THE GOVERNMENT’S MIXED messaging on travel abroad has been criticised by people who need to travel overseas for fertility treatment.
Many people choose to travel to elsewhere in Europe for treatment because the process can be thousands of euro cheaper than in Ireland.
However, people are concerned about the impact Covid-19 travel restrictions, and flights being cancelled, could have on their treatment.
Some people are missing appointments or choosing to delay their treatment, but this is not an option for others – particularly if age is an issue.
There has also been a lack of clarity on what is deemed “essential” medical treatment for travel purposes, and how long a person has to restrict their movements for when they return to Ireland after undergoing a medical procedure abroad.
Emma*, who lives in Dublin, began IVF treatment in Prague in the Czech Republic during the week. She said the process of undergoing fertility treatment is stressful enough without the added worry of travel restrictions and lack of clarity on what people should do.
She believes IVF is an essential journey, but said the government’s messaging on travel has been lacking.
“I’m on a few social media groups for people getting IVF and everyone seems really confused.
“We are allowed to travel abroad, but what is not clear and seems to be causing a lot of confusion for people, is the phase of restriction of movement.
“Do we still have to restrict our movements when returning from treatment? My reading of [the guidelines] would be that if I was an essential worker like a high-level engineer, I would not have to restrict movements coming into Ireland, so is it the same for us?”
Emma is currently taking two weeks of unpaid leave from work so she can self-isolate as a precaution.
TheJournal.ie asked Chief Medical Officer Dr Tony Holohan at Thursday’s Covid-19 briefing if IVF is deemed an essential medical reason to travel, and how long people should restrict their movements for when they return to Ireland.
He replied: “I would hope that anybody in that situation is under the care and direction of a consultant or clinician in this country who would be perfectly well able to understand not just the public health advice, but how it should apply to a particular individual in a particular clinical context.
“And if an individual is worried or concerned about what advice they should be following they should speak to their own consultants.”
Holohan said clinicians in Ireland will understand and interpret public health advice and “provide that to an individual who need individualised advice about their specific circumstances”.
“So anybody in this situation, who is seeking treatment outside of the country, I would hope that’s under the direction of a clinician in this country, to whom they should speak about how best to protect themselves and manage the risks that might arise for them.”
Many of the people who undergo fertility treatment abroad, including Emma, are not under the care of a consultant here.
TheJournal.ie sought further clarification from the Department of Health and the Department of Transport on the issue.
A DOH spokesperson said this: “Decisions as to what constitutes essential reasons for medical travel have to be judged on an individual clinical basis. If an individual is concerned about what advice they should be following, they should speak to their own consultants.”
The government’s latest travel advice can be read here.
PCR test
It was confirmed during the week that from midnight on 29 November, under new guidelines, travellers arriving into Ireland from so-called ‘red’ regions in the EU (most European countries) can move freely once they pass a PCR Covid-19 test five days following their arrival.
This provision will also be available to arrivals from orange regions who may not have availed of a pre-departure test. You can read more about the traffic light system here.
“Obviously, the new guidelines this week were welcome but they won’t apply to me this time. What Covid brings to everyone is uncertainty and that includes those of us doing IVF,” Emma said.
When she has to revisit Prague in a few months, Emma said she will try to get a PCR test when she returns but, even if it is negative, her employers have said she will likely be unable to work as she deals with the public every day so they don’t want to take that risk. She works as a contractor and will need to take more unpaid leave.
Helen Browne, co-founder of the National Infertility Support and Information Group (NISIG), said other women are in the same position as Emma.
“It’s very very tough on people at the moment with Covid-19,” she told TheJournal.ie.
Browne said some people will want to keep the fact they are undergoing fertility treatment abroad private, but those who are upfront with their boss often have to take unpaid leave.
Some women will be able to use holiday leave, but this isn’t always an option.
“It’s very difficult to get paid leave, the employer will probably say it has to be unpaid leave, rather than giving them paid leave,” Browne said.
“They have two weeks of wage or salary not given to them, an added expense on top of everything that they’re going through.”
Some women who undergo fertility treatment abroad attend a clinic that is linked to a clinic in Ireland, but many do not have a clinician based here.
“A lot of them go independently,” she said, so they can’t consult with a doctor here about what they should do in terms of restricting their movements.
Browne said people want more clarity on the right thing to do.
She said she’s aware of women having to stay abroad for longer than they typically would because of reduced flights.
“They now have to stay for about a week, rather than two or three days, because of the reduced flights. They’re actually having to pay more money for accommodation.
“Normally if they’re going abroad for a few days, their partner would go with them. But now because the partner can’t take a week off, most likely can’t take two weeks off, they can’t go with them. It’s really tough all round, they’re all on their own over there as well.”
Time is a factor
It’s hard to get an accurate figure of how many people from Ireland travel abroad for fertility treatment each year but it’s believed to be in the hundreds.
Most people choose to go to the Czech Republic, Browne noted, but others go to countries such as Spain.
She said some people have chosen to delay their treatment but that this is not an option for everyone.
“Unfortunately, some people that go abroad for treatments are told that their ovarian reserve is dropping, and they feel now that they can go.
“By the time they get a chance to go, they’ll have no choice but to go for donor egg. Whereas they would like to have the opportunity of using their own eggs before they embark on donor eggs if they have to.
“If somebody said to me, I’m 39 now and by the time I get to go I’ll be 40, by the time I had my baby, if I’m lucky, I’ll be 41. That’s two years added on.”
The older a woman is when she becomes pregnant, the higher the risk in terms of complications, and many people need more than one round of IVF to become pregnant.
‘It’s a huge undertaking’
During IVF, mature eggs are collected from ovaries and fertilised by sperm in a lab. The fertilised egg or eggs are transferred into the uterus.
One full cycle of IVF takes about three weeks, but can take longer. It may take several rounds of IVF – sometimes over the course of years and costing tens of thousands of euro – for a person to become pregnant, if it’s successful.
“When you decide to do IVF at all it’s a huge undertaking, physically, emotionally and of course financially,” Emma told us.
She said she made the decision to undergo IVF before the Covid-19 pandemic and, over the course of the first lockdown, decided to go abroad for financial reasons.
“We decided to do IVF earlier this year but could not get over the cost of it in Ireland. While saving for a house it just seemed completely out of reach financially.”
Emma did some research online and joined a number of social media support groups, and found out that Prague “seemed to be a place that was affordable and also offered a good medical service”.
“We knew it would be a risk and would mean I would be travelling alone a lot of the time, but when your heart is set on starting a family, you’ll push and push until you find a way.”
Emma said the Irish government should fund fertility treatment so people like her don’t have to travel abroad.
“We are a modern country with an advanced healthcare system and so many more people going for IVF. It’s just prohibitive in its cost as it stands.”
Cancelled flights
Emma was in Prague for her first round of treatment during the week. She said the service was “great” but the overall experience was stressful.
“I’ve just had my first trip to Prague to a great clinic there, but the added layer of having to book flights, presuming they weren’t going to be cancelled, then constantly watching the government advice on international travel and Covid isolation periods was a huge source of stress.
“I’m back now but I have to take two weeks off work to isolate and that’s a tricky thing to do.”
Emma is concerned that if increased restrictions are introduced early next year, she may be unable to travel to Prague.
“This is what really worries me. It will be another few months before I go back for the next round of treatment and I’m really worried that international travel will be banned, we might be in a strict lockdown or the same thing could be happening in Prague.
“What if I have appointments and flights booked and I have to cancel? It’s a hugely stressful time as you have to follow strict hormone protocols for this kind of treatment, so Covid is a very unwelcome complication.”
Publicly-funded IVF in Ireland
Health Minister Stephen Donnelly spoke about plans for a publicly-funded IVF system in Ireland, as set out in the Programme for Government, in the Dáil earlier this month.
“This model of care will ensure that infertility issues will be addressed through the public health system at the lowest level of clinical intervention necessary,” Donnelly said.
He noted that the plan will comprise three stages, starting in primary care (GPs) and extending into secondary care (regional fertility hubs) and then, where necessary, tertiary care (IVF and other advanced assisted human reproduction (AHR) treatments).
“Structured referral pathways will be put in place and patients will be referred onwards for further investigations or treatment as required and as clinically appropriate. It is intended that, in line with available resources, this model of care for infertility will be rolled out on a phased basis over the course of the coming years,” Donnelly said.
“The implementation of the model of care will help to ensure the provision of safe, effective and accessible infertility services at all levels of the public health system as part of the full range of services available in obstetrics and gynaecology,” he added.
Browne believes it will take “quite a few years” for publicly funded fertility treatment to be available in Ireland – making it too late for many people.
She said a part-funded model is more likely – where investigations and blood tests may be paid for by the State.
“I personally cannot see the model in the UK, or in other countries where they will fund for two or three IVF cycles, here. I don’t know, maybe way down the line.”
Guidelines in the UK recommend that IVF is offered on the NHS to women under the age of 40 who have not conceived after two years of regular unprotected sex, or who have had 12 cycles of artificial insemination. These women should be offered three full cycles of IVF, the guidelines say.
In women aged 40–42 years, the guidelines say they should be offered one full cycle of IVF, once certain criteria is met.
Advice and support can be found on the NISIG’s website.
*Emma’s name has been changed to protect her identity.
With reporting by Michelle Hennessy
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