I propose to take Questions Nos. 1511, 1552 and 1616 together.
As the Deputy may be aware, a commitment to “introduce a publicly funded model of care for fertility treatment” is included in the Programme for Government.
The Model of Care for Fertility was developed by the Department of Health in conjunction with the HSE’s National Women & Infants Health Programme in order to ensure that fertility-related issues are addressed through the public health system at the lowest level of clinical intervention necessary.
This Model of Care comprises three stages, starting in primary care (i.e., GPs) and extending into secondary care (i.e., Regional Fertility Hubs) and then, where necessary, tertiary care (i.e., IVF (in-vitro fertilisation) and ICSI (intra-cytoplasmic sperm injection)), with patients being referred onwards through structured pathways.
Phase One of the roll-out of the Model of Care has involved the establishment, at secondary care level, of Regional Fertility Hubs within maternity networks, to facilitate the management of a significant proportion of patients presenting with fertility-related issues at this level of intervention without the need to undergo invasive IVF or ICSI treatment. Patients are referred by their GPs to their local Regional Fertility Hub, which provides a range of treatments and interventions, including: relevant blood tests, semen analysis, assessment of tubal patency, hysteroscopy, laparoscopy, fertility-related surgeries, ovulation induction and follicle tracking. All six Regional Fertility Hubs are currently operational.
Phase Two of the roll-out of the Model of Care will see the introduction of tertiary fertility services, including IVF, provided through the public health system. In this regard, funding was secured in Budget 2023 to support access to advanced AHR treatments, including, crucially, to allow the commencement of Phase Two of the roll-out of the Model of Care.
This investment will facilitate the first steps to be taken towards the provision of a complete publicly-provided fertility service, which is the ultimate objective of Government. In particular, it will allow the development of the first National Advanced AHR Centre, delivering IVF and ICSI through a wholly public clinic and scheduled to open in 2024. Subject to the provision of additional funding in future, it is envisaged that additional National Advanced AHR Centres will be developed and become operational on a phased basis elsewhere in the country.
As an interim measure, I instructed that some funding be made available to support access to advanced AHR treatment via private providers from September 2023. As well as IVF and ICSI, this allocation is also being used to provide, initially through private clinics, IUI (intrauterine insemination), which can, for certain cohorts of patients, be a potentially effective, yet less complex and less intrusive treatment.
In July 2023, I updated the Government in relation to the commencement of publicly-funded, privately-provided IVF, ICSI and IUI. I provided details in relation to the new initiative, including the set of criteria prospective patients must meet to access fully-funded AHR services. The criteria were agreed following consultation with experts in the field of reproductive medicine and include limits in respect of the age of the intending birth mother, body mass index (BMI) and the number of children a couple already have. They are very much in keeping with those applied in other jurisdictions, even though in most European countries, for instance, such treatments are only partially funded and require often significant out-of-pocket payments by patients. More details on public fertility services, including information on the new publicly-funded AHR treatment initiative, are available at: www2.hse.ie/conditions/fertility-problems-treatments/fertility-treatment/
Given the complex regulatory and clinical issues to be addressed in respect of certain categories of AHR treatment, including donor-assisted treatment, public funding of a number of services will of necessity be commenced on a structured and phased basis. While some regulation regarding the provision of AHR services involving donor gametes is currently provided for, there are a number of important clinically relevant issues which are being addressed in the Health (Assisted Human Reproduction) Bill 2022 currently before the Oireachtas.
Advanced maternal age, unfortunately, is associated with a decrease in the number of eggs retrieved and an increase in the miscarriage rate. Most public fertility programmes in other jurisdictions apply an age restriction on the provision of IVF/ICSI treatment to women, commonly set at 39 or 40 years of age. It is proposed that in Ireland the maximum age for intending birth mother means that she must be referred from her GP to a Regional Fertility Hub prior to her 41st birthday. Therefore, she may be older by the time she actually avails of publicly-funded IVF treatment.
It has been decided that one cycle of IVF or ICSI should be publicly funded for eligible patients and be undertaken in an authorised private clinic of their choice. This is to ensure that as many eligible patients as possible can avail of publicly-funded AHR treatment during the initial phase. It should be noted that one cycle shall consist of an episode of ovarian stimulation, egg retrieval, fertilisation and transfer of one fresh embryo (if appropriate, with single embryo transfer as standard). All other suitable embryos created should be frozen and can then be subsequently transferred through a publicly-funded procedure if the access criteria are still being fulfilled. Therefore, a publicly-funded IVF/ICSI cycle may consist of a number of separate embryo transfers.
The access criteria and the scheme will be kept under review as new evidence becomes available, an understanding of how the service provision is working in practice emerges, and when the AHR legislation is finalised.
My Department and the Government are focused, through the full implementation of the Model of Care for Fertility, on ensuring that patients receive care at the appropriate level of clinical intervention and then those requiring, and eligible for, advanced AHR treatment such as IVF will be able to access same through the public health system. The underlying aim of the policy to provide a model of funding for AHR, within the broader new AHR regulatory framework, is to improve accessibility to AHR treatments, while at the same time embedding safe and appropriate clinical practice and ensuring the cost-effective use of public resources.
