Pregnancies and deliveries per fresh cycle are no longer adequate indicators of in vitro fertilization program quality: How should registries adapt?

摘要

As president of the Society for Assisted Reproductive Technology (SART), I initiated the first clinic-specific reporting of success rates, responding to federal legislation requiring that patients have access to actual reported outcomes to aid their choice of provider. In vitro fertilization (IVF) programs promptly realized that their patient volume would be influenced by their success rates relative to their competitors. Initially, low implantation rates required transfer of multiple embryos to achieve a reasonable rate of success. However, as laboratory and clinical techniques improved, a high rate of multiple pregnancies rapidly became IVF's most serious complication. Besides patients' perceptions that multiples are a positive outcome and because most often the costs of multiples are borne by medical insurance whereas the costs of IVF treatment are shouldered by the infertile couple, competition among programs has been a major obstacle to reducing the number of embryos transferred.