Dreaming up fertility treatment coverage and musing on simple and meaningful assisted reproductive technology metrics: the global assisted reproductive technology report by the International Committee for Monitoring Assisted Reproductive Technologies

Reflections

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VOLUME 116, ISSUE 3, P662-663

Authors:

Paul Pirtea, M.D., Dominique de Ziegler, M.D., James P. Toner, M.D.

Abstract:

Reflections on "International Committee for Monitoring Assisted Reproductive Technologies (ICMART): world report on assisted reproductive technologies, 2013" by Banker et al.

Read the full text here. 

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 

Comments

Go to the profile of Manish Banker
12 days ago

We appreciate the opportunity to respond to the editorial by P. Pirtea, D. de Zegler and J. P. Toner that comments on our latest ICMART publication and broaches numerous issues related to human fecundity, ART practice, standardized reporting of ART outcomes, and claims related to individual registry superiority/ There is a resultant recommendation of closer collaboration between ICMART and SART with the view of adapting or replacing ICMART data collection forms with SART’s data collection and reporting system, and for its global adoption. While we agree with some of the authors’ reflections, we would like to offer some clarifications and our experience over many decades in collating global ART data, and how much this differs from regulated collection of national data.

The main reason that ART registries were established throughout the world was to monitor the effectiveness and safety of ART treatment, variations in practice, and availability and utilization. Registries are not intended to report on the limitations of every form of reproduction, especially ART, in achieving an illusionary 100% success rate. Indeed, we would argue that the goal of ART is not to reach 100% success rates (unless we wish to eliminate all natural restrictions inherent in human reproduction) but to give those suffering from infertility an improved chance of having a child. Furthermore, concerning disclosure of center-specific success rates, only a small number of countries report individual clinic success rates and – in contrast to the objectives of regional reports and the ICMART world report - the aim of these center-based results is mostly to support consumer decision making.
 
ICMART has been collecting and reporting global data for over 3 decades. Around 70 countries participate in the collection each year – each with different resources, socio-political environments, healthcare systems and regulations covering ART collection and reporting. For this reason, ICMART collects data in a standardized and simplified format that allows all countries to participate. While, from the perspective of the data, a single collection system used by all countries may be desirable, this would impinge on the autonomy of countries and regions and on the role and responsibility of national and regional leaders to adapt global principles on ART monitoring to local contexts and needs. The latter is essential if registry data are meant to not only be informative but also transformative of rendered care. The growing emphasis on national data sovereignty, and the perception of undue external coercive influence negates the possibility of a single data collection system, at least in the foreseeable future. Also, in addition to SART, there are several sophisticated ART data collection and reporting systems well embedded throughout the world that report success rates based on linked cycles as well as other key indicators of ART care. Moreover, such reporting systems are not restricted to high-income countries; for example, REDLARA has successfully provided a cycle-based registry free of charge to Latin American countries since 2010 and assisted ANARA, representing African countries, to do the same since 2015. In countries where such systems are not feasible for a technical or data reasons, ICMART offers the ICMART Toolbox to aid registry establishment and provides assistance in the development of more sophisticated registry systems. 

ICMART is always striving to improve the efficiency and currency of its data collection and reporting. Most recently, ICMART has successfully implemented new validated data entry forms which allow data discrepancies to be corrected at the source. ICMART strongly welcomes collaboration as well as global debate on principles and standards of ART monitoring in a spirit that respects the privilege of regions and countries to be discerning of their data needs. This includes the understanding that countries and regions wish to publish their own data before ICMART does, and thus the ICMART World Reports will always be some years behind countries such as the US and UK.

Once again, we thank the authors for their reflections and suggestions on the complex task of ART data collection and reporting.

Manish Banker, MD
On behalf of ICMART