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Financial incentives in Australia change doctors' IVF advice

3 November 2017
Appeared in BioNews 925

Australian bioethicists have expressed concern that the country's assisted reproductive technology (ART) industry has become increasingly motivated by profit, causing a conflict of interest.

Research published last week in Human Fertility suggested that some fertility doctors are over-selling ART treatments, commonly offering IVF to patients who do not necessarily need it, or offering repeated IVF cycles to patients where it is known that the chances of success are minimal.

Lead author Dr Brette Blakely explained that by offering IVF to those who are better suited to less invasive treatments, such as intrauterine insemination, the clinicians are attempting to 'mislead future patients who might be tempted to seek unwarranted treatment by high-reported success rates based on women who do not represent the average IVF patient'.

The study, run by researchers at Macquarie University and Sydney University, interviewed eight individuals employed in the IVF industry, including clinicians and fertility counsellors. Most participants in the study expressed a belief that commercial and financial interests impact the level of patient commitment and care from the clinician.

The conflict of interest may risk a patient's physical health as well as being and emotionally and financially draining: ovarian stimulation and egg retrieval during IVF can have harmful side effects.

Dr Blakely, a bioethicist at the Australian Institute of Health Innovation at Macquarie University, explains that 'moderate to severe ovarian hyperstimulation syndrome may occur in one to five percent of treatment cycles and this may result in significant morbidity and can, in rare cases, be fatal'.

The authors also suggested that clinicians are misusing the Medicare system, whereby women whom are eligible for IVF can received an unlimited number of subsidised cycles. By encouraging the use of these unlimited cycles, the clinician appears to be promoting an affordable treatment, but in reality patients still face substantial out-of-pocket costs while clinicians receive large fees, plus extra income from additional services.

Professor Michael Chapman, president of Fertility Society of Australia, criticised the design of the study and said that there is no evidence of clinicians over-selling ART. Chapman argued in the Sydney Morning Herald that '[the] selection of only eight specialists seems likely to be biased given there are over 150 specialists practicing in Australia, and [the researchers] admit to being 'selective' in their comments to illustrate their argument'.

While the issue was investigated on a very small scale, the researchers hope that their 'findings have important conceptual and practical implications and set the terms for a more robust professional and public discourse'.

SOURCES & REFERENCES
Bioethicists raise alarm about conflicts of interest in Australia's IVF industry
Sydney Morning Herald |  2 November 2017
Commercial IVF clinics under spotlight
SBS |  1 January 1970
Conflicts of interest in Australia’s IVF industry: an empirical analysis and call for action
Human Fertility |  1 January 1970
Financial motives drive some doctors’ decisions to offer IVF
The Conversation |  1 January 1970
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