title: Assisted reproductive technologies: a systematic review of safety and effectiveness to inform disinvestment policy.
abstract: OBJECTIVE
  Health policy relating to assisted reproductive technologies (ART) has been variably informed by clinical evidence, social values, political and fiscal considerations. This systematic review examined key factors associated with specific benefits and harms of ART to inform the development of a model for generating policy recommendations within an Australian disinvestment research agenda.
  
  
  METHODS
  Six databases were searched from 1994 to 2009. Included articles contained data on safety and/or effectiveness of in vitro fertilisation (IVF) or IVF with intracytoplasmic sperm injection with reference to female age, male age or cycle rank. Narrative descriptions of key outcomes (live birth, miscarriage) were constructed alongside tabular summaries.
  
  
  RESULTS
  Sixty-eight studies and one registry report were included. There was substantial heterogeneity present within the evidence-base which limited the strength and scope of conclusions that could be drawn. However, this review does affirm the differential effectiveness associated with the ageing of ART patients with regard to live birth and miscarriage.
  
  
  CONCLUSIONS
  From the available evidence, it was not possible to determine an explicit age or cycle rank that could be used to formulate defensible policy responsive to identified differential effectiveness. Stakeholder interpretation of this evidence-base may assist in developing policy that can incorporate uncertainty and reflect social values.
authors.affiliation: School of Population Health and Clinical Practice, The University of Adelaide, Adelaide 5005, SA, Australia. amber.watt@adelaide.edu.au
authors.forename: Amber M
authors.initials: AM
authors.lastname: Watt
authors.forename: Adam G
authors.initials: AG
authors.lastname: Elshaug
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Willis
authors.forename: Janet E
authors.initials: JE
authors.lastname: Hiller
mesh_terms: D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D061214:Patient Safety; D011247:Pregnancy; D011256:Pregnancy Outcome; D027724:Reproductive Techniques, Assisted / Q000191:economics