Jennifer Murnane O'Connor (Fianna Fail)
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I thank the Minister of State for coming in. In October last year, the Government approved the drafting of a Bill on assisted human reproduction and associated areas of research. A commitment was given that to support the commencement of the legislation, officials in the Department would work during 2018 with the HSE to develop a model of care for infertility to ensure the provision of safe, effective and accessible services through the public health system as part of the full range of services available in obstetrics and gynaecology. Part of this work was to include identifying policy options for a potential public funding model for assisted human reproduction treatment. Professor Simon Fishel, former chair in human reproduction at the University of Nottingham and founder of CARE Fertility in Britain, has predicted that increasing numbers of young women will freeze their eggs or ovarian tissues to have babies later in life. Fertility treatment is not available to public patients in Ireland although the tax relief for medical expenses scheme can be availed of. An attempt at in vitrofertilisation, IVF, costs up to €5,000. There is not usually just one attempt, which means poor people cannot avail of it.

Fertility preservation services for cancer patients whose treatment is likely to impact on their future fertility are provided by the Rotunda IVF clinic based on the grounds of the Rotunda Hospital. Funding for fertility preservation services for those with a diagnosis of cancer is €259,000. This has been in place since 2003 without increase despite a growing demand for the service. The funding comes to the clinic via the hospital. It sees 160 to 180 men for sperm freezing and 60 women for egg or embryo freezing. While the number of men has stayed roughly the same, there has been a more than 50% increase in the demand for egg or embryo freezing. It froze gametes for 35 women in 2015 and for over 55 women in 2017.

In 2015, the clinic engaged with the HSE and the national cancer control programme, NCCP, to look at additional funding and to perhaps look at improving the service with a view to considering the introduction of ovarian tissue freezing. In January 2017, a pre-tender interest form was submitted by the clinic to potential stakeholders who were interested in offering the service. In September 2017, they were advised that work was being done on a specification document and that engagement with all parties would commence within weeks. It is now more than one year later. If there was a real possibility for State funding for fertility treatment, which is important in order that there is an equal chance for all families to try fertility solutions that suit their circumstances despite the odds, the provision of fertility preservation needs to be seen as part of these services. They are not the same and due consideration should be given to fertility treatment and preservation. The funding for the Rotunda IVF clinic covers fertility preservation for men and woman with a recent diagnosis of cancer. It does not cover fertility treatment itself. As such, it needs to be managed separately and regulation needs to be structured into any funding models introduced. In the past two weeks, the clinic has had requests from a 15 year old and a 16 year old with recent diagnoses of cancer who are looking to the future. The only real option for these girls is ovarian tissue freezing and unfortunately this is not an option in Ireland at this time. One of the first things that will be talked about to a female up to the age of about 45 in the event of diagnosis of cancer will be future fertility particularly for those who do not already have children. More and more women and men are surviving cancer and having their own biological children should not be denied to them if the possibility of preservation is available to them. The HSE has continued to fund this programme and it is very important for those who have needed to avail of the service. We must not ignore the continuing and growing needs of our society and neither should we force families to put off fertility treatment because they do not have the money.

Catherine Noone (Fine Gael)
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The Senator is out of time.

Jennifer Murnane O'Connor (Fianna Fail)
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I apologise.

Catherine Noone (Fine Gael)
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It is an issue I am very interested in.

Jennifer Murnane O'Connor (Fianna Fail)
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I am nearly finished. Children born through fertility treatment or preservation are children who are wanted, loved and longed for before they are born and will grow up to contribute to society. What are the Government's plans to assist families seeking fertility treatment or preservation? Is there some timescale for those plans? I thank the Minister of State. This is a very serious issue and I look forward to his answer.

Jim Daly (Cork South West, Fine Gael)
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I thank the Senator. I am taking this issue on behalf of the Minister, Deputy Harris. The Government approved the drafting of a Bill on assisted human reproduction and associated areas of research in October last year. The introduction of legislation on assisted human reproduction and associated research is a priority for the Minister for Health and the process of drafting this Bill will be completed in conjunction with the Office of the Attorney General.The general scheme was published on the Department's website, and the Oireachtas Joint Committee on Health is conducting a review of the general scheme of the Assisted Human Reproduction Bill 2017 as part of the pre-legislative scrutiny process, which began in January of this year. However, it is not possible at this time to give a definitive timeline for the completion of the draft Bill and its subsequent passage through the Houses of the Oireachtas.

While the majority of assisted human reproduction, AHR, treatments and services available in Ireland are provided through private AHR clinics, there is a limited specialist AHR service available through the HSE, which provides funding for fertility preservation for cancer patients whose treatment is likely to impact on their fertility. Officials in the Department are working with representatives from the HSE to ensure that there is a coherent approach to the development of the AHR legislation, which is consistent with the existing publicly available cryopreservation service.

In order to support the commencement of the legislation, officials in the Department are working with the HSE to develop a model of care for infertility to ensure the provision of safe, effective and accessible services through the public health system as part of the full range of services available in obstetrics and gynaecology. Part of this work includes identifying policy options for a public funding model for AHR treatment. Once the Minister has had the opportunity to consider these policy options it is his intention to bring a memorandum to Government on a model of care for infertility, including public finding for AHR treatment, for the Government's consideration. No specific decision has been made at this time on the parameters of any potential public funding model. It is important to note that any funding model that may ultimately be introduced would need to operate within the broader regulatory framework set out in the AHR Bill and the model of care for infertility.

Currently, patients who access IVF treatment privately may claim tax relief on the costs involved under the tax relief for medical expenses scheme. In addition, a defined list of fertility medicines needed for fertility treatment is covered under the high-tech scheme administered by the Health Service Executive. Medicines covered by the high-tech scheme must be prescribed by a consultant-specialist and approved by the HSE high-tech liaison officers. The cost of the medicines is then covered, as appropriate, under the medical card or drugs payment scheme. Therefore, while IVF treatment is not currently provided by the Irish public health service, there is some support available for patients who access such treatment privately.

Jennifer Murnane O'Connor (Fianna Fail)
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It is disappointing that the only annual funding for the scheme, which has been in place since 2003, is €259,000. Many cancer patients now live longer than they did in the past and fertility and preservation is a serious issue for them. I want the Minister of State to look into this because it is an area we need to address. I hope he will return soon with good information. It all boils down to funding. We need to get the funding into this area.

Jim Daly (Cork South West, Fine Gael)
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I thank Senator Murnane O'Connor for raising the issue and thereby providing the opportunity to discuss the matter in the House today. The Minister and the officials are acutely aware of how necessary the AHR Bill is and how eagerly some form of additional support for accessing AHR treatments is anticipated. Officials in the Department of Health will continue to work with the Office of the Attorney General and the HSE as required to ensure that the drafting of the AHR legislation, the preparation for the relevant service arrangements regarding the model of care for infertility and the development of specific eligibility arrangements can all proceed in line with each other to allow for the timely commencement of the legislation.