The ABC of IVF and COI

One morning back in 2016, a visiting research fellow from Sydney sent me an email containing a link to a TV programme that had aired on the Australian Broadcasting Corporation (ABC) a few days before. He encouraged me to watch it and a few days later I did. The programme pulled no punches and it portrayed the delivery of IVF in Australia as a huge corporate endeavour which ruthlessly put profits before patients. In the UK we’d had a couple of similar programmes made by the BBC current affairs programme Panorama, which had also sent shock waves through clinics and healthcare professionals. But in this instance, I was not able to see how the programme had been received in Australia. Nor did I have any prism or conduit to know whether or not any of it was true. As such, I was very pleased to see a manuscript submitted to Human Fertility by Brette Blakely and colleagues which examined the Conflicts of Interest (COI) in the Australian IVF industry by conducting semi-structured interviews with a small number of health professionals and which is now published in this issue (Blakely, Williams, Mayes, Kerridge, & Lipworth, 2019). The data provides a first glimpse of some of the COI’s involved in delivering IVF in Australia and how they might be explored further. It is well worth reading.

The second paper in this edition by Klitzman (2019) is not unrelated to the issue highlighted by the ABC TV programme. It describes, for the first time, the phenomenon of “doctor shopping” in the USA by infertility patients who struggle to evaluate and weigh-up bedside-manner against technical skills, finance and other characteristics when deciding which doctor (and presumably clinic) to choose, particularly after treatment failure. The phenomenon of “doctor shopping” has been explored in other fields, but this is its first description in IVF, and we are pleased to publish it in Human Fertility.

Two further papers of note in this issue are those published by Prior, Lew, Hammarberg, and Johnson (2019) and Boivin, Sandhu, Brian, and Harrison (2019) which each examine different aspects of fertility knowledge and plans of young people. The first (Prior et al., 2019) surveyed over 1000 university students in Australia about their intentions and expectations for future parenthood and found, perhaps unsurprisingly, that most were inadequately informed about the impact of age on fertility and many significantly over-estimated what life goals they would be able to achieve before their fertility was affected. Similarly, interviewing a smaller number of young people in the United Kingdom, Boivin et al., (2019) found that adolescents lacked confidence in their fertility knowledge which suggested that would not be able to make informed decisions about their fertility.

Whilst there are five other equally interesting papers in this issue, as Editor in Chief, it strikes me that the four I have highlighted are not entirely unconnected to each other. They tell of a story of a population of young people who may enter their fertile years somewhat poorly prepared to make decisions about their fertility such that if their fertility plans are not realised, find themselves at the mercy of “doctor shopping” or COI’s within clinics with too little information to understand the consequences. Thus, it strikes me that better fertility education in the early lives of men and women might help them navigate these issues more robustly or simply avoid them in the first place.

Disclosure statement

No potential conflict of interest was reported by the author.