IVF Statistic Manipulation and How to Discover it
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.
The number of cycles don't seem to add up for many clinics. If you add up the number of cycles for each age group for Fresh Embryos, Thawed Embros and Donor Oocytes then that number should add up to Total Cycles. This mean that a group is not being represented in the data. The discrepancy rate at the top IVF clinics in which I've compared are any where from 1% to 13%.
What group of cycles am I missing?
@abarri Thanks for the great comment. At the moment, donor and frozen oocytes are not included in our reports. This is the reason why the total cycles != equal each of the age groups of fresh, non-donor cycles. In the future, we may add frozen and donor oocytes to our reports.
I don't understand.
There are sections representing cycles for Donor Oocytes in the Clini Summary Reports (Fresh Embryos and Thawed Embryos) and frozen oocytes (Thawed Embryos From Non-Donor Oocytes) for each age catagory. Those numbers were included in my sum. If they shouldn't be included my total would have been to high.
What your saying doesn't seem correct. Please explain further.
Correction: If they shouldn't be included my totals would have been way too low, making the dicrepancy rates even higher.
@abarri – So you are talking about the report that comes from SART, not the report contained on this site?
This is a good question and I am not sure on the exact answer, though I have a theory.
I am fact checking my theory and will post a new article when I have the answer.
Thanks again for the dialoge.
Yes, I am talking about the SART reports from hospitals in my area that have over 500 cycles reported.
I am interested in your theory and answer.
I am looking at the over 42 section – I am wondering if a good gauge of a clinic is there consistancy to get women in this age group pregnant, or is it a case of them cherry picking cases to look good.
Hi Jane: That’s a good question. There are a couple of things you can look at to try to figure out if there is cherry picking.
The first would be the number of cycles in the age group. The more cycles a clinic performs, the less likely that they are cherry picking.
You can also view more detailed data for each clinic using the “View Current Sart Report” link on each clinic’s profile page. The SART report has a lot more data, which can be overwhelming, but you are able to filter how many cycles the clinic has done for each type of diagnosis. From what I have read, Diminished Ovarian Reserve is one of the harder diagnosis’s to treat. I would think that any clinic with a high number of those cases would most likely not be cherry picking patients.
However, neither of these is a substitute for scheduling a consultation with the clinic in question. Go meet with them in person or, if possible, over the phone. See if they will take your case. I think that’s the only reliable way to know.