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• W2154708889 abstract "We commend Kushnir et al. (1Kushnir V.A. Vidali A. Barad D.H. Gleicher N. The status of public reporting of clinical outcomes in assisted reproductive technology.Fertil Steril. 2013 Jun 8; https://doi.org/10.1016/j.fertnstert.2013.05.012Google Scholar) for their detailed analysis of the publicly available Society for Assisted Reproductive Technology (SART) report in the article “The status of public reporting of clinical outcomes in assisted reproductive technology [ART].” SART continues to believe that any use of the ART report to make direct comparisons of outcomes between clinics is not valid and is inappropriate. The goal of the report is to facilitate reasonable estimation of the success rate at a given clinic. Unfortunately, recent evolution of clinical practice has made the reasonable estimation of success per cycle start much more difficult. The exclusion of “banking” cycles from the denominator of the report is an unintended consequence of our common-sense handling of true “fertility preservation” cycles. The outcomes report would be misleading if it included cycles with no intention for embryo transfer in the near future (for example, cycles conducted to obtain eggs or embryos before chemotherapy). SART has identified the need to distinguish fertility preservation from “short-term” banking. The indications for short-term banking (such as preimplantation genetic diagnosis and endometrial receptivity) are outlined in the manuscript; however, other indications for short-term banking exist, such as risk for ovarian hyperstimulation syndrome, polyps, etc. We fully agree that the outcomes of these cycles should be accounted for in the Clinic Summary Report. The SART Registry Committee and SART Executive Council have discussed this at length, and we have sought input from our members. We do not think that simply indicating the number of embryo banking cycles is adequate. SART has met with the Centers for Disease Control and Prevention, with whom we have a long-standing collaboration, to discuss what our options are for including banked cycles in outcome reports. Although one option, suggested by the authors, is reporting “total reproductive potential per initiated cycle, including initial fresh and subsequent frozen embryo cycles” (1Kushnir V.A. Vidali A. Barad D.H. Gleicher N. The status of public reporting of clinical outcomes in assisted reproductive technology.Fertil Steril. 2013 Jun 8; https://doi.org/10.1016/j.fertnstert.2013.05.012Google Scholar), which has been discussed previously by the SART Executive Council, we have been unable to define this parameter satisfactorily. Moreover, final embryo transfer can occur years after egg retrieval, so calculation of rates will never be final. We think that the best solution to reporting short-term banked cycles is to “link” the initial stimulation cycle to the first or “primary” embryo transfer. Cycles without transfer (preimplantation genetic screening cycles with no normal embryos) would then be accounted for. Linking cycles does have one disadvantage, because the date of retrieval and primary embryo transfer may cross calendar years. SART has proposed to the CDC that a delay in the finalization deadline for 3 months from current dates is appropriate. This approach would allow the vast majority of cycles to be linked with a transfer outcome within a given reporting year. We look forward to working with the CDC to construct a more accurate ART outcome report that takes into account recent changes in ART practice. The status of public reporting of clinical outcomes in assisted reproductive technologyFertility and SterilityVol. 100Issue 3PreviewWe read the article “The Status of Public Reporting of Clinical Outcomes in Assisted Reproductive Technology” by Kushnir et al. (1) with great interest. As stewards of the National ART Surveillance System (NASS), we are always striving to improve data collection and public reporting of clinical outcomes of assisted reproduction, as required by the Fertility Clinic Success Rates and Certification Act (FCSRCA) of 1992. The article refers to the recent but increasing trend of short-term embryo banking—cycles in which all embryos are created with the intent of cryopreservation for subsequent transfer in frozen/thawed cycle(s) in the next few months—which has followed advances in cryopreservation techniques (2). Full-Text PDF Open AccessReply of the AuthorsFertility and SterilityVol. 100Issue 4PreviewWe appreciate the constructive response to our manuscript by the leadership of the Society for Assisted Reproductive Technology (SART) but would like to add several suggestions not fully addressed in our manuscript (1). Because assisted reproductive technology (ART) outcome reports are primarily intended for the public, they should be interpretable by lay people, i.e., without statistical knowledge. This means that biases and effects on reported pregnancy rates should become apparent to the public. Full-Text PDF" @default.
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