Infertility injustices

Who should have access to infertility treatment? It’s an interesting question at a time when healthcare systems, even those in wealthy countries, are crumbling under the pressures of reduced finances and ageing populations. In this environment fertility treatments can seem like a luxurious add-on, distinct and separate from life-saving medicine.

About two years ago I was considering fertility treatment but found it inaccessible for rather different reasons. My partner has cancer so we assumed we’d be unable to conceive naturally, and yet when I made inquiries at a top clinic in Brussels I was told we probably wouldn’t be able to receive IUI or IVF. The reason was not financial (in fact, the Belgian public insurance system covers up to 6 cycles of IVF and attendant therapies) but ethical. The clinic deemed it inappropriate for someone with cancer to have a child–even if their partner wants one. Bizarrely, had I been single, the situation would have been different; having a child with donor sperm would have been entirely okay.

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I’m blurring things a bit because the clinic didn’t absolutely say no. Over the phone, a nice woman told me we’d have to go through counselling and have an opportunity to make our case, meeting several doctors who would assess us psychologically and deduce whether we were in a position to be parents. We’d also have to provide my partner’s medical records and his oncologist’s prognosis of how long he’d live. “It’s very harsh,” she said. “But having a child with IVF is difficult and having cancer is also difficult, so we think both are too much.”

It was the first time I’d come up against a medical decision with which I absolutely disagreed. Who were these anonymous doctors to tell my boyfriend and me whether or not we were fit to have a child? And how dare they make that decision on our behalf? We’d never received a set prognosis from my partner’s current oncologist–and all the predictions we’ve had in the past were inaccurate. Some people with his type of cancer have survived for 6 months, others for 30 years. Getting his doctor to put a figure on paper seemed unhelpful and stressful.

Luckily this was the opinion of just one clinic, albeit the largest and best-publicised in Brussels (it’s popular among international fertility patients and invests heavily in English-language marketing materials). We found another in Leuven that was willing and able to work with us. Its staff were very friendly and kind, but we hit another roadblock, this time in the form of EU law. We’d lived in the US when my partner had his first cancer treatments. It turns out that New York law differs from that in Europe, and tests for conditions like HIV and Hep C only if the sample is intended for a third party.

Because the sample was for my partner’s use, and mine, it wasn’t tested. As a result, it was illegal for us to ship it to Europe. The fertility specialist in Leuven was sympathetic but crystal clear. That was that.

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Since then, and to our huge surprise, we’ve succeeded in conceiving naturally, and a baby’s on the way. All of this made me think though. Fertility treatment isn’t just about money although money plays a big and questionable role in the industry. It also raises so many ethical issues. Should cancer patients be allowed to have kids? (I think so.) Should such treatment be funded from the public purse? (I don’t know.) When is it appropriate for doctors’ views to over-ride those of the patients they treat? (A tricky one.)

What do you think?

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