From “Joyful new mum Sonia Kruger” to the “back-to-front love story” of sperm donor romance, IVF patients across the country are being told their fairy tale ending is just an embryo transfer away. But for every artificially conceived bundle of joy to make the headlines, there are many everyday Australians who have not been so lucky.
Many patients’ lack of success may have more to do with their IVF (in-vitro fertilisation) provider than with their pathology. With the gap between success rates at the highest- and lowest-performing clinics widening each year, it’s time for all fertility clinics to disclose their results to patients.
In Australia, assisted reproductive technology (ART) clinics are required to report success rates to the Australian & New Zealand Assisted Reproduction Database (ANZARD). The National Perinatal Epidemiology and Statistics Unit and the Fertility Society of Australia (FSA) then jointly collaborate to produce a yearly ANZARD report.
Clinics are told where they rank in an IVF “league table”, however, this is not released publicly and clinics only know their own result.
The most recent ANZARD report from 2012 (published in 2014) revealed IVF success rates varied dramatically between clinics. From 35 clinics across Australia and New Zealand the live birth success rate ranged from 4.0% at one clinic to 30.9% at another. No-one knows which clinic is which, and no-one knows why success rates varied so considerably between providers.
However, it was not just last year’s report which revealed alarming results. In 2011, success rates were as low as 3.6%. The year before that it was 4.4%. The year before that it was 4.5%.
In comparison, the overall live delivery rate in 2012 for the middle band of clinics was between 13.3% and 19.6%, and the top performing clinic achieved a live delivery rate of 30.9%.
Year after year, the poor performance of Australia’s worst IVF clinics fails to be explained. Yet these figures raise serious concerns about the practices of the clinics responsible. The issue is there is no obvious plausible scientific explanation for IVF success rates in the single digits. On their own, without clarification, these sorts of figures are simply outrageous and unacceptable.
Many top-ranking clinics have argued for the release of the ANZARD league table. They claim comparisons between clinics are entirely valid and patients should be able to make an informed decision about where they spend their money. It is also consistent with the approaches used in the United Kingdom and the United States. The Fertility Society of Australia, however, remains officially opposed to doing so.
Criticism of the society’s stance on this issue is gaining momentum. As a membership organisation, its interests are conflicted. On the one hand, the society needs to represents its members, even the poor performing ones. On the other hand, it is responsible for overseeing the industry and accrediting IVF clinics through its Reproductive Technology Accreditation Committee (RTAC).
Monash IVF director Dr Richard Henshaw recently accused the society of working against the best interests of patients to protect its worst performing members. He wants the league table released. Others want poor performing clinics shut down. Neither appears to be happening.
What is also confusing about the society’s continued stance on suppressing this table is that so much of it is already in the public domain. Most clinics report success rates on their websites which they claim are either taken directly from the ANZARD report, or independently released by the clinics themselves. If the results published on clinic websites correlate with the results in the ANZARD report, there should be nothing to hide.
Although the release of the league table may not give patients a clear picture of the likelihood of success in their specific circumstances, it would allow them to compare clinics and make an informed choice about where they want to spend potentially tens of thousands of dollars. This is important because it’s an open secret that the quicker a patient gets pregnant, the less money they spend on their treatment.
If there is no incentive for clinics to improve their results, why would they bother? Medicare, private health insurers and patients themselves all pick up the ever-increasing tab and it doesn’t make good business sense to lose what would otherwise be a return customer. Therefore measures to encourage transparency, accountability and responsibility are essential for the protection of vulnerable patients.
As the IVF sector becomes more corporatised, companies are required to balance their obligations to both patients and shareholders. Although there is no evidence that IVF providers have failed to reconcile these tensions, it is an issue that policymakers need to take seriously going forward. Perhaps the IVF industry would be best served by an independent regulator rather than a membership association with a clear conflict of interest.
The ANZARD report revealed that 12,000 babies were born in 2012 following assisted reproductive treatment in Australia and New Zealand. While this no doubt contributed to many happy new parents, sadly it seems, there should have been more.
Loretta Houlahan is affiliated with the Fertility Society of Australia and its special interest group Scientists in Reproductive Technology. Loretta Houlahan has previously been employed at Melbourne IVF, Monash IVF and City Fertility Centre. She is a current member on the Patient Review Panel and a lawyer at Parke Lawyers. These views are her own.