Edition: U.S. / Global

Fertility Inc.: Clinics Race To Lure Clients

Published: January 1, 2002

When Reproductive Medicine Associates, or RMA, decided to open a fertility clinic in Morristown, N.J., the founding doctors left nothing to chance.

The market was already saturated, and the doctors realized that even though they were experts in infertility and had recruited a leading embryologist to work her magic with sperm and eggs, they could not just sit back and wait for patients to appear. They needed to do some aggressive marketing.

That meant courting potential patients and wooing local doctors -- gynecologists, urologists and internists -- who could refer patients. They hired a marketing consultant, started weekly support group meetings for infertile couples and invited doctors to dinners, including a wine-tasting dinner last year with a sommelier flown in from France.

They had little choice but to invest heavily in marketing, fertility experts agree. Infertility has become a big, fiercely competitive business, with a billion dollars in revenues and with more and more doctors fighting for a limited number of patients. The growth of the field has been fueled by rising success rates and increased demand from patients, many of whom pay tens of thousands of dollars out of their own pockets in hopes of having a child.

Some experts are deeply concerned. With marketing promotions that can shade the truth, referring doctors and patients can find it hard to distinguish between centers with good reputations, like RMA, and ones that promise much more than they can deliver. And some clinics that offer inducements like money-back guarantees may end up doing risky procedures hoping to improve the odds of pregnancy.

For example, critics say, they may implant too many embryos -- the number that qualifies as too many depends on the woman's age and other factors. That raises the chances of pregnancy but also increases the odds the woman will end up with three or more fetuses, a hazard to mother and babies.

''You have desperate patients,'' said Dr. Barry Behr, who directs Stanford's in vitro fertilization laboratory and four others. ''And the potential is there to exploit vulnerable people.''

At the very least, said Dr. Alan Garber, an internist at Stanford, patients may want to know that the doctor who referred them to a fertility expert was accepting gifts and expensive dinners.

From 1995 to 1998, the most recent year for which national data are available, in vitro fertilization procedures increased by 37 percent, from about 59,000 to about 81,000, and the number of clinics rose by 28 percent, from 281 to 360. But most of the business goes to a few highly successful clinics, leaving the others to fight over the remainders.

Since fertility became a specialty nearly 20 years ago, the American Board of Obstetrics and Gynecology trained so many fertility specialists that ''they flooded the market,'' said Dr. Richard Rawlins, laboratory director for the Rush Centers for Advanced Reproductive Care in Chicago. Improved methods and competition caused prices for in vitro fertilization to drop precipitously, from highs of about $18,000 in the late 1980's to lows of about $4,500 today, he said. Insurance companies in a few states started paying. The result was more patients, more doctors and more and more competition.

The fertility business is unlike any other in medicine, doctors and laboratory directors say. For one thing, it is regulated: it is the only medical specialty that requires clinics to report success rates to the federal government. But at the same time, it can be as competitive and commercial as laser eye surgery or plastic surgery.

Since most patients pay with their own money, in cash, and cash-paying patients can pretty much pick and choose where they go, fertility specialists say that if they want to survive, they have to get the attention of both patients and referring doctors.

Fertility centers often use some of the same strategies as large drug companies, with dinners, seminars and gifts for referring doctors, and marketing representatives who show up regularly at the referring doctors' doors. To attract patients, many provide special financing schemes, including money-back guarantees.

But fertility experts say that no matter how skilled they are, no matter how honest they are about what they can offer, marketing is a fact of life.

''When you have a lot of doctors fighting for the dollar, there's a lot of competition,'' said Dr. Mark V. Sauer, a highly regarded fertility expert, who directs Columbia University's fertility center.

Dr. Sauer said he found a market niche -- the patients that other centers turn down. They include older patients whose chances of success are very low, lesbian couples and couples in which the man is infected with H.I.V. And he has competitive prices.

''Right now, we have a brand-new site and we want to get some attention,'' Dr. Sauer said. ''The first cycle is discounted so that instead of costing the normal $7,000 they can get it for just under $6,000. It's not meant to undercut other programs, but let's face it, this is a competitive marketing plan.''