Crisis in assisted conception: the British approach to an American dilemma

Although British and American couples who are infertile have similar treatment options in their home countries, the British system for ensuring quality of care has striking advantages over the American status quo in reproductive medicine. The British system effectively addresses what continue to be serious problems on the American scene, such as the lack of any clear license or certification of infertility treatment centers to reassure consumers, the absence of a complete consumer-friendly account of success rates at various sites and by technique, and the continuing proportional increase in multiple births because of high numbers of embryos transferred in in vitro fertilization (IVF) and numbers of oocytes produced as a result of ovulation-stimulating drugs. In addition, the British system has clear compulsory guidelines in place that regulate what kinds of human embryo research can be performed, by whom, and where. In infertility practice, the British also have strict controls on the introduction of innovations, such as intracytoplasmic sperm injection (ICSI) and preimplantation genetic diagnosis (PGD). The British prohibition, for example, against cloning by nuclear replacement is already a matter of record, and there is no necessity (as is the case in the United States with cloning via nuclear transplantation) to invoke a public ban and hope that a private moratorium will be observed. Regardless of what one thinks about the clinical and research issues, the clarity and order that permeate practice and research in reproductive medicine in Great Britain have advantages that could serve as guideposts for necessary reforms in the United States.