The Associated Press today covers a study from the most recent NEJM – apparently fertility clinics are using an expensive (and probably unnecessary) procedure to fertilize eggs, driving the cost of treatment up over a thousand dollars on average. The procedure in question involves injecting a single sperm into an egg, in contrast to the more standard protocol that basically lets egg and (lots of) sperm hang out until one penetrates. The direct-injection method is useful if a man has low sperm count, but probably unnecessary otherwise (both methods result in about the same percentage of live-births).
Whether clinics are intentionally adding the procedure to get more money or not is hard to say. The direct-injection method certainly brings more money to the clinic, but I would imagine it also takes a bit more skill and effort to perform. Still, if it doesn’t result in a better outcome it seems silly to waste the time, effort, and money – those are resources that could be directed elsewhere.
Normally this is where I would start a rant about how clinics can get away with this sort of waste because insurance companies will reimburse them, and patients are shielded from the true cost (forcing their coworkers to help subsidize their fancy and unnecessary treatment). While this is certainly true in some cases, it is my understanding that many fertility treatments are not covered by traditional insurance plans. In this case, and certainly with this paper coming out, it seems possible that clinics are preying on the desperate desire for couples to conceive, tagging on procedures without much evidence to support their use. With empowered consumers, however, it is easier to weed out such waste and move the market toward better and more efficient options….a process that you can be sure is significantly slowed when third parties (insurance companies, government) are the primary payers involved.