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., the six Regional Fertility Hubs located across the country) and then, where necessary, AHR (assisted human reproduction) treatment (e.g., 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 six Regional Fertility Hubs within maternity networks covering the entire country, 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.
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.
Funding of €30m was made available in 2024 to support access to AHR treatment via HSE-approved private providers. 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 form of treatment.
Referrals for AHR treatment by private providers commenced in the week beginning September 25th 2023. Criteria prospective patients should meet in order to access fully-funded AHR services and the services to be initially funded were agreed by the Department and the HSE and subsequently approved by Government in July 2023. 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 publicly-funded AHR treatment initiative, are available from the HSE at: www2.hse.ie/conditions/fertility-problems-treatments/fertility-treatment/
It was proposed that, in order to be eligible for public funding, at least one intending parent must have no living child, in respect of which he or she is officially recognised by the State as being the parent. This would include both biological and adopted children, for instance, but not necessarily children born through surrogacy or a donor-assisted human reproduction procedure.
The rationale for limiting treatment at the initial stage to couples/individuals who have no existing children is based largely on the concept on prioritising the utilisation of finite resources on those who have hitherto been unable to start a family. This type of criterion is used in a number of jurisdictions.
It was pragmatic to allow the service to operate for a period of time before considering any changes to existing criteria. Now that the service has been in operation for almost one year, it will afford us the opportunity to take stock and review the initiative, in the context of determining if there are to be changes to the access criteria, the specific services being provided, or any other aspect of the current system.
I want to reassure the Deputy that 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 is 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.
