The assisted reproductive technology (ART) market is expected to reach $45 billion by 2025, according to Grand View Research. The in vitro fertilization market alone is projected to reach $36.2 billion by 2026. All of this potential profit has some leaders in the field wondering if the commercialization of IVF has gone too far.
A study published in Human Fertility is the first of its kind and scope to examine the potential "conflict of interest between IVF clinics operating as commercial businesses," according to reporting on the study by Macquarie University. The research explores how this potential conflict impacts "the way [clinics] offer and deliver treatment to potentially vulnerable women."
Lead author Dr. Brette Blakeley asserts that this conflict "manifests in patients being offered numerous cycles, even when success is highly unlikely."
Although the study was conducted in Australia, the commercialization of IVF is a global debate. What are reproductive specialists' responsibilities when it comes to balancing the viability of a private or corporate practice with a high standard of care for their patients?
Cost of IVF vs. Patient Need and Candidacy
One point of contention is that patients might be successful using a fertility treatment that is less costly and less invasive than IVF. However, IVF may be the first treatment that clinicians recommend. Given that successful patients often leave positive reviews online and tell friends and family about their experience, patients experiencing infertility may also think of this treatment option before considering others, such as intrauterine insemination or intracytoplasmic sperm injection.
The American Society for Reproductive Medicine (ASRM) published an Ethics Committee opinion about providing fertility treatments when the patient has a poor prognosis. The committee recommended open, clear communication with patients about their situation, potentially providing limited treatment after thoroughly explaining the risks and alternatives. ASRM also supports a physician's decision to refuse to provide treatment altogether in the face of an extremely poor prognosis.
Pushing Patients Beyond Their Limits
Patients who want a genetic connection with their children are sometimes willing to try IVF with their own eggs or sperm over and over until they are successful — even if it depletes them physically, emotionally or financially. Fearing they will not be successful the first cycle, some patients choose to pay for multiple cycles up front in IVF bundle packages. Critics of these purchase options point out that they often do not provide a refund if patients become pregnant after a single cycle.
If first-time IVF patients — not knowing what to expect — need more than one retrieval and have purchased a bundle, it's possible they will be too physically and emotionally exhausted after the first retrieval to pursue a second round. The first retrieval may also result in more than one transfer.
Financial Barriers
Due to the high cost and lack of insurance coverage for fertility procedures, some patients who are paying out of pocket may ask to transfer more embryos than recommended — often resulting in higher-risk multiple pregnancies.
To reduce the impact of this problem, clinics must provide patient education on the benefits of elective single transfer. State and national healthcare policies must change significantly in order to increase ART access for patients.
Desire for Patient Success
The best argument against a conflict between clinics' commercial interests and patients' interests is that most reproductive endocrinologists and their staff truly care about patient outcomes. Clinics must report their data to the Society for Assisted Reproductive Technology with the knowledge that patients review this information and use it to make informed decisions. From time-lapse embryo imaging to preimplantation genetic testing to endometrial receptivity analysis, IVF datafication has increased dramatically in recent years.
This global debate about the commercialization of IVF will likely continue and evolve for some time. Ultimately, patients have significant power over their own care and should take every opportunity to educate themselves about their options.
