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Financial ‘‘risk-sharing’’ or refund programs in assisted reproduction: an Ethics Committee opinion

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Financial ‘‘risk-sharing’’ fee structures in assisted reproduction programs charge patients a higher initial fee that includes multiple cycles but offers a partial or complete refund if treatment fails. This opinion of the American Society for Reproductive Medicine Ethics Committee analyzes the ethical issues raised by these fee structures, including patient selection criteria, conflicts of interest, success rate transparency, and patient-informed consent. This document replaces the document of the same name, last published in 2016. (Fertil Steril® 2024;121:783–6. ©2023 by American Society for Reproductive Medicine.)

KEY POINTS

  • Financial ‘‘risk-sharing’’ programs offer patients a payment structure under which they pay a higher initial fee for a package of multiple cycles that is discounted over the percycle fee, and patients may receive a partial or complete refund when they do not become pregnant or deliver an infant.
  • Financial ‘‘risk-sharing’’ programs present a potential conflict of interest between the patient's desire to become pregnant without compromising their financial ability to pursue other methods of becoming a parent, such as adoption, and the provider's financial interests.
  • Financial ‘‘risk-sharing’’ programs may be ethically acceptable when they are practiced under certain carefully limited guidelines:
    • Criteria for program inclusion and termination must be specified clearly on marketing materials or as early in the evaluation process as possible. This information must be available to all current and prospective patients in a transparent manner.
    • Patients must be fully informed: of the financial costs, advantages, and disadvantages of the programs and available alternatives; of their chances of success when found eligible for the financial ‘‘risk-sharing’’ program; and that acceptance into the program is not (and cannot be) a guarantee of pregnancy and/or delivery.
    • Programs must adhere to all American Society for Reproductive Medicine (ASRM) practice guidelines with respect to ovarian stimulation, the number of embryos to transfer, and ancillary procedures, and they must not take medically inappropriate risks to increase the likelihood of achieving a pregnancy.
  • Ultimately, health insurance coverage that includes fertility treatment is the ideal model for financial risk mitigation for patients and would eliminate the need for risk-sharing programs. All providers should advocate for adequate coverage for their patients.


Some assisted reproduction programs offer in vitro fertilization (IVF) treatment on a financial ‘‘risk-sharing,’’ ‘‘warranty,’’ ‘‘refund,’’ or ‘‘outcome’’ basis, in addition to traditional fee-forservice pricing. Broadly, financial ‘‘risk-sharing’’ patients initially pay a higher fee for treatment, which typically includes more than one IVF attempt (1). When a ‘‘risk-sharing’’ patient has an ongoing pregnancy or delivery (depending on the structure of the program) with the first or subsequent cycles, the provider keeps the entire fee. When treatment fails, however, the patient may be entitled to have some or all of the fees refunded. Pretreatment screening and the cost of medication, both of which can be considerable, are ordinarily not included in these plans.

Such programs have been criticized as being exploitative, misleading, and contrary to long-standing professional norms against charging contingency fees for medical services. Proponents, on the other hand, argue that this form of payment is a legitimate response to the lack of health insurance coverage for IVF and to patient concerns about the high-financial cost and substantial risk of IVF failure. Only 20 states currently have laws that mandate insurance coverage for fertility care, and only 14 states mandate coverage that includes IVF treatment (2). Patients who are not covered by insurance may bear the entire cost of IVF out of pocket, which can exceed 50% of their disposable income (3). In effect, the higher initial fee to enter a financial ‘‘risk-sharing’’ program subsidizes the refunds for patients who are unsuccessful. Although little published literature is available, at least one company managing a financial ‘‘risk-sharing’’ program reported that 20% of participants received refunds because of not achieving a pregnancy (4), and a recent survey of members of the Society of Reproductive Endocrinology and Infertility noted that 58% of group practices offered some sort of refund program, and only 6% of respondents offered a refund to >25% of their patients (5).

ETHICAL ANALYSIS

The ethical acceptability of these plans must be judged by their impact on patients and not by the profit motive or entrepreneurial impulse that may also have motivated their emergence. Financial ‘‘risk-sharing’’ programs are likely to appeal to and are most often only available to, patients who must self-pay for IVF treatment, thus mirroring the financial ‘‘risk-sharing’’ role of health insurance plans. Proponents note that financial ‘‘risk-sharing’’ plans may serve as a form of insurance against the risk of catastrophic costs associated with failure of IVF treatment and might appeal to patients who would wish to recoup financial resources to attempt other methods of becoming parents, such as adoption or third-party reproduction, should autologous IVF treatment prove unsuccessful (6).

There are several concerns that must be addressed to ensure that these plans are executed in an ethical manner. Financial ‘‘risk-sharing’’ programs can be misleading or exploitative in that they have the potential to coerce patients who are desperate to have a child into purchasing a more expensive formof IVF service than is necessary (7). Good prognosis patients who achieve pregnancy after the first cycle or before the program is complete will often end up paying more for IVF treatment than when they had not chosen the financial ‘‘risk-sharing’’ program. To address this concern, programs must strive for the utmost transparency. Clinics should accurately describe the details of the programto patients before enrollment. Patients should be counseled about alternatives to financial ‘‘risk-sharing’’ programs, including undergoing IVF treatment without enrolling in the program (fee for service) and the decision not to undergo IVF treatment. It is important for patients to have as clear an understanding as possible about their own chances of success with various treatment modalities so that they are not induced to purchase services that are more expensive than may be necessary. Equally, patients who meet program qualifications for these plans should be informed by the program whether they are otherwise good candidates for successful IVF treatment outcomes, and their individual percycle chances of success. This information will help them determine whether the higher costs are worth the guarantee given their level of risk tolerance. Although it should be noted that there are difficulties in comparing clinics in terms of efficacy, these difficulties exist independently of financial arrangements, such as financial ‘‘shared-risk’’ programs. Consultation with financial counselors before participation in financial ‘‘risk-sharing’’ programs is recommended to ensure that the cost structure is understandable to the patients and to discuss whether it is financially feasible for them. Costs not included in the program, such as medications and the diagnostic evaluation, should be clearly delineated. Finally, the definition of ‘‘success,’’ whether live birth or pregnancy of a specified duration, should be clearly specified.

Financial ‘‘risk-sharing’’ programs appear to violate long-standing ethical prohibitions against paying contingency fees in medicine. A prior version of the American Medical Association’s Code of Medical Ethics stated that hinging fees on the success of medical treatment implies that ‘‘successful outcomes from treatment are guaranteed, thus creating unrealistic expectations of medicine and false promises to consumers.’’ Although this statement has since been removed from the American Medical Association’s opinion, it still prohibits contingent fees (8). Although it is unethical to create unrealistic expectations or make false promises or guarantees, financial ‘‘risk-sharing’’ plans do not appear to have that intent or effect. Although the provider's willingness to assume some of the risk of failure may convey a message of confidence in its services, patients should be appropriately counseled not to regard the arrangement as a guarantee of success. On the contrary, the ‘‘premium’’ built into financial ‘‘risk-sharing’’ fees signals to the patient that risks need to be pooled precisely because there is a significant chance that treatment will fail. What is guaranteed is not success, but a partial or full refund when treatment fails.

Providers must strive to ensure that potential profit motives do not inappropriately affect the care that is provided when offering ‘‘risk-sharing programs.’’ Some have argued that such programs have a built-in potential conflict of interest that is likely to skew clinical decision-making toward achieving pregnancy, regardless of the impact on the patient, to avoid paying a refund. Two such dangers may be cited. One is that the provider will be biased in favor of stimulation protocols that tend to produce more oocytes and pose increased risks to the woman's health. The other is that the provider will be biased in favor of transferring >1 embryo at a time, thereby increasing the likelihood not only of pregnancy but of multiple gestations, which can harm women, fetuses, and potential offspring. Adherence to standard stimulation protocols and ASRM’s embryo transfer guidelines (9) is critical to ensuring that potential profit motives do not inappropriately affect the care that is provided. Conversely, it could be argued that patients in financial ‘‘shared-risk’’ programs may choose elective single embryo transfer more often than those patients without insurance and not participating in financial ‘‘risksharing’’ programs because they have already committed to potentially undergoing multiple transfer cycles (10).

When providing traditional fee-for-service or financial ‘‘risk-sharing’’ programs, benefits should be practiced and standards of care should be followed. Non ‘‘risk-sharing’’ fee-for-service programs also have incentives to overstimulate the ovaries or transfer multiple embryos to increase success rates with the goal of attracting future patients. The Committee did not find that the incentives are so much greater in ‘‘risk-sharing’’ plans that they deserve special consideration independently of comparable risks in fee-forservice plans. Because of the potential for conflicts of interest, programs should adhere to recommended ASRM practice guidelines regardless of how the treatment cycle is financed. Additionally, outcomes for patients participating in financial ‘‘risk-sharing’’ programs should be periodically reviewed to ensure that the ethical concerns addressed in this document are not violated.

Ultimately, patients must be given the information they need to fully evaluate ‘‘risk-sharing’’ programs and determine if they are appropriate for them as a means of providing some degree of financial recourse to offset the substantial expenses incurred should their treatment not succeed. Mandated insurance coverage for fertility treatment is the best way to provide this support for patients, and all physicians should advocate for the expansion of this coverage to ultimately obviate the need for these alternative fee structures.

CONCLUSION

The Committee finds that the financial ‘‘risk-sharing’’ form of payment for IVF treatment is an option that can ethically be offered to patients without health insurance coverage for IVF treatment when certain conditions that protect patient interests are met. These conditions include: the criterion of success is clearly specified in advance of enrollment; patients are fully informed of the financial costs, advantages, and disadvantages of such programs; excluded costs, such as screening and medication are clearly delineated, informed consent materials accurately describe clinic-specific chances of success when found eligible for the financial ‘‘risk-sharing’’ program; clinics follow standard protocols and guidelines as well as adhere to the relevant ASRM practice guidelines for these patients (i.e., standard stimulation and number of embryos transferred); and patients understand that the program cannot guarantee pregnancy and/or delivery. It also should be made clear to patients that when they achieve success before completing all of the allotted prepaid cycles, they may end up paying a higher cost for IVF treatment than when they had not chosen the financial ‘‘risk-sharing’’ program.

Acknowledgments

This report was developed under the direction of the Ethics Committee of the American Society for Reproductive Medicine (ASRM) as a service to its members and other practicing clinicians. Although this document reflects appropriate management of a problem encountered in the practice of reproductive medicine, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs of the individual patient, available resources, and institutional or clinical practice limitations. The Ethics Committee and the Board of Directors of the ASRM have approved this report.

This document was reviewed by ASRM members, and their input was considered in the preparation of the final document. The following members of the ASRM Ethics Committee participated in the development of this document: Sigal Klipstein, M.D.; Deborah Anderson-Bialis, B.A.; Kavita Shah Arora, M.D., M.B.E., M.S.; Ricardo Azziz, M.D., M.P.H., M.B.A.; Tolulope Bakare, M.D., M.P.H.; Katherine Cameron, M.D.; Susan Crockin, J.D.; Ruth Farrell, M.D.; Catherine Hammack-Aviran, M.A., J.D.; Elizabeth Ginsburg, M.D.; Jessica Goldstein, R.N.; Mandy Katz-Jaffe, Ph.D.; Edward Martinez, M.H.A., M.S.; Joshua Morris, M.D., M.A.; Jennifer Kawwass, M.D.; Catherine Racowsky, Ph.D.; Robert Rebar, M.D.; Jared Robins, M.D.; Mary Samplaski, M.D.; David Shalowitz, M.D.; Chevis Shannon, Dr.P.H., M.P.H., M.B.A.; Hugh Taylor, M.D.; Sean Tipton, M.A.; Lynn Westphal, M.D.; Julianne Zweifel, Ph.D. All committee members disclosed commercial and financial relationships with manufacturers or distributors of goods or services used to treat patients. Members of the Committee who were found to have conflicts of interest on the basis of the relationships disclosed did not participate in the discussion or development of this document.

REFERENCES

  1. Stassart JP, Bayless RB, Casey CL, Phipps WR. Initial experience with a risksharing in vitro fertilization-embryo transfer program with novel features. Fertil Steril 2011;95:2192–7.
  2. RESOLVE. Website, Infertility Coverage By State. Available at: https:// resolve.org/what-are-my-options/insurance-coverage/infertility-covera ge-state/. Accessed July 3, 2023.
  3. Chambers GM, Adamson GD, EijkemansMJ. Acceptable cost for the patient and society. Fertil Steril 2013;100:319–27.
  4. Seattle Fertility. Shared risk refund case studies. Vol. 4, 29 October 2006. Available at: https://web.archive.org/web/20061029214140/http://www. seattlefertility.com/downloads/sharedRiskCaseStudies.pdf. Accessed July 3, 2023.
  5. McLaughlin JE, Knudtson JF, Schenken RS, Ketchum NS, Gelfond JA, Chang TA, et al. Business models and provider satisfaction in in vitro fertilization centers in the USA. J Assist Reprod Genet 2019;36:283–9.
  6. Levens ED, Levy MJ. Ethical application of shared risk programs in assisted reproductive technology. Fertil Steril 2011;95:2198–9.
  7. Hawkins J. Financing fertility. Harv J Legis 2010;47:115–65.
  8. American Medical Association. Council on Ethical and Judicial Affairs. Code of Medical Ethics Opinion 11.3.1 (previously 6.01)-Fees For Medical Services. Available at: https://www.ama-assn.org/delivering-care/ethics/fees-medic al-services. Accessed July 3, 2023.
  9. Practice Committee of the American Society for Reproductive Medicine, Practice Committee of the Society for Assisted Reproductive Technology. Guidance on the limits to the number of embryos to transfer. Fertil Steril 2017;107:901–3.
  10. Stillman RJ, Richter KS, Banks NK, Graham JR. Elective single embryo transfer: a 6-year progressive implementation of 784 single blastocyst transfers and the influence of payment method on patient choice. Fertil Steril 2009; 92:1895–906.

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Billing for assisted hatching at biopsy and transfer

We would also like to know if you can bill assisted hatching with biopsy and then assisted hatching again during the transfer cycle. View the Answer
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Financial ‘‘risk-sharing’’ or refund programs in assisted reproduction: an Ethics Committee opinion (2023)

Financial ‘‘risk-sharing’’ fee structures in programs charge patients a higher initial fee but provide reduced fees for subsequent cycles. View the Committee Document
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Alabama Supreme Court Rules Frozen Embryos are “Unborn Children” and admonishes IVF’s “Wild West” treatment

Legally Speaking™ on presenting facts and reflecting on the impact and potential implications of  legal developments in ART. View the Column
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Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023)

Ovarian hyperstimulation syndrome is a serious complication associated with assisted reproductive technology. View the guideline
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Billing IVF lab work

We typically bill our IVF Lab work under the rendering provider who performs the VOR. Who should be the supervising provider for embryology billing? View the Answer
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IVF Lab Automation

Automation in IVF labs is progressing, focusing on cryopreservation, dish prep, and data integration. Challenges remain in standardizing processes and material safety. View the ASRMed Talk Video
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Journal Club Global: IVM in Clinical Practice: An Idea Whose Time Has Come?

In vitro maturation (IVM) has the potential to make IVF cheaper, safer, and more widely accessible to patients with infertility. View the Video
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Comparison of pregnancy rates for poor responders using IVF with mild ovarian stimulation versus conventional IVF: a guideline (2018)

Mild-stimulation protocols with in vitro fertilization (IVF) generally aim to use less medication than conventional IVF. View the Guideline
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IVF cycle management and facility fees, an overview

How should IVF Cycle Management be coded?  View the Answer
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Limited ultrasound performed by RN

Would it be appropriate to bill a 99211 when an RN is doing a limited ultrasound and documenting findings during an IUI or IVF treatment cycle? View the Answer
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CPT 89253 and 89254 for Assisted hatching

Can I bill CPT codes 89253 and 89254 together? If yes, do I need a modifier on any of the codes? View the Answer
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Journal Club Global - What is the optimal number of oocytes to reach a live-birth following IVF?

The optimal number of oocytes necessary to expect a live birth following in vitro fertilization remains unclear. View the Video
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Patient Education

What is the correct way to bill for the patient education sessions performed by registered nurses to individual patients prior to their IVF cycle? View the Answer
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Pregnancy Ultrasound

Our practice does routine ultrasounds (sac check- 76817) at the end of an IVF cycle and bill with a diagnosis code O09.081, pregnancy resulting from ART.  View the Answer
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IV Fluids During Egg Retrieval

Is it appropriate to bill the insurance company for CPT 96360, Under Hydration Infusion when being used in conjunction with IVF retrieval? View the Answer
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IUI or IVF

Should other ovarian dysfunction (diagnosis code E28.8) or unspecified ovarian dysfunction (diagnosis code E28.9) can be used for an IUI or an IVF cycle View the Answer
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IVF Case Rates

What ICD-10 codes apply to case rates? View the Answer
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IVF Consent Counseling

When a patient is scheduled to undergo IVF and the provider schedules the patient for a 30-minute consultation is this visit billable? View the Answer
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Ovulation Induction Monitoring for IUI

We would like to clarify the correct ICD 10 diagnosis code for monitoring of an IUI cycle.  View the Answer
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In Vitro Maturation

Have CPT codes been established for maturation in vitro? View the Answer
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IVF Billing Forms

I am seeking information on IVF insurance billing guidelines.  View the Answer
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IVF Billing Globally

Am I correct in assuming that it is duplicate billing for both the ambulatory center and embryology laboratory to bill globally? View the Answer
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IVF Billing of Professional Charges

Are we allowed to bill professional charges under the physician for the embryologist who performs the IVF laboratory services? View the Answer
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Lab Case Rates

What ICD-10 codes apply to case rates? View the Answer
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Oocyte Denudation

Is there is a separate code for denudation of oocytes?  View the Answer
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Endometrial Biopsy/Scratch

What CPT code should be used for a “scratch test”?  View the Answer
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Endometriosis and Infertility

For treatment like IVF would we bill with N97.x first or an endometriosis diagnosis? View the Answer
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Follicle Monitoring For Diminished Ovarian Reserve

If a patient has decreased ovarian reserve (ICD-10 E28.8) and patient is undergoing follicle tracking to undergo either an IUI cycle or IVF cycle... View the Answer
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Global Billing Vs Billing Under Provider

For an IVF cycle (that is not being billed global to an insurance plan) is it appropriate to bill the charges under one “global” provider? View the Answer
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Diagnosis of Infertility for IVF Procedure

How important is it to have accurate documentation of the type of infertility diagnosis for IVF procedures?  View the Answer
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Egg Culture and Fertilization

We are billing for the technical component of 89250 and would like to also bill a professional component of the 89250. View the Answer
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Egg Culture and Fertilization: Same Gender

A same-sex male couple requested half their donor eggs be fertilized with sperm from male #1 and the other half fertilized from male #2. View the Answer
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Donor Embryos

Could you give guidance for the correct ICD-10 code(s) to use when a patient is doing an Anonymous Donor Embryo Transfer cycle? View the Answer
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Journal Club Global: Natural versus Programmed FET Cycles

A significant portion of IVF cycles now utilize frozen embryo transfer.
View the Video
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Role of assisted hatching in in vitro fertilization: a guideline (2022)

There is moderate evidence that assisted hatching does not significantly improve live birth rates in fresh assisted reproductive technology cycles View the Committee Opinion
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Journal Club Global - Best Practices of High Performing ART Clinics

This Fertility and Sterility Journal Club Global discusses February’s seminal article, “Common practices among consistently high-performing in vitro fertilization programs in the United States: a 10 year update.” View the Video
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Guidance on the limits to the number of embryos to transfer: a committee opinion (2021)

ASRM's guidelines for the limits on the number of embryos to be transferred during IVF cycles have been further refined ... View the Committee Opinion
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Journal Club Global Live from India - Adjuvants in IVF and IVF Add-Ons for the Endometrium

Many adjuvants have been utilized by IVF centers to improve their success rates. View the Video
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Evidence-based outcomes after oocyte cryopreservation for donor oocyte in vitro fertilization and planned oocyte cryopreservation: a guideline (2021)

A review of success rates, factors that may impact success rates, and  outcomes. View the Committee Opinion
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Development of an emergency plan for in vitro fertilization programs: a committee opinion (2021)

All IVF programs and clinics should have a plan to protect fresh and cryopreserved human specimens (embryos, oocytes, sperm). View the Committee Opinion
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In vitro maturation: a committee opinion (2021)

The results of in vitro maturation (IVM) investigations suggest the potential for wider clinical application.  View the Committee Opinion
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Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion (2019)

The Ethics Committee recommends that in vitro fertilization (IVF) centers develop patient-centered policies regarding requests for futile treatment.  View the Committee Opinion
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Blastocyst culture and transfer in clinically assisted reproduction: a committee opinion (2018)

The purposes of this document is to review the literature regarding the clinical application of blastocyst transfer. View the Committee Opinion
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The role of immunotherapy in in vitro fertilization: a guideline (2018)

Adjuvant immunotherapy treatments in in vitro fertilization (IVF) aim to improve the outcome of assisted reproductive technology (ART) in both the general ART population as well as subgroups such as patients with recurrent miscarriage or implantation failure. View the Committee Opinion
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Performing the embryo transfer: a guideline (2017)

A systematic review of the literature was conducted which examined each of the major steps of embryo transfer. Recommendations made for improving pregnancy rates are based on interventions demonstrated to be either beneficial or not beneficial. (Fertil Steril® 2017;107:882–96. ©2017 by American Society for Reproductive Medicine.) View the Committee Guideline
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Best practices of ASRM and ESHRE: a journey through reproductive medicine (2012)

ASRM and ESHRE are the two largest societies in the world whose members comprise the major experts and professionals working in reproductive medicine. View the Committee Joint Guideline
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In Vitro Maturation Special Interest Group (IVMSIG)

IVMSIG strives to define the best strategies to optimize IVM outcomes. Learn more about IVMSIG
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What support for IVF looks like

Bipartisan support for IVF, that is responsible for the birth of over 2% of all babies born in the USA each year, will ensure that families continue to grow. View the advocacy resource
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It takes more than one

Why IVF patients often need multiple embryos to have a baby View the advocacy resource
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Oversight of IVF in the US

In the US, medical care is regulated by a complex and comprehensive network of federal and state regulations and professional oversight. View the advocacy resource
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Advocacy Resources

ASRM has prepared resources to help explain and advocate for reproductive rights and the continuation of in vitro fertilization and other fertility treatments. View the advocacy resources

Topic Resources

View more on legal/ethical issues
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ASRM announces support for HOPE with Fertility Services Act

The American Society for Reproductive Medicine is proud to endorse the HOPE with Fertility Services Act (HR 8821).

View the Press Release
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Family members as gamete donors or gestational carriers: an Ethics Committee opinion (2024)

The use of adult intrafamilial gamete donors and gestational surrogates is ethically acceptable when all participants are fully informed and counseled. View the Committee Document
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Financial ‘‘risk-sharing’’ or refund programs in assisted reproduction: an Ethics Committee opinion (2023)

Financial ‘‘risk-sharing’’ fee structures in programs charge patients a higher initial fee but provide reduced fees for subsequent cycles. View the Committee Document
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Planned oocyte cryopreservation to preserve future reproductive potential: an Ethics Committee opinion (2023)

Planned oocyte cryopreservation is an ethically permissible procedure that may help individuals avoid future infertility. View the Committee Opinion
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Ethical considerations for telemedical delivery of fertility care: an Ethics Committee opinion (2024)

Telemedicine has the potential to increase access to and decrease the cost of care. View the Committee Opinion
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Interests, obligations, and rights in gamete and embryo donation: an Ethics Committee opinion (2019)

This Ethics Committee report outlines the interests, obligations, and rights of all parties involved in gamete and embryo donation. View the Committee Opinion
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Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion (2022)

Providers may conclude that the medical risks of fertility treatment for a given patient are too high, in which case it is ethical to decline to provide treatment. View the Committee Opinion
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Access to fertility services by transgender and nonbinary persons: an Ethics Committee opinion (2021)

The provision of fertility services to transgender individuals and the denial of access to fertility services is not justified. View the Committee Opinion
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Interpretation of clinical trial results: a committee opinion (2020)

Evidence from clinical trials is fundamental to ethical medical practice. View the Committee Opinion
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Ethics in embryo research: a position statement by the ASRM Ethics in Embryo Research Task Force and the ASRM Ethics Committee (2020)

Scientific research using human embryos advances human health and offspring well-being and provides vital insights into the mechanisms for reproduction. View the Committee Opinion
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Compassionate transfer: patient requests for embryo transfer for nonreproductive purposes (2020)

A patient request to transfer embryos into her body in a location or at a time when pregnancy is highly unlikely ... View the Committee Opinion
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Child-rearing ability and the provision of fertility services: an Ethics Committee opinion (2017)

Fertility programs may withhold services on the basis that patients will be unable to provide minimally adequate or safe care for offspring. View the Committee Opinion
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Disclosure of medical errors involving gametes and embryos: an Ethics Committee opinion (2016)

Medical providers have an ethical duty to disclose clinically significant errors involving gametes and embryos as soon as they are discovered.  View the Committee Document
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Informed consent and the use of gametes and embryos for research: a committee opinion (2014)

The ethical conduct of human gamete and embryo research depends upon conscientious application of principles of informed consent. View the Committee Opinion

Ethics Opinions

Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.
Ethics Committee teaser

Use of preimplantation genetic testing for monogenic adult-onset conditions: an Ethics Committee opinion (2024)

Preimplantation genetic testing for adult-onset monogenic diseases is ethically allowed when fully penetrant or conferring disease predisposition.
Ethics Committee teaser

Family members as gamete donors or gestational carriers: an Ethics Committee opinion (2024)

The use of adult intrafamilial gamete donors and gestational surrogates is ethically acceptable when all participants are fully informed and counseled.
Ethics Committee teaser

Financial ‘‘risk-sharing’’ or refund programs in assisted reproduction: an Ethics Committee opinion (2023)

Financial ‘‘risk-sharing’’ fee structures in programs charge patients a higher initial fee but provide reduced fees for subsequent cycles.
Ethics Committee teaser

Planned oocyte cryopreservation to preserve future reproductive potential: an Ethics Committee opinion (2023)

Planned oocyte cryopreservation is an ethically permissible procedure that may help individuals avoid future infertility.

More Resources

MAC 2021 teaser
ASRM Academy on the Go

ASRM MAC Tool 2021

The ASRM Müllerian Anomaly Classification 2021 (MAC2021) includes cervical and vaginal anomalies and standardize terminology within an interactive tool format.

View the MAC Tool
EMR Phrases teaser
Practice Guidance

EMR Shared Phrases/Template Library

This resource includes phrases shared by ASRM physician members to provide a template for individuals to create their own EMR phrases.

View the library
Practice Committee Documents teaser

ASRM Practice Documents

These guidelines have been developed by the ASRM Practice Committee to assist physicians with clinical decisions regarding the care of their patients.

View ASRM Practice Documents
Ethics Committee teaser

ASRM Ethics Opinions

Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.

View ASRM Ethics Opinions
Coding Corner general teaser
Practice Guidance

Coding Corner Q & A

The Coding Corner Q & A is a list of previously submitted and answered questions from ASRM members about coding. Answers are available to ASRM Members only.

View the Q & A
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Practice Guidance

COVID-19 Resources

A compendium of ASRM resources concerning the Novel Corona virus (SARS-COV-2) and COVID-19.

View the resources
Couple looking at laptop for online patient education materials

Patient Resources

ReproductiveFacts.org provides a wide range of information related to reproductive health and infertility through patient education fact sheets, infographics, videos, and other resources.

View Website