Nicole Ryan (Sinn Fein)
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I am here to speak of a heartbreaking and unjust case. It is the case of Melanie, a woman whose husband died from cancer. Despite doing everything right, she has been locked out of accessing IVF through the public system.Before her husband, Dylan, died or even began chemotherapy, they froze his samples, following medical advice, to preserve a chance of starting a family. Dylan gave full written consent that Melanie could use those samples in the event of his death. Tragically, Dylan passed away earlier this year and now Melanie, who continues to pay monthly to store the samples, is being told she cannot use them through the public system. There is no protocol, policy or pathway for someone in her position. Melanie has gone through so much, losing her beautiful husband to cancer so young, at just 32 years old, and in the midst of her grief the State has forced her to open herself up to scrutiny and to relive her trauma just to be heard, to fight for a small piece of happiness and to fulfil her husband's dying wish that she might have their child, even if he could not be here to see it. Now she is being told she does not fit the system.

Her story raises a wider issue, which is who gets access to fertility treatment in Ireland and who does not. As someone who is in a relationship, I have access to the public system. It is still not fully or fairly implemented and it is under-resourced and overly restrictive, but the point is that, because my partner is alive, I have access to it. Melanie is not asking for the world; she is asking for one chance, a chance that I and other Members have. The public model is built on an outdated definition of family: a heterosexual couple coming together and living together. If, however, you are single, are in a same-sex relationship or, like Melanie, are a widow who has legally consented to samples, you are locked out. Ten years ago we celebrated the marriage equality referendum result, a proud day that changed so many people's lives, but the reality is you can now marry who you love but our fertility system tells us not to expect to start a family with them. The message is that love is equal but family is not.

What kind of health system denies someone the chance because their partner has died, even where their partner gave clear consent? What does the Minister of State say to Melanie as she witnesses this debate, as she listens not just as a grieving wife but as someone who is holding on to a last piece of the future she planned with the man she loved? This is not just about one woman; it is about whether our healthcare system reflects the real Ireland we live in today and the families we actually have, not just the ones the system has decided to serve. We need clear, compassionate protocols for reproduction, we need fertility policies that include all families and we need to stop forcing people in pain to navigate policy gaps and silence when what they really need is support. No one should have to go through what Melanie is going through, and certainly not alone.

I look forward to the Minister of State's reply and to hearing what she has to say about this.

Marian Harkin (Sligo-Leitrim, Independent)
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I thank the Senator for raising this very sensitive matter and for giving me, on behalf of the Minister, Deputy Carroll MacNeill, the opportunity to inform the House of the up-to-date position on the provision of publicly funded fertility services. The Senator and I will both appreciate the fact the Minister cannot comment on individual cases.

As part of the final phase of the roll-out of the model of care for fertility, referrals for publicly funded, privately provided IVF or other assisted human reproduction, AHR, treatment commenced in September 2023. The criteria that prospective patients should meet to access fully funded AHR services were agreed by the Department and the HSE and subsequently approved by the Government 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 and the number of children a couple already have. These 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.Decisions in respect of any proposed changes to the access criteria and-or the range of services provided through the publicly funded AHR treatment initiative require further extensive consultation between Department of Health officials and colleagues in the HSE and also with relevant specialists in the field of reproductive medicine. This process is under way.

Posthumous assisted human reproduction, PAHR, is defined in the Health (Assisted Human Reproduction) Act 2024 as AHR treatment involving the use of the gametes of a person, or of an embryo created by the use of such gametes, subsequent to the death of such person. The Health (Assisted Human Reproduction) Act 2024 includes provisions which will introduce regulation of PAHR but this legislation has not been commenced to date. A key condition in the legislation for PAHR to be permitted is that the relevant AHR treatment should not begin prior to 12 months having passed from the death of the relevant deceased intending parent. This is to allow for an appropriate period of reflection and mourning for the surviving partner and space for her to be certain that she wishes to proceed with PAHR in the new circumstances of her life. The Department of Health understands that, in the few countries which specifically provide for PAHR, there is such a required post-death period. There is also a requirement in the 2024 Act that the deceased person and the surviving partner would have received appropriate counselling and advice on issues in respect of succession rights, for instance, before providing their fully informed consent to PAHR, parentage of an as-yet-unborn child and the implications of same. The provision of treatment related to PAHR is not part of the services currently funded through the publicly funded AHR treatment initiative. I will finish following the Senator's response.

Nicole Ryan (Sinn Fein)
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It is good to hear that consultations are ongoing. The IVF system currently, even the public one, is not up to where it needs to be. Equally, Melanie is under no illusion that she has to wait 12 months. She knows all of this stuff. The problem is that the consultation has not started. There is no legislation around this. As someone who has a low egg count, she does not have the time to be waiting until the Government decides to start this process. Women's reproductive health, and all reproductive health, should be a priority for the Government. I am really asking to for a timeline as to when this will be proposed. We cannot just leave people waiting in limbo. It is ridiculous to have people sitting there, praying and hoping that legislation will change. She has engaged with consultants and hospitals. They have all said they cannot do anything until legislation changes. They are pushing for it equally.

Marian Harkin (Sligo-Leitrim, Independent)
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I thank the Senator. As I said, there are potentially highly sensitive and complex factors which arise here and these would need to be fully teased out, resolved and a firm decision agreed upon before it is decided whether, notwithstanding what is permitted in the relevant legislation, the State should fund this very distinct form of AHR treatment. However, I want to reassure the Senator that the Minister, Deputy Carroll MacNeill, is 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 Minister, Deputy Carroll MacNeill, is eager to see how we can most effectively grow the scheme further, in line with the programme for Government commitment, whether through broadening certain criteria or increasing the range of services available. The Minister hopes to be in a position to announce a clear plan of action in this regard in the coming weeks.