OBJECTIVES: Internationally, public funding for assisted reproductive technologies (ART) faces constant scrutiny; however the arguments employed – both for and against – rarely consider the procedures from a health technology assessment (HTA) perspective. This project sought to evaluate the impact of female age, male age and cycle rank on the safety, effectiveness and cost-effectiveness of ART through systematic reviews. METHODS:   Using an a priori protocol, six databases were searched for relevant primary studies and existing HTAs. After meeting the inclusion criteria, studies underwent appropriate quality assessment and standardised data extraction. RESULTS: The review is currently ongoing. The majority of the 70 included studies consider the impact of female age on the success of treatment; there are little data investigating the contribution of male age or cycle rank to treatment outcome. There are substantial flaws in the evidence base that challenge the application of established HTA methods to ART. There is considerable heterogeneity in the evidence base, and the policy- and patient-relevant outcome of live birth is not well reported, with many studies presenting pregnancy (variously defined) as the primary outcome.  Many studies fail to account for inherent sources of confounding within their patient populations, thus rendering outcome estimates unreliable. Despite broadening the scope of the review to include national registry data, there remain key questions that cannot be confidently answered with the existing evidence base.  The final findings of the review will be discussed, alongside their implications for policy-making and public funding in this area. CONCLUSIONS: Thirty years of clinical practice in ART has created a disparate evidence base that cannot support the application of an evidence-based assessment (HTA) framework. ART exemplifies the contextual nature of HTA and the challenge to researchers and policy makers in generalising the evidence from which to localise the decision.