Publicly-funded AHR: How will it work and how can people avail of it?

The Government has approved plans to publicly fund assisted human reproduction (AHR) for the first time. It follows a budget allocation of €10 million last year, but even though money had been set aside, the timescale and treatments to be provided were not clear until now.

There has been a guarded welcome for the proposals, with most stakeholders saying they are a much needed first step.

So what will change and when?

From September, eligible patients will be entitled to one full cycle of in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Up to three cycles of intrauterine insemination treatment (IUI) will be funded for those clinically determined for it.

How will it work?

There are basically three steps in the care model. Firstly, intending parents would be assessed by their GP, who would then refer them to secondary care at one of six regional fertility hubs within existing hospitals. Where necessary, patients would be referred onwards for fertility treatments outlined which the State would pick up the tab for. This would initially take place in the private sector, and there are many terms and conditions.

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What happens if I’ve had IVF before?

Those who have had more than one cycle of IVF previously will not be eligible. In effect, the State is offering to pay for a first or second round of IVF. All embryos created from a prior cycle must have been used to be eligible.

Is there age criteria?

For IVF, IUI and ICSI, women must be under 41 and men under 60. These limits apply at the time of referral to a regional fertility hub, meaning applicants would not time out when awaiting treatment or further tests post-referral.

What about BMI?

Minister for Health Stephen Donnelly has said the BMI range for women undergoing State-funded therapies would be between 18.5-30.

[ Publicly-funded IVF: Age and BMI cut-offs criticised as move set to help 3,000 couples annually ]

What if I have children already?

Couples applying must have no living children from their existing relationship and at least one partner must have no living child. There cannot be any more than two intending parents and they have to have been in a relationship for at least a year.

Will only male-female couples be able to access the scheme?

In effect, yes, for now. There is no eligibility ban on single women or same-sex couples but the Government has judged that in the absence of the Assisted Human Reproduction Bill, no therapies involving donated materials (an egg or a sperm) can be funded by the State. Therefore, single people or same-sex couples will not be able to take advantage of the services from September, which they can do in the private sector. The same is true for heterosexual couples intending to use donated materials. Mr Donnelly has said he is “absolutely determined” that the legislation will pass all stages this year and ultimately all intending parents would qualify.

What about where no clinical cause of infertility has been identified?

There was some confusion about this, with initial indications from Government being that only those couples with a clinically diagnosed cause for infertility would be eligible. However, it now seems those who do not have a diagnosed cause would also be eligible through the same pathway, though it is likely that for those with no known cause further investigations will take place on the way.

[ Analysis - Publicly-funded AHR: Hands of bean counters all over crude cut-off criteria ]

How does Ireland compare?

As it stands, Ireland performs pretty dismally in comparison with the extent of state provision in other European countries. A 2021 assessment placed Ireland 40th out of 43 European states for fertility treatment policies, with availability in the private market but no state-sponsored provision, education or psychological support for those in treatment.

The World Health Organisation (WHO) classifies infertility as a disease of the reproductive system which “results in disability”, a stance supported by the Workplace Relations Commission, which found that for the purposes of the Employment Equality Acts, infertility is a disability. However, progress has been very slow in addressing State provision.

State-funded IVF was first tabled in 2007 by then minister for health Mary Harney. In 2016 and 2017, then ministers Leo Varadkar and Simon Harris recommitted to the plan, with a goal to provide financial assistance by 2019. Mr Harris said in 2019 that IVF would be available publicly by 2021.

When will services be provided in the public sector?

The intention is to open a dedicated National Advanced AHR Centre in Cork next year, delivering the therapies through a public clinic. Subject to additional funding, more centres would open elsewhere.