- 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
- Prelude Fertility
- Single Embryo Transfer
Fertility, IVF and Egg Donation
The Society for Assisted Reproductive Technology (SART) and the Centers for Disease Control (CDC) have both recently released their 2016 IVF success rate reports and published them online. These reports, which are released annually, allow anyone to investigate either IVF or egg donation success rates using fresh or frozen embryos at almost any clinic in the United States.
Federal law requires that all US in vitro fertilization centers submit their data annually so that it can be published for review by people who are considering in vitro fertilization treatments. Almost all clinics report their data to the government although a small percentage refuse to report it. When the federal government passed a law requiring annual submission of the data they probably assumed that doctors would comply and they did not make a specific punishment for not following the law. The fertility clinics that do not report probably do not want the public to see their success rate data. That is not a good signal about their success rates. I suggest staying away from any fertility clinic that does not report their data to the government.
The Society for assisted reproductive technology (SART) is an organization that the majority of fertility programs are members of. However, membership is voluntary and not all clinics are SART members. Therefore, is not required by law to report IVF data to SART but it is required to report to CDC.
The SART and CDC reports are useful tools for potential consumers of in vitro fertilization, egg donation and surrogacy services because they allow comparison of outcomes at different programs. The reports can be utilized to investigate fertility clinics in terms of their success rates, multiple pregnancy rates, treatment volumes within different age groups and within different treatment options such as using own eggs, using fresh donor eggs or using frozen donor eggs.
The SART site allows you to pull up individual programs results and you can apply various filters to the data if desired. These filters can be useful. For example, you can put a filter on the data to see only those cycles that used PGD or PGS preimplantation genetic screening, etc..
Link to SART site
The CDC site allows you to download a spreadsheet with every program’s data. This could be a somewhat overwhelming method to use – depending on how much familiarity one has with spreadsheets. Also, unfortunately the column headings in the spreadsheet are not intuitive so you need to use the “Clinic Table Dictionary” to find out what the column headings in the sheet mean. Otherwise, most of them will not make sense.
Link to CDC site
However, the spreadsheet format is powerful in that it allows a convenient way of sorting the data to list clinics in order. For example, you could choose to sort on “live birth rate per embryo transfer”, or “live birth rate per cycle”, etc.. With 463 clinics’ data in one spreadsheet it is big – but it could be cut down to the local clinics that someone might want to compare, for example.
Consumers of in vitro fertilization, egg donation, and surrogacy services should utilize these reports before choosing a clinic so they know how successful that program is as compared to other options. People that live in larger cities will usually have several fertility clinics nearby as an option to go to.
Obviously, some people might only have one fertility clinic within a hundred miles of their home. In such a case it may not be as important to compare success rates. However, some couples will travel to another state to have the IVF or egg donation services performed. We have many couples every year that travel from distant states and even from other countries to have their fertility treatments with us.
We are proud that our success rates for 2016 are well above national averages. Our success rates have been higher than average every year for the past 20 years in a row. Superior quality control throughout the entire program is the main factor allowing some clinics to have success rates substantially above average. On the other hand, poor quality control will drag success rates down. Common quality control issues involve problems with ovarian stimulation regimens, the IVF procedures (egg retrieval and embryo transfer) and the laboratory embryo culture systems.
The CDC spreadsheet does not show national averages and so that data cannot readily be compared to this CDC report national averages. Later in the year, the CDC puts out another report for the same year of data which is more comprehensive and includes charts that drill down into certain aspects of the data and also includes national averages. However, that part of the report has not yet been released by the CDC. Below are some charts utilizing the SART data on national averages and our program’s SART data showing comparisons.
There is also a page on our website that discusses how to utilize and understand the SART and CDC report data.
By now you might have heard that our fertility center has been acquired by an entity called Prelude. What does this mean for the future? The short answer is that you should not notice any difference. We will continue to maintain our excellent in vitro fertilization and egg donation success rates and will still be caring for those infertile couples who need caring and compassionate treatment. So what is the merger all about?
Prelude was started by serial entrepreneur Martin Varsavsky, who went through his own journey with infertility. His wife, Nina, only 31 years at the time, was diagnosed with diminished ovarian reserve. Mr. Varsavsky came to the realization that many young women not yet ready for motherhood could protect their future fertility by considering fertility preservation (egg freezing) during their most fertile years. Prelude has partnered with fertility clinics in many states around the US and is still looking to increase the size of the Prelude network. You can learn more about Prelude Fertility on their website.
Prelude was created in an effort to make fertility preservation more available and more affordable for young women, utilizing all the best available technology for egg (and sperm) freezing and preimplantation genetic testing of embryos. Egg freezing for fertility preservation and preimplantation genetic testing are services that we have already been successfully providing for many years, along with the other fertility services we offer. None of that is changing, but we will now have additional momentum getting us even more involved in fertility preservation than in the past.
What does this mean going forward? The merger with Prelude will allow us to also expand our efforts to educate the public about the importance of women considering preserving fertility by freezing eggs to be used later (if needed) when they are ready to have a family. Women that freeze eggs for the future are creating a backup plan that gives them an opportunity to build a family using frozen-thawed “young” eggs even if they are 40 or 45 or older when they decide to have a child. This would allow many people to avoid the difficulties associated with trying to have children at age 40 and older.
What will the future bring on this journey with Prelude as our partner? We expect there will be synergy derived from the merger that will help us to continue to grow and expand into new markets and continue to provide the highest quality fertility services with reasonable pricing.
Richard Sherbahn, MD
Advanced Fertility Center of Chicago
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.
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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- Embryo Screening May Improve Chances Of Successful IVF Pregnancy
- How Body Weight Impacts IVF Success
- SART and CDC Release 2016 IVF and Egg Donation Success Rate Reports
- Advanced Fertility Center of Chicago Merges with Prelude Fertility
- 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?
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- Advanced Fertility Center of Chicago
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