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

Do 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?

Who is SART?

The Society For Assisted Reproductive Technology (SART) is an organization of professionals from a variety of backgrounds dedicated to establishing and enforcing standards for fertility treatments like IVF. While more than 85% of IVF clinics in the United States belong to SART, membership is optional.

What does SART do?

SART members agree to follow a set of standards and guidelines. Failure to follow these rules can result in SART membership being revoked. For the most part, the rules act to protect fertility patients. For example, limits on the average number of embryos transferred per IVF cycle serve to minimize cases of high order multiples that can jeopardize the health of both mother and babies. Obviously these are good things and SART members should be commended on their efforts to adhere to these guidelines.

However, there is one SART restriction that I don’t think is in the best interest of the patient.

The Rule

In their Policy for Advertising by ART Programs, SART specifically prohibits member clinics from “using SART or CDC Clinic Specific Data for advertising/marketing that ranks or compares clinics or practices.” By strict interpretation, member clinics are not even allowed to compare their success data to the national average.

SART requires all member clinics to post the following when discussing success rates, “A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches and entrance criteria for ART may vary from clinic to clinic.”

On one hand both SART feels that the collection, verification and publication of IVF success rate data is important enough that it is mandated for all members. On the other hand, they specifically prohibit member clinics from helping patients use that data to make a more informed treatment decision!

The Reason

The official SART explanation for this restriction states that comparison may not be meaningful because of differences in patient populations, and treatment methods at each clinic. However, by that logic, comparing IVF success rate data between clinics may very well be an important indicator of the quality of the clinic.

Given that most IVF clinics treat patients from the same geographic region, are the differences in success rates between clinics in the same area a factor of the patient population or of the quality of the clinic? I think the latter sounds more plausible.

An explanation provided by some physicians in support of the comparison restriction deal with lack of patient understanding. They claim that the patients aren’t sophisticated enough to realize that there are many other factors which should go into a treatment decision.

Would you go to a clinic with a 60% success rate that transferred an average of 5 embryos per cycle when the suggested limit for women in your age group was 3? What about if their rate of high order multiple births (triplets or more) was double the national average? You are capable of evaluating more than one number at a time, right? Good. If clinics really think that patients don’t know enough to make an informed treatment decision, isn’t the answer education not restriction?

Another point frequently mentioned in favor of restricting comparison is that patient health may be jeopardized in the pursuit of high success rates. Again, the real answer to this valid point is to educate patients on the importance of Average Number of Embryos Transfered, and Percentage of High Order Multiples. Combine that with giving some teeth to the CDC so that they can influence states to revoke medical licenses in the event of gross violations and those fringe cases should decrease.

Finally, comparison opponents say that some clinics manipulate their success rate data and that it can’t be relied on as a result. This certainly happens. But is the answer to abandon comparison all together? Wouldn’t it be more constructive to educate patients so they become better at identifying manipulation?

The fact is that patients are already comparing iIVF success rate data and, as a result, most practices are greatly concerned with those numbers. Visit any popular TTC forum and you will find members freely delving into the success rate data and sharing that information.

From first hand conversations, many high quality IVF clinics would like to be able to so the same. The upside for patients appears to be far greater than the potential pitfalls. So why is it still prohibited?

The REAL Reason

It is my opinion that the larger, unspoken reason for this restriction is that at least 50% of SART members in a given year are going to be upset at the other 50%’s ability to compare success rates. So to keep peace among all members, SART prohibits comparison of success rates. It is my opinion that this is done for the benefit of SART member clinics and not for the benefit of their patients.

What Now?

I am working to make IVF success rate comparisons more accessible while educating patients on how to interpret the data more accurately. I can do this because I am not a member of SART. But that also means I can’t cast a vote in opposition to this policy.

I do hope that a daring group of SART members rises to challenge this unnecessary restriction. In the end, a more informed patient is generally able to make better treatment decisions and we should all strive to enable that.

Comments, questions, concerns? I would love to hear your feedback. Please just post a comment below and let’s keep the discussion going.