Thursday, July 12, 2018

The problem with IVF corporate clinic chains

Practically every newspaper these days has ads for IVF clinics,  and you will also see these ads on large billboards all over the town as well. There's a lot of competition in the field, because lots of financiers believe that there is a lot of money to be made by opening IVF clinics. IVF is thought of being a high-profit business, and they want to make the most of this opportunity. However, their focus is then on how much money they can make by opening as many clinics as quickly as possible, rather than paying attention to making sure that the pregnancy rates are high by providing high quality treatment to their patients.
This creates all kinds of perverse incentives for these clinics , who end up spending a lot of money on advertising (Google Ad words and newspaper articles, whether these are regular ads, or disguised as advertorials)  , because their metric for success is how many IVF cycles they  have done – not what the IVF pregnancy rate is. They don't really care about whether the patient gets pregnant or not because they're not clinicians. They're ultimately just out to get a return on their investment.  And since this is India and there is no regulation, they can claim any success rate they want, because there is no one to verify or check their claims.
 They also incentivize their doctors based on the number of patients they attract for IVF. Ironically, this means that any patient who goes to these clinics is advised IVF . This is very profitable for the clinic, and also improves their pregnancy rates ( because these patients didn’t need IVF, their chances of getting pregnant are very high !), but is a waste of money for the patient. Patients get attracted by these ads, because they're not sophisticated enough to understand that the quality of care in these clinics is poor.
 In theory, one would expect that corporate chains of IVF clinics would be a good idea, as they would offer standardized treatment, at a lower cost, because of their advantage of scale. While they do offer convenience, because patients in small towns no longer need to travel to a metropolis for IVF treatment, the fact remains that their pregnancy rates leave a lot to be desired.
So, why is the quality of treatment poor? This is because these clinics are being run for all the wrong reasons. They're being run to make money, not in order to provide a high quality clinical service, which is why they cut corners all the time. Thus, they typically employ junior doctors , who don't have any experience or expertise . They are taught in a one-week workshop to recite a script at the time of the consultation, and to write a protocol which they perform mechanically and mindlessly. While this may be okay for young patients, they have no idea how to handle complicated patients , as a result of which, the cared for patient continues to suffer.
Most of these new labs don't have highly trained expert embryologists, as a result of which the lab is not able to grow embryos properly. Most of them don't give photographs of the embryos to their patients , because they know they cannot afford to be transparent – patients would start complaining and objecting when they see how poor their embryos are. They fail to follow good global practices, but continue getting away with it , because Indian patients are naive , and don't know any better, and the government has failed to provide any regulatory oversight, though it was tasked to do this over 20 years ago !
This is why these clinics flourish in small towns , where patients are illiterate, and treat the doctors as Gods., They will do everything the doctor tells them to  because they don't know any better. When their cycle fails, they then jump to the erroneous conclusion that all IVF clinics are scams.
The best way to protect yourself from being taken for a ride is to ask a simple question - Do you provide photos of embryos routinely to all patients before transfer ? And if they don't, then this is a red flag !
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