Impact of ART on pregnancies in California: an analysis of maternity outcomes and insights into the added burden of neonatal intensive care

On the basis of observations in Europe and North America, this review will focus on Assisted Reproductive Technologies (ART) and their impact on pregnancy outcomes; in particular multiple births, prematurity, and their impact on birth defects. In Europe, since 1985 this experience has been somewhat different from that in North America due not only to the differing populations, cultures, religious perspectives, but also to the rapid implementation of medical technologies, relative freedom from governmental regulation, as well as the different forms of payment for medical care that exist between the two continents. This review will focus on the impact of ART on the complications of pregnancy, multiple gestations and prematurity, and will evaluate the required process and content of informed consent surrounding ART from the legal perspective. Issues related to complications resulting from the use of ART from the perspective of neonatal care providers will be highlighted as well as its impact on the health care system in both regions. Given the impact of ART on both sides of the Atlantic, we propose that governments, as well as professional organizations – including reproductive specialists, neonatologists, and health economists – recommend that a legal limitation on the number of embryo transfers be imposed and that embryo transfer restrictions be coupled with reimbursement for ART services. We suggest that reproductive rights should not be infringed but that greater concern for and monitoring of the safety of both mothers and their newborns be undertaken by various professional organizations and governments in Europe and North America. We also propose systematic centralized reporting of the effectiveness of each form of ART, along with any associated complications, and that ART babies be carefully monitored for birth defects and imprinting disorders on both continents.

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Andrzej Kochanski

Papers

In vitro babies - medical and legal aspects: a European and North American perspective