Dáil Éireann Debate, Tuesday - 23 January 2024
661. Deputy Alan Dillon asked the Minister for Health to provide information on why the public fertility treatment system does not provide for male fertility specialists, despite the fact that infertility affects both men and women equally; and if he will make a statement on the matter. [2994/24]
View answer662. Deputy Alan Dillon asked the Minister for Health if he will take the necessary steps to ensure that policy related to the public fertility treatment system in Ireland provides equal treatment and care for both men and women; and if he will make a statement on the matter. [2995/24]
View answer663. Deputy Alan Dillon asked the Minister for Health to detail what measures are being taken to acknowledge and address male fertility issues in order to improve the overall success rates of fertility treatments; and if he will make a statement on the matter. [2996/24]
View answerI propose to take Questions Nos. 661 to 663, inclusive, 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 (NWIHP) 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, in order 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. All six Regional Fertility Hubs are currently operational.
Phase Two of the roll-out of the Model of Care relates to the introduction of AHR treatment, including IVF, provided through the public health system at tertiary level. In particular, the first steps have been taken towards achieving the ultimate objective of Government, which is a wholly publicly-provided fertility service.
As an interim measure, funding was made available to support access to 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.
Referrals for AHR treatment by private providers commenced on 25 September 2023 after details of how the new initiative would be initially rolled out – including regarding the set of criteria which prospective patients should meet in order to access fully-funded AHR services and the specific services to be initially funded – were agreed by the Department and NWIHP and then brought to Cabinet in July 2023. 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 generally, including information on the new publicly-funded AHR treatment initiative, are available from the HSE at: www2.hse.ie/conditions/fertility-problems-treatments/fertility-treatment/
Following consultation with the HSE, I can confirm that fertility advice and information provided by the HSE is very much directed at both female and male patients and what each can do to mind their reproductive health and any procedures that either may require. Investigations and tests specifically regarding the fertility status of males presenting at Regional Fertility Hubs are provided with a view to devising the appropriate care plan for the couple in line with evidence-based practice. Where clinically indicated, a referral to a urologist can be made by a Hub fertility team for a male patient where such is deemed clinically required. The HSE is currently working with urology specialists with a view to further expanding the capacity of these public referral pathways in tandem with defining the evidence-based clinical criteria that would trigger such a referral.
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.
