Ladies, We Need To Talk - How much would you pay to have a baby?

0:00Having a newborn is challenging. Little sleep, busted body, complete life upheaval. But what if, at the same time as you're trying to keep a tiny human alive, your partner is cheating on you? Instead of pitching in and dealing with the fact that they're no longer the number one priority, some men turn towards the comfort and attention of another woman. There are even stories of it happening at the very moment the mother is giving birth.

0:31Does this sound familiar to you? If so, we want to hear what happened. We're making an episode about new dads who cheat. Send us an email or a voice note to ladies at abc.net.au. Most of the time, IVF doesn't work and actually it's going to cost you a lot of money and heartbreak and there's a lot of financial and emotional strain attached to it.

1:04We've got friends who have bought houses and investments. They're the sorts of things that we've kind of put on hold. It's still such a tough space for people to feel like they get the permission to say, I've had enough and I want to stop.

1:23If you spend any time scrolling the websites of Australia's big IVF clinics, you'll soon see slick photos of beaming babies, lab technicians peering into microscopes and deliriously happy women holding positive pregnancy tests. The message is clear. Science can help your dream of having a baby become reality. Since Australia's first IVF baby was born in 1980, the country's assisted reproductive industry has skyrocketed.

1:56It's now worth over $800 million annually. But with 95% of Australia's IVF clinics privately owned and charging thousands of dollars per cycle, can their promises be trusted? Or are they selling false hope? So where is the line drawn when the stakes are so high? Is there a line? And what responsibility do clinics have in helping women and families decide when to quit trying?

2:25I'm Yumi Steins. Ladies, we need to talk about the true cost of IVF. The IVF clinic were pretty positive about our chances going into IVF that we would be able to do a few cycles, store a few embryos to be able to potentially have two children. Ladies, meet 34-year-old Bridget from Melbourne.

3:01Four years ago her GP referred her to an IVF clinic after she was diagnosed with unexplained infertility and endometriosis. She left her IVF appointment feeling like the treatment would be straightforward. A success even. So much was put on our age as saying because you are young this will be a smooth process for you even though we didn't really know why we weren't conceiving to begin with.

3:25Bridget and her husband did their first IVF cycle in 2022, excited to start their family. But they came away with no viable embryos to transfer or store. They met with their specialist to discuss the results. The specialist's response was, oh, well, the first cycle of IVF is a bit of a test and we're seeing how your body responds. To me, that was a very expensive test of how my body responded and was not at all the expectation I'd gone in with.

3:54I had assumed we would have at least maybe one embryo or something where we could take next steps with, but we ended that with no embryos back at square one, essentially. Bridget had been referred to a private clinic, so each round of IVF cost between $13,000 and $15,000. This amount had to be paid upfront. After treatment, around half of the money was returned via Medicare. Saving for IVF was quite a substantial financial impact for us. While both my husband and I have careers that are fairly stable, putting aside about $15,000 for a round of IVF is quite a bit of money to have just ready to go. We did, at points, put some of that on a credit card, preempting that we would then get the Medicare rebate just to pay that straight off. It was a significant hit to the finances.

4:52And I suppose not having money for more fun things to put aside for a holiday or saving for a house deposit. Instead, it was all about IVF. Bridget and her husband weren't just investing in the IVF treatment. They were researching treatment options and joining forums that shared success stories about that one egg that finally led to a baby. A lot of the messaging around IVF is that it is a numbers game and it only takes one egg.

5:21So you feel hopeful if you're getting eggs from an egg retrieval that you may get that one egg that is going to take and then progress into an embryo. So we were hopeful that as we were getting eggs but not getting embryos that we may get lucky and there would be just one egg that would work out and get us that baby. To try to boost her chances of getting that baby, Bridget also paid extra for supplementary treatments that are not included in a standard IVF protocol.

5:51testosterone priming with a gel. I did DHEA supplements. I took corticosteroids. I took aspirin, all of those being relatively cheap add-ons. I think at most it was a couple hundred dollars for those in a cycle. The more expensive one I tried being human growth hormone, which is a bit divisive in terms of the risk that potentially poses.

6:16And that cost me about $1,200 for that medication, which was not rebated through PBS like most of the other medications. I definitely felt like a bit of a lab rat through the IVF process. In Australia, we have one of the highest utilization rates of IVF per capita in the world.

6:39Dr Sarah Lenson is a senior research fellow at the University of Melbourne. Her research focuses on evaluating IVF and fertility treatment options. When she says highest utilisation rates, what Dr Sarah means is that relative to our population, Australians do a shitload of IVF. Partly that's driven by the Medicare subsidy. So even though IVF is expensive, right? Like $10,000 for a cycle.

7:08in the States is much more expensive. So it's more like 20 or $30,000 for one IVF cycle in the US. So in Australia IVF is kind of relatively cheap. It's not cheap, but relatively cheap. Depending on the clinic, the cost for a single cycle of IVF can run between $2,000 to $15,000. Some of that amount will come back to the patient via Medicare, but additional costs include theatre, anesthesia and medication.

7:39Dr Sarah says that for some women seeking fertility treatment, there are other options to consider before trying IVF. Intrautorine insemination, or IUI, is a less invasive fertility treatment. It's not suitable for all types of infertility, but about 30% of infertility is unexplained. And for that cohort, IUI is quite an effective treatment.

8:04but we don't even catch the national data about IUI use. Is that right? We just focus on IVF. IUI, or intrauterine insemination, is a fertility treatment where washed and concentrated sperm are placed directly into the uterus, timed with ovulation. Sometimes with hormone stimulation to help things along, sometimes without. So in the trials that we've run, we've shown that IUI is definitely more effective than trying to get pregnant at home for couples with unexplained infertility. And then comparing IOI to IVF, IOI does have a lower success rate, but it is quite a lot cheaper.

8:44Dr Sarah says that the reasons for IUI not being popular comes down to a few factors. Many clinics have IVF in the name, which leads patients to expect that specific treatment. But she also thinks that some clinics might not be promoting it as strongly as they could. There's really not as much of a focus on the...

9:05possibly more low cost, low invasive procedures. And it's still something that patients should know about and have a chance to make their own kind of decision, particularly because we've been talking about the cost of IVF can really be enormous and some patients might prefer a low cost option to start with. Sarah, what kind of messaging do clinics use to sort of sell this idea of success and keep patients returning for multiple cycles?

9:29At the end of the day, they are commercial companies that make money the more IVF cycles that they perform. So there is a risk of a conflict of interest there and clinic websites do tend to kind of overstate the potential benefits overstate.

9:46The likelihood of success have images or photos of babies on their websites and maybe don't always speak to the fact that most of the time IVF doesn't work and actually it's going to cost you a lot of money and heartbreak and there's a lot of financial and emotional strain attached to it. To help people starting or continuing IVF, the Australian Government funds a website which can generate an overall prediction of how successful IVF might actually be for you.

10:15So for the purposes of this podcast, I had to go at entering my stats, but it wouldn't accept me because I'm too old, and the calculator has a hard cut-off once you reach 45. The website also gathers data from around Australia to compare clinic's success rates. So we have introduced standards that success rates need to be reported, you know, per IVF cycle started, not per woman that reached the stage of embryo transfer.

10:42then the success rates wouldn't look better. And they also need to be broken down by age because female age is a massive predictor of whether the cycle will be successful. The calculator isn't a failsafe but it does give patients a little more control over choosing clinics and determining how long it may take to have a baby or if they should continue to try. There's been a lot of discussion about whether in Australia we push patients to IVF sooner than they need to, especially younger patients. And that patients do too many IVF cycles, even when they're prognosis. So their chance of having a baby, say, is lower than five or three percent, same woman over 42. The chance of live birth can become really quite low. And in other settings, if you think about like cancer treatment or something, people sometimes wouldn't even pursue

11:37a medical treatment with a chance of saving their life when the chance is that low, but for some reason in the IVF space we do. We'll come back to Dr Sarah later, but I want you to meet Natalie. She was in her late 30s when she started IVF treatment after surgery for endometriosis. I was extremely optimistic, but also completely naive. Unlike Bridget, the results after Natalie's first egg retrieval were promising. Eight eggs were retrieved from her ovaries.

12:07I think it's something like about 70% of those eggs embryos were created. And that's a significantly high number of embryos per egg collection. After five days incubating in a lab, Natalie had three viable embryos that could be transferred. And I did several transfers. And after the several transfers, they didn't stick. And we couldn't believe it. I mean, it happens. But we just didn't understand that sometimes, especially as you age, and just in IVF generally speaking, that you often need more than just one cycle. So this is really interesting to me, Natalie, because I would imagine that you're going in there and someone is setting your expectations to the reality setting on the dial, which is that you might need more than one round. But it sounds like you were really genuinely expecting just for one round and then a baby.

13:02Yeah, when I reflect upon it, it would have been great to have had that discussion up front. But it wasn't something that we talked about. After the first IBF cycle failed to result in a baby, Natalie and her husband took a whole year of treatment to think about their goals. It's not just a physical process, it's a mental process, and it's an emotional process. And so sort of like figuring out, well, what is it that we want to do?

13:32But ultimately, Natalie and her husband decided to keep trying IVF treatment and they got to the egg collection and transfer stage multiple times. Natalie is now 48 and estimates she's had 25 IVF cycles over 10 years. But that elusive Bonnie baby never materialised. Natalie was so desperate that, like Bridget, she invested in add-ons, treatment options that fall outside of regular IVF.

14:03Natalie says she's tried them all acupuncture, platelet-rich plasma infusions, HRT. They all have very little scientific evidence to prove they actually help. So it's been a combination of doctor-led conversations as well as doing my own research and then me deciding what I thought was best for me based upon the knowledge that I had at the time. So when you're desperate for a baby and you're pouring all this money into this quest, Is it a case of leaving no stone unturned, knowing that you've tried everything, you've done everything you possibly could to help conception? For me, yes, I think so. And I've probably done that, you know, tenfold already. Are your birthdays hard? You know, they're not, but you know what's hard? My periods. Because they're a reminder. We often hear that it's after

15:00one or two IVF failures where things haven't gone as planned and you haven't got pregnant that you start kind of looking around for something different. Something needs to change. This IVF process is not working. What are we going to do differently to make it work this time? This is Dr Sarah Lanson from the University of Melbourne again. Her team runs a website called Evidence Based IVF. The site investigates different supplementary treatments and whether they're backed by scientific evidence.

15:29The term add-on really encompasses anything that people are seeking that's kind of optional or additional to the bog standard IVF process. 80 or 90 percent of patients are using one or more of these add-ons during their cycles. Some add-ons like acupuncture are in high demand. So we find consistently that over 50% of patients are pursuing acupuncture as part of their IVF cycle. One that's kind of popular right now is platelet-rich plasma. So that's when a blood sample is taken from the female patient and spun down to isolate the platelet-rich plasma. And then that can be inserted either into the ovaries with this idea that it's going to kind of rejuvenate the ovaries in some way or insert it into the uterus with the hope that it's going to kind of improve the environment.

16:18inside the uterus and maybe that will make it more likely for the embryo to implant. So you can probably kind of get the sense that a lot of these things are very experimental and theoretical. You know, it kind of sounds good in theory, but sometimes when we do run the studies to test them properly, we find they don't work or sometimes we find they actually reduce the overall chance. Stop it, really? So with acupuncture, is that evidence-based? No. No. And what about the platelet thing?

16:46A big no. Big no. Yeah. Man, do you have any belief in positive thinking or placebo effect? I don't think so because what makes me nervous is that patients are paying a lot of money for these things, especially that platelet-rich plasma injection into the ovaries. That's kind of a big procedure, almost a surgery that's performed that's not without risk and not without big cost. The placebo effect idea kind of is, to me, akin to that kind of false hope.

17:15that we don't have any evidence this is going to help you make more eggs as part of your IVF cycle. So patients just need to know that if they're forking out all this money and putting themselves at risk and maybe delaying their treatment cycle, they need to know that there's not good evidence that is going to help them. And do you think that the clinics are communicating that?

17:35I don't think they're communicating in as well as they can. If you Google Platelet Rich Plasma IVF, I think a lot of the clinic websites that would come up, it's a lot of the overstating of the potential benefit. Not really specifically saying there is no evidence for this. We actually ran into...

17:53Lovely couple and they had like a two-week-old baby in their arms. Oh my god. He was so cute. And then I'm like, congratulations. And they were like, oh, we've done 10 rounds of IVF and it's cost us over a couple of hundred thousand dollars. This is IVF patient Natalie again. She and her husband's dream of having a baby isn't something that they're ready to surrender just yet. They're like, don't worry about the money. Just do it. You know, money comes and goes. Don't worry about the money.

18:22In all the years they've been trying, Natalie reckons they've invested at least a healthy house deposit into IVF treatment. It's got to be over 200, I mean definitely over 200,000 when I think about it. We've used our savings and you know we've had support from family and also we've accessed super as well as part of the process. So what has been the knock-on effect of spending so much money on IVF?

18:49Well, I mean, I think there are other things in life that we haven't been doing. We've got friends who are bought houses and investments. They're the sorts of things that, you know, we've kind of put on hold. Really? So no house? No. No, we don't have a property. Can you tell us how much you took out of your super? Oh, I think it was about $80,000. Right. You mean? Far out. But then it ended up being like a hundred, you know, like plus the tax. Yeah.

19:19It's quite a lot of money. Quite a lot of money. Yeah, it is a huge amount. Yeah. Timers of the essence. And so it's sort of like you're not truly thinking about your financial situation when you're going through IVF. You're more focused on, you know, the IVF process. How can you make this happen? Like if I was just sitting there thinking solely about my wealth accumulation and what was in my best interest from a financial perspective, I probably would have made a different choice. We would have made a different choice together.

19:47Money aside, Natalie says that one of the biggest frustrations is not administering daily injections or the transvaginal ultrasounds. It's waiting to hear about results. A fertility patient generally has to wait for a call from the nurses for those results. And that can happen anytime. Right. And if you don't pick up that call in time, then you're waiting for that call and you're in this state, you mean of significant anxiety, right? Unnecessary anxiety. Yeah. It's not very patient-centred. I feel like a patient should be able to, you know, be able to call up between that time and speak to a nurse and, you know, have a chat about the results when it suits the patient. Totally. Not the other way around. Not the other way around. It's a cliffhanging kind of experience. It's horrible. After all these years focused on getting their very own baby,

20:44Natalie and her husband are starting to think about what life might look like without one. I do have friends that have chosen not to have children. Yeah. Quite a few. And their lives look amazing. Have you had conversations with your specialists about when to stop? I have. And we've talked about like what if, you know, what would I do with the embryos that I have left?

21:13And I guess I'm not prepared to make that call yet. But it is a decision that we will have to make. And I'd say it'll be soon. I had a very supportive husband through the process and he did my injections for me, came to all of the appointments with me. This is Bridget again. At 30 she'd been diagnosed with unexplained infertility.

21:39After her first cycle didn't produce the predicted results, her husband was ready to pull the pin. He was pretty irritated after that first round and the results we got for the money and effort we put into it. I can't remember how long it was after that egg retrieval but I feel like it was fairly soon after I did raise that conversation of how much are we willing to do and what do we think is worth really investing in this process. He was definitely at a...

22:08hard, ready to stop at that point. Even though Bridget's husband was ready to stop, they decided to do two more cycles. Over the next two years, Bridget and her husband dutifully saved money to cover the upfront fees. She also invested in therapy to get her through the hard moments. I found getting the results from an egg retrieval really stressful. That was probably the most traumatising part of IVF for me.

22:36given that you wake up from anesthetic and you will have your specialist come in and tell you how many eggs were retrieved and then they sort of leave you there on your own to process that. You are just curtained apart potentially from other people who've also just had egg retrievals and I think the person next to me had gotten 15 or more eggs and meanwhile I'm sitting next door with my three. Oh okay like you got lucky I did not.

23:05On this second cycle Bridget and her husband crossed their fingers that the three eggs would be enough to help make the baby they desperately wanted. I stayed hopeful that out of the few eggs we got we could get some embryos but from that egg retrieval my level of hope sort of just kept dipping down and down and down until we got lab results which unfortunately were pretty negative anyway.

23:30Directly after her third and final retrieval, which resulted in Bridget's only transfer, she decided she was done with treatment, regardless of whether or not it worked.

24:00$50,000 or what is our cutoff to stop putting so much of our resources, being financial and emotional and mental resources as well, into this process when we have no guarantee and it's feeling decreasingly likely that this is going to work out for us. Before they made a final decision, Bridget met with her fertility specialist to discuss what more IVF might actually look like. Our specialist wasn't willing to put any numbers to that in terms of if we do more rounds there will be this percentage chance of success and it just felt so unclear to us that our specialists or ourselves felt that we knew enough about the situation to say IVF would ever be the answer. I felt like we could do

24:5210 years of IVF had maybe never get success because it wasn't understood why we weren't conceiving to begin with. So it felt a bit like just throwing darts in the dark and hoping one of them would hit. Bridget, how did making that decision to stop IVF change your life? I feel like so much freedom to look at what I wanted outside of growing our family was given by making that decision and committing to that decision.

25:21I had already started doing post-grad study while we were in the process of IVF. I subsequently was able to leave my job and focus on doing my post-grad and finishing that off. I would not have done that if we were still in IVF or had succeeded through IVF. I probably would have just stayed at that job. And similarly for my husband, he's now been able to do a career shift that would have just felt like too much of a risk financially to do if we were still in that process.

25:51Bridget was still only 33. She'd spent almost three years of her life dedicated to the IVF process. She gave herself time to grieve the future she'd imagined. I had to then sit down and think about what...

26:07being a parent had meant to me and the biological part of that of having a child that had characteristics and traits similar to myself and my husband. Thinking about your life without those things when you had built up those concepts partially to get you through doing IVF is such an extreme mental load to process through what does this mean for me and how attached was I.

26:35to these particular things that I thought would happen, but now they're not. Bridget and her husband are now considering other ways to create their family. But her biggest takeaway from her experience is patient advocacy and remembering that the wannabe mum is an actual human being at the centre of this quest. In IVF, your clinic is very focused on...

27:00the medical drivers of you doing IVF. So if they think there's a chance, they're happy to let you continue doing IVF cycles. It's still such a tough space for people to feel like they get the permission to say, I've had enough and I want to stop. It is absolutely for each person to decide when they've had enough and that it's completely okay to decide you have had enough. This podcast was produced on the lands of the Gadigal, Moenina and Daroel people.

27:33Ladies We Need To Talk is mixed by Ann-Marie Debettencore. It's produced by Elsa Silberstein and Sarah Mashman. Our supervising producer is Emma Morris and our executive producer is Taymar Kranzwick. This series was created by Claudine Ryan.