Assisted conception and the audit culture.

This paper explores the benefits and burdens of regulation in assisted conception, drawing on a series of interviews with practitioners and a range of recent writings on the social and political context of audit and bureaucracy. The process of regulation brings accountability and new competencies to assisted conception professionals, increasing their influence locally and nationally. Early career and laboratory staff are able to draw on protocols and standard operating procedures to improve their practice and enhance their authority within the assisted conception team and the wider institution. However, audit intensifies the focus upon paperwork rather than practice. Measures such as double witnessing can undermine trust amongst professionals, and this can have detrimental effects on performance. Systems such as incident reporting can become overloaded with minor problems, and do not necessarily allow sufficient time for reflection and feedback regarding the best ways of preventing errors. Performance data designed to increase patient choice can undermine it when clinics have to limit their treatment options or change practices to try to 'improve' their results. In conclusion, feedback and discussion between the regulator and a range of staff groups enhances the benefits of regulation and reduces its burdens.