Seán Sherlock (Cork East, Labour)
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128. To ask the Minister for Health if the free fertility treatment as recently announced can be considered on a case-by-case basis, rather than as one matrix; his plans to do so; if the case of persons (details supplied) will be examined; and if he will make a statement on the matter. [45319/24]

Paul Kehoe (Wexford, Fine Gael)
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140. To ask the Minister for Health if an exemption for women with polycystic ovary syndrome could be introduced in relation to the BMI requirements for publicly funded IVF; and if he will make a statement on the matter. [45415/24]

Stephen Donnelly (Wicklow, Fianna Fail)
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I propose to take Questions Nos. 128 and 140 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.

Appropriate funding has been made available 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 September 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: .

The access criteria were developed by a multi-disciplinary group, with reproductive medicine expertise and followed consultation with experts in the field and a review of the international evidence. The clinical parameters of the access criteria include an assessment of such areas as age, body mass index (BMI) and other health and well-being elements.

Specifically in relation to the clinical parameter of BMI, extremes of BMI are associated with decreased natural fecundity and increased rates of infertility.

When availing of AHR treatment, women with high BMI may demonstrate lower pregnancy rates, lower live birth rates, and higher miscarriage rates following IVF, ICSI, or frozen embryo thaw/transfer cycles. It has been shown that the probability of pregnancy is reduced by 5% per unit of BMI exceeding 29 kg/m2. This association between higher BMI and lower fertility rates has been shown in several studies.

Meanwhile, underweight women who conceive using AHR treatments are at increased risk of miscarriage, preterm birth, and low birth weight babies. The extremes of maternal BMI have been shown to decrease success rates of fertility interventions and increase maternal–foetal morbidity. It is for these reasons that defined parameters (upper and lower) regarding the BMI of an intending birth mother was established for the purposes of publicly-funded AHR services.

The approach adopted by the Department of Health in relation to defining clear parameters regarding specific clinical criteria for AHR is in line with many European and international counterparts, allowing for necessary accountability for the cost-effectiveness use of public funds, and the safety of patients and any consequent pregnancy that may result.

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.