IVF 'greed': clinics shun cheaper treatment

Private IVF clinics are resisting moves to offer cheaper treatment, which would give more Australian women a chance to conceive a child, because they are worried about their profit margins, according to one of the world's leading fertility experts.

Professor Alan Trounson, who delivered Australia's first test tube baby in 1980, said cheaper IVF was available to women overseas, including a method being trialled in Africa for less than $300 a cycle, plus labour costs. While the method would be more expensive here because of the high price of labour, it could still be provided at a fraction of the price private clinics now charged for their treatments, he said.

Medicare covers about 80 per cent of standard treatment fees but out-of-pocket costs can range from $1000 to $3000 per IVF cycle, making it too expensive for many couples.

Professor Trounson, founder of The Low Cost IVF Foundation, said the low-tech method, which he piloted, was as effective as treatments used now in Australia and should be made available to all women - particularly those in developing countries and on low incomes.

But he said a widespread rollout would be scuppered by those with commercial interests at all stages of the IVF process. ''This should be about freedom of choice, but everywhere you go there's entrenchment,'' Professor Trounson said from San Francisco, where he is president of the California Institute for Regenerative Medicine. ''We've got under-resourced populations that can't access IVF, and the ethics committees say 'well, they shouldn't get a lesser treatment', but that's not a reasoned argument.

''Clinicians who work in this area make an awful lot of money and they have an interest in keeping it that way.''

IVF is an increasingly common procedure in Australia, with more than 85,000 babies born since the technology was introduced. There is a growing global push for low-cost or ''minimally invasive'' IVF amid concerns increasingly expensive drugs and refined technology are making fertility treatment the preserve of the wealthy.

Professor Trounson's low-tech procedure strips treatment back to its early days, with basic equipment and oral drugs that are cheaper and have fewer side effects than hormone injections used in conventional treatment, meaning fewer blood tests and ultrasounds are required.

The drugs stimulate the body to produce one or two eggs per cycle, with a 12 per cent pregnancy rate, compared with 10 to 12 eggs per cycle and a 30 to 35 per cent success rate with conventional IVF. Fertility doctors are divided on its efficacy, with critics saying it is unethical to offer women a ''substandard'' treatment that has a lower pregnancy rate per cycle.

But supporters argue that over several IVF cycles the success rate is comparable. This is because the low-cost method is less gruelling, allowing patients to start another cycle within a month rather than having to delay their next attempt.

The method has been delivered in pilot form in Sudan, Namibia and South Africa for less than $300 a cycle. Some countries, including Japan, are already offering women a low-cost option. Women in Britain can access publicly funded IVF through the National Health Service.

In Australia, a few public hospitals do offer discount IVF but the waiting lists are long.

But Geoff Driscoll, founder of IVF Australia, who left the organisation in 2002, said prices would remain high here as there was no competition between the private equity groups that now owned the major clinics.

''The commercialisation of IVF is a potent disincentive to deliver the product cheaper,'' said Professor Driscoll, who is director of reproductive medicine at the University of New South Wales and is on the scientific board of the Low Cost IVF Foundation.

He said pharmaceutical companies were pushing the most expensive drugs. ''It gets back to the the philosophy of offering [IVF] to the masses. Not everyone needs caviar. Many people can get by with rice.''

Gab Kovacs, international medical director with private clinic Monash IVF, argued that Australian treatment was relatively affordable. Optimal treatment incurred costs for services including nurses, embryologists, doctors, counsellors, laboratory work and blood tests which might not be available with a low-cost model.

''It's not up to the IVF units to look after people who can't afford it, it's up to the government,'' Professor Kovacs said.

''This is not a medical decision, it's a social decision, and our politicians have to decide whether IVF is something that should be made available to poor people free of charge.''



Jill Stark
February 13, 2011

Student Braves Controversy, Refuses to Recite Pledge

"Liberty and justice for all?"

Will Phillips doesn't believe that describes America for its gay and lesbian citizens. He's a 10-year-old at West Fork Elementary School in Arkansas, about three hours east of Oklahoma City. Given his beliefs, he refused to recite the Pledge of Allegiance, specifically because that one phrase, "liberty and justice for all," he says, does not truly apply to all.

That did not go over well with the substitute teacher in his fifth-grade classroom.

The Arkansas Times reports that he started refusing to say the pledge Mon., Oct. 5. By Thursday, the substitute was steamed. She told Will she knew his mother and grandmother and they would want him to recite the pledge.

Will told the Times the substitute got more and more upset. She raised her voice. By this point, Will told the newspaper, he started losing his cool too, adding: "After a few minutes, I said, 'With all due respect ma'am, go jump off a bridge.'"
That got him sent to the principal's office. The principal made him look up information about the flag and what it represents. Meanwhile, there was the inevitable call to his mother.

At first, mom Laura Phillips told the Times, the principal talked about Will telling a substitute to jump off a bridge. When pressed, the principal admitted the whole incident was sparked by the boy exercising his constitutional right not to recite the Pledge of Allegiance.

Phillips suggested an apology was in order -- from the teacher. When the principal said that wasn't necessary, Will's mother started venting to friends via Twitter. Those friends, in turn, told the news media. And what would have been a minor classroom incident has people throughout Arkansas and beyond choosing sides.

As for Will, he continues to exercise his right to remain silent. It can be rough at times, he and his family admit. He has his share of supporters, however, his critics are louder and nastier -- especially because he took his stand to defend gay rights.

"In the lunchroom and in the hallway, they've been making comments and doing pranks, calling me gay," he told the Times. "It's always the same people, walking up and calling me a gaywad."

Nonetheless, Will told the paper, he is sticking to his convictions. A reporter for the paper asked Will -- with all this talk about patriotism and the pledge -- what he thinks it means to be an American.

"Freedom of speech," he responded. "The freedom to disagree. That's what I think pretty much being an American represents."

His mother is proud.

"He's probably more aware of the meaning of the pledge that a lot of adults," Phillips told the Times.

8-year lawsuit settled over US lesbians denied IVF

A lesbian couple has won a landmark case against a Californian clinic, where doctors allegedly cited their religious beliefs as grounds to refuse the couple IVF (in vitro fertilisation) treatment.

Guadalupe Benitez, 36, of Oceanside, and her spouse, Joanne Clark, sued doctors Douglas Fenton and Christine Brody, at North Coast Women's Medical Group in Vista for discrimination in 2001. The doctors treated Ms Benitez with fertility drugs and provided her guidance about self-insemination but allegedly told her they would not inseminate her, due to their religious objections.

The couple was, however, referred to another clinic by the North Coast doctors, which they were told would have no moral objections. Ms Benitez underwent treatment and the couple have since had three children. The discrimination case was finally settled after eight years for undisclosed sum of money. 'It's been a long, hard fight to get to this point,' Ms Benitez said following the settlement announcement, adding: 'But we know we've made a difference in the law that will help people in California and across the country.' The clinic released a statement saying it welcomed lesbian and gay patients.

Californian civil rights law prohibits discrimination in businesses which serve the public. Although the law does allow doctors the option to refuse certain medical procedures, such as abortion, if a procedure is available to the public, it must be made available to all.

The case went through a state appeals court in San Diego in 2006 which ruled in favour of the doctors. However, in 2008, the California Supreme Court barred Christian doctors denying treatment to patients on the grounds of sexual orientation. The ruling stated that the laws preventing discrimination based on sexual orientation extended to the medical profession. According to Jennifer Pizer, the lawyer for Benitez and Clark, the ruling 'shows a journey that our whole society is taking together, away from intolerance and towards inclusion.'

In the UK, the introduction of the Human Fertilisation and Embryology Act 2008 (amending the Human Fertilisation and Embryology Act 1990) allows lesbian couples to more easily receive IVF treatment on the National Health Service (NHS). Prior to this, the 'need for a father' criterion in the 1990 Act enabled some clinics to deny same-sex couples and single parents IVF treatment, through statutory interpretation. This was challenged in two legal battles earlier this year in Scotland and England. In both cases the initial decisions to deny treatment, made by NHS trusts, were overturned following threats of legal action.