Professional Self-Regulation and Shared-Risk Programs for In Vitro Fertilization

Author:

Robertson John A.,Schneyer Theodore J.

Abstract

In vitro fertilization (IVF) is now a well-established practice in the field of assisted reproduction. In 1995, over 41,000 IVF cycles were done in the United States, at a cost of more than $300 million. The overall success rate has risen to 22.8 deliveries per 100 egg-retrieval procedures (19.6 deliveries per initiated cycle). As the field has matured, the attention of policy-makers has shifted from questions about the ethical and legal status of human embryos to concerns about providing access and protecting consumers.Three such concerns have emerged. One is the danger that IVF programs will disseminate misleading information about their success rates in order to attract patients. This problem, however, may be alleviated by the publication in late 1997 of the first of annual national and clinic specific reports, based on randomly audited data, by the Centers for Disease Control and Prevention, the American Society of Reproductive Medicine (ASRM), the Society for Assisted Reproductive Technology (SART), and RESOLVE, pursuant to the federal 1992 Fertility Clinic Success Rate and Laboratory Certification Act.

Publisher

Cambridge University Press (CUP)

Subject

Health Policy,General Medicine,Issues, ethics and legal aspects

Reference44 articles.

1. 37. Another concern occasionally voiced about shared-risk programs is the restriction placed by some programs on patient choice, if one is to qualify for risk-of-failure insurance. Some programs, for example, require that all frozen embryos from a cycle be used before the next cycle is initiated. At least one program requires that some of a patient's eggs be fertilized by intracytoplasmic sperm injection (ICSI) at the discretion of the embryologist. But it is not clear that such practices are against a patients' interest, nor that they are not freely chosen by patients rationally weighing the advantages of this type of insurance. In any event, a particular restriction, such as the use of ICSI when a patient otherwise objects, could be prohibited without prohibiting shared-risk programs. Indeed, the National Advisory Board on the Ethics of Reproduction report on shared-risk, which discusses this issue as one of four main ethical concerns raised by these programs, makes no recommendation, other than disclosure that such restrictions exist. See National Advisory Board on the Ethics of Reproduction Report, supra note 12, at 3.

2. 31. See Levy, , supra note 13.

3. 6. See 1995 Assisted Reproductive Technology Success Rates, supra note 1.

4. 10. See Wozencraft, A. , “It's a Baby, or It's Your Money Back,” New York Times, Aug. 25, 1996, at 3.

5. 32. See Pear, , supra note 4.

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