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What You Need to Know about Fertility Clinic Success Rates
April 29, 2013
Fertility clinics are mandated by the CDC to report the success of their in vitro fertilization (IVF) cycles each year. The CDC Assisted Reproductive Technology report containing these success rates takes approximately three years to compile. In addition, the Society for Assisted Reproductive Technologies (SART) and other resources like IVFreports.org aim to present accurate data which represents clinic success rates on the same plane. Although success rates are not intended to be a basis for comparison between fertility clinics, some would suggest that success rates provide a window into the operation of the clinic’s IVF lab. Many times these success rates are difficult for the layperson to interpret, however, so fertility patients should understand what each report says and the data most helpful for choosing their fertility clinic.
Success rates reported to the CDC contain information about the number and types of fertility treatment cycles performed. They are divided by age, use of a patient’s own eggs or donor eggs, and diagnosis. Success rates are presented as a percentage but the number of cycles performed, cancellation rate, and number of embryos transferred can influence a clinic’s success.
Success rates reported to SART are presented in a similar format, but there are specific guidelines for submitting to SART and not every fertility clinic reports to SART. Clinics that agree to be a part of SART are only able to present their success rates according to the established guidelines, so there is strong baseline data between clinics. Joshua Hurwitz, M.D. of Reproductive Medicine Associates of Connecticut says SART success rates are slightly more beneficial to the fertility patient because the reporting guidelines are strict and all data is represented on the same plane. “You want to compare apples to apples, donor egg success rates versus own egg rates, and success rates for a specific date range in which you are reporting. SART success rates cannot be manipulated in the same way CDC rates may be,” he says.
There are also resources like IVFreports.org which aims to present success rates in a way so that patients can easily understand and interpret the outcome of cycles at their fertility clinic. Jacques Cohen, Ph.D., embryologist and founder of IVFreports.org says that while CDC and SART success rates are not designed to rank or compare clinics, fertility patients often use the data this way. “It is nearly impossible for a layperson to understand the data reported by SART and the CDC and evaluating a clinic's performance. IVFreports was created to do this work for the patient and compare clinics as objectively as possible. There are a lot of special considerations behind the system used by IVFreports, such as maternal age, complexity of the patient population, and success per embryo transferred,” he states. Clinics are then scored according to safety and quality.
One of the most important factors to determining a clinic’s success is the number of embryos transferred. Dr. Hurwitz believes that the most advanced labs, qualified doctors, and skilled embryologists are able to transfer fewer embryos as recommended by the American Society for Reproductive Medicine (ASRM) in order to produce high success rates while making patient safety a priority. ”Embryo transfer is what separates the most skilled reproductive endocrinologists. The way you can prop up IVF success rates is by transferring more embryos for a higher chance of one sticking, but then the rate of high order multiples is going to be too high. Picking the right embryo and transferring just one embryo is the holy grail of IVF,” Hurwitz explains. Currently, ASRM advises fertility doctors to transfer no more than two embryos to a woman under 37, no more than three embryos to a woman 37-40, and no more than four embryos to a woman 40-42. Guidelines are more liberal for women over the age of 42, as fertility is further confounded by age.
Information about the number of embryos transferred can be obtained from the SART and CDC reports, but this information is not emphasized and presented in a way which demonstrates how number of embryos transferred could inflate a clinic’s success. Fertility patients should focus on the average number of embryos transferred at their clinic and the live birth rate to get a clearer picture of how the IVF lab operates. The “take home baby” rate is much more valuable to a fertility patient than knowing the clinical pregnancy rate, which may include ectopic or chemical pregnancies. “IVFreports has gathered publicly available statistics from [SART], and has made use of two key measurements: the average number of embryos transferred per cycle, and the average implantation rate per embryo. These parameters are on each page of the SART report for each clinic, but they are not emphasized. SART and CDC prefer to present live birth and pregnancy rate as the most important factors when evaluating a clinic. Those parameters are outdated and biased because clinics can transfer more embryos than is needed in order to inflate pregnancy results. The parameter IVFreports uses is implantation rate; the chance that one embryo will produce a pregnancy. The number of embryos per patient group provides information on how aggressive a clinic has to be in order to compete and have the highest possible pregnancy rate,” Cohen says.
It is important for fertility patients to consider all of the data and to choose the clinic that is right for them based on safety and efficacy. Understanding the difference between pregnancy rates and live birth rates is a small step toward choosing the fertility clinic that is right for you.
To find a fertility doctor in your area, contact our Patient Care Coordinators at 1-855-955-BABY (2229) or fill out the Contact Fertility Doctors Near Me form.