading for some on the below forum on fertility issues and experiences.. 

[broken link removed]


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## Purple

This is a result of a superb piece of lobbying from the healthcare industry in general and a specific private clinic in particular.
Speaking as someone with first hand experience of IVF I am completely against this proposal. It is yet another case of the heart leading the head with no control on cost. Once this is in the price the State is charged will just go up and up and RTE will run this, as always, as a human interest story without asking any hard questions.


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## gnf_ireland

Purple said:


> Once this is in the price the State is charged will just go up and up


You could say this about anything that the state pays for - not just IVF. There would have to be caps/limits applied, and would probably have to be reviewed on a periodic basis as well.



Purple said:


> Speaking as someone with first hand experience of IVF I am completely against this proposal.


The difference here is you could afford to pay for it, and therefore it was a financial decision for you. There are many who cannot afford to pay for it.

Lets assume cost is 10k - so the net cost is 8k after the tax relief. If they have 1k covered by health insurance, the net cost would be around 7200. 
Lets say the government was to subsidise this by 50% of the cost up to 5k - so 5k cost on the person. Health insurance tends to cap it at around 1k, so and say its 800 euro tax relief. This would leave the person paying 3200. This is a big difference to most people.

Would the price of IVF rise - maybe, but they again every government subsidy rises prices by enlarge. Look at the Help to Buy scheme or anything similar
Would the price rise to cost by 50% - probably not ... 

Sadly this is an emotive issue for a lot of people, and until you are affected by it, its really hard one to call... 


@Purple   lets say you and your partner could not afford the cost of IVF. Any idea on the emotional and mental cost of knowing that you could possible had a child if you could have managed to get 10k together to give it a go? You cleared make the decision to go down the IVF route for a reason - what if that route was not open? 
The financial cost/exposure here is relatively low in the grand scheme of things....


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## gnf_ireland

TheBigShort said:


> I for one, will be supportive of a bill that assists those who worked hard to build their careers but in doing so got caught out on the other side when trying to start a family.


Ok, so how do you enforce that bit - base it on number of PRSI stamps paid? Age limit it etc? 


I 100% agree with what you are saying and kind of alluded to the same thing above in my post - and to be honest I doubt many who know me would call me a 'bleeding heart'


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## Purple

gnf_ireland said:


> The difference here is you could afford to pay for it, and therefore it was a financial decision for you. There are many who cannot afford to pay for it.


 It's far more than a financial decision.



gnf_ireland said:


> Lets assume cost is 10k - so the net cost is 8k after the tax relief. If they have 1k covered by health insurance, the net cost would be around 7200.
> Lets say the government was to subsidise this by 50% of the cost up to 5k - so 5k cost on the person. Health insurance tends to cap it at around 1k, so and say its 800 euro tax relief. This would leave the person paying 3200. This is a big difference to most people.


 The average cost per round is €5,000 without donor eggs, €10,000 with donor eggs. The important thing is that cost is per round. The more thy fail the more they make. Please don't delude yourself into thinking that isn't a factor for the businesses which offer the service.



gnf_ireland said:


> Sadly this is an emotive issue for a lot of people, and until you are affected by it, its really hard one to call...


 That's the problem; it's an emotive issue. The medical industry knows that and uses it to steer the conversation and focus away from that they are actually doing and why they are doing it.



gnf_ireland said:


> @Purple lets say you and your partner could not afford the cost of IVF. Any idea on the emotional and mental cost of knowing that you could possible had a child if you could have managed to get 10k together to give it a go? You cleared make the decision to go down the IVF route for a reason - what if that route was not open?
> The financial cost/exposure here is relatively low in the grand scheme of things....


 In my experience it involved many failed rounds with some very dubious medical advice based on a totally incorrect diagnosis. On the up-side we did pay them enough to buy someone a boat so at least there was some winner.
The overall impression I got was that they were like a dodgy second hand car dealer, confidence men playing on vulnerable people.


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## torblednam

To give a real life perspective on it, and the type of dilemmas that real-life, working couples who pay plenty of taxes, face:

A previous poster has already pointed out that this type of dilemma is most likely to only affect the professional classes, or as I would call them, responsible people.  

My wife and I had both been affected by the recession, losing ground career-wise, earnings-wise and savings wise during our mid-late 20's with us each experiencing unemployment / underemployment.

So we found ourselves saving as best we could towards our first house whilst also conscious of the clock ticking for starting a family as we entered our 30s. Unsure of when and where we would be able to buy, we decided we had best start trying to conceive before buying, which proved fortunate because we only learned of a fertility problem after nearly 2 years without success.

So we saw a substantial chunk of our savings towards a house swallowed up by the rounds of IVF that it took to successfully conceive. If it weren't for the help to buy scheme lowering the hurdle for us, we still wouldn't have been able to buy, as prices have increased and kids are expensive, so it takes a lot longer to save that money the second time around.

Sure, we could have decided to buy a house first, but that's the thing with fertility related matters, time is not your friend and it becomes all consuming when you're in that situation. I've heard and seen horror stories of couples who end up broken up, indebted and broken as a result of keeping rolling the IVF dice in the hopes of bringing a child into the world. There but for the grace of god...

Of all things that the State can set aside resources for, I think this is an extremely  worthwhile one. It's merely a question of how much and how that State support should be delivered.

Tax relief should apply at the marginal rate for most, if not all, medical expenses, and certainly for fertility treatment. If you want to facilitate people having babies it should be the ones who have an income capable of supporting them so this is one area where there's a logical justification for the State favouring the higher earner. 

There also should separately be a hefty subsidy or support in whatever form, for childless people accessing treatment. From personal experience, there's a fundamental difference between struggling to conceive your first child versus subsequent ones.


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## TheBigShort

gnf_ireland said:


> Ok, so how do you enforce that bit - base it on number of PRSI stamps paid? Age limit it etc?



Obviously it is a complex issue and you raise some interesting questions in your post.
I don't have direct experience with IVF but I know two couples that have gone down that route.
But one of the other factors for infertility is lifestyle habits, unhealthy eating, heavy drinking, smoking, drugs etc.
My understanding is that the IVF assessment requires applicants to be adhering to a healthy lifestyle. So people with high alcohol levels in their bloodstream, high blood pressure, who smoke, are overweight or obese etc will not be accepted for the program because the chances of failure are vastly increased with such conditions.
The second thing I would imagine, is that women coming close to the end of the normal reproductive age cycle will be prioritized ie women in mid to early forties.
So a young couple at 18yrs of age will not qualify (unless in exceptional circumstances) because of the time available to investigate reasons for the infertility and propose alternative, cheaper treatments to be tried.
That is my assumption, based on what I know so far.


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## gnf_ireland

TheBigShort said:


> My understanding is that the IVF assessment requires applicants to be adhering to a healthy lifestyle. So people with high alcohol levels in their bloodstream, high blood pressure, who smoke, are overweight or obese etc will not be accepted for the program because the chances of failure are vastly increased with such conditions.


Absolutely agree in theory, but this would be a tricky one in a number of cases. Some people have naturally higher blood pressure, others have higher BMI (I am told muscle weights more than fat) etc. Trying to define a one size fits all is really tough thing to do, and even harder when relating to medical. But I agree with the principle



TheBigShort said:


> The second thing I would imagine, is that women coming close to the end of the normal reproductive age cycle will be prioritized ie women in mid to early forties.


Early-mid 40's would be deemed a very old mother in general terms. I think when we were going through the maternity cycles, any first time mother over 35 was deemed in the high risk category. This should also be kept in mind, but I imagine cutting off based on age is probably illegal !


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## Purple

TheBigShort said:


> So people with high alcohol levels in their bloodstream, high blood pressure, who smoke, are overweight or obese etc will not be accepted for the program because the chances of failure are vastly increased with such conditions.


That is incorrect in my experience.
You can be as fat as you like as long as you have the cash.


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## gnf_ireland

Purple said:


> It's far more than a financial decision.
> 
> The average cost per round is €5,000 without donor eggs, €10,000 with donor eggs. The important thing is that cost is per round. The more thy fail the more they make. Please don't delide yourself into thinking that isn't a factor for the businesses which offer the service.
> 
> That's the problem; it's an emotive issue. The medical industry knows that and uses it to steer the conversation and focus away from that they are actually doing and why they are doing it.
> 
> In my experience it involved many failed rounds with some very dubious medical advice based on a totally incorrect diagnosis. On the up-side we did pay them enough to buy someone a boat so at least there was some winner.
> The overall impression I got was that they were like a dodgy second hand car dealer, confidence men playing on vulnerable people.



@Purple - without having first hand knowledge of the 'game/industry', nothing of what you say above would surprise me. Certain emotive issues pull at the heart strings more than others, and the medical industry knows how to play the game more than most. Add to the fact this is a private area means there will always be a financial motive.

The quote "confidence men playing on vulnerable people" does sound about right. They are selling a dream to fulfill the 'textbook' lifestyle, but its only a gamble and the more you lose, the more they gain from it.


There is a way to address this however, if the government are serious about it:
1. Set up 4 centres around the country to support the service, run by a special unit within the HSE/maternity structures
2. The medical assessment and consultations are done by the special unit, not the private operators
3. Sign the private operators up on a 5 year contact with fixed price per treatment - open it up to tender and make it transparent
4. After the assessment is done, the private operator and HSE unit review the file and jointly recommend the course of action - but HSE unit has final authority
5. In the 5 year window, build the expertise up in the HSE units to allow them undertake the work, so there are no longer a need for private operators within the scheme.
Basically, the role of the private operators needs to reduce in the medium term, and removing them from the assessment means recommendations are likely to be based on medical evidence rather than financially motivated.


*Despite all of this, I don't believe the principle behind the scheme is wrong, but it could be very badly implemented if done wrong*


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## TheBigShort

gnf_ireland said:


> Absolutely agree in theory, but this would be a tricky one in a number of cases. Some people have naturally higher blood pressure, others have higher BMI (I am told muscle weights more than fat) etc. Trying to define a one size fits all is really tough thing to do, and even harder when relating to medical. But I agree with the principle



It wouldn't be the State defining the health it would be the medical practitioners. As far as I know, the IVF treatment has greatest chance of success where an applicant to be treated is free of conditions such obesity and isn't a smoker or heavy drinker. In other words, you would only qualify for state benefit if a medical practioner deems that you fit into the category of reasonable to high chance of success. If a practioner considers your chances low to zero ( because you smoke) then you can still have the treatment but will not receive state benefit - you pay for it yourself.



gnf_ireland said:


> Early-mid 40's would be deemed a very old mother in general terms. I think when we were going through the maternity cycles, any first time mother over 35 was deemed in the high risk category. This should also be kept in mind, but I imagine cutting off based on age is probably illegal !



Not if people have being postponing starting a family due to their careers it would not. I'm not suggesting any age should be cut off, rather that those women from mid thirties on would be prioritised. 18yrs olds still have time on their hands and can try vastly cheaper treatments.


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## gnf_ireland

Purple said:


> That is incorrect in my experience.
> You can be as fat as you like as long as you have the cash.



True in the private financial set-up - if you have the cash you can pay for whatever you fancy

In the UK, the rules are different and assume we would align to those somewhat

http://www.nhs.uk/Conditions/IVF/Pages/Availability.aspx

_CCGs may have additional criteria you need to meet before you can have IVF on the NHS, such as:_

_not having any children already, from both your current and any previous relationships_
_being a healthy weight_
_not smoking_
_falling into a certain age range (for example, some CCGs only fund treatment for women under 35)_
_In some cases, only one cycle of IVF may be routinely offered, instead of the three recommended by NICE._

https://www.nice.org.uk/guidance/cg156


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## Purple

gnf_ireland said:


> Basically, the role of the private operators needs to reduce in the medium term, and removing them from the assessment means recommendations are likely to be based on medical evidence rather than financially motivated.


That would be fine if doctors only worked in the private or public system but they don't. They would be assessing their mates who would in turn be assessing them.


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## TheBigShort

Purple said:


> That is incorrect in my experience.
> You can be as fat as you like as long as you have the cash.



As long as you have the cash you can have anything you like. This topic is about those who cannot afford the treatment.


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## Purple

TheBigShort said:


> As long as you have the cash you can have anything you like. This topic is about those who cannot afford the treatment.


It will be down to the doctors "clinical" decision. Translated that means if he/she wants the money they will approve the treatment.


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## TheBigShort

Purple said:


> It will be down to the doctors "clinical" decision. Translated that means if he/she wants the money they will approve the treatment.



And you can't think of any checks and balances that may deter professional doctors from fraud? For instance, having to fraudently alter blood test results? Or being the doctor with a patients who success rates are below average? Or losing your licence to practice?
There is a reason why medical doctors can command good salaries, it rewards them for their professionalism and dedication, provides them with reasonably well-off lifestyles and in turn reduces their need to act in a corrupt manner.


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## Purple

TheBigShort said:


> And you can't think of any checks and balances that may deter professional doctors from fraud? For instance, having to fraudently alter blood test results? Or being the doctor with a patients who success rates are below average? Or losing your licence to practice?
> There is a reason why medical doctors can command good salaries, it rewards them for their professionalism and dedication, provides them with reasonably well-off lifestyles and in turn reduces their need to act in a corrupt manner.


You say that despite all of the evidence to the contrary over decades in this country and elsewhere. Why do you use the phrase "professional doctors"? You you think professionals are less prone to human frailties that the rest of us plebs? Take a look at the tax defaulters list and, this may shock you, but doctors pop up with great regularity. Work on the assumption that they are just the same as the rest of us, no better or worse. Very few are ever sanctioned, particularly is specialist areas. 

Diagnosis is based on their opinion after looking at multiple factors. They can just play the emotive card, they are good at that, and talk about the unfortunate people to whom they are peddling their wears rather than the large incomes they are getting from their customers. You will never be more vulnerable, more open to grasping at straws, than when you sit across from them and they are offering you the chance to have a family.  
While you may be slightly more reticent when it is your money there is no chance of rationality coming into it when they are asking you to gamble with someone else's money.  

If it is run by a public only system with everyone concerned getting a flat salary with limits on the numbers of times each person/couple can access the service and with a limit on the overall number of IVF rounds the State funds each year then maybe it could be done but the most likely outcome from this is rich doctors getting richer.


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## gnf_ireland

@Purple What you say above is the exact reason I suggested that the medical assessment is done by someone who would not financially gain from the outcome. This is the only reasonable way that the financial aspect can be minimised.



Purple said:


> If it is run by a public only system with everyone concerned getting a flat salary with limits on the numbers of times each person/couple can access the service and with a limit on the overall number of IVF rounds the State funds each year then maybe it could be done but the most likely outcome from this is rich doctors getting richer.


I absolutely agree that if this is to be state funded, it needs to be taken away from the private operators within a pre-defined amount of time and limits/controls put in place.


This is not an uncommon practice - in the IT industry, it is common practice that anyone who supports a selection process for a major piece of work would be automatically excluded from bidding from that work.




Purple said:


> Take a look at the tax defaulters list and, this may shock you, but doctors pop up with great regularity. Work on the assumption that they are just the same as the rest of us, no better or worse.


While not appropriate to this conversation, doctors in general tend to rely on professional advice around their finances. They are normally too busy working and earning money to be coming up with schemes on how to avoid/evade tax. They rely on professionals to advise them in this area. Much of that advice can be poor, and what really 'kills' them is they discuss some scheme in the staff canteen with some others and they suggest it to their accountant and all of a sudden they are caught as well. Sheep mentality is definitely at play here. 
While not defending anyone who defaults on tax, I doubt doctors themselves (to a large degree) come up with the 'avoidance' schemes.


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## michaelm

Brendan Burgess said:


> The taxpayer will not just be paying for the IVF, we will be paying for providing for them throughout their childhood because the parents presumably wont' be able to afford that either. And they won't be able to continue living in their one bed apartment, so we will have to provide them with "decent housing" as well. And it won't pay them to work and pay for childcare, so we will have to provide social welfare to the parents as well.


Don't worry Brendan.  Knock-on costs you envisage will be more than offset by the savings made when 8th amendment is weakened and the State ramps up abortion funding.


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## TheBigShort

Purple said:


> You say that despite all of the evidence to the contrary over decades in this country and elsewhere. Why do you use the phrase "professional doctors"? You you think professionals are less prone to human frailties that the rest of us plebs? Take a look at the tax defaulters list and, this may shock you, but doctors pop up with great regularity. Work on the assumption that they are just the same as the rest of us, no better or worse. Very few are ever sanctioned, particularly is specialist areas.
> 
> Diagnosis is based on their opinion after looking at multiple factors. They can just play the emotive card, they are good at that, and talk about the unfortunate people to whom they are peddling their wears rather than the large incomes they are getting from their customers. You will never be more vulnerable, more open to grasping at straws, than when you sit across from them and they are offering you the chance to have a family.
> While you may be slightly more reticent when it is your money there is no chance of rationality coming into it when they are asking you to gamble with someone else's money.
> 
> If it is run by a public only system with everyone concerned getting a flat salary with limits on the numbers of times each person/couple can access the service and with a limit on the overall number of IVF rounds the State funds each year then maybe it could be done but the most likely outcome from this is rich doctors getting richer.



I never suggested that there is no such thing as corrupt doctors, merely implied that they are not all on the take. If I was to take a guess, I would say the ratio of corrupt doctors to professional doctors would be very low.


In the meantime, back on topic, here is the report from the Commission on Assisted Human Reproduction

http://health.gov.ie/wp-content/upl...Commission-on-Assisted-Human-Reproduction.pdf


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## Purple

TheBigShort said:


> I never suggested that there is no such thing as corrupt doctors, merely implied that they are not all on the take. If I was to take a guess, I would say the ratio of corrupt doctors to professional doctors would be very low.


 What's the difference between a corrupt doctor and a professional doctor?



gnf_ireland said:


> While not defending anyone who defaults on tax, I doubt doctors themselves (to a large degree) come up with the 'avoidance' schemes.


 Yea, that's why they insist on cash only payments


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## Firefly

Brendan Burgess said:


> I fee sorry for couples who can't have kids or who can't afford to have kids, but...
> 
> If they can't afford IVF, then they can't afford to have children.



And since when did that ever stop anyone? 

Those with a medical card* should get free IVF and everyone else should pay. "Works" for everything else so I don't see why it should be any different for IVF.

* Excluding OAPs unless they're up for it!


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## TheBigShort

Firefly said:


> Those with a medical card* should get free IVF and everyone else should pay.



They would need to be infertile first.


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## cremeegg

TheBigShort said:


> In the meantime, back on topic, here is the report from the Commission on Assisted Human Reproduction
> 
> http://health.gov.ie/wp-content/upl...Commission-on-Assisted-Human-Reproduction.pdf



"Back on topic" with a 12 year old report that also does not actually address the topic. It a report on : 

"possible approaches to the regulation of all aspects of assisted human reproduction and the social, ethical and legal factors to be taken into account in determining public policy."

So no mention of taxpayers paying for IVF or not.


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## Purple

cremeegg said:


> "Back on topic" with a 12 year old report that also does not actually address the topic


 C'mon cremeegg, Carl Marx came up with socialism in 1848. 12 years is nothing!


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## gnf_ireland

Purple said:


> Yea, that's why they insist on cash only payments


I have always received a proper receipt from any medical professional I have ever encountered, no matter how it was paid.

I have lots of experience recently where tradesmen refused to take on the job when I asked for a receipt or when I said I would not pay by cash !


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## TheBigShort

cremeegg said:


> "Back on topic" with a 12 year old report that also does not actually address the topic. It a report on :
> 
> "possible approaches to the regulation of all aspects of assisted human reproduction and the social, ethical and legal factors to be taken into account in determining public policy."
> 
> So no mention of taxpayers paying for IVF or not.



Your gas, I'll give that. The report from the Commission on Human Reproduction has nothing to do with the Assisted Human Reproduction bill put to the cabinet today as reported by RTE?
If you go through the report and the now (censored from AAM) Dept of Health press release you would clearly understand that the state has every intention of providing AHS services to the public in a regulated form.
In what composition those services would be provided we did not know. Until today at least, when the Minister indicated that prospective families would get clarity on any government financial commitment.
Which is great, because the one of the factors for providing support is acknowledging the hard work people put into developing their careers, but as a consequence, are contributing to low fertility rates amongst that sector of taxpayers.
We don't know the detail yet, how much, who qualifies etc, but one thing is sure, between reports, press releases, proposed bills etc, nowhere does it mention that children born through IVF will presumably need their childhoods paid for by the State, their housing etc as implied in post no 2.
But don't let that stop you trolling.


----------



## TheBigShort

Purple said:


> C'mon cremeegg, Carl Marx came up with socialism in 1848. 12 years is nothing!



There is nothing in the RTE report today about Karl Marx. Cremeegg will be hounding you now for being 'off-topic'


----------



## Easter

Wow! Is Brendan's second post here possibly the most insensitive ever? 

Given the huge financial pressures couples starting out face, it seems really misguided to say that because they can't come up with an extra 5-10k in a year that they can't afford children. 

Loads of people are gifted money from parents for IVF and can provide for their children just fine. 
A couple might save for one round of IVF only for it to fail. The first round is often diagnostic and the same couple might have success with a second round, but be unable to afford it. It doesn't mean they cannot afford children.

I think the proposal to pay for IVF is premature though. Until we can reduce waiting lists for essential surgeries, offer more support for home carers and children with disabilities, we cannot afford to fund IVF. People can already claim back 20% on ivf expenses. Maybe start by increasing the tax back.

Lets base arguments on realities though. That people who cannot afford IVF cannot afford children isn't a reality.


----------



## Purple

Easter said:


> Given the huge financial pressures couples starting out face, it seems really misguided to say that because they can't come up with an extra 5-10k in a year that they can't afford children.


 There are lots of things that people can't afford. Should their neighbours have to pay for those as well? 5-10k a year, it would be far more than that!



Easter said:


> The first round is often diagnostic


 I'm aware of the risk of breaching the posting guidelines here but that's rubbish.


----------



## Purple

Easter said:


> Wow! Is Brendan's second post here possibly the most insensitive ever?


 No, he's posted far more insensitive stuff than that!


----------



## odyssey06

Easter said:


> I think the proposal to pay for IVF is premature though. Until we can reduce waiting lists for essential surgeries, offer more support for home carers and children with disabilities, we cannot afford to fund IVF. People can already claim back 20% on ivf expenses. Maybe start by increasing the tax back.



Exactly. I can't believe a Health Department that staggers from one crisis to the next would even think of losing focus and spending time\resources\budget on something like this. Suggests a disconnect from reality.


----------



## Purple

odyssey06 said:


> Exactly. I can't believe a Health Department that staggers from one crisis to the next would even think of losing focus and spending time\resources\budget on something like this. Suggests a disconnect from reality.


It's just another example of what governments do best; bribing people with their own money.


----------



## Easter

I agree Purple that people aren't automatically entitled to something for free just because they can't afford it. With the state of our health service at the moment I think IVF is a luxury budget item. On the other hand though, we do need a future generation to fund our pensions!

I don't think it's unrealistic to say 5-10k a year. For lots of couples this would be the cost. I won't go further in replying to Purple's rubbishing of the suggestion that round 1 is often diagnostic, because we would be breaching AAM guidelines. A full discussion of the funding needs around IVF would have to involve the need for more than one cycle in a lot of cases. Lots of people have success with changed protocols. That's not rubbish, it's fact.


----------



## Purple

Easter said:


> I don't think it's unrealistic to say 5-10k a year. For lots of couples this would be the cost.
> I won't go further in replying to Purple's rubbishing of the suggestion that round 1 is often diagnostic, because we would be breaching AAM guidelines. A full discussion of the funding needs around IVF would have to involve the need for more than one cycle in a lot of cases. Lots of people have success with changed protocols. That's not rubbish, it's fact.


Proper diagnostics would greatly reduce the need for a "sure we'll try it and see what happens" first round but that involves a serious investment in equipment and sure why bother when you get paid more the less successful you are. Sure the only down side is the cost and heartache for the customers (would-be parents) and the physical toll on the woman.


----------



## Easter

Purple, is it possible that your own bad experience is colouring your judgement of what is very often different outcomes for others? To say something is 'rubbish' is very absolute. For many people a tweaked second protocol works, diagnostics won't necessarily predict an individual response to a protocol. You could know exactly what the problem is and still respond differently to another with the same issue. I know many people whose diagnosis never changed, but a changed protocol worked for them - the very one that didn't work for another with the same issue. People respond differently. No doubt there are people who would benefit from lengthier and more costly investigations in advance of a first attempt, but the usual suite of tests can be sufficient for many.


----------



## gnf_ireland

michaelm said:


> Knock-on costs you envisage will be more than offset by the savings made when 8th amendment is weakened and the State ramps up abortion funding.


I was waiting for someone to bring that topic up !


----------



## gnf_ireland

Easter said:


> Wow! Is Brendan's second post here possibly the most insensitive ever?



To be fair, I imagine the post is poorly worded more than anything else. I think the concern for a lot of people in general is how things like this could be abused, both by the provider of the service and recipient of it. 

Some have relayed personal experience of some of these providers acting like user car salesmen, selling the dream of the 'textbook' life, and likely to ratchet up the prices if it is approved. Others have concerns that it will encourage those of the 'welfare train' to have more kids for a bigger free house or jump the housing list queue. Both groups are well able to play the system to their advantage

If this is introduced, it does need a level of controls around it at least initially. However it is a very emotive topic and one where some's dream of having children could be shattered by the decision of a medical professional...


----------



## gnf_ireland

odyssey06 said:


> Exactly. I can't believe a Health Department that staggers from one crisis to the next would even think of losing focus and spending time\resources\budget on something like this. Suggests a disconnect from reality.


and there was me thinking they had another budget overrun this year. Maybe there is more money down the back of the sofa !


----------



## Purple

Easter said:


> Purple, is it possible that your own bad experience is colouring your judgement of what is very often different outcomes for others? To say something is 'rubbish' is very absolute. For many people a tweaked second protocol works, diagnostics won't necessarily predict an individual response to a protocol. You could know exactly what the problem is and still respond differently to another with the same issue. I know many people whose diagnosis never changed, but a changed protocol worked for them - the very one that didn't work for another with the same issue. People respond differently. No doubt there are people who would benefit from lengthier and more costly investigations in advance of a first attempt, but the usual suite of tests can be sufficient for many.


 People are people and they act in their own self interest. If they are rewarded more for doing something one way then that's the way they will do it. At the moment they get paid more the less successful they are. That's my point. It extends to many areas in the medical industry; a lack of capital investment means that doctors get additional sales for the same issue. My chiropractor has a x-ray machine in his clinic. My GP has bugger all.


----------



## Easter

People select IVF clinics based on their success rates though. Failed rounds impact on statistics and put off potential patients. Each case is different. I don't really believe there is a conspiracy to put couples through failed attempts.


----------



## Brendan Burgess

Brendan Burgess said:


> If they can't afford IVF, then they can't afford to have children.



Would someone like to analyse this in financial terms? 

How much does IVF actually cost? 

How much does rearing a child actually cost? 

I fully appreciate that it might be more difficult to come up with the €15k (?) for a round of IVF than to pay €10k(?) a year to raise a child. 

But is it not much more expensive to have a child than to have IVF? 

Brendan


----------



## Andy836

Brendan Burgess said:


> I fee sorry for couples who can't have kids or who can't afford to have kids, but...
> 
> If they can't afford IVF, then they can't afford to have children.
> 
> The taxpayer will not just be paying for the IVF, we will be paying for providing for them throughout their childhood because the parents presumably wont' be able to afford that either. And they won't be able to continue living in their one bed apartment, so we will have to provide them with "decent housing" as well. And it won't pay them to work and pay for childcare, so we will have to provide social welfare to the parents as well.
> 
> Brendan



I disagree with this.

The cost of IVF is huge - €10k per go. 
Many of those trying to have kids this way are those who left it late (so have jobs, worked hard etc). 
Sometimes it can take 4 or 5 goes, sometimes more with no guarantee of success. €30k to €50k to have a kid is too much - remove this cost and they can still pay their house deposit, pay their mortgage etc and raise a kid. We cover all sorts of other illnesses so why not this?


----------



## Leper

Many people with children love telling other people without children that they really don't need children. Most of us cannot afford anything let alone afford children. We must pay for houses, cars, food, clothes, entertainment, income taxes,  property taxes etc etc. 

Very few can really afford any children. But, we want children and no matter what you might want to think, we need children. Great if genuinely you don't want children - problem solved - don't have children. But for those of us who want children and cannot afford IVF treatment it would be a godsend for the HSE to provide finance for any treatment necessary. I have no problem with this being done properly and at the expense of the taxpayer. The taxpayer finances the unemployed, 3rd Level Grants, medical cards, free travel, Social Welfare Pensions, Public Service wages, etc. Therefore, why not allow couples the benefit of free IVF? These couples pay their taxes too. Isn't it about time we started to look after those who foot the tax bills and not just the chosen few? Let's stop playing God for a change.


----------



## gnf_ireland

Brendan Burgess said:


> Would someone like to analyse this in financial terms?
> How much does IVF actually cost?
> How much does rearing a child actually cost?
> I fully appreciate that it might be more difficult to come up with the €15k (?) for a round of IVF than to pay €10k(?) a year to raise a child.
> But is it not much more expensive to have a child than to have IVF?



http://www.telegraph.co.uk/news/uknews/11360819/Average-cost-of-raising-a-child-in-UK-230000.html
According to this article, the average cost of raising a child in the UK until the age of 21 is roughly £230,000 - so lets say 250,000 euro. Over the 21 years, this works out at say 12k a year. The government contributes 1700 roughly a year towards that in children's allowance.

[broken link removed]
According to the NICE site above, _"the [broken link removed] increases the chances of a successful pregnancy to 45-53%."_
It is highly likely those 3 cycles would be done within a 6 month period, probably in sequence depending on the initial assessment and earlier results.

https://merrionfertility.ie/patient-information/how-much-does-fertility-treatment-and-ivf-cost/
I am not familiar enough with IVF to understand what is involved in a single cycle, but there is nothing cheap on that list. And they are a not for profit organisation. Based on a number of people I know who went down the route, there would be little change (if any) out of 40k for 3 cycles.

So yes, rearing a child costs more over the life of the child than IVF. However, IVF is a very high upfront cost, and normally when couples are starting out and are saving for or have just purchased a house. There is also only a 45-53% success rate after that cost. This also does not include the emotional cost and strain on the family, relationship, potentially work etc.


What I personally found is that once I had my children, our lifestyle adjusted accordingly. The nice meals went out the door, the adventurous holidays disappeared, and a reliable family car became the priority. We just spent differently, and probably saved less than we would have if they had not arrived.

Am I financially poorer as a result - most definitely; but I do try and tell myself I am emotionally richer ;-)


----------



## gnf_ireland

Leper said:


> Therefore, why not allow couples the benefit of free IVF? These couples pay their taxes too. Isn't it about time we started to look after those who foot the tax bills and not just the chosen few?



@Leper so are you assuming only those that pay taxes should be able to avail of the state funded IVF ? Or should it be open to all... 

I think most people are in favour of this in principle, as long as reason controls and restrictions are in place. I put a few comments on my thoughts on this in a much earlier post. I think there should be limits, pre-conditions, medical assessment, age restrictions, PRSI stamp minimums etc. I also believe it should only be funded for couples who already do not have a child - something that was also referenced by someone who has gone through IVF. The devil will be in the detail here, and how it is implemented

A genuine concern was raised about the risk/likelihood of IVF shooting up in price as a result - this is something that needs to be taken into account. There is also a genuine concern raised around doctors [in particular private practices] encouraging IVF when medically it would not be the most advisable, as they would benefit from a higher failure rate. I suggested the assessment and the procedure should be separately run and one not benefit from the other.

This is an emotive topic for those effected by it. I agree that we should support our tax payers and those who try and act responsibly.


----------



## Brendan Burgess

Thanks GNF for those numbers.  Let's take them as a reasonable estimate of the costs involved. 

So people who choose to have a child can expect to pay €12k a year for 20 or so years. 

Let me put it another way...

If they can afford to have children, they can afford to pay for their own IVF. 

If they can afford to pay €12k a year, they can afford to pay €40k on a once-off basis. 

Of course, they might not be able to afford both the IVF and raising the child. 

I presume that IVF qualifies for the 20% tax relief which applies to medical treatments? 

I have argued elsewhere that those who pay for their own medical treatment and who take pressure of the public health service should get tax relief at the marginal rate. 

But IVF is different. It is not like treating cancer or a broken leg or diabetes.


----------



## Brendan Burgess

Leper said:


> I have no problem with this being done properly and at the expense of the taxpayer. The taxpayer finances the unemployed, 3rd Level Grants, medical cards, free travel, Social Welfare Pensions, Public Service wages, etc. Therefore, why not allow couples the benefit of free IVF?



But based on that argument, why not provide everything free of charge to those who pay tax?

I would like to see a lot less government spending on almost everything. Not more government spending.

There _might _be an argument for tax relief.

I don't know what is proposed, but if it's made available at all, it will probably be made available to people on medical cards only, even if they already have children. 



Brendan


----------



## cremeegg

Andy836 said:


> €30k to €50k to have a kid is too much



For the parents, but you seem to think its not too much for the state.


----------



## JoeRoberts

Ironic in light of the current big push to repeal the 8th.  I guess they will fund abortions at the same time as IVF.


----------



## torblednam

Brendan Burgess said:


> Thanks GNF for those numbers.  Let's take them as a reasonable estimate of the costs involved.
> 
> So people who choose to have a child can expect to pay €12k a year for 20 or so years.
> 
> Let me put it another way...
> 
> If they can afford to have children, they can afford to pay for their own IVF.
> 
> If they can afford to pay €12k a year, they can afford to pay €40k on a once-off basis.



This is nonsense Brendan and you're just digging yourself a deeper hole as you go.

When you actually have a child or children, it affects every facet of your life as their needs take priority, so social life, hobbies etc may have to take a back seat. So even if 12k is an accurate figure, which seems a tad high in the early years anyway, it's not obviously an incremental 12k.

I don't have hard stats but from personal experience, and from seeing the other anxious faces in the waiting rooms, it's pretty obvious that the age related aspects and time sensitivity of fertility problems means that there's no scope to go away and save, or necessarily to borrow from the normal sources, the cost of what is an uncertain number of IVF cycles. A lot of people finding they need to go down that road have mortgaged themselves to the hilt buying the home they intend to rear their children in.

Your attempt at fudging some numbers to justify your frankly inhumane attitude is derisory TBH. And that's a far more polite response to your contributions than you were getting until I counted to ten a few times.


----------



## Andy836

cremeegg said:


> For the parents, but you seem to think its not too much for the state.



Brendan's point was "if they can't afford IVF then how can they afford to raise children" - people can afford one or two rounds of IVF but they can't afford 5 or 6. 

And yes, Orkambi is going to cost the state €150k per patient so why shouldn't those with fertility issues get help.


----------



## TheBigShort

Brendan Burgess said:


> Would someone like to analyse this in financial terms?



Hard to quantify it financially imo. But from an economic perspective the reality is Irish family sizes are on a downward trajectory long-term, similar to trends across Europe, US and Japan.
People who work hard, develop a career are discovering that after all their efforts, studying, working, saving etc that they are still can't get on housing ladder and as a consequence are delaying starting a family.
This is leading to reduced rates of fertility amongst the hard working, tax paying, population.
Population replacement will be reliant more so on immigration. If economic conditions take a turn for the worst, immigrants won't come.
In the end, if Irish people stop having children (admittedly a long way off), or enough children to replace the population, then everything you own, your house, your car, your pension, your investment property etc, will very quickly become worthless.
Having children may be expensive for parents, but for the economy as a whole, they are priceless.


----------



## Delboy

I heard a couple on the radio today saying thay had 14 rounds of IVF treatment before they had children 
Is there stats available on the average # of rounds it takes to have kids?

I'd also like to call BS on those stats that it costs 12k a year per child from 0 to 21. Way over the top in my experience


----------



## RedOnion

Delboy said:


> I'd also like to call BS on those stats that it costs 12k a year per child from 0 to 21. Way over the top in my experience


I was just going to say, I'll have to give my kids away cause I can't afford them! 

And we'll have to make a massive increase in payments for social welfare if it costs that much...

Any survey published by an insurance company has a bias to overstate. The equivalent here was done by Aviva but they only added it up to 105k - obviously didn't want to overdo it if they don't have the same target market.


----------



## gnf_ireland

I found the report that says it's 105k as well. Clearly there is something amiss with both numbers !!!

One thing I can say with fact is that for both of my daughters the childcare bill was/will be 45,000 euro each before they started primary school. That is ~48 months at 1015 each less 3600 roughly ECCE contribution. We will start both after the age of 5.
I will also have to continue paying childcare until they leave primary school, working out around another 10k a year between them for 9 years. We don't have any family members in Dublin and that covers a 3 day week only since July, and includes longer hours during the school holidays. We pay a childminder to come to the house on a fair wage, all put through the books. 
So I calculate my childcare bill alone until the start of secondary school to be 180k divided 2 so 90k each.

I think the 250k is closer to my costs than the 105k. Others may have cheaper options available to them for childcare to bring costs down.


----------



## gnf_ireland

Just on the couple with 14 rounds of IVF - they must have seriously deep pockets and be very mentally strong to keep it up 

However, I would not like to see the state fund that level of IVF for anyone. Personally, I think anything beyond 3 cycles is excessive


----------



## TheBigShort

gnf_ireland said:


> Just on the couple with 14 rounds of IVF - they must have seriously deep pockets and be very mentally strong to keep it up
> 
> However, I would not like to see the state fund that level of IVF for anyone. Personally, I think anything beyond 3 cycles is excessive



Presumably they wouldn't fall into the category of 'can't afford to pay for it'.


----------



## gnf_ireland

No, but I still think state supported IVF should be available to them. I do think this is something that should not be means tested.


----------



## torblednam

gnf_ireland said:


> I found the report that says it's 105k as well. Clearly there is something amiss with both numbers !!!
> 
> One thing I can say with fact is that for both of my daughters the childcare bill was/will be 45,000 euro each before they started primary school. That is ~48 months at 1015 each less 3600 roughly ECCE contribution. We will start both after the age of 5.
> I will also have to continue paying childcare until they leave primary school, working out around another 10k a year between them for 9 years. We don't have any family members in Dublin and that covers a 3 day week only since July, and includes longer hours during the school holidays. We pay a childminder to come to the house on a fair wage, all put through the books.
> So I calculate my childcare bill alone until the start of secondary school to be 180k divided 2 so 90k each.
> 
> I think the 250k is closer to my costs than the 105k. Others may have cheaper options available to them for childcare to bring costs down.



Don't forget that the average should include families with a stay at home parent.


----------



## gnf_ireland

@torblednam fully accepted re average including a SAHP. I was just saying in my personal case the 250 is closer than the 105.

Obviously the more kids you have the cheaper it is on average also. 

I guess I just wanted to say that in some cases 250 is not unheard of !!


----------



## Easter

People can be very creative in how they raise children. It can be done on a lot less than 12k a year per child. Perhaps that article should read 'average middle class spend'. So many people adapt their lifestyle to raise children. It's often about the choices you make.  

I think something that Brendan's thesis is missing is that there is a difference between being able to generate more money and being able to live well on the lesser amount you do have. There are plenty of working class families that can make 40k go much further than 70k for a more well off family. Living in a place where cost of living is less, childminding to cut out your own childminding costs, sourcing second hand goods, clever shopping, meal planning. You just can't say that someone who cannot come up with 5-10k for IVF cannot afford children. Perhaps they can't afford to raise their kids like you do, but that's a different thing.

I still think we don't have the money in our health budget to afford to fund IVF, but the child affordability argument doesn't hold up. Unless you know individual circumstances you can't know how people will manage.


----------



## Leper

For the record:- I think the service should be available to everyone and not just those who pay tax. Sorry if I caused confusion. Merely, I was pointing out that couples seeking free IVF probably pay tax so what's the problem with them benefiting?


----------



## gnf_ireland

For the record I do not believe it should be made available to all. I believe it should be based on a number of factors - including a health assessment of the mother AND a minimum number of PRSI stamps paid.


----------



## cremeegg

TheBigShort said:


> In the end, if Irish people stop having children (admittedly a long way off), or enough children to replace the population, then everything you own, your house, your car, your pension, your investment property etc, will very quickly become worthless.
> Having children may be expensive for parents, but for the economy as a whole, they are priceless.



The single most important point in this and any other debate on the future of the economy.


----------



## Purple

cremeegg said:


> The single most important point in this and any other debate on the future of the economy.


Are you really suggesting that IVF can and will solve the problem of population replacement?


----------



## qwerty5

Purple said:


> Are you really suggesting that IVF can and will solve the problem of population replacement?



I think it was pretty obvious that he wasn't. It was obvious to me anyway.


----------



## gnf_ireland

Maybe lowering the cost of raising a child may help here. I know lots who stop after 2 kids as they make a financial decision that they cannot afford a reasonable lifestyle if they have more. May be more a middle class view but then again maybe not


----------



## cremeegg

Purple said:


> Are you really suggesting that IVF can and will solve the problem of population replacement?



No. I am agreeing with The Big Short, for a change, that the problem of population replacement is fundamental to our future economic well being.


----------



## Purple

cremeegg said:


> No. I am agreeing with The Big Short, for a change, that the problem of population replacement is fundamental to our future economic well being.


Okay, but let's not falsely associate one as a solution for the other, thereby using such as issue as a justification for the State funding IVF.


----------



## Delboy

Morning Ireland had a UCD Legal bod on who was speaking on how any IVF legislation could be worded, what would be in and what could not be included.
Apparently it would be discriminatory to stop someone who has 2,3,4+ kids from applying for this if they had the need and wanted more kids. No cap could be put on it.

They didn't talk about age but wouldn't it be discriminatory also to stop a 60yr old woman for example from applying?

This being Ireland, I can see some serious issues arising into the future with whatever system is brought in.


----------



## gnf_ireland

Delboy said:


> Apparently it would be discriminatory to stop someone who has 2,3,4+ kids from applying for this if they had the need and wanted more kids. No cap could be put on it.



There are clear restrictions in the UK on availing for this. I cannot see how they can do it and we cannot. If our laws are that silly, then they need to be adjusted.


----------



## TheBigShort

cremeegg said:


> I am agreeing with The Big Short, for a change, that the problem of population replacement is fundamental to our future economic well being.



We are breaking some ground here! Last week you were for the workers to control all the wealth, now this!! 



Purple said:


> Okay, but let's not falsely associate one as a solution for the other, thereby using such as issue as a justification for the State funding IVF.



I don't think anyone is arguing that it is the solution for declining family sizes, but rather that it may act as part of the solution.
There is a prevailing viewpoint propagated that 'responsible' people wait until they can 'afford' to have children. That those who require state assistance to raise their children shouldn't have children if they can't 'afford' to provide adequately for them. That they are irresponsible.
But what is emerging is that the people who work hard and build careers for themselves are delaying starting a family, taking longer to get onto the housing ladder, to such extent that fertility rates in that sector of society are falling. They are relying on expensive IVF treatment to assist in human reproduction.
So if the 'irresponsible' people should not have kids because they can't afford them, and the 'responsible ' people are having difficulty having kids, where are all the kids supposed to come from?


----------



## gnf_ireland

TheBigShort said:


> So if the 'irresponsible' people should not have kids because they can't afford them, and the 'responsible ' people are having difficulty having kids, where are all the kids supposed to come from?


Can I suggest cloning !


----------



## Mark_jmc

just my 2 cents - my wife & I have gone through 6 unsuccessful IVF cycles.  Did we pay for it ourselves- yes.  Could we afford it?- yes- but this involved making financial sacrifices elsewhere. Do I feel that we should have gotten one or more of these cycles for free- no but from a selfish point of view we both have paid a large amount of tax over the last 15-20 years.  Of course we get the benefit of public services etc.  But we have private health insurance- neither of us (thankfully ) have been in the situation where we have had to draw JSA/JSB.  Obviously we have never availed of childrens allowance. It just feels like when we could use a 'little' helping hand we were left high & dry.  We did claim back 20% through the med 1 each time- if we had been able to claim back at our marginal rate of tax it would have been a great help.  (I understand that claiming back at the marginal rate of tax with respect to IVF may not be fair to lower earners).  It will be interesting to see the final detail of the proposals


----------



## Purple

Mark_jmc said:


> just my 2 cents - my wife & I have gone through 6 unsuccessful IVF cycles.  Did we pay for it ourselves- yes.  Could we afford it?- yes- but this involved making financial sacrifices elsewhere. Do I feel that we should have gotten one or more of these cycles for free- no but from a selfish point of view we both have paid a large amount of tax over the last 15-20 years.  Of course we get the benefit of public services etc.  But we have private health insurance- neither of us (thankfully ) have been in the situation where we have had to draw JSA/JSB.  Obviously we have never availed of childrens allowance. It just feels like when we could use a 'little' helping hand we were left high & dry.  We did claim back 20% through the med 1 each time- if we had been able to claim back at our marginal rate of tax it would have been a great help.  (I understand that claiming back at the marginal rate of tax with respect to IVF may not be fair to lower earners).  It will be interesting to see the final detail of the proposals


Since this seems to be about people like you; hard working, high tax paying people who put off having kids until a little later in life, maybe the fairest thing to do is allow everyone to claim back their medical expenses at the margin tax rates.


----------



## TheBigShort

Or seeing as lower rates of fertility were identified in socio-economic groups such as those who delayed starting families in order to develop and establish careers (in turn generating wealth and paying taxes), and seeing as the trend in irish families is getting smaller and smaller, and acknowledging that the value of all investments, pensions and wealth can only be sustained by the emergence of future generations, then perhaps a bit more than a tax break?


----------



## Purple

TheBigShort said:


> Or seeing as lower rates of fertility were identified in socio-economic groups such as those who delayed starting families in order to develop and establish careers (in turn generating wealth and paying taxes), and seeing as the trend in irish families is getting smaller and smaller, and acknowledging that the value of all investments, pensions and wealth can only be sustained by the emergence of future generations, then perhaps a bit more than a tax break?


Ok, a USC break as well. That means 50% funding. Most people would be happy with that.


----------



## rob oyle

cremeegg said:


> The single most important point in this and any other debate on the future of the economy.


What is this problem with population replacement? Ireland's family sizes stopped shrinking in the 1980s, have ticked up since then (according to the World Bank) and our population, before migration, has increased by 995,000 since 1985 (according to the CSO). We're on track to exceed 6.7m by 2046 (also from the CSO projections). The natural increase each year is more now (41.6k) than it was in the 1980s (32.8k) or 1990s (19.5k). Seems to me we are fixing a problem that doesn't exist. We're among the fastest-growing populations in the developed world and we're suggesting this will help address this 'problem'?


----------



## TheBigShort

rob oyle said:


> What is this problem with population replacement? Ireland's family sizes stopped shrinking in the 1980s, have ticked up since then (according to the World Bank) and our population, before migration, has increased by 995,000 since 1985 (according to the CSO). We're on track to exceed 6.7m by 2046 (also from the CSO projections). The natural increase each year is more now (41.6k) than it was in the 1980s (32.8k) or 1990s (19.5k). Seems to me we are fixing a problem that doesn't exist. We're among the fastest-growing populations in the developed world and we're suggesting this will help address this 'problem'?



It's a fair point if figures are correct, and in truth, it was my understanding that the population was increasing. But it was also my understanding that families sizes were also reducing?
I, perhaps wrongly assumed, our population growth was down primarily to immigration.

On the other hand, applicants for IVF, facing huge costs should still, in my opinion be offered assistance where time is not on their side, and they have a proven track record of a reasonable healthy lifestyle.

The plot thickens...


----------



## Sanparom

The insensitivity of some people here astounds me.

Let's clear up some facts - IVF (unless donor) in Ireland costs anywhere from €4000-8000. The costs are dependant on what actual procedure you have (ivf v icsi for example and the cultivation process, all the extras...). Given the fact that a lot of couples cannot even afford the €4000 it could cost at the cheaper end of the scale, if the government funded this, more couples would be able to undertake ivf, thus lowering the cost by the clinic. So, the govt would not be forking out anywhere next nor near 15k per cycle, more like 2-3k, if even.

Unless you have walked this road, you don't have a clue.

And for what it's worth, it is much cheaper and sometimes more advantageous (better lab conditions, doctors etc) to head to the likes of the Czech Republic for treatment. We did 4 cycles there and have 2 beautiful children from 2 of those cycles.

We are not loaded. Not anywhere near, but we paid for ivf and we adjust our budget to be able to raise our kids. It would be nice if people were less patronising about this topic.


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## TheBigShort

Well I apologize if my ignorance on this matter has shown through. But my view is that people, who through no fault of their own, have ended in a situation where they cannot conceive a child naturally, should be given as much assistance as practically and reasonabley possible by whoever is willing to do so. 
As a taxpayer, I welcome the cabinet approval to bring forward the Assisted Human Reproduction Bill. I await the proposals later this year.


----------



## rob oyle

TheBigShort said:


> It's a fair point if figures are correct, and in truth, it was my understanding that the population was increasing. But it was also my understanding that families sizes were also reducing?
> I, perhaps wrongly assumed, our population growth was down primarily to immigration.
> 
> On the other hand, applicants for IVF, facing huge costs should still, in my opinion be offered assistance where time is not on their side, and they have a proven track record of a reasonable healthy lifestyle.
> 
> The plot thickens...


Hi BS, the fertility rate in Ireland is here: https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=IE

I have to revise what I said... the lowest fertility rate was in 1995, not 1985. Hasn't been over the supposed 'replacement rate' since 1990 but the native population has been rising since CSO records began: [broken link removed]


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## torblednam

rob oyle said:


> Hi BS, the fertility rate in Ireland is here: https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=IE
> 
> I have to revise what I said... the lowest fertility rate was in 1995, not 1985. Hasn't been over the supposed 'replacement rate' since 1990 but the native population has been rising since CSO records began: [broken link removed]



You seem delighted with yourself gleefully throwing out stats about fertility rates, replacement rates and blah blah blah. 

I don't really see the relevance of those things to this issue though, which is about what we as a society choose to say and do for couples who find themselves in a particular situation. I can tell you with absolute certainty that the rate of reproduction across the country as a whole never crossed my mind or my wife's when we were at our lowest.


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## gnf_ireland

At the moment, anyone who can afford to pay for IVF today is in the high tax bracket. There is no way someone on the lower tax bracket could afford this treatment unless they were gifted the money. These people, by enlarge, have contributed their share and more to the cost of running the country. When the time comes for them to get support from the government on this issue, it is currently lacking. It must be hard enough to be in this situation, without trying to consider major financial impacts on this also.

Personally, I would see way more merit in supporting couples in this journey than funding first holy communion grants for example.

The question is - if/when the government decide to implement this policy, will it be means tested so these people are still excluded from the support and only helps those who cannot afford it today, or will it be inclusive to all persons requiring the support. What will the entry criteria be, and what will be parameters of the support be (how many cycles etc). Will they support the service in Ireland only, or also support it across the EU ? Will it be private clinics (for profit) or public clinics (not for profit) running the service 

My view is those who pay into the system sometimes need a helping hand, and the government should be there to support them. The available funding should not only be for those who pay nothing/minimum into the system. 

Population growth means little in this discussion. If you want to take that macro view, you need to look the amount of workers to non-workers in the future not what the population will be. What are the expected changes to this in the event the 'repeal the 8th' passes ?


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## rob oyle

torblednam said:


> You seem delighted with yourself gleefully throwing out stats about fertility rates, replacement rates and blah blah blah.
> 
> I don't really see the relevance of those things to this issue though, which is about what we as a society choose to say and do for couples who find themselves in a particular situation. I can tell you with absolute certainty that the rate of reproduction across the country as a whole never crossed my mind or my wife's when we were at our lowest.


I'm sorry that providing statistics and correcting preconceptions about our population decline upsets you. Do you believe the State should be funding an increase in our fertility rates, given the evidence I've shared?


gnf_ireland said:


> Population growth means little in this discussion. If you want to take that macro view, you need to look the amount of workers to non-workers in the future not what the population will be. What are the expected changes to this in the event the 'repeal the 8th' passes ?


If we repeal the 8th amendment, I would expect that women that currently have to travel to the UK for an abortion will be able to get them at home, under advice from the doctor they know and trust.


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## Purple

Sanparom said:


> if the government funded this, more couples would be able to undertake ivf, thus lowering the cost by the clinic. So, the govt would not be forking out anywhere next nor near 15k per cycle, more like 2-3k, if even.


 You're having a laugh, right? There is no way doctors will ever reduce their costs. There's no way IVF will ever cost 2-3k a cycle unless there is a significant change in technology and a more open market. This will be a licence to print money for the medical industry.



Sanparom said:


> Unless you have walked this road, you don't have a clue.


 I did walk the road, for a lot longer than you did.



rob oyle said:


> If we repeal the 8th amendment, I would expect that women that currently have to travel to the UK for an abortion will be able to get them at home, under advice from the doctor they know and trust.


 They will indeed. Many other women will also have abortions.


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## torblednam

rob oyle said:


> I'm sorry that providing statistics and correcting preconceptions about our population decline upsets you. Do you believe the State should be funding an increase in our fertility rates, given the evidence I've shared?



I've already said I believe the evidence you've shared is irrelevant to this discussion. This is not about the State "funding an increase in our fertility rates", as the overall effect of what's proposed would most likely have a RELATIVELY small effect on those macro figures.


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## torblednam

Purple said:


> You're having a laugh, right? There is no way doctors will ever reduce their costs. There's no way IVF will ever cost 2-3k a cycle unless there is a significant change in technology and a more open market. This will be a licence to print money for the medical industry.



So if the government were to announce a policy of subsidised fertility treatment and invite tenders for what would inevitably become the majority market share of the industry, no-one, not even new entrants from U.K./EU would make competitive bids?


----------



## Purple

torblednam said:


> So if the government were to announce a policy of subsidised fertility treatment and invite tenders for what would inevitably become the majority market share of the industry, no-one, not even new entrants from U.K./EU would make competitive bids?


They would need to tackle the closed shop that is the Irish Medical Industry. GP's refer their customers to the specialists they were in college with, specialists refer their customers to other specialists they were in college with.


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## michaelm

If the State is to fund IVF one of the qualifying conditions must be an age limit . . probably 35.


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## torblednam

michaelm said:


> If the State is to fund IVF one of the qualifying conditions must be an age limit . . probably 35.



Why 35? 

A large proportion of the people in difficulty conceiving are in their mid-30's, and find themselves in that situation specifically because they've done everything "right" - been responsible citizens.


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## Mark_jmc

michaelm said:


> If the State is to fund IVF one of the qualifying conditions must be an age limit . . probably 35.



When you say probably 35 can I ask where you pulled that number from?


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## michaelm

Mark_jmc said:


> When you say probably 35 can I ask where you pulled that number from?


Female fertility goes off a cliff from 35.  There must be some cut-off, maybe 35 is to low and 39 would be more reasonable, but some sensible cut-off is required.





torblednam said:


> A large proportion of the people in difficulty conceiving are in their mid-30's, and find themselves in that situation specifically because they've done everything "right" - been responsible citizens.


That's one viewpoint alright.  Another is that people should be aware that female fertility drops off drastically after 35 and if they intend having children they should adjust their life plan accordingly.


----------



## gnf_ireland

michaelm said:


> Female fertility goes off a cliff from 35. There must be some cut-off, maybe 35 is to low and 39 would be more reasonable, but some sensible cut-off is required.


The UK has a formal cutoff of 43 according to the below NHS site
http://www.nhs.uk/Conditions/IVF/Pages/Introduction.aspx

But it does caveat it that "some CCGs only fund treatment for women under 35"

I do believe a cutoff should exist, but based on medical reasons. Once of those should be age, but will let the medical professionals best advise on this. I also believe the number of funded/supported cycles should be capped, probably at 3 based on NICE guidelines.

http://www.nhs.uk/Conditions/IVF/Pages/Introduction.aspx


----------



## Purple

gnf_ireland said:


> I do believe a cutoff should exist, but based on medical reasons. Once of those should be age, *but will let the medical professionals best advise on this*. I also believe the number of funded/supported cycles should be capped, probably at 3 based on NICE guidelines.


See that's the problem; they make more money the more they do so they have a vested interest in saying yes. The purchaser isn't spending their own money so there is no downside for them.


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## torblednam

Purple said:


> See that's the problem; they make more money the more they do so they have a vested interest in saying yes. The purchaser isn't spending their own money so there is no downside for them.



While I don't doubt the veracity of what you're saying, that is a reason for proper control / regulation / oversight (for the good of all users/payers), not an argument against State subsidised fertility treatment.


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## gnf_ireland

Purple said:


> See that's the problem; they make more money the more they do so they have a vested interest in saying yes.


You are talking about medical professional in private practice on a case by case basis. I am talking about strict medical guidelines, in particular around eligibility. We have a medical authority who decides what drugs to fund or not fund, the same principle can be used to defined eligibilty for this scheme.
I have repeatedly said the purchaser should have to pay something for this - it should be discounted, not free.
I have also said I believe the assessment should be done by the public 'maternity' system, along with the determination of the treatment to be used. This should be delivered by a different group, so the outcome of the assessment gives no financial gain to the assessor.
Ideally, I would prefer this to be run on a not for profit basis by the public hospital system - but will see.

Your experiences of the private operators working in this space has clearly not been positive. You clearly feel like you were subjected to poor medical treatment based on financial objectives rather than medical best practice.
My small number of experiences in private medical practice have been nothing but positive.


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## Easeler

I totally agree ,as a society we should pay for this, everyone pays tax and contributes some more than others yes but everyone contributes, mankind would be extinct by now if we waited for the rich to have kids because a lot of them are too mean and selfish to have kids.


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## Purple

gnf_ireland said:


> You are talking about medical professional in private practice on a case by case basis.


 I'm talking about a business owner/stakeholder. What letters they have before or after their name makes them no less greedy than the next person. I thought that tugging the forelock to out "betters"; the doctor and the priest, was a thing of the past.



gnf_ireland said:


> We have a medical authority who decides what drugs to fund or not fund, the same principle can be used to defined eligibilty for this scheme.


Right, and a few "human interest" stories on RTE fills the debate with emotion so that cost/benefit and scientific rationale goes out the window. It is, and always will be, a political decision based on vates in the next election.    



gnf_ireland said:


> I have also said I believe the assessment should be done by the public 'maternity' system, along with the determination of the treatment to be used. This should be delivered by a different group, so the outcome of the assessment gives no financial gain to the assessor.


 There is no different group. They all went to college with each other, went through the hospital system together and work in both Public and Private practice, usually at the same time.



gnf_ireland said:


> Ideally, I would prefer this to be run on a not for profit basis by the public hospital system - but will see.


 The Hospital may not make a profit but the doctor will.



galwaypat said:


> mankind would be extinct by now if we waited for the rich to have kids because a lot of them are too mean and selfish to have kids.


 What a bigoted thing to say! "The rich", are they a distinct group like "The Poor" and "The Queers" and "the Blacks"?


----------



## gnf_ireland

Purple said:


> There is no different group. They all went to college with each other, went through the hospital system together and work in both Public and Private practice, usually at the same time.


So should we ban all medical treatment in this case? Since someone profits from it at some stage in the process?

Certain Health Insurance companies can support IVF treatment without the world falling down. Why can the state not do the same?



Purple said:


> I thought that tugging the forelock to out "betters"; the doctor and the priest, was a thing of the past.


I am under no illusion that a doctor or priest is better than me or anyone else.

Lets say someone crashes into me. The other drivers insurance company is footing the bill to fix it - so its not costing me a cent.
The insurance company can have a list of suppliers they will deal with, where rates have been agreed between them and I just drop in the car to get fixed. In most cases decisions will need to be taken around the repairs - should the panel be fixed or replaced etc.
Can the garage inflate the cost to the insurance company? Probably. Will they - who knows, but depending on the amount of work the insurance company gives them, that may not be the best idea for them long term.

The same should be done if the state wishes to implement this - if not, the state is wasting tax payers money and holding it to account. If we are always scared that someone is trying to/going to rip us off, then we should just become hermits and not spend anything at all.

I accept you had a bad experience. It does not mean the state is going to get ripped off in the future by agreeing to support taxpayers when they need that support.


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## gnf_ireland

galwaypat said:


> we waited for the rich to have kids because a lot of them are too mean and selfish to have kids.


Remember the definition of rich is 10k about your own salary !


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## Purple

gnf_ireland said:


> Lets say someone crashes into me. The other drivers insurance company is footing the bill to fix it - so its not costing me a cent.
> The insurance company can have a list of suppliers they will deal with, where rates have been agreed between them and I just drop in the car to get fixed. In most cases decisions will need to be taken around the repairs - should the panel be fixed or replaced etc.
> Can the garage inflate the cost to the insurance company? Probably. Will they - who knows, but depending on the amount of work the insurance company gives them, that may not be the best idea for them long term.


 Do you think you get good value for money from your insurance company? Do you think they pay out too much when lawyers and doctors get involved? Do you think that fraudulent claims and large settlements mean you end up paying more insurance? 



gnf_ireland said:


> The same should be done if the state wishes to implement this - if not, the state is wasting tax payers money and holding it to account.


 I agree. That's my point; the State has a long track record at being rubbish as controlling costs. Add in the medical industry and all the emotive stuff that goes with this and it's a licence to print money. 



gnf_ireland said:


> I accept you had a bad experience. It does not mean the state is going to get ripped off in the future by agreeing to support taxpayers when they need that support.


 It's not about me having a bad experience. It is about an industry which is not in the least price sensitive and the allocation of limited resources. If we do this it means that we don't do something else in healthcare. What should we not do in order to get the money for this?


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## Easeler

gnf_ireland said:


> Remember the definition of rich is 10k about your own salary !


Ok rich was the wrong word we are all rich in something, my point being my ould lad had 10 kids and he hadn't an This post will be deleted if not edited to remove bad language in his trousers and he worked for a large estate in his younger days and I think they had only 2 kids and there is no sighn of them now


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## RentingD

It certainly is an emotive topic. 

Just wanted to add that there are a myriad of reasons why ivf might be required, not always age related. 50pc of fertility problems are male factor. 
In financial terms some fertility problems will work out particularly expensive. For example if a man needs a TESE due to blockage the procedure will add 1200 to the bill. If a woman has recurrent miscarriages the additional treatment is expensive on top of "straightforward" IVF. 
There are lots of additional costs like paying for the drugs, vitamins, acupuncture, counselling, loss of earnings due to taking time off, loss of overtime, travel to clinic, etc. When you are paying that much for medical treatment you want to do it all right. I wouldn't like to add up exactly what we spent but happily it lead to success. 
We financed it through some savings, credit union loans, paying back when Med1 came through, topping up loan again, taking all overtime and extra income available, etc. A lot of stress as we didn't know how long it would take. A particularly low point was lying on a trolley in a&e knowing I was miscarrying and while my heart was breaking over losing the (expensive) pregnancy I was also broken at the thoughts of pulling another 7000 together just for the 30pc chance of success of going again. 
Whereas some women are availing of free maternity care for multiple children (rightly so) and then child benefit, free u6 gp care. Seems unfair that there's not much help for couples going through IVF. I wouldn't expect it all to be covered but even being able to claim medical expenses at the higher rate would make an enormous difference.


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## Susie2017

I must agree with Purple above and will give a couple of comments. I would have huge reservations about handing over taxpayer cash to Irish private IVF clinics. I have been down this route and it is far from simple on many fronts. 

Firstly to my knowledge there is no regulator/ oversight agency of IVF in this country similar to the UK HFEA. Irish clinics are not obliged to provide annual published success rates per age group of woman treated, data re fresh vs frozen cycles, donor vs own egg/ sperm etc etc. If you go to their websites you will see that they also don't bother publishing their data in any great detail. 

Second,  the Irish clinics tend to get you in for a cycle or two before actually doing several tests, which I and many others would argue should be done initially as part of your baseline fertility investigations. If you are on the right treatment from day one you could reasonably expect to reduce the number of cycles you are going to pay for to be successful. This is absolutely not the approach currently in Ireland. 

Let me give one example; there are blood tests called 'Chicago bloods' which are not done until you fail several IVF cycles.  They are sent to the US from the Irish clinics. I note the cost for them on SIMs website is now still very high at 1k, but when I did them they were 3 k. There is no logic why these blood tests should (a) cost so much and (b) not be offered by the clinic themselves here for a small nominal fee or (c) be done in a public hospital laboratory in Ireland for free. I work in such a hospital lab and there is no reason why this testing could not be set up quickly and easily at low cost at one public hospital into which all the clinics could send their requests. Why has this not been organised by now ? Vested interests ? Why are the IVF clinics not setting this up themselves or asking a public hospital lab to do it ? There are far more complex blood tests offered in Irish hospital labs. One can only surmise. 

Aside from this every blood test done in public hospitals in Ireland is not billed unless the patient is an inpatient with private health cover and even then the fee is only around 60 euro for an unlimited volume of blood tests, even if you are in hospital for months. The reason I believe these tests are so costly is to deter the patient from having them done in the first instance when they present with infertility.  There are other examples of add on blood tests such as clotting or thrombophilia tests which again are not offered on initial presentation. These can actually also be done by their GP with no bill from the hospital, but yet the clinics don't get them done routinely until cycles have failed. GPs in some instances would charge only a small fee eg 30 euro for doing these tests. Therefore many many patients end up having high numbers of cycles of IVF to be successful when perhaps one or two would might have worked if the patient had been on the correct medication eg blood thinners from day one. This is happening everyday and the desperate but poorly informed couples are paying the price of delaying tests which should not be costly and which are sufficiently relevant to be offered on day one. 

There is a menus of other add on tests which all add to the overall cost. Let me give one or two other examples:
EEVA is a monitoring video of the developing embryo which as I understand it actually reduces the workload done by the embryologist in the IVF laboratory yet it costs 550 extra per cycle. Why is it so expensive ? It just takes pictures ?  Why not include as standard part of the cycle if it improves the overall selection of embryos which are more likely to implant based on a score ?

Endometrial scratching is a 5 minute procedure which can be done during the IVF cycle.  It's been proven to increase implantation rates in the medical literature. Yet it costs 220 as a separate add on procedure. Why is it (a) so expensive given that it is very similar to a smear test and (b) why is it not now a routine non optional part of a cycle when you are already spending 5k, given that it improves the %chances of success? 

I could go on. I would have serious reservations about the overall ethics of the process currently. Not to mention the clinic experience is like being on a conveyor belt. They want you in and out as fast as possible and try getting them after hours if there is a problem ! Oveseas you can pick a clinic with a high published and independently verified success rate and get treated for issues which can go undiagnosed here.  I would encourage anyone going through this incredibly difficult process to do their research in depth before they open their wallets. There is one great UK website which was a wealth of information- I will state it later if allowed to on here. I seriously think if free IVF is going to be offered here then it should NOT be done in the private sector. Get a public hospital or two to become specialist centres like the Uk where free cycles are on the NHS I.e where the doctors have NO FINANCIAL BENEFIT if you fail. Fund, staff and resource the hospitals properly. Believe me IVF is not something you want to repeat unnecessarily for your mental state. I still get flash backs from the procedures and the anxiety. Horrendous traumatising experience.


----------



## gnf_ireland

Susie2017 said:


> I would have huge reservations about handing over taxpayer cash to Irish private IVF clinics.


Why is there an assumption that the benefactors will be Irish private IVF clinics? Why can it not be put out to tender across all of Europe and it could very easily result in increased competition?

Why can the HSE not hire doctors directly who specialise in the area, and create specialist public clinic in the area. I am sure there are plenty of doctors who would be more than willing to specialise in the area

Some of these things take time, so it would be possible to tie any private clinics used to a fixed cost & defined number of procedures for that duration - e.g. min 5,000; max 7,500 per year and they will cover the cost of treatment x, y, z and anything additional is covered by the couple. Cost subsidised per treatment is 4k euro (for example)

This should be standard part of any procurement process. The government work with private operators all the time - this is nothing new.



Susie2017 said:


> Firstly to my knowledge there is no regulator/ oversight agency of IVF in this country similar to the UK HFEA.


This would have to be a pre-condition of any state support. There needs to be oversight before any state spending happens. Again, this is just basic governance.



Susie2017 said:


> Second, the Irish clinics tend to get you in for a cycle or two before actually doing several tests, which I and many others would argue should be done initially as part of your baseline fertility investigations



Again, as part of any 'qualification' for the scheme I would expect that the required level of medical data is available, based on accepted international standards. The process should be based on the highest possible standards as defined internationally.  You cannot compare what a private operator does today with a proper regulated and controlled environment where government is spending taxpayer funds. If the government decide to do this without these controls, they should be held to account on it - as there is a lack of basic governance

This is no difference to the taxpayer funding the likes of Rehab with no governance in place, and then crying foul when something goes wrong. Set up the controls from the outset and do things right. 



Susie2017 said:


> Aside from this every blood test done in public hospitals in Ireland is not billed unless the patient is an inpatient with private health cover and even then the fee is only around 60 euro for an unlimited volume of blood tests, even if you are in hospital for months.


I understand this - but you are not in a public hospital, you are at a private clinic. If I go to the Beacon and I need blood tests done, I will be charged for them also. In the public hospital the state funds the majority of the costs.



Susie2017 said:


> I seriously think if free IVF is going to be offered here then it should NOT be done in the private sector. Get a public hospital or two to become specialist centres like the Uk where free cycles are on the NHS I.e where the doctors have NO FINANCIAL BENEFIT if you fail.


You will see from above, I have said the same thing repeatedly and we have no experience of the system. There may need to be a transitional process put in place in the interim though


That said, there is a difference between the discussion on HOW it is implemented versus whether there should be funding support for this


----------



## Purple

gnf_ireland said:


> This should be standard part of any procurement process. The government work with private operators all the time - this is nothing new.





gnf_ireland said:


> This would have to be a pre-condition of any state support. There needs to be oversight before any state spending happens. Again, this is just basic governance.


Given the State's track record at regulation how confident are you that this will happen?


----------



## gnf_ireland

Purple said:


> Given the State's track record at regulation how confident are you that this will happen?



One can only hope. However, this applies to all spending and not just this
In the grand scheme of things, the cost of this will be minimal ...


----------



## Susie2017

I don't agree. How will the costs be minimal ? . Infertility is on the rise. There are packed waiting rooms in these clinics already. The cost of a basic cycle is approx 4600 with no extras or even basic infertility investigations included. With the extras, some of which I outlined above you can easily double this. Then double again if you are going to give two cycles per couple. That's not small money. This industry requires serious scrutiny and proper oversight before any of this funding is rolled out. Why not base the public funded cycles in a couple of the maternity hospitals ? Some of them eg Rotunda, Holles st already have clinics operating on site. Private clinics are operating with zero regulation. The already burdened taxpayer should have the confidence that each funded treatment cycle is not wasted and is based on the latest medical evidence and available technologies. If a patient gets cancer nowadays they get the best and latest available drugs which give them the best 5 year survival rate not the stuff they used 10 years ago because it might work in a lower percentage of cases. IVF is a serious mental and physical challenge where the odds are already stacked against the couple for success. The clinics know this. Why do they deliberately try to reduce the odds by not insisting on basing treatment cycles on best available medical evidence ? WHY ?


----------



## gnf_ireland

gnf_ireland said:


> In the grand scheme of things, the cost of this will be minimal ...





Susie2017 said:


> How will the costs be minimal ?



I said in the grand scheme of things, the cost will be minimal. The below site shows the total healthcare spend in 2017 will be 14.6bn, or 21.2% of the budget.
http://whereyourmoneygoes.gov.ie/en/

Lets say the state funds up to 3 cycles per couple, and supports it by up to 5k a cycle => max 15k a couple. Assuming they would have received 20% tax refund on this anyway, it costs the state 12k net per couple.

There was 64,000 babies born in Ireland in 2016
http://www.cso.ie/en/releasesandpublications/ep/p-vsys/vitalstatisticsyearlysummary2016/

Lets say 5% of that may involve IVF (no idea, but it is just a guess including failed IVF) - so say 3200 IVF couples @ 12k each works out around 38 million.  38m is minimal when looking at 14.6bn.

The state is funding drugs which cost ~150k per patient per year. This is minimal in comparison, as it is time limited.

Of course the number depends on the qualifying criteria - age, medical condition, previous children etc... and of course how much would be funded by the state



Susie2017 said:


> This industry requires serious scrutiny and proper oversight before any of this funding is rolled out. Why not base the public funded cycles in a couple of the maternity hospitals ?


If you look at my posts, I repeatedly state this. I do not believe we should be funding private operators in this space beyond a transitional period when the state can have build up the required expertise themselves. 
Surely this could be included as part of the move for the NMH to Vincents?




Susie2017 said:


> Why do they deliberately try to reduce the odds by not insisting on basing treatment cycles on best available medical evidence ? WHY ?


This is something you will have to ask the clinics themselves.


I repeat the statement I made earlier
*There is a difference between the discussion on HOW it is implemented versus whether there should be funding support for this*


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## Sanparom

You don't need a referral to have IVF treatment.


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## Purple

Sanparom said:


> You don't need a referral to have IVF treatment.


Nope, just money (yours or someone else's)


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