Sharpening the focus on ART outcomes-tracking a decades long moving target

“Although medical progress has been extraordinary, its path has often been directed by the overwhelming acceptance of unproved but popular ideas—the bandwagons of medicine. Some of these ideas eventually prove valid, and their uncritical acceptance is belatedly justified. More often, however, they are disproved and abandoned or replaced by another bandwagon. A new idea can frequently help overcome stagnation and inertia, but unfortunately, an object in motion tends to remain in motion, and the bandwagon becomes an overwhelming force.” [1]

The years following the singular accomplishment of Edwards and Steptoe resulting in the birth of Louise Brown were charged with excitement and promise that some forms of infertility might be managed by what was then a nascent and rough-edged version of what would become human Assisted Reproductive Technology (ARTs) or Medically-Assisted Reproduction (MARs). JARG was but one of the medical journals tasked in the early years (founded by Edwards as the Journal of In Vitro Fertilization and Embryo Transfer) with the responsibility of delivering to the medical community sound scientific documentation of the successes and failures attending well-intended efforts to revise, implement, and monitor emergent changes in laboratory and clinical practices that would enhance outcomes of medical intervention with respect to efficiency, safety, and health of offspring generated by many founders in the reproductive medicine enterprise. As known by many, the Nobel Prize committee’s reluctance to have awarded Edwards the Physiology and Medicine Prize was founded over concerns raised about the longer-term health of children born by ARTs. But progress prevailed and in due course Professor Edwards received the recognition he so well deserved in 2010 (https://www.nobelprize.org/prizes/medicine/2010/edwards/facts/).

To suggest that “the rest is history” would be a gross understatement given progress made in the arena of reproductive medicine since 2010. Well beyond the glorification, notoriety, and popularity that ARTs have attracted over the past decades, persistent and evolving attempts to establish criteria that truly reflect the successes and failures of ARTs for all stakeholders, invested in the now commercialized medical discipline, have at many levels required a myriad of adjustments, constituting in the end nothing short of a moving target.

The matter of how best to monitor ART outcomes has been widely debated and rightfully continues to be so given the inherent challenges posed by the complexities of human reproduction and fluctuating nature of what could become an outcome or outcomes suitable for gauging where the field stood in the eyes of Mother Nature! That we have arrived at live birth rate as a biomarker for clinical success has come with a price, literally and figuratively speaking. From heralding the sequence of outcome measures dotting the ART landscape over the years-from cleavage to chemical pregnancy, to fetal heartbeat, and now cumulative live birth rate in a setting where single embryo transfer is becoming the norm, the lens through which ART outcomes is now understandably focusing on more than the long-term follow-up of offspring health and well-being to now include maternal health in the context of pregnancy complications.

With this backdrop, JARG is proud to announce to our readership the latest Topical Collection of Articles on Outcomes in ARTs with Drs Judy Stern and Alex Quaas taking charge of what we hope you will find to be both a timely and instrumental course of new research into this area of reproductive medicine (https://link.springer.com/collections/cihjjgihgg).

Building upon recent papers from Conrad and colleagues, the uptake of programmed embryo transfer cycles relative to fresh transfers raises new concerns about one set of practice pattern adjustments contributing to the matter of pregnancy complications, several papers in this special issue add to the broader topic of ART outcomes [2, 3]. And at the heart of growth and commercialization in ARTs today is our collective reliance on registries that span not only regional territories and countries but those capable of archiving, integrating and analyzing outcomes in a fashion and scale that would add a measure of confidence to our discipline if harnessed and implemented across the globe as has been recently proposed by Pinborg and colleagues [4]. Following the lead of existent registries and the coordinated efforts implemented under the direction of the European Union, the time will come in the future where the promise of “Big Data” will be realized for the benefit of all stakeholders in the ART and MAR enterprise, assuring in the end inclusive and affordable access to reproductive care, as Bob Edwards could only have dreamt of during their pioneering efforts of yesteryear [5].