Commercial Impacts on Assisted Reproductive Technology: A Scoping Review.

Assisted reproductive technology (ART) is a growing global industry, projected to reach $37.7 billion by 2027. Predominantly offered in private healthcare settings, concerns have been raised about the potential negative impacts of commercialization on ART services. Despite numerous accounts of these impacts, a comprehensive synthesis and critique of arguments are lacking. This scoping review aims to provide a nuanced understanding of commercial impacts on ART by exploring how commercial forces have been identified, studied, and evaluated, and what strategies have been suggested for their management in health-related journals. PubMed, Web of Science, Cinahl, and Scopus were searched between January and July 2023 for articles addressing commercial impacts on ART. Database searches identified 11,873 articles, with 163 articles included in the final review. Commercial impacts on ART were most frequently mentioned in discussions of "add-on" interventions (40/163; 25 per cent of articles). Many articles were critical of commercial impacts on ART; however, several suggested that there may be benefit in the delivery of ART by the private sector. This review offers a number of proposed strategies for the mitigation of potential adverse effects of commerce on ART that may be useful to service providers and policymakers. These include improving patient information, enhancing informed consent processes, and increasing regulatory oversight. The review also alerts us to potential challenges that might arise in the context of regulatory reform and reminds us that enhanced regulation is not universally supported.