title: Assisted reproductive technology: an overview of Cochrane reviews.
abstract: BACKGROUND
  As many as one in six couples will encounter problems with fertility, defined as failure to achieve a clinical pregnancy after regular intercourse for 12 months. Increasingly, couples are turning to assisted reproductive technology (ART) for help with conceiving and ultimately giving birth to a healthy live baby of their own. Fertility treatments are complex, and each ART cycle consists of several steps. If one of the steps is incorrectly applied, the stakes are high as conception may not occur. With this in mind, it is important that each step of the ART cycle is supported by good evidence from well-designed studies.
  
  
  OBJECTIVE
  To summarise the evidence from Cochrane systematic reviews on procedures and treatment options available to couples with subfertility undergoing assisted reproductive technology (ART).
  
  
  METHODS
  Published Cochrane systematic reviews of couples undergoing ART (in vitro fertilisation or intracytoplasmic sperm injection) were eligible for inclusion in the overview. We also identified Cochrane reviews in preparation, for future inclusion.The outcomes of the overview were live birth (primary outcome), clinical pregnancy, multiple pregnancy, miscarriage and ovarian hyperstimulation syndrome (secondary outcomes). Studies of intrauterine insemination and ovulation induction were excluded.Selection of systematic reviews, data extraction and quality assessment were undertaken in duplicate. Review quality was assessed by using the AMSTAR tool. Reviews were organised by their relevance to specific stages in the ART cycle. Their findings were summarised in the text and data for each outcome were reported in 'Additional tables'.
  
  
  RESULTS
  Fifty-eight systematic reviews published in The Cochrane Library were included. All were high quality. Thirty-two reviews identified interventions that were effective (n = 19) or promising (n = 13), 14 reviews identified interventions that were either ineffective (n = 3) or possibly ineffective (n=11), and 12 reviews were unable to draw conclusions due to lack of evidence.An additional 11 protocols and one title were identified for future inclusion in this overview.
  
  
  CONCLUSIONS
  This overview provides the most up to date evidence on ART cycles from systematic reviews of randomised controlled trials. Fertility treatments are costly and the stakes are high. Using the best available evidence to optimise outcomes is best practice. The evidence from this overview could be used to develop clinical practice guidelines and protocols for use in daily clinical practice, in order to improve live birth rates and reduce rates of multiple pregnancy, cycle cancellation and ovarian hyperstimulation syndrome.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Auckland ,Auckland, NewZealand.
authors.forename: Cindy
authors.initials: C
authors.lastname: Farquhar
authors.forename: Josephine R
authors.initials: JR
authors.lastname: Rishworth
authors.forename: Julie
authors.initials: J
authors.lastname: Brown
authors.forename: Willianne L D M
authors.initials: WL
authors.lastname: Nelen
authors.forename: Jane
authors.initials: J
authors.lastname: Marjoribanks
mesh_terms: D000022:Abortion, Spontaneous; D016206:Databases, Bibliographic; D005260:Female; D006801:Humans; D007246:Infertility / Q000628:therapy*; D046609:Libraries, Digital; D050498:Live Birth; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control; D011247:Pregnancy; D011272:Pregnancy, Multiple; D027724:Reproductive Techniques, Assisted / Q000145:classification / Q000592:standards*; D012196:Review Literature as Topic