An Overview of Fertility and Family Planning Options

Around 1 in 4 pregnancies end in miscarriage in Ireland. Around 1 in 5 people in Ireland need help to have a baby, through IVF and other fertility treatments.

Individuals and couples may then consider fertility treatments, surrogacy and adoption. This article provides an overview of these options and some factors that may be taken into account by an individual or couple.

Adoption

Domestic infant adoption is the process whereby a child is placed with an alternative set of parent(s). All legal rights, responsibilities and duties are transferred to the new parent(s) and the birth parents relinquish all their legal rights and duties in relation to the child. 

Intercountry adoption refers to the situation where persons resident in Ireland decide to adopt a child who is resident in a country other than Ireland.

Long term fostercare to adoption is a type of adoption that occurs where a child has been placed with a couple initially in a foster care situation because the birth mother/parents are unsure of what decision they wish to make about caring for the child themselves or allowing the child to be adopted. 

Steps in the Domestic Adoption Process:

1. Assessment

2. Adjudication

3. Determination

As each application is completely different, indicative time frames cannot be provided by the Adoption Authority of Ireland. However anecdotal evidence provides an estimate of 18 months from assessment to determination.

There are no direct fees charged by the Adoption Authority of Ireland or Tusla Child and Family Agency or relevant Accredited Body to apply for adoption in Ireland. As part of the Assessment process you may have to pay your GP or other medical personnel for reports regarding your health, or pay for a copy of your Marriage Certificate or Birth Certificate from the General Register Office, but these are private expenses, and are not adoption fees.

Adoptive Leave and Adoptive Benefits rights of adoptive parents

An adoptive parent is entitled to take adoptive leave from employment. Adoptive leave gives 24 weeks’ leave off work to one parent of the adopting couple (or a parent who is adopting alone). The 24 weeks start from the date the child is placed in your care.

Adoptive parents are also entitled to 5 weeks’ parent’s leave within 2 years of the child being placed with the family.

You may also be entitled to take parental leave, to spend time looking after your children. You can take up to 26 weeks’ parental leave for each eligible child before their 12th birthday.

Your employer does not have to pay you during adoptive leave, unless it is included in your contract. You can get Adoptive Benefit, if you have enough PRSI contributions.

You can take up to 16 additional weeks’ unpaid adoptive leave, but you cannot claim Adoptive Benefit for these extra weeks.

Before adopting a child, you may have to attend preparation classes and pre-adoption meetings with social workers. You are entitled to paid time off work for these classes and meetings.

The adopting couple can choose who should take the adoptive leave (they must decide who will be the nominated parent). The parent who does not take adoptive leave is entitled to paternity leave. 

Tusla is appealing for Foster Carers. Information can be found https://www.tusla.ie/services/alternative-care/foster-care/

IVF

In vitro fertilisation (IVF) is one of several techniques available to help people with fertility problems have a baby.

IVF can overcome a wide range of issues that obstruct natural conception.

There are many different steps to the reproductive process and a problem occurring at any of these stages can potentially result in difficulties getting pregnant.

There are many different kinds of fertility issues that can make it difficult to conceive. It’s helpful to be aware of these issues and how IVF works to address these problems.

·       Fallopian Tube Damage

·       Endometriosis

·       Age and Your Eggs

·       Ovulatory Issues (PCOS)

·       Male infertility

There are also solo parents wishing to use donated sperm or to adopt an embryo.

During IVF, an egg is removed from the woman's ovaries and fertilised with sperm in a laboratory. The fertilised egg, called an embryo, is then returned to the woman's womb to grow and develop. It can be carried out using your eggs and your partner's sperm, or eggs and sperm from donors.

It is recommended that you see a fertility specialist to discuss IVF or other fertility options if:

·       You’ve been having regular, unprotected intercourse for one year (or 6 months if the female partner is over 35) and you have not yet become pregnant

·       The woman has irregular painful periods or a history of abdominal or pelvic surgery

·       You’ve had two or more miscarriages, as this might indicate that there is something preventing your embryos from implanting

Since September 2023 there is free IVF and specialist treatment available through the HSE. To get free IVF, ICSI and IUI treatment through the HSE, you need:

·       a GP or consultant to refer you to a regional fertility hub 

·       to meet the access criteria for free IVF 

·       your specialist to decide that you need this treatment 

If IVF results in viable pregnancy, then you are entitled to Maternity Leave and Maternity Benefit (if you have enough PRSI contributions).As an employee, you have the right to take 26 weeks’ maternity leave if you become pregnant. You also have the right to take up to 16 weeks’ additional maternity leave.

If you have enough social insurance (PRSI) contributions, you are entitled to Maternity Benefit (including self-employed) for the 26 weeks’ of basic maternity leave. Maternity Benefit does not cover additional maternity leave.

Since 3 July 2023, all the rights and protections also apply to transgender men who are pregnant or have given birth. You must have a gender recognition certificate, in accordance with the Gender Recognition Act 2015.

The cost of IVF can vary, with clinics charging between €5,000 to €10,000 per cycle, as does the level of cover under insurance policies. If you are considering IVF treatments, research the various insurance options available.

Once pregnant, if you are ordinarily resident in Ireland you are entitled to free maternity care under the Maternity and Infant Care Scheme. 

IVF and adoption are two of the most common options considered when conception has not occurred naturally. Unfortunately, IVF is not always successful and adoption waiting lists in Ireland are long and the process so complex that prospective parents may need to look at other options to start a family of their own.

Surrogacy

Surrogacy enables family creation for persons or couples where the intending parent or parents cannot carry a pregnancy. Most surrogacy practised today is gestational or IVF surrogacy where an embryo is created using the intending parents’ sperm and egg (or a donor egg or sperm, if required). The embryo is then transferred to the uterus of the surrogate.

Surrogacy can take place using either:

·       The commissioning mother’s egg and the commissioning father’s sperm

·       The commissioning mother’s egg and donor sperm

·       The surrogate mother’s egg the commissioning father’s sperm

·       The surrogate mother’s egg and donor sperm

·       Donor egg and the commissioning father’s sperm

·       Donor egg and sperm

·       Donor embryo

Legal advice and support is recommended. For Irish nationals, surrogacy in International surrogacy will cost between €40,000 and over €100,000 depending on the country and agency you choose.

When a child is born via surrogacy, whether in Ireland or oversees, the surrogate is recognised as the only parent and automatic guardian of the child at birth. If she is married there is a presumption that her husband is the child’s father.

Commissioning parents do not automatically have the same rights as other parents. For example, as the commissioning mother does not become pregnant, she cannot get maternity leave.

Maternity Benefit and Leave for Surrogacy:

As the commissioning mother does not become pregnant, she is not entitled to statutory maternity leave or Maternity Benefit if she is in employment. However, she (and her partner) may be able to get parental leave.

The commissioning couple may also be entitled to parent’s leave, depending on their circumstances. The father of a child born through surrogacy can qualify for parent’s leave if he is the biological father of the child and declared to be the parent of the child. In these circumstances, the father's partner may qualify for parent's leave if they are married to, in a civil partnership or cohabiting with the child’s biological father.

On 26 June 2024, the Health (Assisted Human Reproduction) Bill 2022 was passed by both Houses of the Oireachtas. However the legislation needs to be commenced to come into effect.

The Bill aims to protect the safety and rights of children born by surrogate but also aims to protect the safety and rights of the various parties involved in a surrogacy arrangement such as the surrogate mother and the intended parents. If enacted, the Bill will also provide women with up to 20 days' leave for early miscarriage and give an entitlement to all employees of up to ten days' leave for access to reproductive healthcare treatment, such as IVF.

Supports

Popular fertility treatment supports also include Acupuncture and Reiki. Grace Sheridan, of Therapy Centre, summarises her therapies as “Acupuncture and Reiki work to truly treat the person on all levels of their self and recognises that, particularly in today’s hectic Western society, physical health problems are very often as much a result of emotional and spiritual distress as they are of any physical issues. Natural medicine move us internally, bringing us toward healing ourselves.”

Roz Drake of Drake Chiropractic also states that “regular chiropractic care is an integral part of the pre and postnatal stages of pregnancy. Prior to pregnancy is helps to achieve a viable pregnancy and then during the 3 trimesters keeps mum feeling good during the physical and emotional changes that occur.”

Individuals and couples considering adoption or surrogacy may also consider inducing lactation. Caoimhe Whelan IBCLC advises “there are protocols for induced lactation and they can be employed with great success by adoptive parents or parents having a baby with the help of a surrogate.”

Supports and treatments exist, and more are being made available.

In April 2022 retailer Lidl made headlines when it announced the introduction of Fertility Leave for Lidl employees who are undergoing IVF fertility treatments. These employees are offered two days at full pay per cycle, regardless of length of service. There is no limit to the number of cycles for which employees can avail of the policy. Since then more employers have added similar benefits to their Employee Wellness Packages. The Irish Trade and Professional Association for Doulas CLG works with employers to offer workshops and doula support services through Employee Benefits.

Resources and contacts: The National Infertility Support and Information Group (NISIG), Irish Families Through Surrogacy, Tusla, the Adoption Authority of Ireland, HSE, LGBT Ireland, Equality for Children, Irish Gay Dads, the National Infertility Support and Information Group and Independent Living Movement Ireland

 As featured in Mums and Tots Magazine September 2024