Birth rates are at a record low and there’s a chronic donor sperm shortage. Should fertility treatments in New Zealand be subsidised like they are in Australia?

This article is the second in a two-part series on fertility. Read more: I always wanted to have children – $100,000 later, I’m still trying.

Some names have been changed.

Lani and Malie are obsessed with their daughter. At six months old, she’s the centre of their life, arriving after they spent nearly three years trying to conceive. As two women wanting children, they needed a donor. Where many same-sex couples seek a donor and treatment through fertility clinics, the couple wanted someone they knew and opted for at-home insemination. 

“My aunt did this in the 90s, and my sister started doing it five years ago, then we started doing it,” Lani says . They tried at home with their first donor for 18 months, taking “mental health breaks” every few attempts. After a painful miscarriage, their donor took a break, then opted not to continue. By that point, the donor waitlist was “too far and too hard”, so, with difficulty, they found a new donor, negotiating the role he would play in the baby’s life, especially given the couple considered his a “gift of lineage”. “It’s an indigenous framing and there’s so much power in that,” says Malie. “That’s why we didn’t want to go through a clinic.”

Lani fell pregnant after one at-home attempt with their new donor. If she hadn’t been able to, Malie would have tried. “The clinic is not where my mind would go at all,” Lani says. 

She sums up why in 10 words: “If it was more affordable, we’d have thought about it.”

Birth rates at record lows

In 2025, New Zealand’s total fertility rate (TFR) was 1.55 births per woman, continuing a downward trend for the last decade, thanks to both fewer births and a growing population of women at reproductive age. New Zealand’s birth rate has fallen steadily since 2013 when it first fell under the replacement rate – the average number of births per woman of reproductive age needed to replace the population long term, without migration – of 2.1. 

Nearly one in four New Zealand couples will experience infertility in their lifetimes, meaning they won’t conceieve after 12 months of regular, unprotected sex. That number has also increased as fertility lessens with age and women are, on average, waiting longer to have children. 

A rise in infertility (or, at the very least, infertility awareness) means an increased interest in IVF and other fertility treatments. In 2014, there were 5,891 “rounds” of fertility treatment (typically IVF) administered in New Zealand. In 2023, that number had increased to 9,151. 

Alex Price, CEO of Fertility Associates, the largest provider of fertility care in the country, says the company has seen “about 3-4% volume growth” year-on-year, with a spike during the Covid years. But despite the growth, New Zealand’s access to fertility treatment still pales in comparison to Australia, where in 2023 the treatment cycle rate was 18.7 per 1,000 women of reproductive age, compared to New Zealand’s 8.6. 

The main factor? Cost.

The cost of a baby

While the cost of the treatment here, when paid in full, is comparable to Australia, our neighbours have a suite of subsidies and rebates on offer for those experiencing infertility. In New Zealand, approximately 65% of fertility treatment cycles are paid for in full by patients. Yesterday, The Spinoff published the story of Molly, who is trying to have a child as a single woman, and with no diagnosed health concerns, has struggled to conceive with a sperm donor. She has spent more than $100,000 to date and feels “just depressed about it now”, though she is still trying.

But not all patients are paying six figures. In 2021, Emma was single and wanting to start a family. Based in Auckland, she had the luxury of options, with Repromed, Fertility Plus and Fertility Associates all operating clinics in the city. She opted for Fertility Associates and was advised that at 36, with endometriosis and a low ovarian reserve, there was no point joining the up-to-three year waitlist for a donor and she should find her own donor and go straight to IVF. “Basically I was fucked,” she remembers.

With that prognosis, Emma anticipated a costly journey ahead, and was “extremely lucky that my parents were very supportive and offered to pay”. But even so, she didn’t want to “do a million rounds of extremely expensive IVF and get very stressed and just feel worse”. 

But she managed to find a personal donor “surprisingly easy” and when his sperm was tested, it was so good the doctor suggested intrauterine insemination (IUI) instead, a lower-success but far cheaper and less invasive method.

On the second attempt, Emma became pregnant, and gave birth to her daughter in 2022. She engaged with Fertility Associates for six months and her total cost was about $10,000. A success story on all fronts. Looking back, she’s not sure what decisions she would have made if IUI hadn’t worked – as it doesn’t for the majority of patients – and how long she would have kept trying, but is relieved to have not had to find out. “It’s such a horrible game of luck.”

The cost of business

Alex Price knows the service Fertility Associates provides is prohibitively expensive. He says the cost in providing it is too, citing one specific embryonic monitoring machine costing “hundreds of thousands of dollars”, and highly-trained medical professionals making up the bulk of personnel costs. For much of the country, Fertility Associates is the one and only option for fertility treatment. Only in Auckland are there competitors, with Fertility Associates the most expensive of the three. 

For Molly, that soft monopoly has added to her frustrations about her care there. “If there was even one other clinic in my area, that’s where I would be. I wouldn’t be in this place because it doesn’t serve me.” But Price doesn’t anticipate any new players entering the market anytime soon. “To have a single clinic outside Auckland would be, I think, extremely challenging economically, [especially] around just getting sufficient volume of work.” (In 2014, Fertility Associates expanded to Malaysia and Thailand, which has allowed some of its base costs to be shared across a larger consumer area.) 

Others have tried, however. In 2011, Repromed Australia withdrew from the Christchurch market, selling its clinic to Fertility Associates. In 2020, another Christchurch clinic, Genea, also shut its doors after failing to win a local DHB tender to provide publicly funded fertility treatment to the South Island (that tender was won by Fertility Associates, who had been providing the care for five years already). 

The cost of healthcare is always increasing, for both providers and patients. Price confirms that Fertility Associates is currently training its nurses to perform more procedures and tasks that have historically been performed by doctors. “There are some tasks that those [specialist doctors] have to do, but there are some tasks that we can allocate to nurses. Not all, but some. And that’s part of the way we try to drive productivity,” he says. With personnel costs making up “60-70%” of operating costs, nurse hours replacing doctors hours would, in theory, result in a personnel cost reduction. When asked if this would reduce the price of treatment for consumers given nurses are paid significantly less than doctors, Price equivocated. “Nurses get paid less, but nurses get paid a lot more now than they did three or four years ago.”

A leaked memo of a Fertility Associates’ presentation to potential investors five years ago revealed it would file a profit of $14m on revenue of $44m in the 2021 financial year, making it a high-margin business. At the time, Price did not dispute those figures when questioned by NZ Herald, but did cite heavy investment in lab equipment and IT infrastructure meaning net profit would be tighter. 

The donor tax

The costs are myriad in fertility care. Visit any fees page on clinic websites and every appointment, scan, pill or procedure has a hefty price tag attached. But one cost that continues to confound clients is a fee commonly referred to as the “donor tax”. At all fertility clinics, a “sperm addition fee” is placed on any round of IVF or IUI that requires donor sperm. That fee is highest at Fertility Associates, with patients paying an additional $1,800 every time their donor sperm is used in a cycle.

Price says the fee is not for the handling of the sperm itself, but for the cost of running a full donor programme within the clinic. With New Zealand’s restrictive legislation around sperm and egg donation, donors cannot be paid and sperm and eggs cannot be bought, meaning sperm banks must be run within fertility clinics rather than as separate businesses. Price specifies recruitment, counselling, screening and storage as making up the high cost of running the programme.

Those programme costs are then split into an estimated “per use” fee for sperm, rather than a “per donor” fee. For Molly, who has undergone two rounds of IUI and three rounds of IVF using a friend’s sperm, that fee has grown to $9,000. She says the “idiotic” fee has been salt in the wound for not conceiving faster.

“So at the moment, those who pay more are saying it’s unfair,” Price acknowledges. “But if we changed it around the other way, those people who got pregnant quickly would complain, saying ‘I’ve spent $4,000 for this donor for one cycle treatment. That’s a lot of money.’”

The limits of public funding

Price says approximately one third of IVF cycles in New Zealand are publicly funded, at a cost of about $15 million. The government offers funding to select patients for up to two rounds of IVF, but the criteria to receive this public funding is narrow and requires the following:

• The person wanting to become pregnant is under 39 years of age at time of referral 
• You have been trying to get pregnant for at least 12 months
• You have a known male or female factor such as endometriosis; blocked tubes; anovulation; a very low sperm count
• The person wanting to become pregnant  has a BMI of <32

Much has been written of the eligibility criteria, particularly the BMI requirement, given the differences in body mass index across different ethnicities. It’s a global debate, with the BMI cut-off around the world ranging from 35-45, and places like the United Kingdom doing away with the criteria altogether. Academics have argued New Zealand’s BMI criteria is outdated and discriminates against Pacific people in particular, who research has shown are much leaner than Europeans and Asians at higher BMIs. Māori and Pacific people are already less likely to seek fertility treatments for reasons ranging from cost to religion to cultural competency in healthcare settings.

In 2021, Pacific people made up 8% of the New Zealand population, but only 2.1% of fertility treatment rounds. Similarly, Māori made up 17.1% of the population but a mere 4.3% of fertility treatment rounds. 

Health NZ has confirmed to The Spinoff, via associate minister of health Casey Costello, that “there are no current plans to change the criteria for publicly funded fertility treatment”. 

During the 2017 election campaign, the National Party announced a “new families” policy package, which would allocate an extra million dollars to IVF funding, specifically to pay for a third round of IVF for those who did not conceive after two publicly funded rounds. It was calculated that approximately 100 people a year receive two publicly funded rounds of IVF and don’t conceive. 

National didn’t win that election and hasn’t pitched the policy again. 

The way forward

While always welcome, Price and Molly agree that a simple increase in public funding is not the solution to inaccessible fertility care or New Zealand’s declining birth rate. For Molly, it’s all about competition. She wants to see it made easier for new providers to enter the market. For Price, IVF is just part of the solution, alongside “housing affordability, childcare costs, the cost of taking maternity leave“. 

And for those still trying to conceive and spending their life savings doing so, like Molly, there’s still a privilege involved. “There’s so many people who have no story to tell,” she says. “They just took one look at that price list and said, guess this dream is over. What a heartbreaking reality.”