Reproductive medicine is big business. About seven million women or husbands/partners sought fertility care between 2006-2020, according to a National Survey of Family Growth published by the Centers for Disease Control and Prevention (CDC).
There is a growing demand for in vitro fertilization (IVF) and assisted reproductive technologies (ARTs).
What does this baby boom mean for prospective parents seeking help and hope through reproductive medicine?
"The transition of IVF from a physician- to an investor-controlled business environment could be detrimental for patients and their quality of care," says Pasquale Patrizio, M.D., MBE, HCLD, FACOG, a board-certified specialist in Reproductive Endocrinology and Infertility (REI), and chief of the UHealth Center for Reproductive Medicine.
As a specialist working in a university-based not-for-profit fertility clinic, he says that retail clinics may not always prioritize people above profits. "It can happen that the interests of patients will be marred by the interests of investors, and they may offer services (so called 'add on' services) that are expensive and not always necessary," says Dr. Patrizio.
"There are so many background economic pressures and forces that the patient doesn't see."
Dr. Patrizio investigated the topic. His five-year research effort yielded an article detailing guidance for consumers. He describes the article as "a wake-up call on the risks" commercial clinics pose to the access and quality of reproductive care.
His findings show a difference between for-profit clinics, now merged into large chains of corporate enterprises, and those based at academic institutions where care is personalized and driven by evidence-based data.
Does the clinic you are considering meet these three criteria?
Before booking a consultation with a physician or clinic, Dr. Patrizio urges consumers to consider:
- Is the doctor board-eligible or board-certified in reproductive medicine and fellowship-trained in reproductive endocrinology and infertility?
- Does the clinic report their data to the Society for Assisted Reproductive Technology (SART) or to the CDC? (Clinics have been required to make data public since 1992.)
- Is the clinic's embryology lab inspected and accredited by the College of American Pathologists (CAP)? "This adds another layer of safety and security," Dr. Patrizio says.
Consider reputation when evaluating a physician or facility.
- Read online reviews.
- Ask your obstetrician/gynecologist who they respect.
- Ask friends and acquaintances for referrals.
- Find out who owns the practice: physicians, investors, or a mix of the two?
- Are there any conflicts of interest when physicians propose a particular add-on?
Dr. Patrizio says that large conglomerates of chain clinics are owned by private equity capital investors that need a financial return on their investments.
Patients should be aware of potential problems in the for-profit model:
- Physicians may shy away from offering more affordable, but effective treatments.
- Some commercial clinics use marketing campaigns and affiliated lending businesses to pressure patients into expensive treatments. "To avoid racking up debt without a guarantee of pregnancy, patients should ask, 'What's the proof this will work?' Some treatments, such as pre-implantation genetic testing, the use of time-lapse embryo monitoring, and/or endometrial receptivity assays may be offered but are still unproven."
- Some private clinics may limit or avoid offering treatments based on a patient's age. They may treat the patient once, but then advise using donor eggs, which can cost up to $25,000-$30,000 per attempt.
"One can foresee that larger provider networks will select better prognosis patients and avoid those with a poorer prognosis unless they can direct them towards the most profitable IVF treatment – third party egg donation. This could jeopardize comprehensive care," Dr. Patrizio says.
What are the advantages of an academic-based fertility clinic?
Dr. Patrizio says there are several.
It's not a numbers game. "We're not linked to the number of cases we see. We can spend more time with patients and individualize their care."
Care is comprehensive and interdisciplinary. Having access to the "entirety of care" at a university-based health system allows doctors to see "an entire spectrum of patients with conditions affecting reproductive issues."
Using a whole-patient approach, Dr. Patrizio says the team can "get to the bottom of an infertility problem." For example, a patient may have underlying endocrine issues (thyroid, pituitary, or adrenal) or male factor pathologies. Often, treatments are available for these issues, so fertility patients do not necessarily require IVF.
Treatments are driven by research. Dr. Patrizio and his colleagues use an approach driven by the latest evidence-based protocols. And academic centers and teaching hospitals like those within UHealth are more likely to offer fellowship training.
Fellowships attract the brightest and best minds to an institution, which benefits patients.
"Except for a few private clinics that are connected with academic institutions, the majority do not have fellows rotating through their private clinics."
No matter how exciting the latest research findings may be, "We encourage realistic expectations. The patient is always involved in the decision-making process."
Dr. Patrizio says that a 43-year-old patient requesting IVF needs to understand that success is lower than in younger patients.
"However, if the patient still says, 'If I don't do this treatment, I will regret it forever,' that's not my decision. It's the patient's decision after being fully and properly informed."
Reproductive medicine would not exist without research and training the next generation of reproductive and infertility specialists – two elements that rely on academic institutions.
Dr. Patrizio is pushing for more insurance-mandated coverage for fertility services and more public fertility clinics.
"Such efforts might give women access to evidence-based treatments without running up huge bills and be less likely to be driven by the need to pay dividends to shareholders or return profits on private equity firms."
In the meantime, would-be parents should do their research.
Taking the time to find a clinic that meets their needs and budget just might mean the fulfilment of a dream.
To schedule a consultation with the UHealth Center for Reproductive Medicine, call 305-243-8642.
Nancy Moreland is a regular contributor to UMiami Health News. She has written for several major health care systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.
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