Emer Currie (Dublin West, Fine Gael)
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1126. To ask the Minister for Health to outline the steps her Department has taken to expand IVF support to those experiencing secondary infertility; the supports currently in place for secondary infertility; and if she will make a statement on the matter. [24012/25]

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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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, which provides a range of treatments and interventions. These Hubs have been fully operational for a number of years now.

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 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 publicly funded, privately provided AHR treatment commenced in September 2023. Criteria prospective patients should meet in order to access fully funded AHR services were agreed by the Department and the HSE and subsequently approved by 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 (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 publicly-funded AHR treatment initiative, are available from the HSE at www2.hse.ie/conditions/fertility-problems-treatments/fertility-treatment/.

Over 2,450 couples have been referred to date by a Reproductive Specialist Consultant for AHR treatment following extensive investigations and/or secondary level treatment within the Regional Fertility Hubs. Furthermore, the Hubs have successfully and directly managed numerous patients presenting with fertility-related issues who have been referred by their GP. Not all couples experiencing fertility challenges actually require such advanced and invasive interventions as IVF.

The access criteria for public patients to avail of services provided at a Regional Fertility Hub are less stringent than those required to be met in order to avail of free AHR treatment. For instance, a couple with existing children within their current relationship may be able to avail of such secondary care level if they meet other criteria. Therefore, it is advised that if a couple is experiencing fertility challenges, and they meet the access criteria for care and management at Regional Fertility Hub level, then they should seek a referral from their GP. Each Regional Fertility Hub is positioned to provide a suite of investigations and tests free of charge and can commence working with the couple to identify next appropriate clinical steps, many of which may be available within the Hub itself or by means of a referral to another public service, for example, endocrinology or urology.

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, colleagues in the HSE and also with relevant specialists in the field of reproductive medicine. This process is under way.

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.