Many IVF clinics' websites are continuing to advertise confusing and potentially misleading claims to aspiring parents despite the industry being put "on notice" by the Australian Competition and Consumer Commission (ACCC) a year ago, an Australia-wide review has found.
Around one in every 25 children are now born through in vitro fertilisation in Australia, but it's a process which remains expensive, time-consuming and potentially traumatic for many couples.
With less than one in five cycles of IVF in Australia leading to the looked-for bundle of joy -- a figure that's budged little in the past four decades -- clinics are fighting to stand out in an increasingly competitive and profitable industry.
In November 2016, the ACCC announced it had asked several major IVF clinics and some smaller ones to change potentially illegal advertising claims on their websites, following what ACCC Commissioner Sarah Court described as a "race to the bottom".
Only 48 percent of clinics advertise "success" as the birth of a live baby (as opposed to an early-stage pregnancy);
Most clinics report "success" out of embryo transfers, which doesn't take into account the 15-20 percent of women who are unable to have the embyro transferred;
14 percent of clinics still don't advertise age-based success rates, despite it being the most significant factor to success.
The ACCC audit found that some IVF websites were comparing their success rates to other clinics without disclosing the information they used to make those claims. Many were advertising their rate of "success" based on clinical pregnancies instead of live births.
But a review of accredited clinics' websites before and after the ACCC audit show only 10 of the 29 clinics had improved the transparency of their online advertising claims, while five clinics received a worse score than before the audit.
The review, conducted by the Victorian Assisted Reproductive Treatment Authority (VARTA) and Monash University researchers, was published in the Australian and New Zealand Journal of Obstetrics and Gynaecology on Sunday.
It found less than half (48 percent) of the 29 accredited clinics assessed advertised their "success" rate as the live birth of a baby, up slightly from 45 percent at the beginning of 2016.
"Obviously everyone who does IVF wants to have a baby," lead author of the study, Monash University's Dr Karin Hammarberg, told HuffPost Australia.
"If success is counted as a clinical pregnancy -- which means an early pregnancy which you have seen on an ultrasound -- it doesn't actually tell you that 23 percent of those pregnancies will never become a live baby."
It comes a week after a separate study by Macquarie University found evidence of conflicts of interest in some doctors working within the commercial IVF sector, which the authors said was causing some couples being offered IVF when they didn't actually need it.
Other key findings to come out of Monday's review included: a quarter of the clinics' websites didn't publish what their statistics were out of (i.e. is the "success" percentage taken from those who began IVF treatment, or only those who successful had an embryo transfer?); almost half (45 percent) of clinics didn't publish separate success rates for frozen embyro transfers compared to fresh eggs taken from a woman at the time; and 14 percent were still not publishing their success rates by age.
Such confounding of statistical data makes it very difficult for people looking into IVF to compare success rates across different clinics, Dr Hammarberg explained.
Questions To Ask Your IVF Doctor*
Considering my circumstances and medical history, what chance of having a baby can I expect?
What is this clinic's chance of a baby per started stimulated treatment cycle?
What is this clinic's chance of success for women of my age?
What proportion of women in my age-group have embryos available for freezing after a stimulated treatment cycle?
What is the cumulative chance of a woman of my age having a baby if she has three stimulated treatment cycles?
*From 'Understanding IVF Success Rates' by the Victorian Assisted Reproductive Treatment Authority
"Age is the single most important factor that determines you chance of having a baby," she said.
According to UNSW figures from 2013, a woman in her early 30s has a one in four (24.1 percent) chance of achieving a live birth with each cycle of IVF, but that rate drops dramatically as she approaches 40.
Only one in 17 IVF cycles will be successful for women aged 40 to 44, while a woman over 44 using her own fresh eggs has little more than a one in a hundred chance of success for each cycle.
But the body responsible for accrediting IVF clinics, the Fertility Society of Australia (FSA), has defended the clinics' practices, claiming the study didn't take into consideration other information provided on the IVF clinics' websites outside of the parameters being assessed.
"Websites are only part of the information base provided to patients. Much information is also provided at doctor and clinic level," FSA President Professor Michael Chapman said in a statement.
But the industry may be set to receive a further push towards more consistent reporting.
The arm of the FSA responsible for accreditation of clinics, the Reproductive Technology Accreditation Committee (RTAC), is currently in the process of developing standardised guidelines which look set to become compulsory for all clinics practicing in Australia.
These guidelines will include reporting success rates based on a woman's age at the time she starts receiving IVF.
Dr Hammarberg says the review is about creating realistic expectations on what can be achieved through IVF.
"Generally speaking, most IVF cycles fail so you would expect to have to do it maybe three or four times to have a good chance," she said.
"If people went in to the process of treatment having that expectation, perhaps it wouldn't be quite as traumatic if they did fail once or twice."
For couples considering IVF treatment, Dr Hammarberg says it's important to ask your clinician what your chances of having a baby are based on your personal circumstances.
More information about how to choose an IVF clinic for your situation -- including how to look beyond the hype, why age matters and how to reckon up the cost -- is available here.