Effectiveness of assisted reproductive technology (ART)

Area of Science:

• Reproductive medicine and endocrinology
• Evidence-based medicine
• Infertility research

Background:

• Infertility affects many couples, carrying significant emotional and economic burdens.
• Current treatments include ovulation induction, superovulation, and in vitro fertilization (IVF).
• Understanding the short-term and long-term outcomes of these interventions is crucial.

Purpose of the Study:

• To review existing evidence on the outcomes of infertility treatments.
• To assess short-term outcomes (pregnancy, live birth, multiple gestation, complications) and long-term outcomes (maternal and infant complications).

Main Methods:

• Systematic review of MEDLINE and Cochrane Collaboration resources.
• Inclusion of English-language studies from January 2000 to January 2008.
• Exclusion of non-randomized studies and studies lacking calculable pregnancy/live birth rates for short-term outcomes; exclusion of studies with <100 subjects or no control group for long-term outcomes.

Main Results:

• Limited high-quality evidence exists for most infertility interventions.
• Sufficient evidence supports clomiphene citrate for PCOS, metformin plus clomiphene, ultrasound-guided embryo transfer, and assisted hatching in specific cases.
• Infants born after infertility treatment face risks, but the contribution of infertility versus treatment is unclear. Infertility itself is linked to increased cancer risk.

Conclusions:

• There is a notable lack of high-quality evidence to guide the selection of specific infertility treatments.
• Conducting more robust, well-designed studies is essential.
• Addressing barriers to research is a critical policy objective.