Egg donation has been utilized to help infertile couples since the early 1980s. Donor egg IVF utilization has continued increasing as more couples delay childbearing until their late 30s and 40s. In the United States in 2009 there were over 15,000 cycles using fresh donor eggs reported to SART (Society for Assisted Reproductive Technologies) from their member clinics. Links to the SART and CDC IVF and donor egg success rate reports

Until the last few years all donor eggs cycles were done with fresh eggs retrieved and fertilized the same day with the male partner’s sperm. Over the years egg donation using fresh eggs has become highly successful at some fertility clinics in the US.

Live birth rates with fresh donor eggs are over 70% per fresh transfer procedure at the best egg donation clinics. Success rates at these same donor egg programs using fresh eggs are over 50% for live birth per transfer using a single embryo for transfer. This approach almost totally eliminates the risk for multiple pregnancy.

In recent years the techniques for freezing and thawing eggs have advanced significantly. As a result of these advances, success rates at some frozen donor egg banks has increased from about 10% success in the past to approximately 50% – at least this is what they claim.

Accordingly, business models have developed for frozen donor egg banks. Egg banks sell frozen donor eggs on a per batch or per egg basis. This can make the cost of using frozen eggs seem to be less than the cost of egg donation with fresh eggs. However, there are some significant problems with this approach.

1. Uncertain and relatively low success rates – with low success rates the cost per baby is actually higher
2. Uncertainty about long-term health issues for the children born from frozen eggs

(continue reading…)

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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• A few days ago SART (Society for Assisted Reproductive Technologies) released its 2009 IVF Success Rate Report
• This report comes out annually and provides clinic specific in vitro fertilization success rates for all SART member clinics in the US
• The report includes a national summary which shows national averages for IVF success rates broken down by the age of the female partner
• It also has live birth rates for IVF with donor eggs

This report is a useful resource for couples pursuing fertility treatment. Success rates are significantly different between programs. When you go through an IVF cycle you are not getting the same treatment at every program.

It’s not like going out and buying a Jeep:

• If there is a Jeep dealer closer to home, or a little cheaper – then a Jeep is a Jeep, so buy it there
• However, IVF is not a commodity
• IVF at one clinic may result in an average success rate of 25% while at another clinic it might be 60% for the same age group
• In vitro fertilization at “Clinic A” does not equal IVF at “Clinic B” – so do your research

Our IVF success rates
Our egg donation success rates

The clinics must turn in their data every year (to SART and the CDC)  in November for the IVF cycles performed during the previous calendar year. SART then takes a few months to prepare the report and publish the results on the web.

The CDC (Centers for Disease Control and Prevention), a US government agency, also publishes annual IVF success rate reports

• However, release of the CDC report is delayed by about 8 to 10 months after the SART report
• The CDC’s report is more comprehensive and includes more clinics with additional analysis of data beyond clinic success rates
• The drawback of the CDC report is the additional delay before publication

To go to the 2009 SART report and check IVF live birth success rates for any SART member clinic, follow these steps:

• Click this link: www.sart.org
• Click on the orange button “IVF Success Rate Reports”
• Click on the state that you want on the US map
• A list of all SART member clinics in that state will come up
• Click on the clinic you want to see results for
• Click next to “ART Data Report” (at the bottom) and that clinic’s IVF success results for 2009 will come up

Study the report in the area relevant to you – own eggs and age 40, or donor eggs, etc. If a clinic is missing from the SART or CDC reports it is probably a bad sign. Find out why they did not report – or go elsewhere. Buyer beware.

If you check the success rate information for a clinic you are considering for treatment and find that they are low compared to national averages or other clinics in your area – go to a clinic with higher success rates. It would likely increase your chance to have a baby with IVF.

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.

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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Cherry Picking?

I see a lot of couples that fail IVF at other in vitro fertilization programs and then come to us for their 3rd or 4th or 5th IVF attempt. They seek an IVF clinic that can give them a better outcome. Recently I’ve been hearing a similar story from couples that have failed at certain other IVF clinics in the Chicago area.

What to do if your first IVF cycle fails

These couples asked their fertility doctor why our clinic (Advanced Fertility Center of Chicago) has higher IVF and donor egg success rates than they have. They have been told that “Dr. Sherbahn cherry picks the best patients and does not treat patients with a low chance to get pregnant”. In other words they are accusing me of turning patients away with a low chance for pregnancy in order to cherry pick only the best patients and thereby artificially pump up our success rates.

It is a total crock. Patients that fail IVF again and again are likely to do IVF related research on the internet. They will find the CDC and SART websites where they can see if another clinic in their area has better pregnancy rates than the program where they failed.

How to research IVF success rates at US clinics

• People are often motivated enough at that point to drive farther to a clinic that might give them a better chance for success.
• Therefore, people that fail and often have egg quality problems or other issues holding back their success will tend to switch to programs with higher success rates after they have done research.
• This results in programs like ours with higher than average success rates getting more patients with previous failures - which tend to be the most difficult cases.
• As a result, we will get relatively fewer “easy” cases

We do not send patients away or tell them we will not do IVF on them unless they are menopausal or otherwise clearly have a very low chance of success. I believe that if the couple has about a 5% or better chance of success and has been educated about their chances – we should allow them to cycle here. Taking patients with a 5% chance of success is certainly not “cherry picking”

• Some fertility specialists with big egos and poor quality IVF programs either just can’t accept the fact that their IVF programs aren’t very good – or perhaps they’re in denial and really believe that other programs have better success rates because they “cherry pick”
• Either way it’s pitiful

The clinics with low success rates often say that the reason IVF success rates are different between clinics is because:

• Patient populations are different between clinics
• Criteria for canceling IVF stimulation cycles are different
• The number of embryos transferred is different
• The percentage of single embryo transfer cases performed is different

Because these things can be different between clinics they claim that comparing success rates is not valid. However, just because comparisons are not perfect does not mean that comparisons should not be made. We cannot expect 100,000 IVF patients coming to 500 clinics across America to all have equal potential for a successful pregnancy. Every case is different, every egg and every sperm is unique and even the uterus can vary to some extent.

• However no clinic gets all the good cases, and no clinic gets only bad cases
• A mix of patients will present themselves to every clinic for treatment

If we look at success rates of clinics in the US according to the CDC and SART 2008 data sets (see graph below), we see a range of live birth success rates for cycles using fresh donor eggs from 25% to 81% per transfer. The national average for 2008 was 55% per transfer.

Our donor egg success rates

(continue reading…)

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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Single embryo transfer is an up-and-coming more commonly utilized procedure in the field of in vitro fertilization in recent years. There has been a push for several years to reduce the number of multiple pregnancies by reducing the number of embryos transferred with IVF. However, the push to do elective single embryo transfer is opposed by most couples that do IVF in the US.

It is a simple problem without a simple solution:

• Single embryo transfer success rates are lower than when 2 are transferred
• Couples want a baby (or twins) ASAP, and they don’t want to pay for multiple IVF attempts
• They fear failing to become pregnant more than they fear the risks from a twin pregnancy

This dilemma is often due to the fact that the large majority of patients in the US are self-pay for all costs associated with IVF. In the US the average cost of IVF is about $10,000 (for monitoring and procedures) and about $3500 for the medications. With these high costs, couples will often push for at least two embryos for transfer – even if the female partner is young.

Guidelines from the American Society for Reproductive Medicine (ASRM) were established many years ago for the maximum number of embryos to transfer (see table below). These guidelines take into consideration the age of the female and other criteria that help predict risks for having a multiple pregnancy.

ASRM guidelines have been modified over the years – with the recommended maximum number for transfer being reduced each time. I believe that the ASRM guidelines on the maximum number of embryos for transfer are excellent.

See PDF document with ASRM transfer guidelines

Currently the guidelines suggest a maximum of 1 to 2 embryos to be transferred for a female partner under 35 years old if the transfer is being done on day 2 or 3 – and a maximum of one embryo to be transferred for that age group if the transfer is being done on day 5. These maximum numbers are for patients considered to have a “favorable prognosis”.

When female age is over 35, the maximum number of embryos allowed increases. Everyone knows about the Octomom mess – a situation where a physician went way overboard – with a patient that was just as far out there…

Favorable prognosis would be couples having their first IVF attempt, good embryo morphology scoring, left over embryos available for freezing, or a previous successful IVF cycle. The guidelines allow transfer of additional embryos for patients that have a less favorable prognosis.

When single embryo transfer is performed, blastocyst embryo transfer on day 5 after fertilization appears to be the best method. Embryos that have continued developing normally to the 5th day have a higher chance of implanting than do day 3 embryos (on the average).

• Learn more about blastocyst transfer and multiple pregnancies
• Learn about day 5 blastocyst embryo grading

(continue reading…)

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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There are some in vitro fertilization clinics in the US that market aggressively for mini-IVF or micro IVF (also called mild or minimal stimulation in vitro fertilization). Some claims regarding the benefits of mini-IVF are exaggerated or completely untrue. This post clarifies some issues regarding standard vs. mini IVF.

Mild IVF (or micro, or mini IVF) seems to be slowly growing in popularity over the last few years. Is it a good fertility treatment?

• The basic concept is to do in vitro fertilization after a low level of ovarian stimulation with oral medications (possibly with some “low dose” injectables as well).
• This is in contrast to the usual method of ovarian stimulation for IVF which involves more aggressive stimulation of the ovaries with multiple injections over about 8 to 15 days.
• The standard method of stimulating is done in order to try to get about 10 or more eggs to work with for in vitro fertilization.
• The IVF cycle cost for mild IVF (including medications and everything) should be less than the total cost for standard in vitro fertilization
• However, the success rates for standard IVF are much higher
• Success rates with mild in vitro fertilization are much lower – often in the range of about 5% to 15% per attempt, depending greatly on the age of the female

Why do we try to get so many eggs for “standard” IVF?

IVF success rates are much higher with a “good” number of eggs due to the substantial drop-off that is seen in early embryo development.

The chart below shows the average number of eggs, mature eggs, fertilized embryos, “good” embryos on day 3, blastocyst embryos on day 5, etc. in three age groups of women at our clinic.

• If there are extra embryos available for freezing, we freeze on day 5 and day 6 (possible freezing shown by purple arrow going up).

As shown in the chart, in the average case there is progressive drop-off over time with in vitro fertilization. Human reproduction is not extremely efficient – if we were mice or cows we would be efficient reproducers. Alas, we are not so lucky – we are stuck being human…

• We expect drop-off in the eggs and embryos in the fertilization and development process
• Therefore, having more eggs at the beginning makes it more likely to have at least one embryo at the end that is strong enough to make a baby
• Read more about the IVF process and how it increases efficiency of human reproduction

(continue reading…)

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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In the United States it is very easy to investigate IVF success rates for all in vitro fertilization clinics

There are two websites that report IVF success rates annually to the public:

• CDC website (Centers for Disease Control and Prevention)
  • CDC is a US government agency
• SART website (Society for Assisted Reproductive Technology)
  • SART is an organization dedicated to the practice of IVF in the US
• Links to these sites that report IVF success rates

The CDC IVF Success Rate Report for 2008 report has not yet been released. In vitro fertilization statistics are currently available from the CDC for 1999 through 2007.

In late February 2010 the Society for Assisted Reproductive Technology (SART) released the IVF Success Rate Report for 2008 cycles.

The SART report is released every year on the web and is available to the public. Almost all reputable in vitro fertilization centers are members of SART. Members are required to submit their in vitro fertilization data annually. Each clinic has its own listing page that shows its success rates on the SART website.

To view any clinic’s success rates through SART:

1. Go to the SART website
2. Click on IVF Success Rate Reports
3. On the map, click the state that you are interested in.
4. A list of all reputable SART member clinics in that state comes up.
5. Click on any individual clinic – a page called “Clinic Contact Information” appears. At the bottom click the link next to “ART Data Report”. You will go to a page showing that center’s in vitro fertilization success rates for 2008.
6. To see the center’s IVF statistics from a previous year, use the pulldown menu at the upper left where it says “Select Year”.

Although clinics with low success rates don’t mention it, there are large differences in success rates between clinics

There are number of reasons for this, but the biggest difference between different clinics is the degree of quality control within the system.

Patients often ask me why our success rates are so high. The answer is simple. (continue reading…)

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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What are the issues with freezing eggs to preserve fertility?

Can you freeze eggs in an attempt to preserve fertility for a future pregnancy?

• Yes, egg freezing (oocyte cryopreservation) is being done – some women freeze eggs to try to reduce the impact of aging on fertility
• Success rates for IVF with fresh eggs are high in young women
• Success rates for IVF using frozen eggs are generally much lower – but are improving. This technology is rapidly evolving.

There is currently controversy about:

• Who should be offered egg freezing?
• What should women of different ages be told about their chances for having a baby with frozen eggs?
• Are women who freeze eggs well informed about the chances to have a baby in the future with their frozen eggs?

What do recent studies show regarding pregnancy success rates using frozen eggs?

Egg freezing is relatively new

• IVF with fresh eggs has reportedly resulted in the birth of about 3 million babies worldwide
• IVF with frozen eggs has resulted in the birth of about 2000 babies worldwide
• Studies continue to investigate whether the older “slow freezing” technology or the newer method of “vitrifying” eggs will be better

Older studies

• Studies from the 1990′s to early 2000′s showed pregnancy success rates with frozen eggs of about 2% to 10% (live birth rate per embryo transfer cycle).

Recent studies

• A recent study from an Italian group found similar fertilization and embryo development rates of vitrified versus fresh eggs. Vitrification is a relatively new freezing method.
  • This study involved 40 cycles in women (average age 35.5)
  • The ongoing pregnancy rate (beyond 12 weeks of pregnancy) with vitrified eggs was 30% per cycle.
  • This is a good rate since only 3 eggs can be inseminated under Italian law.
    • Study by L Rienzi, et al, Human Reproduction; January 2010

• A 2009 study of 23 IVF cycles using frozen eggs (average age 31.5)
  • There were 14 pregnancies, 1 miscarriage and 13 ongoing pregnancies (57% per transfer)
    • Study by J Grifo and N Noyes, Fertility and Sterility; May 2009

• A large multicenter Italian study compared IVF using fresh vs. frozen eggs
  • Italian IVF clinics tend to have lower success rates because only 3 eggs can be inseminated per cycle (by law)
  • They compared 2209 cycles with fresh eggs to 940 cycles with frozen eggs
  • The success rate was halved using frozen instead of fresh eggs
  • 748 thawing cycles in women less than 39 years old (average age 33.6)
    • Live birth rate per transfer with frozen eggs was 13.3% (age < 39)
  • 192 thawing cycles in women 39 and older (average age 40.5)
    • Live birth rate per transfer with frozen eggs was 8.1% (age 39+)
  • Study by A Borini et al, Fertility and Sterility; January 2010

(continue reading…)

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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Our society has undergone significant change since the 1960s. Women’s liberation is definitely a good thing. Women can now do pretty much anything that a man can do. However, the one thing that they cannot do is delay childbearing as long as a man can.

Our society has evolved and many women are pursuing advanced educations and career advancement – and delaying childbearing as a result. However, in general women should be more knowledgeable about the impact of delaying childbearing on fertility potential.

Fertility specialists know this is a problem. We commonly see women in their late 30s and early 40s that are very bright and well-educated who are surprised and very disappointed when told that it may be very difficult (or impossible) to get pregnant and have a baby using their own eggs.

I like to use a “garden” analogy when discussing infertility with patients. The uterine lining is the “garden”  and the embryos are the “plants”. As women age, the garden is rarely the problem – the plant is often the problem. This is why using donor eggs is so successful regardless of the age of the recipient woman. (continue reading…)

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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We know that chromosomal abnormalities in eggs are responsible for fertility problems – particularly when the woman is in her late 30s or 40s.

• An abnormal number of chromosomes is referred to as aneuploidy
• Aneuploidy causes the increased rate of miscarriage with aging
• Aneuploidy is responsible for most of the decline in fertility with advancing age (both with and without IVF)

In recent years research has shown the importance of a structure in the egg called the meiotic spindle. This spindle is involved with aligning chromosome pairs so proper division of pairs can occur during egg maturation.

• As women age they are more likely to have an abnormal spindle apparatus that does not efficiently line up chromosomes prior to division
• This causes a higher likelihood for an unbalanced chromosomal situation in the mature egg – and then in the embryo

A recently published study (referenced below) might help us to understand why some women have more chromosomally abnormal eggs at a given age. This study was performed in mice, but may well have relevance for human reproduction as well (in many ways we aren’t as different from mice as we might like). (continue reading…)

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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Age and female fertility and waiting to have babies

• A recent report on the average age at first childbirth from the CDC’s National Center for Health Statistics showed that as of 2006, women in the US waited an average of 3.6 years longer to have their first baby, as compared to 1970.

• There is not enough discussion in our society about the effect of age on fertility.

• Women’s liberation is a good thing and women have made very significant advances over the past 40 years. Many women are pursuing advanced education and careers.

• However, there is a potential “disconnect” involved. Women are waiting longer to have children – but many are not educated about what that delay can do to their fertility.

These days, many couples try to have their first child when the woman is in her mid-to-late 30s. Some will get pregnant easily, and others end up needing fertility treatments. (continue reading…)

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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