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these disparate outcomes. ETHICAL BENEFITS OF IMPROVING ACCESS AND OUTCOMES Reproduction is a fundamental interest and human right, and the access, treatment, and outcome disparities that are associated with infertility care and ART are a form of stratified reproduction that warrants correction (78, 79). Moreover, supporting increased access to reproductive and infertility care, including ART, appropriately recognizes infertility as a disease, in keeping with pronouncements by the WHO, American Medical Association, and worldwide trends. The status of fertility treatment as being available mainly to non-Hispanic whites and the economic elite perpetuates the unfair dismissal of fertility treatment as a lifestyle choice or as a luxury comparable to elective cosmetic surgery. VOL. 116 NO. 1 / JULY 2021 57 Fertility and Sterility® Improved access to ART also serves social justice ends. An Ontario, Canada, governmental panel on reproductive health has articulated these interests this way: ‘‘We believe all Ontarians should have opportunities to build a family free from discrimination based on socioeconomic status, geography, reproductive health needs, marital status or sexual orientation.The way Ontario’s assisted reproduction system is currently operating is not acceptable. The cost of services means that treatments are out of reach for many people. Social and legal barriers limit access and, in some cases, force people to use less than ideal alternatives..We imagine an Ontario where people are given information on fertility and assisted reproduction, those who need assisted reproduction are not limited by what they can afford to pay, and where the services they receive are safe and effective (80).’’ These interests apply equally in the United States and argue for universal coverage for infertility on par with coverage for other diseases. In December 2014, the Canadian Fertility and Andrology Society issued a position statement supporting public funding of IVF in Canada (81). The ASRM has joined the call for greater equity. In its 2020–2025 strategic plan, the ASRM lists as a priority ‘‘Engage with other medical and scientific organizations, payors, employers, and policymakers in advocating for equitable, inclusive, and affordable access to reproductive health and reproductive care’’ (82). To that end, ASRM has established an Access to Care Special Interest Group for members and in September 2015, convened a 2-day summit on improving access to care. This summit resulted in a white paper and a series of articles in the May 2016 issue of Fertility and Sterility which, collectively, present a range of approaches through which the profession can alleviate the exclusion of many from needed fertility care (83). Encouragingly, in a 2017 survey, 78% of SART members favored insurance coverage for anyone who required IVF for infertility treatment (84). Legal scholars have argued that the lack of insurance coverage for infertility in the United States operates to discriminate against significant groups of people and prevents them from obtaining medical assistance to reproduce (79, 85, 86). In contrast, others have argued that expanded insurance coverage is not appropriate. This argument includes several subparts, including a disavowal that infertility is a disease or its treatment a medical necessity; that adoption is a suitable substitute for treatment to have a child (87); that insurance coverage is too expensive or is an unjustified use of limited health care dollars; or that physicians should not be subjected to the difficulties of dealing with insurance companies. The ASRM has joined the worldwide trend of recognizing infertility as a disease and so arguments to the contrary or against the medical necessity of treatment are unpersuasive (88). Infertility represents the dysfunction of a major bodily system and burdens the quality of life in significant ways (50, 89). The continued exclusion of infertility treatment from most private health care insurance policies and governmental programs of health care in the United States, long after fertility treatment has ceased to be experimental, discriminates against those who need medical help to procreate. As for adoption, it is an excellent family-building choice for many people, but it is paternalistic to mandate that it should be the sole (and again, expensive and self-pay) family-building option for all those who cannot conceive without medical assistance, or that its existence obviates the need for fair access to medical treatment. The objection that infertility coverage is an especially expensive benefit is baseless. First, in practice, the price of this insurance is modest. In a 2006 survey of >600 employers that offered an infertility benefit, 91% reported that it did not add significant cost (90). Large employers have reported in other studies that a limited infertility benefit accounted for Venous Thromboembolism in Aesthetic Surgery: Risk Optimization in the Preoperative, Intraoperative, and Postoperative Settings Christopher J. Pannucci, MD Abstract The purpose of this Continuing Medical Education (CME) article is to provide a framework for practicing surgeons to conceptualize and quantify venous thromboembolism risk among the aesthetic and ambulatory surgery population. The article provides a practical approach to identify and minimize venous thromboembolism risk in the preoperative,
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