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Assisted Reproductive Technologies Review.

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MEDIA RELEASE Minister for Health and Ageing

Tony Abbott MHR

29 November 2006 ABB156/06

Assisted Reproductive Technologies Review

The Government has released the Report of Independent Review of Assisted Reproductive Technologies along with its response.

The report was produced by an independent committee chaired by Professor Ian Fraser, Professor of Reproductive Medicine in the Department of Obstetrics and Gynaecology at the University of Sydney.

The Government has accepted most recommendations. The key findings of the report were that:

• both clinicians and patients would benefit from national accreditation of ART practices, underpinned by evidence-based guidelines; • patients should be better informed about the risks and benefits of different procedures, and that advertising by ART clinics should describe success rates in a simple and

uniform manner; and, • Intracytoplasmic Sperm Injection (ICSI) should be publicly funded.

Although it has decided not to limit funding for ART by maternal age or the number of cycles, the Government strongly supports the use of evidence-based practice by clinicians in determining what services are provided. It is clear that some services do not have good success rates for all people. It is better that both patients and their doctors understand the risks and benefits of different treatments before deciding what to do.

The report also found that the Extended Medicare Safety Net has significantly improved the affordability of ART for Australian families.

The changes outlined in the Government’s response will ensure that affordable, safe and high quality ART services will continue to be available to Australian families and that clinicians are supported in delivering these services.

I would like to thank Professor Fraser and each of the committee members for their consideration of these issues.

The Report of Independent Review of Assisted Reproductive Technologies and the Australian Government’s response are available at:

Media Contact: Claire Kimball, 0413 486 926


Independent Review of the

Assisted Reproductive Technologies Review Committee

Assisted Reproductive Technologies (ART) refers to a range of techniques and services i.e. not exclusively in vitro fertilisation (IVF), which are performed by specialist medical practitioners to assist people who are having difficulty naturally conceiving and carrying a baby to full term. ART has now replaced the term IVF.

The ART Report defines ART as the application of laboratory or clinical techniques to gametes and/or embryos for the purposes of reproduction. ART can involve many different medical procedures, using differing paths to conception.

The range and number of Medicare items claimed for treatment cycles will differ however, the Medicare item associated with the planning of an ART cycle is used as a reliable indicator that a woman has commenced an ART cycle, and to determine the number of cycles patients undergo and the outcomes of treatment.

How does the Government provide funding for ART?

In the 2005 calendar year 27,663 patients benefited from 182,834 ART services.

In 2003, the Australian Government provided $50 million under Medicare for ART services, increasing to $78.6 million in 2004.

For 2005 only, Medicare expenditure for ART services continued to increase, but at a slower rate, with expenditure of $108.4 million, representing a 38% increase in expenditure from 2004 to 2005.

Calendar Year Expenditure under Medicare ($ million)

2000 $39.3

2001 $43.3

2002 $46.0

2003 $50.0

2004* $78.6*

2005 $108.4

*Extended Medicare Safety Net introduced in March 2004.

Will IVF treatment continue to be subsidised through Medicare?

Yes. The Government will continue to offer Medicare rebates for IVF and all forms of Assisted Reproductive Technologies (ART) treatment through Medicare.

Will the Government restrict access to ART services?

No. The Government does not intend to restrict access to ART services either on the basis of maternal age, or number of treatment cycles.

What were the major findings of the ART Review?

The key findings of the ART report seek to improve the clinical and cost-effective delivery of publicly funded ART services. A copy of the ART Report is available at:

The ART Review Committee made 13 recommendations which are directed to the Commonwealth, clinicians and ART peak bodies. The key recommendations relate to: • Accreditation - introduction of a national accreditation system for ART clinics;

- updating of Clinical Practice Guidelines on which accreditation will be based; and - linkage of access to Medicare for ART services to accreditation. • An education campaign to raise awareness of factors associated with infertility; • Improvements in ART data collection and reporting; • Restructuring of the ART section of the Medicare Benefits Schedule (MBS) to better reflect current clinical practice, including the development of MBS items for Intracytoplasmic Sperm Injection (ICSI) and associated surgical sperm retrieval procedures.

What is the Government’s response to the ART Report?

The Government’s response to the ART Report is available at:

The Government broadly supports the key findings of the ART Review Committee but does not intend to restrict access to ART services on the basis of maternal age or by the number of cycles or treatments.

Why has the Government taken so long to prepare its response?

ART involves sensitive and complex issues. The issues raised by the ART Review Committee therefore required careful consideration within Government and particularly in regard to the use of evidence-based clinical decision making.

The Government is supportive of most of the recommendations, in full or in part, but will not be limiting ART treatment by maternal age or number of cycles or treatments.

Is there anything in the response that will improve the affordability of ART?

The Government has indicated that it is broadly in support of the ART Review Committee’s recommendations.

Medicare benefits will continue to be paid for ART treatments and the Extended Medicare Safety Net will continue to benefit patients who reach thresholds in out-of-pocket costs.

Intracytoplasmic Sperm Injection (ICSI) will be included in the update of existing ART items in the MBS advocated by the review, thereby permitting funding of a procedure not previously covered by Medicare.

Does the Government intend to impose any restrictions on doctors who provide ART treatment?

No. The Government seeks to promote and support evidence-based decision making by clinicians.

Why did the Government commission the independent review of ART?

It was timely that a comprehensive review was conducted, given that ART is a rapidly changing area of health technology with significant changes occurring in clinical practice and indications for treatment.

How long has the Government funded ART treatment under Medicare?

ART items were introduced to the MBS in 1990.

What evidence did the ART Review Committee consider?

The ART Review Committee reviewed the most recent national and international evidence to advise the Australian Government on appropriate funding for ART. Research and evidence-based literature reviews were conducted to produce evidence-based clinical and cost effectiveness analyses for the ART Review Committee’s consideration.

Did the ART Review receive submissions?

No. The ART Review did not receive submissions. The ART Review Committee did consult with key consumer and professional stakeholder groups.

Who was consulted in the review? The ART Review Committee consulted with representatives from: - ACCESS Australia - the peak ART consumer group; - the IVF Directors Group;

- the Fertility Society of Australia; - the Australian Institute of Health and Welfare; - several jurisdictional ART advisory bodies; and - international public health advisers.

Did the ART Review consider regulation of ART?

No. The regulation of ART services is a state and territory responsibility.

Will the government be amending eligibility for ART to allow same sex couples to access Medicare funding for these services?

No. There will be no changes to eligibility criteria for ART services provided under Medicare.

What were the restrictions bought in under the Labor Government?

A six-cycle limit on Medicare claims for stimulated ART treatment cycles was introduced in 1990 at the time the ART items were introduced onto the MBS. The six-cycle limit was removed in 2000.

Why were the restrictions removed?

Very few couples had been shown to either want or need more than six treatment cycles. The considerable psychological stresses associated with ART resulted in very few couples undertaking more than six cycles and so there was no need to restrict the number of treatment cycles.

Who were the ART Review Committee members?

Professor Ian Fraser (Independent Chair) Professor Reproductive Medicine, Department of Obstetrics and Gynaecology University of Sydney

Professor Peter Illingworth Director, Reproductive Medicine Westmead Hospital, Sydney

Ms Bettina Arndt Feature writer, Australian Consolidated Press Regular speaker, ABC radio (Sydney, Melbourne and Canberra)

Dr Therese McGee Head, Department of Obstetrics and Gynaecology Westmead Hospital, Sydney

Dr Andrew Pesce AMA Representative Obstetrics and Gynaecology Services Westmead Private Hospital, Sydney

Professor John Horvath Chief Medical Officer Department of Health and Ageing, Canberra