REPORTS OF FERTILITY SOCIETY OF AUSTRALIA CONFERENCE
28-31 OCTOBER 2012
John Angus (Chair) and Nikki Horne attended the conference on behalf of ACART.
John was also a presenter. Betty-Ann Kelly from the Secretariat also attended.
John, Nikki and Betty-Ann have each provided reports.
John Angus, Chair of ACART
Introductory comments
I attended the conference on the Monday, Tuesday and Wednesday, going to all the
plenary sessions and several of the concurrent presentations. It was a large
conference with many delegates from Australia.
Presentation on NZ regulatory framework
I presented a short paper in one of the concurrent sessions on some reflections on
the current New Zealand regulatory framework for ART which was well received by
an audience of 30 - 40 attendees. A copy is attached.
Transborder reproduction
I co-chaired one of the livelier sessions at the conference on Transborder
Reproduction, which featured presentations from clinic representatives from the
USA, Spain and Australia, and a New Zealand barrister, Margaret Casey. The
session engendered considerable discussion about the provision of identifying
information to children and young adults about their genetic parents, which is
prohibited in Spain, voluntary in the USA and required in most Australian
jurisdictions.
Margaret Casey provided a case-based paper on the legal perils of transborder
reproduction, in particular surrogacy. One case involved a New Zealand couple
whose child, when DNA tested, revealed no genetic link to them or their donor,
despite the couple having proved an embryo to the clinic involved.
Other papers of interest to ACART
The plenary papers included:

an interesting survey by Dr Wayne Gillett of New Zealand’s contributions to
infertility treatment

John Peek on the development of public funding and the formulae he
developed with Wayne Gillett that is used to determine service priorities

an Australian health economist’s ( Dr Georgina Chambers) findings on value
for money in Australia which demonstrated that, using common dollar values
on the value of a life, ART was an effective use of public money
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
an interesting paper on the social and family impacts of infertility (Dr
Christianne Verhaak from The Netherlands) which found that 70% of those
treated coped well, 20% had some mild distress, and 10% severe; that it
could be predicted; and that extra support should be offered

Dr Ana Cobo from Spain who demonstrated that at the clinic in which she
worked, vitrification of oocytes (rapid freezing) was leading to high success
rates for thawing (93%). The paper also noted the use of oocyte freezing for
social purposes (delaying reproduction while increasing the chances of a
positive outcome: 15% in her sample).

Dr Richard Scott from New Jersey on PGS testing of embryos showing
advances in knowledge of the causes of infertility and of problems in ART.
The concurrent papers I heard included:

Rachael Varady on a Victorian surrogacy programme (have to apply through
Patient Review Panel; includes criminal and child protection checks; do not
use surrogate’s eggs; and do independent psychological tests). The sample
included 3 same sex couples, 12 pregnancies.

Sam Everingham of Surrogacy Australia on Australians’ use of commercial
surrogacy overseas. Used 2009 survey data of 217 users; 53 % homosexual
(mostly male couples and singles); well off; hetero couples had all had 3 years
plus local treatment. Used USA and India clinics – big growth in latter
because cheaper at $77,000 c.f. $176,000; much higher success rates than
local; high numbers of multiple births. Reasons for going overseas were:
perceived less risk of surrogate keeping child, more equal transaction, big ask
of family or friend if done locally, complicated local regulatory framework.
Child knowing identity of donor was not regarded as important at all. Concern
about breaking the law (illegal to go overseas for commercial surrogacy in
some states) was discounted because of desire to have a family, and belief
that law would not be enforced.

VARTA public awareness campaign about fertility

Astrid Indekeu on disclosure to children and stage of ART process – arguing
that it was a process and more relevant to parents as children got older

IVF impact on subjective quality of life of children, based on Melbourne
sample of 547 ART and 549 non ART matched young adult singletons born
1982 – 1992. Once adjusted for other variables data showed no significant
difference.

Use of surplus embryos in a rural Australian clinic (difficult decisions: out of
850 couples, 207 discarded, 26 donated to others, 20 to research) – very low
rates of donation and more information about donation made no difference to
the rate. Of those discarding without any live births (#67), the variety of
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reasons included (for a third of them) fear of further treatment difficulties in
particular ovarian hyperstimulation syndrome.
General comments
Overall there was a considerable emphasis on scientific and research papers about
treatment improvements and success rates, and less emphasis on social and ethical
considerations. As usual, the interests of different occupational groups surfaced on
occasions (clinicians, scientists, nurses, and counsellors).
Things to follow up
The information on the use of overseas commercial surrogacy by Australians was
perhaps the most interesting information. The presenter linked it to the intended
parents’ perception that the internal policy and regulatory regime in Australian and
the culture in Australian services were inimical to their interests. The respondents
saw the internal providers as oppositional and thought that sanctions were unlikely to
be applied where what they were doing was illegal. The focus was on having a child.
Issues of its genetic and cultural inheritance were well outweighed by the higher
prospects of having a child.
While the results are for Australia not New Zealand, the question should be asked of
how different the responses of New Zealanders in similar circumstance might be.
Margaret Casey’s description of the process and criteria used in applications to the
Minister of Immigration on behalf of children born of surrogacy arrangements
seeking to enter New Zealand was also useful information for ACART’s work on
import/export of gametes and embryos.
Nikki Horne (member of ACART able to articulate issues from a consumer
perspective)
I would like to acknowledge and thank the Ministry of Health for the funding which
allowed me to attend this meeting.
From a consumer’s perspective the conference was very well structured whereby a
lot of the sessions were split into breakouts of clinical, scientific and psychosocial
areas. I focused most of my time attending psychosocial type talks as they covered
topics of interest to my consumer role with ACART, including surrogacy
programmes, disclosure to and follow up studies of children conceived via IVF and
donors, and the contentious and “hot” subject, of transborder reproduction.
There was a very large programme of talks and below I have highlighted just a few of
those that I attended which were of interest.
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Wayne Gillett’s presentation of New Zealand’s Contribution to Reproductive
Medicine
This gave a very good background to reproductive medicine in New Zealand and the
order of events leading to the first IVF baby born in Auckland in 1984. He also gave
the background and insights into the setup of the current CPAC (Clinical Access
Priority Criteria) funding system which still exists today for government funding of
fertility treatment. In many areas New Zealand has led the world including in
“openness”, particularly through the work of Joi Ellis and others such as Ken Daniels.
This is of course one of the principles that underpins the work of ACART with strong
consideration being given to the rights of any future child born through these
processes.
Rachael Varady talked about The Development and Implementation of a
Victorian Surrogacy Program
This was based around Melbourne IVF (MIVF) setting up an internal programme to
support both patients and surrogates through the process. In Victoria the Assisted
Reproductive Treatment Act 2008 states that all clinic assisted surrogacies must go
through a Patient Review Panel for approval. Of interest, in Victoria, all surrogates
must have previously carried a child and given birth and be 25+ in age. As part of
the MIVF Surrogacy Program they have a dedicated Registered Nurse who provides
ongoing pregnancy support for surrogates and commissioning parents from the start
of treatment through the pregnancy until birth.
Sam Everingham spoke on The Growth in Australians’ Use of Commercial
Surrogacy as a means of Family Formation
This talk covered a study recently done in Australia of 217 couples who have either
done surrogacy recently or plan to do surrogacy in the future. The purpose of the
questionnaire was to provide reliable insights into:

the proportions of people undertaking surrogacy both at home versus
overseas

the barriers to people trying to undertake surrogacy in Australia

the amounts of money spent on surrogacy locally versus overseas

the attitudes to criminalisation laws and their impact on current and future
behaviour.
He reported some interesting facts/outcomes.

The study cohort was made up 45% heterosexual couples and 55% gay male
couples.
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
The mean age of participants was 40 and household income for 52% was
over $156,000.

63% had engaged in an Australian surrogacy arrangement at some point.

The most commonly considered alternative to surrogacy was adoption (over
50%).

When asked why they didn’t consider doing surrogacy at home 60 couples
stated the risk of the surrogate keeping the child, 48 couples stated asking a
surrogate to carry a child for love was an unfair exchange (i.e. felt more
comfortable paying someone).

Of those that went overseas there was 27% success for heterosexual
couples, 48% success for gay couples.

The average costs of surrogacy are $45,000 in Australia, $77,000 in India and
$176,000 in USA.

Figures show in 2011 there were 394 applications for Australian Passports for
babies born in India, i.e. one baby a day being processed.

India appears to be the main destination for overseas surrogacy with up to 4
times more couples heading there than to any other country.

On average 2.6 embryos are transferred to a surrogate each time in USA
versus 3.3 embryos implanted in India to achieve a successful outcome.

When asked about the importance of egg donor characteristics, 28% placed
the donor’s health at the top of their considerations; the lowest ranking of the
list was willingness to be identified.

The twin rate for those that returned to Australia after overseas treatment was
60%.

Despite the criminalisation laws in some Australian states that apply to
overseas arrangements, 82% said they would either move state or go ahead
anyway and take the chance of not being prosecuted.
Sam stated that the criminalisation laws are failing to stem the flow of families going
offshore to access surrogacy. People had concerns about the lack of ability to
compensate surrogates in Australia. There was concern about the emotional
exploitation of potential known surrogates. The inability to advertise for a surrogate
was a barrier.
Bill Hummell, Ana Cobb and Kate Stern talked on their perspectives of Egg
Donation in USA, Spain and Australia
Bill Hummell opened with a talk about what they currently do in San Diego at his
clinic and the laws in California. He outlined how the clinic goes about attracting
donors and the process used to select donors. These donors are mainly women
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aged 21 – 26 with low stress levels who have passed thorough medical and
psychological screening tests.
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He stated that they have a single embryo transfer success program available and
that they also have known donors available through their clinics. Their success rates
are exceedingly high, he stated them as being 82.2% with two embryos transferred
and 52% with one embryo replaced. They use an aggressive antagonist approach
and have miniscule amounts of hyperstimulation.
Ana Cobo spoke next about egg donation in Spain.
 Spanish donors are paid EURO 800 per donation.
 Under the law donors must be anonymous and the donor cannot be selected
by the recipient.
 Children born from donations are entitled to a small amount of general
information about the donor but not entitled to any identifying information.
 There is a limit of six babies who can be born from the same donor including
their own children.
 There is a national donor registry.
 A mandatory serological/psychophysical study is done on all donors.
 In 2010 there were over 5000+ cycle completed with 53.6% success rate.
 They bank most of the donor oocytes and use frozen eggs for intending
parents as this process shortens the waiting time for recipients.
 A computer programme has been set up to make automatic matches between
donors and intending parents.
 They have collected over 33,000 oocytes, so have a very large bank
established.
 They have a 93% survival rate of oocytes after vitrification.
When asked how the children deal with not being able to find out identifying
information about their donors, Ana Cobo stated that in Spain donor children are
often not told of their origins and that it was a “cultural/European” way of doing
things. She did not seem concerned that children may find it difficult in later years to
discover they were donor children but were unable to trace their heritage.
Kate Stern from Melbourne talked last.

Open disclosure to donor conceived offspring about their genetic origins is
important.

Surrogates and intending parents undergo extensive counselling.

No commercial trading is allowed in New Zealand or Australia.

Most people find surrogates through relatives, friends, on-line forums.
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
2.7% of all cycles in New Zealand/Australia are donor cycles.

Approximately 50% of couples go overseas because they can’t find a donor.

Average age of egg donors in New Zealand/Australia is 33.4 years.

Average age of recipients is 40 – 44 years.

Success rates were stated as 50%+ in USA, 40%+ in Spain and 24.1% in
Australia.

She saw risks in using younger donors as their motivation would be
commercial rather than altruistic.

Where to from here – accept the status quo, debate the ethics or look at
commercial aspect and try to increase younger donors?
Transborder reproduction
There was a lot of discussion at the conference about transborder reproduction. This
appears to be a fairly hot topic, particularly in New Zealand and Australia currently,
with reported substantial increases in the numbers of people going overseas to find
younger oocytes and in some cases surrogates.
I also attended an interesting talk about legal issues in transborder reproduction by
Margaret Casey. She highlighted the huge risks people are taking by going
overseas to use surrogates in other countries. They are often under-prepared when
they start these processes, with many not contacting a lawyer until after a child has
been born. In many cases there are difficulties in getting passports for these
children, and entry is at the discretion of the Minister of Immigration.
I also enjoyed talks by my fellow ACART members, Andrew Shelling, John Angus
and Karen Buckingham, on a variety of subjects. I felt it was very important to have
a strong ACART presence at this meeting and it was invaluable to be able to network
with people within the fertility industry and find out what current issues they are
dealing with on a daily basis. The current work to advise the Minister of Health on
the import and export of gametes and embryos is of high interest to a lot of different
parties.
Betty-Ann Kelly (Senior Policy Analyst, ACART Secretariat)
High level impressions from presentations and conversations

From a regulatory/policy perspective, the focus is generally on the generic
description of a procedure e.g. embryo donation, egg freezing/vitrification, in vitro
fertilisation. A number of presentations on clinical and research developments
were a reminder that the generic descriptions do not capture the variety of
protocols, approaches, debates, and changes both concurrently and over time.
This raises the question of the extent of limitations on data about long term
outcomes for children, given shifts over time in how procedures are carried out.
8

Transborder reproduction continues to be of interest in various jurisdictions, and
is now an established fact of life given the ease of travel and access to
information about fertility options in other countries. While the main focus in
discussion at this conference and elsewhere was on surrogacy arrangements,
import and export of gametes and embryos are part of the picture. We know little
about the extent to which flows for one reason (e.g. surrogacy or for IVF using
donated eggs) are substitutes for treatment in New Zealand (e.g. using imported
gametes, impact of domestic shortage of donated eggs).

Interest in fertility preservation in relation to oncology continues to grow.

Clinics are anxious about the operation of the statutory 10-year limit on the
storage of gametes and embryos, and of the extended storage guidelines. In
particular, they are concerned about having to discard embryos and gametes
where they have lost contact with the gamete providers. They are also
concerned about what will count as “reasonable steps” to try to contact gamete
providers for consent to extend storage.

There is limited public knowledge about fertility and the extent to which
treatments can overcome fertility challenges. Arguably, this is an area where
improved knowledge could contribute to reduced pressure on public funding and
also avoid for some people the financial and emotional costs associated with
fertility treatment which in the end may not be successful.
Transborder reproduction
Margaret Casey (lawyer in Auckland) gave a stand out presentation on legal Issues
in transborder reproduction that focused on New Zealanders entering overseas
surrogacy arrangements.

She reiterated many of the messages that underpin the advice prepared by
CYF, DIA and Immigration New Zealand (available on ACART and ECART’s
websites) – that this is a fraught area in regard to the different standards and
regulatory requirements across countries. People should seek advice when
considering an overseas surrogacy arrangement.

Margaret described fertility treatment as a “results driven field” – the focus is
on getting a baby, with a substantial denial of the challenges involved in
getting a baby home. She is concerned that not enough people find out the
legal requirements before they leave home. She made the point that
whatever the legal parent-child relationship in the country where the child is
born, New Zealand law always takes the position that the woman who gave
birth is the legal mother. Intending parents should not rely on a birth
certificate from another country that says they are parents.

She described Australian arrangements for dealing with the entry of children
born overseas from surrogacy arrangements as being more ‘streamlined” than
9
in New Zealand, where ministerial discretion plays a significant role in
achieving the entry of children.
I talked to one of the exhibitors, from the European Sperm Bank USA (based in
Seattle) which in turn is associated with the Danish Cryobank (not to be confused
with the Danish Cryos). He had been told anecdotally that he might face difficulties
in New Zealand, though his sperm bank was exporting to some parts of Australia.
He told me the sperm bank donors were identifiable and paid around $40 per
sample, with frequent donations.
Sam Everingham from Surrogacy Australia (a non-government organisation)
presented on The Growth in Australians’ use of Commercial Surrogacy as a
Means of Family Formation. The research he described had the aim of identifying
the routes taken by Australians to achieve surrogacy arrangements, the reasons for
their choices, and the number of children born each year to Australian intended
parents through surrogacy. Sources of data included:

an online survey with 217 Australians who were considering surrogacy, in the
surrogacy process, or already had a child via surrogacy

14 large overseas surrogacy agencies reporting on annual surrogate births to
Australian intending parents

Australian Department of Immigration & Citizenship data on the number of
Citizenship by Descent applications for infants aged 0-2 months (2008 –
2011).
The research concluded that “strict and onerous” domestic regulations re altruistic
surrogacy mean there was no growth in numbers of local surrogacy arrangements,
whereas there had been ”enormous” growth in Australians accessing overseas
commercial surrogacy arrangements in recent years. Various data sources strongly
suggest that well over 350 infants were born overseas in 2011 to Australian parents
through commercial surrogacy.
The key barriers to accessing altruistic arrangements were found to be the perceived
risk of the surrogate keeping the child, discomfort with asking someone to carry for
love alone, and the difficulty in locating a surrogate willing to carry altruistically.
Conclusions were:

many involuntarily infertile Australians are highly motivated to invest large
amounts in creating a family

Australian altruistic surrogacy processes fail to meet the needs of Australians
wanting to create a family

criminalisation laws in some Australian states fail to discourage Australians
from entering overseas commercial surrogacy.
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Egg Donation in Perspective from USA, Spain and Australia
This presentation further highlighted differences between countries: Australia
accepting the importance of the opportunity to access identifying information; Spain
with donor anonymity and no access to identifying information; and a US clinic
walking in both worlds. These differences become particularly salient where people
cross borders to access procedures.
Astrid Indekeu presented on Change and Consistency in the Views and
Feelings of Parents about Disclosure over Time
Astrid is a doctoral candidate from Belgium who has spent time in New Zealand
because one of her supervisors is Ken Daniels from Canterbury University. Her
presentation looked at the contribution of the offspring’s age and the stage of the
family cycle in parents’ disclosure decision.
Her preliminary results suggest that in the preconception phase of treatment,
couples are focused on their position as future (social) parents. At that time, the
donor is not seen as potentially meaningful to the offspring. Parents with young
families seem to be growing in awareness that the donor could be of interest to the
offspring. This awareness seems to strengthen when the offspring becomes an
adult.
As parents’ perspective on the donor changes, they also begin to see the donor from
the offspring’s perspective. Donor anonymity was mostly experienced positively by
the parents but created discomfort when they considered this from the offspring’s
perspective. These imagined offspring perceptions strengthened or questioned the
parents’ earlier disclosure decision. Parents wished for more guidance in this
ongoing process after the offspring is born.
In a context of anonymous donation, both offspring’s age and the family phase
impact the way parents imagine the offspring’s perspective, which contributes to the
parents’ decision-making process regarding disclosure. Preconception and familycounseling can actively help (future) parents in this process.
Her research, together with other research by Ken Daniels (who did not present at
the conference) indicates that people going overseas for treatment and who are
currently either indifferent to non-identifiable donors/surrogates, or who prefer nonidentifiable donors/surrogates, may in time see access to information as important
for their children. However, identifying information at that point may be either
extremely challenging to access, or impossible.
11
Fertility preservation and oncology
I attended three presentations on fertility preservation for oncology patients. With
significantly improved survival rates for cancer, including for children and young
people, the profile of fertility preservation before treatment is growing. While ACART
has no specific role in this area, there is an interest in ensuring that its guidelines are
well understood e.g. Guidelines on Extending the Storage Period of Gametes and
Embryos. Young people storing gametes in early adolescence may not have an
interest in using them during the 10-year statutory period, so need to know in good
time that they have the option of applying to ECART to extend the storage period.
Another factor that is part of the fertility preservation story is the improved outcomes
from the use of frozen eggs. At the conference I learnt that the American Society for
Reproductive Medicine’s Practice Committee has very recently issued a new report
on egg freezing, replacing earlier guidance in 2008. The 2008 report said that the
technique was experimental and should be offered only in that context. The new
report says that the technique should no longer be considered experimental.
Kate Bourne (Education officer, Victorian Assisted Reproductive Treatment
Authority) gave a very good presentation Fertility Preservation in Young Cancer
Patients: The Development of an Education Programme for Oncology Health
Professionals.

30-60% of cancer patients are not told about fertility preservation options or
don’t recall such a conversation.

Fewer than 50% of oncologists in Melbourne routinely refer patients for a
fertility preservation consultation. Barriers include:
o ethical concerns about the appropriateness of such discussions with
very sick people or where the prognosis is poor
o discomfort with the issue
o knowledge gaps
o the pressure of time to begin treatment
o patient’s age and partner status.

The programme was an initiative between VARTA, the Youth Cancer network,
and cancer services in Victoria. It aimed to raise awareness of health
professionals caring for young people with cancer about the importance of
discussing fertility preservation and making referrals. The programme
promoted the existing fertility preservation guidelines.

Nine education sessions conducted across Victoria were attended by 230
health professionals from a range of backgrounds.
12

The presentations talked about the guidelines and options available with and
without fertility preservation before treatment.

The programme did not include any invitations to talk to paediatric
oncologists. It was concluded that this group found the topic particularly
challenging.

The education programme was extremely well received and achieved the aim
of raising awareness of the importance of discussing fertility preservation
before cancer treatment.

An outcome was a recommendation that fertility preservation is included in
regular clinical education programmes in oncology health services to ensure
that those working in cancer care remain up to date with current fertility
treatments and practice. Collaboration between fertility services and oncology
services is also recommended to encourage ongoing fertility preservation
education.

The future of the programme depends on the availability of funding.
Clare Garrett from Melbourne IVF presented on the Uptake of Fertility
Preservation Options, looking at the characteristics of patients by age, diagnosis
and treatment regime.

The population reviewed was 868 patients 2006-2010 consulting on fertility
preservation options.

Options included cryopreserving ovarian tissue, embryos, eggs and also using
gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy.

Seventy-two percent of the patients sought fertility preservation were
oncology patients, with a mean age of 30.5. Nearly half used GnRHa, 15%
stored embryos, 10% stored eggs, and 14% stored ovarian tissue.

The oncology treatment and the type of cancer were often related to the
fertility preservation option used.

The research concluded that despite the limited evidence of efficacy of
GnRHa and the experimental aspects of tissue cryopreservation/autograft, a
large proportion of patients at high risk of treatment-induced ovarian failure
are prepared to try these options instead, or in conjunction with, established
oocyte/embryo cryopreservation.
Manuela Toledo from Melbourne IVF presented on Female Fertility Preservation in
Oncology Patients.

In Australia almost 1 in 600 women of reproductive age will be affected by
cancer. Many of these women will survive their disease and go on to lead
normal lives which often includes the desire to have children. Increasingly the
discussion about the potential impact of cancer treatment on fertility is
becoming commonplace prior to chemo- and radiotherapy.
13
14

This presentation gave an overview of the established fertility preservation
techniques (such as egg and embryo freezing) and less proven treatments
including the use of gonadotrophin releasing hormone analogues and ovarian
tissue cryopreservation.
Knowledge about fertility
Dr Karin Hammarberg presented on Fertility Awareness Among Australian
Women and Men of Reproductive Age.

A telephone survey of a representative sample of Australians aged between
18 and 45 explored the extent of fertility awareness.

The majority of the 462 participants underestimated, by about 10 years, the
age at which male and female fertility starts to decline.

Only one in four respondents correctly identified that female fertility starts to
decline before age 35 while 42% believed this occurs after age 40.

A significantly higher proportion of men than women thought female fertility
decreases after age 40 (51% vs. 33%).

One in three respondents correctly stated that male fertility starts to decline
before age 45 but 58% thought this occurs after age 50 or that male age does
not affect fertility.

Overall 59% of respondents recognised that female obesity and smoking
adversely affect fertility but few believed that male fertility is affected by
obesity (30%) or smoking (36%). Higher proportions of men than women
believed that male obesity (25% vs. 13%) and smoking (15% vs. 7%) do not
influence fertility at all.

One third of respondents correctly identified the fertile window in the
menstrual cycle.
The knowledge gaps identified in the survey are being used to inform the
development of educational materials produced by ‘Your Fertility’, a government
funded public education campaign to improve awareness of potentially modifiable
factors that affect fertility [see next presentation report].
Louise Johnson from the Victorian Assisted Reproductive Treatment Authority
(VARTA) presented on Your Fertility: Development of a Public Awareness
Campaign.
VARTA’s functions include a public education role. VARTA received a federal
government family planning grant, and established a partnership with three other
bodies to undertake the ‘Your Fertility’ education campaign.
15
Based on the findings of research (see above), evidence-informed material about the
adverse effects of age, smoking, obesity, and excessive alcohol consumption on
fertility and information about the fertile time during the menstrual cycle are
disseminated through a dedicated website, social marketing, and the media.
The Your Fertility website and campaign launch in March 2012 received substantial
media coverage, potentially reaching 4,933,000 people throughout Australia (based
on viewer and readership numbers). On the launch day there were 905 visits, 7363
page views, and 175 attempts at the fertility quiz on the Your Fertility website. In its
first two months the website received over 4,000 visits and 24,000 page views.
Louise concluded that the formative community research and positive response to
the Your Fertility campaign confirm the need for public education about the impact of
age and lifestyle factors on fertility.
The New Zealand environment
Wayne Gillett (Medical director, Otago Fertility Services) presented on New
Zealand’s Contribution to Reproductive Medicine.

New Zealand has always had a close relationship and bond with Australia.
Much of what has been achieved in reproductive medicine in Australia has
also been realised in New Zealand. He noted that some of Australia’s
pioneers were New Zealanders.

Since New Zealand’s first IVF service was first established in 1983 by Freddie
Graham and the academic department at National Women’s Hospital, New
Zealand clinics have contributed to providing ARTs to a high standard.

Arguably New Zealand’s most important contribution has been leading the
world in openness around gamete donation. Clinic policy initiated by Joi Ellis
in Auckland in the early 1980s led other clinics to adopt this practice. Both
clinical practice and psychosocial research contributed to policy and shaped
legislation that came into being 20 years later. The HART Act in large part
followed established practice.

Ken Daniel’s contributions have had direct influence on policy and legislation
in at least 10 jurisdictions, most notably UK, Canada, Sweden and USA.

Other New Zealand contributions include the role of prioritisation tools in
defining access to public funding for ART [see next report of a presentation]
and leadership in evidence based practice, especially with the Cochrane
menstrual disorders and subfertility group led by Cindy Farquhar at Auckland
University.

A strong relationship with reproductive scientists including Ken McNatty and
Allan Herbison will mean New Zealand’s contribution has a strong future.
16
John Peek gave a very clear presentation about Fertility Funding in New Zealand
– How to Allocate? This included a history of the access criteria which he and
Wayne Gillett were closely involved in developing.
Other New Zealand presentations included:

Mary Birdsall (Medical Director, Fertility Associates, Auckland) gave a thoughtful
presentation on the clinic’s experiences and learnings when things go wrong in
the embryology laboratory, describing two different major events in the clinic’s
history. A key message she wanted to give was that laboratory events go
unreported and there is no forum for sharing experience. A repository of
information would help technical trouble shooting by the lab and care of patients
by doctors. With over a million IVF cycles annually worldwide, there is urgent
need to start talking about lab incidents and to develop guidelines.

Greg Phillipson (Medical Director, Fertility Associates, Christchurch) presented
on the experience of his clinic over the period of the Christchurch earthquakes.
This was a moving account of the impact on staff as they managed their
professional obligations while dealing with the personal impacts. One key
learning was that cellphones and handheld phones are useless when the power
goes off: old fashioned plug in phones will continue to work.
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