Marie Sherlock (Dublin Central, Labour)
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770. To ask the Minister for Health when the Budget 2025 announcement relating to the expansion of the publicly-funded IVF scheme will take effect; and if she will make a statement on the matter. [27588/25]

Marie Sherlock (Dublin Central, Labour)
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771. To ask the Minister for Health the status in progressing to phase 2 of the model of care relating to assisted human reproduction treatment; and if she will make a statement on the matter. [27589/25]

Marie Sherlock (Dublin Central, Labour)
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772. To ask the Minister for Health if she intends to review the criteria for eligibility such as BMI, to publicly funded assisted human reproduction services. [27590/25]

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I propose to take Questions Nos. 770, 771 and 772 together.

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 elements, starting in primary care (i.e., GPs) and extending into secondary care (i.e., six Regional Fertility Hubs located across the country) and, 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. This means that a significant proportion of individuals presenting with fertility-related issues are managed 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 people, 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 information is available on the HSE website in respect of the publicly-funded AHR treatment initiative at: www2.hse.ie/pregnancy-birth/trying-for-a-baby/your-fertility/getting-ivf-icsi-iui-hse/, or on public fertility services more generally at: www2.hse.ie/conditions/fertility-problems-treatments/fertility-treatment/.

Over 2,300 couples have been referred to date by a Reproductive Specialist Consultant for AHR treatment following extensive investigations and/or secondary level treatment within the HSE-run Regional Fertility Hubs. Furthermore, the Hubs have successfully and directly managed thousands more 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.

Regarding the particular criterion related to BMI, the clinical advice is that women presenting with high BMIs are at a high risk of reproductive health complications, as are their babies. The risk of sub-fecundity and infertility, low conception rates, miscarriage rates, and pregnancy complications are increased in women with raised BMI, in both natural and assisted conceptions. Furthermore, reproductive outcomes for all fertility treatments are poor in this cohort. Obesity may impair reproductive functions by affecting both the ovaries and endometrium. Meanwhile, underweight women who conceive using AHR treatment are at increased risk of miscarriage, pre-term birth and low birth-weight babies. The extremes of maternal BMI have been shown to decrease success rates of fertility interventions and increase maternal-fetal morbidity. It is because of these safety concerns and poor outcome facts that it is recommended, in line with the UK, the BMI parameters for intending birth mothers are a minimum of 18.5 kg/m2 and a maximum of 30.0 kg/m2.

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 example, the maximum BMI for a woman to access services at a Hub is 35.0 kg/m2, instead of 30.0 kg/m2. Further details are available through the links above.

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.

Proposed changes to the access criteria and the publicly-funded AHR treatment initiative more broadly are being considered. At the moment, couples with no existing children in their current relationship are ineligible to avail of AHR treatment. I hope to be in a position in the coming weeks to make an announcement in respect of this specific criterion in order to allow for those with one child already but who are having difficulties in having a second child – what is known informally as “secondary infertility” – to access publicly-funded AHR treatment, as long as, of course, they meet all the other existing criteria. However, it is highly unlikely that changes will be made to clinically-based criteria such as those in relation to BMI limits.

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.

Finally, there are commitments in the Programme for Government to both “expand eligibility to State-funded IVF” and establish the first public AHR treatment centre. In relation to the latter, Ireland’s first public AHR centre is scheduled to open in Cork later this year. It is anticipated to commence service provision in late 2025 and expected to be fully operational in 2026.