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The Cash Cow in 'Fertility' Medicine

by Pamela M TsigdinosHealthcare in America
October 23rd, 2016

On average, the cost of a basic IVF cycle in the U.S ranges from $12,000 — $15,000 yet three out of four times it fails

20 million fails. This is one stat not discussed at the latest American Society for Reproductive Medicine (ASRM) Scientific Congress and Expo. It’s also not posted on fertility clinic member websites nor shared on their social media feeds but it should be.

Last week thousands of physicians, nurses, scientists and lab technicians gathered in Salt Lake City joined by legions of pharmaceutical representatives, ‘fertility’ entrepreneurs and service providers in full on ‘sell mode.’

It’s been nearly 40 years since in vitro fertilization (IVF) became available. There has been explosive growth in the size and scope of clinics and profit taking but no commensurate improvement in IVF outcomes.

Here are five other facts that aren’t widely known but should be:

Fact #1: ‘Fertility’ is now a huge market. That’s right: a market. The global In-Vitro Fertilization (IVF) market size was valued at $9.6 billion in 2014. A more recent report by Grand View Research, Inc. projects the global (IVF) market will reach $27 billion by 2022. At an average of $15,000+ per cycle, clinics profit handsomely. Not surprisingly, several cycles are common and recommended. The lack of regulatory oversight in the U.S. has caught the attention of investment banks who see ‘market’ opportunities:

Harris Williams & Co. investment bank slide points out the lack of strict regularoty oversight in the US fertility services industry. Bulletpoints read: (1)human embryo research is highliy restricted at federal level. (2) clinical services are largely subhect to professional regulation. (3) Anti-regulatory sentiments are strong among fertility service providers as they view themselves performing a service rather than medical research.

Harris Williams & Co. investment bank slide

Fact #2: IVF cycles more often end not with a baby but with heartbreaking failure. Low success rates and health risks associated with treatment are absent from clinic marketing materials, but the best available data from the Centers for Disease Control shows a failure rate of 73% across all ages. The industry has done its best to downplay the procedure’s impotence. Globally the procedure failed an estimated 20 million times during the last 40 years.

In a New York Times story, Dr. Mark Sauer acknowledged that “there’s a lot of massaging of the data, often combining data from several years to make the results look better. And clinical pregnancy rates do not necessarily reflect live birthrates.”

New York Times article's (referenced in text--titled "The Misleading Promised of IVF for Women Over 40) icon, displaying an illustrated couple conversing with an older white male doctor holding a clipboard.

Fact #3: Also hidden from marketing materials is the significant emotional toll caused by IVF failure. Research reveals that distress from a cancer or infertility diagnosis is equivalent, however, cancer survivors have better emotional outcomes.

Dr. Julie Bindeman tweets, "@SilentSorority @DebSimmondsPhD @ReproMed Interesting that research shoes better outcomes (emotionally) for cancer survivors vs fertility"

Fact #4: Developed initially for a medically indicated fallopian tubal disease, IVF is now routinely marketed and dispensed in cases of mild male subfertility, endometriosis or unexplained infertility. Yet there is no evidence-based science to support these applications.

Fact #5: A study published in the British Medical Journal in 2014 went further stating the risks of IVF could outweigh the benefits. There are calls this year in Australia and the UK for greater scrutiny of reproductive medicine practitioners. That is not the case in the United States.

Instead, the unfettered infertility industry focus is on ‘Scaling New Heights in Reproductive Medicine.’

American Society for Reproductive Medicine online banner advertisement promoting its gathering in late-October 2016 in Sal Late City, Utah, as "Scaling New Heights in Reproductive Medicine"

There’s some troubling irony, foreshadowing even, in this event theme given that the American Society for Reproductive Medicines’ ‘supporters’ include a who’s who in Big Pharma, a group of companies not well known for putting patients ahead of profits.

ASRM 2016 poster expressing gratitude to its supporters. At the Ruby level is AbbVie, Cook Medical, and Ferring Pharmaceuticals. At the Platinum Level is Pfizer. The Gold level includes: Counsyl, EMD Serano, Illumina, Merck, Natera, VitraMed

While most people would hope a fertility clinic’s first priority would be patient well-being and ‘do no harm’ evidence-based healthcare, we can’t ignore the fact that clinics are increasingly turning to aggressive medical treatments which are not supported by strong evidence. As a patient advances on the IVF journey she may be offered the choice of whether or not to submit to an experimental protocol. As Julia Leigh in her new memoir Avalanche learned, the tables turn. Rather than the doctor advising the patient based on settled science, it is up to the patient consumer to become the expert. She described how a doctor told her about a new add-on service called ‘embryo glue:’ “There’s not enough evidence yet, it’s all so new.” The patient, Leigh wrote, will cling to that ‘yet’ like a life raft.

This is now the state of play in medicine promoted for infertility. The clinics invoice regardless of how well they perform. That’s because clinics earn based on cycles and add-ons sold. The business goal — they are businesses after all — is to sell as many treatments as they can regardless of outcome.

Jonathan Catley tweets, "How can #FertilityClinics maximize #ROI [return of investment]? Learn more at #ASRM2016 Booth 825" with image of a young woman working at a desk, thinking as a planner is laid open.

The only paper at the ASRM event to discuss the infertility patient experience in the U.S. reveals only 29.4% of 499 surveyed agreed their nurse mentioned resources for emotional support. That’s truly disturbing given the level of distress raised earlier.

Based on his tweets, the ASRM’s spokesperson didn’t seem fazed by the industry’s poor treatment outcomes and patient care.

Sean Tipton tweets, "#ASRM2016- the scoop on Utah's liquor laws. Better for Manhattans than Martinis." linking to an article on "eater.com"

Here are a few headlines we should have seen but didn’t coming out of the ASRM event:

Has Patient Health Taken Back Seat to Fertility Industry Commercialism?

How Has Fascination with Science and Profit Become a Priority Over the Human Toll Caused by IVF Failure?

The industry’s behavior during the past 40 years has clearly demonstrated it is incapable of policing itself. When patient emotional distress is as high as cancer patients and with the IVF procedure now a cash cow it is time this profit-driven branch of medicine had independent oversight.


Pamela Mahoney Tsigdinos is the author of the award-winning book Silent Sorority. Her latest ebook is Finally Heard: A Silent Sorority Finds Its Voice.

See image credits at Healthcare in America

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