National ART Surveillance

How Do We Monitor Assisted Reproductive Technology?

According to the Fertility Clinic Success Rate and Certification Act, all ART cycles performed in United States fertility clinics are reported to CDC. National ART Surveillance System (NASS) is supported by the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, under contract, currently with Westat, Inc. NASS is the only CDC-approved data reporting system for ART procedures. CDC (through contract with Westat, Inc) and the Society for Assisted Reproductive Technology (SART) maintain a list of all ART clinics known to be in operation and tracks clinic reorganizations and closings.

NASS data include—

• Patient demographics.
• Patient obstetrical and medical history.
• Parental infertility diagnosis.
• Clinical parameters of the ART procedure.
• Information regarding resultant pregnancies and births.

When drawing conclusions from NASS data, it is important to consider that a small number of clinics do not report data to CDC, and are listed as non-reporters in the ART Report. Because most non-reporting clinics are small, we estimate that NASS contains information about more than 95% of all ART cycles in the United States.

In addition to providing consumers with information about national and clinic-specific pregnancy success rates, national ART surveillance allows for the assessment of infant outcomes (birth weight, plurality, maturity), and the monitoring of trends in ART use in the United States.

ART surveillance data are protected under 308(d) Assurance of Confidentiality. Because of this Assurance, all data files are considered confidential materials and are safeguarded to the greatest extent possible.

Data Submission

ART clinics that are submitting data to CDC via the National ART Surveillance System (NASS) reporting system or through an approved alternative will be considered to be in compliance with federal reporting requirements of the FCSRCA. CDC’s NASS is a Web-based ART data reporting system. Clinics either electronically enter or import data into NASS for each ART procedure they start in a given reporting year. SART-member clinics may report their data to NASS through SART.

Representatives of a new clinic preparing to submit ART data or an existing clinic with data submission questions, can contact NASS Help Desk by calling 1-888-650-0822.

Confidentiality

ART surveillance data are sensitive because they contain personal medical information about both the people undergoing ART and the infants born after ART. These data are protected by the Assurance of Confidentiality under the Public Health Act Section 308(d). Due to these confidentiality restrictions, access to data files is currently limited to CDC staff and approved guest researchers. NASS data cannot be released to external researchers.

How Do We Ensure Data Accuracy?

Clinics are required to verify all reported data. CDC conducts data validation through yearly audits and site visits. To have their success rates published in the annual report, clinics’ medical directors must verify by signature that the tabulated success rates are accurate. The submitted data are then reviewed, and clinics are contacted if corrections are necessary.

After the data have been verified, a quality control process called validation begins. Every year, a sample of reporting clinics is selected for data validation. Members of the validation team meet with selected clinics and review medical record data for a sample of the clinic’s ART cycles. For each cycle, the validation team compares information abstracted from the patient’s medical record with the data submitted for the report. Validation primarily helps ensure that clinics are being careful to submit accurate data. It also serves to identify any systematic problems that could cause data collection to be inconsistent or incomplete.

What Improvements Were Made to NASS Over the Years?

ART data collection requires periodic improvements to continue accurately reporting on ART practices and outcomes. These needs stemmed from rapid changes in the field of ART, where new treatment methods and approaches are quickly adapted. In 2016, an updated version of the National ART Surveillance System, NASS 2.0, was launched, which included changes to variables, definitions, and reporting requirements (especially prospective reporting), improved functionality that allowed users to link information on oocyte retrievals and embryo transfers, improved security, and a streamlined user interface. CDC made these changes to ART data collection in collaboration with many stakeholders, from professional societies, such as the American Society for Reproductive Medicine (ASRM), the Society for Assisted Reproductive Technology (SART), and the American Urological Association (AUA), and to consumer organizations, such as RESOLVE—the National Infertility Association, and Path2Parenthood. After participating in CDC’s Data Modernization Initiative, an updated version of the National ART Surveillance System, NASS 3.0, was launched in 2022. For the first time, NASS was hosted and maintained exclusively on CDC servers. Other improvements included the development of an automated process for system updates, a new interface for clinic users to view detailed success rate information about their clinic, improved functionality that allowed for automated data processing and publishing, and further improved system security.

History of ART Surveillance

1978—The first IVF birth in the world was reported in England.

1981—The first IVF birth in the United States was reported.

1986—The Society for Assisted Reproductive Technology (SART) was established in the early 1980’s, and began to collect data from its member clinics in 1986.

1992—The Federal Trade Commission intervened in a case of false advertising by a fertility clinic. As a result, the Fertility Clinic Success Rate and Certification Act of 1992 FCSRCA), Section 2(a) of P.L. 102–493 (42 U.S.C. 263a-1(a)) was passed, which mandated that CDC collect information yearly about ART cycles performed at clinics in the United States.

1997—CDC collaborated with SART to publish the first ART Success Rates Report to describe ART procedures performed in 1995.

2001—CDC began linking ART data with state surveillance data, which later developed into the States Monitoring ART (SMART) Collaborative.

2002—CDC published the first ART Surveillance Summary in the Morbidity and Mortality Weekly Report (MMWR), which reports ART use and outcomes by state.

2004—CDC started development on the National ART Surveillance System (NASS). This builds on previous data collection systems and implements CDC model standards for surveillance. NASS goes live.

2016—NASS 2.0 goes live, featuring cumulative ART success rates. 

2019—IVF Success Estimator, a tool to estimate the chance of having a live birth using in vitro fertilization (IVF) using NASS data, was created and launched.

2022—NASS 3.0 goes live, featuring automated data processing and publishing.

CDC partners include the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART), who are involved in framing the surveillance and research questions and in collecting and reporting data from member clinics. Other important partners who represent consumers of ART and infertility services include RESOLVE, Path 2 Parenthood, and Livestrong Fertility. These organizations provide ongoing consultations about the ART Report and its use for public health communications and education.