Australia's twin and triplet birth rate could rise as more women undergoing IVF ask doctors to implant multiple embryos to reduce the cost of fertility treatment.
Specialists say cuts to the Medicare rebate have increased patient costs by about $1500 for each IVF cycle, forcing many to delay or abandon further attempts to conceive. Others are insisting on several embryos being transferred in one go to boost the chance of pregnancy, despite the increased medical risks associated with carrying several foetuses.
Australia has one of the lowest multiple embryo transfer rates in the world but doctors say pressure from cash-strapped patients could change that. Clinic chiefs across Melbourne have told The Sunday Age that despite multiple births carrying a fivefold increased risk of foetal death, premature births or conditions such as cerebral palsy, more couples are now willing to take the chance.
''They're saying, we understand that it's more dangerous but we can't afford to do another cycle so we'll have two embryos put back and we'll deal with the consequences. If our baby ends up born at 32 weeks and has to have eight weeks in intensive care, well Medicare pays for that,'' said Monash IVF's Gab Kovacs.
Dr Kovacs said patients were re-mortgaging their homes or dipping into superannuation savings to fund the rising cost of fertility treatment.
David Wilkinson from City Fertility Centre said he fears Australia could follow the United States, where patients often have four or five embryos implanted in one cycle because of rising IVF costs.
''The big problem with that is it might be a short-term saving for that patient but the long-term effect is that the medical budget will go through the roof as the multiple birth rate increases,'' he said.
Federal Health Minister Nicola Roxon moved to cap Medicare safety net payments - which paid 80 per cent of the gap between the fee charged by doctors and the Medicare rebate - after a review found specialists were rorting the system by charging patients excessive fees.
As of January 1, IVF payments were capped at different rates for each stage of treatment, which has led to out-of-pocket costs for patients rising by between $1500 and $2000.
Ms Roxon vowed that patients would be no worse off if specialists charged $6000 - the cost of a typical cycle, according to the government.
But doctors claim they have not increased their fees and the average cycle costs up to $7500 or more if the patient requires additional treatment.
Sandra Dill from infertility support group Access Australia said that since the changes came in they had been receiving up to 40 calls and emails a week from patients complaining they were under increased financial stress.
''When you have an older woman she can't afford to wait around for six months while the minister decides whether or not she will alleviate the financial pressure on that woman. Every month she waits she becomes less fertile,'' Ms Dill said.
In a statement Ms Roxon said: ''Before this action, of every taxpayer dollar spent on IVF, nearly 80¢ were going to doctors, with only 20¢ going to help patients.
''This program was designed to assist patients, not line the pockets of doctors. Medicare data shows that the highest 10 per cent of assisted reproductive technology specialists were paid $4.5 million each by taxpayers through Medicare … The government is urging women to closely question their doctors about their fees.''
Lyndon Hale, medical director at Melbourne IVF, said the claims were misleading.
''The patient comes to the clinic, she has to see the counsellor, the nurses, the injections are given, the scans done, the blood tests taken, the egg collection procedure. Then it goes into the laboratory, the scientists work on it - all of that gets billed under the doctor's name,'' he said. ''But from that has to be paid all the scanning, the blood tests, the embryologists, the data collection.''
Dr Wilkinson said feedback from patients suggested the multiple birth rate would rise: ''I'm fearful that as costs do increase and the Medicare rebates go down we're going to be fighting an uphill battle to convince patients that it's not a good idea to have multiple embryo transfers.''