Sunday 13 February 2011

IVF 'greed': clinics shun cheaper treatment

Private IVF clinics are resisting moves to offer cheaper treatment, which would give more Australian women a chance to conceive a child, because they are worried about their profit margins, according to one of the world's leading fertility experts.

Professor Alan Trounson, who delivered Australia's first test tube baby in 1980, said cheaper IVF was available to women overseas, including a method being trialled in Africa for less than $300 a cycle, plus labour costs. While the method would be more expensive here because of the high price of labour, it could still be provided at a fraction of the price private clinics now charged for their treatments, he said.

Medicare covers about 80 per cent of standard treatment fees but out-of-pocket costs can range from $1000 to $3000 per IVF cycle, making it too expensive for many couples.

Professor Trounson, founder of The Low Cost IVF Foundation, said the low-tech method, which he piloted, was as effective as treatments used now in Australia and should be made available to all women - particularly those in developing countries and on low incomes.

But he said a widespread rollout would be scuppered by those with commercial interests at all stages of the IVF process. ''This should be about freedom of choice, but everywhere you go there's entrenchment,'' Professor Trounson said from San Francisco, where he is president of the California Institute for Regenerative Medicine. ''We've got under-resourced populations that can't access IVF, and the ethics committees say 'well, they shouldn't get a lesser treatment', but that's not a reasoned argument.

''Clinicians who work in this area make an awful lot of money and they have an interest in keeping it that way.''

IVF is an increasingly common procedure in Australia, with more than 85,000 babies born since the technology was introduced. There is a growing global push for low-cost or ''minimally invasive'' IVF amid concerns increasingly expensive drugs and refined technology are making fertility treatment the preserve of the wealthy.

Professor Trounson's low-tech procedure strips treatment back to its early days, with basic equipment and oral drugs that are cheaper and have fewer side effects than hormone injections used in conventional treatment, meaning fewer blood tests and ultrasounds are required.

The drugs stimulate the body to produce one or two eggs per cycle, with a 12 per cent pregnancy rate, compared with 10 to 12 eggs per cycle and a 30 to 35 per cent success rate with conventional IVF. Fertility doctors are divided on its efficacy, with critics saying it is unethical to offer women a ''substandard'' treatment that has a lower pregnancy rate per cycle.

But supporters argue that over several IVF cycles the success rate is comparable. This is because the low-cost method is less gruelling, allowing patients to start another cycle within a month rather than having to delay their next attempt.

The method has been delivered in pilot form in Sudan, Namibia and South Africa for less than $300 a cycle. Some countries, including Japan, are already offering women a low-cost option. Women in Britain can access publicly funded IVF through the National Health Service.

In Australia, a few public hospitals do offer discount IVF but the waiting lists are long.

But Geoff Driscoll, founder of IVF Australia, who left the organisation in 2002, said prices would remain high here as there was no competition between the private equity groups that now owned the major clinics.

''The commercialisation of IVF is a potent disincentive to deliver the product cheaper,'' said Professor Driscoll, who is director of reproductive medicine at the University of New South Wales and is on the scientific board of the Low Cost IVF Foundation.

He said pharmaceutical companies were pushing the most expensive drugs. ''It gets back to the the philosophy of offering [IVF] to the masses. Not everyone needs caviar. Many people can get by with rice.''

Gab Kovacs, international medical director with private clinic Monash IVF, argued that Australian treatment was relatively affordable. Optimal treatment incurred costs for services including nurses, embryologists, doctors, counsellors, laboratory work and blood tests which might not be available with a low-cost model.

''It's not up to the IVF units to look after people who can't afford it, it's up to the government,'' Professor Kovacs said.

''This is not a medical decision, it's a social decision, and our politicians have to decide whether IVF is something that should be made available to poor people free of charge.''



Jill Stark
February 13, 2011