Paying for treatment | Public funding & eligibility

Public funding and eligibility

Fertility Associates undertakes both privately and publicly funded treatment. There are two clear stages of public funding: a publicly funded consultation and publicly funded treatment.
 

1. A publicly funded consultation

• There are a number of criteria you must meet to be eligible for a public referral (please see below for details).
• Your GP or specialist may also be required to do some workup tests before referring you to the public system (please see below for details).
• In the Northern Region (Auckland, Waitemata, Counties Manukau and Northland), the referring doctor must complete the Northern Regional Fertility Service (NRFS) referral form - you can download a copy here - and then they must send it to the NRFS (not Fertility Associates).  The NRFS will then allocate you a consultation at a fertility clinic based on your date of birth. 
• In the Midland Region (Waikato, Bay of Plenty, Lakes, and Taranaki) the referring doctor can refer directly to Fertility Associates, or you can self-refer, but either way the caller must ask specifically for a publicly funded consultation, otherwise the request will be treated as a private referral.
• In the Central Region (Tairawhiti, Hawkes Bay, Whanganui, MidCentral, Wairarapa, Capital and Coast, and Hutt) the referring doctor should refer directly to Fertility Associates and must ask specifically for a publicly funded consultation, otherwise the request will be treated as a private referral.
• In the Upper South Island Region (Nelson, Marlborough, Canterbury, South Canterbury and West Coast) the referring doctor should refer directly to Fertility Associates and must ask specifically for a publicly funded consultation, otherwise the request will be treated as a private referral.

• Waiting times for publicly funded consultations vary from clinic to clinic.
• At publicly funded consultations, patients will be scored for publicly funded treatment.  On the otherhand, if you have a publicly funded consultation you can still elect for private treatment should you wish.

 

Publicly Funded Consultation - Eligibility Criteria

	All areas	Additional mandatory criteria for Auckland and Northland
Eligibility criteria for public consultation	At least one year duration of infertility, or Known severe cause of infertility	Woman's age less than 40 at referral Woman's BMI=<32 Not smoking for the last 3 months
Prior Work up	Check woman's health with respect to pregnancy Physical examination of woman, and man if appropiate Laboratory tests (see table below)

Copies of the following laboratory tests are required for public referral, and are appreciated for private referral. In some regions, the patient will need to pay for some of these tests if they have not been done by their GP.

Test	Timing of Test
Rubella	Once only
Blood Group	Once only
VDRL/TPHA	Once only
Full Blood Count	Within last 12 months
Hepatitis B antigen	Within last 12 months
Hepatitis C antibody	Within last 12 months
HIV antibody	Within last 12 months
Endocervical Chlamydia swab*	Once in this relationship
High vaginal swab*	Once in this relationship
Cervical Smear	Within last 3 years if normal
Day 2 FSH and oestradiol ("Basal FSH")	Within 6 months if ovulating
Prolactin T4 TSH	Only if irregular periods
Testosterone LH	Only if irregular periods
Progesterone 6-8 days before menses	Only if regular periods
Woman's Partner
Semen analysis	Within last 12 months
Hep B Hep C HIV status	Within last 12 months

* Not required at Fertility Associates Hamilton

 2. Publicly funded treatment

• Waiting times for publicly funded treatment vary from clinic to clinic. 
• Even if you have a private consultation you can still be scored for publicly funded treatment.
• It is also possible  to have privately funded treatment while on the waiting list for publicly funded treatment - you would only lose your place if you achieve a succesful pregnancy.
   

Publicly Funded Treatment – Eligibility Criteria

Eligibility for publicly funded treatment is determined by CPAC (Clinical Priority Assessment Criteria) specific for fertility services. Our fertility specialist calculates the CPAC score once they have all your test results.  The CPAC score cannot be calculated or predicted by a GP or yourself – it requires the medical knowledge of a fertility specialist. Your eligibility for public funding will be confirmed to you in a letter from the clinic within one month of your consultation with a fertility specialist.
 

Couples require a CPAC score of 65 or more to access publicly funded treatment. The fertility CPAC combines points from objective criteria related to the chance of pregnancy (prognosis without treatment, woman’s age, FSH level, smoking) and points from social criteria (duration of infertility, previous children, voluntary sterilisation). The Ministry of Health has set the threshold at 65 points.   Both partners need to be New Zealand residents or be eligible to live in New Zealand for more than 2 years.

If you do not become pregnant from your first cycle of publicly funded treatment you maybe eligible for second cycle – you need to see your fertility specialist and still gain a CPAC score of 65 or more.

Typical scenarios, which gain a score of at least 65, include:

• A couple with severe infertility, no children, who have been trying for a year or more
• A couple with unexplained infertility who have been trying for five years
• A couple with severe infertility, one child from a previous private treatment, who have been trying for at least three years
• A lesbian couple where the woman wanting to become pregnant has a biological cause of infertility of at least a year’s duration
• A single woman whose investigations are normal, but who has not become pregnant after 12 cycles of privately-funded donor insemination.

Although calculation of a couple’s score is complex, some points stand out:
 

Factors which make patients ineligible for public funding

• Women who smoke (women need to have been non-smokers for at least 3 months) 
• Women who have a BMI greater than 32 must reduce weight to become eligible
• Women aged 40 or older
• Having two or more children aged 12 or younger living at home

Factors associated with a higher CPAC score

• Severe cause of infertility - such as no or very poor sperm, severe endometriosis, damage to both the fallopian tubes, anovular or not pregnant after clomiphene treatment
• Longer duration of infertility

Factors which reduce CPAC score – but funding may be possible:

• Having one child 12 or younger living at home
• Having had a vasectomy or tubal ligation.  Where one of the couple has had a vasectomy or tubal ligation, duration of infertility for CPAC scoring starts from when the couple first see a doctor about having a child.

In addition

• Since duration of infertility is a major prognostic factor, most couples gain more points with time. A 'Care and Review' option is managed by Fertility Associates for couples who are likely to become eligible within two years of consultation.
• Lesbian Couples and single women are eligible for treatment if they have a biological cause for infertility, or if they have not become pregnant from 12 cycles of donor insemination.
• Funding covers the most appropriate treatment, which may include insemination with partner's sperm, donor insemination, IVF, IVF with sperm microinjection (ICSI), egg donation and surrogacy.
• Treatment can be stopped if a woman does not respond sufficiently well to the drugs used for treatment.
• Public funding covers the cost of treatment, but does not cover legal costs for surrogacy and some types of donation.  Only the first $400 of egg donor reimbursements is covered.

Privately funded consultation

There is minimal wait for privately funded consultations. You can be scored for public treatment at a private consultation.
 

Privately funded treatment

There is minimal wait for privately funded treatment, apart for the use of donor sperm and donor eggs. It is also possible  to have privately funded treatment while on the waiting list for publicly funded treatment - you would only lose your place if you achieve a succesful pregnancy.
 

Where to refer for consultation

Auckland & Northland - PRIVATE ONLY
Post: Fertility Associates, Private Bag 28910, Remuera, Auckland 1541

Fax: 09 520 9521

Email: faa@fertilityassociates.co.nz

Healthlink: Use the EDI for the Auckland clinic or its specialists

Auckland & Northland – PUBLIC ONLY
Post: Northern Regional Fertility Service, PO Box 24 587, Royal Oak, Auckland

Fax: 09 631 0728

Waikato, Bay of Plenty, Taranaki, Lakes - private and public

Post: Fertility Associates, PO Box 598, Hamilton

Fax: 07 839 2603

Email: fah@fertilityassociates.co.nz

Healthlink: Use the EDI for the Hamilton clinic or its specialists

Wellington, Wairarapa, Palmerston North, Whanganui, Hawkes Bay & Gisborne - private and public

Post: Fertility Associates, PO Box 11048, Manners St, Wellington 6142

Fax: 04 384 8402

Email: faw@fertilityassociates.co.nz

Healthlink: Use the EDI for the Wellington clinic or its specialists
 

Nelson, Marlborough, Canterbury, South Canterbury and West Coast
Post: Fertility Associates, PO Box 36560, Merivale, Christchurch 8146

Fax: 03 355 8851

Email: fac@fertilityassociates.co.nz

Healthlink: Use the EDI for the Christchurch clinic or its specialists

 

For further questions

If you have further questions, please call 0800 10 28 28 and ask to speak with one of our public funding coordinators.