Can we modify assisted reproductive technology practice to broaden reproductive care access

Capsule:
Access to care may be enhanced by modifying standard assisted reproductive technology practice to make fertility treatment cheaper, simpler, and better tolerated by patients.

Authors:
Richard J. Paulson, M.D., Bart C.J.M. Fauser, M.D., Ph.D., Lan T.N. Vuong, M.D., Kevin Doody, M.D., H.C.L.D.

Volume 105, Issue 5, Pages 1138-1143

Abstract:

One of the barriers to access to fertility care is the relative complexity of fertility treatments. If these can be simplified, more patients may be able to take advantage of these treatments. In this overview, we review the potential benefits of simplifying ovarian stimulation by the means of four distinct methods: 1) using mild stimulation for IVF cycles; 2) using in vitro maturation to allow for the retrieval of oocytes that are not yet fully mature yet have the potential to result in live births; 3) conducting IVF in modified natural cycles which use no exogenous FSH stimulation; and 4) allowing embryo culture to take place in a novel intravaginal incubation system. These methods are considered to be somewhat unconventional, yet they have all been shown to lead to live births. In the era of individualized patient care, these techniques present viable alternatives to standard treatment. As experience and outcome data accumulate, they may prove to be not just alternatives to standard treatment, but potentially first-line treatment choices.

  • Broadening access to ART should be a priority for our field and this article nicely discusses potential innovations that could make this possible.
    While the review lists data to support each of the four cost-saving measures, none of them have found widespread acceptance in our field.

    Is the reason for this that the definitive data demonstrating equivalence of these techniques to the current way of doing things are not there (leading practitioners to believe that decreased cost means decreased success), or is it a reluctance to change and innovate?

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