IRELAND IS CURRENTLY a laggard on state-funded fertility treatment when compared to other European countries, but a new scheme announced yesterday is set to change that.
From September, one publicly funded IVF cycle will be available to couples that meet certain criteria.
The scheme will also fund one cycle of intracytoplasmic sperm injection (ICSI) and up to three cycles of intrauterine insemination (IUI).
Strict restrictions, as recommended by a working group of clinical experts, will be in place to access the scheme.
This will include limits on maximum age, body mass index (BMI), and the number of existing children a couple have.
But how do these restrictions compare to other countries that offer free IVF, particularly when it comes to age and weight limits?
Out of 43 European countries, only Ireland, Albania, Armenia, and Poland do not currently offer any public funding for IVF.
Of the countries that do, there are significant differences in access to treatment according to age, relationship status and third-party donation.
The Journal understands that in crafting the Irish system, Scotland was looked to for guidance.
Just 12 countries offer up to six funded cycles of IUI , while only three countries offer up to six fully funded cycles of IVF/ICSI. Some 35 offering it partially funded.
Under the new 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.
Many other countries have higher age restrictions in place when it comes to accessing fertility treatment.
This ranges from 45 years of age in Denmark and Belgium to 51 in Bulgaria.
In Spain a restriction is set at the “age of the menopause”, and in the Netherlands at the age 49.
Even in other countries that set a lower age limit, it is still higher than Ireland.
In the UK, the NHS offers free fertility treatment to women up to the age of 40 but in some circumstances will extend this to 42 where all other criteria is satisfied.
In France, as of 2021, all women under the age of 43, including those who are single and lesbians, now have access to IVF.
Up until 2021, fertility treatment in France was restricted to heterosexual couples where one of the partners was infertile or risked passing a disease on to their child.
According to Politico, before this law change single women and lesbian couples often travelled to Spain, Belgium or Denmark, where the procedures were allowed.
Speaking to RTÉ Radio One yesterday, Minister for Health Stephen Donnelly said the rationale around an upper age restriction came from the expert group who said “there is a very significant reduction in the chances of success as a woman moves from around her mid 30s up into her 40s.”
“It’s about targeting the resources where there is the greatest chance of success for couples,” he added.
Under the new Irish scheme the intending birth mother must have a BMI within the range of 18.5 kg/m2 to 30.0 kg/m2.
This is the same as in Scotland.
In England and Wales, restrictions based on weight are set by local integrated care boards’ (ICB) policies and best practice is guided by the National Institute for Health and Care Excellence (NICE).
Under the guidance issued by NICE women with a BMI above 30 should be informed that they are likely to take longer to conceive.
Some ICB’s have criteria which stipulates that a woman must be “a healthy weight” and there has previously been media coverage of women being denied access to the publicly-funded scheme as a result of this.
In one instance, a woman was denied access for having a BMI above 35.
In New Zealand and Australia, publicly funded IVF is limited to those with a BMI of less than 32.
Many have been critical of the use of BMI as a factor for deciding whether someone should be granted access to publicly-funded fertility treatment.
Speaking on RTÉ’s Morning Ireland yesterday, Labour Senator Marie Sherlock said the age limit and BMI criteria seem “rather crude”.
Critics of BMI point out that it does not work well as a measure of an individual’s weight as it fails to account for differences in body composition, while also ignoring differences between men and women and between ethnicities.
Opposition parties in the Dáil have largely welcomed yesterday’s announcement.
Speaking to The Journal, Sinn Féin health spokesperson David Cullinane described it as a welcome first step in publicly funded IVF.
However he said it is “problematic” to limit it to one round of IVF and said that the norm elsewhere is for two or three rounds to be included.
He said another problematic element is the restrictions that exist when a couple has existing children.
Cullinane said he would like to see the scheme extended on both of these fronts, however he noted that the scheme was designed in consultation with clinical experts and he said he “wouldn’t want to second guess clinical guidance”.
The TD said his understanding is that these restrictions are due to funding limitations and he said while it is a “positive first step, more needs to be done”.
He added that his message for people who will be disappointed that they will not be able to access this scheme is that it needs to be seen as a start and that it will be built on.
This was also the message from Minister for Health Stephen Donnelly who told RTÉ yesterday: “This is the first step. Many other countries will not have started off by funding several cycles, it may be something that future governments look to do.
“What we wanted to do was give the greatest possible opportunity to the greatest number of people based on the resources for IVF we have in the country now.”
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