Cassie Van Swol and her husband, Steven, spent $40,000 and took out a second mortgage chasing the promise of parenthood.
“The whole time they kept telling me, ‘We’ll just get you pregnant,’” she says of their privateIVFprovider.
“But the thing about IVF is there’s no just ‘getting pregnant’. Every round is just heartbreaking, jumping through these hurdles, hoping for a good outcome and not knowing if it’s ever going to happen for you.”
After four “financially draining” rounds, the couple could no longer afford private care and underwent two additional rounds at Victoria’s public fertility service.
Doctors at Melbourne’s Royal women’s hospital looked at their medical history and found that theendometriosisCassie had previously been told “shouldn’t affect” her fertility was doing just that.
They ended up taking a different approach and the couple conceived their daughter, Xena – named after the warrior princess and born on Valentine’s Day.
“Xena is an absolute miracle,” Cassie says. “Sometimes I look at her and I just honestly can’t believe how we got so lucky.”
Amid the fallout ofbungles at Monash IVF, Cassie – who wasn’t a patient of the private provider – is part of a growing chorus of Australians calling for fertility care to return to public hands, where it all began nearly five decades ago.
Australia’s first baby conceived through in vitro fertilisation, Candice Elizabeth Reed, was born on 23 June 1980.
Dubbed “Australia’s first test tube baby” and the “million-dollar baby” by the Australian Women’s Weekly, Reed was the culmination of a decade’s research and work at the Royal women’s hospital, the Queen Victoria medical centre, Melbourne University and Monash University.
The Weekly reported that the program was at risk of closing down because it was running out of funds, with researchers seeking donations to keep going.
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A Royal women’s hospital obstetrician, Ian Johnston – part of the team who delivered baby Candice – thought the fertility treatments they had developed were “potentially enormous” and could ultimately help as many as 70,000 infertile Australian women.
He wasn’t exaggerating. In 2022 alone about 20,000 babies were born in Australia and New Zealand thanks to assisted reproductive technology.
Forty-five years on from that birth, IVF isbig business. Australia’s 100 or so clinics are mostly privately owned and operated, and access often depends on what patients can afford.
IVF costs up to $10,000 out-of-pocket for each cycle, with the price varying dramatically across clinics and depending on the treatments needed. Patients require an average of three cycles.
“All of the fertility treatment started off in the public women’s hospitals and was to a certain extent publicly funded,” says Dr Manuela Toledo, the medical director of TasIVF and a board member of the Fertility Society of Australia and New Zealand. “Then, after the success of the first IVF births around the world, groups split off and formed the private clinics.
“What’s happened now is that IVF is in such high demand … every classroom at the moment has a child there as a result of IVF. One in five couples are now experiencing infertility and we need to understand that this is the new normal.”
That shift has raised concerns about how people, desperate for a child, are being treated.
There are worries that success rates are inflated, that non-evidence based “add-ons” are being sold. And the expense makes it inequitable.
Errors – at Monash IVF there have been two separate cases of the wrong embryo being implanted – have further shaken public trust.
Now state and federal governments are examining the fertility industry’s underpinnings, with a “rapid review” looking at establishing consistent national rules and an independent accreditor.
“We need to inject some confidence and independence and transparency into that system,” said the federal health minister, Mark Butler.
The Monash IVF mistakes may have sparked the review but its outcome could have much broader implications, including better and more affordable fertility treatments and a renewed focus on public funding.
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“What will improve the birthrate in the long term are publicly funded IVF clinics, so patients can access them based on their need,” Toledo says. “We know there’s a lot of individuals and couples out there who will never see the inside of an IVF clinic because they can’t afford it, and that is not right.”
And “the fact that people are accessing their superannuation … sends a very clear message that there needs to be more public funding”.
The number of applications to the Australian Taxation Office for super to pay for IVF has been rising, from 3,380 in 2018-19 to 5,200 in 2023-24. Of those 5,200, 4,210 were approved for 3,460 individuals (each new cycle needs a new application). Individuals withdrew an average of about $18,500.
“The psychological impact of not being able to conceive can be significant and it’s unfair that some women are being forced to decide between their wellbeing in retirement and their health today,” says the Super Consumers Australia chief executive, Xavier O’Halloran.
A range of third-party service providers now exist to help patients, for a fee, access their super.
O’Halloran warns people to look out for other costs such as taxes, which are typically between 17% and 22% on an early withdrawal, as well as the compounding impact of that withdrawal on the eventual retirement amount.
The Fertility Society of Australia and New Zealand has a 10-year roadmap for a sector overhaul, written by Greg Hunt, a former Coalition health minister, and Rachel Swift, a healthcare consultant and former Liberal candidate.
It notes that as the age of hopeful parents keeps going up, so too will demand for medical help, and calls for uniform laws, a national fertility plan, an independent accreditation authority with a formal complaints process, and real-time reporting systems for adverse events and complications.
It highlights that publicly funded IVF is “limited and inconsistent” and economic barriers could be reduced by setting up more public units, or by providing a low-income subsidy to be redeemed through private clinics.
There are some Medicare and pharmaceutical benefits scheme rebates for IVF. Some states, including New South Wales, provide additional rebates.
Victoria has gone further, launching itspublic fertility servicein 2021. So far it has treated 5,000 Victorians free of charge, with priority given to low-income families, regional patients and those needing fertility preservation due to illness.
“We wanted to ensure that decision to start a family was not made because of where you lived or because of how much was in your bank account,” says the state’s health minister, Mary-Anne Thomas.
Instead of subsidising “a very profitable public sector” via rebates, she says, the service builds expertise and capacity in the public system. It’s “not in the business of upselling” and seeks to try the “least-invasive treatments first”, which Thomas says “may not always happen in the private system”.
Despite this progress, much of Australia still lacks accessible public fertility care.
For Cassie, the contrast between the private and public systems couldn’t be clearer.
“In the private system it felt transactional,” she says. “They never told us we had about a 20% chance [of conception]. It was just ‘try again next month’.
“But not everyone can do that – not everyone has the ability to spend massive amounts of money.”
The public system “took extra time”, she says. “They knew we had only two rounds with them and they wanted to make it work.
“I’m so grateful. They gave us our baby.”