Title: The status of public reporting of clinical outcomes in assisted reproductive technology
Abstract: We read the article “The Status of Public Reporting of Clinical Outcomes in Assisted Reproductive Technology” by Kushnir et al. (1Kushnir VA, Vidali A, Barad DH, Gleicher N. The status of public reporting of clinical outcomes in assisted reproductive technology. Fertil Steril. Published online June 8, 2013.Google Scholar) with great interest. As stewards of the National ART Surveillance System (NASS), we are always striving to improve data collection and public reporting of clinical outcomes of assisted reproduction, as required by the Fertility Clinic Success Rates and Certification Act (FCSRCA) of 1992. The article refers to the recent but increasing trend of short-term embryo banking—cycles in which all embryos are created with the intent of cryopreservation for subsequent transfer in frozen/thawed cycle(s) in the next few months—which has followed advances in cryopreservation techniques (2Gobsen R. Cryopreservation: a cold look at technology for fertility preservation.Fertil Steril. 2011; 96: 264-268Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar). Some of the potential reasons for delaying embryo transfer include embryo accumulation from several short-term embryo-banking cycles allowing a better choice of good-quality embryos, the desire to avoid potentially negative effects of stimulation on implantation/pregnancy rates and fetal development, and a need to wait for the results of preimplantation genetic screening. In contrast, long-term embryo-banking cycles are generally used for fertility preservation for patients who are undergoing gonadotoxic medical treatments or for those who wish to delay childbearing for other reasons. Although NASS is currently unable to distinguish between short-term and long-term banking cycles, we note that the total number and percentage of embryo-banking cycles in the United States has increased dramatically during recent years (Fig. 1). Because FCSRCA requires public reporting of ART success rates, embryo-banking cycles (which by definition do not result in a clinical outcome) are not shown in the national or clinic-specific pregnancy success rate tables. However, all embryo-banking cycles fit the definition of ART and thus must be reported to the CDC. Thus, we believe that the authors incorrectly assumed that embryo-banking cycles are unreported or excluded by clinics. The outcomes of all frozen/thawed embryo transfers have been publicly reported for cycles started during or after 1995, the first year that national ART surveillance began. In addition, the reporting of embryo-banking cycles is validated annually (3Centers for Disease Control and Prevention American Society for Reproductive Medicine Society for Assisted Reproductive Technology 2010 Assisted Reproductive Technology National Summary Report. U.S. Department of Health and Human Services, Atlanta2012Google Scholar). We agree that with recent increases in embryo-banking cycles, concurrent changes in the information provided to consumers are warranted. For that reason, the 2011 ART Fertility Clinic Success Rates Report will include the number of embryo-banking cycles reported. Ideally, the outcomes of embryo-banking cycles would be reported both per cycle and per transfer, and separately for short-term and long-term embryo banking. This approach, however, would require the collection of additional information on cycle intent and/or on the linkage between embryo-banking cycles and subsequent frozen/thawed embryo transfer cycles, which often occur in different reporting years. Reporting the number of cycles using frozen/thawed embryos from previous transfer cycles and the number of short-term and long-term embryo banking cycles will inform potential ART consumers about differences in clinical practices and outcomes. Public reporting on the clinical outcomes of ART has been providing useful information for ART providers, patients, researchers, and the general public for the last 16 years (4Adashi E.Y. Wyden R. Public reporting of clinical outcomes of assisted reproductive technology programs: implications for other medical and surgical procedures.JAMA. 2011; 306: 1135-1136Crossref PubMed Scopus (37) Google Scholar). The use of NASS data has contributed to improvements in the field and has made studies such as the one by Kushnir et al. (1Kushnir VA, Vidali A, Barad DH, Gleicher N. The status of public reporting of clinical outcomes in assisted reproductive technology. Fertil Steril. Published online June 8, 2013.Google Scholar) possible. That study serves as a reminder that the reporting of ART clinical outcomes needs to keep pace with rapidly changing clinical practice. We are considering revisions to the NASS data collection to better assess new methods and technologies and to include some of the measures we have described here. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The status of public reporting of clinical outcomes in assisted reproductive technologyFertility and SterilityVol. 100Issue 3PreviewTo assess the transparency of assisted reproductive technology (ART) surveillance reports published by the Centers for Disease Control and Prevention (CDC) and by the Society for Assisted Reproductive Technologies (SART). Full-Text PDF Open AccessReporting of clinical outcomes in assisted reproductive technologyFertility and SterilityVol. 100Issue 4PreviewWe commend Kushnir et al. (1) for their detailed analysis of the publicly available Society for Assisted Reproductive Technology (SART) report in the article “The status of public reporting of clinical outcomes in assisted reproductive technology [ART].” SART continues to believe that any use of the ART report to make direct comparisons of outcomes between clinics is not valid and is inappropriate. The goal of the report is to facilitate reasonable estimation of the success rate at a given clinic. Full-Text PDF Reply of the AuthorsFertility and SterilityVol. 100Issue 4PreviewWe appreciate the constructive response to our manuscript by the leadership of the Society for Assisted Reproductive Technology (SART) but would like to add several suggestions not fully addressed in our manuscript (1). Because assisted reproductive technology (ART) outcome reports are primarily intended for the public, they should be interpretable by lay people, i.e., without statistical knowledge. This means that biases and effects on reported pregnancy rates should become apparent to the public. Full-Text PDF Reply of the AuthorsFertility and SterilityVol. 100Issue 3PreviewWe appreciate the interest of Kissin et al. (1) from the National ART Surveillance System (NASS) group at the Centers for Disease Control and Prevention (CDC) in our recent article. Our article also apparently prompted a communication from the president of the Society for Assisted Reproductive Technology (SART) to member clinics, acknowledging the issues we raised with public ART surveillance and promising to find a solution to improve transparency of future reports. Full-Text PDF Open Access