An unlimited number of free in vitro fertilization treatments and the raising of age limit are the things that the citizens and non-governmental organisations are asking for the Republic of Srpska and Brcko District’s health insurance funds.
Written by: Vanja Stokic; Photograph and video taken by: Ajdin Kamber
Couples from the Republic of Srpska, who have difficulties conceiving, are entitled to free in vitro fertilization procedures, financed by the Health Insurance Fund. However, this number of attempts is often nowhere near enough for a woman to get pregnant. Another limiting factor is age, because the procedures are covered only for women not older than 40 years. In addition, couples can undergo this procedure only in one clinic in the Republic of Srpska.
„Even the doctors say that the success of in vitro fertilization is cumulative. In other words, the more times you undergo the entire stimulation and everything that the procedure entails, the higher is the probability that there will be a positive outcome. Sometimes it simply happens that the IVF succeeds, but the pregnancy is not kept, because certain complications occur. Three attempts are really insufficient. The act of condemning couples to three attempts only, where these three cycles can be performed in one clinic only, is a true discrimination”, says Dajana Kuzmanovic from the Association of Families with Sterility Problems „Roda“.
Practice shows that couples need much more than three attempts. Some of them succeeded in getting a child only after their 10th attempt.
„In our Association we have a couple whose 8th attempt was finally successful. Seven unsuccessful in vitro fertilizations, and the eight one was a successful one. We have a couple in Doboj who succeeded after their 7th attempt. There are very many couples whose 5th, 6th or 10th attempt was successful. As if there was something predestined for them. The doctors also say it is important to keep trying. However, you cannot keep trying if you don’t have a possibility for that“, emphasizes Dajana Kuzmanovic.
One of the problems she highlights is the reaction of medical staff once a woman approaches them for a medical advice for the first time. If she is older than 40, she often gets negative comments. And faces needles prying into her intimate life.
„What hurts us all in this Association is when a woman aged 40, 41-42 goes to see a reproductive health specialist she is often asked: “Where have you been until now?” She is not to be blamed for not getting married before the age of 40. Not everyone can get married at the age of 20. Not every woman can give birth at the age of 22-23. We have a couple here, they met in their 40s. It simply happened to them like that. However, no matter if a woman is 40, or 30 or 25 years old, she has the same wish as every other woman, and surely has to have the same right to become a mother. But no one can just say: “You can be a mother, and you cannot”, she adds.
The stereotypes that are predominant in our society and stigma against couples who have problems conceiving result in their inactivity to publicly fight for a better position. Even makes them hide from the public.
“We currently have some 50 families as members of our Association. Each time when I ask if someone would like to make a statement, even if it is a statement for the radio, for the newspapers, when it is not required to reveal the name, no one wants to do it. We cannot fight like this. I agree this is a big problem. It hurts us, it bothers us. I have been going through this alone for years. But by hiding so that no one could see me will not help me accomplish anything”, says Dajana Kuzmanovic, adding that there is no reason for a man and a woman to blame themselves for the problem they have.
For the couples in the Republic of Srpska to have more opportunities for conceiving, it is necessary to change the law. Mirna Savic Banjac, a deputy in the Republic of Srpska National Assembly, plans to launch her initiative with questions to the parliamentarians.
„We need to see if there is a plan at all to increase the number of free IVF procedures, i.e. to have an unlimited number of attempts, as it is the case with Serbia. It is necessary to provide all couples who wish to have children, but cannot have them, with adequate medical assistance. This is a very important issue, a good thing to invest money into. It is in no way a failed investment, not without any purpose, it is very justifiable. These are extremely expensive procedures, and a very few citizens in the RS can afford a large number of attempts. This exhausts them, they take loans from the banks, and we all know here that the citizens are struggling with basic existential problems on a daily basis“, explains Mirna Savic Banjac.
As the Banja Luka mayor’s adviser for culture and social policy, last year she partook in the amendments to the Rulebook based on which the City finances one attempt of in vitro fertilization.
„The major changes in the amended Rulebook were that we first raised the age limit from 42 to 45 years of age. So we made in vitro fertilisation available for much more couples. All those couples who met the conditions, 40 of them, received financial support. Their number was much higher than before. We also succeeded in extending the deadline for application to 90, instead of 30 days. And we introduced special treatment for a group of women who needed to have an egg donation. Until now these women were unable to get funds from the City for this purpose”, she highlights.
The situation is better in Brcko District, where the couples have a right to five free in vitro fertilization procedures, in a clinic of their choice on the territory of Bosnia and Herzegovina. Also, the age limit has been moved to 45 years.
„All our activities are aimed at individuals. There was a woman who came to our Association, a young woman, aged 42. She wanted to undergo the IVF treatment. She could not as she was not entitled to it due to the mentioned restriction, due to her age. We then sent a letter of urgency to the Management Board of the Fund and they accepted it. It is not difficult to resolve this problem once it is diagnosed and once you have someone to present it to. It is often the case that those who are members of the Management Board or hold leading positions, despite their good will to help, simply do not know a lot about this”, says Zeljko Lazarevic, Centre for Community Support “Beba vise” („More babies“).
However, their effort to improve the situation does not end here. Just like in the Republic of Srpska, their goal is to achieve an unlimited number of free IVF procedures and to increase the age limit.
“Someone can become a parent at the age of 48 or 50 and be a perfect parent. When we say that we want to have an unlimited number of free IVF attempts, we are not asking for this without any grounds. There are examples in our local community, there are women who have undergone the IVF treatment 12-13 times and have become pregnant after the 13th attempt. We think that this makes sense,” Zeljko Lazarevic emphasises.
There is no law in Brcko that regulates this matter, instead this matter has been regulated with different rulebooks of the Health Insurance Fund. This is an advantage because changing a Rulebook is much simpler than amending the law. However, this is also a disadvantage, because the Government of the Brcko District can at any point refuse to cover the IVF, because there is no legal obligation to finance this procedure.