OVER 1,000 COUPLES have been referred for free fertility treatments, such as in-vitro fertilisation (IVF), since the government launched the country’s first ever publicly funded scheme last September.
Health Minister Stephen Donnelly said the state-funded scheme passed two important milestones this week with over 1,000 couples being referred to clinics for free IVF, intrauterine insemination (IUI) and intracytoplasmic sperm injection (ICSI).
Noting another important marker, the minister said the first baby conceived through the programme has also been born.
“We’ve just had our first live birth from IVF. It’s fantastic, new life,” Donnelly said.
Speaking to The Journal, the health minister said he wants to expand the criteria to allow more people to avail of free IVF supports which could include the widening of the age brackets, a wider definition of the length of a relationship or increasing the number of cycles couples can avail of for free.
Since last September, one publicly funded IVF cycle has been available to couples that meet certain criteria, which includes limits on maximum age, body mass index (BMI), and the number of existing children a couple have.
While the announcement of the scheme was welcomed last year, there were criticisms about the narrow scope of the criteria, which resulted in cohort of people, such as single people and those using donor material unable to avail of the free supports.
Donnelly told The Journal that the current criteria is “conservative” and he plans to widen it so as to include more people.
At the launch last year, the minister predicted that around 3,000 couples would avail of the scheme, though he acknowledged that as it was the first free fertility treatment programme in the country, the demand was difficult to predict.
“We’re at a run rate now of about 1,500 [couples] annually,” said Donnelly, stating that he believes the numbers will rise as more people become aware of the government funded scheme.
“Will it go up to 3,000? Let’s wait and see,” he said, stating that his department has now been asked to carry out a review of the scheme over the last 12 months.
“I want to widen the criteria. The clinical advice that I got at the start, the team themselves said ‘this is conservative’.
We had a table of all the different eligibility criteria and where different countries are, and ours was conservative. Too conservative for my liking.
“But the clinical point made back to me was that we had never done this before, let’s start and get it right,” said the minister.
Donnelly said there is now room to expand the programme and the review due to be carried out “quickly” in September will determine where criteria changes would be most warranted.
He said he has asked the department to outline in the review how the criteria might be expanded and if the department can fund it, either from within the allocated budget and outside of it.
One area the government will expand the scheme to, regardless, is those using donor assisted material.
Currently a single person, same-sex couples, or hetrosexual couples who require donor eggs or sperm are not be eligible for the scheme.
With the passing of the Assisted Human Reproduction legislation through both Houses of the Oireachtas in June, action can now be taken by government to address this issue.
The minister acknowledged that when the state-funded IVF scheme was launched last year some people were “very understandably disappointed” as no donor assisted IVF was state-funded.
“I wanted to move on it straight away. I got a very clear clinical view back from the HSE that it’s not a regulated area,” he said.
However, the minister said with the passing of the AHR bill, and the setting up of a new authority that will oversee the regulations, an amending piece of legislation is to be introduced to expand the criteria for donor assisted IVF by the end of the year.
“I want to go further,” the minister stated, adding that his department will now gather feedback from the six regional fertility centres which have been in operation over the last year.
“I think we will listen very carefully to the frontline clinicians,” he added.
One area which was criticised last year was the age restrictions put in place.
Under the Irish scheme, the woman should be a maximum age of 40 years plus 364 days at the time of referral to the regional fertility hub.
For the man, the maximum age is 59 years plus 364 days at the time of referral.
By comparison, there are no legal age limits in place in Finland, Germany, and Norway, while other countries have higher age restrictions in place when it comes to accessing fertility treatment.
When asked if there could be changes to the age requirement, Donnelly said:
“I want eligibility to increase. I don’t want to prejudge. We have to be led by the science on this, and we have to be led by the doctors. So I want to let them do their work and come back, and if they recommend on age or number of living children, or length of relationship, or whatever it is, then we’ll look at that.”
“The other big one that people have asked for is a second round [of IVF]. We only fund one round of IVF, three rounds of IUI,” he said, stating that moving to a second round needs to be reviewed.
Donnelly said he needs to ascertain if rolling out another free round of IVF would jeopardise the ability to expand the eligibility criteria, for example.
“I think we need to look at all of that in the round,” he said.
The minister said it was a “radical move” to launch the scheme by striking a deal with the private clinics that were already operating the service, stating that he didn’t believe the government could ask people to wait while the state built its own capacity.
The first state-owned clinic in Cork will begin IUI in the first quarter of next year, before moving to IVF, he confirmed.
“The idea that we would have asked all of these couples to wait for five years so that we could do it publicly” would not have been acceptable to him, said Donnelly.
When asked about wait times for couples, the minister said the scheme has been running smoothly, but said there has been a “hiccup” at the Rotunda clinic with the waiting list, due to historical issues around the ownership and operation of the service from the hospital. It is understood that it relates to delays in the consultant referral to a private clinic, with some waiting months for the matter to be resolved.
“I’m not satisfied with it. It’s too long. I’ve raised it with the department, and we’ve discussed it the National Women and Infants programme and there is an identified capacity issue there that is being addressed. But the timelines are too long. I’m not satisfied with them. We can’t have people waiting. There were some concerns that people might age out [of the scheme]. They don’t age out. The age is from your GP referral,” he confirmed.
“For the woman, time matters, right? And if she is already 40 years of age, then she needs rapid access. There is an issue in the Rotunda. We know what the problem is and we’re sorting it out,” he said.
Speaking about reports that the government plans to roll out free access to HRT for all women, the minister said it is a “central” pillar for him.
“It’s something that all women may want access to… it’s core to women’s healthcare. We can’t have a situation where any woman in Ireland feels they can’t afford access to HRT… I think universal access to it is the way to go. I’d like us to fund universal access. The department are working through further detail on that,” he said.
He stated that while there isn’t a competition between HRT and IVF in terms of funding, he would like to be able to expand the eligibility criteria for IVF within the existing funding package as it would protect new development funding for other things, such as free HRT for everybody.
“I want the IVF criteria to be in line with Europe and we’re still conservative,” he concluded.
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