The Playing Field is Changing . . .

7 01 2014

To the Editor:

The clinical practice of assisted reproductive technology (ART) has continued to evolve rapidly. The Practice Committee of the American Society for Reproductive Medicine (ASRM) in collaboration with the Society for Assisted Reproductive Technology (SART) in October 2012 e-published a guideline indicating that the cryopreservation of oocytes should no longer be experimental (1). As a direct result, the current system of data collection for SART and the Center for Disease Control and Prevention (CDC) requires revision. Additional data collection is required to comply with the Fertility Clinic Success Rate and Certification Act (FCSRCA) of 1992 (Wyden Law).

Moreover, other trends in ART practice have been identified. The freezing of embryos following blastocyst biopsy is often necessary to allow adequate time to obtain results of genetic testing prior to embryo transfer (2). Some clinics also freeze eggs or embryos from multiple stimulations/retrievals prior to transfer as a strategy to manage low responder patients (3). Critiques of our current reporting system together with suggested changes have recently been published by SART members (4, 5). SART has been well aware of these practice trends and the inability of our current reporting system to handle them. Read the rest of this entry »

Consumer-friendly reporting of in vitro fertilization outcomes

29 10 2013

To the Editor:

Dr. David Meldrum proposes a revision of the clinic-specific Society for Assisted Reproductive Technology (SART)/Centers for Disease Control and Prevention (CDC) reporting format to better reflect the current practice of in vitro fertilization (IVF) by combining the outcomes of fresh and frozen embryo transfers in the numerator while making transfer procedure the denominator of choice (1). I concur with the first but disagree with the second part of his proposal, making transfer the preferred denominator without regard to the number of retrievals contributing embryos to the transfer. In addition to accuracy, a reporting system needs to be readily accessible to potential consumers.

With accumulation of eggs from multiple retrievals for a single transfer, this metric fails to differentiate between two distinct scenarios: A) one live birth from one transfer and one retrieval; B) one birth from one transfer following, say, four retrievals (2). Both scenarios generate 100% delivery rate per transfer, but the delivery rate per retrieval is 100% for scenario A but only 25% for scenario B. Such a reporting system would be misleading and leave patients vulnerable to exploitation by volume-driven clinics.

In the case of high responders, a single retrieval may lead to more than one live birth from sequential frozen embryo transfers (FETs), thus elevating the delivery rate per retrieval above 100% unless all births after the first one are censored—a crucial point the author does not address. Read the rest of this entry »