Fertility Success Rates

Why doesn’t SART Want You To Compare Success Rates Among Clinics?

Censored IVF Success RatesDo you know that the largest group of fertility clinics in the United States doesn’t want you to compare their IVF success rates? This organization, SART, actually restricts member clinics from comparing their own success rates to other clinics or even to the National Average.

There should be a variety of factors that go into making an educated decision concerning fertility treatment. Why would this powerful group want to keep such an important piece of data out of that equation?

Continue reading Why doesn’t SART Want You To Compare Success Rates Among Clinics?

Looking beyond Fertility Clinic Success Statistics

IVF Statistic Manipulation and How to Discover it

Fertility Clinic Success Rates can vary dramatically based on a doctor's approach.Critics of using IVF success statistics like Live Birth Rate Per Transfer as a method of evaluating the quality of a fertility clinic say that statistics can be manipulated. There is no doubt that this is being done. But is the answer really to prohibit comparison?  Isn't it more desirable to expose these manipulations and educate prospective patients on how they can be detected? Many medical professionals would say that most patients are not capable of making this kind of detailed analysis. Really, they say that.

I have seen plenty of examples where savvy patients are digging deeper into the data to make highly informed treatment decisions. The purpose of this post is to encourage that deeper investigation by shedding light on how some clinics may act to protect their success rate data. Let's educate instead of obfuscate.

Background

Consider that there are two broad groups of fertility patients seeking treatment at IVF clinics. One group has an ideal diagnosis; the couple has been trying to get pregnant for 6 to 18 months and have no major indication that IVF will fail. This ideal patient group has the best possible chance of successful treatment. Their doctor recommends IVF and is pretty confident that the couple will have a baby on the first try.

On the other side, there is the second group of patients who do not have such a great diagnosis; maybe they had a few failed IUI cycles and are dealing with some issues like advanced maternal age or Endometriosis. In this situation, the doctor is sometimes inclined to recommend other treatment options such as egg donation or even surrogacy. Despite this advice, some patients will insist on trying IVF with their own eggs, totally aware of the very limited chance for success.

The doctor now has to make a decision. He or she can take on the challenge of a difficult case and help the couple go through IVF, which will most likely lower the clinic’s success rates. The other path is to insist on other treatment options and refuse IVF. This course of treatment will most likely be successful and not harm the clinic's success rates. Of course the patient can always seek treatment at another clinic, which is willing to perform IVF despite the odds.

The doctor's decision can be made with good intention in wanting a successful outcome for the patient or less than noble intention in only wanting to preserve the clinic’s success rate. Letting the couple go through IVF despite the great chance of an unfavorable outcome can show that the doctor is compassionate and cares more about the patient than the clinic's success rates.

However, the flip side of insisting on going straight to egg donation can be seen as more compassionate because it will save the couple time, struggle and cost associated with an IVF cycle that will most likely fail. It is really the question of how many patients a clinic has in this most challenging group, the course of action they take and the intention in taking that action. As we can never really know the true intention behind the action, the following should only be seen as potential indicators of manipulation. As always, a direct conversation with the physician you are considering is critical to making the most informed treatment decision possible. 

What are the indications of the degree to which a clinic is protecting their success rates?

Average Number of Embryos Transferred: With very good reason, one big objection some experts have with using Live Birth Per Transfer as a measurement of success is that it will encourage physicians to engage in risky practices like transferring a high number of embryos to increase the chances of a successful outcome.

Total number of IVF Cycles: One indication is the total number of IVF cycles in the high maternal age groups. If the numbers are low in the age groups 38 to 40 and 40 to 41, the clinic could be cherry picking IVF cases to preserve success rates.

Number of IVF Cycles Per Age Group:
The likelihood of success is greater the younger the age of the woman. While it is true that there are generally more younger women seeking treatment, if a clinic has a significantly disproportionate number of their total cycles in the age group for women < 35, it may mean that they are turning down prospective patients of advanced maternal age in an effort to increase their overall

Percentage of Canceled Cycles: An IVF cycle can be canceled by either the physician or the patient. There are a number of reasons a cycle could be canceled. One reason is that the physician refuses to attempt transfer of embryos after the initial egg retrieval. Since Live Birth Per Transfer is a closely monitored statistic, canceling an IVF cycle before attempting transfer will preserve this number while still keeping a high total number of cycles.

In conclusion, there are two sides to the story. Clinics that have low success rates may say they don’t manipulate their success rates, and instead, listen to their patients. Clinics that have good success rates but low numbers of patients of advanced maternal age or higher numbers of egg donor cycles may defend themselves by saying that they are not taking a couple's money for treatment that has a low chance of success, which is also a noble reason.

So, what do you think? Are there other forms of data manipulation that you have come across? Post a comment. Let's talk about it.

IVF Success Rates Frequently Asked Questions

Doctor with baby

After three years of running this site, we have fielded dozens of questions about IVF Success Rates. Here are some of the most popular ones. Have a question that isn't here? You can ask it in the comments section and we will do our best to get it answered.

Why are the most recent published success rates on SART two years old and on CDC three years old?

IVF success rates are based on live births and counted in the year the IVF cycle was started not the year of birth. For example, if a woman had a successful IVF cycle in December, SART gets the IVF success data from fertility clinics at the end of the following year, and counts that woman's baby as a successful IVF case for the previous year. Because of popular demand, SART started to publish this data on their website a few years ago. However, the SART data is not verified by any third party agency. The Center for Disease Control (CDC) and other Government offices take about 12 months to verify, analyze and compile the data and publish the verified fertility success rates in the first quarter of the new year in the ART (Assisted Reproductive Technology) section of the CDC's website. The CDC is three years old at the time it is published.

Why do you compare the life birth rates than pregnancy or implantation rates?

As an example, in 2005 there were 97,442 IVF cycles using fresh embryos across all age groups. Of those cycles, 34% got pregnant, but only 28% carried the baby to term and gave birth. That's a big difference! This site was built for IVF patients. Most of them want to know the chance of taking home a baby.

IVF doctors like to present you success rates based on pregnancies or even implantation rate. Pregnancy rates are based on a positive pregnancy test result in the first trimester. Implantation rates don't even factor in a pregnancy test. Both Implantation Rate and Pregnancy rate are going to be higher than the Live Birth Rate, that's why doctor's quote them so much. You, as a patient, however, want a baby. So we rate the clinics compared to Life Birth Rate.

Why do SART and CDC make it difficult to compare IVF success rates?

Good question. We have a separate post about that controversial rule here.

Still have unanswered questions about IVF success rate data? Great! Post them in the questions and we will do our best to get you an answer.

How to Improve IVF Success Rates

A few things you and your physician can do to improve IVF success.

There are a few factors you can influence in increasing your chances with IVF. Eat well, exercise, get enough sleep and reduce stress in your life among other things.

However, the most important factor to increase your IVF success is your decision in choosing a fertility clinic. Once you choose a fertility clinic, the outcome of your IVF treatment is mostly in the hands of the fertility doctor and his staff. They choose the IVF protocol, the medication with dosages and all the little details concerning timing, which you will follow exactly. That's why it is so important to look at IVF success rates! It can give you an indication of a fertility clinic's skill and expertise. So, be good to your body and wise in your decision of your IVF doctor!

How Fertility Doctors And Patients Can Improve IVF Success Rates

Ultrasound Guided Embryo Transfer: When physicians see where the embryo is placed, the chances are higher for you to get pregnant. Not every fertility doctor is using this technology.

Lower Stress level of the patient at the time of transfer: If you can afford it, you might consider having alternative therapy treatment like acupuncture or massage with your IVF cycle. Many clinics these days allow acupuncturists into their offices or even have one on staff to accommodate their patients. Fertility doctors shouldn't mind concurrent alternative treatment because it can help increase IVF success rates.

IVF Success Rates with Donor Eggs: If you are using donor eggs, your age does not play a role in determining your chances of IVF success. No matter if you are 35 or 45, your IVF success rate is turned into the one that applies to a woman in the age of your egg donor.

Advice for Egg Donation

When looking for an egg donor, go to an IVF clinic instead of a donor agency. An in-house egg donor program at an IVF clinic has to follow the strict guidelines of the ASRM when choosing egg donor candidates.

IVF clinics have a high interest in getting you pregnant because it directly affects the success rate which they must report annually. This means that, most of the time, only the best qualified candidates are chosen to be part of an IVF clinic's egg donation program.

Egg donor agencies work more independently with less oversight and some might admit egg donor candidates that have been denied at fertility clinics.

There are outstanding independent egg donor agencies and there are clinics with substandard internal egg donation programs. Fortunately you can verify the IVF success rates for an IVF clinic by examining their full IVF Clinic Success report at http://www.sart.org or http://www.cdc.gov/ART/. At this time, there is no nationally audited success rates report for independent egg donor agencies.

The information provided on this web site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her health professional.

Compare and review current IVF success rates.

SART vs CDC IVF Success Rates Report

Which IVF success rate data is more accurate?

IVF mother father and child

When looking at IVF success rates, you have two data sources available in the US.

1. SART: The Society for Assisted Reproductive Technology reports the most recent IVF success rates of their member fertility clinics. Their annual report is entitled "IVF Success Rate Reports" and is available at http://www.sart.org. Fertility clinics who are current SART members are required to follow SART guidelines, which includes the reporting of IVF success rates. However, not every clinic is a member and not every member submits their data to SART. The SART data is therefore not as complete.

2. CDC: The Center for Disease Control also provides an annual IVF success rate report called "Assisted Reproductive Technology (ART) Report" This report is compiled after an extensive verification and analysis and contains nice graphs and charts. The data is more complete and includes fertility clinics that didn't report to SART. However, the data is at least three years old because of the year long verification process. A lot of changes can happen in a clinic during a three year time frame. The CDC reports are available at http://www.cdc.gov/ART/ARTReports.htm

Since the SART data is more recent, our Comparative IVF Success Rate Reports are based on this data. We encourage you to view the complete SART and CDC reports for each clinic you want to evaluate.

Compare and review current national IVF success rates.

National Average Fertility Success Rates

Based on live birth rate as reported by the CDC

The Center for Disease Control does some extensive analysis each year to compile the data submitted by all practicing fertility clinics in the United States.

The latest report from 2008 shows that there were 475 reporting fertility clinics performing IVF treatment that year.

These 475 clinics reported a total of 148,055 IVF cycles. These cycles resulted in 61,426 infants being born!

Percentage of fresh, non-donor cycles resulting in live birth in 2008:

Younger than 35
35-37
38-40
41-42
41%
31%
22%
5%

 

Compare and review current IVF success rates.

Understanding SART and CDC IVF Success Rate Data

How to make sense of the Assisted Reproductive Technology (ART) Report.

The statistics provided in a fertility clinic's IVF success rate report can tell you a lot about that practice. Here are a few helpful tips on what to look for and what it may mean to you.

Total IVF Cycles Performed Per Year

Total IVF Cycles Reported

First you may want to verify that a fertility clinic is doing a good number of IVF cycles a year. You want a clinic that is proficient and experienced in the art of IVF. 120 total IVF cycles or more in one year is a good number. That means that they average more than 2 cycles a week, which gives you an indication that they routinely perform IVF procedures.

Fresh Embryos From Non-Donor Oocytes

Fresh Embryos From Non-Donor Oocytes

The group of patients counted here are couples who engaged in IVF using a fresh cycle. A fresh cycle means that their eggs were taken from the ovaries and inseminated in the embryology lab of the clinic,  put in an incubator to mature and then implanted back into the uterus. In these cycles, the embryologist or doctor picks out the best looking of the matured embryos to put back into the woman's uterus. The ones that show healthy development and look great under the microscope have the highest chance of implantation and pregnancy.

These cycles do not include the freezing and thawing that happens to the "leftover" embryos. Couples can use frozen embryos in a second try, but a lot of mishandling can happen during the freezing and thawing process and success rates are lower for the thawed embryos.

Of course, if you are evaluating a clinic for frozen transfer or will be using donor eggs, then you will want to focus on those numbers.

Success Rates By Age Group

Success Rates By Age Group

Younger than 35: Statistically, the highest chance of IVF success.
35-37: Still statistically favorable for a successful IVF outcome.
38-40: This segment shows the real talent of a fertility clinic
41 and beyond: This is an age category, where fertility doctors either tend to recommend egg donation or take on the challenges and perform IVF. Based on the number of cycles performed in this segment, you can tell the type of doctor you are evaluating. Low numbers (below 10) shows you that he/she tends to recommend egg donation to older women. High numbers (10 and more) shows you that they are confident enough to lead this age group through IVF despite the odds. 

Obviously the most relevant numbers are the one that correspond to your particular age group.

Percentage of transfers resulting in live births

Percentage of transfers resulting in live births

This is the most important number for your age group. It tells you how many cycles with transfers resulted in a baby. Sometimes there is an egg retrieval, but no transfer of the embryo(s). Sometimes an IVF cycle gets started, but cancelled for whatever reason. All of those scenarios are excluded in this number.

Every cycle that was completed has to have an embryo transfer. The percentage of transfers resulting in live births is the best way to evaluate a fertility clinic's IVF success rate. That being said, there are ways that the IVF data can be manipulated and you should consider this before you make your final decision.

Success rates are listed as a fraction when the total number of cycles in a segment is less than 20. SART and the CDC feel that with a low number of total cycles, success rates expressed as a percentage are too unreliable. For instance a clinic that performed a single cycle would have either a 100% or 0% success rate.

For a complete explanation of this please see the Latest CDC Assisted Reproductive Technology (ART) Report.

We have factored out any clinics with less than 20 cycles in a segment in our Comparative IVF Success Rate Report. However, we have provided success rate as a percentage on individual clinic report pages on this site regardless of the number of cycles. Please evaluate total number of cycles per segment when evaluating IVF success rates.

Average Number of Embryos Transferred

Average Number of Embryos Transferred

This can vary from age group to age group, and it strongly depends on the physician and your diagnosis. The national average is 2.3 embryos in the age groups up to 37 years old in 2006. This number should continue to decrease over time as IVF technology gets better.

The transfer of multiple embryos increases pregnancy success, but also increases the risk of multiple births. There was a study in 2005 that showed that birth rates are nearly the same with single embryo transfer instead of two-embryo transfer (Fertility & Sterility, December 2005). Also, in 2006 the ASRM revised their guidelines for the number of embryos to transfer to protect couples. The new guidelines recommend that no more than two embryos should be transferred for a woman under the age of 35 under normal circumstances. In fact, with the best diagnosis a woman age 35 or younger undergoing a fresh IVF cycle should be offered a single embryo transfer by her fertility doctor Read for yourself in this 2-page document published by ASRM: http://www.asrm.org/Media/Practice/Guidelines_on_number_of_embryos.pdf).

If your doctor recommends transferring more than what ASRM recommends for your age group, ask for a complete explanation to justify the higher number of embryos.

For complete reports provided by SART please visit http://www.sart.org.

For complete reports provided by the CDC please visit http://www.cdc.gov/ART/

Wondering why there are two different reports for IVF success rate data? Check our IVF Success Rates Frequently Asked Questions

Compare and review current IVF success rates.

Comments on the IVF Success Rates Website

Please post your comments, suggestions, and bug reports about the Fertility Success Rates web site here by clicking on the comments link below. Your feedback is greatly appreciated.

The New IVF Cost Calculator

We are pleased to announce our new IVF Cost Calculator web site. This personalized tool allows you to calculate the cost of treatment based on over 30 variables. The web site guides you through each choice, explaining each fee in common english. 

You can try the IVF Cost Calculator here:

http://ivfcostcalculator.com

We would love to hear your feedback below. Please leave your comments and suggestions by filling in the comments field below.

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