Survey assessing policies regarding patient age and provision of fertility treatment in the United States

• Published in: Journal of assisted reproduction and genetics 2023-09, Vol.40 (9), p.2117-2127
• Main Authors: Selter, Jessica H., Woodward, Julia, Neal, Shelby
• Format: Article
• Language: English
• Subjects: Age; Assisted Reproduction Technologies; Embryos; Female; Fertility; Fetuses; Geographical distribution; Gynecology; Human Genetics; Humans; Maternal Age; Medicine; Medicine & Public Health; Neonates; Ovulation; Patients; Policy; Pregnancy; Pregnancy, Multiple; Reproductive Medicine; Reproductive Techniques, Assisted; Reproductive technologies; Surveys; United States - epidemiology
• ISSN: 1058-0468; 1573-7330; 1573-7330
• DOI: 10.1007/s10815-023-02877-x

Purpose To determine what policies exist regarding age and provision of fertility treatment in United States fertility clinics. Methods Medical directors of the Society for Assisted Reproductive Technology (SART) member clinics were surveyed regarding clinic demographics and current policies pertaining to age and provision of fertility treatment. Univariate comparisons were performed using Chi-square and Fisher exact tests as appropriate, with significance set at P ≤ 0.05. Results Of the 366 clinics surveyed, 18.9% (69/366) responded. A majority of clinics who responded 88.4% (61/69) reported having a policy regarding patient age and provision of fertility treatment. Responding clinics with an age policy did not differ from those without a policy on the basis of geographical location, ( p  = 0.5), insurance mandate status ( p  = 0.9), practice type ( p  = 0.4), or annual number of ART cycles ( p  = 0.7). Of all clinics who responded, 73.9% (51/69) had a maximum maternal age for autologous IVF, with a median of 45 years (range 42–54). Similarly, 79.7% (55/69) of responding clinics had a maximum maternal age for donor oocyte IVF, with a median of 52 years (range 48–56). Slightly under half, 43.4% (30/69) of responding clinics had a maximum maternal age for fertility treatment other than IVF (including ovulation induction or ovarian stimulation with or without IUI) with a median of 46 years (range 42–55). Of note, only 4.3% (3/69) of responding clinics had a policy with respect to maximum paternal age, with a median of 55 years (range 55–70). The most commonly cited reasons for having an age-limit policy were maternal risks of pregnancy, lower ART success rates, fetal/neonatal risks, and concerns about patients’ ability to parent at an older age. More than half 56.5% (39/69) of responding clinics reported making exceptions to these policies, most commonly for patients who have pre-existing embryos. The majority of medical directors who responded to the survey believed there should be an ASRM guideline regarding maximum maternal age for autologous IVF 71% (49/69), donor oocyte IVF 78% (54/69) and other fertility treatments 62% (43/69). Conclusions Most fertility clinics who responded to this national survey reported having a policy regarding maternal age (but not paternal age) and provision of fertility treatment. Policies were based on risk of maternal/fetal complications, lower success rates at older age, and concerns about patients’ ability to parent at an