The hidden costs of infertility treatmentBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2204 (Published 22 May 2018) Cite this as: BMJ 2018;361:k2204
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I read with interest the article by Sally Howard on the hidden costs of infertility treatment. I hereby would like to express some of my thoughts.
In the question as to why infertile patients would preferably explore the option of private treatment, there is always a strong belief, and I think this applies to at least the rest of the European countries, that private IVF centers are better and more equipped in managing infertility, have the economic capacity to equip their clinics and their laboratories with more sophisticated and latest technology utilities, while an attentive environment and friendlier staff provide an impression of privacy and personalized care, although this is indeed the case at many instances. True, a private IVF clinic has better opportunities to advertise their assets and success rates and from another point of view in some instances there are no other options, if, for example, a couple have diminished their possibilities of funding in the public sector. Public clinics appear more strict and driven by guidelines, as, for example, those posed by NICE or RCOG, and there is a strong possibility that they wouldn’t offer any adjuvant treatments, as mentioned already, reasonably. Oppositely, infertile patients with failed attempts at IVF would consider anything, even if it is on an experimental stage and non-routine approach.
I do agree that the respective regulatory authorities should control any additional treatments offered to improve the possibility of a successful IVF cycle and how this information is passed on to the patients especially in terms of adverse effects and the degree of standardization of the treatment offered, and consent should be obtained without any promises for improved pregnancy rates as most of these adjuvants have yet been fully explored signify their clinical importance.
Besides, legal uniformity is required widely in order to stabilize the option on single embryo transfer and reduce the risks of complications on a pregnancy, many countries have now conformed to single embryo transfer or the transferring of two to three embryos at most, in the presence of special indications.
The social and mental costs can be reduced primarily by precise counseling prior to any IVF cycle as this period is a challenge for the couple and the individual itself and secondarily by providing meticulous information on the process, the possible side-effects and a clear view on the success rates in order to avoid supplemental disappointment.
And because reduction of IVF costs is not only referred to national systems, but primarily affects the couples at an individualized level, the burden of the proper choice of the right IVF centre/specialist, balancing success rates and financial packages, has to be imposed in the couples discrepancy.
History shows that success rates of infertility treatments have improved but not efficiently during the last 4 decades. I personally believe that this is principally due to the disease itself and the human inability to force and replace human nature that denies a 100% implantation and live birth rate, but also the biological and physiological pathways that remain hidden, as, for example, the effect of molecular structures.
I find the statement, given through numbers in the paper, that IVF is associated with increased risk of developing a high risk pregnancy somehow overdrawn, as this is not adequately supported by current published evidence; in contrast, there is plenty of robust enough evidence to support exactly the opposite. I am afraid that any readers currently on IVF treatment would acquire an additional burden from this statement as to the progression of the pregnancy having increased risk of adverse events.
Competing interests: No competing interests