The HSE calls Ireland’s public fertility service holistic and patient-centred, but what is glaringly missing is the measure of what the patient’s came for.
The HSE Fertility Services Report 2025 counts referrals, appointments, treatment cycles, cycles reaching egg collection, embryo transfers and inseminations.
It describes Ireland’s public fertility service as “holistic” and “patient-centred”. It calls the report comprehensive, the data robust and the service effective.
But it does not measure the outcome the patients came for.
For every couple whose fertility care has ended, there are only two outcomes:
They achieve a pregnancy, or they are discharged without succeeding.
Everything else is the pathway between them.
The service is counted. The patient is not followed.
In 2025, the six regional fertility hubs accepted 5,818 referrals. During the same year, 2,921 new couples attended a consultant appointment, 3,305 attended review appointments and 1,996, just over one third, were referred onwards for assisted reproduction with an HSE-approved private provider.
These figures show how much work passed through the service.
They do not show how many couples reached either outcome.
The patients referred, assessed and treated during 2025 are not one defined group being followed through the pathway. Some couples counted later in the report entered the service in an earlier year. Others accepted during 2025 were still undergoing investigation or treatment when the year ended.
The HSE says this prevents it from calculating an overall clinical pregnancy rate because fertility pathways can cross calendar years.
But a pathway crossing into another year does not make the patient untrackable.
At the reporting cut-off, the patient is still receiving care, pregnant or discharged without succeeding. Those categories can be carried forward until the pathway ends.
The report does not do that.
The headline success rates begin after the patients most likely to fail have already been removed
The report publishes clinical pregnancy rates of 30% for IVF, 31% for ICSI, 34% for frozen embryo transfer and 11% for IUI.
These percentages are not calculated from everyone who started treatment.
For IVF, ICSI and frozen embryo transfer, the calculation begins with the patients who reached embryo transfer. For IUI, it begins with those who reached insemination.
Patients whose treatment did not reach that stage are excluded from the denominator.
That includes cancelled cycles, cycles that did not reach egg collection, cycles with no embryo available for transfer and IUI cycles that did not proceed to insemination.
These are not patients who stood outside the treatment pathway.
They entered it, underwent treatment and experienced its attrition. Removing them from the denominator makes the published percentage look more successful than the complete treatment journey.
The 30% IVF pregnancy rate becomes 12.4% when the calculation starts where treatment starts
The report records 712 IVF cycles started and 88 clinical pregnancies.
That gives a clinical pregnancy rate of 12.4% per IVF cycle started — not 30%.
The difference is created by the denominator.
The HSE calculates its 30% rate from the 284 IVF cycles that reached fresh embryo transfer. The 428 cycles that started but did not result in a fresh transfer are no longer represented in that headline percentage.
Clinical pregnancy is also not the final point in the attrition funnel.
The UK fertility regulator reported an average fresh-transfer pregnancy rate of 31% and a birth rate of 25%. Applying the same pregnancy-to-live-birth attrition to the HSE figures reduces the estimated live birth rate to 10% per IVF cycle started.
The headline figure is 30%.
The estimated live birth rate from the point where the IVF cycle began is 10%.
That is the figure a patient needs in order to understand the scale of attrition between starting treatment and taking home a baby.
The same denominator problem runs through the other treatment figures
The ICSI, frozen embryo transfer and IUI rates use the same narrowed view.
The ICSI pregnancy rate begins with embryo transfers, not the 1,020 cycles recorded as started in the detailed section of the report.
The frozen embryo transfer rate begins with transfers performed, not all 1,319 cycles started.
The IUI pregnancy rate begins with the 478 inseminations completed, not the 594 cycles started.
These figures measure what happened after a patient reached the final procedure.
They do not measure the outcome from the point treatment began.
That distinction should be made explicit wherever the rates are published. Otherwise, a patient reading “30% IVF pregnancy rate” could reasonably believe that approximately 30% of those who started IVF became pregnant.
The HSE’s own figures show that this is not what the percentage means.
The regional fertility hubs do not systematically count either outcome
The six regional fertility hubs recorded 435 clinical pregnancies during 2025.
But this was not systematic outcome tracking.
Of the 435 pregnancies, 291 were reported by patients themselves. The remaining 144 were identified through scans carried out within the hubs, usually incidentally during ovulation induction monitoring. The hubs do not routinely perform dedicated pregnancy confirmation scans as part of conservative management pathways.
In other words, a pregnancy is counted if the patient reports it or if it happens to be seen during care. Patients are not routinely followed to establish whether they became pregnant.
The report also does not record how many couples completed regional hub care and were discharged without succeeding.
So neither outcome is systematically measured.
The 435 pregnancies are not a complete pregnancy count, and there is no corresponding count of unsuccessful discharges. That means the report cannot show the success rate for couples entering the regional fertility hubs.
A total pregnancy count does not repair the missing patient pathway
The report states that 664 clinical pregnancies were recorded during 2025.
That figure is presented as evidence of an effective service.
But 664 pregnancies during one calendar year cannot be set against the 5,818 referrals accepted during that year.
They are not the beginning and end of the same patient journey.
The patients may have entered the service in different years. Some may have undergone several treatment procedures. Some patients referred in 2025 were still receiving care when the report closed.
A total pregnancy count measures activity during a period.
It does not show what proportion of couples completed the pathway pregnant or were discharged without succeeding.
Live birth is not the only missing outcome
The HSE acknowledges that it does not capture live birth outcomes.
That is a serious gap in assisted reproduction reporting because clinical pregnancy is not the outcome patients ultimately hope to take home.
But the missing information begins before live birth.
The fertility service should know whether the patient was pregnant when fertility care ended.
That does not require the regional fertility hub or fertility clinic to follow the patient throughout antenatal care. It requires a final fertility outcome to be recorded at discharge.
Pregnancy achieved.
Discharged without succeeding.
Live birth reporting would then show how many clinical pregnancies progressed to birth.
The report currently provides neither the complete fertility outcome nor the final birth outcome.
Patient-centred reporting starts with the patient
A patient-centred report would keep each couple connected to one pathway from accepted referral until fertility care ended.
Appointments, investigations, cancelled cycles, egg collections, embryo transfers and inseminations would remain attached to that patient record.
At the end of the reporting period, each couple would be recorded as:
Still receiving care.
Pregnant.
Discharged without succeeding.
The first category carries forward into the next reporting year. The other two provide the final fertility outcome.
Procedure pregnancy rates could still be reported because they show what happens once transfer or insemination takes place.
But they should sit alongside the patient outcome.
They cannot replace it.
Access is progress. Activity is not success.
Ireland’s public fertility service has given thousands of couples access to investigations and assisted reproduction that were previously unavailable through a national public pathway.
That matters.
But referrals, clinics and treatment cycles show what the service did.
They do not show whether the patient got what they came for.
Until the HSE reports how many couples achieve a pregnancy and how many are discharged without succeeding, its claim to provide a holistic, patient-centred fertility service has a patient-shaped hole in the middle.
