Preying on fear fuels IVF cash cow

Thousands of IVF patients are upsold extra treatments every year which don’t improve their chance of having a baby.

Every year, more than 13,000 Victorians seek help from IVF clinics to try for a baby.

Many of these people will tell you it can be an expensive and gruelling process involving invasive procedures, time off work, and emotional highs and lows.

Another thing that makes fertility treatment challenging is the extensive range of extras you can pay for in the hope it will improve your chance of success.

As IVF clinics have become more commercialised and competitive in Australia, IVF add-ons have become commonplace.

Add-ons are procedures, techniques or medicines that are used on top of standard IVF protocols to try to give patients a winning edge. They include technology such as time-lapse imaging of embryos and procedures such as an “endometrial scratch” of a woman’s uterus to try and make it more receptive to an embryo implanting.

Research by the University of Melbourne and the Victorian Assisted Reproductive Treatment

Authority has found that most IVF clinic websites in Australia advertise add-ons, often with claims they will benefit patients.

The trouble is, some of the add-ons advertised have been shown to be ineffective and none of them have robust evidence to show they are safe and improve the chance of a baby. 

Another study reported by the Herald Sun this week shows add-ons are popular. A survey of more than 1500 Australian women who recently had IVF found 82 per cent had used add-ons. More than half of them chose to use an add-on after their clinician suggested it.

One of the most commonly used add-ons reported by women in the survey was preimplantation genetic testing of embryos for aneuploidy (abnormal number of chromosomes). The test, also known as PGT-A, costs hundreds of dollars per embryo with no reliable evidence to show it improves the chance of a baby.

While PGT-A has the potential to reduce the time involved in fertility treatment for some women, particularly those with large numbers of embryos, most women will not benefit from it for two reasons.

Firstly, it is not 100 per cent accurate so some embryos that have the capacity to form a healthy embryo will be discarded.

Secondly, while the risk is small, embryos can be damaged in the biopsy procedure.

Survey participants also reported using corticosteroids — a class of drugs that reduce immune system activity and have been linked to an increased risk of birth defects, premature birth and low birth weight for babies.

Therein lies the problem with a lack of evidence for add-ons. Because many have not been thoroughly assessed in the context of IVF, they may harm patients, their embryos and/or their babies.

When a new test, procedure or medicine has not been studied properly, it can play out in several ways.

The best-case scenario is that it benefits the patient and doesn’t harm their embryo or their baby. But there may be an equal or even greater chance it will harm them and/ or their baby, setting them back in their quest to finish IVF with a happy ending.

The other thing to think about is cost. For most people, IVF comes with significant out of pocket expenses, usually totalling thousands of dollars, if not tens of thousands of dollars. If you opt for a full menu of add-ons with an IVF cycle, this can reduce your capacity to pay for more IVF cycles — a proven way to improve your chance of a baby.

Research commissioned by VARTA shows most people don’t have a baby after their first IVF cycle.

For women who start IVF at age 35, there is a 42 per cent chance of a baby after one cycle, a 56 per cent chance of a baby after two cycles, and a 61 per cent chance after three.

So, it might pay to know that IVF can be a long game. When you’re tired and desperate for a conclusion, it’s easy to think optimistically about add-ons and fear that you’re not doing everything possible for success.

But there are countless examples of new medical interventions doing more harm than good because they have not been rigorously studied.

Fertility specialists are obliged to outline the potential risks and benefits of all interventions they offer to their patients, as well as the strength of the evidence behind them. This applies to add-ons, too.

If you’re going through IVF and considering an add-on, try asking your doctor the following questions: (some from Choosing Wisely, a not-for-profit group that helps Australians get the best bang for their buck with healthcare):

* Do I really need this?

* What are the risks?

* What are the costs?

* Are there simpler, safer options?

* What happens if I don’t use it?

* Will it improve my chance of a baby?

Anna MacLeod is chief executive officer of the Victorian Assisted Reproductive Treatment Authority. VARTA is running a free webinar about add-ons on July 14.

Grant McArthur

Grant McArthurHealth editor

Grant McArthur is the Herald Sun’s health editor, having first joined the paper’s health/medical team in 2007. Focussing on policy and regulation, research and the inspiring personal stories side of health, Grant’s objective is to place the human aspect forefront of any issue. He received a Walkley for uncovering a cluster of avoidable baby deaths at Bacchus Marsh Hospital, and has covered everything from the separation of Bangladeshi conjoined twins Trishna and Krishna, to revelations a Victorian anaesthetist had infected dozens of patients with hepatitis C and uncovering anti-vaxxer GPs and a string of world-first medical breakthroughs.

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