Maybe, baby? An investigation of In Vitro fertilisation success rate disclosures made by Australian fertility clinics on their consumer websites
Creators: name: JURIC, Daniela
Publisher: name: RMIT University
Year: 2024
Subjects: classificationCode: 350199
subject: Accounting, auditing and accountability not elsewhere classified

description: In 2016, the Australian Consumer and Competition Commission (ACCC), undertook an investigation `amid mounting complaints about the lack of transparency of IVF success rates, with consumers saying they are in the dark about their chances of conceiving at different clinics' (Morris 2016). Media scrutiny intensified with television programs such as the ABC's `7.30' and `Four Corners' leading their own investigations, resulting in negative news headlines and decreased levels of public sentiment towards the industry. Following the ACCC investigation, the IVF industry was put `on watch' by the ACCC after it was found that several IVF clinics had made potentially misleading claims in relation to their success rates (ACCC 2016).

Prompted by the findings of the ACCC investigation, this study has three key research objectives. The first objective is to examine and explain any changes to reporting practices of Australian IVF clinics in the three-year period following the 2016 industry crisis characterised by increased levels of regulatory oversight and negative media attention. The second objective is to establish the criteria and/or characteristics that success rate disclosures `should' possess in order to provide decision-useful information for patients. The third objective is to evaluate whether the changes to success rate reporting practices following the ACCC investigation have improved the quality of success rate information in terms of its decision-usefulness for patients.

This research is motivated by several factors. The first motivating factor is the pervasiveness of infertility. Infertility affects one in six couples in Australia (Fertility Society of Australia 2016) and the demand for and use of IVF treatment is growing. Over the five-year period from 2012 to 2017, the number of women undertaking IVF treatment each year in Australia increased by 11.6% from 36,171 to 40,375 women (ANZARD 2014; 2019).

The second motivating factor is the high level of emotional, physical and financial costs associated with IVF treatment. Studies have shown that many women who experience infertility describe the treatment to be the `most upsetting experience of their lives' and infertile women report twice the prevalence of depressive symptoms when compared to healthy fertile women (Downey et al. 1998). In addition to the emotional toll associated with treatment, the physical undertaking is significant, invasive and in rare cases, can have fatal consequences (Wilkinson et al. 2016). Further, the (out-of-pocket) financial costs associated with each IVF treatment can be significant.

The third motivating factor is the lack of industry regulation, particularly with respect to the reporting of success rates on clinic websites. Due to the lack of prescribed reporting standards and the fact that these disclosures are not required to be independently audited, patients are provided with little protection from potentially misleading claims.

This study analysed data obtained from Australian IVF clinic websites each year for the period from 2016 to 2019. Supplementary data sources include industry bulletins, newsletters and the industry code of practice. An instrument was developed in order to assess the relevance of success rate information to patients for the purpose of making decisions regarding whether to continue, commence or cease treatment at a particular IVF clinic. In addition, the decision-usefulness of success rate information reported on clinics¿ websites was assessed in terms its faithful representation (reliability), comparability, understandability, verifiability and timeliness.

Several changes were identified following the 2016 industry crisis in relation to the success rate information Australian IVF clinics are reporting. The changes made to reporting practices between 2016 and 2019 are consistent with both legitimacy and stakeholder theories. More specifically, IVF clinics and the IVF industry more broadly appear to have undertaken legitimising strategies and responded to the power exerted by the ACCC as a salient stakeholder. However, I found that the changes have not significantly improved the decision-usefulness of this information for patients. In particular, the faithful representation (reliability) and verifiability of success rate information remain problematic. The relevance, comparability,
timeliness and understandability of reported information appears to have improved in some respects; however, this is undermined by the failure of the industry and clinics to address other key aspects. The findings indicate that although the ACCC wields the necessary power and influence to initiate changes to reporting practices, it appears that they do not possess (and have not accessed) the necessary skills and expertise in relation to the complexities of IVF in order to promote effective change which improves decision-usefulness for patients.

I make recommendations for enhanced patient decision-usefulness based on the findings of this analysis. These recommendations centre on the development of a conceptual framework which has clear practical and societal implications and may be of interest to industry participants,
policymakers and government agencies (including the ACCC). Improved reporting regarding the likely success of IVF treatment can empower patients to make better-informed choices regarding IVF treatment. Greater effectiveness and efficiency in infertility treatment has the potential to reduce the emotional, physical and financial cost to the patient as well as decrease the extent of public monies that are used to subsidise treatment costs. For this reason, the findings and recommendation of the present study are of significance to both IVF patients and the wider public.

This study contributes to the academic literature in three key ways. First, the study develops a disclosure instrument which is specific to the reporting of IVF success rates. Second, the study examines success rate reporting, for the first time, using a combined theoretical lens comprising
stakeholder and legitimacy theories and draws on the concept of surrogate accountability. Third, the study examines the voluntary disclosures of health care information to patients by commercial healthcare providers. This is an area that is currently under-explored in the accounting literature.

Accounting researchers are in a unique position to contribute to the ongoing discussion regarding IVF success rate reporting since accounting information provides the basis for making decisions about resource allocation. In the context of IVF and patient decision-making, these resources include not only `financial resources' but also `physical' and `emotional' resources. Further accounting and accountability-based research in this area is encouraged.