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Outside the world of academic medicine, fertility clinics are even more overtly commercial. They compete actively in the market for infertile patients, often relying on carefully nurtured relations with a circle of referring physicians. “We wine and dine them,” reports one lab director, “and tell them how good we are.” “We do newsletters, dinners, parties at medical meetings,” recounts another. [45] Many of the clinics hire high-powered marketing consultants and advertise their services on billboards, in magazines, online, and on the radio. “We’ve tried everything,” one doctor says, laughing. [46]
Some even compete directly on price. The Advanced Fertility Center of Chicago, for example, offers a money-back guarantee for patients who do not produce a baby after treatment. [47] The ARC Family Building Program, a nationwide network of doctors, offers several standardized options, including the Three-cycle Plus program and the Affordable Payment Plan. According to the company’s Web site, the Plus program includes additional services such as “assisted hatching” and the opportunity to purchase a money-back guarantee. The Affordable Payment Plan “can make your fertility care less expensive than a second car.” [48]
Other efforts are subtler. Most of the clinics’ Web sites, for example, feature gauzy photos of infants and joyous couples rather than syringes and invasive medical procedures. Many tout optimistic success rates and book their physicians to speak at infertility gatherings organized by local advocacy groups. Like other businesses, they are increasingly turning to incentive schemes and performance measures to gauge their own productivity. At several Northeastern practices, for example, doctors’ pay is aligned with three quantitative goals: patient satisfaction, financial performance, and birthrates. As a result, says a beaming outside consultant, “The whole clinic is obsessed with outcomes.” [49]
Finally, across the United States, private fertility practices are increasingly consolidating into networks such as IntegraMed, a publicly listed company that provides member clinics with management advice, pharmaceutical products, and in-house financing. One doctor who joined his practice to IntegraMed in 1997 expected his annual caseload to rise by 80 percent, allowing him to keep his practice open “52 weeks a year, fully staffed all the time, offering even the most exotic reproductive technologies.” [50]
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