ASRM Today: International Perspective on Reproductive Rights and Issues

In today’s episode, we continue our season-long examination of reproductive justice and reproductive rights—issues that remain at the forefront of clinical care, public policy, and patient advocacy. For our season finale joining me today is Dr. Alison Gee, a reproductive specialist working in Sydney, Australia to give us an international perspective on the impact of the recent ASRM definition of infertility, and other areas of reproductive issues. 

Welcome to ASRM Today, a podcast that takes a deeper dive into the current topics in reproductive medicine. I'm Jeffrey Hayes. In today's episode, we continue our season-long examination of reproductive justice and reproductive rights.

For our season finale, joining me today is Dr. Allison Gee, a reproductive specialist working in Sydney, Australia, to give us an international perspective on the impact of the recent ASRM definition of infertility and other areas of reproductive issues. Here is my interview with Dr. Gee. In Australia, what are the biggest barriers patients face when trying to access reproductive healthcare or is there large barriers? Look, I think in every country there's going to be barriers to accessing reproductive healthcare and it's very much dependent on a number of factors.

It's funding, it's location, we have a big country, particularly in Australia, to get to centres that provide assisted reproduction. We did, up until recently, have even more barriers to fertility and to reproductive services based on what was a classic definition of infertility. Just to give you a bit of a background, in Australia, the Australian government actually supports Australians to access very high quality and affordable healthcare by providing free and subsidised healthcare services, depending on location and the services being provided.

What this does, it provides Medicare benefits or rebates for privately rendered services on our medical benefit schemes and that includes assisted reproduction. Up until recently, those benefits were provided on the basis of a classic definition of infertility, as this is very important for patients trying to access reproductive services. That classic definition of infertility, which you'll be aware, was World Health Organisation described as a disease of the male or female reproductive system, defined by failure to achieve their pregnancies after 12 months or more of regular unprotected intercourse.

That definition was then further defined to say, 12 months if you're less than 35 years of age and you're over six months would be a reasonable thought to look towards treatment. This was actually the definition underpinning the rebate for those services for reproduction in Australia. It actually predates the SRM revised definition of infertility, but in 2022, a group of medical directors, the IVF medical directors group, which is part of the Fertility Society of Australia, it did a paper of the review of the status of Medicare rebates for those who access donor sperm to achieve a pregnancy.

Because you can see from that definition, it is excluding solid parenting, same-sex couples, single women accessing donor sperm. That was endorsed by the Fertility Society of Australia and the College of Obstetricians and Gynaecologists. But it didn't go very much further after that was put to the government.

And as you know, ICMART had updated its definition of infertility and that dated back, I think, about 2017. And that did have some provisions, obviously, for what we might say is more a circumstantial infertility. You know, are you in a same-sex relationship, you're looking at female solid parenting.

And so then in 2023, the ASRM put out a very considered revised definition of infertility. Yes. And that was 2023.

And so we had a look at that at the Australian Society for Reproductive Endocrinology and Infertility Specialists. So that's a subgroup of subspecialists. And we have a society that, you know, have an annual meeting.

And so it sits aside from the Fertility Society of Australia and New Zealand. And the president at that stage, Louise Hull and I, had a good look at this. And then we went back and looked at how we fund, how do we get equitable access for everybody in terms of our Medicare system.

And what the Medicare system provides for you is that to get a medical rebate, it must be a clinical relevant service. But interestingly, the clinically relevant service is one which was generally accepted in the medical profession as being necessary for the appropriate treatment of the patient to whom it was rendered. So what, after reading that, and we did have the benefit of, I had the benefit of reading a legal opinion from a lawyer in Queensland who does a lot of surrogacy work.

And after reading that, what it became apparent to us is that we as a medical profession, much like the ASRM, needed to update our definition of infertility. And that needed to be widely accepted by the profession. And to do that, the Australian New Zealand Society for Reproductive Endocrinology and Infertility Specialists went back to the Fertility Society of Australia and New Zealand and the Royal Australian College of Obstetricians and Gynaecologists and said, and prior to doing that as an executive group, we had made that decision to adopt the ASRM definition of infertility.

And we took that back to the other professional bodies in Australia. And they also agreed that that was a very thoughtful, considered and appropriate definition of infertility. And it really reflected the way that we practice in 2024.

And so with that, that then went obviously to our annual meeting and a decision was made to create a consensus statement of these three peak professional bodies who look after patients in Australia and actually New Zealand for reproductive services. And that consensus statement was then agreed upon. It was published.

We had some media on that. But more importantly, that consensus statement went back to our government, to the federal government and to Services Australia to say that, well, actually, we have updated our definition of infertility and that should be reflected in the Medicare rebates for assisted reproductive technology. We had a meeting in July.

We put out a media release in August and we deferred to the government. And very pleased to say, Geoffrey, that in March of this year, we had confirmation from the Australian government that they had accepted that expanded definition of infertility as per the consensus statement of the three peak professional bodies. And we also had support from other groups, you know, rainbow families in Australia.

And I think this is a long awaited definition, expanded definition. Also on that note is that the Department of Defence runs a separate department for our Defence Force. And one of our Queensland fertility specialists, Dr. David Malloy, has been very instrumental in assisting with the changes, was also able to work with them to ensure that those changes are occurring just not only with our Medicare rebates, but also for our Defence Forces in Australia as well.

And so we thought that was a really wonderful outcome and really reflected a much more equitable platform for all of our patients that we see. There is an outstanding though, Geoffrey, in the fact that, interestingly, surrogacy is still not covered. There's a particular provision in our rebates that does not allow for Medicare funding or rebates for patients looking at surrogacy or undertaking surrogacy arrangements.

And so that is now something and that needs to go through a separate pathway for us to get that changed. And that is sort of our next area that we are hoping that government will look towards. And I suppose, I guess a little bit of a lobbying never helps, always helps.

So that's the only outstanding that we felt we still not, where we would like to be in terms of that equitable access to reproductive services for patients seeking surrogacy arrangements for all the reasons that patients may be seeking those arrangements across all of the patients that we see. Is there a large divide between rural or remote areas as far as... I was just going to mention that, I mean, so that was sort of our big change in terms of access in Australia. Australia, as you know, look, we have a lot of region, rural and regional centres.

And by and large, probably perhaps like in the States, the assisted reproduction services are generally based in the more populated centres. And we have a mix of both private and public access in most, but not all states in Australia. So we have a public hospital system, patients can access services through there, which is generally by and large covered through the Medicare with little out of pocket.

We have private medical services, which will get a part rebate through our government and there'll be a private co-payment. And obviously, the very large public hospitals are located in the public, you know, by and large in the public cities, and the smaller regional hospitals don't, you know, have the funding to support assisted reproduction services. So I think there is a divide.

What I would say is that that has become, access has become a lot more affordable through telehealth. So patients are now able to access telehealth consultations. A lot of the investigations can be done at their regional providers, if patients undergoing assisted technology, IBF, a lot of, you know, the monitoring can be done in regional centres.

The government does provide some funding for patients for cost of travel, so travel reimbursements, if they don't have services that are available within their regional area. But as you know, assisted reproduction, it may take, you know, many goes to attempts to achieve a positive outcome for some patients. And that certainly takes its toll when you're travelling, you know, hundreds of kilometres distance to access services.

So I think it's not a problem that's unique to assisted reproduction. It's a problem that is across the board in medical services in Australia, is that the distance in regional centres is very wide. And that's always going to be a barrier for whatever services are being offered medically.

Yes. So, you know, the emergence of telehealth, of course, has expanded areas greatly. Have patients come to you or to others and talked about still having access challenges? Look, I think most regional patients will acknowledge and most specialists acknowledge that they do have access barriers.

And even doing a telehealth is not as personal as sitting down with a patient or a couple and going through their issues. So it is, I think, to a degree, less personal. They're having to navigate, you know, where they can get ultrasounds or blood tests or in a particular unique test that they need to have done in a remote and rural centre.

You know, we might say, look, I might say to a patient, I think you may have endometriosis. And where do they get the new ultrasounds to look for deep infiltrating endometriosis? Now, where they're in a rural centre, you know, 200 kilometres from the nearest major city. And so I think there is still, you know, I think everybody will acknowledge that regional remote patients in Australia are looking to access fertility services, but still have barriers despite telehealth.

Yeah. And from your perspective or even in your opinion, what would you say? How well informed are patients about their reproductive rights? Does it come from mainly providers or does it come from some other sources? Look, I think these days it comes from mixed sources. And I think the fact that we're also doing this podcast tells us that a lot of patients are getting, not patients or individuals, are getting information about reproduction from social media, from podcasts, perhaps not from the traditional pathway of a general practitioner.

In terms of looking at equitable access to information, I think a lot of younger individuals are looking to those sources because access is sometimes difficult. Sometimes the difficult conversations to have with medical practitioners, particularly in a remote area with only one or two general practitioners, you know, that may not have an interest area in sort of, you know, reproduction, you know, women's health, men's health. It does make that provision of information more difficult.

I think individuals have a lot more access to information because of the Internet, because of social media. And I think it's up to also groups. And I think fertility and sterility does it very well to provide that information.

You know, you have a lot in front of the wall that provides good information, podcasts, individual clinicians who have some very informative either podcasts or Instagram. So I think a lot of patients are getting information from those providers now. But it's very important that as professional bodies, we ensure if that's a platform that the younger generation is looking at, that we need to be providing really good, informative information on that platform, as well as informing our general practitioners, specialists with information to provide to individuals that are looking for reproductive information.

I think reproductive autonomy is growing. I think there are a lot of more younger women are freezing eggs. There's a lot more information about that.

It's important that we're providing good information also on those topics. Similarly, for men, there's a lot more information on men's health now on many different platforms, ageing, the ageing male profile, its effect on reproduction. So I do think that individuals have a lot more access to information and access about reproductive autonomy.

And I think largely that's been driven by the Internet and to a degree, social media. And I think that professional bodies and professionals have a responsibility to ensure that the right information is also being put out on those platforms. What world does contraception play? Is it is it in is there information in schools or is it more community based or? So most schools run programs in terms of sexual health in both primary and high schools.

So I think in Australia, the information is generally well provided in most communities. And, you know, what we are seeing in Australia or I certainly am in my practice is a lot of women coming in in their 30s saying, look, Alison, we were provided with so much information on contraception and not to get pregnant. But now we find ourselves in our 30s and now we're sort of looking at achieving pregnancy.

So I think that that information is on a lot of platforms provided. Well, look, it's probably never provided well enough to every individual, but certainly, you know, we have our contraceptive also covered with our Medicare funding as well in Australia. So contraception is well funded for the medical benefits scheme.

Generally, general practitioners are well informed. You know, they're well trained in Australia. So I think a lot of information on contraception is is available to Australians in 2025.

Wonderful, wonderful. Well, I want to thank you so much for taking time out of your day today to answer some of our questions. This has been absolutely enlightening.

And just again, thank you so much for being here. Well, thank you very much, Jeffrey, for having me. It's been a real pleasure.

That was my interview with Dr. Alison Gee. Thank you for joining us for this episode of ASRM Today. For more information on ASRM's education, advocacy and clinical resources, visit ASRM.org or subscribe to stay updated on future episodes.

Until next time, I'm Jeffrey Hayes and this is ASRM Today. This concludes this episode of ASRM Today. For show notes, author information and discussions, go to ASRMToday.org. This material is copyrighted by the American Society for Reproductive Medicine and may not be reproduced or used without express consent from ASRM.

ASRM Today series podcasts are supported in part by the ASRM Corporate Member Council. The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates. These are provided as a source of general information and are not a substitute for consultation with a physician.