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Eligibility For Publicly Funded Treatment

To be eligible for a publicly funded specialist appointment (FSA), a woman must be a New Zealand resident, under 40 years of age and have at least one year of infertility. We assess your eligibility for publicly funded treatment following your initial consultation (FSA) and investigations. Your eligibility is determined by a scoring system called Clinical Priority Assessment Criteria (CPAC). To be eligible for publicly funded fertility treatment the woman must be a non smoker with a BMI of less than 32.

Once eligibility for treatment has been confirmed, at Fertility Plus there is approximately a 14 month wait for an IVF cycle. There is no wait time before commencing Intrauterine Insemination (IUI) cycles.


Assessing your eligibility
Repeat treatment cycles
How some factors affect your CPAC score
Private treatment

Assessing your eligibility

CPAC-based systems are used for assessing eligibility for a range of medical treatments in New Zealand. Specific fertility criteria are assessed for accessing fertility services. Although we can give you an indication of whether or not you will be eligible for publicly funded treatment after your first visit, your exact CPAC score can only be determined once we have all your test results.

  • Couples require a CPAC score of 65 or more to access publicly funded treatment.
  • CPAC scoring is based on how likely a couple is to conceive spontaneously and how long they have been trying.
  • Other factors such as previous sterilisation and having had children already will also affect a CPAC score.
  • Both partners need to be New Zealand residents or be eligible to live in New Zealand for more than 2 years.

Repeat treatment cycles

If you do not become pregnant from your first cycle of publicly funded treatment you may be eligible for a second cycle but couples will still need a CPAC score of 65 or more. Women who turn 40 years old during their first publicly funded treatment cycle will not be eligible for a second cycle. There is a wait of several months before a second cycle begins.

How some factors affect your CPAC score

There are some couples who will not be eligible for publicly funded treatment. These include:

  • Women aged 40 or older
  • Women who smoke (women need to have been non smokers for at least three months)
  • Women who have a BMI greater than 32
  • Couples who have two or more children, aged 12 or younger, living at home

There are some factors that will increase your CPAC score. These include:

  • Very low numbers or no sperm.
  • Severe endometriosis or damage to the fallopian tubes
  • A long duration of infertility

There are some factors that will reduce your CPAC score. These include:

  • Mild fertility problems or unexplained infertility
  • A short duration of infertility
  • Having one child 12 years or younger living at home
  • Having had a vasectomy or tubal ligation

A score of over 65 is likely for:

  • Couples with severe infertility who have been trying for over a year
  • Couples with unexplained infertility who have been trying for five years
  • Couples with moderate problems who have been trying for three years
  • A single woman who has not become pregnant after 12 cycles of private donor insemination
  • Same sex couples where the woman hoping to conceive has a severe fertility problem

Private treatment

Couples can have private treatment if they are not yet eligible for publicly funded treatment or they are on the waiting list for treatment. If they have a baby from their private treatment cycle they may still at some point be eligible for funded treatment but will be rescored and may gain fewer points because they now have a child at home.

If their treatment is not successful their eligibility or place on the waiting list will not be affected.

Can we be scored without being seen at Fertility PLUS?

It is not possible to score couples without reviewing their results and fertility problems at a clinic appointment. Scoring criteria also change from time to time and some couples may become eligible for public funding if they make some lifestyle changes such as stopping smoking or losing weight. These issues can be discussed with you in clinic.
National Women's Health
Phone: 09 307 4949
Email:
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