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The Journal
2 days ago
- Health
- The Journal
State-funded IVF to be expanded 'imminently' to couples facing difficulty conceiving second child
COUPLES EXPERIENCING 'SECONDARY infertility', whereby they are having difficulty conceiving a second child, will soon be eligible to avail of free fertility treatment, such as IVF, under the government-funded scheme. While the Department of Health confirmed to The Journal that the plans are 'currently being finalised', it is understood the expansion of the scheme will be launched 'immently' and by the end of the month. Last October, the government said the scheme would be expanded to couples who already have children, however there have been criticisms about the delay in rolling out the expanded services. The expansion will mean the reversal of one element of the scheme's current criteria which requires that a couple accessing publicly funded IVF or fertility treatments must have no living children together. The so-called 'existing child limit' had been criticised by GPs . 500 referrals per month to fertility hubs While many couples will welcome the news of the service expansion to include couples who have difficulty conceiving a second child, concerns have been raised about current delays with the service and whether enough resources are being given to fertility hubs tasked with handling the high number of referrals. Advertisement Nationally, the six regional fertility hubs receive approximately 500 referrals per month for fertility assessments. As of the end of May, the six regional fertility hubs have made 2,335 referrals to HSE authorised Assisted Human Reproduction providers for advanced fertility treatment, including IUI, IVF or ICSI. Wait times to see a consultant following completion of required investigations are on average three months nationally, the department told The Journal. Previously, Clinical Director of the HSE's National Women's and Infants Health Programme Dr Cliona Murphy told RTÉ that waiting time for patients who are due to attend a regional fertility hub for an initial appointment is approximately ten to 11 weeks while most are seeing a consultant within around six months. Currently, a total of 45 staff work across the six fertility hubs, including consultants, fertility clinical nurse specialists, and administrative teams. This figure includes 13 consultants who manage and provide fertility services as one of the duties and roles assigned to them while they also work as consultant obstetricians and gynaecologists in maternity and gynaecology services. The remainder of the staff work full time in public fertility services. Recently, Labour TD Marie Sherlock hit out at the false starts of the service, stating that some families have delayed adding to their family on the promise from government that this would be addressed. Related Reads GPs believe 'no existing children' limit on state-funded IVF is unfair, survey indicates First baby born through state-funded IVF scheme with eligibility criteria expansion on the cards How do Ireland's age and BMI limits for free IVF compare to other countries? Criteria 'It's beyond cruel to treat women and families in this way,' she said. Sherlock also criticised the 'very restrictive' criteria applied to scheme. Health Minister Jennifer Carroll MacNeill has confirmed that she hopes to be in a position 'in the coming weeks' to make the announcement to expand the government-funded scheme to 'secondary infertility', but only 'as long as, of course, they meet all the other existing criteria'. There are commitments in the Programme for Government to both 'expand eligibility to State-funded IVF' and establish the first public AHR treatment centre. While the minister has said consideration of possible further expansion of the relevant criteria will continue, she has clarified that 'it is highly unlikely that changes will be made to clinically-based criteria such as those in relation to BMI limits '. Decisions on further proposed changes to the access criteria or the scheme more broadly requires continued consultation between Department of Health officials, colleagues in the HSE and with specialists in the field of reproductive medicine, she said in a recent reply to a parliamentary question. Ireland's first public AHR centre is scheduled to open in Cork later this year where it is anticipated service provision will commence in late 2025, with the facility fully operational by 2026. Currently, fertility treatments through the state-funded model, are largely outsourced to private operators. Readers like you are keeping these stories free for everyone... A mix of advertising and supporting contributions helps keep paywalls away from valuable information like this article. Over 5,000 readers like you have already stepped up and support us with a monthly payment or a once-off donation. Learn More Support The Journal
Irish Examiner
25-04-2025
- Health
- Irish Examiner
Leading women in medicine reflect on progress made in women's healthcare — and what still needs to be done
Much has changed in women's medicine over the past 25 years. Issues that were once spoken of in hushed tones are now openly discussed and receive the medical attention they deserve. However, further changes are necessary to ensure women receive the best possible care. We talk to four leading doctors in the Irish healthcare system about significant developments in women's healthcare and the changes they'd like the minister for health to introduce. Much done, more to do Dr Cliona Murphy is chair of the Institute of Obstetricians and Gynaecologists. She started working in this field 27 years ago and remembers it as a different time. 'Women's health wasn't even a phrase that was used then,' she says. Women's reproductive rights were strictly controlled. 'If a woman became pregnant, she had to stay pregnant,' says Murphy. 'I saw how devastating this was for women carrying babies with foetal abnormalities, and I experienced how fraught it could be getting terminations for women whose pregnancies posed a risk to their life and health. I'd have to make sure another practitioner and the multi-disciplinary team agreed with my decision to avoid any legal implications afterwards, all while trying to look after my patient.' She recalls women needing their husbands' consent before they could get their tubes tied for sterilisation and adds how even then, the request had to be submitted to the hospital's ethics committee. Dr Cliona Murphy: 'IVF has come on in leaps and bounds. Egg donation, for example, now enables women who have undergone premature menopause to carry children. And to see Ireland providing public funding for fertility treatment is fantastic.' 'It's hard to believe a third party had a say when the decision should have been hers alone.' The successful 2018 Repeal the Eighth campaign was pivotal. 'So many women shared their stories of suffering due to not having the right to full reproductive healthcare during that campaign,' says Murphy. That led to a change in the law, and changes in healthcare followed. Murphy cites improvements in fertility treatment as another significant change in women's health. 'IVF has come on in leaps and bounds. Egg donation, for example, now enables women who have undergone premature menopause to carry children,' she says. 'And to see Ireland providing public funding for fertility treatment is fantastic.' However, she says there is still room for further progress, especially in paediatric and adolescent gynaecology. She explains how certain gynaecological conditions only show up when a girl's periods don't arrive as expected. 'These are mostly rare conditions. But there is also the issue of painful periods and girls developing problems like endometriosis. These can make school, sports, and exams extra challenging for girls. 'Just as we now have specialised menopause services, I'd like to see more specialised services aimed at supporting these girls and their parents in dealing with these problems.' Taking women seriously Dr Deirdre Lundy is the clinical lead of the complex menopause clinic in the National Maternity Hospital in Dublin. Thinking back 25 years, she recalls an era when 'women's health wasn't taken seriously at all'. However, three milestone developments highlight that the healthcare system was undergoing significant changes. She also remembers the repeal of the Eighth Amendment. 'It still amazes me how smoothly Ireland made that transition,' she says. 'When you see places like the US rolling back on women's reproductive rights while we're moving forward, I feel proud of how Ireland has allowed women the autonomy to make decisions about their bodies.' The establishment of the women's health taskforce in 2019 marked another significant step forward. Set up following a recommendation from the Scoping Inquiry into the CervicalCheck screening programme, it allowed women's voices to be heard through workshops, research, and outreach programmes. 'This has allowed women to tell the department of health what their needs are directly,' says Lundy. Dr Deirdre Lundy: 'When you see places like the US rolling back on women's reproductive rights while we're moving forward, I feel proud of how Ireland has allowed women the autonomy to make decisions about their bodies.' The third pivotal development holds special significance in her area of medicine: the healthcare of women undergoing menopause. 'Sallyanne Brady contacted RTÉ's Liveline, explaining how unhappy she was with the [menopause] treatment she had received from GPs and gynaecologists, and this led to an outcry from Irish women,' says Lundy. 'There was so much correspondence that Joe Duffy devoted a whole week to the issue.' According to Lundy, the taskforce had already identified menopause as an unmet need, but the public uproar precipitated their response. The taskforce set up six complex menopause clinics across Ireland — in Dublin, Cork, Galway, and Nenagh — to look after women who struggle during this stage of their lives. Lundy's advice for the minister for health, Jennifer Carroll MacNeill, is to 'build on' these achievements. 'Throughout history, women's lives have been affected by their ovaries, wombs, and hormones, but we've made such progress in overcoming problems associated with this,' she says. 'Continue to expand the free contraception scheme. Fulfil the promise to provide free HRT. Remember that initiatives like these make a huge difference to women.' Stop exporting problems Dr Suzanne O'Sullivan is chair of the institute of obstetrics and gynaecology at the Royal College of Physicians of Ireland and clinical lead of the National Mesh and Complex Pelvic Floor Centre in Cork. The death of Savita Halappanavar, who died from sepsis after being refused an abortion during a prolonged miscarriage in 2012, was a landmark for her in a career spanning more than 25 years. 'It prompted many healthcare professionals to speak up during the Repeal the Eighth campaign,' says O'Sullivan. 'Our hands had been tied for so long by a law that prevented us from helping women who needed our help. We recognised that access to terminations had to be there for women who wanted and needed them.' She also points to the development of the national maternity strategy in 2016 as a key moment that marked the first in a series of improvements in women's healthcare. 'That strategy came about in response to several poor outcomes for mothers and babies in the maternity services,' she says. 'It recognised the need to implement standardised maternity, gynaecology and neonatal services across the country. Resources and funding had to be provided to make sure there was good national distribution of these services.' O'Sullivan has a particular interest in pelvic floor dysfunction, a problem experienced by many women post-childbirth and wants them to know that physiotherapy can help. 'It's on offer in every maternity unit to anyone who needs it,' she says. 'And your GP can also refer you if you have incontinence or other pelvic floor issues.' She is also eager to see vaginal mesh implants reinstated as an option for women suffering from stress urinary incontinence, pointing out that they are a standard treatment for this issue everywhere except for Ireland and Britain. The chief medical officer paused their use here in 2018 following complaints from women reporting post-surgical complications. 'That pause was to allow the medical system to tighten up procedures and governance,' she says. O'Sullivan is the clinical lead of the diagnosis and management of mesh complications guidelines, published in 2022, and is adamant that procedures and governance have been tightened. 'However, the pause still hasn't been lifted,' she says, despite evidence showing that these operations are safe. 'They have high success rates, fast recovery times, and low complication rates.' She says some 200 women in Cork alone need this surgery. 'They cry in my clinic every week because they can't play with their kids for fear of leaking. 'They've been waiting years for surgery. Some have travelled abroad to get it, in an example of Ireland once again exporting its women's health problems. 'I'd love to see the minister for health show her support for ending the pause on vaginal mesh implant surgery.' Removing barriers Professor Susan Smith is a GP in Dublin, a professor of general practice at Trinity College and the chair of Deep End Ireland GPs, a group of doctors working in disadvantaged communities who are campaigning to end inequities in the Irish healthcare system. When reflecting on how women's healthcare has changed, she recalls a statistic she heard as a trainee doctor in the 1990s. 'Back then, some 30% of women had hysterectomies in their 40s due to heavy bleeding,' she says. 'The Mirena coil brought an end to that. By delivering a small dose of progestogen, it reduces bleeding and serves as a form of contraception. It's been a gamechanger for women.' She also recalls the furore that surrounded the publication findings of the Women's Health Initiative in the early 2000s. 'Until then, hormone replacement therapy (HRT) had been prescribed as a way of managing menopause symptoms in women,' she says. 'But overnight, that study's suggestion that HRT increased their risk of breast cancer meant that all prescribing stopped.' Dr Susan Smith: 'Research tells us these women's lifestyles are too busy for them even to think of going to the doctor. And this doesn't only impact their health in menopause. It also negatively impacts other health outcomes."Picture: Moya Nolan. It took more than a decade for scientists to show that this study was flawed and that HRT was safe. 'During that time, a lot of women suffered with debilitating symptoms that went untreated,' says Smith. 'But now women have heard the message and more and more are asking about HRT.' However, this is not necessarily the case for women from more disadvantaged areas. According to Smith, they are far less likely to be prescribed HRT than women from more affluent communities. 'Research tells us these women's lifestyles are too busy for them even to think of going to the doctor,' she says. 'And this doesn't only impact their health in menopause. It also negatively impacts other health outcomes. These women have higher rates of heart disease, are less likely to attend cancer screenings, and are more likely to present later with cancer,' she says. Smith would like to see targeted measures taken to improve these health outcomes. One is free GP visits for everyone to remove all financial barriers to accessing primary care. Another is providing a level of care based on need. 'Research shows that people living in disadvantaged areas develop multiple health conditions 11 years earlier than those living in more affluent areas,' she says. 'We would love for the capitation for medical card payments to be weighted more for doctors working in these areas. 'This change would allow them to spend more time with their patients, which would benefit the patients and the health system as a whole. 'It would result in better health outcomes for women, and ultimately, in better health outcomes for all.' Read More Workplace Wellbeing: Most of us benefit from connecting with colleagues in the office
The Journal
21-04-2025
- Health
- The Journal
Maternity care chief warns wealthy families have greater access to the best prenatal screening
PEOPLE ON HIGHER incomes have greater access to the best prenatal screening, the HSE maternity care chief warned in 2023. Non-invasive prenatal testing is an accurate form of screening for chromosomal conditions such as Edwards Syndrome and Patau's Syndrome, fatal foetal anomalies likely to result in death in utero or in infancy. The tests are only available privately, except in a few exceptional cases, and cost hundreds of euro. The HSE told The Journal in recent days that it is now developing a proposal to incorporate this testing into routine maternity care in Ireland, with a view to providing 'equitable access…for all pregnant women'. Dr Cliona Murphy, then-clinical director of the National Women and Infants Health Programme, raised inequitable access to this testing with the National Screening Advisory Council in January 2023. The correspondence was released to The Journal under freedom of information. Murphy told the committee, which advises the Minister for Health on population-based screening programmes, that it could suggest that the HSE establish a national programme, based in the public maternity system. However, two years later, this testing remains available only to expecting parents who can pay, with some private health insurance plans covering a portion of the bill. The HSE proposal to widen access to this care is being drafted by the National Women and Infants Health Programme and by a group implementing the recommendations of the O'Shea and Regan reviews of abortion services. Both reviews called for a national programme for prenatal testing for common chromosomal conditions, with the Regan review criticising 'unregulated, inequitable access to commercially provided screening tests…without the protection of the governance or quality assurance that would come from a structured screening programme'. Advertisement The HSE said a final decision on whether to proceed with such a programme will depend on 'national priorities' and the availability of resources, as well as 'broader health policy'. The Department of Health said that the National Screening Advisory Council decided to 'defer consideration' of proposals it received in 2021 and 2022 to introduce first trimester prenatal screening for chromosomal and congenital conditions. This deferment followed 'careful consideration' of the National Women and Infant Health Programme's 2023 advice, it said. The Department said the deferment was also based on consideration of 'associated ethical issues related to screening for these conditions'. It declined to specify what these ethical issues were. 'Single best screening test' Non-invasive prenatal testing is deemed the 'single best screening test' for chromosomal conditions in the HSE's 2023 clinical guidelines on foetal anatomy ultrasound. It comprises a blood test accompanied by an ultrasound scan, and is sold under brand names including Harmony and Panorama. During pregnancy, some foetal DNA passes into the mother's bloodstream, and this can be used to screen for genetic conditions, such as Down Syndrome. Recent research by University College Cork found these tests currently cost between €380 and €650 at private obstetric clinics and at four of the 19 maternity hospitals. Ultrasound clinics and some GPs also offer the tests. The researchers warned that access to the tests and to information on the tests was 'inequitable' and said a national screening programme would improve reproductive autonomy. In her correspondence with the National Screening Advisory Council (NSAC), Dr Cliona Murphy described provision of non-invasive prenatal testing in Ireland as 'unstructured and random'. She said the tests were 'more likely' to be accessed by parents who were well educated, as 'prior knowledge' was required. Given that access is 'contingent on ability to pay', the tests are 'more accessible [to] those on higher incomes', she added in a letter to NSAC. Related Reads 'I'll never forgive my country': Women on the trauma of having to travel to UK for terminations Irish parents face difficulties accessing prenatal testing for chromosomal conditions A national screening programme would ensure information on screening was standardised and people who received high-risk results could access 'high quality diagnostics', Murphy said. She added that such a programme would be on an opt-in basis, meaning women would not have to avail of it if they chose otherwise. Earlier testing Non-invasive prenatal testing can be performed early in pregnancy, usually from nine or 10 weeks. By contrast, the foetal anomaly ultrasound scan provided to all patients through the public system in Ireland is performed at 20-22 weeks. Some women who learn after 20-22 weeks of a fatal foetal anomaly could have discovered this earlier had they had access to non-invasive prenatal screening at 10 weeks. The introduction of a national prenatal screening programme in the Netherlands, with an uptake rate of approximately 46%, has led to earlier diagnosis of major foetal anomalies with a significant reduction in late termination of pregnancy, the UCC researchers said. The American College of Obstetricians and Gynecologists recommends offering prenatal screening to all pregnant people regardless of maternal age or risk. The NSAC requested advice from the National Women and Infants Health Programme on prenatal testing in 2022. The NSAC received calls for the introduction of a population-based screening programme for chromosomal conditions in 2021 and 2022. The Department of Health said that another call for submissions to the NSAC will be launched later this year. 'Should new evidence have emerged' on screening for chromosomal conditions, 'NSAC would be open to receiving an updated proposal', the Department said. Readers like you are keeping these stories free for everyone... A mix of advertising and supporting contributions helps keep paywalls away from valuable information like this article. Over 5,000 readers like you have already stepped up and support us with a monthly payment or a once-off donation. Learn More Support The Journal
