Final Report (all chapters)

includes ethicists, scientists, mental health care providers, lawyers, and members of the general
public. 46
Table 2 and Table 3 illustrate the scope of the ASRM system of self-regulation. As these
tables clearly demonstrate, over the years, ASRM has adopted guidelines and recommendations
on many issues raised by the practice of reproductive medicine. Remarkably, these
recommendations are often quite specific. For example, ASRM discourages pre-implantation
genetic diagnosis for elective sex selection; it also does not recommend post-menopausal
pregnancies through oocyte donation, and it is strongly opposed to reproductive cloning. On
other, critical issues such as the number of embryos to be transferred during IVF, ASRM has
adopted a more flexible position: It recommends transferring two embryos in favorable cases,
four embryos in the case of “average” prognosis, and five embryos for women with a “poor”
prognosis.
Guidelines
Year of publication
Position Statement on West Nile Virus 2005
Ovarian Tissue and Oocyte Cryopreservation 2004
Position Statement on Donor Suitability of Recipients of
2004
Smallpox Vaccine
Estrogen and Progestogen Therapy in Postmenopausal
2004
Women
Round Spermatid Nucleus Injection (ROSNI) 2003
Clomiphene Citrate Use in Women 2003
Salpingectomy for Hydrosalpinx Prior to IVF 2001 (reviewed 2003)
Table 2: Recent guidelines published by ASRM/SART. 47
The recommendations on the number of embryos to be transferred provide an excellent
illustration of the strengths and weaknesses of self-regulation. ASRM could have adopted a rigid,
universal rule as did the British legislation. For example, it could have recommended that no
more than two embryos be transferred, in any case. Instead, ASRM in this case opted for
flexibility. Flexibility generally protects the ART practitioners’ prerogative to take what is
thought to be the most appropriate course of action – certainly a desirable feature. In this case,
however, professional autonomy tends to operate in favor of the prospective parents and against
the interests of future children. As discussed in Appendix C, a high number of simultaneously
transferred embryos are responsible for most twins and higher-order pregnancies. Higher-order
pregnancies are the single most important factor affecting the health of newborn babies – they
are associated with serious health problems and are extremely costly. 48 For these reasons, many
46
47
48
Sandra Carson, Biotechnology and Public Policy: Professional Self-Regulation (Session 5, President's Council
on Bioethics Meeting, March 7, 2003 [cited September 16, 2005]); available from
http://www.bioethics.gov/transcripts/march03/session5.html.
See Appendix E for a comprehensive list of published guidelines.
L. Garceau et al., "Economic Implications of Assisted Reproductive Techniques: A Systematic Review," Human
Reproduction 17, no. 12 (2002), p.3104-05; C Jones and R. Ward, "Cost-Minimization Analysis of One-, Two-,
136