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SART and ART Reporting
Profiling assisted reproductive technology: The Society for Assisted Reproductive Technology registry and the rising costs of assisted reproductive technology
Author:J. Garcia
Address:Birmingham, Alabama
Source:Fertility and Sterility 69: 624-626 (April)1998
Summary:In a blame diffusing rebuttal to the Registry critique (last week's "Whats Up Doc?") Dr. Garcia admits that SART's original goals included collecting data on : IVF indication(s); the number of IVF cycles and IVF related procedures; ovulation induction protocol usage; effectiveness of those procedures; patient response; number of oocytes recovered and quality assessment; fertilization rate and incidence of polyspermia; embryo quality and embryonic arrests; number of embryos transferred(ET) and cryopreserved; pregnancy rate (PR) and outcome; number of implantation sacs per ET; number of multiple pregnancies; prevalence of fetal demise; and number of deliveries. The author describes these original goals as being, ³easy to describe but complex to execute² citing multiple barriers such as varying insurance coverage, different ovulation induction protocols, limited ART laboratory guidelines and the lack of follow-up on pregnancy outcome.
But with the passing of the Fertility Clinic Success Rate and Certification Act, mandating the creation of a public registry- an unfunded mandate, SART had to quickly decide on a preferred model for the registry. The result is the current and hastily designed version of the SART original goals. This unfunded mandate along with the issue of overall lack of funding is a central and recurrent theme in this editorial.
The next issue addressed in this editorial is the cost of ART and the exploitation by the insurance companies and the news media. Current IVF-cycle costs have increased to between $6,000 to 10,000 dollars, according to Dr. Garcia, and that calculating the cost of IVF as based on total cost per delivery, is misleading. He feels that costs should be calculated based on the actual costs per insured member which is, according to the author, approximately 26 cents of the total monthly premium paid by the subscriber.
The author asks that IVF costs be viewed in the light of a treatment based on life expectancy and productivity, comparing an infertility patient with a triple bypass patient. ART treatment has intangible rewards associated with it - providing for the emotional and mental well being of infertile couples. His final arguments as to the acceptance of the high costs of ART, are the categorization of ART as a protective procedure for women with regard to the diseases that are more prevalent in childless women and as a contribution to society by perpetuating the species. The author concludes by the admission that SART¹s original goals should be the current goals and could be if the federal government would support these goals with federal grants for IVF and associated ART and if ART could receive the benefit of non-biased reporting with the avoidance of sensationalism.
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