Jane felt like she was living with PTSD while spending $80k to start a family

Ms Morris from Spring Hill, a small village southeast of Orange in regional NSW, experienced several devastating miscarriages before she explored In Vitro Fertilisation (IVF).

The financial cost was huge. Ms Morris told ACM she and her husband "put every cent we had".

There is only one IVF provider in Orange and while she has never regretted it, she laments how inaccessible the treatment is.

"It is $13,000-$15,000 a round," she said.

"We had seven failed rounds before we got our daughter. Most Australians couldn't afford it."

While the NSW government under then-premier Dominic Perrottet in 2022 announced a cash rebate of $2,000 for IVF treatments, Ms Morris said that was a "drop in the ocean" compared to what it costs.

The trauma was also huge with Ms Morris comparing undergoing IVF repeatedly to "living with post-traumatic stress disorder".

Thirty per cent of Australians live in regional, remote and rural areas. Roughly seven million people.

But access to IVF, like most healthcare, is "paltry".

National Rural Health Alliance CEO Susi Tegen told ACM the "postcode does make a difference".

'There is a market in the city but in rural areas there is no market or it is a failed market," she said.

"Rural patients do pay more because you just don't have the economies of scale plus there are fewer fertility treatments available in small or medium size towns than in urban centres."

Those that have to travel, often end up out-of-pocket, despite government subsidies.

"You might be able to claim $74 back when the cost of accommodation is usually $250" and the cost of fuel was high, she said.

Ms Tegen wants all levels of government to engage in "proper population health planning".

"If you know there is a rural town that has a certain amount of women of a certain age and you also know that x percent have fertility problems, population health planning would help," she said.

Adora Fertility CEO Vanessa Ferguson said their clinics in Sydney, Melbourne, Brisbane and Perth are seeing an uptick in regional patients.

"The cost and waitlists in some regional areas is so prohibitive it is actually more cost-effective for them to incur the travel and accommodation costs," she said.

Karlee Sondergeld traveled more than 1,350km to achieve her dream of a baby.

Ms Sondergeld, who married in 2021, had wanted to start a family immediately but struggled with infertility.

The cost of IVF in her hometown of Townsville, not to mention the wait times, made starting a family "difficult" with assisted technology.

Last year she welcomed baby Rylan after a successful IVF cycle at Adora Fertility in Brisbane.

It was roughly 75 per cent cheaper than the Townsville clinic.

Ms Sondergeld told ACM it was "crazy" to think about the price difference.

"Townsville is a lot smaller than Brisbane and it makes me sad to think people could miss out because of it," she said.

Deakin University's Dr Christopher Mayes said the drive for profits by private commercial IVF providers complicated access.

He surveyed women in regional and rural Australia about their experience of IVF in researched published in the Journal of Bioethical Inquiry in 2023.

Commercial operators found it more lucrative to set up clinics in bigger cities as opposed to where the services were needed ensuring rural women often had to travel long distances for IVF treatment.

"One woman we spoke to said her career took a hit due to the amount of time she was forced to take off work to attend reproductive appointments," he said.

"Others said the travel subsidies offered by some state governments were inadequate to offset the additional costs they faced to access these services."

Dr Mayes said "it is something of a myth that we all have equal access to healthcare services".

The issues around IVF are part of a broader problem around gynecology services in the bush.

"We don't have much in terms of hospital-based public gynecology services," Armidale doctor Rod Martin said.

"IVF, even at the lower tech services, is thin on the ground".

Dr Martin works as a GP and anesthetics, obstetrics and emergency medicine Visting Medical Officer.

He delivers around 150 babies a year in Armidale. Around 1 in twenty-five women he sees has some type of fertility issue

It takes at least 12 months for women to access a public gynecologist for specialist fertility issues.

"We can do the blood tests but doing the more elaborate investigations is the domain of good generalists [in] gynecology if not fertility specialists," he said.

There are no IVF clinics in Armidale. Patients are sent 500km away to Newcastle. General consultations, on an "intermittent basis", could be performed at Tamworth.

"Any of the invasive procedures and the actual process of IVF need to be done in a large metropolitan area," he said.

Dr Martin said that regional Australia could be a "very lonely place" for those struggling with infertility or complex pregnancy needs.

A recent review by former health minister Greg Hunt recommended uniform laws for the IVF sector across states and territories as well as the development of a national fertility plan to equalise access regardless of postcode.

IVF access is on the national agenda after Australia's birth rate hit record lows. The national total fertility rate dropped to 1.5 babies per woman in 2023.

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