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Beginning the journey of private fertility treatment, my wife and I were in disbelief when we discovered a technicality that cost us an extra few thousand dollars. LGBTQIA+ couples and single parents are considered “socially infertile” — meaning we lack some of the ingredients or equipment required to reproduce and have to jump through hoops to access Medicare rebates for assisted reproductive technology (ART).

ART is a growing industry in Australia. In 2019, there were 81,049 in vitro fertilisation (IVF) cycles started in Australian fertility clinics, an increase of 6% from 2018.

Patients only qualify for Medicare rebates for ART if their fertility specialist diagnoses them with medical infertility, which is at the doctor’s discretion. My fertility specialist advised me that I would have to undergo two rounds of intrauterine insemination (IUI) and fail to fall pregnant afterwards in order to be eligible for Medicare ART rebates. An IUI might be cheaper than IVF, but two rounds of IUI cost close to the amount of the Medicare rebate for a round of IVF. This impacts many people trying to conceive through ART, but has particular consequences for LGBTQIA+ and single people.

ART is expensive, even with Medicare rebates or access to public services, and is stressful, time-consuming and occasionally degrading. As author Jasper Peach writes in their recent book You’ll Be a Wonderful Parent: Advice and Encouragement for Rainbow Families of All Kinds:

Conception via assisted reproductive technology is forging your family through fire. The process and its impact on everyone involved is not to be underestimated. My wife bore the physical and hormonal brunt of IVF, and we clutched one another for dear life throughout. Along the way we faced police checks, blood screening for both of us (with no clarification offered as to why my blood was needed too), and counselling to determine if we would even be approved, both for us as a couple and for our donor. We were labelled geriatric, bariatric, socially and psychologically infertile, and countless other derisive things that have fallen through the cracks of memory.

The prejudice evident in Australia’s ART services is the shameful legacy of the Howard government (with Tony Abbott as health minister) and is long overdue to be amended. Decades later, those of us considered socially infertile continue to reckon with the consequences.

I know couples and individuals who have gone into debt to access private fertility treatment. Some were able to access the “bank of mum and dad”, and some paid for fertility treatment with an early release of super. Some sourced sperm via a Facebook group and encountered varying issues — from men who insisted on “natural” insemination to those who donated their sperm widely, far beyond Victoria’s limit of 10 families per donor or New South Wales’s limit of five per donor, which can have intense consequences for the children.

While there are national guidelines and a national accreditation scheme regulating ART, four states have their own regulatory frameworks (New South Wales, South Australia, Victoria and Western Australia). Due to the inconsistent approaches to ART across the country, progress towards equitable and affordable ART access is mixed in Australia.

In 2022, Victoria introduced public fertility care services, which include IUI, IVF, altruistic surrogacy services, fertility preservation, genetic testing, and a public sperm and egg bank. These services are now being scaled up across the state, which, understandably, is in high demand. Patients are limited to two cycles in their lifetime.

New South Wales is offering a rebate of $2000 to 12,000 eligible patients who have undergone ART in private fertility clinics from 1 October 2022. Another 6180 patients will be able to access publicly supported IVF treatment from June 2023.

After South Australia passed a bill in 2017, allowing LGBTQIA+ couples to access ART and altruistic surrogacy, it is just Western Australia and the Northern Territory that require those accessing IVF to be medically infertile. LGBTQIA+ couples have allegedly been denied treatment for this reason in the Northern Territory.

LGBTQIA+ people are able to seek surrogacy arrangements in New South Wales, Queensland, South Australia, Tasmania and Victoria. In the Australian Capital Territory, the Northern Territory and Western Australia, the laws are murkier — in some, only heterosexual couples are eligible to access surrogacy; in others, only heterosexual couples and single women.

With some states and territories far behind the rights and resources available in others, it’s clear that there is much that needs to be updated in policy and legislation.

For couples and individuals who may not be able to conceive any other way, the inequity and inaccessibility of ART prevent people from having options and rights that other people have, which is the definition of discrimination.

I am filled with gratitude for my family. Our baby is priceless. My wife and I were able to handle the cost, financially and emotionally, but we need policy change to make sure this is the case for everyone who wants to start a family.