Violet-Anne Wynne
Ceist:1311. Deputy Violet-Anne Wynne asked the Minister for Health if he will review the upper age limit for a scheme (details supplied); and if he will make a statement on the matter. [48556/23]
Amharc ar fhreagraTuesday, 7 November 2023
Ceisteanna (1311, 1336, 1337)
Michael Ring
Ceist:1336. Deputy Michael Ring asked the Minister for Health if any allowances can be made for a person who has just missed the age cut-off point for publicly funded IVF; and if he will make a statement on the matter. [48610/23]
Amharc ar fhreagraMichael Ring
Ceist:1337. Deputy Michael Ring asked the Minister for Health if any allowances can be made for a person who has just missed the age cut-off point for publicly funded IVF in view of their medical circumstances (details supplied); and if he will make a statement on the matter. [48612/23]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 1311, 1336 and 1337 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. 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 has been 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 September 25th 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/
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. Nevertheless, all aspects of the newly-introduced scheme here will be kept under ongoing review as new evidence becomes available, an understanding of how the service provision is working in practice emerges and the AHR legislation comes into operation.
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.