Public Funding for Fer0lity Dr Olivia Stuart Fer.lity Specialist
Initial Fertility Consultation Fer.lity specialist • Public • Private
Private consultation option • Pa.ents can self refer • Pa.ents can choose their fer.lity specialist • No mandatory tests required pre-‐referral • Fer.lity Associates’ specialists can see new pa.ents within 2 weeks in all our clinics • consulta.on, scan, organise all their tests, assessed for public treatment, nurse
Public consultation • Condi.ons apply • Referring doctor needs to do a preliminary workup • Wait .me 3-‐4 months • Randomly allocated to one of 3 Auckland units, no choice
Eligibility criteria for public consultation NZ residency Both partners must have • NZ residency, citizenship or • Work visa showing at > 2 years
Additional criteria for initial consultation
Work-up tests for initial consultation Female
Male
Day 2-3 FSH Oestradiol
Semen analysis
Hepatitis B,C HIV syphilis rubella
Hepatitis B,C HIV
Blood Group FBC Smear Day 21 Progesterone
Publicly funded treatment • Clinical Priority Access Criteria (CPAC) form • Criteria are the same across New Zealand • People need > 65 points using the fer.lity CPAC scoring tool • Score > 65 means eligible • All have same wait .me .l treatment • The CPAC score can only be calculated by a fer5lity specialist.
CPAC Form
6
> 65
Couple A – Unexplained Infertility 10 10 1 50 30 20 6
100
Couple B – Male vasectomy 10 10 1 40 30 10 6
80
Couple C – Same sex couple 10 10 1 20 30 20 6
70
Waitlist for treatment • The wait to treatment varies across the country • Generally 12–18 months • Pa.ents can access private fer.lity treatment whilst on the public wai.ng list
Second publicly funded packages
• • • • •
Requires rescoring All same eligibility criteria apply S.ll need CPAC score > 65 wait .me less Same unit
Treatment pathways to having a baby‌
All public… First Appointment Public ($0) 6 Months
Laparoscopy Public ($0)
Couple Start Trying
3 Months
12 Months
See GP
6 Weeks
Follow Up Public ($0) Need IVF 6 Weeks
Funded Appointment FA ($0) 12 Months
Funded IVF ($0)
• Do everything Publicly Funded • Total Cost $0 • Total Time from GP to IVF – 24 months
Public and private 1… Couple Start Trying
First Appointment FA ($270)
12 Months
See GP
Laparoscopy Public ($0)
2 Weeks
6 Months
2 Weeks
Funded IVF ($0) 12 Months
Follow Up Private ($165) Need IVF
• 1st Appointment in Private then Lap and IVF Public • Total Cost $435 • Total Time GP to IVF – 19 Months
Public and private 2… Couple Start Trying 12 Months
First Appointment FA ($270) 2 Weeks
Laparoscopy Public ($0)
See GP 6 Months
2 Weeks
Follow Up Private ($165) Need IVF 4 weeks
• 1st Appointment in Private then Lap in Public and IVF Private • Total Cost $10435 • Total Time GP to IVF – 8 Months
Private IVF ($10,000)
All private… Couple Start Trying 12 Months
First Appointment FA ($270) 2 Weeks
See GP
2 Weeks
Laparoscopy Private (? Insurance) 2 Weeks
• 1st Appointment in Private then Lap and IVF Private • Total Cost $10435 +/-‐ Lap cost (insurance) • Total Time GP to IVF – 10 weeks
Follow Up Private ($165) Need IVF 4 weeks
Private IVF ($10,000)
On the horizon… • Male smokers • Unexplained infer.lity for > 3 years in > 36 year old women • BMI < 36
Ques0ons?