News: Analysis & Commentary: MEDICINE
A PREGNANT CLAUSE
Fertility clinics are offering controversial guarantees
For thousands of infertile couples, in vitro fertilization is the option of last resort. In the process, eggs are harvested from a woman's ovaries, joined with sperm in a petri dish, and the resulting embryo or embryos are planted in the uterus. The vast majority of attempts fail--draining patients' wallets in the process. Couples often spend $50,000 before they either conceive or give up. To complicate matters, recent scandals at fertility clinics have included charges that doctors are purloining embryos for use in other patients and secretly using their own sperm to fertilize patients' eggs.
Now, the infertile have yet another variable to consider: money-back guarantees. In exchange for up-front fees of as much as $16,500--nearly triple what many clinics charge--Pacific Fertility Center in San Francisco and Reproductive Health Associates Inc. (RHA) in St. Paul, Minn., are offering up to 90% refunds to medically qualified patients who don't sustain a pregnancy past 12 weeks.
UNETHICAL? For some patients, the guarantees are more than financially reassuring. "It was a confidence-builder that they knew what they were doing," says a Los Angeles surgeon. He and his wife spent about $75,000 on IVF before trying Pacific, where she became pregnant with twins after one procedure.
The medical Establishment, though, is up in arms. The American Medical Assn. says charging a fee based on outcome is unethical. Dr. John C. Nelson, an AMA trustee, worries that such plans can "create an incentive [for doctors] to do things that may not be medically appropriate," such as overprescribing fertility drugs that increase cancer risk.
Dr. Geoffrey Sher, Pacific's Executive Medical Director, says ethical concerns about contingency-based fees shouldn't apply to infertility treatment. Unlike disease treatment, the success of fertility treatments is easy to assess. He contends there is no cancer risk from the fertility drugs he uses and his patients' exposure to them is limited.
Since January, RHA's business has doubled and Pacific's toll-free number has received 2,000 calls. Plenty of couples seem willing to risk paying more for success--and less for failure.By Joan O'C. Hamilton in San Francisco