Stanford, J. B., James, G., & McLindon, L. A. (2020). Is ART utilization the best indicator of access to fertility care? Reproductive Biomedicine Online, 41(6), 1157. https://doi.org/10.1016/j.rbmo.2020.09.010
Stanford JB, James G, McLindon LA. Is ART utilization the best indicator of access to fertility care? Reprod Biomed Online. 2020;41(6):1157. doi:10.1016/j.rbmo.2020.09.010
Stanford, Joseph B., et al. "Is ART utilization the best indicator of access to fertility care?" Reproductive Biomedicine Online, vol. 41, no. 6, 2020, pp. 1157.
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Letter argues ART use alone is too narrow a measure of access
This one-page letter to the editor, by three researchers, argues that counting ART use is too narrow a way to judge access to fertility care. The authors say access should be judged by healthy live births, with or without ART. The letter reports no new data.
Study at a glance, letter to the editor: Letter argues ART use alone is too narrow a measure of access. Source: Stanford JB et al., 2020, PMID 33191132.
Key Findings
The authors say an ART-only indicator leaves out information that matters to couples who have trouble getting pregnant, to populations, and to policymakers.
They cite an earlier population-based study: where ART is widely available, more births to couples with reduced fertility follow non-ART treatment than ART.
The letter states that ART is not required for many couples with reduced fertility, and that overuse of ART may potentially be harmful.
The authors believe the registry focus on ART has stunted development of non-ART treatments, including those that address underlying health conditions.
They call for registries covering every kind of fertility treatment, while acknowledging methodologic challenges.
Interpretation
The letter is an expert opinion piece replying to a recent RBMO commentary that proposed ART utilization as the access indicator. The letter presents no new data and no analysis. Its main empirical claim rests on a cited population-based study of births in Florida, Maryland, and Utah (named in the reference list). The letter gives no figures from that study. The authors advocate registries for all fertility treatments. The letter does not describe how outcomes would be defined or compared across treatments.
RRM Context
ART bypasses the reproductive problem and leaves open why conception fails. Registries built around ART counts capture little of the care that addresses underlying causes, including restorative reproductive medicine. In support of that point the letter cites a 2018 Frontiers in Medicine paper on healthy singleton pregnancies from restorative reproductive medicine after failed IVF. A live-birth measure also counts couples who did not need ART.
Our editorial summary of this paper, not the article's abstract.
Abstract
While we agree with many of the points stated by Dyer et al. in their recent commentary inRBMO(Dyer et al., 2020), we believe their conclusions are focused too narrowly. Limiting the indicator of access to, and utilization of, fertility treatment to assisted reproductive technology (ART) excludes information that is of key importance for subfertile couples, populations, and policymakers. Even in countries where access to ART is widespread, there are more births in subfertile couples through non-ART treatment than through ART (Stanford et al., 2016). While ART is necessary for some couples to have a child, it is not required for many subfertile couples, and overuse of ART may potentially be harmful (Annual Capri Workshop Group 2019). Focusing solely on ART as a metric may unnecessarily encourage overutilization (Boltz et al., 2017). We believe the focus on ART and its outcomes for national and international registries of fertility treatment has stunted the scientific development of non-ART treatments, including those which seek to address underlying health conditions (Boyle et al., 2018). There is a pressing and critical need to develop robust registries of couples treated with non-ART treatments, for the improvement of outcomes and the promotion of robust consumer choice. (Spandorfer, 2020). The ultimate measure of access to fertility care should be determined by the proportion of those with a desire for fertility who achieve a healthy live birth, whether or not ART is required to do so (Mascarenhas et al., 2012). Therefore, notwithstanding methodologic challenges, registry assessments should be developed and supported for all fertility treatments, not only ART.
