Written answers

Wednesday, 22 January 2025

Photo of Matt CarthyMatt Carthy (Cavan-Monaghan, Sinn Fein)
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1384. To ask the Minister for Health for an update on the efforts to ensure that a child (details supplied) will receive the treatment they need; his proposals for other children with the same condition; and if he will make a statement on the matter. [46586/24]

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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As this is an operational matter relating to an individual case, I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy, as soon as possible.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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1385. To ask the Minister for Health if he will address the policies underpinning a matter raised in correspondence (details supplied); and if he will make a statement on the matter. [46589/24]

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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As per European legislation – and as transposed into Irish law as the European Communities (Quality and Safety of Human Tissues and Cells) Regulations 2006 – patients undergoing advanced fertility treatment such as IVF (in-vitro fertilisation) and ICSI (intra-cytoplasmic sperm injection) are required to undergo viral screening. This mandatory requirement screen bloods for the presence of HIV 1 & 2, Hepatitis B core antibody and surface antigen, Hepatitis C and syphilis. Section 2.3 of Schedule 3 of the 2006 Regulations states: “Where HIV 1 and 2, hepatitis B or hepatitis C test results are positive or unavailable, or where the donor is known to be a source of infection risk, a system of separate storage must be devised”. The Health Products Regulatory Authority (HPRA) holds responsibility for ensuring compliance with the 2006 Regulations; however, neither I, as Minister for Health, nor HPRA has the power to direct private assisted human reproduction (AHR) providers operating in this country to put in place the necessary facilities and systems to cater for prospective patients who have, for example, tested positive for HIV.

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 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.

The Regional Fertility Hubs offer patients who are experiencing challenges with their fertility both medical and surgical interventions, including: relevant blood tests, semen analysis, assessment of tubal patency, hysteroscopy, laparoscopy, fertility-related surgeries, ovulation induction and follicle tracking, 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.

As part of the final phase of the roll-out of the Model of Care for Fertility, referrals for AHR treatment by one of eight HSE-approved private providers, as chosen by the eligible patient concerned, commenced in September 2023. As well as IVF and ICSI, the funding allocated is also being used to provide, again 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.

It is important to ensure that patients are clinically determined by a consultant in a Regional Fertility Hub for IVF, ICSI or IUI before being referred for such treatment, having undertaken at the Hub, as appropriate, extensive consultation, assessment, and the types of procedures and interventions outlined above which are available at the secondary care level. In this regard, numerous patients have had their fertility-related issues resolved through the six Regional Fertility Hubs without having to undergo what can be highly invasive and gruelling AHR treatment such as IVF or ICSI.

In relation to the management and care of public patients who are HIV+, within the pool of the eight private AHR providers, the HSE has informed my officials that three are currently positioned to manage women with HIV who require IUI and whose male partner is negative. If alternative advanced treatment such as IVF or ICSI is required, in which the gametes (egg or sperm) of the patients are handled and managed as part of the care, no AHR provider in Ireland is currently positioned to offer care if either the female or male is HIV+.

Any couple identified at Regional Fertility Hub level, in which one or both partners are living with HIV, who have been clinically determined as requiring AHR treatment, meet the national access criteria, and cannot be managed and cared for within the current network of HSE-approved providers will be able to receive their treatment under the HSE’s Treatment Abroad Scheme (TAS). The relevant Regional Fertility Hub, NWIHP and the TAS will work closely together in relation to meeting the needs of individual couples in this regard.

Funding has been made available to develop the first public National AHR Centre which is scheduled to open in Cork this year. NWIHP is currently working with the Cork AHR team with a view to developing in the first instance an IUI service that can manage patients living with HIV. This service is being developed in close collaboration with the infectious disease services and will involve the development of a joint package of care, such that a couple requiring IUI treatment can receive it in time in the Cork Centre and will no longer have to travel abroad. With the planned development and delivery of further advanced treatments in Cork, such as IVF, again NWIHP is working with the Cork team to assess the ability and feasibility of providing those services to patients living with HIV – thereby removing the need for any couples to travel abroad for treatment.

Whilst this work is ongoing, with a view to ultimately positioning the public service to meet the needs of individuals living with HIV in relation to the provision of advanced fertility treatment, it is important to note that no patient is being denied treatment. AHR treatment, if indicated, can and will be enabled by the HSE and its Treatment Abroad Scheme.

In conclusion, the Department of Health and the Government have been 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.

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