Inside the secret world of IVF

There is big money to be made in the IVF industry and many Australians are prepared to pay up, writes Amin Abboud.

What is the real agenda of the IVF industry in the stoush over Canberra's plan to roll back funding for IVF? Is it to ease the pain of infertility for desperate couples or to insulate a cushy industry from the pain of regulation?

Australia is the only country in the world with unlimited government reimbursement for IVF. In Australia, the IVF industry is worth at least $170 million and growing at a rate of 8 to 10 per cent a year. When other services offered by the industry are included, such as sex selection of the child, the figure is considerably higher.

And the future looks bright for IVF impresarios with the help of government subsidies. The chief executive of one Sydney IVF clinic said last year: "In the future you will have sex for fun, but when you want babies, you'll have IVF."
Over the past two weeks, the IVF industry has conducted an aggressive campaign to embarrass the Howard Government into dumping its plans to impose some reasonable restrictions on funding fertility treatment

Their public catchcry is that Health Minister Tony Abbott should stay out of the bedrooms of Australians. Their real aim is to keep Treasurer Peter Costello out of the wallets of IVF practitioners.

Now it seems the Government has caved in by sending the proposed restrictions to a committee.

Sandra Dill, a vocal participant in the debates, is CEO of a group called Access Infertility Network. This group is partially funded by biotech companies and IVF clinics, so they can hardly be objective critics of any change in government funding. David Malloy, president of the Queensland AMA, has also been very vocal. He is a fertility doctor and part of the large Queensland Fertility Group.

Professor George Annas, a leading US bioethicist at Boston University, has made a very astute comment on the American IVF industry: "The whole world of assisted reproduction has been described, I think aptly, as kind of the Wild West mated with American commerce and modern marketing. You have a variety of highly professional individuals pitching their wares - their success rates, their new technology, their cutting-edge technology - to this highly susceptible group of infertile couples who are almost willing to try anything, and almost pay any price to get a baby. The industry has consistently resisted regulation."

The competition is not quite so vicious in Australia but the general pattern is the same.

The debate in the media has focused on how many cycles of IVF are needed for women to become pregnant. But the real issue here is how many women would become pregnant anyway without IVF.

Just-released scientific reviews of IVF show that it is no more effective than other treatment options for couples with unexplained infertility - which is one third of infertile patients. The authors of the prestigious Cochrane study conclude: "Until more evidence is available, IVF may not be the preferred first line of treatment for these couples and it might be more appropriate to continue with less invasive options."

Genuinely infertile couples, who can often benefit from less invasive techniques, are offered IVF instead. Michael Chapman, chairman of the IVF directors group, admitted in an interview last year that some people were conceiving through IVF who could get pregnant by other means.

The problem is that the gatekeepers of infertility advice are the reproductive industry themselves. Not surprisingly, about 3 per cent of births in Australia are through IVF, three times the level in the US and UK.

A compounding concern has been the creation of a false infertility crisis through deliberate distortion of infertility data. Sandra Dill claims that one in six people will need access to IVF. This puts infertility at 15 per cent of the population - way above even the most negative estimates of infertility in the community.

Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. It is a functional definition and an inadequate way to define a medical condition. Many couples conceive naturally after 12 months but can be erroneously labelled as infertile.

Media reporting of these claims are particularly confusing to women in their late 30s. In subtle ways, they are being told that they are more likely to be infertile. This is a claim that is greatly exaggerated. A study by David Dunson and his colleagues published in the Journal of Obstetrics and Gynaecology in 2004 concluded that sterility did not increase with age. The authors found that even the most difficult demographic, the 35 to 39 age group, could still conceive within a two-year period in nine out of 10 cases. They just needed to relax and do what is naturally necessary to conceive.

While sex is something that can be controlled by couples, fertility is not. Infertility generates anxiety in many couples. Exaggerated talk of growth in infertility makes couples insecure and, rather than try to conceive naturally, throws them into the arms of waiting IVF clinics. This is good news for clinics, of course. With more fertile couples - who with time could have conceived naturally - entering their IVF programs, the better their success rates will be.

Infertility is one of the most protracted and painful problems couples can experience. A willingness-to-pay study suggests that to have a healthy child, couples would accept a 20 per cent risk of death and would give up 29 per cent of their income. Couples in this situation deserve the most comprehensive and objective advice available.

All these factors call for a more comprehensive scientific review of IVF than just the simple restrictions proposed by the Government.

Dr Amin Abboud is a medical doctor and assistant lecturer in medical ethics and health law at the University of New South Wales. He is also director of Australasian Bioethics Information.

Source: http://www.theage.com.au/news/Opinion/Inside-the-secret-world-of-IVF/2005/05/05/1115092621694.html

Category: infertility, IVF