Stephen Donnelly (Wicklow, Fianna Fail)
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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) 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 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.

Phase Two of the roll-out of the Model of Care relates to the introduction of assisted human reproduction (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. This publicly funded (privately provided) service commenced in September 2023. As well as IVF and ICSI, this allocation is 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 in the week beginning September 25^th2023 after details of how the new initiative would be initially rolled out – including regarding the set of criteria prospective patients should meet to access fully-funded AHR services and the specific services to be funded were agreed by the Department and NWIHP and agreed by Cabinet in July 2023. The criteria were agreed following consultation with experts in the field of reproductive medicine and include criteria 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 including information on the new publicly-funded AHR treatment initiative, are available from the HSE at: .

As expected, there has been a significant increase in the numbers of patients being referred from their GPs to one of the six Regional Fertility Hubs since the new AHR treatment initiative was announced. Many of these patients will be managed in these Hubs without the need to undergo invasive IVF or ICSI treatment. In total, as at the end of Friday, January 12^th2024, a total of 227 referrals for AHR treatment have been made by the Hubs, and this number should continue to increase over the coming weeks and months as the new service provision beds down further.

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 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.