A leading Australian fertility specialist has expressed concern that IVF approaches that seem cheaper and less invasive to patients might be costing the health care system – and Australian taxpayers – more.
Speaking at the International Society for Mild Approaches in Assisted Reproduction (ISMAAR) meeting in Sydney today, Associate Professor Mark Bowman, Medical Director of fertility group Genea, noted that the ‘low cost’ models of IVF recently introduced in Australia do not really represent low cost to society and bore little resemblance to true low cost methods that were utilized in developing countries.
“An approach to ‘more affordable’ IVF in this country will potentially come at a higher cost per baby to Medicare and therefore the outcomes from these approaches need to be properly evaluated and compared to usual IVF treatment,” Associate Professor Bowman said.
“In IVF treatment, a woman will usually receive a judicious series of injected medications to attain a number of eggs (perhaps 10) and, following fertilization with her partner’s sperm, one resulting embryo can be immediately transferred and often another two embryos frozen. If this first stimulation cycle doesn’t lead to pregnancy, the patient can return later to have a frozen embryo thawed and transferred – a process that is very simple, just as successful as a fresh transfer and relatively inexpensive to both the patient and to Medicare.
“Even better, if the initial cycle does lead to success, the woman can return some time later to have a second child using a frozen embryo that was derived from the initial stimulation cycle.”
Assoc. Prof Bowman presented results to the conference from frozen embryo transfers undertaken at Genea over one calendar year. Of the 857 patients having a frozen embryo transfer during the 12 month period, one third were returning after a previous live birth and almost half of those patients achieved a second successful pregnancy.
“Without embryo freezing, these patients would have required much more invasive and costly treatment to achieve their success,” he said.
In contrast, some Australian low cost models involve patients undergoing a much lower dose of ovarian stimulation, leading to just a small number of eggs being retrieved and perhaps just one embryo.
“Whilst this means that the patient has an immediate embryo transfer and the chance for pregnancy, this model does not lead to any extra embryos being frozen,” Assoc. Prof Bowman said.
“If the patient does not conceive, she will then require a further stimulation cycle involving far more cost to Medicare (compared to a frozen cycle) and a more invasive treatment cycle for the woman.”
Associate Professor Bowman noted that repeated stimulation cycles, at very reduced out of pocket cost, with no embryo freezing might sound attractive to patients but risked adding significant cost to Australian society for IVF treatment.
“To have two children, undertaking two separate stimulation cycles for two children – as would occur in the ‘low cost’ model – would cost Medicare twice as much as having one stimulation cycle for the first baby and then having a remaining frozen embryo for a second baby,” he said.
Assoc. Prof Bowman also questioned whether the drug regimens and procedures involved in most ‘typical’ IVF cycles in Australia really represented any material difference in risk, in comparison to minimal stimulation approaches that have been proposed.