A recent Australian study has found that the commercialisation of assisted reproductive technologies (ART) such as in vitro fertilisation (IVF), hormone implants and oral stimulants could subtly be changing the advice doctors give to their patients.

The study, which was published in the Human Fertility journal, was conducted by researchers from the University of Sydney and Macquarie University. It recorded in-depth interviews with healthcare professionals involved in ART in Australia, such as obstetricians, counsellors and policy advisors.

They found that despite many of the risks associated with IVF for example, such as ovarian hyperstimulation syndrome and as-of-yet unresolved concerns about later child development, some doctors “oversell” the treatment option and its likelihood of success.

Fertility issues need a more open discourse

Fertility is a tricky subject, one that scientists are still learning about and one that holds a certain amount of taboo in society. This is often compounded by the fact that today, more than ever, women are choosing to have children later in life, when the chances of conceiving naturally lower with each passing age, after 35.

Oluwakemi, a mother of two sets of twins and a writer for a fertility website says, “the commercialisation of IVF and other ART is real. It is like the newest product on the medical market right now in terms of reproduction.”

Yet, “there are no guarantees,” she expresses. “No doctor, not even the pioneers of the IVF technology would say IVF comes with the guarantee of carrying a baby home from the hospital.” But, it is not just IVF – the same applies to all forms of ART.

Professor Robert Sparrow, a bioethicist and Monash University associate acknowledges the fact saying, “It’s often a very psychologically gruelling experience for lots of couples, instead of perhaps coming to terms with the fact that their lives aren’t going to have children in them, or at least not their own children, they spend years in and out of hospitals having lots of tests and experiencing lots of stress and anxiety and then they still come out childless. So, being very honest about what the technology can and can’t achieve is terribly important when it comes to the ethics of business in this area.”

Commercialisation affects several areas

Giving women this false hope can go against the expectation that doctors should be committed to their patients; instead of being primarily concerned with their own financial interests. “It is all too easy to attract patients by quoting inflated and unsubstantiated ‘success’ rates and then relieve them of thousands more euro than they had anticipated spending,” says Dr John Waterston, president of the Irish Fertility Society (IFS).

According to the study, as many as one in 25 Australian babies are conceived using ART. Some of the interviewees said that some women who did not need ART, were still offered it and that some were offered repeated treatment even though it was known that they were unlikely to succeed. Often, there is no cap on the number of services or the cost of each offered.

"Of course, the financial and physical concerns of unnecessary ART is in addition to the emotional impact on women being given continued treatment when perhaps advice on cessation of treatment should instead be given," remarks Dr Brette Blakely. Given all these factors, patients should be able to make proper informed decisions.

IVF inventor Robert Winston himself has spoken out against the commercialisation saying, “more and more infertile couples are being exploited by an increasingly grasping industry that frequently ignores ethical standards.”

There are two sides to every coin

Two sides to a coin: According to Professor Bill Ledger, more often, the problem is convincing couples desperate to have a baby that the treatment is “fruitless”.

Two sides to a coin: According to Professor Bill Ledger, more often, the problem is convincing couples desperate to have a baby that the treatment is “fruitless”.

It is important to note that none of the study’s interviewees said ART clinicians were deliberately misleading patients. They believed it was a more subtle and ambivalent problem at the heart of medicine, itself.

Leading fertility specialist and head of obstetrics and gynaecology at the University of New South Wales, Professor Bill Ledger, says that actually more often, the problem is convincing couples desperate to have a baby that the treatment is “fruitless”.

“OK, we make money when we do a cycle of IVF; but, most of us are phenomenally busy. We have plenty of patients. We are not looking for more work,” highlights Ledger. “You spend your whole life as a doctor trying to help and admitting that you’ve got nothing left is a tough place to be,” he adds.

The researchers of the study, which involved only eight professionals have recommended that healthcare professionals involved in ART seek the help of bioethicists in creating solutions and examine how other fields, have tackled similar problems.
Commercialisation also raises the question of whether patients should be viewed as vulnerable and in need of guidance, including strong discouragement, or as consumers free to choose any intervention even if it is unlikely to work. MIMS

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Quality vs. quantity: Does egg count determine a woman’s fertility
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Fatwa prohibits Malaysian Muslim women from freezing their eggs before marriage