Morgahna Godwin felt she had no other choice than to move from Bundaberg to the Gold Coast to realise her dream of having a baby.
"We wanted to bring that joy and love into the world, and experience it for ourselves," she said.
"But the majority of my specialist needs couldn't be met in Bundaberg."
The 32-year-old lives with endometriosis, a chronic condition that affects her ability to conceive, and had to plan her treatment appointments around the five-hour drive to Brisbane.
"It became far too hard, far too stressful," she said.
"And the financial outlay that we would have spent had we continued living regionally, it's almost double."
Limited access to reproductive services is a problem affecting aspiring parents across rural and regional Australia, a new study from Deakin University has found.
Lead researcher Christopher Mayes said some of the qualitative study's participants were forced to make days-long round trips to capital cities for in-vitro fertilisation (IVF) or even simple blood tests.
He said the findings showed the drive for profits by private commercial operators had "complicated" access to fertility care in Australia.
"It is something of a myth that we all have equal access to healthcare services," he said.
"People want to access [reproductive services] in regional areas, but they are prevented from doing so partly because commercial operators find it more lucrative to set up clinics in bigger cities instead."
The peer-reviewed research, which is expected to be published in the Journal of Bioethical Inquiry, was undertaken as part of a wider project run by the University of Sydney and was funded by the National Health and Medical Research Council.
Going the distance
Dr Mayes hoped, as part of the first bioethical study to explore the influences of commercial operators on remote access to reproductive care, the findings would prompt a "rethinking" of the way services were distributed.
"For some people the requirement to travel long distances, pay for accommodation and meals, put existing children in care, or take days off work, can make the entire process prohibitive," he said.
"A procedure like IVF can be very emotionally taxing, and so the people in our study — in addition to that — had the [physical] distance affecting their psychological and emotional wellbeing."
Ms Godwin said the barriers caused by distance had added to the emotional strain of having to go through extensive tests as a same-sex couple.
"[My wife] is a medical professional so that meant time away from her patients, and it was a really big sacrifice in the end," she said.
"We had to pass all these counselling sessions, our known [sperm] donor had to have a counselling session, and then we had to have a counselling session together."
Dr Mayes said some people in the study also had to travel vast distances for egg retrievals and medical scans because some services were only offered on days that did not fit with their fertility cycles.
"Some people we spoke to felt they lacked continuity of care when they used smaller satellite services … because these clinics often operate with a fly-in fly-out staffing model and have high staff turnover," Dr Mayes said.
"These smaller clinics were also viewed by some to offer a substandard treatment quality compared with their larger metropolitan counterparts."
Centralisation 'a necessity'
Professor Anusch Yazdani works at a private fertility clinic in Brisbane and is a spokesperson for the Fertility Society of Australia and New Zealand.
He said specialists needed a minimum number of patients to maintain the quality of their service.
"If you're only going to [see patients] once every two years you're not going to be able to deliver the same quality of service as someone who does that day in and day out," he said.
"So for us to bring everything into one capital area is a necessity, but we do try and spread out our services as much as we can."
Professor Yazdani said it resulted in a "terrible inequity of access" that was most pronounced among First Nations people.
"Not only because of geographic reasons but also because of cultural restrictions – all of these services are unfortunately designed in culturally Caucasian domains," he said.
Ms Godwin said she had also felt there was a lack of "inclusivity" in the type of fertility care provided regionally.
"When it came to specialist conversations about same-sex parenting we didn't find that to be a comfortable conversation," she said.
Improving access
Professor Yazdani said fertility services were trying to address barriers to access by using telehealth services.
"I can, at least, organise investigations and initial assessments without having the patient come down and see me," he said.
"But blood tests for example, that I need to have done in a timely way for me to monitor something like an IVF cycle that takes two weeks to run, I need to have those results pretty much that day."
Professor Yazdani said they were also exploring methods of monitoring hormones remotely.
"We're looking at urine and saliva samples because they're a little bit more stable than blood samples and can be self-collected," he said.
"Patients can then just drop them into a postal pack and we can get that quicker than we would potentially a blood sample.
"We've also been working with self-directed ultrasound scans of women who do their own scans at home and are then interpreted by our staff."
For Ms Godwin, who has been trying to conceive for the past three years, those methods were not enough to give her the quality care she needed.
Now that she lives close to her specialist she hopes she will find success.
"My journey lends itself to that wider question of 'why isn't women's health prioritised in the regions?'" she said.
"This is something I'm ready to do, I'm ready to become a loving parent and live with that joy. I think 'why are we putting all these barriers for couples?'"
