Minister for Health Stephen Donnelly has announced full public funding for a cycle of IVF (in vitro fertilisation) for eligible couples from September.
This will be the first time in the State that Assisted Human Reproduction (AHR) treatment is publicly funded.
Speaking on RTÉ's News At One, Minister Donnelly said: "For too many couples in Ireland it simply hasn't been affordable and so what we're doing is providing full funding for eligible couples for three cycles of IUI (intrauterine insemination) and one cycle of IVF."
The Cabinet was updated on the plan today and it follows on from the €10m allocated in the Budget for IVF funding.
An age limit will be in place for a woman up to 41 years of age and men up to 60, Minister Donnelly said.
He said these recommendations have come through an expert group, similar to the NHS in the UK and large parts of Europe.
"The rationale around age from the expert group is that there is a very significant reduction in the chances of success as a woman moves from around her mid 30s up into her 40s," he added.
"So, really it's about targeting the resources where there is the greatest chance of success for couples."
Eligibility
To be eligible individuals must be ordinarily resident in the State and referred through their GP to a regional fertility hub.
Eligible couples must have no living children from the existing relationship and include at least one partner with no living child.
Access to publicly-funded AHR treatment is available for those individuals who have previously undertaken a maximum of one previous IVF cycle and where all embryos created as part of that cycle have been used.
A couple or individual will not be eligible for publicly funded AHR treatment if either has had voluntary sterilisation.
To ensure the welfare of any children resulting from AHR treatment, an assessment will be carried out, based primarily upon a self-declaration form.
There shall not be more than two intending parents of a child born as a result of AHR treatment and, they shall be in a relationship for at least one year.
The intending birth mother should be a maximum age of 40 years plus 364 days at time of referral to a fertility hub, while the maximum referring age for males is 59 years plus 364 days.
The BMI of an intending birth mother must be within the range of 18.5 kg/m2 – 30.0 kg/m2.
Asked why the funding is limited to one cycle when the success rate after one cycle is so low and in Britain it can be funded up to three cycles, the Minister said "this is a first step".
"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," Minister Donnelly said.
He said the first national HSE fertility centre is being opened in Cork next year, which is set to do about 500 IVF cycles.
Minister Donnelly said they are targeting people "who have not had any access to IVF in the past or have had one cycle".
"And then we would be funding either their first or second cycle and the view of the expert group is that 'this is the group of people we need to start with'," he said.
People who are unable to conceive because of an unknown cause will be eligible for the funding.
'Referral pathway'
Minister Donnelly said a "referral pathway" will be in place.
"Essentially, we've a new fertility service in place, which has three levels to it," he said.
"First of all people will start with their GP. GPs can provide counselling, baseline investigations, lifestyle advice and more.
"The GPs can then refer to six regional fertility hubs, these are new hubs we’ve put in place over the last two years."
He said that these hubs, "its estimated will actually be able to help about 50-70% of the people who were referred from the GP".
"From these six hubs, people will be referred either to the HSE centre in Cork or to one of the private providers," he said.
"The patient will be able to choose which of the providers they want to go to."
HSE
The service will initially be provided by private clinics on behalf of the HSE, while the HSE builds up "a network of public capacity to deliver the service directly within the public health system".
Minister Donnelly said the first national HSE centre is being opened in Cork next year, which is set to do about 500 IVF cycles.
In a statement, the HSE said it would work closely with the approved private providers and aim to have services available across the country, to support "eligible people" in accessing services as close to where they live as possible.
There are six regional fertility hubs within public maternity hospital networks across the country that are providing services to people experiencing fertility issues.
The hubs currently receive approximately 150 new referrals on a monthly basis.
Minister Donnelly said that these hubs, "its estimated will actually be able to help about 50-70% of the people who were referred from the GP".
"From these six hubs, people will be referred either to the HSE centre in Cork or to one of the private providers," he said.
"The patient will be able to choose which of the providers they want to go to."
From September, if further advanced treatment is recommended by a reproductive medical consultant and the patients meet the access criteria, the hubs will refer patients to a HSE-approved private provider of their choosing.
There is no cost to patients for the recommended treatment through the private providers.
Clinical Director of the HSE National Women and Infants Health Programme (NWIHP) Dr Clíona Murphy described the roll out of services as an "important development" and "very exciting".
"We are delighted to see investment in this area to ease the financial burden for public patients and it will significantly increase access to services for many," she said.
"We have designed caring and efficient pathways for patients, ensuring a safe and quality service, so that fertility issues are addressed through the public health system at the lowest level of clinical intervention necessary."
'Very disappointing'
LGBT Ireland, Irish Gay Dads and Equality for Children have called on the Government to rethink the new IVF/IUI funding scheme which they say has excluded many families.
LGBT Ireland described the scheme as "very disappointing".
Its spokesperson Paula Fagan said the decision to bar those who use a donor from the funding scheme means that all same-sex couples will be excluded.
Ms Fagan said there was no justification for this.
"On the one hand, under the current provisions of the Children and Family Relationships Act (2015), female same-sex couples are required to undergo clinical conception to be jointly recognised as parents," she said.
"On the other hand, the State is now saying that it won't fund these required procedures under the terms of the new IVF/IUI funding scheme. This makes no sense," she added.
Ranae von Meding of Equality for Children, welcomed the new financial supports, however, she said they should be open to everyone regardless of their sexual orientation or relationship status.
"The exclusion of everyone who uses donor gametes is deeply unfair," she said.
"We are also concerned that in order to avail of this funding you must have a known fertility issue. Over half of those seeking fertility assistance have unknown fertility issues," she added.
The advocacy groups have also reiterated their call on the Government to urgently progress the Assisted Human Reproduction legislation.
Séamus Kearney Martone of Irish Gay Dads, said: "The Bill has been delayed time and again. Each deadline the Minister set has been missed."
"It’s deeply unfair to keep families waiting indefinitely for this important legislation," he added.
In a statement the groups pointed out that for LGBT people and couples; the issues around fertility and family formation cause the same stresses, anxiety and worry as they do for other members of Irish society.
They described the exclusion of LGBT people from the scheme as "totally unfair".
Fianna Fáil Senator Catherine Ardagh, who has spoken publicly in the Oireachtas about the IVF process she went through, said that once the legislation comes into place, free IVF is likely to be widened to include gametes, donor eggs and donor sperm.
With additional reporting by Ailbhe Conneely
