Assisted reproductive technology: Impact on society and need for surveillance.

Since the first successful treatment with conventional in vitro fertilization (IVF) in 1978 assisted reproductive technology (ART) has become an integral part of modern medicine and now plays a key role in the fulfillment of family planning. At least five million of infants have been born as a result of ART and in some countries the proportion of infants born after ART now exceeds 5%. Such an impact of ART on society and demography call for adequate surveillance including vigilance of occurring adverse events, especially when novel technology is introduced. In many countries the activities in ART are being recorded and analyzed by national registries, either on a voluntary or on a compulsory basis. Despite all endeavour, the data sets are still incomplete and complications are underreported. In addition, the published reports usually contain cross-sectional data only, collected and analyzed on an annual basis. However, current ART is now developing towards a segmented longitudinal approach, in which single therapeutic steps may be spread over prolonged time intervals. In the near future, ART-data should be handled and reported in a cumulative fashion. The final outcome of ART, defined by the birth of a healthy baby or by the final consumption or destruction of cells and tissues, must be made traceable to one single initiating event, such as the first day of ovarian stimulation or the collection of oocytes, even if that event took place several years earlier. In failed cases or when frozen material was lost or destroyed or transported, negative outcome events should be recorded in order to avoid overestimation of treatment efficacy. To all stakeholders, both surveillance and vigilance in ART are crucial steps towards better quality control and full transparency.