IVF practitioners, and consumers have little reason to feel confident about the validity and reliability of SART published ART outcome statistics and here is how I reach this conclusion: About 30 years ago, I was a member of a steering committee charged by the American Fertility Society to form the “IVF Special Interest Group”, whose mission it was to make reliable IVF outcome statistics available to American consumers. The name, “IVF Special Interest Group” soon morphed into “The Society for Assisted Reproductive Technology (SART)”. Soon after its founding, SART committed to publishing annual IVF outcome statistics on its Website and has done so ever since. Soon numerous complaints of SART reports lacking accountability and not being validated through audit, began to surface. Unfortunately, in spite of feeble attempts to address this concern the problem escalated. Aside from lack of compliance, cost as well as other issues led to SART losing interest and about 15 years ago, in completely abandoning its stated quest to generate verifiable IVF outcome statistics. So it was that I, about 12 years ago , in protest, decided to resign my SART membership To this day, SART still reports, unaudited (with very few onsite reviews), self-generated, non-validated/unverified annual IVF outcome statistics and posts this on its website. While most physicians/clinics provide their data as honestly as they can, lack of oversight on the part of SART, in my opinion, leaves the door open to abuse which in turn prompts similar behavior by others in an effort to remain competitive. But a lack reliability of SART, IVF outcome statistics, albeit the main problem, is by no means the only one. In its current form, SART reports, categorize IVF cases on the basis of the woman’s age and the type of ART procedure performed. This fails to adequately differentiate between “easy” and “more difficult” cases, thereby rendering any comparison of success rates a matter of comparing “apples with oranges”. To make matters worse, such results are published 2 years after the fact. It is also common knowledge that in an attempt to report the highest possible success rates so as to be competitive, some IVF programs, deliberately either decline treating very difficult cases, or avoid reporting such cases categorizing them under the heading of “research”. Another serious blow delivered to SART reporting came with the introduction and rapid proliferation of preimplantation Genetic Testing (PGT) of embryos in preparation for frozen embryo transfer (FET). PGT has further complicated the expression of IVF outcome statistics. Consider the fact that SART currently expresses IVF outcome as pregnancy or birth rate per IVF cycle initiated. This means that patients undergoing IVF with PGT, (which of necessity requires deferring the transfer of tested embryo to another cycle) will of necessity be compromised because the initial cycle (which ended with an egg retrieval- ER) would be counted as a “failed cycle”. Thus PGT- selection of embryos for subsequent FET, negatively biases results reported by SART. At the same time, it makes a mockery of expressing IVF outcome in terms of the age of the egg provider. As such, SART reporting disincentivizes IVF doctors from doing what is in the best interest of their patients. The effect is that many patients who because of advancing age or diminished ovarian reserve (DOR) produce less “competent” eggs and who require PGT with embryo banking/stockpiling for future use are prejudiced in the process. I therefore submit that the original name “IVF Special Interest Group” is more fitting than SART.
Fertility Topics Explained from the Experts at SFS