ACTIVITY NUMBER:  RES014

ACTIVITY TITLE: Assisted Reproductive Technology

ACCREDITATION STATEMENT

The American Society for Reproductive Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Release Date:  September 1, 2013

Reviewed and Updated 2016

Expiration Date: August 31, 2019

Under Review July 2022

Estimated Time to Complete Activity: 1.0 hour

NEEDS ASSESSMENT and IDENTIFICATION OF PRACTICE GAP

Assisted reproductive technology (ART) offers infertility treatment for couples who are unable to conceive by other methods. ART includes all treatments in which both eggs and sperm are handled.  Use of ART has doubled over the past decade, and ART-born infants now account for more than 1% of all U.S.-born infants and 18% of all multiple births.¹  In 2008, the Society for Assisted Reproductive Technologies reported that 140,795 cycles using in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT) were performed in the United States.²  Because ART encompasses highly-specialized clinical treatments and laboratory procedures³,  referral by the primary care physician or obstetrician-gynecologist to a board-certified reproductive endocrinologist with an approved ART clinic enables couples to begin the process for ART in a timely manner.  The Fertility Clinic Success Rate and Certification Act (FCSRCA) of 1992 mandates that clinics performing ART annually provide data for all procedures performed to CDC, which is required to publish success rates for each clinic.  

One of the significant risks of ART is multiple gestation, yet infertility specialists appear to lack knowledge of the efficacy of single embryo transfer (SET) in reducing the multiple birth rate.  A 2009 ASRM survey of practicing reproductive endocrinologists found that fewer than half could accurately describe the appropriate use of elective SET.⁴

This presentation examines the various types of ART procedures and their clinical indications including IVF, GIFT, ZIFT, intracytoplasmic sperm injection (ICSI), gamete donation and preimplantation genetic diagnosis.  Clinicians are also provided with information on prognosis for and complications associated with various ART procedures. 

1.      Macaluso M, Wright-Schnapp TJ, Chandra A, Johnson R, Satterwhite CL, Pulver A, Berman SM, Wang RY, Farr SL, Pollack LA. A public health focus on infertility prevention, detection, and management. Fertil Steril. 2010 Jan;93(1):16.e1-10.

2.      Society for Assisted Reproductive Technologies. SART Cors Online Clinic Summary Report.  https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0.  Accessed April 6, 2010.

3.      Practice Committee of Society for Assisted Reproductive Technology; Practice Committee of American Society for Reproductive Medicine. Revised minimum standards for practices offering assisted reproductive technologies. Fertil Steril. 2008 Nov;90(5 Suppl):S165-8.

4.      American Society for Reproductive Medicine. 2009 Scientific Program Pretest Data. 

This educational activity is designed to address the Unit 5 Reproductive Endocrinology educational objectives from the Council on Resident Education in Obstetrics and Gynecology (CREOG) on this topic.

EDUCATIONAL OBJECTIVES

At the conclusion of the educational activity, participants should be able to:

1.      Describe indications for ART procedures, including in vitro fertilization (IVF), Intracytoplasmic sperm injection (ICSI), third-party reproduction, and preimplantation genetic diagnosis.

2.      Describe the prognosis for, and complications of, ART.

TARGET AUDIENCE

This activity is designed to meet the educational needs of resident physicians in obstetrics and gynecology and other related specialties.

ACGME COMPETENCIES

Medical Knowledge

SUCCESSFUL COMPLETION REQUIREMENTS

Successful completion of this educational activity requires the learner to:

·        View a course overview page, containing all CME and disclosure information, including acknowledgement of commercial support and disclosure of unlabeled use, prior to the start of each module.

·        Complete a 10-question pre-exam prior to the module. Learners should note any pre-exam questions answered incorrectly for clarification during module study.  

·        Be given the option of downloading a printed syllabus containing the presentation and narrative.

·        Participate in the interactive activity: Audio narration is synchronized with PowerPoint presentation that can be advanced, stopped or reversed as desired.

·        Complete a 10-question post-exam, with feedback of correct/incorrect answers, scoring a minimum of 70% in two attempts.

·        Complete the evaluation survey.

·        Print certificate of completion.

DISCLOSURES FOR PLANNERS AND FACULTY

Ruben J.  Alvero, MD – Nothing to Disclose

Alicia Y. Armstrong, MD – Nothing to Disclose

Valerie Baker, MD – Institutional Support from IBSA

G. Wright Bates, MD – Nothing to Disclose

Nancy A. Bowers, BSN, RN, MPH – Nothing to Disclose

Bruce R. Carr, MD – Research support from Wyeth, Neurocrine, Boehringer Ingelheim; Consultant for Novo Nordisk

Marcelle I. Cedars, MD  – Nothing to Disclose

Bradley S. Hurst, MD – Nothing to Disclose

Andrew R. La Barbera, PhD, HCLD  – Nothing to Disclose

Lawrence C. Layman, MD – Nothing to Disclose

Meredith Loveless, MD – Nothing to Disclose

Jennifer Mersereau, MD – Nothing to Disclose

Patricia M. McShane, MD – Consultant, World Egg Bank

Shona C. Murray, MD - Consultant, World Egg Bank

Steven T.  Nakajima, MD –Consultant, research support, speaker’s bureau for Warner Chilcott; Stockholder for IntegraMed

Genevieve Neal-Perry, MD, PhD – Nothing to Disclose

Linda R. Nelson, MD, PhD  – Nothing to Disclose

Lubna Pal, MBBS, MS – Research grant from Ferring

Staci E. Pollack, MD – Nothing to Disclose

Robert W. Rebar, MD – Nothing to Disclose

Richard H. Reindollar, MD – Nothing to Disclose

Randal D. Robinson, MD -  Speaker’s bureau for Merck and Teva

Nanette Santoro, MD  – Consultant for QuatRx

James H. Segars, MD – Nothing to Disclose

Mary D. Stephenson, MD, MSc –  Consultant for NoraTherapeutics

Kim L. Thornton, MD – Consultant for Parexel

James P. Toner, M.D., Ph.D. -  Research support from Columbia LaboratoriesEllen Wilson, MD – Nothing to Disclose

Bo Yu, MD – Nothing to Disclose

It is the policy of the ASRM to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. All faculty/authors participating in this activity were required to disclose any relationships they may have with commercial entities whose products or services are used to treat patients so that participants may evaluate the objectivity of the presentations. The content and views presented in this activity are those of the faculty/authors and do not necessarily reflect those of the ASRM or CREOG. Any discussion of off-label, experimental, or investigational use of drugs or devices will also be disclosed. The disclosure statements were reviewed by the Subcommittee for Standards of Commercial Support of the CME Committee of ASRM and any perceived conflicts of interest were resolved in accordance with the policies of the ACCME.

STATEMENT OF SUPPORT

No commercial support has been provided for this activity.