Table 1 Case Study 1 Assisted Reproductive Technologies (ART) for women over 42 years of age

ART does not specifically affect morbidity or mortality (with some exceptions). The debate has, and continues, to occur prominently in the broad community as well as government. In 2003, age-specific success rates of In Vitro Fertilisation (IVF) cycles using fresh oocytes were [28]:

• 27.7% for women aged 25–29

• 24.9% for women aged 30–34

• 17.1% for women aged 35–39

• 6.8% for women aged 40–44

• 2% for women aged ≥ 42 (some clinics have cited success rates of 5–10%)

This success rate for women aged 42 years or more has been cited by one Australian clinic as a reason for refusing to treat women of that age [29]. Politicians have also engaged with this debate. In April 2005 the Australian Government Minister for Health and Ageing considered limiting ART funding under Medicare to three cycles per year for women 42 and under, and to three cycles in total for women over this age [30]. Rising expenditure on ART and the low age-specific success rates were cited as justification for this policy. This proposal for reduced support was subsequently abandoned by the Australian Prime Minister in May 2005. Table 3 further explores some of the methodological issues associated with this as a potential case study in disinvestment.