I propose to take Questions Nos. 1839, 1850 and 1851 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., 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. 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/
The Regional Fertility Hubs offer patients who are experiencing challenges with their fertility both medical and surgical interventions so as to assist achieve natural conception. However, if all available services at secondary level care are exhausted, reproductive specialist consultants can refer clinically-indicated patients who meet the eligibility criteria for specialist AHR services such as IVF. There have already been over 1,000 couples referred by their consultant for AHR treatment, while thousands of other patients have had their fertility-related issues resolved through the six Regional Fertility Hubs over the past number of years without having to undergo what can be highly invasive AHR treatment such as IVF or ICSI.
As the new scheme has bedded in, the system appears to be reaching a steady state with approximately 125 referrals for AHR treatment being made on a monthly basis. This equates to around 1,500 referrals over the course of a full year.
The total cost of the overall care provided to a particular couple can vary greatly due to numerous factors such as the cancellation of cycles, the use of frozen embryos as opposed to fresh embryos and the number of separate embryo transfers undertaken as part of any one publicly-funded cycle.
None of the fertility hubs manage a waiting list system for advanced treatment – once any couple is clinically determined as appropriate for advanced treatment and they meet the national access criteria, then further to them consenting to such treatment and consenting to a referral being made to their chosen private providers, a referral is made for them within a matter of working days, with private providers then providing an initial consultation to referred public patients within a six week period if not earlier.
There is no average time for a referral from a Regional Fertility Hub to a private provider, as each couple is unique and need to be managed by Hubs according to their individual circumstances. Some couples have very complex conditions that may require surgical intervention and follow-up, while others may have a previously-diagnosed fertility issue whereby secondary level intervention is fruitless and an immediate AHR referral is clinically indicated.
There was an anticipated higher level of referrals to the Hubs in the early months to the public fertility services as the new advanced care pathway became operational. This is starting to level off, and the HSE anticipates that this will enable a more stable and consistently timely access to services across the country.
The teams delivering this service are highly skilled and specialised. As such, it is advisable to concentrate staff to the six Hubs such that each staff member retains the specialist skills and knowledge through exposure to an optimal level of cases required to most effectively deliver fertility services.
The support previously available to patients who access IVF, or other AHR treatment, privately, whereby tax relief on the costs involved can be claimed under the tax relief for medical expenses scheme, continues to be provided.
In addition, it is important to note that a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Arrangements administered by the HSE. Medicines covered by the High Tech Arrangements must be prescribed by a consultant/specialist and authorised for supply to the client’s nominated community pharmacy by the High Tech Hub managed by the Primary Care Reimbursement Service. The cost of the medicines is then covered, as appropriate, under the client’s eligibility, i.e., Medical Card or Drugs Payment Scheme.
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.
