The fertility industry is usually treated as a monolithic industry pushing basically the same techniques and the same product, with some adventurous clinicians specialising in niche markets. However, papers filtering out from a congress held in London last December shows that a divide is opening up over the use of the powerful IVF drugs which are a key feature of normal IVF treatment.
The current issue of Reproductive BioMedicine Online features two papers from the First World Congress on Natural Cycle/Minimal Stimulation IVF. In one of them, the doctor responsible for the first IVF baby in 1978, , who has been called the most knowledgeable endocrinologist in the world today, argues that routine IVF is being challenged by simpler methods. These include natural cycle IVF, in which no artificial hormones are used, and minimal stimulation IVF, which uses reduced doses.
In a companion paper, , of the National University of Singapore, contends that these would be very helpful for younger women with mild sub-fertility. The benefits include reduced medical fees because fewer drugs are used, a shorter treatment cycle and greater safety. However, he says, these are being ignored by IVF clinics, partly because "the use of low or nil dosages of recombinant gonadotrophins would drastically cut profits from drug prescription sales to patients."
Other financial factors play a part as well: natural cycle IVF is less effective on a per cycle basis and health insurance normally covers only a limited number of attempts. Finally, doing without drugs would "drastically reduce the numbers of surplus oocytes and embryos available for donation to other patients."
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