Australia’s peak fertility organisations say Medicare’s current definition of infertility is outdated and discriminatory, urging the federal government to give equal access to reproductive services regardless of a person’s relationship status, sexual orientation or gender identity.
At a meeting in Sydney last week, the Australian New Zealand Society for Reproductive Endocrinology and Infertility (ANZSREI), Fertility Society of Australia and New Zealand (FSANZ), and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) all agreed to expand their definition of infertility to better represent same-sex and solo parents.
Claire Sara and Nina McCann with their baby, Emily. Sara was eligible for Medicare-funded IVF because she had a burst appendix. Credit: Kelly Barnes
The update could have major implications for Medicare funding of fertility treatment, which is currently limited to people unable to conceive after one year of regular, unprotected intercourse, as is the Commonwealth Ombudsman’s definition of infertility.
Single people and LGBTQ couples often have to pay thousands of dollars for failed IVF treatment before they can be deemed “medically infertile” and receive Medicare rebates.
The groups’ new definition expands fertility to mean “the inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing or any combination of these factors” and the need for “medical intervention … to achieve a successful pregnancy either as an individual or with a partner”.
The consensus statement was based on the definition devised by the American Society of Reproductive Medicine.
ANZSREI President Dr Alison Gee said the updated definition acknowledged LGBTQ people, single women, women with medical conditions that affected their fertility and single men wanting to conceive via surrogacy.
“This is about the medical profession stepping up and acknowledging the patients we can now help with the advancements in reproductive technologies and wanting the government to acknowledge them as well,” Gee, who is also an FSANZ board member, said.
ANZSREI past president Professor Louise Hull said the Medicare definition should not be used to “deny or delay fertility treatment to any individual, regardless of relationship status or sexual orientation”.
Federal Health Minister Mark Butler was advised of the groups’ updated definition last week. A spokesperson for the Department of Health and Ageing said the government was considering the implications of the proposed change.
“We informed [Butler], and we didn’t feel there was any conflict,” Hull said. “It will take some time, but hopefully, we can align legislation and Medicare with the new definition.”
LGBTQ advocacy group Rainbow Families equality director Heather Corkhill said many LGBTQ families experienced medical infertility just like anyone else, but they were automatically assumed to be socially infertile and excluded from access, calling the process unjust, discriminatory and distressing.
“Three failed fertility treatments seems to be the magic number before most doctors agree to [enable] the rebates, but it’s arbitrary and totally at the discretion of the doctor,” Corkhill said.
“Some doctors think the rules are unfair and will allow the rebates immediately; others will feel trapped by these archaic rules from the 1990s, and then we have people running the gauntlet to prove that they are medically infertile.”
Fertile men are ineligible for the only Medicare rebate available for people trying to conceive through surrogacy.
New mum Claire Sara says her burst appendix was a strange blessing in hindsight. The major abdominal surgery that followed left her with scar tissue around her ovaries, which meant she was deemed medically infertile and eligible for IVF Medicare rebates.
“Faced with ‘you might not be able to conceive’ gave me so much clarity that I really wanted to [carry a baby],” Sara, 38, said.
But if her partner, Nina McCann, 36, had wanted to carry their baby, she would not have been eligible for the rebate, despite having a better chance of conceiving with assisted reproductive technology and no chance of conceiving through regular intercourse for 12 months.
“Try as we might, we are not going to get pregnant the way God intended,” Sara joked.
Having their daughter, 11-week-old Emily, cost the couple more than $40,000. The Medicare rebate was $5843.
“It doesn’t come close to covering the whole cost, but it helps,” McCann said, who, with Sara, documents their IVF, pregnancy and postnatal experiences on their YouTube channel.
RANZCOG president Dr Gillian Gibson said Australia’s health system must evolve to meet the needs of today’s diverse communities.
“The revised definition will make a big difference in improving access to essential care and reproductive services, especially for aspiring LGBTQIA+ parents,” she said.