A new study looking at the economic costs and consequences of assisted reproductive technology (ART) has concluded that governments reap long-term economic benefits from funding ART services.
The European Society of Human Reproduction and Embryology (ESHRS) Infertility and Society Task Force, who published the report, found that how ART treatment is funded and subsidised is an important control on its use, treatment choices available, embryo transfer practices and, ultimately, multiple birth rates.
The authors report that governments receive the equivalent of an eight-fold return on investment 30 years after a child conceived by IVF enters the workforce, given it costs approximately €15,000 to conceive an IVF child. The authors argue that this high estimated return on investment for ART children could mean it makes good clinical and economic sense to provide affordable treatment for those who need it.
Affordability is a powerful determinant of whether couples pursue ART treatment. Public funding of ART ranges from virtually no subsidy in the US to funding of a limited number of cycles based on female age in most European countries.
The cost, as a proportion of an individual's annual disposable income, of a single ART cycle can range from 50 per cent in the US to 20 per cent in the UK. After government subsidies, the costs in the US remained unchanged, whereas those in the UK fell to 12 per cent.
Affordability can influence clinical practice: the financial incentive to achieve pregnancy in a limited number of cycles can lead to the transfer of multiple embryos.
Affordability also influences consumer behaviour. The authors found that patients lacking financial support often sought cross-border reproductive treatment in countries with cheaper or less restrictive services than those in their native country. The risks of this lie in potentially lower standards of care and less responsible embryo transfer practices.
In addition to this, there is evidence that lack of affordable treatment encourages patients and clinicians to opt for cheaper fertility treatments such as stimulated intrauterine insemination and ovulation stimulation. These often less regulated procedures have less controllable means of minimising multiple births.