Amid the emotion around infertility, the IVF industry has been criticised for cherry-picking its success rates. But applying the rigour of accounting can help bring more certainty to how these are reported.
For many people who are looking to choose a clinic for their IVF journey, it can be an emotional decision, made even more difficult by the lack of regulation around IVF success rate disclosures.
With IVF clinics generating strong profits but no standardised reporting across the industry, this means anyone choosing to go down the IVF road does not have access to clear statistics on which to base their decisions.
Enter Monash Business School’s Daniela Juric and her supervisors who have been working closely with the industry to develop a framework to improve the clarity of the information that is disclosed.
She explains that people who work in the industry are supportive of trying to standardise their reporting in order to help people achieve their aim of having a family.
“I am working closely with the industry to develop a framework to make clear objectives for disclosing that information,” Ms Juric says.
When her framework study commenced in 2016, there were five measures of success including pregnancy, clinical pregnancy, chemical pregnancy, live births and an unspecified measure of success.
“When the analysis was completed, successful measures had been reduced to just two: clinical pregnancies and live births. While this represents some progress, there is still room for improvement,” she says.
Industry under the microscope
Since the Australian Competition and Consumer Competition (ACCC) launched an investigation into IVF success rates in 2016, the industry has been under the microscope.
The ACCC found that some IVF clinics used ‘clinical pregnancy rate’ data to compare their success rates where that data reflected the clinic’s success in creating an embryo, rather than live birth rates.
With so much on the line, it is perhaps not surprising that many had chosen more favourable measures which led to some media reports of IVF success rate disclosures being ‘misleading and deceptive’.
Ms Juric’s doctoral research examines the Australian fertility clinics IVF success rate disclosures over a period of time and observes how the reporting of the success rate measures has changed and attempts to explain the reasons for such changes.
While the accounting discipline seems to be far removed from the scientific community of embryology and artificial insemination, there are lessons that can be learnt from the requirements of financial accounting and audit.
“Research is all about engaging with the broader community. Sometimes disciplines have to collaborate,” Ms Juric says.
“The goal of accounting and accountants is to provide financial information to help people make informed decisions about the allocation of scarce resources. We can think of IVF patients as users of non-financial information that they rely on to make well-informed decisions, as there is not an unlimited amount of eggs or embryos that can be created.”
Data and insights
The data was collected in 2016, 2017 and 2018 with the analysis taking into consideration the regulatory environment and how institutional pressures resulted in a convergence of reporting in the year after the ACCC investigation concluded.
The response from the fertility clinics industry has been receptive and Ms Juric has been invited to share her insights, at this year’s Fertility Society of Australia conference in Melbourne.
As there are currently no mandated or standardised requirements for IVF success rate disclosures, it is little wonder that patients often find interpreting the reported statistics to be quite perplexing.
“For many, the decision to undertake fertility treatment may be the biggest decision of their lives. The physical and emotional undertaking is often excruciating. It affects the whole social network and not only the individual and it can be expensive,” Ms Juric explains
So much so, that the latest reports suggest that patients are often diving into their superannuation to fund this treatment.
Building a framework
During the study fertility clinics changed their reporting practices, making it difficult to definitively state if disclosures have become better or worse.
The research went further to develop a Stakeholder Relevance Index which incorporates best practice criteria as discussed in the scientific literature, regulatory guidelines and international fertility registers, to evaluate how Australian fertility clinics reporting compares to the best practice criteria developed in the index.
While IVF clinics are attempting to make improvements in their reporting, they are in a piecemeal fashion and without the guidance of a framework that establishes the criteria necessary to ensure comparability.
“It became clear that there needs to be a shift in focus. We need to focus more on the patients’ view and how they will be impacted by the success rate information,” Ms Juric says
Her next step was to consider how the accounting could assist in the effort to improve this accountability to patients.
Standards ensure consistency
Financial accounting requires that financial statements are prepared in accordance with accounting standards. The reason for this is to ensure that there is consistency across companies that have stakeholders who are unable to directly access company accounts.
“Accounting standards require that companies provide information that is useful to the primary users of financial statements, which are the providers of capital. Relevant financial information is capable of making a difference to the decision made by users,” she says.
“Faithful representation is the second fundamental characteristic of financial reporting. Financial information that faithfully represents economic phenomena has three characteristics: it is complete, neutral and free from error,” Ms Juric says
“Financial statements can be relied on by users because they have been verified by an independent third party, a process that the IVF industry may want to look at in the future.”
With the assistance of the industry, she believes that together they can build a framework that will give IVF patients standardised data that is comparable, timely and straightforward so that they can make a considered decision at this emotional time.