Is the IVF industry really misleading women?

The recent media beat up of Australia's fertility industry was unfair. Here are the facts they forgot to mention.

Don’t get me wrong, I'm a big fan of the ABC. But the recent Four Corners piece on Australia’s fertility industry was just plain irresponsible journalism and concerned more with pulling on heartstrings than presenting facts.

The underlying message was that the three major IVF providers – Virtus Health, Monash IVF, and Genea – are hiding low success rates in pursuit of profits.

True, the odds of success are low, especially for women over 40 (see chart 1). But the idea that the industry is misleading prospective mothers is ridiculous. For one thing, you can't do a google search for IVF or look through the company websites without seeing that success rates for women over 40 fall off a cliff (see here, here or here).

The real issue isn’t a lack of published success rates: the Australian and New Zealand Assisted Reproduction Database (ANZARD) annual review provides 89 pages of mind-numbingly detailed and independent data for anyone wanting to know the odds. The trouble is that fertility issues are so patient specific that broad 'success rates' hardly mean anything anyway.

Forcing individual clinics to publish success rates, as the program suggests, could just encourage them to turn away the more difficult cases. Any clinic could boost its success rate overnight by cherry-picking those patients under 30. How would that help desperate couples?   

Think of the children!

The other issue raised by Four Corners was public funding. Between Medicare and the Extended Medicare Safety Net (EMSN), a bit over half of the $9,000 cost per cycle is covered by the Government.

Putting a cap on the number of subsidised treatments for 42 year olds is sensible enough given the miniscule odds of success (the presenter and I can at least agree on that). But cutting the Medicare rebate for everyone could cause more harm than good.

In fact, there are several reasons to actually increase funding. For one thing, lower out-of-pocket expenses mean couples are under less pressure to conceive during the first cycle. This, in turn, has encouraged Australian doctors to overwhelmingly opt for single embryo transfers, which is safer for both the mother and developing child. Only 2% of Australian cycles result in multiple births, compared to 30% in the USA and 18% in the UK, where funding is less generous.

Even from a financial standpoint, though, there’s a good argument for the Government to increase funding. A child’s future economic contribution in taxes, insurance and productivity will, in most cases, far exceed the cost of their birth. In 2006, UK researchers concluded that a newborn’s long-term financial benefit to society was more than 10 times the cost of IVF.

Changes to Medicare funding are undoubtedly the biggest risk facing IVF providers and there’s no getting around the fact that success rates are low. Still, at current levels, almost one child in every classroom – 3.3% of Australian children – is born as a result of assisted reproductive technology. Had the ABC interviewed the parents of even one of those success stories, the IVF providers might seem more like problem solvers than predators.

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Disclosure: The author owns shares in Virtus Health and Monash IVF.

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