In considering the uptake of ART around the world and in particular regions, it is crucial to consider outcome and what is considered to be successful treatment. Standardisation of reporting for comparability between clinics and countries is essential. This will be affected by multiple pregnancy and efforts to minimize them and the anxiety relating to possible problems such as imprinting abnormalities. General access is influenced by ethical by ethical and religious value systems, which in turn impinge on the political nature of discussions about provision. Of primary importance is the extent of access to treatment; the need for ART in the first instance is related to the prevalence of STDs and the quality of reproductive health services in the community. Access is critically determined by whether ART is provided by the public health system, otherwise it is the preserve of the better off. However, the public health system does not usually accord ART high priority. Even in the UK where there has been a positive analysis of the evidence base by the public health service, funding remains a major issue. ART is not explicitly included in the UN Millennium Development Goals, however they could be interpreted as including it. Of importance was the WHO Ministerial Summit on Health Research held in Mexico last November. Its recommendations and timetable were aimed at overcoming health system constraints to the delivery of all health care, in particular promoting access in low income settings. Successful implementation of any recommendations will likely have a long term impact on the provision of all health care. Perhaps 50% of all infertility can be treated by ART. It should no longer be seen as the high tech end of provision, only required by a few. It should be widely available and included in public health provision. The technical challenge is to reduce the cost and increase the efficacy. But the greater challenge for the medical scientific communities is to educate the public and the politicians to understand the techniques and their implications. Cost-benefit analyses will be required to demonstrate appropriate and wise spending and to show a rational case for the public health expenditure. The development of trusted regulatory system will also be necessary, ideally with legal flexibility to encompass scientific advances. Only then can public health provision of ART be envisaged; funding allocation must follow for it to become readily available. Although ART births are now contributing significantly to national data in some countries, the social impact on the world community will continue to be minimal until these changes have taken place.
REPRODUCTIVE TECHNIQUES, ASSISTED