New research has found that most women undergoing IVF treatment in Australia are paying for costly add-on treatments despite “rather weak” evidence of their effectiveness and safety.
According to lead author and University of Melbourne researcher Dr Sarah Lensen, the most common add-on treatments are acupuncture, pre-implantation genetic diagnosis to detect chromosomal abnormalities and Chinese herbal medicine. Some treatments can cost up to $3,000.
She noted that, "None of the add-ons that they use in Australia are supported by high quality, robust evidence that they help people to have a baby from IVF and that they're safe to use. There is some, you know, lower-quality evidence that suggests that they might. But for some of the add-ons that are being used, there's not a single randomised controlled trial that's been conducted.”
Dr Lensen emphasised the importance of clinics providing information regarding benefits, potential risks and costs to those having IVF. This was similarly asserted in a report by the Victorian Health Complaints Commissioner last year which called for IVF clinics to get written, informed consent before the use of each add-on treatment. It has also been highlighted by the Fertility Society of Australia which instructed its members in 2019 to give clear information about the effectiveness and risks associated with any add-on treatments.
Notwithstanding the lack of evidence around their effectiveness, it seems the demand for add-ons is being driven by both the marketing from IVF clinics and the psychology of patients who have done their own research and are willing to try anything to increase their chances of success.
But one of the study’s co-authors, Monash University and VARTA researcher Dr Karin Hammarberg cautioned about false hope.
“[W]e want people to be really aware that the chance has not increased by using these…People need to question these things and not think that because they’re offered, they are going to be improving their chance,” she said.
Dr Hammarberg is correct to caution about false hope, particularly when that hope is being instilled by an industry geared towards maximising its bottom line and with a track record of misleading patients about the effectiveness and risks of its services. However, while patients should exert personal responsibility in determining the best course of action when it comes to decisions about their fertility, the onus should not be on them to “ask the right questions” or to ensure they’re not being misled by fertility clinics. Clinics have an obligation to be honest about the services they are providing and to ensure patients are giving fully informed consent to any procedures undertaken.
An alleged failure to carry out this duty has recently given rise to a class action investigation against Monash IVF for selling expensive and ineffective add-on therapies to thousands of women undergoing IVF in Australia, including pre-implantation genetic testing to determine the viability of embryos, which can cost up to $895 per embryo.
Practice group leader Margaret Kent said there were serious questions concerning the efficacy of the test and that evidence suggests that it might even reduce to chance of a live birth.
“Frankly, we think people who are already incredibly vulnerable are getting ripped off,” she said.
“Going through IVF is incredibly stressful – physically, emotionally and financially – and it is incredibly concerning that women are being encouraged to spend more for additional treatments or procedures that have no proven benefit."