1475. Deputy Shay Brennan asked the Minister for Health if persons whose disability directly affects their ability to meet the BMI threshold of 30 for publicly funded IVF may be assessed on an individual clinical basis; if she plans to provide reasonable accommodation within the scheme’s eligibility criteria; and if she will make a statement on the matter. [65928/26]

The Model of Care for Fertility was developed by the Department of Health in conjunction with the HSE’s National Women & Infants Health Programme 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.

Referrals for publicly-funded, privately-provided assisted human reproduction (AHR) treatment – including IVF (in-vitro fertilisation), ICSI (intra-cytoplasmic sperm injection) and IUI (intrauterine insemination) – commenced in September 2023, subject to patients meeting the criteria agreed by my Department and the HSE.

Specifically in relation to the clinical parameter of body mass index (BMI) for intending birth mothers – which are a minimum of 18.5 kg/m2 and a maximum of 30.0 kg/m2 – extremes of BMI are associated with decreased natural fecundity and increased rates of infertility. Possible aetiologies in both under- and over-weight women include oligo- or anovulation, changes in endometrial receptivity, and diminished oocyte quality or competence.

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. High BMI has also been associated with increased odds of IVF cycle cancellation and reduction in number of oocytes retrieved. 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–fetal 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 treatment 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.

It is important to note that the specific access criteria to avail of services provided at a Regional Fertility Hub are less stringent than those required to be met in order to qualify for 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. Furthermore, the Hubs have successfully and directly managed thousands of patients presenting with fertility-related issues who have been referred by their GP, without having to undergo such advanced and invasive interventions as IVF.

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. However, it is considered unlikely that changes will be made to clinically-based criteria such as those in relation to BMI limits as opposed to other access criteria which are based more on ‘social’ factors.

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.