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Where fertility treatments are concerned, however, there are few incentives to stop treatment. Sally is determined to keep trying, the state has no guidelines, and the business side of Dr. Welby would be foolish to say no. The only constraint comes from price: at roughly $3,000 a month, Sally will eventually run out of money. If Sally is wealthy, however, or has devoted all her savings to pursue a child, “eventually” may not come for quite some time. And during that period, Dr. Welby can continue to sell multiple rounds of a product that probably won’t work.

Now consider what happens next. Sally despairs of hormone treatment and asks Dr. Welby for more aggressive treatment. She wants to try IVF, or its even higher-technology sibling, ICSI (intracytoplasmic sperm injection). Dr. Welby again faces a dilemma. Commercially, he has every interest in encouraging Sally to proceed: depending on where he is located, Dr. Welby charges between $6,000 and $14,000 for each round of in vitro fertilization, and most women undergo an average of three cycles before either conceiving or giving up. [53] Financially, therefore, IVF is a great boon to Dr. Welby. Indeed it is IVF that provides infertility centers with the bulk of their profits. Most centers, according to industry experts, try to perform between three hundred and four hundred cycles of IVF per year just to break even (see table 2-1). [54] The revenues from these cycles cover the centers’ fixed costs: nurses, laboratories, counselors, office rent. After that point, revenue from additional cycles translates almost directly into profits. And at $6,000—or $14,000—a cycle, the profits for the largest clinics can be considerable.

Whenever Dr. Welby dons his marketing hat, therefore, he faces a statistical and moral conundrum. On the one hand, he dearly wants to convince Sally that the likelihood of success in her case is high. He wants her to believe that his practice is particularly good at producing babies and that IVF is a particularly attractive path for her to pursue. All these arguments are easy to make, because most women in Sally’s position desperately want to believe that fertility treatments will cure their condition. In fact, they tend to overestimate their chances of conception by an extremely wide margin. [55] So Dr. Welby will not have a hard time convincing Sally about the benefits of treatment. Moreover, his own preferred method of treatment—IVF—is indeed increasingly successful: on average, in vitro fertilization results in a live birth more than 25 percent of the time. [56] And so again, what makes financial sense for Dr. Welby will also strike a happy chord with Sally.