Fertility as a public health priority, not an individual misfortune, means earlier specialist input, better parental leave, and policy that helps families start when they're ready, not when the system finally gets around to them.
We’re in the midst of finals season, when AFL and NRL fans criss-cross the country, full of hope, excitement, and trepidation. Every supporter has their own reason for following their favourites, journeying from different towns and cities, bedecked in the colours synonymous with each team.
What brings all of them together is a shared anticipation and the knowledge that, despite perhaps travelling thousands of kilometres, the set of rules their team will compete under is the same, no matter where the game takes place.
A recognised set of standardised rules that provides governance and clarity for everybody involved, across the entire nation. That’s not a comfort enjoyed by fertility patients in Australia.
If the fans, club owners, and administrators who shape the landscape our sporting codes take place on can adhere to a unified set of rules, is it too much to ask that the same is in place to ensure Australia remains a world leader in fertility care?
Currently, many patients have no choice but to travel to access the treatment required to make their desire a reality, often stepping into unknown territory as soon as they cross a state line.
Different donor requirements. Different consent rules. Different costs. Different chances of getting the treatment they need. Aside from being unfair and unsettling for people already involved in what can be a challenging time, this fractious regulatory environment risks reduction in quality of care, patient safety, and serious incidents.
Patients don’t travel interstate for treatment to be deliberately difficult or even because they want to; more often than not, it’s simply them responding rationally to a system that gives them no choice.
This was underlined this month with news showing that states and territories can’t even agree on what constitutes a “family” when setting donor limits.
Advocacy led by the Fertility Society of Australia and New Zealand saw Queensland Health clarify its donor limits apply to families, rather than individual women or children. This announcement removes a discriminatory barrier for same-sex couples and better reflects contemporary family formation but highlights how wildly and fundamentally rules can vary between jurisdictions.
From where I sit in Wellington, watching both the Australian and New Zealand systems closely, it’s a reality that should concern anyone who cares about this region’s standing as a world leader in fertility care.
Australia, in geographic terms, is vast but is more interconnected than ever and, realistically, isn’t able to sustain nine different jurisdictions, racking up more than 40 pieces of state and territory legislation covering fertility. That fragmented existing system leads to confusion, and the gaps and challenges we see besetting fertility care in Australia.
What is needed is one uniform national fertility law.
New Zealand has the advantage of operating under a single national framework, the Human Assisted Reproductive Technology Act, and it’s one of the clearest illustrations of why a single law matters: it removes an entire category of unfairness that Australian patients still have to navigate.
More than 18 months have now passed since the FSANZ called for that in its landmark 10-Year Fertility Roadmap.
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It’s fair to say the government is now deep into overtime in paying heed to the expert recommendations contained within the Roadmap. Time is running out to ensure prospective parents across Australia aren’t losing out when it comes to being able to access high-quality and safe fertility care.
Since the Roadmap called for the harmonisation of fertility laws, federal, state and territory health ministers did commission a rapid review into the sector. This increased scrutiny and concern was prompted by a number of high-profile incidents, further illustrating the urgent need to take on recommendations from the Roadmap.
Despite this, when the rapid review reported in September 2025, ministers stopped short of implementing the Roadmap and opted instead for a 10-point, three-phase reform package. Undeniably, this approach is progress – stronger accreditation, clearer complaint pathways, a push towards national standards – but it’s still not enough.
We recognise change can’t happen overnight, but the concern remains: does government believe a single national approach would provide enough benefit to make the complexity of achieving it worthwhile?
I’d argue the clear answer is “yes”, and that genuine reform needs to move higher up the agenda and promptly.
National reform will remove inconsistencies between states and territories, and has a role to play in addressing key challenges facing the sector and those who rely on it. That should include funding because whether you can access publicly funded IVF still depends heavily on your postcode.
Some states offer extra public funding, others don’t, and there are discrepancies between metro and regional areas. More access in some places isn’t the same as fair access everywhere.
Reform on a national scale can help solve the donor shortage being experienced through establishing a national donor registry. It would cover not only donations made via established clinics but also the informal, non-clinic donations that have and always will exist.
A national registry isn’t about stopping home donation. It’s about protecting the rights of all donor-conceived children to know their biological origins and preventing the rare cases where one donor’s genetic material ends up used more widely than is safe.
The fertility sector in Australia is not in crisis, but the lack of national-level reform is significantly impacting its ability to meet its potential. A potential that that could be helping not only many more prospective families, but also wider society.
Birth rates are falling, people are starting families later, and the costs of raising children – everything from housing to needing a third car seat – are pushing families towards having fewer children, later.
Treating fertility as a public health priority, not an individual misfortune, means earlier specialist input, better parental leave, and policy that helps people start families when they’re ready, not when the system finally gets around to them.
My one piece of advice to Australian policymakers is: get the legislative foundation sorted first. Once that infrastructure exists, everything else – funding, donor programs, regional access, national law – can be built on top of it.
Dr Simon McDowell is Medical Director and Laparoscopic Surgeon at Wellington Public Hospital, a fertility specialist at Fertility Associates and a Senior Lecturer in the University of Otago’s Department of Obstetrics and Gynaecology (Wellington), and Vice President of the Fertility Society of Australia and New Zealand.