The big business of infertility.

Ask any parent currently navigating the world of daycare fees, weekend sports (since when does a nine-year-old's soccer season cost upwards of $500?) and their toddler's mildly concerning blueberry addiction, and they'll tell you: having kids is a costly business.

But for a growing number of Australians, that cost kicks in well before those two pink lines on a pregnancy test show up.

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"We paid $90,000 for our baby," jokes Sydney dad Kellen, who, together with his partner Michael, used IVF with a voluntary surrogate to become a dad to three-year-old Joey.

"At the time, that was Michael's yearly salary. We knew it was going to be expensive and, of course, Joey makes the money we spent seem like pennies in comparison to the joy he brings — but sometimes I look around at our friends who conceived naturally and my eyes water at how far behind we are financially right out of the gates."

According to a 2024 report, the global fertility market is valued at US$34.7 billion (AUD 51.8 billion) in 2023, and is projected to grow to US62.8 billion (AUD 96 billion) in just 10 years.

In Australia, IVF treatments often exceed $10,000 per cycle, with out-of-pocket expenses for a first cycle typically ranging from $6,000 to $7,500, even after Medicare rebates. These costs are highly variable across clinics and treatment types, compounded by ancillary expenses like medication, storage, and day surgery fees.

And more of us than ever need to fork out. 

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In Australia, one in every 18 babies is born with the help of IVF. Research from UNSW found 18,594 IVF babies were born in this country in 2021. Infertility impacts one in six couples, with one in five women having their first child over the age of 35.

For Sydney woman Julie Sweet, IVF was on the cards from the minute she met her now-husband.

"We started discussing IVF in 2019, and by 2020 we had begun the process," Julie explains. 

Julie, who was 44 when she started IVF, knew there was a chance she would age out of the public system and thus have to pay additional costs for going privately. 

"I think I was really naive," she says. "I thought the costs would be in the range of $20,000 to $30,000, which is still a lot of money. It ended up costing us between $170,000 and $180,000."

"We initially used the public pathway, but lost access to public healthcare once I turned 45. I must admit though, I can't complain about the Australian healthcare system. I remember how surprised I was to find out that you can access IVF through the public system until age 45. That's a luxury compared to other parts of the world. I was actually really grateful and impressed."

Throughout the process, however, Julie had to undergo several unforeseen operations.

Julie Sweet during one of her many hospital visits throughout the IVF process. Image: supplied.

Before pursuing IVF privately, Julie and her husband took a break and reassessed things. 

"During this time, I experienced a natural, spontaneous pregnancy at 45," she says.  

"Sadly, I miscarried at six weeks and needed surgical management."

There were other hidden costs, too. Infertility is cascading expense after cascading expense.

"Procedures, tests, appointments, hospital stays, medication costs," (besides IVF medications, Julie was taking over 11 supplements and medications each day at one stage) "... and therapy, both individuals and couples", Julie lists off. 

"Plus, of course, pregnancy tests, ovulation kits, diet, nutrition, and exercise programs.

"In addition to that, I underwent Chinese medicine, alternative therapies, and other treatments, all of which were approved by my fertility specialist and OB/GYN."

Brendan Ayres, CEO of Connect IVF, one of Australia's few bulk-billed IVF clinics, says cases where couples were priced out of having a family were the impetus for starting the organisation.

Prior to opening Connect IVF along with a group of doctors and a Director of Nursing, Brendan worked for one of the major clinics. And what he saw "struck him as wrong".

"For every couple that could come through and access IVF, there was at least another couple that just couldn't afford it, and therefore couldn't access it," he says. 

"We looked at different ways to make it more affordable, and we were able to do that. We were able to work out how to make it far more affordable so that every Australian who suffers from infertility can access IVF if they need to."

While there are still out-of-pocket costs through bulk-billing services, the difference in cost is remarkable. 

"We accept what Medicare pays as complete payment for all the IVF components, but Medicare doesn't cover everything," he explains. 

"So for instance, in the egg pickup, we use a day surgery, and there's sedation involved, so there's an out-of-pocket there, and because Medicare doesn't cover day surgery, there's an out-of-pocket of $1,000 to cover that, and then there's a $300 copay to the anaesthetist and a procedure room fee for the embryo transfer, but essentially, that's it."

"With many traditional providers, you can be $10,000 out of pocket for a fresh cycle," continues Brendan. "It's an enormous cost, and if you look at the statistics, they tell the story, which is that it's very unlikely you're going to be successful on the first IVF cycle. You'll likely need three or four. So that $10,000 turns into $30,000 or $40,000. With us, you know a fresh cycle and two frozen cycles is less than $4,000."

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Bulk-billed IVF is a game-changer for couples who otherwise wouldn't have been able to have babies, says Brendan, and while some elements of the process are different — for example, patients have procedures done by whichever doctor is working that day, rather than a dedicated specialist through every stage — the hoards of parents who come back through his doors with a bouncing baby in tow to show off are proof enough for him that the system works.

"We regularly get couples come through and bring their bubs into the clinic and many of them have just burst into tears and said 'we never thought we'd be able to afford a family,'" says Brendan. 

"It's a good feeling. It gives you a good reason to get out of bed and go to work in the morning."

Indeed, while the idea that 'you get what you pay for' might be pervasive in some when it comes to assisted reproduction, experts warn couples' desperation to make it work can leave them open to exploitation. 

"It's the constant additional tests and procedures that send you broke," explains Melbourne mum of one, Lily, who tried unsuccessfully for years to have a second child.

"You're constantly being upsold, and when the sales tactic is the fear that not doing the 'added extras' could result in the procedure not working at all, it's almost impossible to say no."

Experts echo these concerns.

In a Lancet editorial entitled The fertility industry: Profiting from vulnerability, the authors point to a trial proving no difference in the effectiveness of different endometrial preparation protocols for the transfer of frozen embryos. 

"Many patients are also offered non-essential procedures related to IVF, so-called add-ons, including time-lapse imaging for embryo selection, pre-implantation genetic testing for aneuploidy screening (PGT-A), and endometrial scratching," it continues. 

"These procedures are widely advertised and promoted by private fertility clinics. Yet strong evidence of their effectiveness is often lacking. A trial in this issue shows that time-lapse imaging for embryo selection in IVF does not improve birth outcomes compared with routine care. Another trial published earlier this year showed that intracytoplasmic sperm injection — an invasive procedure — does not improve the live birth rate, while increasing costs and potentially risking offspring health."

And while there are some aspects of infertility that remain a mystery to doctors, this process of diminishing returns seems especially cruel if not based on solid evidence. 

"A profit-driven fertility industry cannot continue to prey on the vulnerabilities of people who desperately hope to have children," the article concludes, and while Julie Sweet doesn't regret a cent of the money she paid to eventually hold her little boy, now two, in her arms, she does wish she'd known how difficult it would be to remain objective. 

While having to weigh up the dream of motherhood with the realities of the huge financial cost was a major internal conflict, once Julie started down the path of IVF, she found it difficult to keep perspective. 

"I couldn't rationally access any logical, cognitive part of my brain at one period and was completely governed by my emotions," she says.

"I was eventually able to ground myself and accept not only the process but also the cold, hard facts [Julie had a 3 per cent chance of a positive outcome when she first started IVF, which dropped to 1.5 per cent chance toward the end of her journey]. I could then, with support, maintain a healthier perspective."

"I acknowledge that I'm speaking from a place of privilege, having had the opportunity and experience of a worthwhile result," says Julie. 

After years of treatment, Julie is pregnant with her son. Image: supplied.

"That's not lost on me. We frequently hear about successful outcomes and dreams fulfilled, but the reality is that many people don't have what they yearn for, and it's not their fault. That's deeply saddening to me."

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