Illustration: Judy Green
In a departure from the usual IVF miracle baby stories, much attention has been devoted recently to IVF success rates, or more specifically the lack thereof at some of Australia’s worst-performing clinics. Pregnancy rates hover in the single digits at these places, and many industry insiders say the only miracle about these clinics is that they haven’t been shut down. Debate has been raging about whether to publish a confidential league table that would name and shame these poor performers, give public recognition to high achievers, and allow patients to make an informed choice about where they spend their money.
As an embryologist for more than eight years, I know the ugly side of IVF in this country. Hidden behind the 12,000 babies born each year from assisted reproduction are the stories of people whose hopes, dreams and bank accounts have been shattered by unscrupulous and incompetent IVF providers. Adding insult to injury is how quick unsuccessful patients are to blame themselves instead of their underperforming clinics for failed IVF treatments and the lost chance of parenthood.
Each year a collaborative report between the Fertility Society of Australia and the National Perinatal Epidemiology and Statistics Unit is released. It analyses the IVF success rates of Australian and New Zealand clinics. The most recent report, released late last year, was undeniably shocking. Results of live birth outcomes varied from 4 per cent at one clinic to 30.9 per cent at another. No explanation was provided for this huge and unacceptable discrepancy between the top and bottom clinics.
Although the FSA keeps the league table and knows where individual clinics rank, the findings are not made public and clinics are only told their own results. Some of the top-performing clinics have argued they are in a league of their own and want these rankings made public. The FSA, however, refuses to do so.
But with no incentive for poor-performing clinics to achieve better results, why would they bother? The cost of treatment continues to go up, patients continue to roll through the doors and, in a world where fresh cycles cost about $10,000 a pop, unsuccessful patients are otherwise known as return business.
Criticism of the FSA’s perceived lack of independence is also mounting. As a membership organisation, the FSA represents industry doctors and other IVF clinic employees. It functions similarly to a union whose objectives are to represent the views of members. The FSA board is comprised mainly of IVF clinic directors, and through their Reproductive Technology Accreditation Committee they are also responsible for the accreditation of IVF clinics. In other words, the IVF industry is in effect self-regulated.
Dr Robert Woolcott is a director of Genea, an IVF clinic in Sydney that claims to be consistently ranked as one the best in Australia. Dr Woolcott recently remarked in The Age that poor performing clinics should be given a lift or close down. I agree, but unfortunately it doesn’t appear to be anyone’s job to ensure this occurs.
In Britain the Human Fertilisation and Embryology Authority acts as an independent authority that licenses and oversees clinics. Clinics are required to report success rates and also patient incidents to HFEA, both of which are reported to the public in various ways. We need a similar independent regulator in Australia. With most clinics already reporting their success rates on their websites, there should be nothing to hide.
There are many doctors, scientists, nurses and counsellors who have made outstanding contributions to field of assisted reproduction and the lives of many patients. I am immensely proud of my work as an embryologist and the thousand of families I’ve helped create. However, as it is often said, the standard you walk past is the standard you choose to accept.
To excuse the pun, it is inconceivable that these rogue poor-performing clinics are financially rewarded by return customers for their incompetence and exploitation. There is, therefore, a public interest in the release of the IVF league table because, quite clearly, some clinics should be booted into the reserves.
Loretta Houlahan is lawyer, a former embryologist and a member of the Fertility Society of Australia. These are her own views.