Affordable IVF Initiative

FREQUENTLY ASKED QUESTIONS

What is In Vitro Fertilisation (IVF) treatment? IVF treatment is a technique of assisted reproduction used to overcome a range of fertility issues. An egg and sperm are joined together outside the body, in a specialised laboratory. The fertilised egg, called an embryo, is then transferred to the woman's womb, to implant and become a pregnancy. IVF can be carried out using the couple’s eggs and sperm, or using eggs and/or sperm obtained from donors.

Who can have IVF treatment? IVF treatment assists people who are infertile to conceive and have a baby. It may be a male and/or female infertility issue preventing conception. Infertility is the term used when couples have not been able to conceive after 12 months of regular unprotected sex when the woman is under 35 years of age. Or, when the couple has not been able to conceive after 6 months of regular unprotected sex when the woman is 35 years of age or over. A doctor will typically conduct some diagnostic tests to determine the cause of infertility. Not all couples will require IVF treatment; some may be able to conceive a baby through less invasive therapies. It is best to discuss your options for IVF with your doctor.

How widely is IVF used in Australia? Annually, approximately 12,000 women undertake IVF treatment in NSW.

Experts say 1 in 22 babies born in Australia is conceived using some form of assisted reproduction.

What is the NSW Government’s election commitment to improve affordability and access to IVF services? The NSW Government is investing $42 million over four years to:  Introduce a $500 rebate to assist with costs of pre-IVF fertility testing  Expand the availability of lower cost IVF treatment at government supported IVF clinics for around 6,000 women over four years  Establish a state-wide fertility preservation service for younger cancer patients

What is the objective of the Affordable IVF initiative? The objective of the Affordable IVF initiative is to boost affordability and accessibility of pre-IVF fertility testing and IVF for people who need it.

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PRE-IVF FERTILITY TESTING REBATE

Who is eligible to claim the pre-IVF fertility testing rebate? Residents of NSW who have confirmation from their Specialist that they have incurred out-of-pocket costs from 1 October 2019 for fertility testing that is eligible under the rebate, are eligible for the pre-IVF fertility testing rebate. Only women can lodge the claim for the $500 rebate with Service NSW.

A receipt for male or female fertility testing that occurred from 1 October 2019 can be used as evidence of out-of-pocket costs for the purpose of the rebate. Women make the rebate claim using their receipt, or receipt of their partner or donor (as long as their partner or donor has consented to this).

A woman can only receive the rebate once. The fertility testing receipt you provide when claiming the rebate must show the out-of-pocket cost incurred.

Who can order fertility tests for the purposes of the rebate? Both General Practitioners (GP) and Specialists can order fertility tests. GPs are often the first point of call for families commencing their fertility journey and order initial fertility tests.

Who can confirm eligibility for the rebate? The following Specialists can confirm eligibility for the rebate: • Specialist Obstetrician and Gynaecologists • Specialists in Obstetric and Gynaecological Ultrasound • Specialists in Reproductive Endocrinology and Infertility • Specialist Urologists • Specialist Endocrinologists.

While GPs can order fertility tests, only Specialists can confirm eligibility for the rebate as they are best placed to confirm a person has a fertility issue.

Can my GP complete the Pre-IVF Fertility Testing Rebate form? Is a referral letter from my GP sufficient? No, only a Specialist can confirm your eligibility for the rebate on the Pre-IVF Fertility Testing Rebate form. A referral letter from a GP is not sufficient.

What fertility testing is covered by the rebate? To be eligible for the $500 rebate, you must have incurred out-of-pocket expenses from 1 October 2019 for one or more of the following:  Anti-Mullerian Hormone (AMH)  Pelvic ultrasound  Ovulation test  Semen analysis

How much do fertility tests usually cost? Costs vary greatly depending on the provider, but some tests can cost hundreds of dollars and often multiple expensive tests are required to assess fertility. Proof of receiving at least one of these expensive tests is required to receive the rebate. Page 2 of 8

The rebate is provided in addition to Medicare and any private health insurance rebates available to you.

How do people claim the rebate? Service NSW is offering the rebate state-wide through MyServiceNSW www.service.nsw.gov.au/campaign/cost-living and will provide customer support for the application process through Service Centres and Contact Centres.

Once having selected the Pre-IVF Fertility Testing Rebate, you must follow some simple instructions including to upload the endorsed Pre-IVF Fertility Testing Rebate Form and one fertility testing receipt. Remember this receipt can be for fertility tests you received or that your partner or donor received, as long as you have their consent to provide their receipt. You must also provide proof of identity.

Is there a non-digital option available? There is no non-digital option for claiming the Pre-IVF Fertility Testing Rebate. Also you must have a MyServiceNSW account. You can contact Service NSW on 13 77 88 for assistance with setting up a MyServiceNSW account.

How will people receive their rebate? At completion of an application through MyServiceNSW applicants will nominate their preferred bank account that the rebate will be paid to. A transfer of funds will be made directly into your nominated bank account within 5 business days.

When will the rebate commence? The Pre-IVF Fertility Testing Rebate commences in January 2020.

You can claim the rebate for out-of-pocket cost for pre-IVF fertility tests received from 1 October 2019. When lodging your application with Service NSW you must provide a copy of a receipt for a fertility test and the Pre-IVF Fertility Testing Rebate form that confirms your Specialist has endorsed your eligibility for the rebate.

Is the rebate just for women, or are men also eligible? The receipt used as evidence of out-of-pocket costs can be for tests that a man or woman has received. So men and women are eligible for the rebate because it is designed to reimburse for expenses incurred by men and women.

Why is the rebate available only for women to claim? While tests related to the man or woman’s fertility issues can be used to show that an out-of-pocket cost has been incurred, only women can lodge an application or the rebate. This ensures only one applicant from the partnership seeking to have a child can claim the rebate.

The woman is the most appropriate person to receive the rebate as this covers the range of partnerships who want to have a baby and need to access fertility treatment. It includes same sexual relationships, including where a female surrogate is involved.

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Are same-sex couples eligible for the rebate? Yes. Anyone who has out-of-pocket medical costs for testing to determine their fertility, and where IVF treatment may be appropriate option for them, is eligible to receive the rebate.

Will private providers of fertility tests increase their prices of tests because of the rebate? While the NSW government does not regulate fees charged for health care services by private health providers, any reports of unreasonable and unethical pricing practices will be taken very seriously.

The NSW Ministry of Health will investigate reports of unethical pricing, and if deemed unreasonable, action will be taken including potentially suspending or removing providers by excluding receipts from the rebate program.

If I live in a state other than NSW, am I eligible to receive the pre-IVF rebate? Only people who are residents of NSW at the time of making a claim are eligible for the pre-IVF fertility testing rebate. NSW residents can claim the rebate regardless of whether they received fertility testing within or outside the state of NSW.

Can I claim the rebate at Service NSW Service Centres and Contact Centres? You can only submit a claim for the rebate by accessing the Service NSW website and by logging in to you MyServiceNSW Account – www.my.service.nsw.gov.au/MyServiceNSW/PersonalDashboard.

You can visit the Service NSW Service Centre to use the Digital Kiosk, which is the Service NSW website, to submit the rebate application and upload required supporting documents. If you need help submitting a claim or setting up a MyServiceNSW account, you can contact Service NSW on 137 788 to be guided through the process of submitting the application online.

GOVERNMENT SUPPORTED IVF CLINICS

How are you providing lower cost IVF treatment? The NSW Government is improving access and affordability of IVF services by investing in three high quality, government supported IVF clinics.

This will see an expansion, to provide lower cost IVF treatment, at: 1. The Royal Prince Alfred Hospital IVF clinic, which partners with the private provider Genea 2. The Fertility and Research Centre at The Royal Hospital for Women, and delivered in partnership with the University of New South Wales, where IVF treatment will now be provided in addition to the existing fertility preservation service 3. The Westmead Fertility Centre, which Sydney University owns and runs, and under this initiative will partner with Westmead Hospital.

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Why were these three clinics chosen to deliver this initiative? These clinics have a unique existing relationship with a public hospital which helped to ensure the government investment would reach an optimal number of women and provide them with access to lower cost IVF treatment.

A rigorous business planning process has underpinned allocating this investment to the clinics which encourages public benefit including:  Use the funding efficiently so more women can access to IVF treatment, at a lower cost  Access for women who may not otherwise be able to afford IVF treatment  Outreach across the state to deliver lower cost IVF to women living throughout NSW and/or disadvantaged groups.

How many women will be able to access the government-supported IVF clinics once this policy is implemented? By June 2023 this investment will have supported 6,000 women to access lower cost IVF treatment.

How much will IVF treatment cost at government-supported IVF clinics? Under this initiative patient’s out- of -pocket costs at government supported clinics are substantially lower than most private ones.

Why is the IVF treatment cost at government-supported clinics not free? Offering lower cost IVF is more equitable than free IVF services as it enables more women and men to be able to access lower cost IVF over the next four years.

Will the publicly supported clinics provide frozen embryo transfer (FET) services? Yes, all three clinics will offer frozen embryo transfer (FET). During the IVF cycle, a number of eggs may be collected during the retrieval stage. All three clinics will freeze the extra eggs and can then do an FET cycle should the IVF cycle not be successful.

Will patients of the lower cost IVF clinics be means tested? No, clinics will not means test their patients under this initiative. The clinics are responsible for supporting women from disadvantaged groups and those who might not otherwise be able to afford IVF treatment and so may use other mechanisms such as prioritisation to ensure access by the target group of women.

How many women accessed IVF treatment in previous years in NSW? Publicly available data is not available on the number of women in NSW who accessed IVF treatment in a year.

The number of Assisted Reproductive Technology (ART) treatment cycles in a year in Australia is reported, with 74,942 treatment cycles provided in 2017. ART is the term for the set of procedures where human oocytes (eggs) and sperm, or embryos, are handled outside the body for the purposes of establishing a pregnancy. IVF treatment is one of a number of ART procedures. Detail on how many unique women accessed IVF treatment and/or the number of treatments provided in NSW is not collected or reported. Page 5 of 8

Will clinics have a waiting list? If demand is higher than can be met by a clinic then patients will have the option to join a waiting list.

When will the additional clinics start operating? All clinics will start to provide lower cost IVF in the 2019-20 financial year. Start dates will depend on the need for new equipment purchases and staff recruitment. It is anticipated that the clinic at RPA and the Westmead Fertility Centre will start to offer lower cost IVF from early 2020. As the provision of IVF treatment by the Fertility and Research Centre is a new service offering, this IVF clinic may open a few months later than the others.

Will this impact private providers? The demand for fertility services is growing with an estimated 1 in 6 couples experiencing trouble falling pregnant. We would expect all operators in the fertility area would be supportive of moves to enable more women to access services.

There is strong demand for IVF treatment and the vast majority of IVF clinics in NSW are private providers. Government investment in lower-cost centres will increase choices for people struggling to conceive.

Will these clinics be the only providers of lower cost IVF in NSW? No. There are other lower cost options in the market including private centres that offer bulk-billing treatment.

Are gay and lesbian people eligible for the lower cost treatment? All women and men who are assessed by an IVF clinic clinician who determines that IVF treatment is clinically appropriate for them, are eligible for lower cost IVF treatment.

Is there an equivalent to this commitment other states or territories? There is no directly comparable investment by another government in Australia in lower cost IVF. Other related initiatives include:  The Victorian government committed $32 million in 2018 to set up and run low fee bulk-billing clinics, but this is yet to be rolled out  A public funded reproductive medicine clinic at King Edward Memorial Hospital in Perth is operating, but it has strict criteria including no previous children, age and weight restrictions and a one round limit

FERTILITY PRESERVATION SERVICE

What will the fertility preservation service provide? It will provide accessible and comprehensive fertility services to oncology patients as a state-wide service.

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Younger cancer patients can have sperm, ovarian tissue, eggs or embryos frozen and stored before undergoing chemotherapy or radiation therapy.

The side effects of chemotherapy and radiotherapy can leave cancer patients infertile, destroying a young person’s dream of one day starting a family.

How many cancer patients will benefit? It is estimated that around 150 patients a year will be given the hope of having a family after cancer treatment.

Does The Royal Hospital for Women already provide fertility preservation? The Royal Hospital for Women currently provides a limited service which freezes and stores sperm and ovarian tissue for a limited number of patients.

This investment will expand this service to open it up to patients state-wide. Also it will introduce cutting edge technology that enables the freezing and storing of eggs and embryos (as well as traditional sperm and ovarian tissue) to greatly improve their chances of having a healthy baby.

The Fertility and Research Centre will collaborate with other hospitals offering a fertility preservation service for cancer patients, including at Royal Prince Alfred and Westmead Hospitals, and will formalise existing informal pathways for state-wide access to fertility preservation.

There are a small number of private fertility centres that offer fertility preservation at a discounted cost for cancer patients.

Where will the fertility preservation service be located? At the Fertility and Research Centre at The Royal Hospital for Women.

It will be run in partnership with UNSW. The Sony Foundation has also donated $400,000 to the centre.

How will this benefit young cancer patients? Cancer treatment can render patients infertile, adding to the psychological and emotional burden of a cancer diagnosis and treatment.

There is usually only a small window of time to freeze eggs, ovarian tissue or sperm prior to a patient receiving potentially sterilising cancer treatment.

The new state-wide service will provide these patients with access to the latest technology, research and comprehensive ongoing fertility treatment to give them the best chance of having a family in the future.

What age group? Clinicians will determine whether the cancer patient, depending on their age and stage of reproductive development, would be able to benefit from the service.

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GENERAL

Why is the focus of the commitment on affordability and access? The initiative is designed to assist in reducing cost of living pressures faced by people with fertility issues who access treatment. IVF treatment can be expensive, as well as difficult emotionally. Before IVF treatment begins, women may pay hundreds of dollars in out-of-pocket expenses associated with pre-testing. The rebate will reach a larger number of people who access fertility testing and lower cost IVF will help those who need to access IVF treatment.

Has the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) been informed about this initiative? Yes. RANZCOG is aware and supportive of the implementation of this initiative.

Is this commitment similar to the Victorian Government’s election policy? The Victorian Government has also identified the need to support people with fertility issues who are wanting to start a family. The Victorian Government’s policy does not include pre-screening costs or fertility preservation for younger cancer patients.

What does this mean for research? Having Government-supported clinics aligned with a hospital and/or university means patients receive up-to-date, high quality fertility treatments at affordable prices.

It also increases the sector’s capacity to research and develop breakthroughs in the IVF treatment process.

What about patients in rural and regional NSW? Any eligible NSW resident can claim the Pre-IVF Fertility Testing Rebate. It doesn’t matter where in NSW – or Australia – they accessed the testing.

The digital claim process means people don’t have to travel to claim the rebate – just lodge their application using their computer or smartphones through Service NSW and then the rebate will be paid to their nominated bank account within five business days.

Any NSW resident can access the government-supported IVF clinics and the fertility preservation service at the Fertility and Research Centre. Their doctor simply has to refer them.

People based in a regional or remote location, may be eligible for financial assistance for specialist treatment under the Isolated Patient Travel and Accommodation Scheme (IPTAAS). For more information, visit www.health.nsw.gov.au/transport/Pages/iptaas.aspx

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