Penn Study Emphasizes Need for National Guidelines for Assisted Reproductive Technology Programs

Infertility prevents roughly 6.1 million people in the United States from having children. As a result, infertile individuals and couples commonly seek to become parents through assisted reproductive technology (ART). Since 1981, approximately 177,000 babies have been born via ART: and, in one year alone (2000), some 100,000 cycles of ART were attempted, resulting in 60,253 live births. Beyond the factors of infertility and a candidate’s ability to afford treatment, little is known about the qualifications that ART programs use to determine a candidate’s eligibility for parenthood. This raises the question: Should there be guidelines to determine who should be eligible to use this technology for reproduction?

A new study sponsored by the Center for Bioethics at the University of Pennsylvania School of Medicine sheds important light on the values that govern access to ART. The study, published in the January 2005 issue of the journal Fertility and Sterility, reveals an alarming inconsistency in the candidate-screening practices of different ART programs in the United States. Indeed, “the majority of programs in the U.S. do not have a formal policy for screening, leaving individual clinics and programs to set their own boundaries” says Andrea Gurmankin, PhD, principal investigator for the study, which was completed while Gurmankin was still a member of Penn’s faculty: she has since joined the Harvard School of Public Health, where she now serves as Assistant Professor in the Department of Society, Human Development and Health. By contrast, many countries, such as the United Kingdom, have national or professional guidelines for screening program candidates. According to the researchers, the important role played by clinics in controlling access to ART in the U.S. emphasizes the need to more openly discuss and, in turn, establish ART candidate-screening qualifications to ensure equality across different programs.

The study also revealed that “… the majority of the ART programs believe that they have the right and responsibility to screen candidates before providing them with assisted reproductive technologies to conceive a child… the key value being that they ensure a prospective child’s safety and welfare and not risk the welfare of the prospective mother.”

The study also found that there was a significant variation across programs in their reported likelihood of turning away candidates. The researchers found, for instance, that when program directors were addressed with a hypothetical situation in which the prospective “mom” in a couple was addicted to marijuana, 33% of the programs said they would accept the couple for ART services, whereas 47% of programs would have denied that couple access. The researchers also found that a couple on welfare is as likely to be granted access as they are to be denied. “The frequency of these variations highlight the need for a formal policy and common guidelines for candidate screening utilized by all ART facilities,” states co-author Arthur Caplan, PhD, Chair of the Department of Medical Ethics at Penn’s School of Medicine.

The study began in 2001 when a six-member expert panel — which included infertility specialists, an obstetrician/gynecologist, bioethicists, and a clinical psychologist from an ART clinic — developed a survey and refined it into a final questionnaire. A total of 210 out of 369 ART program directors responded to the anonymous, self-administered, mailed questionnaire.

In addition to Drs. Gurmankin and Caplan, the research team included Andrea Braverman, PhD, from the Woman’s Institute for Fertility, Endocrinology and Menopause, in Philadelphia.