Doctors MUST stop cashing in on desperation
THE desperation and vulnerability of infertile couples leads them to grasp at straws. There are many causes for infertility and just as there are different causes, so there should be different treatments. Each couple requires the most suitable, cost-effective and safe treatment depending on the cause for their failure to conceive. Increasingly, they are offered the treatment most convenient to the doctor.
IVF – the most complex, expensive and demanding of all infertility therapies – is seen as the standard procedure. It is the treatment suggested before the specific cause of the infertility is investigated.
There is no other medical therapy where treatment is offered before proper attempts at diagnosis are made. Such practice is seen as highly unethical and is likely to be found legally negligent.
To make matters worse, because each cycle of IVF has such a high failure rate, there are many emptyhanded women left distressed after their IVF has failed. They often find themselves confronted by a doctor trying to consider how their IVF treatment might be improved.
Without the underlying cause of failure properly established, they are encouraged to buy one of many add-on treatments which mostly have little or no serious evidence for their effectiveness.
Nearly all, for different reasons, add substantially to the costs that a couple has already incurred.
For example, pre- implantation genetic screening involves taking a few cells from the embryo during its first five days and analysing its chromosomes for abnormalities.
If they appear normal, the embryo is assumed to be healthy and is transferred to the uterus. If abnormal, the embryo is discarded.
Although the basic procedure was pioneered in my lab at the Genesis Research Trust, it was never intended to screen embryos and it angers me to see a scientific study misused for commercial purposes.
In spite of the treatment having been in use for nearly 30 years, there are no conclusive, proper studies or good evidence that it improves the chance of a live birth. Some studies even show it reduces success rates because healthy embryos may be discarded.
Endometrial scratching at least has the virtue of being cheap. A small wound is deliberately made in the womb lining a few days or weeks before embryo transfer.
Initial reports from Israel suggested improved pregnancy rates, for reasons which are still unclear. More recently, Israeli scientists published conclusions suggesting no benefit. Now, 25 years since scratching was introduced, scientists from Utrecht in the Netherlands have initiated a huge randomised trial.
So far, the evidence is dubious. Yet, according to a recent publication, up to 83 per cent of patients in New Zealand, Australia and the UK are advised to have the scratch.
Embryo glue is also advocated by some clinics to help the embryo stick to the uterus after it is transferred. It involves dipping the embryo into a special fluid which may interact with the womb lining – and some clinics in London only charge £250 for it. The problem is that it probably doesn’t work and there are no definitive randomised trials which show otherwise.
There are also a variety of complex treatments offered which are meant to change a patient’s immune system so an embryo is less likely to be rejected after transfer.
The treatments add several hundred pounds at least to the cost of IVF. There are expensive tests on ‘killer cells’ in blood taken from the patient’s arm, but it is doubtful whether this gives seriously useful information about what is happening in the uterus.
Steroids and drugs which could predispose to cancer are also occasionally offered. A recent study from Sheffield and Sheffield Hallam Universities showed no benefits to using steroids, and they may be occasionally associated with abnormalities in the developing baby.
It is clear these immunological treatments have not been properly assessed by detailed randomised trials, and until they are, they should not be sold.
This list of dubious treatments is only a few of those offered.
Regrettably, the market in IVF has led to doubtful practice. Even the NHS, in its need for funding, is happy to profit from IVF.
I am not against experimental treatments, but responsible, ethical approval is essential and couples should not have to pay for unproven therapies.
But while the desperation of vulnerable patients is a fertile commercial opportunity, it may not improve their chance of a baby.