[Ethical problems with the decision of refusal to a request for intra-conjugal in vitro fertilization]

What is our knowledge of the couples who suffer refusal of access to IVF when information is available for only 52% of the pregnancies obtained by IVF? With a retrospective study on IVF refusal datas in a centre where they are available, and an investigation by questionnaire in twelve other centers, the authors tried to evaluate the incidence of these refusal. IVF refusal concern 6 to 30% of the couples addressed, varying on a plurifactorial preselection; but a register including refusal is available in only four of the twelve centers. The main reason for refusal is maternal age. Only three of the twelve centers inquired have a real multidisciplinary staff for access decision. Moreover, if the twelve centers knows the future for the obtained pregnancies, it's true sometimes for only seven centers when IVF is unsuccessful, and never for ten centers when refusal of IVF. Assessment of IVF is incomplete, and improvement is needed based on: a better diffusion of the actual knowledge and its applications; a vast application of "ethical committee procedure" when decision for access is taken; and a global approach of IVF, considering refusal as well as success.