The Truth Is Undefeated: A hard look at "questionable techniques" and the current state of fertility marketing

By Griffin Jones

You can tell I'm still relatively new to the fertility space. I don't appear in the top ten Google search results for "fertility marketing". I'm working on that, that's what brought me to check. I was both encouraged and discouraged by something else that did come up, however.

On the first page of Google search results for the term, "fertility marketing".

On the first page of Google search results for the term, "fertility marketing".

It's unfortunate for the field of reproductive medicine when our top search results for marketing include, "Many Fertility Clinics Use Questionable Marketing Techniques Online", a Jezebel reiteration of a Huffington Post article from three years ago. I would normally argue that we should avoid questionable marketing techniques by using only real patient testimonials and images. But authentic content does not fully address the issue of transparency in fertility marketing . The fundamental problem is that fertility clinics serve two different populations who sometimes overlap and who are sometimes at odds. Until we equally recognize both groups and the value of their experiences, I'm afraid we'll continue to have more problems. 

Flowers over figures

Both articles are sensational summaries of a report called Selling Art: An Empirical Assessment of Advertising on Fertility Clinics' Websites by Jim Hawkins, of the University of Houston Law Center. The report suggests that the content on fertility centers' websites may be misleading--using pictures of smiling babies and the words, "miracle" and "dream". The report offers criticism that these images and words may influence a prospective patient's decision instead of focusing on the Society for Advanced Reproductive Technology's (SART) published data on success rates. Such advertising may suggest that a pregnancy after IVF treatment is a certainty, when we know that in some cases, it's not even likely. 

It does seem that people sometimes feel misled. In a small survey I finished in April of 2015, patients told me that confusion about success rates was one of their greatest pain-points in selecting their fertility clinic. We also read in negative fertility doctor reviews that people sometimes feel rushed into IVF treatment. I recently spoke to a couple at Resolve's Night of Hope who felt the same way. It is certainly the case that some people feel that IVF is being sold to them. 

So why do I also find it encouraging that highly authoritative links to this report ranked so highly in the search results for "fertility marketing"? For the same reason I am building a company that will also rank among those results. I believe in a marketing strategy built on support and transparency. The report suggests that fertility clinic marketing should be more thoroughly regulated because of these questionable marketing tactics. My largest problem with that notion is that it shares a faulty belief with the lousy marketers that implement those tactics: obscurity works. Indeed, not being fully transparent may work in the short term. Some people clearly feel that they were persuaded with unrealistic expectations to pay for expensive IVF cycles. This strategy may have been tenable twenty years ago. Today's data, however, proves that people increasingly make decisions based on what they read in online reviews from their peers

You can run but you can't hide 

Fertility centers need to properly manage new patient expectations or their online ratings will suffer. Social proof in the form of online reviews should be the cornerstone of every good fertility clinic's marketing efforts. If any prospective patients or patient advocates read this post, I implore you to check the reviews of a provider before you decide on them. Investigate both the fertility practice and the reproductive endocrinologist (RE) on Yelp, Health Grades, Vitals, ZocDoc, RateMDs, Google reviews, or whichever of those are the most used in your area. Don't look at the star rating alone, but pay attention to the comments. If there are enough reviews, you will be able to get an idea of the culture of the practice or physician you are considering.

I don't know if fertility practices should be required to post their success rates, but I certainly think that they should post them. Patients are looking for that information and if they don't find it from you, it will be from a site like fertilitysuccessrates.com or from one of your competitors. Clinics should be transparent with success rate info and create content explaining the complex data to patients. 

Patients will find your success rates from one website or another. Fertilitysuccessrates.com

Patients will find your success rates from one website or another. Fertilitysuccessrates.com

Miracles happen and dreams are real 

I disagree that it would be appropriate to remove baby pictures and words like "dream" and "miracle" from your site.Those words belong to the patients themselves. If you look at the Facebook pages of nearly any fertility clinic in America, there is almost certainly a photo post from a happy patient that includes the word, "miracle". That child truly is a miracle for the parents that ventured that hard, lonely journey for so long. Their fertility specialist and their practice helped bring that miracle into existence. And for those couples and individuals that are struggling with infertility, it is their dream to have a baby of their own, a dream stronger than any other. We should speak to people in the language that they use, especially when it's based on results you've achieved. Your practice exists because people vividly dream of a miracle. Ideally, we should use baby pictures from actual patients. I think it's time to get the HIPAA release forms ready. The authentic account of someone who has actually realized their dream  is critical motivation for people under enormous emotional stress who are making a complicated medical decision. Sadly, however, we know that dream will not come true, in that form, for many people. So we must recognize the value of two communities rooted in the journey of infertility.

The word miracle belongs to the infertility community.

The word miracle belongs to the infertility community.

Serving two communities at the same time

I will oversimplify the infertility community for the sake of fundamentally understanding our responsibilities to them. As I see it, the infertility community is one population of people that becomes two. There are those who have ended their journey by achieving their dream of a biological child. In parallel, there are those who are still very much on their journey who may never realize that version of their dream. I hope this is the beginning of a much longer dialogue, because not recognizing the significance of both groups' feelings leads to many problems. We often hear complaints from patients without children when little ones are in the waiting room. Yet, we hear grievances from patients with children when they are asked not to have their child in the sitting area. For one group, Facebook and Instagram are places to celebrate their triumph over the darkest period of their lives. For the other group, they are in the midst of darkness and every pregnancy announcement on Facebook and every baby photo on Instagram is excruciatingly painful . Both communities have an inalienable right to the way they feel. These two communities overlap and we serve both of them. Because we're serving two communities, we have to be able to offer them a variety of benefits or some will never get value from their experience with us. I think fertility centers need to consider themselves agents of help beyond clinical treatment. Both groups need access to support; a peer support group member should never have to find out about her support group on her own. To better serve both populations, we need to

  • Send patients home with information on support groups in their area. RESOLVE facilitates infertility patient support groups in most mid-size to large U.S. metro areas and Fertility Matters is their peer in Canada. These are only two examples of support networks. There are patient advocacy groups and countless independent support groups throughout North America. I believe it's our responsibility to promote support groups when they ask for our help in distributing their information.
  • Empower people on social media. Whether it's on your fertility practice's Facebook page, or in a private forum, people coping with infertility use social media to connect with people who know their struggle. Promote RESOLVE Fertility Matters, and other groups online and share their groups if they ask you to. We don't not need to participate in these support forums (it may be better if we don't), but simply connect the people who are interested in them.
  • Give patients a list of popular infertility blogs and infertility podcasts so that they can interact with people who share their experience. 

Can you grow your practice by reconciling your results as a "miracle worker" with empirical expectation setting? I am building a business with my vote of confidence that it's the best way to do so.

Setting up for success

There are real life examples of the virtuous cycle I propose--attract new patients with the experience of delighted former patients, offer support and other resources, temper with very realistic expectations, and repeat. Dr. Ilan Tur-Kaspa is one of the highest rated REs in the Chicagoland area. I spoke with him about his approach. Dr. Tur-Kaspa says that the number of new patients that tell him they chose him because of his online ratings has increased. He credits a strong emphasis on properly managing expectations with the patient before treatment. "We talk a lot about the difference between disappointment and surprise," Tur-Kaspa says. "Whatever the probability of success is, it is important to communicate that in the terms of the probability of failure. i.e. if there is a 30% chance of success, we should communicate that there is a 70% chance that it won't work. The patient should preferably  acknowledge the odds of failure. Wait until they say 'I understand'".

When a patient looks at your online reviews on a site like ratemds (pictured), they are one click away from every other RE in your city. We want your reviews to be the best they can be.

When a patient looks at your online reviews on a site like ratemds (pictured), they are one click away from every other RE in your city. We want your reviews to be the best they can be.

I'm not a physician, so I certainly can't advise physicians on how to speak to their patients. Nor do I want to offer an incomplete solution, because I see that positivity is hugely important.  I'm simply a marketer who sees the impact that clear expectations have on the public image of the practice. Some marketers may ignore expectation setting for the sake of scheduling more IVF cycles in the short term. A good marketer will use the patient delight that comes from proper education as the pillar of their marketing strategy. For highly rated REs and fertility clinics, those reviews belong front and center on your website. A window to Yelp and Facebook  provide a balance to the testimonials that you've selected . It's okay for patients to see the occasional one-star review. Not every one will be satisfied 100% of the time. I believe that when we publicly acknowledge that, we begin to ensure that people are satisfied as much as possible.

The truth is undefeated (eventually)

We don't have to use "questionable marketing tactics" because they won't grow our practices over the long term. For those that embrace transparency and connection to support, market share will grow and marketing will be more effective and less expensive. We have to provide the best possible patient experience in order to build public social proof. That social proof, tempered with clear expectations and information, is the best way to attract new patients. In order to preserve this virtuous cycle, delighted patients bringing in more patients, we have to recognize the dynamics of both populations in the infertility community, and the equal worth of their experiences.