New study on the commercialisation and conflict of interest in the IVF industry

An Australian-first study into the commercialisation of IVF treatments has found that some professionals in the artificial reproductive technology (ART) industry believe that there is a conflict of interest between IVF clinics operating as commercial businesses, which is therefore impacting on the way in which they offer and deliver treatment to potentially vulnerable women.

The study, published today in Human Fertility, found evidence from those in the industry that women may be given false hope and continued IVF treatment, despite success being unlikely.

According to most participants in the study, commercial interests were seen to have the potential to conflict with physicians' commitments to their patients. This was seen to be particularly true of doctors working for corporations.

"In this research it appears conflicts of interest in artificial reproductive technology (ART) manifests in patients being offered numerous cycles, even when success is highly unlikely. This is obviously significant, not only in financial terms due to the cost to patients – and the government – of multiple cycles, but also the physical and psychological impact on the woman because ovarian stimulation and egg retrieval may be harmful in the short term and potentially the longer term," said Dr Brette Blakely lead author from the Australian Institute of Health Innovation at Macquarie University.

There is currently no Medicare limit to the number of cycles that can be reimbursed or the age of the woman receiving IVF. Even with such rebates, there is an out of pocket per cycle cost, which can vary from a few hundred to many thousands of dollars, depending on the actual fees set by individual doctors.

In some cases, there is concern that financially motivated clinicians might offer IVF to patients who do not actually need it (those who would be likely achieve pregnancy using less invasive and expensive methods). This was, in turn, seen to not only place current patients at risk, but also to mislead future patients who might be tempted to seek unwarranted treatment by high-reported success rates based on women who do not represent the average IVF patient.

"Of course, the financial and physical concerns of unnecessary ART is in addition to the emotional impact on women being given continued treatment when perhaps advice on cessation of treatment should instead be given," said Dr Blakely.

With an estimate that one in 25 babies currently born in Australia have been conceived using ART, the industry needs to act to investigate the impact of commercialisation.

"This is a complex and sensitive area, and there are multiple complex relationships and interests involved, making this issue of conflicts of interest unlikely to be easily resolved. While we cannot say that corporatisation and conflict of interest exists across the whole industry, our findings have important conceptual and practical implications to set the terms for a more robust professional and public discourse on the issue," said Dr Blakely.

The researchers propose that ART professionals draw on the expertise of bioethicists to assist in generating solutions and look to other fields which have tackled similar issues.

"The corporatisation of the fertility industry has led some clinicians and advocates to publicly express their concerns about the impact of profit-making on IVF (over)use in Australia, so this study is further evidence that this practice must be looked at, sooner rather than later," concluded Dr Blakely.

The study was based on a small convenience sample of eight professionals in the ART industry in Australia.