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

Currently, success rates using frozen donor eggs are not well documented – or consistent between different centers. There are certainly babies being born from frozen eggs. However, the number of births is tiny in comparison to the many thousands of births using fresh donor eggs that occur every year in our country. There are very few published reports on live birth success rates per cycle using frozen donor eggs.

A few egg bank centers claim to have success rates above 50% with frozen donor eggs. However, other clinics using frozen donor eggs are not saying anything about their live birth success rates – and this is not being tracked and reported publicly by SART or the CDC at this time. In my opinion, the use of frozen donor eggs is an area in our field with a high likelihood for couples to pay a lot of money for something with (at best) very uncertain results.

The business model for selling frozen donor eggs can be attractive for those interested in recruiting donors, stimulating them, retrieving the eggs and freezing them for later sale to recipient couples. This is very similar to the current situation for donor sperm banking.

The big difference is that sperm freezes and thaws quite well but eggs are much larger cells and do not tolerate the freezing and thawing process well. Because of the damage to the egg that can occur with the freeze/thaw process, success rates with frozen eggs are generally reported to be significantly lower than with fresh eggs.

Another concern is the potential for birth defects or other problems in the children arising from frozen eggs. It is very possible that this will not be a problem at all. However, at this time there are not enough studies that have looked at the long-term health of the offspring using frozen eggs to make a thorough assessment of whether there are negative consequences for the resulting children.

Donor sperm is been frozen and kept in quarantine for 6 months, then the sperm donor is retested for infectious diseases. If the repeat testing for infectious diseases is negative then the sperm can be released from quarantine for use.

The sperm quarantine process should eliminate the risk of infection from virus (such as HIV) in the semen because it allows time for antibodies to develop in the donor within the 6 month quarantine time. The repeat testing of the sperm donor would find the antibodies and the sperm would be disposed of.

As far as I know, there has never been a case of an infectious disease passed on through transfer of a donor egg. With hundreds of thousands (possibly millions) of egg donation cycles performed worldwide over the past 30 years, the risk is extremely low for any significant infection to be transmitted with fresh egg donation.

Therefore, we should not think we need frozen egg banks in order to reduce the risk of infectious disease transmission – because this does not seem to be a significant risk. It appears that the main reason that frozen eggs are used for egg donation at this time is that it suits the business models for some providers of fertility services.

Egg banks could also provide a convenient way for couples to search online egg donor databases to find a suitable donor. However, I suggest that this is not a good reason to move from the tried and tested, safe and effective method of fresh egg donation.

The best approach is to continue using fresh donor eggs until:

1. Research demonstrates that using frozen eggs is a safe procedure for the resulting children
2. Success rates with frozen donor eggs are better documented for the clinics providing that service

Consumers of egg donation services should certainly know if they are paying their money for a a 70% expectation to have a baby – or only a 10% chance for  success.

Another way to say it is, “If it ain’t broke, don’t fix it”.

Our donor egg success rates

Our egg donation costs

See our list of available egg donors

How to donate an egg

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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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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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

Egg donation cycles should be homogeneous with little chance for “cherry picking”. This is why I use donor success rates here for comparison.

• Egg donors are generally quite young – usually under 35 years old
• The recipients tend to have an a normal uterus – a low percentage of patients have uterine problems
• It is therefore unlikely that uterine problems would be a significant factors affecting a clinic’s overall egg donation success rates
• So how can we explain the dramatic differences in success rates between clinics doing egg donation?
• The differences are not due to the quality of the donor’s eggs or the recipient’s uterus or the number of embryos transferred
• These variations in success rates are a result of differences in treatment protocols and quality control in the IVF labs

Execution from beginning to end is critical:

• Proper regulation of IVF stimulation of the egg donor and the recipient properly
• Performing the egg retrieval procedure expertly and at the right time
• Many variables exist in the in vitro fertilization laboratory which impact the quality of the embryos
• Choosing the proper high quality embryos for transfer
• Properly performed embryo transfer using ultrasound guidance is critical for a good outcome

Can there be differences in patient selection and other factors for egg donation cycles?

• Yes

Will these differences have a substantial impact on success rates?

• No. This is why egg donation is an excellent model for comparing IVF clinics.

Consumers of fertility services should go to the CDC and SART websites and study egg donation success rates of the programs that they might consider going to for IVF or for egg donation. This is a way to compare IVF clinics which pretty much eliminates the “cherry picking issue.

• So to the fertility doctors that accuse other doctors with higher success rates of “cherry picking”, I say:
• Stop whining and put your energy into fixing the problems in your own IVF program instead of making excuses for why another clinic is doing better than you are.
• Or consider quitting IVF and focus on artificial inseminations and infertility surgery

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

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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

So if we do mild IVF and we only get a few eggs instead of a larger number as in standard IVF, do we still get enough to end up with a good pregnancy success rate?

• The short answer is no. On the average, low egg numbers will translate over to low chances for success.
• With mini or micro-IVF:
  • The IVF stimulation process is easier for the woman
  • Medications are cheaper
  • The cost for one cycle of IVF should be substantially less
  • But the pregnancy success rate is much lower compared to conventional in vitro fertilization
  • What good is cheap and easy if you don’t have a baby?

What is the best number of eggs to get?

• The answer depends on what the goal is
  • > 10 eggs = The highest possible chance for success – and likely to have leftover embryos for freezing
  • 5-9 eggs = Slight to moderate reduction in the fresh cycle success rate – and reduced chances for having leftover embryos for freezing
  • 1-4 eggs = Substantially lower success rate, particularly in older women – almost never any leftover embryos for freezing
  • The chart below shows our live birth rate per egg retrieval procedure by age group and number of eggs retrieved
  • Read more about number of eggs and IVF success rates by age

Let’s review some of the claims made by some US IVF doctors that are pushing mini-IVF

• Claimed by some fertility doctors: “Mini IVF is a cost effective treatment option for young women attempting to conceive”.
  • This depends on how you measure “cost-effectiveness”. If the total cost for a successful cycle (baby) is the measure, then mini-IVF will not measure up to the cost-effectiveness of conventional in vitro fertilization at a clinic with high IVF success rates.
  • For example, if it costs half as much for the IVF cycle (including all medications) but the success rate is 1/4 of standard IVF at a good program – then it is not “cost-effective”. In this example the average cost per live birth would be twice as much for mini-in vitro fertilization as for standard IVF.

• Claimed by some fertility doctors: Mini-IVF is a dramatically lower cost option that simplifies IVF for patients and maintains the same success rates”.
  • It’s not polite to call another doctor a liar, but this is simply not true. Unfortunately, not all fertility doctors tell the truth.
    
  • Mini or micro IVF has a much lower chance of success for the large majority of couples.

• Claimed by some fertility doctors: “For older patients, the success rate with micro-IVF is even higher than with conventional IVF”.
  • This is generally not true. As shown in the chart above, our in vitro fertilization program had a 7% live birth rate per egg retrieval procedure for women 41-42 if they had 1 or 2 eggs vs. 35% if they had over 10 eggs (yellow columns on chart). Mini-IVF tends to produce low egg numbers.
  • However, it is possible that the success rate would be similar for standard and mini-IVF for the subset of women that respond very poorly to aggressive stimulation with standard medication protocols.
    • Either method would be likely to give them a low number of eggs to work with and a low chance for success.

Mild IVF is a reasonable option for some patients

• However, in the US it is a situation of “buyer beware” as it is being aggressively sold by some clinics using sales pitches full of hype and little truth.

PR: wait… I: wait… L: wait… LD: wait… I: wait… wait… Rank: wait… Traffic: wait… Price: wait… C: wait…

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

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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.

• We invest in the best technology and work hard to maintain ideal quality control
• It is much easier to do “average IVF” than it is to do “high quality IVF”
• High quality ovarian stimulation for IVF can result in better egg quality
• High quality embryo culture in the lab can result in better embryo quality
• High quality embryo transfer procedure to put them back in the uterus results in a higher chance for embryo implantation

Some clinics in the Chicago area tell patients that our success rates are high because of our “patient selection”. They say that “Dr. Sherbahn gets the easy cases” and that their center gets more of the difficult cases. This is absurd.

• After couples check success rates on the CDC or SART websites, they do not gravitate to clinics with low success rates.
• They do the exact opposite. They go to clinics with higher success rates – and avoid further treatment at clinics with low success rates.
  • The effect is that clinics with higher success rates get a mix of more difficult cases compared to clinics with low rates.
• The more times a couple has failed in vitro fertilization, the more likely they are to check success rates online to research their options.
  • Learn more about what to do if your first IVF cycle fails

So do your research before you do your IVF

Look up the live birth success rates on the SART or CDC sites and make an informed choice – before your first cycle. I suggest that you trust your in vitro fertilization cycle to a clinic with success rates at or above the national average.

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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The Society for Assisted Reproductive Technology (SART) released its version of the report on 2007 IVF cycles several months ago. However, clinics are not required by law to report to SART. They are required to report to the CDC. Therefore, the CDC report shows success rates for more clinics than the SART report does.

The CDC report covers data from 430 fertility clinics. Over 142,000 assisted reproductive technology (or IVF) cycles were done at these “reporting clinics”.

There were (as always) some fertility clinics that broke federal law and refused to report their data. These IVF clinics are referred to as “non-reporting clinics”. If fertility doctors will go so far as to break federal law to keep their IVF outcome statistics from the public – those “non-reporting clinics” most likely have very low success rates.

Before you choose a fertility clinic for IVF – check success rates.

Links to both the CDC and the SART IVF success rate reports

See our IVF success rates

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

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Learn about blastocyst transfer

Couples with infertility often need IVF to get pregnant.What should they know about IVF clinic success rates?

• An interesting and unusual aspect of IVF is that there is a definitive outcome for each procedure.
• When an IVF cycle is done there is a baby born from it – or there is not. Therefore, keeping track of (and comparing) IVF live birth success rates is very straightforward.
• Medical treatments in general rarely have such “black and white” outcomes.
• Another unique aspect of IVF is that (in the US) all IVF clinics are required by federal law to report their in vitro fertilization success rates annually to the government. The CDC, a US government agency produces a report called the “Assisted Reproductive Technology (ART) Report” detailing IVF success rates for all individual clinics.
• This report is commonly called the CDC IVF success rate report. It is released to the public on the web every year (usually in December or January).
• Another useful report, the SART report (Society for Assisted Reproductive Technology), is very similar to the CDC report – and it is released about a year earlier. However, clinics are not required by law to report to SART – so some clinics are not listed there.
• These 2 annual reports allow consumers to view and compare IVF success rates for reputable fertility clinics.

Common excuses used by fertility clinics with low success rates:

• “We take a lot of very difficult cases that clinics with high success rates turn away”
• “We take women with high FSH levels that will have low IVF success rates”
• “We have a high percentage of cases that have failed IVF multiple times”

What is wrong with these excuses?

• Few fertility clinics would turn away a significant number of couples because they are “difficult” cases with a low chance for success. Couples with fertility issues are savvy and would complain to their OB/GYN doctor, to their friends, etc.  The word would get out, and it would damage the clinic’s reputation.
• Also, most docs in this field believe in doing their best for every couple – regardless of their FSH level, etc. The goal is not to artificially “pump up” their own clinic’s success rates by excluding difficult cases.
• Patients that fail IVF and realize they have more significant fertility issues are the ones most likely to do internet research and compare IVF success rates.
• After failing IVF and then comparing success rates of numerous clinics, they are unlikely to choose a clinic with below average success rates for their next IVF cycle.
• The more IVF failures, the more motivation to seek a clinic with better success rates, even if it requires more travel.

Learn about what to do after failing an IVF cycle

Why do some IVF clinics have higher success rates?

• Why do some restaurants serve better food than others?
• Why are some models of cars more reliable than others?
• Because the work is done with precision and high quality control standards.  
• Expert and precise maintenance of quality control during the ovarian stimulation process, in the IVF laboratory, and during embryo transfer will maximize IVF success.
• We can’t do much (just good ovarian stimulation) to change the raw materials (eggs and sperm).
• However, we can work hard to expertly culture, select and transfer the best embryos.
• There are not any secrets involved in high quality IVF.
• It is not about patient selection.
• Some clinics work harder – and do better at getting it right.

How to improve success rates of IVF?

• Utilize the excellent resources on the CDC and SART websites.
  • Study in vitro fertilization success rates for fertility clinics in your area.
• You probably will have a better chance for success at a clinic with a high success rate.

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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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