While we agree with many of the points stated by Dyer et al. in their recent commentary in RBMO (
Dyer et al., 2020
), we believe their conclusions are focused too narrowly. Limiting the indicator of access to, and utilization of, fertility treatment to assisted reproductive technology (ART) excludes information that is of key importance for subfertile couples, populations, and policymakers. Even in countries where access to ART is widespread, there are more births in subfertile couples through non-ART treatment than through ART (Stanford et al., 2016
).While ART is necessary for some couples to have a child, it is not required for many subfertile couples, and overuse of ART may potentially be harmful (
Annual Capri Workshop Group 2019
). Focusing solely on ART as a metric may unnecessarily encourage overutilization (Boltz et al., 2017
).We believe the focus on ART and its outcomes for national and international registries of fertility treatment has stunted the scientific development of non-ART treatments, including those which seek to address underlying health conditions (
Boyle et al., 2018
). There is a pressing and critical need to develop robust registries of couples treated with non-ART treatments, for the improvement of outcomes and the promotion of robust consumer choice. (Spandorfer, 2020
).The ultimate measure of access to fertility care should be determined by the proportion of those with a desire for fertility who achieve a healthy live birth, whether or not ART is required to do so (
Mascarenhas et al., 2012
). Therefore, notwithstanding methodologic challenges, registry assessments should be developed and supported for all fertility treatments, not only ART.References
- Towards a more pragmatic and wiser approach to infertility care.Hum. Reprod. 2019; 34: 1165-1172
- Fertility Treatment, Use of in Vitro Fertilization, and Time to Live Birth Based on Initial Provider Type.J. Am. Board Fam. Med. 2017; 30: 230-238
- Healthy Singleton Pregnancies From Restorative Reproductive Medicine (RRM) After Failed IVF.Front Med. (Lausanne). 2018; 5: 210
- ART utilization: an indicator of access to infertility care.Reprod. Biomed. Online. 2020; 41: 6-9
- National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys.PLoS Med. 2012; 9e1001356
- Creating a national database that is inclusive of all infertility therapies: a notion whose time has come.Fertility Steril. 2020; 113: 758
- Fertility treatments and adverse perinatal outcomes in a population-based sampling of births in Florida, Maryland, and Utah: a cross-sectional study.Brit. J. Obstet. Gynaecol. 2016; 123: 718-729
Article info
Publication history
Published online: September 11, 2020
Accepted:
September 7,
2020
Received:
July 23,
2020
Identification
Copyright
© 2020 Published by Elsevier Ltd on behalf of Reproductive Healthcare Ltd.
