We need one Australian IVF regulatory system, not eight

Mao's Last Dancer, Li Cun Xi noted that a whole continent, Australia, had the population of one city in China, that of Shanghai.

In Li's adopted city, Brisbane, the Assisted Reproductive Technology Act 2024 (Qld) commenced, which now regulates Queensland's IVF clinics (see BioNews 1248). The commencement of the law at once illustrated the difficulties with a federation: there are now eight systems of regulation of IVF in Australia (see BioNews 1249); 22 of the 24 IVF clinics in Queensland are parts of IVF chains that operate across state borders, and there will soon be six central gamete donor registries – each a perfect island, separated from the rest.

When six British colonies federated as Australia in 1901, they bequeathed two legacies: most of the legislative powers remained with the states and not the new Commonwealth, and each colony had different rail gauges. To this day, the rail gauge in New South Wales remains that of standard gauge (1,435mm or 4' 8½" in Imperial), Victoria is wide gauge (1,520mm or 5'3"), and Queensland, Tasmania and Western Australia are narrow gauge (1.067mm or 5'3"). South Australia has a mixture of all three. While there has been some smoothing over of these differences, this 19th century infrastructure remains a 21st century problem.

State Parliaments have repeated the rail gauge problem with the regulation of IVF. There are now 70 laws regulating IVF clinics nationwide. As illustrated in Queensland, most Australian IVF clinics are part of national chains. Compliance costs for these clinics have continued to increase due to operating across state borders and dealing with different laws in different places. These higher costs are inevitably passed on to consumers.

Keen to ensure that there was a more straightforward system of regulation, the Fertility Society of Australia and New Zealand commissioned former Australian Health Minister, Professor Greg Hunt, and Professor Rachel Swift, to come up with something different. Their vision, launched at the Fertility Society's annual scientific meeting, is of a national plan for the industry, to be in place by 2026. Professor Hunt described the current regulation of the industry as being a repeat of the rail gauges.

Their proposal includes a national fertility law to be adopted by co-operation of the states and territories and the Commonwealth, in conjunction with patients, clinicians and the sector. The national fertility law might be modelled on the New Zealand Human Assisted Reproductive Technology Act 2004. Like other national uniform laws, while states and territories would be strongly encouraged to maintain consistent laws, so that the perfect is not the enemy of the good, there would be the capacity to accommodate historic or other perspectives.

Another proposal is to replace the six central registers with one national central register to prevent genetic relatives from unknowingly meeting and forming relationships. This register would include genetic identity of donors and would ensure transparency and traceability.

Similarly, it is proposed that there be a national health standard for egg and sperm donation, to ensure consistency and safety. The standard should cover donor limits, standards of care, and procedures for IVF regulation. Currently, the family limit is 10 Australian families in the Northern Territory, Queensland, South Australia, Tasmania and Victoria. Elsewhere, New South Wales limits use of the same donor to five Australian families, while the Australian Capital Territory limit is nine Australian families, and four families within the territory. The limit in Western Australia is five recipient families worldwide.

Victoria has retrospective transparency for anonymous donors from the commencement of sperm donation in the 1970s. South Australia has enacted the same, but that is yet to commence. Queensland has enacted the same – to commence in 2026. The Australian Capital Territory is keen to do so, as part of stage two of its reforms, following commencement of its central registry in March 2025. The other states and the Northern Territory have not enacted retrospective transparency.

Hunt and Swift propose that the Reproductive Technology Accreditation Committee (RTAC) be independent of the Fertility Society, with an independent constitution, funding and board. RTAC would have a board with a mix from industry and government, with an independent chair, an expanded panel of assessors under a full time CEO, recognition of its role under the uniform national law, and mandatory provision of IVF results to Your IVF Success as a condition of continued accreditation from 1 July 2026. Currently 90 percent of IVF clinics report their clinical data to Your IVF Success, thereby providing transparency to consumers.

It is proposed that funding for RTAC be based on a hybrid model of industry support and government funding, with 50 percent coming from the industry, 25 percent from the Commonwealth and 25 percent from the states and territories on a pro rata basis. Funding would be agreed on a five-year cycle basis.

There would be a structured process to deal with consumer complaints: firstly, to the IVF clinic, secondly, unresolved complaints would be dealt with by RTAC for review and conciliation, but if still unresolved then to the current state or territory health ombudsman, commissioner or complaints office. RTAC would have a graduated set of powers which would allow it to issue requirements for rectification or provision of information or to ensure that actions were taken or not taken until rectification was completed.

And to ensure that reforms kept up to date, RTAC would be the subject of independent review every five years.