Are Australian fertility clinics selling non evidence based interventions and if so, is it an indicator of financial conflicts of interest?

Background and rationale: Adjunct services aim to improve fertility outcomes such as live birth rates. However, studies in the United Kingdom (UK) have found that adjuncts lack robust evidence for efficacy. This has raised concerns that financial interests of clinics are subordinating patient interests. Conditions where financial interests could unduly influence treatment decisions is a conflict of interest. Financial conflicts of interest may be an issue in Australia's lucrative fertility industry but with regard to adjunct services, there are no equivalent studies to show whether Australian clinics are also selling unproven interventions. The objective of this study was to determine whether Australian clinics are selling unproven interventions and if so, whether their sale could constitute a financial conflict of interest. Method: Through a content analysis of Australian fertility clinic website texts, this qualitative study examined the adjunct treatments being offered and assessed them for efficacy. Websites for accredited Australian fertility clinics (n = 91) were located. After excluding duplicates and inaccessible sites, texts from the treatment pages of each of the remaining sites (n = 41) was captured to generate data on all interventions being offered by Australian clinics (n = 73). These services were coded in Nvivo to determine which were adjunct services and to facilitate evaluation against empirical evidence. Results: This study found that most adjuncts lacked the clinical evidence for efficacy. Of the 18 adjuncts investigated, only one was robustly supported by evidence but this evidence has since been called into question. These results show that Australian clinics are indeed offering expensive adjunct interventions with limited or no therapeutic benefits to patients so the practice does raise the possibility that financial interests are asserting undue influence on patient interests.