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Self proclaimed “fertility planner” Angie Best-Boss, founder of My Fertility Plan, is quoted in the Washington Times (“Having a baby in the fertility maze: new specialty guides for parents“), regarding the value of her services:

“This is an industry that is not regulated at all. What you can’t get on Google is whether an agency is going to push you toward using an egg donor so that clinic can boost its stats.”

The misconception that the fertility industry is unregulated is so persistent, even so-called experts perpetuate it (out of ignorance and laziness). Fertility medicine is highly regulated by the FDA, and there are some firm ground rules set by the ASRM as well.*

On the second part of her statement: I do not know why an agency would have any interest in increasing a clinic’s statistics; I guess if the agency were affiliated with the clinic, this statement may make some kind of sense. But statistics are highly accessible to anyone, and you don’t need to hire a consultant for $125 an hour. I encourage all our clients to go to SART, click on For Patients, the Find a Clinic: plug in your zip code for a clinic near you or click on a state for all its registered clinics. There you can find the clinic’s CDC-reported statistics for the past few years, where they separate their cycles by donor and non-donor, and in the cases of non-donor,

(Article in New Scientist: “Cheap IVF offers hope to childless millions”)

Despite the public perception that Africa is overpopulated, the majority of infertile couples reside in Third World countries, especially in Africa. The causes of infertility in Africa are much different from those in Europe and the US. In my experience, Western couples seek IVF and egg donation because of premature ovarian failure, polycystic ovarian syndrome, reproductive organs damaged by cancer, or unexplained infertility, either primary or secondary. In Africa, it is caused mainly by epidemic, untreated sexually transmitted disease and infection. Furthermore, there are horrific conditions unimaginable in the West, such as early teenage intercourse and pregnancy that leads to vaginal fistula or other complications, infections from genital mutilation, and the severe social ostracism associated with these genital diseases and infertility.

So low-cost ART (assisted reproductive technology) in Africa is controversial, since it treats a symptom, rather than a cause. But efforts to find low cost methods of treatment have created some ingenious, low-tech methods. One is the INVOcell, a capsule that uses the intended mother as an embryo incubator, rather than a costly mechanical incubator that requires electricity. The most typical treatments are less invasive (such as IUIs) that avoid costly IVF, although the success rates are lower than those in developed countries.

There are programs that raise money for equipment and training for these clinics: see the site for the Low Cost IVF Foundation.

It was a shock to learn that “Octo Mom” got pregnant with all those babies through IVF (in vitro fertilization) rather than just IUI (intrauterine insemination): what doctor would transfer all those embryos? Unfortunately, there are a few unethical doctors out there who make the industry look like a freak show.

An excellent article in today’s New York Times (“Birth of Octuplets Puts Focus on Fertility Clinics“) explains the issues very accurately: the ASRM’s recommended limit on the number of embryos transferred, versus the financial pressure to keep the number of transfers low (and therefore the number of embryos transferred high).

This story gets to the bottom of the conflict: the need for better insurance coverage for infertility treatment.