THE PROGRESSIVE CORPORATIZATION OF INFERTILITY—with a Side Note about SO-CALLED “EXPERTS”
We noted before in these pages that The New England Journal of Medicine initiated a series of articles on the corporatization of medicine. Today, we here comment on one of those articles that appeared in the September 4, 2025, issue of The Journal,1 and the reason for our choice was not that we particularly liked the article; really, it was one of the weakest in the series.
So, why then the attention?
The answer is that sometimes bad information can be more informative and more interesting than good information and that—we feel—was for three reasons the case here: (i) Because, in addressing corporatization in medicine, it of course addresses an in principle important issue for the infertility field; (ii) The authors—in contrast to the other articles in the series—specifically cite IVF practice in their article; and (iii) as “experts” in economics (they list as their academic home the National Bureau of Economic Research at Harvard University in Cambridge, MA), they demonstrate—once again an issue—repeatedly discussed a subject we love to address, how dangerous “expert” opinions can be when “experts” go with their opinions beyond their own areas of expertise.
So here is what this is all about: The authors in their paper made the likely correct argument that when quality (of a product) is difficult to assess, market power is sizable, and patients are vulnerable, corporatization carries the risk of increasing prices and/or reductions in quality of care. And they then list three examples in support of this statement, including in vitro fertilization (IVF).
Interestingly, they then, however, noted regarding IVF that, “corporate ownership has had positive effects,” referencing the statement with one publication2 and ignoring many other publications in various medical fields, including infertility, which—practically uniformly—have demonstrated the opposite, increasing costs and declining quality. To demonstrate the absurdity of their statement based on this reference, the BOX below reprints the abstract of this reference.
Acquisitions by corporate entities have fueled the growth of chain organizations in healthcare. A chain is a multiunit firm under the same ownership and management, providing similar services in different locations. Chain ownership has been credited with boosting firm performance in the retail and service sectors but has been criticized for prioritizing profits over the well-being of patients in the healthcare sector. This paper finds that chain ownership improves healthcare outcomes in the market for In Vitro Fertilization (IVF). Using novel data on U.S. fertility clinics and difference-in-differences methods, we find that IVF cycles increase by 27.2%, and IVF success rates increase by 13.6% after acquisition by a fertility chain. We provide evidence that fertility chains facilitate resource and knowledge transfers needed to enhance quality and expand the IVF market. For example, acquired clinics change IVF processes and procedures to achieve the IVF gold standard of simultaneously reducing higher-risk multiple births and increasing singleton births. We discuss how the fertility sector’s relatively minimal market frictions and information asymmetries may incentivize chain owners to invest in quality.
Chain clinics in the U.S. already control over half of all U.S. IVF cycles. That fresh U.S. IVF live birth rates since 2010 have, parallel to expansions of chain clinics, been steadily declining,3 is, of course, not very supportive of the claim that chain clinics have positively affected IVF outcomes. The truth is, indeed, exactly the opposite: national IVF pregnancy and live birth rates have been declining in parallel to increasing additions of individual clinics by chain operators. That IVF success rates increased by 13.6% in clinics that were acquired by a fertility chain is, therefore, not credible and is also not compatible with what we hear from the field (the latter obviously not being hard data).
How little the two authors of this New England Journal article apparently knew about infertility and especially IVF is also demonstrable by their second—maybe even more inaccurate—conclusion that measuring quality of IVF clinics was “straightforward.”
Nothing is, of course, further from the truth!
This sentence alone, indeed, demonstrates the rather surprising level of ignorance of the two authors when it comes to IVF because we really do not have any method available to compare the quality of IVF practice between individual clinics. And the reason is not only obvious for everybody with even minimal statistical knowledge, but is clearly pointed out in both national annual reports published in the U.S. about IVF by CDC and ASRM/SART (with 2-3 years delay): The reported data are cumulative and, therefore, do not allow for outcome comparisons between individual clinics because individual clinics often serve very different patient populations.
Here is only one example: Median age of patients for all U.S. clinics has been for almost a decade 36 years; yet at the CHR, the median age of IVF patients between 2022 and 2024 was 43, 44, and 45 years, respectively. Pregnancy and live birth expectations, however, of course, decline with advancing age. To compare outcomes in a clinic with a median patient age of 36 years to a clinic with a median patient age of 45 years without appropriate statistical age adjustments for every patient is completely nonsensical. And that the peer review process at the New England Journal of Medicine did not pick up this point is rather disappointing!
CDC, as well as ASRM/SART, in their respective reports, therefore, in clear language point out that these reports should not be used for comparison between IVF clinics, and this is, of course, exactly what these two economic “experts” apparently did. Comparing clinic quality based on IVF cycle outcomes as reported by CDC and/or ASRM/SART registries, therefore, is anything but “straightforward;” it is impossible!
And shouldn’t economists be fully aware of these facts?
Of course, they should! But this example once again demonstrates what has been a subject of repeated communications from the CHR: “expert” opinions must always be treated with a healthy degree of skepticism; but caution is especially warranted when “experts” comment on things outside of their usually very limited field of expertise.
A little more on “experts” in general
And since we are already talking about “experts,” here is another story documenting the at times truly abusive effects of so-called “experts” on society, though this time in the political arena. One of our favorite news sources, The FREE PRESS, recently published a rare (anonymous) editorial under the title, “Another Reason Not to Trust the “Experts.”4 It had nothing to do with medicine, but the limitations of “experts” are—as behavioral scientists have written about forever—universal and apply to all areas of human existence. We, therefore, could not help ourselves and, considering our obvious obsession with this subject, had to bring attention to this article.
It started with the following all-telling sentence: “One of the great lessons of the past decade is that when you read a variation of ‘experts say’ in a headline, you ought to think twice and for yourself.” And—though we in general don’t like generalizations—how correct and all-encompassing this statement is in today’s increasingly complex world (despite or, maybe, because of AI) is not only demonstrated by the circumstance that made the editors of The FREE PRESS write this editorial, but also by innumerable examples in medicine in general and—as already noted above with an example—including the infertility field.
A political event initiated the FREE PRESS article, the International Association of Genocide Scholars (IAGS) having voted on a resolution accusing Israel of committing genocide in its war against Hamas. What makes this story so interesting and telling is the fact that—as The FREE PRESS noted—the whole story turned out to be “a sham, from top to bottom.” And to give credit where credit is due, it was not only The FREE PRESS that noted. As a sign of how easy this sham was to detect (and, therefore, should have been obvious for major organizations, like the Washington Post, The Guardian, and the BBC), several other news organizations also picked up on it.
And here is why it was so easy to figure out: Though the IAGS per the IAGS’ president claims that its membership mainly is made up “of people who are academics and scholarly experts in different communities within the field of genocide prevention, education, and punishment,” a board member of Honest Reporting5 and contributor to the NGO Monitor6 discovered that basically anybody could become a member of the Association, as long as they donated $30 in membership fees.
He furthermore discovered that the organization had a total of approximately 500 members, of which 80 were based in Iraq (obviously, a country with extremely “balanced” views about Middle East conflicts). But his most interesting discovery was that out of the organization’s headcount of 500, only 129 members voted on the resolution (how many among them from Iraq is as of this point unclear).
But that is not even the end of the story. As The FREE PRESS Editorial also noted, a very prominent member of the IAGS and famous author of a book on genocide in Rwanda (i.e., apparently a real “expert” on genocide) claimed in a post on X that the leadership of the IAGS prevented members from filing critical comments on the resolution prior to the vote. Moreover, the president of the IAGS cancelled a promised town hall before the election and refused to disclose who wrote the resolution. One, therefore, of course must wonder whether the whole sham may not have been the personal endeavor of only one person, i.e., the personal sham of only one alleged “expert”!
Like this obviously political example discredits “expertism” within international politics, the same issues also apply to other areas of human endeavors, including science and, of course, reproductive medicine. And to reemphasize this point, here is just one example that has greatly affected infertility practice. Founded in 2002 in Chicago, the Preimplantation Genetic Diagnosis International Society (PGSIS) sprang to live in the early days of embryo testing,7 when the testing of embryos for chromosomal abnormalities was still called preimplantation genetic diagnosis (PGD); in 2016, it changed to preimplantation genetic testing for aneuploidy (PGT-A).
Founded by a small group of individuals, practically all making a living from offering PGD, this new society, seeing itself as the “expert” society for PGD, within a few years, decided to start publishing formal practice guidelines regarding the utilization of PGD (and later PGT-A) in association with in vitro fertilization (IVF). In other words, the PGDIS, despite the very obvious economic conflicts of its leadership and most of its membership, established itself as jury, judge, and executioner for PGD/PGT-A in IVF.
And to make things even worse, the American Society for Reproductive Medicine (ASRM) and its daughter society, the Society for Assisted Reproductive Technology (SART), accepted this fact, as documented by citing in formal ASRM/SART guidelines PGDIS opinions as authoritative sources. All of this happened despite the fact that—as repeatedly demonstrated by the CHR—PGDIS guidelines were lacking even the most basic criteria medical science expects from medical guidelines, like method of data selection and even references.8,9 But what produced the conceptual association with above above-noted FREE PRESS editorial was the fact that those PGDIS guidelines also lacked authors. In other words, the “experts” who have been influencing PGD/PGT-A practice in IVF to this day have remained anonymous.
Just as the headline of the FREE PRESS editorial suggested, another reason not to trust the “experts,” just in this case, in IVF practice!
References
Chandra A, Shepard M. N Engl J Med 2025;393(9):833-835
La Forgia A. SSRN. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4428107 and Manager Sci 2024;71:5022-5044
Gleicher et al., Hum Reprod Open 2019;(3);hoz017
Editorial. The Free Press. September 4, 2025.
https://ngo-monitor.org/
https://pgdis.org/
Gleicher et al., Reprod Biol Endocrinol 2020;18:57
Gleicher et al., Reprod Biol Endocrinol 2021; 19:23