- Age and Fertility
- CDC Report on Fertility Clinic IVF Success Rates
- Chromosomal Abnormalities in Eggs
- Donor Eggs
- Egg Banking
- Egg Donation
- Egg Donation Cost
- Egg Freezing
- Egg quality
- Embryo freezing
- Embryo implantation
- Fertility Preservation
- Frozen embryo transfer
- IVF Clinic Success Rates
- IVF Cost
- IVF Poor Responders
- IVF success rates
- Low ovarian reserve
- Micro IVF
- Mild IVF
- Mini IVF
- Minimal Stimulation IVF
- Multiple Pregnancy
- Number of IVF Embryos to Transfer
- Oocyte Cryopreservation
- Ovarian Reserve
- Ovarian Reserve Tests
- Preimplantation Genetic Screening
- Single Embryo Transfer
Fertility, IVF and Egg Donation
The Advanced Fertility Center of Chicago is now offering 2 low cost fertility screening packages. These fertility screening tests will allow couples to have important information about their fertility reserve for the future.
- In women these tests measure egg supply for the future, also called “ovarian reserve”
- Ovarian reserve testing is done to estimate the status of the current egg supply
- In men a semen analysis is done to evaluate the sperm
|Partner||Basic Fertility Screening for $90||Fertility Screening including AMH for $110|
|Female||Day 3 FSH||Day 3 FSH|
|Female||Day 3 Estradiol||Day 3 Estradiol|
|Female||Transvaginal ultrasound for antral follicle counts||Transvaginal ultrasound for antral follicle counts|
|Male||Semen analysis||Semen analysis|
Basic Fertility Screening Package
The basic fertility screening package includes two blood tests and a transvaginal ultrasound on the female partner and a semen analysis on the male. The blood tests include day 3 FSH (follicle stimulating hormone) and estradiol hormone levels. These blood tests give us some indication as to whether there could be a low remaining egg supply.
The ultrasound test counts the antral follicles in the ovaries (2-9mm cystic structures) as another gauge of the woman’s ovarian reserve. The total cost for the basic fertility screening package is $90.
Comprehensive Fertility Screening Package
Our more comprehensive fertility screening package includes all of the tests from the basic screening package and adds an anti-mullerian hormone (AMH) blood test. See table above.
AMH levels give us another way to estimate a woman’s ovarian reserve The total cost of the comprehensive fertility screening package is $110. The cost of either one of our fertility screening packages will be credited back toward fertility treatment done in the future at any of our 3 Chicago area offices.
Testing for causes of infertility
It is important to understand that these fertility screening tests do not investigate all of the causes of infertility in men or women. The tests in our fertility screening packages look at egg supply and at the sperm situation which are only two of the many possible reasons for having difficulties conceiving.
A full workup for infertility is indicated in couples after 12 months of trying to get pregnant when the female is under age 35, and after 6 months of trying when she is 35 or older. We also perform full infertility workups as well as fertility treatments such as intrauterine insemination and in vitro fertilization.
Women are delaying childbearing more and more over time
Over the past several decades many women have been waiting progressively longer to start trying to have a family. In the 1960’s and 1970’s it was very uncommon for a woman to have her first child after the age of 30. Obviously, this is now common and many women are waiting until the late 30’s or even early 40’s until they try to get pregnant with the first child.
As women delay their childbearing longer, fertility screening for ovarian reserve becomes more important because it allows a woman to have some knowledge about her remaining egg supply.
A woman’s egg supply declines throughout her lifetime from birth. By the time of menopause there are no eggs left. In general, egg supply is related to a woman’s age. However, there is a lot of variation around the average and some women will lose their eggs faster and have an early menopause (and early loss of fertility) while other women will lose their eggs at a slower rate and have a later than average age of menopause.
A woman’s fertility potential declines many years before she reaches menopause. This is because the quality of the eggs declines significantly with aging – particularly after about age 35 to 37. We do not currently have a good test for a woman’s egg quality. At this time, female age is the best predictor of egg quality that we have.
As more women put off their childbearing until their later reproductive years, some will decide to freeze eggs to try to preserve their fertility. This is becoming much more common in recent years. If low ovarian reserve is found on a fertility screening test, fertility preservation could be a smart option for her to consider if she is not ready to have a child soon.
Summary: Our low cost fertility screening panels
We perform two different low cost fertility screening panels at all 3 of our Chicago area offices. If you are interested in having this testing, please call one of our offices to schedule a visit. The testing requires one visit to the office for the woman and one for the male. The results will be mailed to you approximately 7-10 days after the tests are completed. The cost of either fertility screening package will be credited back toward fertility treatments done in the future at our offices.
The Society for Assisted Reproductive Technology (SART) has released the 2014 IVF success rate report in 2016. The SART in vitro fertilization outcome reports have been coming out annually for over 15 years. We are proud of our consistently high success rates. We encourage people to examine both our IVF success rates and our egg donation success rates and compare them to the national averages as well as to those of other clinics they might consider.
This year’s report represents a significant change in the way the data is reported as compared to the past. SART is trying to make the report more representative of IVF outcomes as they relate to the current styles of practice in IVF centers in the US.
In the past the SART report showed the IVF outcome data on a per started cycle, per egg retrieval, and per embryo transfer basis. However, this has basically been done away with in the 2014 report. The new SART report organizes IVF outcome metrics differently.
I will review some of the main highlights of the new report using screen shots from our own clinic’s 2014 SART report that can be found online at:
The first section in the outcome tables shows what start calls the Preliminary Cumulative Outcome per Intended Egg Retrieval. The intention is to show the cumulative chance for having a baby from both the primary embryo transfer procedure and any also any subsequent embryo transfers using frozen eggs or embryos that were not transferred initially.
I think it is unfortunate that SART put this table at the top of the report. It makes it seem that this is the most important outcome metric. However, there are problems with this metric including the fact that any embryo transfers with subsequent live births that do not fall within that calendar year will not be included in the cumulative outcome.
SART is extremely focused on singleton pregnancy outcomes. Many couples with infertility are much less focused on avoiding twins. The SART report highlights the singleton line in green. I have highlighted the live birth line in red. This line shows the cumulative live birth rate per intended egg retrieval. In my opinion the live birth rate is also important for couples struggling with infertility.
The next table is referred to by SART as the Preliminary Primary Outcome per Intended Retrieval. The preliminary primary outcome is the outcome of the first embryo transfer following the egg retrieval.
- Therefore, if there is a fresh embryo transfer that is done several days after the egg retrieval that outcome would be the preliminary primary outcome.
- However, if all of the embryos from that egg retrieval were frozen and none were transferred fresh – then the first frozen embryo transfer cycle would give the preliminary primary outcome.
- If all embryos were frozen from the fresh egg retrieval and preimplantation genetic screening (PGS) was performed and all PGS results were abnormal resulting in no frozen embryo transfer – then the outcome is a failed cycle at that point.
This change in outcome metrics was put into place by SART because in recent years some clinics have moved more to performing frozen embryo transfers and are doing more “freeze all” cycles. In a freeze all cycle, all embryos are frozen several days after the egg retrieval and then thawed and transferred in a subsequent cycle. I think that SART should have put this table at the top of the page.
Again, I have highlighted the live birth row which I believe is important in red in contrast to what SART is highlighting in green.
The next table is for what SART refers to as Preliminary Subsequent Outcomes (frozen cycles). SART defines this as cycles using any frozen thawed eggs or embryos after there has already been a primary outcome. So for the most part this table represents the frozen embryo transfer success rates for the clinic. However, it excludes frozen embryo transfers that would have been the primary embryo transfer (from freeze all cycles).
The next table SART calls the Preliminary Live Birth per Patient. This table is reporting outcomes only for those patients who are new to that specific clinic and starting their first cycle for egg retrieval during that year. I have no idea why SART thinks that this is an important metric and deserving of its own table.
The last 4 tables on the page of the new SART report are for donor eggs and donor embryos. There is a table for live birth outcomes using fresh donor eggs, another table for frozen donor eggs, then frozen thawed embryos from donor eggs, and finally a table for transfers using donated embryos. These tables are easier to understand because they do not follow the “preliminary” and “subsequent” outcome methodology that SART now uses for the cycles performed using a woman’s own eggs.
There are some interesting and potentially useful features built into the new report. For example, the report now allows the viewer to apply filters to the data set. For example, you can filter frozen embryo transfer cycles to see only those results that had preimplantation genetic screening (PGS) performed on the embryos. Other filters can be applied as well.
SART is an organization of medical and other professionals. SART members are from academic medical centers and also from private practice fertility clinics. SART members could be fertility doctors, nurses, embryologists, lab directors, mental health professionals, attorneys that specialize in reproductive law, and others.
SART members have different agendas depending on the details of their own organizations and business models. Therefore, SART will be pulled in different directions by members with their own agendas. Such a varied organization will never be able to please all members. The major changes in the 2014 SART report seems to have been done in an effort to satisfy some factions within the organization. However, that has led to some problems with the report.
I have been working as a fertility doctor for over 20 years and during that time have used databases and spreadsheets on a daily basis. Understandably, I am very familiar with IVF outcome measures. However, this report was confusing for me until I studied it carefully. It took some time to figure it out. Therefore, I think that this report will be very difficult (or impossible) for the average infertility patient to understand well.
If the 2014 SART report satisfies some SART members regarding their gripes about past year’s reports then maybe it serves the SART organization’s agenda. Overall, I think it is a work in progress.
Do IVF frozen embryo transfer (FET) cycles have increased success rates or other benefits as compared to fresh transfers?
Over the past several years there have been several studies published that investigated whether fresh or frozen transfers result in higher IVF pregnancy success rates and also which type of transfer is associated with healthier outcomes for mothers and babies.
In fact, some IVF programs have completely stopped doing fresh embryo transfers and are only performing frozen embryo transfers. As of now (summer 2016), the IVF field in the US seems to be slowly moving toward doing more frozen embryo transfers and less fresh transfers. This might be a long-term trend that could help us achieve the most successful treatment outcomes.
There are 2 general issues related to the possible superiority of frozen embryo transfer as compared to fresh transfer.
- The rate of implantation could be reduced in fresh transfers as compared to frozen embryo transfers.
- There could be a “healthier” implantation process in FET cycles with development of a better connection between the placenta and the mother. This could potentially result in benefits at multiple levels.
Over the last 10 years or so embryo freezing and thawing efficiency has improved dramatically with widespread use of vitrification (ultra-rapid freezing) vs. the older slow freezing method. This led to much better pregnancy success rates with frozen embryos than we saw in the past. Now some fertility specialists are claiming that frozen embryo transfers actually give higher success rates than fresh transfers.
Embryo implantation with a frozen cycle could be better with the more “natural” hormone environment in the uterus. The uterine lining in a fresh cycle with ovarian stimulation is exposed to unnaturally high levels of the reproductive hormones estrogen and progesterone which could deter effective embryo implantation.
Some of the studies done so far show significantly higher pregnancy rates with frozen embryo transfers as compared to fresh embryo transfers. However, other studies have shown no significant difference in success rates between fresh and frozen transfers.
One problem is that there are several variables that are difficult to control for in order to have the proper study design to answer this question. Overall, at this point the evidence suggests that frozen transfers seem to have somewhat higher pregnancy rates as compared to fresh transfers.
Further studies should be done to confirm (or deny) this and also to investigate whether there are subsets of patients that benefit more than others by having their transfer “deferred” to a frozen cycle. It is possible that some patients would get a large increase in their chances for pregnancy with an FET and others would get little or no benefit at all. We just don’t know enough yet.
For example, several studies that have shown that IVF patients that take a “pure” Lupron trigger (without any HCG trigger) have better pregnancy rates in an FET cycle vs. with fresh transfer. However, the magnitude of the difference is debatable and in many clinics (ours included) it is a relatively small percentage of the patients that get a pure Lupron trigger.
This issue is about ovarian hyperstimulation syndrome, OHSS. Mild ovarian hyperstimulation is fairly common with IVF and is not a major medical problem. It goes away fairly quickly and has no major consequences. However, severe OHSS is serious and needs to be avoided.
By utilizing a pure Lupron trigger (also called an agonist trigger) severe OHSS can be completely avoided. However, some IVF patients do not get a pure Lupron trigger (they took some HCG at trigger time) and these women might become significantly hyperstimulated if they become pregnant from a fresh embryo transfer. These women should have their embryos frozen and then later thawed and transferred (FET) after the hyperstimulated ovaries regress to normal.
Tubal pregnancy rates
There is some evidence from retrospective studies that ectopic pregnancies are more common after fresh as compared to frozen embryo transfers. For example, one study reported ectopic pregnancies occurring in 4.6% of clinical pregnancies after fresh transfers and 2.2% of clinical pregnancies after frozen transfers. Some other studies have shown smaller differences.
Obstetric and perinatal outcomes
So far, the studies on health outcomes for mothers and babies after fresh vs. frozen embryo transfers show mixed results. Overall, it seems that there might be more healthy outcomes after FET as compared to after a fresh transfer. However, more research is needed in this area. The list below summarizes results from some recent studies.
- The risk for a baby to have low birth weight is increased after fresh compared to frozen transfers (favors doing FET)
- The risk for having a preterm birth is increased after fresh compared to frozen transfers (favors doing FET).
- The risk for having placenta accreta (placenta attached deeply in uterine wall and difficult to separate at delivery) seems to be increased in frozen as compared to fresh embryo transfers (favors doing fresh transfer).
- The risk for having a large for gestational age baby seems to be increased in frozen as compared to fresh embryo transfers (favors doing fresh transfer).
There is some evidence that pregnancy rates are somewhat higher and overall outcomes may be better for pregnancies with frozen transfers compared to with fresh transfers. However, as discussed above, some of the outcome data shows pros and cons for FETs.
Other important questions are how much better will these outcomes be, and how much extra will it cost with switching from fresh embryo transfers to FETs? Then, couples (and their doctors) must decide whether that additional benefit is worth that extra cost.
That question will not have the same answer for every couple because financial resources and insurance coverage varies between couples. If patients have excellent insurance coverage that will pay for multiple cycles of fresh and frozen embryo transfers then the economic decision for a couple could be easy. However, few people have insurance coverage like that.
The debate about these issues continues in our field of medicine. There are important questions to answer and well designed studies are needed. In the meantime we try to make the best decisions with our patients on a case by case basis.
IVF patients often focus attention on the grading of their embryos at the time of transfer. We do the morphological grading on IVF embryos to assess the rate of development, the number of cells and how healthy the cells look.
However the underlying chromosomal competence or lack of chromosomal competence is far more important than the morphological grade of an embryo. Grading involves shades of gray but chromosomal competence is a black or white issue.
The beautiful looking embryo that is chromosomally abnormal is not going to make a healthy baby and an embryo that does not get a high grade but is chromosomally normal should still have a high implantation potential and be likely to result in the birth of a healthy baby after transfer to the uterus.
As far as embryos go, it’s good to be pretty but much more important to be chromosomally normal. Chromosomal competence can be determined with preimplantation genetic screening (PGS) which should be done at the blastocyst stage of embryo development with trophectoderm biopsy.
Beautiful looking blastocyst,Not as pretty looking blastocyst
The blastocyst embryos shown above look different. The embryo on the left gets a high grade and the one on the right does not. There are far less cells in this embryo and the appearance of those cells results in a lower grade.
However, if the “lower grade” embryo was tested and normal by PGS and the “high grade” one was abnormal then the lower grade embryo would be very likely to result in a healthy baby after transfer and the pretty one would have no chance.
Advancing female age results in changes in the eggs leading to more errors occurring when the egg matures at the time of ovulation. This causes an increased percentage of embryos that are chromosomally abnormal as women get older.
At age 30 the percentage of chromosomally abnormal embryos (called aneuploid) is about 30%. Beyond age 30 the rate of these abnormalities in eggs goes up significantly as shown in the table below.
|Female Age||Percent of Embryos Aneuploid|
With genetic screening of embryos we can eliminate the embryos with chromosomal abnormalities from being transferred back to the uterus. When we get the IVF chromosome screening test results back we hope to have at least one chromosomally normal embryo for transfer.
IVF with PGS success rates are significantly higher in our program than success rates for IVF without PGS for all age groups. The amount of improvement seen in success rates after preimplantation genetic testing increases with female age because of the increasing chance for unscreened embryos to be abnormal.
Avoiding transfer of embryos with chromosomal abnormalities significantly improves embryo implantation. What we are currently seeing with PGS in our center is:
- 63% for live birth if we transfer back one PGS normal embryo
- 80% for live birth if we transfer 2 normal embryos (a lot of twins)
- See our overall IVF success rates
This is independent of female age. It does not matter if we got the eggs from a 30 year old or a 42 year old. After having PGS testing (and found normal) they have the same chance for implantation – at any age.
I believe that the future of IVF will be to do PGS on almost all IVF embryos. The two issues holding us back from using PGS more are the additional costs and the 24 hour turn around for test results.
This 24 hour delay results in the need for a frozen embryo transfer being done a few weeks later instead of a fresh embryo transfer right away. Patients sometimes don’t want to wait any longer to try to get pregnant.
However, some recent studies suggest frozen embryo transfers allow a better uterine environment for embryo implantation and better success rates. Therefore, perhaps frozen transfers will be utilized more in the future even when PGS is not done.
The cost for PGS screening will go down over time as will the time needed to get results back from the genetics lab. This will result in more utilization of this powerful technology by couples having IVF.
The 2013 SART report was released in early March 2015 by the Society for Assisted Reproductive Technology. It reports clinic-specific pregnancy outcome results from in vitro fertilization cycles done by SART member clinics in 2013. The SART report is a useful resource for couples considering in vitro fertilization treatment using their own eggs or donor eggs.
Most IVF clinics in the US are SART members and have their data included in this report. A small percentage of clinics choose not to be SART members so their IVF outcome data will not be in it. However, federal law mandates that all IVF clinics in the US report their data annually to the United States Centers for Disease Control and Prevention (CDC), a federal government agency. The CDC IVF report for a given year is usually released several months after the SART report.
The SART report shows both individual clinic results and national averages for IVF live birth success rates by age of the female partner. It also shows live birth success rates for treatments using donor eggs. Pregnancy and live birth success rates are shown separately for cycles using fresh eggs and embryos and for cycles using frozen embryos.
For the first time, this year’s report also shows pregnancy outcome results for frozen (banked) donor eggs. Egg freezing and egg banking is a new and rapidly evolving technology. Success rates at some clinics using frozen donor eggs are now approaching the success rates for using fresh donor eggs. Not quite as good yet, but getting closer over time.
The report also shows various other statistics for the clinics including a breakdown of diagnosis categories for the patients having IVF and the average number of embryos transferred in the various groups and percentage of singleton, twin and triplet or higher pregnancies. Learn more about the SART and CDC IVF success reports on our website.
Couples needing fertility services can utilize the SART report to compare success rates between clinics that they might consider utilizing. Success rates vary dramatically between programs and it is important for couples to understand the success rates at any fertility clinic they consider.
- The national average for IVF live birth success per cycle for 2013 was 40%. Our clinic’s IVF results were much better than average at 58%.
- The national average for egg donation live birth success per transfer for 2013 was 56%. Our clinic’s egg donation success rates were much higher at 77%
This year SART included a new metric in the report that reports the “percentage of cycles where thaw was attempted that resulted in live birth”. In the past frozen embryo transfer cycles were only reported on a “per embryo transfer” basis. Therefore, in previous SART reports if there was an attempt to thaw and transfer a couple’s embryos but no embryo survived the thaw – the data would not show up at all in the report (it was reported on a “per transfer” basis).
In the current report it shows outcome statistics on a “per thaw cycle” basis and also on a “per embryo transfer” basis. If a clinic has technical problems with embryo freezing and thawing they could have low success rates for both metrics or could have better success rates on a per transfer basis but lower rates per thaw. This would indicate embryos were not surviving well after thawing.
The SART report is a useful and timely tool for couples needing in vitro fertilization or egg donation services. The complete 2013 SART report is available through this link to the SART website. It shows national average pregnancy outcome statistics as well as clinic-specific reports for all SART member clinics.
- More about the SART and CDC IVF success rate reports
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.
Welcome to the
Advanced Fertility Center of Chicago
Richard Sherbahn, MD is a Board Certified Reproductive Endocrinology and Infertility specialist.
Dr. Sherbahn founded the Advanced Fertility Center of Chicago in 1997.
He will post regularly about fertility issues.
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- Benefits of Elective Single Embryo Transfer – eSET
- Chicago low cost fertility screening tests
- SART Releases 2014 IVF Success Rate Report
- Is fresh or frozen embryo transfer better for IVF?
- IVF Genetic Testing Improves Embryo Implantation
- 2013 SART IVF Success Rate Report Released
- IVF Success Rate Report Released – 2012 SART Report
- Pros and Cons – Frozen Donor Eggs for Egg Donation
- CDC Releases 2011 IVF Success Rates Report
- SART Releases 2011 IVF Success Rate Report with Outcome Results for All IVF Clinics
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