IVF: Putting Our House in Order

Public trust is the single greatest factor that has allowed the miracles of medicine to evolve. The public has allowed the medical community a great deal of latitude to decide where to go and how to get there. It is unfortunate that we have not in all cases returned that respect with an equal degree of explanation and understanding by addressing the fears and concerns of the public in general. Even within our industry, we are not of a single mind as to the appropriate course or the end?point in decision?making with regard to the ethics of in vitro fertilization therapy and research.

How should the IVF medical community respond to that public trust? I believe the first step should be to make IVF more accessible to all consumers. This can be achieved by:
1) cooperatively working to improve standards of care such that ultimately, consumers can expect about the same chance of having a baby regardless of the IVF program they choose.
2) willingly providing consumers with access to reliable and understandable data regarding IVF outcome statistics.
3) working with consumers, health insurance companies and legislators to make IVF more affordable.

A proactive approach on the part of the medical community toward compiling and disseminating IVF information would go a long way toward educating members of the media, who all too often misunderstand and consequently misrepresent what IVF is all about. We are faced with too many contentious newspaper editorials and oversimplified TV reports that paint an inaccurate and sometimes alarmist picture about the success of IVF. Reversing the harmful trend of bad press by being openly accountable is one giant step that could be undertaken immediately.

Standards must be established for all IVF programs in the United States, and consumers must have easy access to understandable data about success rates. Consumers deserve to have similar outcomes from every IVF program in the United States. Presently, a patient seeking IVF might have more than double the chance of having a baby through one program versus another. To make matters worse, such a patient would presently have no reliable way of knowing which program was the better one to go to. This (as explained elsewhere on this blog), is because IVF outcome statistics published annually by the Centers for Disease Control (CDC) and the Society for Assisted Reproductive Technology (SART) are currently reported through an unaudited/non-validated process and are thus of questionable reliability. It is not right that patients/couples should pay such huge amounts when they don't know what their prospect of success will be.

One way in which IVF programs can meet minimum standards is by learning from and replicating the performance of proven programs. The general factors that contribute to a successful IVF program can be viewed as a triangle, with each side of the triangle representing a crucial ingredient: (1) technical expertise, (2) proven, standardized clinical and laboratory protocols and techniques, and (3) rigid quality assurance. Commitment, teamwork, and determination comprise the “glue” that holds the walls of the triangle together
Ultimately, consumers can control the debate. They may have to band together to make their voices heard against the forces of the marketplace, but they can bring about change. Now is the time for IVF consumers to be outspoken. If they don't participate in the campaign to put the IVF house in order, they have only themselves to blame if progress comes slowly. One of the most promising lobbying avenues would be to join an infertility support group such as the International Council on Infertility Information Dissemination (INCIID) (http://www.inciid.org/ ) both to become more informed and to speak with a louder voice before the medical profession, legislative groups, and the insurance industry.

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