The Irish Times view on the Government’s IVF package: public provision welcome but eligibility needs to widen

The Government announcement that publicly funded assisted human reproduction (AHR) treatment will be available for the first time from this September is welcome but long overdue. European analysis of fertility policies in 43 countries in 2021 rated Ireland as “exceptionally poor”.

One in six heterosexual couples in Ireland experience infertility. Up to now ability to pay has been a determining factor in access to AHR treatments, with a round of in-vitro fertilisation (IVF) costing between €4,500 and €6,000 at private clinics. Under the new scheme, eligible patients will be entitled to one free cycle of IVF or intracytoplasmic sperm injection (ICSI) treatment, or three cycles of intrauterine insemination (IUI).

These services will initially be provided in private clinics approved by the HSE. Patients will be referred by consultants in the six regional fertility hubs that are already operating within public maternity hospital networks. The first step in the process will be to see a GP, who will refer on to a hub as appropriate; there will be no self-referring.

Details of eligibility criteria, such as age, the woman’s body mass (BMI) and number of previous IVF cycles accessed, have been outlined by the Minister for Health, Stephen Donnelly, who expects 3,000 couples a year to be able to avail of the programme.

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Couples must be in their relationship for at least a year and have no children from it, while at least one of them must have no living child. The use of donor egg or sperm in publicly funded treatments will not be allowed until after the Assisted Human Reproduction Bill becomes law, possibly by the end of this year. This means all same-sex couples and single women, as well as heterosexual couples needing to use a donor, are temporarily excluded.

Cut-off points for the AHR programme were always going to be contentious. Under the rules as outlined, women must be under 41 years of age and men under 60. The rigid requirement that the BMI of the intending birth mother be between 18.5 and 30 seems out of step with the move away in recent years from using BMI as a measure of an individual’s health.

In comparison, the UK’s National Institute for Health and Care Excellence (Nice) recommends an age limit of 42 for women having IVF under the NHS and says simply that those with a BMI of 30 or over should be advised on how to increase their chance of conception. Nice also recommends up to three IVF cycles for women under 40. However, these are only guidelines and some local NHS boards apply narrower limits.

The Minister would need to deliver on his commitment to expand eligibility here as soon as possible before campaigners for equal and adequate access to fertility treatment could start to consider if their job is done.