The public health implications of assisted reproductive technologies

OBJECTIVE

The public health implications of Assisted Reproductive Technologies (ART) are largely unknown by researchers and policy makers alike. Outcomes need to be considered, not just as clinical issues, but in terms of effect on public health.

METHODS

Using a qualitative key informant process involving interviews with selected professionals and a review of the medical literature, eight general themes of public health issues associated with ART were identified, and are discussed.

RECOMMENDATIONS

Short and long-term health outcomes of women undergoing ART procedures, and of their offspring, need to be considered, as do the epidemiological risks associated with donated gametes and the effect on health services of multiple and preterm births, both produced in higher rates by ART. A national surveillance system and greater inter-jurisdictional communication are important strategies for addressing these evolving concerns.

A comparison of methods for measuring socio-economic status by occupation or postal area

Seven methods of estimating socio-economic status (SES) were compared, including four based on data specific to individuals (Blishen, Pineo-Porter, British Registrar General, Hollingshead) and three based on the average characteristics of the postal code area in which people live (income alone, education alone, income and education combined). Data from the files of 151 patients undergoing in vitro fertilization were used. The four individual scales were highly correlated among themselves (Spearman's correlation coefficient between 0.6 and 0.9) but only moderately correlated with the measures based on postal code (Spearman's correlation coefficient between 0.2 and 0.3).

IVF births and pregnancies: an exploration of two methods of assessment using life-table analysis

PURPOSE

Our purpose was to explore two methods of expressing the performance of IVF programs.

METHODS

Using life-table methods, hazard and cure rates and a "monthly fecundability rate" were calculated for an Ontario IVF clinic. The rates were evaluated for their meaningfulness as indicators of the clinic's performance.

RESULTS AND CONCLUSIONS

While the hazard rate describes monthly fertility among those who will eventually become pregnant, the fecundability rate describes fertility for all patients who enter the program, making it the more appropriate index for program comparisons. However, from a prospective patient's perspective, both methods are valid indices for summarizing a program's performance.

Toward a more meaningful in vitro fertilization success rate

PURPOSE

The objective was to explore the variability in in vitro fertilization (IVF) success rates.

METHODS

Published success rates from IVF clinics in North America were investigated to establish types of biases and potential inaccuracies.

RESULTS

Success rates reported by IVF clinics vary with regard to the indices and patient populations used to compute them. Selection bias and misunderstood statistics are major factors contributing to the inappropriateness of certain rates.

CONCLUSIONS

The influence of privatization and market forces also may contribute to the need to oversimplify IVF statistics.