The Australian Boradcasting Corporation recently did an interview with doctors and industry professionals on the efficacy of different IVF clinics in Australia. You can hear the segment here:
I really appreciate how much thought and effort the interviewees make to demonstrate how complex the issues are here. I may be biased, but it seems to me that they are working hard to convince the interviewer that the situation is not so black and white as it appears. In addition to the interviewees comments, I wanted to add a few more concerns.
At least at the beginning of the interview, the interviewer seems to make out that IVF clinics are hiding some raw data number that indicates clinic success rates. On the contrary, just about all clinics self publish their own success rates, as advertising. It is true that there is no way for the public to access the collected and collated data on all clinics, but they can certainly get information on individual clinics and compare those that they are considering using.
One of the biggest factors overlooked by the interviewer, at least at the beginning of the interview, is that the procedures and processes of the clinic are only one (relatively small) factor which will affect a couple’s ability to conceive. Far more significant are the couple’s overall health status, age, existing hormonal problems, etc. Each of these factors usually outweighs the influence of variations between labs and clinics.
The other thing the stats don’t take into account is that there are two very different types of clinics in Australia, publicly and privately funded. The public, Medicare funded clinics typically perform worse than the private, expensive clinics. Part of the reason for this is the demographic of the patients at each clinic. People at Medicare clinics, often have lower socio-economic status than those at expensive clinics, and correspondingly also have lower overall health rates. Further more, even those that do start at the expensive clinics, and find themselves having to go for multiple cycles, will run out of money and end up at the Medicare clinics. By default, these are often the harder cases to get babies from, since they are the cases that have had to go through more cycles, because the problem is not so easily fixed. Medicare clinics also have the same disadvantages of all public health systems, being under resourced to deal with a huge volume of patients, and lacking sustained individualised attention for patients who are treated by whoever is on duty, rather than any one doctor they have chosen to develop a relationship with. This is a problem in something like fertility, where treatment is often long term, and having a doctor who can readily recall the patient’s history is an advantage.
Further more, there are potential problems in ranking clinics, and developing competition in their published success rates. There are accusations that American clinics have raised their pregnancy rates by doing much more risky treatments, like transferring embryos to women who are overstimulated (which risks a potentially fatal condition involving built up fluid in the abdominal cavity) and transferring more than one embryo at a time, which brings all the complications of twins and higher miscarriage rates. In these clinics, increased pregnancy rates come along with increased rates of complications, endangering both the woman’s current health and her potential to continue trying to conceive. Publishing pregnancy rates also means very little, since pregnancy rates mean nothing if they are not followed by live, healthy baby birth rates. Finally, doctors and clinics who are more concerned about their published success rates are more likely to turn away couples who they think will be ‘too hard’ to treat, preferring not to risk lowering their published stats, and advertised reputation.
The long and the short of the situation is that it is not as simple as it may seem, and requires detailed and thoughtful attention, like so many of the issues in this area.