PROFILING ASSISTED REPRODUCTIVE TECHNOLOGY - OUTCOMES AND QUALITY OF INFERTILITY MANAGEMENT

Objective: To critically appraise the content of the American Society for Reproductive Medicine (ASRM)/Society for Reproductive Technology ( SART) Registry. Design: English-language literature review. Patient(s) : Women undergoing treatment with assisted reproductive technology (AR T). Intervention(s): Current ART treatments, including NF, GIFT, zygot e intrafollopian transfer (ZIFT), oocyte micromanipulation, and cryopr eserved embryo transfers. Main Outcome Measure(s): Compliance with cli nical practice guidelines, and casemix-adjusted rates of live delivery , clinical pregnancy, ectopic pregnancy, miscarriage, birth defects, i mplantation, fertilization, and retrieval. Result(s): Outcomes should be adjusted for variation in patient characteristics known to affect p rognosis, including maternal age, the duration of infertility, the pre sumed cause(s) of infertility, the patient's prior history of treatmen t for infertility, and diethylstilbestrol exposure. Outcome rates shou ld be reported using the patient as the denominator, as well as cycle, retrieval, and transfer. The statistical significance of observed dif ferences in events rates should be indicated. Because widely accepted clinical practice guidelines related to performance of ART procedures are not available, compliance with practice guidelines cannot currentl y be assessed. Conclusion(s): Reports based on ASRM/SART Registry data can be enhanced by refined casemix adjustment, assessing outcome rate s per patient, as well as per component of ART procedure, and by provi ding an indication of the statistical significance of observed differe nces in event rates. In addition, a critical appraisal of available ev idence related to particular aspects of infertility management would h elp clarify the areas in which there is an evidentiary basis for formu lation of practice guidelines, as well as topics requiring additional clinical research. (C) 1998 by American Society for Reproductive Medic ine.