60 - Understanding Factors That Influence the Assessment of Outcomes in Assisted Reproductive Technologies

Summary

INTRODUCTION

Therapeutic intervention to alleviate infertility has steadily evolved since the initial success of in vitro fertilization in the late 1970s. The path to a desired outcome for many remains long, daunting, and uncertain. From the outset of assisted reproductive technologies (ART) applications, clinicians and patients held mutual desire for meaningful expression of its outcomes. The approaches to identifying such data have been diverse, controversial, at times contentious, and, as yet, continuously changing. Professional societies and government regulatory agencies have focused on deciphering parameters and collection of statistics that were substantive to clinicians and yet did not fail or mislead when viewed by the patient consumer. This effort has been in place in the United States and many other countries for a fair length of time. Recent legislation demanding compliance with and contribution to a national database has made reporting mandatory for ART clinics and laboratories within the United States. Debate exists as to whether adherence to a unified system has yielded recognizable improvements in the scientific or public understanding of ART outcomes. The following critical review may lead to the recognition that current methods of ART outcomes reporting and analysis offer no more certainty to clinicians than to the public for whose benefit the government-mandated reporting was imposed.

Despite disclaimers against the utility of direct comparison between practice-reported success rates, inherent and unavoidable human behavior, for both clinician and consumer, has created a very public and competitive environment. Has this improved patient care or impaired it?