IVF and Fertility Specialists Clinic
Comparing IVF Success Rates Between Clinics
Advanced Fertility Center of Chicago
Are IVF success rates at specific fertility clinics a meaningful method of comparison for consumers of assisted reproductive technology services?
To illustrate some concepts involved, we have taken the liberty of copying some text from the web site of another infertility and IVF clinic in the Chicago, Illinois metropolitan area. Some comments regarding the issues involved are at the bottom of this page. We hope that none of the physicians, scientists, etc. at the other fertility clinic are offended by our comments. We should all be striving for complete honesty and the best medical care for our patients struggling to overcome their infertility.
The blue text between the horizontal lines below was copied directly from the other clinic's web site - with the name of that clinic removed. We are not identifying the IVF clinic from which the information below was copied.
The American Society of Reproductive Medicine is "Infertility's" self-governed body. The Society for Assisted Reproductive Technology is where fertility centers must report their statistics. Both societies state that any advertisements of comparative pregnancy rates include the following:
"As entry criteria are highly variable for each program, a center-by-center comparison of results is not valid."
As a patient, you are interested in selecting the right fertility center. We are a very experienced fertility center. We understand what you are looking for but we also understand how confusing and frustrating it can be. Although we have great statistics, we encourage you to look beyond statistics to get a total assessment of whom you will trust with this important decision. The statistics may indicate the competence of a fertility center, but we regret to inform you that they may indicate something else. Please be careful.
The following provides you with insight to 5 ways in which a fertility center can increase their pregnancy rates without increasing the care provided:
Regarding patient selection, who are the right patients? They are young patients, with normal clomiphene challenge tests, with a previous pregnancy, no prior IVF or gonadotropin IUI failures, no prior pregnancy loss, short duration of unexplained infertility, known tubal blockage, low FSH values, and have a partner with normal sperm. These are just some of the criteria an initial consultation/screening process may include. From two different centers, a couple may hear two different responses:
a) "I'd only be taking your money."
b) "Your chances are lower, but we are willing to help."
"Higher pregnancy rates" will then be used as a marketing tool to lure the right type of patients, while simultaneously provided difficult patients to the competing fertility center.
There are two main ways to classify patients to improve pregnancy rates. The first is research. If a center has a difficult patient, that patient can be a research patient. The statistics from research patients are not reported.
The other method is to convert cycles mid-stimulation. If an IVF cycle stimulation does not look good, it can be converted to an IUI cycle and avoid reporting. Conversely, if an IUI cycle looks good, it can be "enhanced" as an IVF cycle and be reported. The patient may have gotten pregnant anyway.
There are proper times to convert cycles, it is the frequency of this occurrence that should be alarming.
There are basically three types of advanced infertility therapy. They are gonadotropin IUI, IVF and donor IVF. Patients can be encouraged to accept a therapy that is beyond their current need. A patient likely to get pregnant on a simple Ovulation Induction cycle is even more likely to conceive with an IVF cycle. This drives IVF pregnancy rates up, and makes the choice between the two therapies even more distinct and confusing for future patients. The same holds true for IVF patients with somewhat questionable egg quality and the choice to pursue donor IVF.
There are two strategies to improve pregnancy rates regarding stopping therapy. The first is canceling a cycle mid-stimulation and thus avoiding the reporting requirement. Although canceling a cycle is sometimes necessary, it is important to know a fertility center's cancellation rate and how often IVF cycles are converted to Ovulation Induction cycles.
The second strategy is to encourage difficult patients to quit therapy. Although there is a time for this, typically the pregnancy rates stagnate after the third or fourth attempt. Most pregnancies take place during the first or second attempt. If a center can avoid the third and fourth attempt, their rates will not be compromised.
The chance of becoming pregnant increases with the number of embryos transferred. Therefore, some physicians are more aggressive, and often carry a higher multiple birth rate. (With the existence of selective reduction, it is important to know multiple rates before reductions.) Sometimes more embryos are encouraged to transfer because of their "poor quality". Sometimes this "poor quality" embryo discussion leads to another strategy.
Frozen cycle pregnancy rates are not as high as fresh cycles (or as expensive). Overall pregnancy rates improve with fewer cycles that are frozen embryo transfers. Therefore, there are subtle ways to discourage freezing embryos.
There are many other ways pregnancy rates can be improved. One can just look at a specific time period. We hope that you will look at all the factors that ultimately make up success. Our experience speaks for itself. We encourage you to speak to medical professionals about our character, philosophy and treatment. We are here to help.
It is virtually impossible for a clinic to select patients to any significant degree as implied here. The patients that present themselves for infertility treatment are infertile, and consist of a mixed population with a variety of specific problems and differing egg quantity, egg quality, etc.
If anything, clinics with higher success rates attract more couples with difficult fertility issues - after patients fail IVF, they often do more research and then switch to a clinic with better success rates for subsequent IVF attempts. Couples that fail IVF treatments will very often do research on the internet and learn about IVF success rates at other programs. These couples do not seek out and go to clinics with low success rates. Therefore, the excuse given at some (low quality) IVF programs that "we take all of the hard cases and that other clinic with higher success rates has mostly easy cases" is absurd. The patients that fail will tend to migrate to clinics with higher success rates in the hope that they will have a better chance for a successful pregnancy outcome there.
Couples that have failed tend to do research, check the CDC report on IVF live birth success rates and consider switching to a center with higher IVF success rates. We get new patients every week that have failed multiple IVF attempts at other centers in the Chicago or Milwaukee metro areas. These patients have usually done research and are interested in our program because of our consistently higher than average live birth rates. We accept them for treatment here, and because some of them really do have egg quality issues, the success rates overall in this group are lower than in patients that have never failed IVF before. This tends to lower our overall success rates some - but so what? Our goal is not to manipulate our success rates, it is to provide the best fertility services to everyone that wants to come to us. Even if a clinic did want to exclude tougher IVF cases, how would they tell these couples that they will not accept them? Clinics such as ours with higher than average IVF success rates attract and accept into their program many patients that have failed IVF at lower quality programs. Many of the couples that have multiple IVF failures elsewhere have success with IVF at our clinic, not uncommonly in their first attempt here.
Another way to compare success rates between different IVF programs is to compare donor egg pregnancy rates. This category should be very homogeneous since egg donors are not infertile, and the large majority of donors are under age 35.
This is totally irrelevant. These issues probably do not apply to any significant degree at any infertility clinic in the U.S.
We do not have any IVF cycles classified as research at our center.
Cancelled cycles must still be reported - and are counted as failed cycles. Therefore, canceling cycles will decrease (not increase) a clinics success rates on a per cycle basis.
All IVF clinics do insemination cycles. No one does IVF on everyone. Egg donation can not be pushed on patients that don't need it - they would never accept it.
Cancelled cycles are addressed in # 2 above.
I do not know of any clinics that stop treatment after 2 IVF cycles. Most clinics will stop after 4 or 5 cycles. The large majority of patients have stopped before this (by their own choice), or have gotten pregnant - if they have been treated at a good IVF center.
This is true. Some clinics transfer higher numbers of embryos than other clinics do. Consumers of IVF services should look carefully at both pregnancy rates and multiple pregnancy rates (particularly triplets and higher) of any clinic they are considering.
At some centers, the IVF lab is inadequate at properly culturing the embryos. With very low embryo quality, they can still have low success rates even with high numbers of embryos transferred. Therefore, the numbers that are most important are the live birth rates per cycle, and the rates of multiples and triplets produced.
The statement regarding frozen cycle pregnancy rates and overall pregnancy rates is from somewhere out beyond left field. "Overall" pregnancy rates are not reported - and are not at all relevant to individual patients.
Success rates at specific IVF clinics are useful as a means of comparing clinics. That is why the data is collected and reported by the government (available to the public on the CDC web site).
Every IVF program is unique. Therefore, comparing 2 different clinics will never be comparing "apples and apples". Some of the factors discussed above can have a relatively small impact on a program's pregnancy rates. However, that does not mean that the IVF success rates collected by SART and reported by the U.S. government are irrelevant. It just means that exact side-by-side comparisons are not perfect. That same logic can not be used to say that couples have the same chance for having a baby if they do their IVF treatment at a clinic with a 15% live birth rate per cycle as they would if they did IVF at a clinic with a 60% live birth rate.
Some clinics are much better at IVF than others. This is not questioned by the experts in the field of reproductive endocrinology and infertility. The only place it is "debated" is in the marketing propaganda from IVF clinics with low pregnancy rates. Some IVF specialists from those clinics argue that it is irrelevant to compare success rates between IVF programs. Their egos and concerns about the financial performance of their clinics prevent them from facing (or telling) the truth.
SART and the CDC report annually to the public on IVF clicic success rates. This information allows consumers needing IVF treatments to compare (and validate) success rates from all reputable IVF and egg donation clinics.
In 2014, the Society for Assisted Reproductive Technology, SART released clinic-specific IVF program success rates for 2012 cycles on the web.
Go to the SART site to check 2012 IVF success rates
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