3799. Deputy Fionntán Ó Súilleabháin asked the Minister for Health if she will consider extending the current state funded IVF scheme to allow who had previous IVF Treatment to be admitted to the scheme; and if she will make a statement on the matter. [57810/26]

4063. Deputy John Brady asked the Minister for Health for an update on the implementation of the expansion of free fertility care; if she is aware of unequal access to public IVF funding; if she can address the issue in Wicklow, referencing the number of applicants and length of waiting list; and if she will make a statement on the matter. [59006/26]

I propose to take Questions Nos. 3799 and 4063 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 (NWHIP) to ensure that fertility-related issues are addressed through the public health system at the lowest level of clinical intervention necessary.

The Model of Care comprises three stages of care. These begin in primary care (GPs), progress to secondary care through the six HSE-run Regional Fertility Hubs located across the country, and, where clinically indicated, advance to tertiary care.

Patients, following consultations in primary care, are referred by their GP to their designated Regional Fertility Hub for assessment and investigation. Before making a referral, the GP will provide appropriate advice and information on lifestyle factors, carry out relevant tests and examinations, and undertake any necessary initial interventions. The GP must also be satisfied that the couple has been trying to conceive naturally for an adequate period of time. The specific access criteria to avail of services provided at a Hub are less stringent than those required to be met in order to qualify for free assisted human reproduction (AHR) treatment.

Upon receipt of a GP referral, the Regional Fertility Hub assesses the referral to determine whether it can be accepted or whether further information is required, or if the patient does not meet the access criteria. Once a referral is accepted, patients are issued with an information booklet and questionnaire for completion. Upon return of the completed questionnaire, the fertility nurse coordinates the baseline investigations required for both partners in advance of consultation with a Reproductive Medicine Consultant.

At Hub level, a range of diagnostic tests and treatments are available, including blood tests, semen analysis, assessment of tubal patency, hysteroscopy, laparoscopy, fertility-related surgical procedures, ovulation induction, and follicle tracking.

The NWIHP, as well as my officials and myself, are fully cognisant of the time-sensitive nature of fertility care and the significant emotional stress associated with fertility treatment. Accordingly, pathways are designed to ensure that patients engage with Regional Fertility Hubs from an early stage and that care progresses efficiently from fertility nurse assessment to consultant review. By the time patients attend their consultant appointment, initial investigations and blood tests will have been completed, allowing a plan of care to be developed immediately. This may include medical management, surgical intervention, or referral for AHR treatment – including IVF (in-vitro fertilisation), ICSI (intra-cytoplasmic sperm injection) and IUI (intrauterine insemination) – based on clinical indication.

Referrals for publicly-funded, privately-provided AHR treatment commenced in September 2023, subject to patients meeting the criteria agreed by my Department and the HSE. It should be noted that there are currently no waiting lists for AHR treatment once patients have been referred for same.

The access criteria were developed by a multi-disciplinary group, with reproductive medicine expertise and followed consultation with experts in the field along with a review of the international evidence. These criteria are in keeping with those applied in other jurisdictions. There is a criterion regarding the number of previous IVF cycles / AHR procedures undertaken which means patients can still be potentially eligible for publicly-funded AHR treatment if, for example, they have had one privately-funded IVF cycle and no frozen embryos from that cycle remain.

An important criterion for accessing state-funded AHR treatment was broadened last year. Couples with one existing child in their relationship, and who meet all the other current access criteria, can now access publicly-funded AHR treatment. including one full cycle of IVF or ICSI, if they are referred for same by a Reproductive Specialist Consultant within one of the six HSE-run Regional Fertility Hubs. Previously, couples with one child in their current relationship were not eligible to access publicly-funded AHR treatment.

The access criteria and the terms of the AHR treatment initiative are being kept under ongoing review. Further potential changes to the access criteria or expansion of the initiative require continued extensive consultation between Department officials, colleagues in the HSE, and also with relevant specialists in the field of reproductive medicine. This will include consideration of additional funding requirements which may ensue from any proposed expansion of the initiative.

The type of patient data sought by the Deputy is not collected on a county-by-county basis. Nationally, more than 4,800 couples to date have been referred 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 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. In this regard, it should be noted that IUI represents a significantly less invasive and less complex form of treatment which can prove to be very effective for certain cohorts of patients.

It should be noted that supports previously available to patients who access IVF, or other AHR treatment, privately, whereby tax relief on the costs involved can be claimed under the tax relief for medical expenses scheme, continues to be provided.

In addition, a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Arrangements administered by the HSE. Medicines covered by the High Tech Arrangements must be prescribed by a consultant/specialist and authorised for supply to the client’s nominated community pharmacy by the High Tech Hub managed by the Primary Care Reimbursement Service. The cost of the medicines is then covered, as appropriate, under the client’s eligibility, i.e., Medical Card or Drugs Payment Scheme. The annual cost to the State of the financial support for these medicines is far from insignificant.

I want to assure you 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 most effective deployment of finite public resources.