Going through IVF brings physical and mental challenges for people needing assistance to conceive a baby. With basic public funding available, why does the criteria make it harder on some than others?
Alyssa Stringfellow and her fiancé Joel Shadbolt are eager to start a family — but with complications in their ability to conceive, they need help.
Two years ago, they turned to IVF, facing a series of agonising egg collections and embryo transfers - one which resulted in a devastating miscarriage.
It has been the most difficult time in their relationship, but by enduring the false highs and dark lows together, they have become more resilient as a couple.
While remaining hopeful, they have a few options left - but Alyssa can't shake her frustration knowing her options are not the same as others because of where in New Zealand she lives.
An IVF journey
Alyssa and Joel live in the Bay of Plenty. At age 20, she was diagnosed with stage four endometriosis. Alyssa later found out her chances of having a baby were significantly limited due to a complication with her fallopian tubes.
The couple turned to IVF, a process which sees eggs collected from ovaries and fertilised by sperm in a lab. Once they are embryos, they're transferred to a uterus.
During her consultation for public funding, she was told she had a low egg count, so the couple decided to go down the private track - which can cost couples in New Zealand tens of thousands of dollars.
Her first egg collection with private funding wasn't good — she had four eggs taken out and got her first IVF jolt when none of them survived.
Alyssa's second collection was better with eight eggs turning into embryos and the possibility of being transferred.
So far, she's attempted three transfers. The first and third were unsuccessful. During the second, Alyssa got pregnant only for her excitement to be cruelly taken away when she was told she would miscarry, before eventually losing the baby.
When Alyssa and Joel received their first round of public funding in November last year, the couple did another egg collection. Ten eggs were collected, seven turned into embryos but none of them survived.
Her faith is not lost. One in four New Zealanders are affected by infertility and some couples will try for years before successfully having a child of their own.
She still has five embryos which survived their second egg collection. These are able to be transferred to her uterus with the hope of becoming pregnant.
But because Alyssa lives in the Bay of Plenty, she is unable to use her public funding for these transfers. If she lived in Auckland, she could. Instead, if Alyssa wants to access her next round of funding, she has no choice but to start at the beginning with another egg collection.
The egg collections can be gruelling, taking up three months of her life at a time. She can't exercise, run or do any activities that could potentially harm her ovaries when they're swollen.
Alyssa said: "There's a huge repercussion in regards to my body."
Fertility shots and prescribed pills can make her put on weight, emotions become hard to control and she's had an allergic reaction to some of the drugs.
She explained: “For me, it was a really long and harrowing process, and then at the end of it, nothing good came of it."
The couple don't want to stop trying, but Alyssa needs to consider the highly demanding toll it takes on her body and her strength of mind.
According to guidelines stated on the Fertility Associates website, if you are in Auckland or Northland with frozen embryos stored from a previous private IVF cycle and then you become eligible for publicly-funded treatment, you must use your public funding to transfer those embryos first before starting a new cycle.
But in the Bay of Plenty and Waikato, or anywhere outside of Auckland and Northland, if you have embryos banked from a private round you are not allowed to use your public funding to transfer them.
Alyssa said: "If I go through another round of public funding, I have to go through another egg collection and then potentially not have any eggs again, and then won't be able to go for any live transferals again."
Her concerns sit with the eligibility model, not with the medical staff involved in the fertility process on the ground.
She said: "The nurses and the doctors who I personally worked with made me feel comfortable and safe. They're amazing.
"It's the business behind it that made me feel like 'why isn't anyone listening', 'why is it like that down here?'
"It's unfair. That should be our choice whether you want to go through egg collection or use your own banked embryos, that should be a choice and it's not."
There are also other areas of concern regarding the eligibility criteria of IVF per region which hasn't changed for more than a decade.
It uses the BMI tool to measure body fat and has age limits labelled "inappropriate" by charity Fertility NZ. Funding isn't provided for gay male couples and many lesbian couples while support is limited for single parents.
Associate Health Minister Willow-Jean Prime told 1News IVF funding is available through fertility services run in Te Whatu Ora districts, formerly referred to as district health boards.
She said: "I acknowledge for those accessing those services that the overall journey can be incredibly hard.
"The current eligibility system is used to ensure fairness and transparency, and that services are provided to people with the greatest need and ability to benefit from fertility treatment."
But Fertility New Zealand spokesperson Juanita Copeland disagrees.
She says infertility is "stressful, scary and daunting", and it's a "heavy burden to carry" for someone to know that they can get the treatment they want a few hundred kilometres away, but not at their local clinic.
Copeland said: "People are missing out on funding due to discriminatory and inequitable criteria. This is a big concern for us and the community we serve and is compounded by the fact that these criteria can vary from region to region.
"The current criteria for deciding who is eligible for publicly funded treatment is outdated and doesn’t reflect modern society.
"While these regional variations are well considered before being put in place, they do create a situation where the type and timeliness of treatment a person receives depends on where they live."
Calls for 'overhaul'
Copeland said an overhaul is overdue around public funding for IVF and the decisions around the allocation of that money.
She said: "In a country as small as Aotearoa New Zealand this can be a frustrating position to find yourself in. We believe that the same criteria should be used for everyone.
"A full review as well as the criteria and allocation of that money is well overdue. We know society has changed and the funding model should reflect that.”
Fertility Associates, which acts as New Zealand's main fertility specialist, were unable provide a statement before the time of publication.