- 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
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.
The 2012 SART report was recently released by the Society for Assisted Reproductive Technology (SART). This annual report details IVF success rates and egg donation success rates for individual clinics that are members of the SART organization. The large majority of US IVF programs are SART member clinics so their IVF success rates are therefore included in this report.
A separate report on IVF success rates, the US government’s Centers for Disease Control (CDC) report also comes out every year and covers all US clinics (by federal law). However, the CDC report is released much later than the SART report. The CDC report is released in sections with the first part out 4-5 months after the SART report.
The SART report also shows national average statistics. This allows couples with fertility problems that are considering in vitro fertilization to investigate the live birth success rates at any IVF program that they are considering. They can compare the success rates to other programs in their home area, to other programs in the US, and to national averages.
The data in this report is broken down by age group and also by whether fresh eggs and fresh embryos were transferred to the uterus or whether frozen embryos were thawed and transferred. Cycles using donor eggs are also reported separately both for fresh embryo transfers and frozen embryo transfers.
We are proud of our IVF and egg donation success rates. Our rates have been above national averages for 16 years in a row.
- For 2012 our live birth success rate for women under age 35 was 55% per egg retrieval compared to the national average of 43%
- For egg donation our 2012 live birth success rate was 82% per transfer which compares to the national average of 57%
Additional information is included in the SART report including the percentage of pregnancies with twins and triplets, the average number of embryos transferred in the different groups, and information about the diagnosis categories of patients being treated. For example, it gives the percentage of IVF cases that had a male factor infertility diagnosis, and the percentage with diminished ovarian reserve, endometriosis, tubal factor, etc.
The SART report is a valuable asset for couples considering in vitro fertilization or egg donation. They can compare success rates between clinics in order to find the clinic that will best be able to help them build their family.
The 2012 SART report is available through this link to the SART website:
More about the SART and CDC IVF success rate reports
Egg freezing has been used in reproductive medicine for many years for fertility preservation as well as for banking of donor eggs. In the last several years egg freezing technology has improved significantly. Therefore, in the fall of 2012 the American Society for Reproductive Medicine (ASRM) removed the “experimental” designation for egg freezing.
Embryo freezing has been utilized very effectively since the 1980s and live birth success rates in some IVF programs (including ours) with frozen embryos at the blastocyst stage are as good or even better than the success rates seen in the same IVF clinics using fresh embryos. However, eggs are more difficult to efficiently freeze and thaw without damaging the cell.
Eggs are frozen using either “slow freeze” technology or vitrification which is ultra-rapid freezing. We believe that egg vitrification is superior and are using it successfully at the Advanced Fertility Center of Chicago.
The first baby from in vitro fertilization using fresh eggs was born in 1978. Not long after that egg donation was being done. Since then millions of babies have been born after IVF and many studies have been done to see whether there are increases in birth defects or other problems in the children.
Thousands of children have been born following thawing of frozen eggs. Thus far the results are reassuring regarding the health and well-being of children born using frozen eggs. Although there are not large numbers of children in the studies there does not seem to be an increased risk to the children for birth defects or other problems for babies from frozen eggs as compared to babies born after IVF with fresh eggs.
Egg banking done for egg donation is becoming more common. Egg donation success rates are higher when using fresh eggs as compared to frozen eggs but there are some potential advantages to using frozen donor eggs:
- With frozen eggs there is a lower cost per cycle (per attempt)
- With frozen eggs there is likely to be less waiting for a donor to be ready
- With frozen eggs there is more certainty regarding the number of eggs that will be available to use
- For example, problems with the donor’s ovarian stimulation process have already been dealt with when using frozen donor eggs
I believe that over time we will see a gradual shift towards doing more frozen donor egg cycles. Many factors will influence the rate of change including:
- The success rates with frozen donor eggs that will eventually be reported on a per clinic basis through the SART and CDC IVF success rate reports
- Availability of frozen donor eggs and availability of donors for fresh cycles
- Perceptions and preferences of couples needing egg donation about issues with fresh and frozen donor egg cycles
- Cost issues
At the Advanced Fertility Center of Chicago we have been doing egg donation with fresh eggs for 17 years and now have frozen donor eggs available as well.
The CDC recently released the new IVF success rate report that shows individual IVF clinic’s IVF success rates as well as national averages. This report covers IVF treatments performed in 2011. It is available to the public on the CDC website as a PDF or as a downloadable Excel spreadsheet.
The CDC IVF success rate report shows success rates for individual IVF centers in the United States. This allows couples struggling with infertility to evaluate live birth success rates for any fertility program.
The report also includes a page showing national average success rates for all categories of patients. I suggest that before having in vitro fertilization performed anywhere, couples should look up the clinic in the CDC report and compare its success rates to national averages. They should also compare the numbers to other clinics in their area.
The CDC report also shows the number of cases done in various diagnostic categories and age groups. So, for example, if someone needs IVF with donor eggs they should look at how much experience the program has with egg donation as well as the success rates using donor eggs.
For example, some IVF programs will do a significant volume of IVF using women’s own eggs but do very few cases with donor eggs. This should be an important consideration for patients needing IVF with donor eggs.
The CDC report is organized by state and within the states are listed alphabetically by city where the clinic is located. All IVF programs are required by federal law to report their IVF outcome data to the government for reporting to the public. Some clinics choose to violate federal law and not report their data.
Unfortunately, when the government passed the law they did not make a specific punishment for clinics that violate this law. Therefore, at this time the punishment for not reporting is only to be listed as a “non-reporting clinic”. Some clinics prefer to be listed as a non-reporting clinic rather than to have the public see their IVF statistics.
This obviously suggests that these programs have something to hide. Most likely they have low IVF success rates and do not want the public to see the numbers. I recommend couples stay away from any program that is breaking federal law by not reporting its IVF statistics.
The CDC report also shows the diagnosis categories of patients that are treated with IVF. It shows the percentage of cases that had male factor problems, the percent with tubal factor, the percent with diminished ovarian reserve, with endometriosis, unexplained infertility, etc.
The success results are broken down by age group. Less than 35 is the youngest age group, the other age groups are 35 to 37, 38 to 40, 41 to 42 and 43 to 44. For donor eggs all recipient ages are lumped together. This is because there is almost no difference in outcome statistics based on the age of the recipient female when using (young) donor eggs.
Results are shown on a per cycle basis and on a per transfer basis in the 2011 CDC report. A “cycle” is defined as all cases that started stimulation medications with the intention of having IVF performed. Not all patients to start cycles make it to the egg retrieval procedure because some will be canceled for a very poor response to the ovarian stimulating drugs.
Cancellation criteria will very between fertility clinics but most clinics in the US want to see a minimum of three or four mature size follicles before proceeding to the egg retrieval procedure. With less mature follicles than that the success rates are extremely low.
In the past the CDC report showed statistics on a per egg retrieval basis as well. It has always been traditional to report outcomes on a per cycle, per egg retrieval, and per embryo transfer basis. However, for some reason the CDC dropped the per egg retrieval reporting from the 2011 results page.
I think this is unfortunate because the live birth rate per egg retrieval shows how good the clinic is at getting couples pregnant if they make it to an egg retrieval procedure. There are number of reasons aside from cycle cancellation for low response to stimulation that a patient might not have an embryo transfer procedure.
For example, they could have all embryos frozen (for various reasons), or they could have poor embryo development resulting in no viable embryos for transfer.Fortunately, the other IVF success reporting system (SART IVF success rate report) still shows the live birth rate per egg retrieval statistic.
The CDC IVF report is released in 3 parts.
- A spreadsheet with all reporting clinics success rates is released in early summer
- A PDF document with statistics for all reporting clinics is released in late summer
- The complete report with clinic success statistics and other compiled statistics based on the aggregate national data is released in late winter (early 2014 for the 2011 report)
Overall, the CDC has put out an excellent report that allows consumers of IVF services to examine success rates at clinics they are considering.
- IVF success rates vary significantly between programs
- Couples should make an informed choice about where to have IVF after studying clinic success rates in the CDC report.
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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