Private fertility clinics charge up to €450 for blood tests, which some couples can get from their GP for a fraction of the cost, the Irish Independent can reveal.
It comes as two leading Irish fertility doctors warned that IVF clinics have been “commercialized” and charging couples for expensive “add-on” treatments that are said to improve a couple’s chances of conceiving but are not backed by evidence.
A fertility consultant said that Irish Independent Couples spend hundreds of dollars on treatments he believes don’t work. Meanwhile, a former staffer said she had to leave a separate clinic after being made to feel she was “selling” IVF.
Ireland is one of the worst countries in Europe for fertility treatments: it was recently ranked 40th out of 43 nations.
It is the only country in the European Union that does not offer publicly funded IVF services.
For decades, private clinics have offered couples in Ireland expensive, but unregulated, fertility treatments. IVF can cost an average of €6,000 per cycle, with many couples spending tens of thousands of dollars on multiple cycles, tests and “add-on” treatments.
Couples must have a virus screening blood test before each IVF cycle. Clinics charge around €150 per person for the test, which is called “ EU Blood.” This is often done in conjunction with an anti-Müllerian hormone test known as an AMH test, which is a blood test used to check a woman’s ovarian reserve.
The AMH test costs between €100 and €150 in clinics, meaning couples face a bill of €450 on top of the cost per cycle. But two GPs confirmed they could do an EU blood test for the cost of a routine appointment.
Several couples have said this Irish Independent They were not told that their GP could do the same test more cheaply.
A number of GPs across the country could also do an AMH blood test, depending on whether they’re based near a lab that processes them. Fertility clinics use private labs — often their own labs — for blood tests, which cost more than public labs available to general practitioners.
Meanwhile, a leading doctor has warned that “commercialized” fertility clinics are pressuring staff to offer treatments even when they’re not backed by evidence. dr John Kennedy, medical director of Thérapie Fertility, said his clinic doesn’t offer add-ons that aren’t supported by evidence, even if a couple asks for them.
dr Kennedy, who previously worked for Sims IVF and testified before an Oireachtas committee considering new legislation to regulate assisted human reproduction, said he believes “add-ons” have been commercialized.
“A new add-on is coming along and will be commercialized before the evidence is out. Everyone adopts it for two reasons. First, because you never know it could work and help people. Second, it is a source of income for the organization. And if you’re not offering it, you need to be able to explain to your paymasters or whoever it is why you’re not doing it,” said Dr. Kennedy.
The fertility expert said he doesn’t think clinics offering such add-ons “came from a place of commercialized wickedness,” but they do need to consider the ethical issues of making couples pay for treatment that’s unlikely to work.
“The emotional, psychological toll that women take, these guilt feelings associated with feelings of failure, like ‘there’s something wrong with me as a person, that I can’t carry a child’ would be furthered by these tests. I think we need to show that a little more respect,” added Dr. Kennedy added.
dr John Waterstone, who runs the Waterstone Clinic in Cork, said fertility “has become increasingly commercialized around the world”.
“IVF clinics are bought up by a lot of money and sometimes the people who work there just get incentivized if they just sell IVF and add-ons because they need more money for the clinics involved,” he said.
dr Kent Ayers, an independent fertility consultant, said IVF should be the last option for his patients, “not the first”.
“I agree that couples have to undergo too many expensive tests and treatments that have no proven benefits. Basically, I think too many couples are told they need IVF when simpler treatments have not been tried,” said Dr. ayers
Immunological treatments are one of several so-called “add-ons” that have been flagged by a UK regulator for lack of evidence.
Ireland does not regulate the efficacy and evidence for fertility treatments, but the UK Human Fertilization and Embryology Agency (HEFA) uses a ‘traffic light’ system to assess the evidence base for additional fertility treatments. Treatments that HEFA says have no evidence to increase a person’s chances of having a baby, such as B. immunological blood tests, are classified as “red”.
Sims IVF, a large chain of clinics, offers “red” rated treatments including reproductive immunology, assisted hatching and IMSI. Assisted hatching is when clinics use acid or lasers to break open a layer of protein around an embryo, believing this will help it “hatch,” but evidence says it doesn’t improve pregnancy rates.
IMSI is a treatment in which sperm are examined under a high power microscope to select individual sperm to be injected into an egg. It tends to be more expensive than simple ICSI, which involves injecting sperm into an egg without first selecting it under a microscope.
There is no evidence that IMSI should be used over ICSI.
A spokeswoman for Sims said a “small number” of the above treatments “are performed annually due to clinical need and there is no commercial impact on any treatment plan developed for our patients. It is important to note that all treatment plans are clinically guided and decided by the medical team in consultation with the patients.”
ReproMed, which also has several clinics across Ireland, also offers ‘red’ rated treatments including reproductive immunology and assisted hatching. In a statement, ReproMed said it “only practices evidence-based medicine in our clinics.” It said it does not offer reproductive immunology “on a routine basis.”
separately the Irish Independent spoke to a former employee of a well-known Irish fertility clinic who, despite having worked there for a long time, felt a moral obligation to quit her job.
“The whole ethos of the place went from trying to figure out why women weren’t getting pregnant to selling IVF,” she said. “You don’t actually diagnose and find out if there’s anything treatable, you just sell IVF right away.
“Covid was used as an excuse but we had to do all our consultations via Zoom. We were not allowed to meet the patients face-to-face and we were not allowed to perform ultrasound scans on them,” she said.
“So that meant you couldn’t see any fibroids. They couldn’t pick up polyps. You couldn’t meet with the patients in person, you should promote IVF without actually meeting them.”
Some experts have called for more transparency about how often fertility treatments and IVF don’t work.
Helena Tubridy, a fertility coach and bioethics and fertility expert, said there is a disproportionate focus on “the 25 percent of IVF success stories”.
“Couples are seduced by IVF perception as a silver bullet…IVF is not a silver bullet nor is it a first port of call. More of a last resort. Investigations are often retrospective and come after failed cycles and miscarriages. This increases the emotional and financial toll when timely diagnosis could have prevented errors, losses, wasted time and expense,” Ms Tubridy said.
In 2020, 1,591 IUI cycles and 4,700 IVF cycles were performed in Ireland. This was a decrease from 2019’s 1,862 IUI and 5,117 IVF cycles, but the decrease is likely due to the closure of clinics due to the pandemic. It is not known how many of these treatments resulted in a live birth. In the UK, where fertility clinics are regulated, the success of clinics is often measured in terms of live birth rates. That Irish Independent could only find two clinics in Ireland that provide their live birth statistics: the Waterstone Clinic and the Merrion Fertility Clinic. Many other clinics, including Sims IVF, Beacon Care Fertility, and ReproMed, use “clinical pregnancy rates” — pregnancy confirmed by a scan between eight and 12 weeks gestation.
dr Ahmed Omar, Beacon Care Fertility’s medical director, said clinical pregnancy rates are comparable to live birth rates because “the likelihood of a patient losing a pregnancy after the first 12 weeks is quite low. Yes, that can happen, but it’s pretty minor.”
He added that clinics are in contact with a patient who is 12 weeks pregnant, but is then cared for by her obstetrician. A spokeswoman for Sims IVF said: “There are no guidelines for publishing success rates. We are reporting our success in line with most other clinics in Ireland.” ReproMed said: “Clinical pregnancies are an industry standard measure of success. Our two IVF laboratories meet all international KPIs and industry standards.”
https://www.independent.ie/irish-news/fertility-clinics-seeking-450-for-test-that-couples-can-get-from-gp-at-fraction-of-cost-41564690.html Fertility clinics charge €450 for a test, which couples can get from a GP at a fraction of the cost