Guest Editorial: The Future of ART. (Opinion).

As the founder of the first in vitro fertilization program in the United States, I'm frequently asked about where I see the future of assisted reproduction heading.

In the next 10 years, I think we're going to see the emergence of a new specialty, complete with its own board examination that combines an in-depth knowledge of the female, the male, and early embryonic development.

Although I'm not sure what it will be called, I see this specialty growing out of the recognition that today's ob.gyns. with an interest in fertility services are strapped with the added burden of having to be andrologists, a void left by the many urologists who don't adequately address issues of male infertility. Nor can today's reproductive endocrinologist get far without a thorough knowledge of fertilization and early embryonic development. So it's increasingly clear that we need a specialty dedicated to these issues.

I'm also deeply concerned about what IVF costs our patients. Couples in the United States pay more for IYF treatment relative to their income than people in any other developed nation. In terms of relative costs, patients in the United States pay only slightly less for IVF than those in Saudi Arabia, Thailand, Pakistan, and China.

Based on many talks I've had with third-party payers in recent years, I'm convinced that in time more insurers are going to have to face up to public demand and start reimbursing for fertility services.

That said, however, when the insurance industry finally does kick in more, it's going to have a far more active role in identifying who the "qualified providers" are, and there is going to be more work for less pay. We see this trend in states where payment is mandated. On the surface, such mandates may sound appealing, but in truth the compensation they provide often doesn't meet the costs of providing care.

Advances in IVF have made a huge difference in how we approach causes of infertility. Today, for example, I believe that the surgical treatment for tubal disease is obsolete, except for maybe re-anastomosis when there's been surgical separation.