Is IVF really an elective procedure?

During Victoria’s moratorium on elective surgery this year, IVF treatments ceased, causing anxiety among patients. But should baby-making really be considered an ’emergency’ procedure? Body+Soul explores this emotionally charged debate.

What is going on?

When the Victorian government instituted a Pandemic Code Brown on January 19 in response to a rampant Omicron outbreak, it stopped all procedures considered elective surgery, including in-vitro fertilisation (IVF). A video of Victorian citizen Melanie Swieconek tearfully pleading with her elected representatives to change their position soon went viral. “I just wanted to let you know that this is something that not I elected to do [sic], and not one other person who is going through IVF… has elected to do,” she said.

While the government soon did a backflip, it raised the question of whether IVF should be considered an emergency procedure, and put ahead of elective surgeries such as hip replacements and tonsillectomies.

So what does elective surgery really mean?

The Victorian Agency for Health Information refers to elective surgery as “necessary surgery that can be delayed for at least 24 hours”. Although one of the three sub-categories is “urgent”, indicating a patient may deteriorate quickly, “elective, in medicine, means scheduled. It’s not an emergency,” explains the medical director for City Fertility NSW Dr Devora Lieberman. “There were cancer surgeries that were cancelled during that Victorian brown-out of medical services as well.”

Even so, “I have huge empathy and sympathy for the women going through IVF treatment,” she says. Research done in the US last year, where doctors held off on cycles, showed “there was actually no difference in the take-home baby rate after a delay of one to three months”.

While “women may feel that every month is their last month”, Lieberman adds, “the reality is that a couple of months won’t make a difference to their ultimate outcome”.

Does that mean that IVF is not essential?

IVF may not be a minute-to-minute health emergency, but “the option for a woman to do IVF is definitely essential as everyone should have the freedom to choose if they want to have their own child,” says How To Stay Sane On The Baby Making Train author Bernadette Andrews, who spent 16 years trying to conceive.

Dr Matt Vickers, clinical advisor for tele-health platform Kin Fertility, agrees that IVF services are an essential part of women’s health but stops short of suggesting the “elective” title be changed. “The distinction between accessibility and the terminology used by public health departments may not correlate directly with the view on its importance,” he says.

“Of course there are time-critical elements of IVF treatments and we should review decisions that affect accessibility,” he explains. “However, I don’t believe it is as black and white as classifying medical procedures into elective versus essential.”

Why is IVF so integral in women’s health these days?

The fertility rate (number of babies born) for younger age groups “is falling, while the 40- to 44-year-old age group has seen a tripling of births over recent decades”, says Vickers, citing recent Australian Bureau of Statistics data.

Andrews, who was 31 when she went through IVF, wants to raise awareness around infertility in younger mothers. “The idea that IVF is only needed because ‘women wait too long’ is completely absurd and out of touch with current reality,” she says. “Yes, the average age of first-time mothers in Australia increased from 27.9 years in 2009 to 29.4 in 2019; however, medical fertility issues arise equally in both males as to females.”

For aspiring parents “IVF can certainly be quite mentally taxing”, Lieberman adds. “The stress and trauma of couples going through fertility treatments has been equated to the level of trauma that people going through cancer treatments experience.”

For aspiring parents, IVF can take a toll on their mental health. Image: Getty

Accessing IVF on Medicare

For a patient deemed “medically infertile”, IVF is covered under Medicare and is not means tested, meaning the rebate is available to everyone with a Medicare card. There is no cycle limit and the gap depends on which provider you go with and if you have any private cover.

There is also a “safety net” where you get more money back from Medicare when you reach a certain amount of gap payments (more than $2k in 2021); however, there is a cap for this extra payment in relation to IVF.

But there are notable exceptions. Dr Devora Lieberman says there is no Medicare rebate for those without the infertility diagnosis, which includes single women, female same-sex couples, and surrogacy (also used by male same-sex couples).

Article originally published in Body and Soul