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…

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 both of 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.

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

Aging and female fertility issues

Many women pursue advanced education and career advancement – and delay childbearing. Fertility specialists commonly see women with fertility issues due to aging in their late 30′s and 40′s who  are disappointed when told that it may be too late to have a baby with their eggs.

When an “older” woman switches to using “young” donor eggs, she is very likely to have a successful pregnancy outcome. Some women are comfortable moving on to using donor eggs to have a baby. For others, using their eggs is critical.

Think of the uterine lining as the “garden”  and the embryos as “plants”:

• Aging does not compromise the garden
• Aging “weakens” the plant
• That is why success rates with egg donation are so high – regardless of the age of the recipient woman
• Egg freezing could let women extend their biological clock and delay childbearing for social or professional reasons.
• Women could “self-donate” eggs – freeze and store them for the future in case they age significantly by the time they want a baby.

Risks of egg freezing to the woman donating are low:

• Women are stimulated with medications as for IVF to produce multiple eggs prior to aspirating eggs from the ovaries and freezing.
• The rate of serious complication (severe ovarian hyperstimulation, serious bleeding, infection, etc.) is less than 1%.
• There is the risk that women might delay having children because they have frozen eggs that they expect to have success with. Some would have poor results later after thawing, fertilization and embryo development.

Questions and potential problems with elective oocyte cryopreservation to  delay childbearing

• Do the women have realistic expectations of the pros and cons and alternatives to freezing their eggs?
• What effect would deferral of childbearing with egg freezing have on our society if it becomes common?
• Will some fertility doctors mislead women about benefits of this process for their own economic gain?
• Is it proper to allow women to make their own decisions about using this new technology now, or should “social” egg freezing to extend fertility be reserved for the future – after we have better outcome studies?
• At what point is an “experimental” procedure done enough, understood enough, and researched enough so that it is no longer considered experimental?

The definition of ‘‘experimental procedures’’ according to the Practice Committee of the American Society for Reproductive Medicine (ASRM):

• “Procedures (including tests, treatments, or other interventions) for the diagnosis or treatment of infertility will be considered experimental or investigational until the published medical evidence regarding their risks, benefits, and overall safety and efficacy is sufficient to regard them as established medical practice.”

What is the position of the American Society for Reproductive Medicine (ASRM) regarding egg freezing?

It appears that the current position of the ASRM is:

• Egg freezing is appropriate for women with cancer and other medical conditions needing treatment that is likely to impair their fertility.
  • These women usually do not have any other good option for having a baby with their own eggs.
• ASRM currently discourages egg freezing for women who want to electively extend their fertility into the future. Apparently, this is due to concern that there is some risk, and could even be harm done by using new technology prematurely.
  • “Prematurely” means before both safety and efficacy have been reasonably established.
• When eggs are frozen, it should only be done with appropriate informed consent in an IRB approved study protocol.
• There is not enough data to properly inform women about chances for success using frozen eggs.
• There is not enough data to know if egg freezing might cause an increase in problems in children.

Conclusions about egg freezing

• Egg freezing for extending female fertility is showing great potential for the future.
• It is currently being used for women with cancer that need treatments that impair their future fertility.
• Some IVF clinics are offering social egg freezing to extend fertility.
• Although some recent studies report good success rates for IVF with “young” frozen eggs, there is little data on success rates using “older” eggs.
  • Women considering freezing eggs tend to be in their late 30′s and early 40′s.
  • We need more outcome data using frozen eggs in this age group.
• This is an evolving technology with important questions still to be answered before it is “ready for prime time”.

The Advanced Fertility Center of Chicago is currently involved in an IRB approved study on egg freezing using vitrification technology.

• Read more about our egg vitrification study
• Call us  for details about enrolling in this study.
  • 847-662-1818

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.

When an “older” woman switches to using “young” donor eggs, she is much more likely to end up with a high quality “plant”. The ability of the uterus to accept implantation of embryos does not decline significantly with aging (the older garden is receptive).

Sometimes when in vitro fertilization (IVF) is not successful, women ask about using a surrogate to carry their embryos – hoping that would solve the problem. However, it is not an effective solution. We would be switching from her uterus (which is not defective) to using another woman’s equally receptive uterus. There is no point in it.

However, switching to higher-quality eggs from a younger woman is more likely to result in successful pregnancy outcome. If the problem is in the “plant” then we can switch the “seed” and expect a better chance for success. But switching the “garden” doesn’t help because that was not the problem.

So what should women and their primary care doctors do regarding aging and fertility issues?

Women that might want kids (or more kids) in the future should:

• Educate themselves regarding fertility and female age
• Ask their doctors to test their egg supply as they get into their 30′s

Tests of the egg supply are referred to as “ovarian reserve” tests.

Blood tests for ovarian reserve

• Day 3 FSH, LH and estradiol
• AMH, anti-mullerian hormone

Ultrasound tests for ovarian reserve

• Antral follicle counts
• Ovarian volume

However, regardless of the ovarian reserve, female age is a very important consideration.

Conclusions:

• Many women want to have kids – but delay it too long
• Our society is not educating women well about aging and fertility
• Women should learn about declining fertility potential – and be tested for it

In a perfect world:

• Women would be well educated about fertility and aging
• Early screening for ovarian reserve should be done by the OB/GYN, or other MD
• Then women can make well-informed choices about delaying childbearing
• Society should better accommodate childbearing during educational and early workforce years

Related links:

Age and fertility

Fertility after 40

IVF and age

Testing for egg supply – ovarian reserve

Egg donation
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• 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).

• The researchers identified a specific gene mutation in mice that is associated with a high rate of chromosomal abnormalities in the eggs and embryos
• The gene is called Bub1
• They showed that this gene is involved in regulation of division of pairs of chromosomes during egg maturation
• The severity of the chromosomal problems increased with age
• Because the chromosomal abnormalities were passed on to the resulting embryos, there were high rates of loss after embryo implantation

This could give us insight into reasons for some couples having infertility, repeated miscarriages, or repeated failures with in vitro fertilization. More research is needed in this area.

If humans are found to have a similar gene, it is possible that a blood test could be developed to see if women are at increased risk for having eggs and embryos with chromosomal abnormalities. Then fertility specialists could more accurately advise couples about effectiveness of available treatment options.

Reference for article discussed above:

S. Lelanda, et al: Heterozygosity for a Bub1 mutation causes female-specific germ cell aneuploidy in mice. PNAS August, 2009; Pages 12776-12781.

Links to related pages:

Eggs and chromosome problems

Age and fertility

IVF and age

Fertility and IVF in women after age 40

Egg donation

PGD, preimplantation genetic diagnosis: Should we test chromosomes of embryos?

• 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. It is not uncommon for me to see a couple with the woman in her early or mid-40s who say that they had no idea that getting pregnant would be a problem. These are educated and intelligent people. Maybe they were not exposed to the right information about fertility and aging – or maybe they never paid attention to it.

• As the American Society for Reproductive Medicine has pointed out: “As women delay childbearing, there is now an unrealistic expectation that medical science can undo the effects of aging”.

• We try our to overcome the effects of age with advanced treatments such as in vitro fertilization. But IVF success rates decline significantly with advancing female age.

What causes fertility to drop with age?

• Success with fertility treatment using the woman’s own eggs is closely tied to her age.
• When using donor eggs, the recipient woman’s age is not important. It is then the egg donor’s age that matters.
• This tells us that the age of the egg is important and the age of the uterus is not.
• Because of declining egg quality, chances for successful pregnancy begin dropping in the early 30′s and usually drop faster in the mid-30′s (by about 36-37).
• For many women there is little or no fertility potential left by about age 40, and very few women over 43 are fertile.

Even with aggressive fertility treatment (such as IVF) success rates are very low by the mid-40′s. In 2006, the national average for live birth success rate in women over age 44 using their own eggs was less than 1% per attempt (CDC data). Miscarriage rates also increase significantly with advancing age.

Both the fertility decline and the increase in miscarriages are largely due to increased rates of chromosome abnormalities in eggs as women age. Research has shown that a structure called the meiotic spindle in the microscopic eggs in the ovaries becomes damaged with aging. The spindle is involved in organizing pairs of chromosomes for proper division into 2 sets during maturation of the egg. An abnormal spindle can cause disordered chromosome arrangements in the mature egg – and therefore in the embryo.

Can we test the quality or quantity of eggs in a woman?

Since we know that the issue causing fertility problems as women age is declining egg quality, it would help to have a test to check how good a woman’s eggs are. Unfortunately, there is not a good test for egg quality. A woman’s age is the best “test” for quality.

There are screening tests for “ovarian reserve”. However, these are tests of quantity rather than quality. Ovarian reserve tests include:

• Day 3 FSH and AMH levels – blood tests
• Ovarian antral follicle counts – determined by ultrasound.

Conclusions

• “Society” and the medical field should do a better job educating women about declining fertility with advancing age.

• If women are making a conscious choice to delay childbearing and understand the fertility implications – then at least they make a conscious choice.

• However, if they go to their doctor annually for a checkup – at some point (early to mid-30′s) there need to be discussions about declining fertility potential.

More information:

Age and Fertility

PGD – preimplantation genetic diagnosis (or PGS) – does it help to test the chromosomes of IVF embryos?

In Vitro Fertilization

Egg Donation

• In June of 2008, Nadya Suleman was a single, unemployed mother of 6 children
• According to reports, she was receiving some “public assistance”
• All six of her children were reportedly conceived through in vitro fertilization
• All 6 kids were under 7 years old, including 2 year old twins

Then, she does IVF again

• In June of 2008, her IVF doctor transferred 6 frozen-thawed embryos to her uterus.
• Apparently, all six embryos survived – and 2 split into identical twins – so she ended up with eight fetuses growing in her uterus.
• Nadya declined having a fetal reduction procedure. Reduction can be done to selectively reduce the number of fetuses.
• The vast majority octuplet pregnancies would be expected to result in death of all fetuses after a severely premature birth.
• In her case the pregnancy progressed to viability. All 8 babies were born (prematurely) in January of 2009.
• This is apparently only the second living set of octuplets ever born in the United States.

Public debate rages

• Is she a fit mother?
• Should the fertility specialist have been willing to treat her at all?
• How many embryos should the doctor have transferred to her uterus?
• Should a physician that transfers that many embryos to a 33-year-old be sanctioned – or even lose his medical license?
• Why doesn’t the government pass laws to control fertility doctors?

Violation of guidelines of the American Society for Reproductive Medicine, ASRM

Her fertility physician has been identified as Dr. Michael Kamrava who practices in Beverly Hills California. The American Society for Reproductive Medicine is reportedly investigating Dr. Kamrava related to violating its guidelines on the maximum number of embryos to transfer. Although there are guidelines, there are not any laws in the US regulating the maximum number of embryos transferred.

The ASRM guidelines in place when Nadya Suleman had her IVF procedure said that the maximum number of embryos to be transferred to a woman under 35 years of age should be 1 or 2 depending on the specific medical issues. There was some wiggle room in the guidelines. Since they were frozen embryos, a max of 3 for transfer might also have been considered appropriate.

Comments from a fertility specialist

• Physicians, including fertility specialists cannot play god and judge who will be a “fit enough parent” to have fertility treatments.
• Patients undergoing fertility treatment desperately want children and can face huge financial burdens.

The costs of IVF treatment are substantial and although sometimes medical insurance in the US will cover fertility treatment and IVF, more often it does not. Therefore, patients often pressure fertility specialists to transfer more embryos with the hope that they will be more likely to be pregnant.

The ASRM guidelines on the maximum to transfer are appropriate. However, patients are sometimes unhappy about limitations on the number of embryos for transfer – particularly couples with financial difficulties due to IVF costs. For example, some couples will put a second mortgage on their house, max out credit cards, and borrow from parents.

As IVF success rates have increased over the years, the average number of embryos transferred to the uterus has declined. Some cases are now even having single embryo transfers (SET) by choice. This has become a more viable option with utilization of blastocyst embryo transfer which can result in better embryo quality and more control of multiple pregnancy risk.

However, although I have substantially increased the time spent discussing risks of multiple births (including twins), our rate of single embryo transfer is still low. Patients rarely accept single embryo transfer – even after hearing about increased risks with twins. Infertile couples fear failing to become pregnant at all more than they fear the risks to the babies from multiple pregnancies.

When will there be laws regulating the number of IVF embryos that can be transferred?

I think it unlikely that our government will pass laws regulating how many embryos can be transferred unless they also mandate insurance coverage for IVF treatments in order to relieve the financial burden for couples with fertility problems.

Conclusions

• The ASRM guidelines on the maximum number for transfer should be closely followed (whenever possible)
• In a case such as this, a maximum of 2 embryos should be transferred
• 6 embryos should never be transferred to a 33 year old woman – no matter what she says about accepting risks.

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

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.