Michael Feinman

Auditing ART success rates: It can be done

The need for audited success rates for assisted reproductive technologies (ART) may not seem obvious, at first. The medical profession is generally seen as honor-bound and truth-seeking, yet for many reasons, the public doubts the validity of reported success rates. These doubts led to the creation of a self-reporting system sponsored by the Society of Assisted Reproduction (SART) (1). The lack of public confidence also led to the congressional hearings held by Congressman Wyden and, ultimately, the first step toward government regulation: The Fertility Clinic Success Rate and Certification Act in 1992. While these represent steps in the right direction, they still tend to protect the status quo. The current reporting system is not a true audit and continues to foster doubt in the public mind. Government regulation can ultimately lead to restrictions imposed by lawmakers without an understanding of clinical principles. For example, in the United Kingdom, only three embryos can be transferred to a woman, regardless of her age. Beyond honesty and integrity, there is also an economic issue. The United States represents the only industrialized country in which ART proce-

The Day-to-Day Realities: Commentary on The New Eugenics and Medicalized Reproduction

Physicians have a sacred commitment to dedicate themselves through their art and through science to the improvement of the human condition. They have the solemn responsibility to focus on both the prevention and the cure of disease. The human genome project, a 15-year effort to draw the first detailed map in human DNA, will inevitably lead to the widespread implementation of human-gene therapy for the treatment and prevention of disease. We are on the verge of nothing less than a biomedical revolution, the likes of which have not been encountered before. The human genome project will lead to profound changes in the ability to manipulate genes. It will change the way we are born, how we live, how we die, and how we view ourselves in relation to our destiny. Before us lies a difficult transition.