As a not-for-profit clinic, we at Merrion Fertility Clinic and the National Maternity Hospital are passionate about fairness and making our treatment as affordable as possible for all our patients. An Irish IVF Clinic group has recently advertised an IVF refund scheme and other payment incentives for treatment. In the past, we have carefully explored such schemes whereby patients only pay for their IVF treatment if they are successful and have a baby. While some people will be lucky with such an arrangement, others will end up paying more than they need to. It is our considered opinion that such schemes do not reduce costs overall for the majority of patients and that they may even be unethical. We are not aware of any other branch of medicine where patients are asked to pay up front for several episodes of treatment – in case the first treatment does not work.
In 2017 in Merrion Fertility Clinic, for couples undergoing IVF where the woman was under 35 years, 45% had a livebirth on their first cycle of treatment and 79% of those also had embryos to freeze for the future. They paid for one cycle of treatment. If they had opted for a ‘no baby no fee’ scheme, each couple would effectively have paid an unnecessary €6,000-€7,000 for two fresh cycles they never needed and the clinic would have made a nice profit. Incentive schemes are subject to medical review such that only patients with a good prognosis for success are deemed eligible and there is little transparency about the kind of clinical criteria that need to be met. The schemes also discriminate against couples who do not have €10,000 to €17,000 to spend. There are many other cost considerations also – for instance, Merrion Fertility Clinic does not charge for embryoscope or for sedation administered by Consultant Anesthetists. These services which are included in our base fee are not included in incentive schemes.
In multi-cycle fixed schemes, patients who do very poorly on their first cycle (e.g. get no eggs) will be locked into paying for two cycles, with no refund if they do not conceive. With a pay-as-you-go policy such as ours, such patients may decide to stop after one treatment and will only pay for that one treatment.
It is important to note that the companies offering these incentive schemes are commercial companies with shareholders who want to see a return on their investment. Their investment in fertility clinics reflects the sad but increasing commercialization of fertility treatment, with fertility care (in particular IVF) now being recognized internationally as ‘big business’ offering attractive financial returns. We are not alone in raising questions about incentive schemes for treatment. This recent article from Prof Nicky Hudson (Centre for Reproduction Research) discusses the growing commercialisation of fertility treatment in the UK and internationally, and what this means for the potential exploitation of patients.
We urge patients and the general public to carefully consider how they choose to pay for fertility treatment. And we encourage you to write to the Minister for Health advocating for public funding of IVF for all Irish patients.