A Retrospective Comparison of the Impact of Industry Payments on Assisted Reproductive Technology (ART) Practice and Outcomes

Abstract

To determine if industry payments to physicians are associated with a difference in ART practices and outcomes. Retrospective Cohort SETTING: ART centers in the United States SUBJECTS: ART centers EXPOSURES: Industry payments reported to Open Payments 2020 database MAIN OUTCOME MEASURES: Live birth rate, frozen embryo transfer (FET) rate, intracytoplasmic sperm injection (ICSI) rate, preimplantation genetic testing (PGT) rate and percentage of patients >40 years of age were obtained from Center for Disease Control 2020 database. Linear regression analysis was performed comparing the percentage of physicians per center receiving industry payments to clinic-level outcomes. A total of 873 REI physicians received payments in the 2020 database. At least one physician received a payment in 80.5% (437/543) of IVF centers. 873/1724 REI physicians (50.6%) received at least one payment in 2020. Live birth rate, ICSI rate, FET rate, PGT rate and percentage of patients >40 years of age did not significantly differ between centers by percentage of physicians receiving industry payments. However, in sub-analysis of 99 large centers (defined as 5 physicians or more), each percentage increase of physicians receiving industry payments was associated with a 0.20% (CI 0.02-0.39, p = 0.03) PGT rate increase and a 0.14% (CI 0.05-0.24, p <0.001) FET rate increase. Live birth rate, ICSI rate, and percentage of patients >40 were not associated with increased industry payment rates to physicians. Industry payments were not associated with differences in IVF center outcomes overall. However, large centers with more physicians receiving industry payments may be more likely to utilize additional procedures such as PGT and FET, without improvement in final outcomes such as live birth rate. Further research is needed to determine whether these differences reflect the industry payment influence versus individual center/provider practice habits in larger practices.