The American Fertility Association

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The American Fertility Association’s Monthly Newsletter

October 30, 2007

Mark P. Trolice, M.D.

Caveat Emptor
By Mark P. Trolice, M.D.

As fertility patients increase in incidence given the delay in childbearing and earlier recognition, fertility treatments have become more acceptable and aggressive. For example, the number of total IVF cycles reported to the Society of Assisted Reproductive Technology (http://www.sart.org) in 2005 was 123,200 almost doubling in less than 10 years from 64,724 in 1996, the first full year the Centers for Disease Control & Prevention (http://www.cdc.gov) collected data as mandated by the 1992 Fertility Clinic Success Rate and Certification Act. During 1996-2005, the number of ART clinics slowly increased nationally from 330 to 384 and the field of infertility has become a $2 billion industry.

SART annually publicizes every registered clinic’s pregnancy rate statistics. As a result, competition among ART clinics has been fueled by patients using these statistics to select a physician despite SART’s disclaimer to avoid comparison of clinics for a variety of valid medical reasons. Furthermore, competition also compels some clinics to cancel an IVF cycle despite the patient understanding and accepting a poor prognosis for pregnancy, thereby effecting that clinic’s statistics.

Fertility patients have been likened to other chronic diseased patients such as cancer and pain because of the impact on quality of life and lack of certainty with a cure and/or endpoint. Additionally, the devastation of being childless can result in desperation to resort to experimental and/or unproven offers of treatment. Consequently, fertility patients are potentially at risk of exploitation. Medical professionals are obligated to remain objective and avoid this slippery slope unfounded treatments at all cost despite the pressure to accommodate the eagerness of patients.

Over the last several years, evidence based medicine has gained momentum in all areas of health care to become the standard for medical practice. Nevertheless, the growth of science and services in ART has resulted in some treatments being thrust into medical practice before appropriate rigorous clinical trials. This has the potential risk of harm to the patient and offspring.

A prime example of premature clinical application is the advanced technology of egg freezing. For years, sperm and embryo freezing have been well documented to be safe and effective options for fertility patients. As research flourishes in reproductive medicine, egg freezing has emerged as an option for cancer patients as well as younger healthy women to preserve their fertility and utilize when applicable. Despite the experimental nature of egg freezing, clinics have begun to offer this option to patients as a ready and viable alternative. Additionally, there is at least one company that provides a donor bank of frozen eggs.

The American Society for Reproductive Medicine (http://www.asrm.org) classifies egg freezing as experimental and recommends its clinical application as part of a research protocol only after careful review and acceptance by an Institutional Review Board. As point of fact, the Food and Drug Administration (http://www.FDA.org) guidelines prohibit an organization or indidividual from profiting from an investigational drug or device aside from appropriate reimbursement for expenses. Unfortunately, without randomized and long term studies including outcome of children, the growing use of egg freezing adds to the commercialization of the fertility field alongside egg donor brokers, embryo banks, reselling fertility medication, and sex selection.

Fertility patients strive to maintain control of a problem that often enables them out of control. Hopefully, education and insurance coverage will empower them to reach closure and fulfillment. The goal of a healthy child may come at a cost, but it does not have to be at all costs.

Mark P. Trolice, M.D., FACOG, FACS, FACE is the Director of Fertility C.A.R.E. (Center of Assisted Reproduction & Endocrinology) as well as the Division Director of Reproductive Endocrinology & Infertility (REI), at Orlando Regional Healthcare in Florida, responsible for the medical education of Obstetrics and Gynecology (OB/GYN) resident physicians and third/fourth year medical students in REI. Additionally, Dr. Trolice is a Clinical Associate Professor in the Department of OB/GYN at the University of Florida in Gainesville and Florida State University.

In 2004, he founded Fertile Dreams, Inc. a non-for-profit organization dedicated to increasing fertility awareness and granting scholarship for those unable to afford fertility treatment.

The American Fertility Association, 305 Madison Avenue Suite 449, New York NY 10165.
Support Line: 888-917-3777. Fax: 718-601-7722. www.afafamilymatters.com