- 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
- 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 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.
SART has recently released its 2011 IVF success rate report. This report details the in vitro fertilization pregnancy and live birth success rates for all US IVF clinics that are members of the SART organization (Society for Assisted Reproductive Technology).
Almost all IVF clinics in the US are members of SART. However, some clinics are not SART members so their IVF success rates are not in the SART report.
See our IVF success rates
See our donor egg success rates
IVF clinics were required to submit their data to SART in November 2012 after they collected the live birth information from all IVF cycles performed in 2011. SART then takes a few months to prepare the data for public distribution.
The same data is reported by IVF clinics to the CDC. The CDC is a US government agency (Centers for Disease Control and Prevention). Membership and reporting IVF results to SART is voluntary. However, reporting to the US government through the CDC is required under federal law for all IVF centers.
The SART report is a useful tool for couples with infertility that might need to consider in vitro fertilization to get pregnant. Using this report, couples can investigate live birth success rates per IVF treatment cycle in their age group.
Patients needing fertility treatments should investigate IVF success rates at clinics they are considering for treatment.
- Success rates vary between programs. All IVF clinics to not produce viable pregnancies at the same rate.
- There are over 200 variables involved with quality controlduring an IVF cycle
- Two critical variables are the quality of the clinical side of the IVF program and the quality control system in the IVF laboratory
The SART report allows couples to learn about various details about a specific clinic’s success rates and they can compare those numbers to national averages.
- Outcome data are shown separately for cycles using the woman’s own eggs vs. egg donation cycles
- Pregnancy results are also given for transfers using fresh embryos vs. frozen-thawed embryo transfers
- Success rates can be filtered for different diagnostic categories such as male factor infertility, diminished ovarian reserve, endometriosis, tubal factor, etc.
Below is a screenshot of a portion of our 2011 SART results page showing live birth rates in 3 age groups (under 35, 35-37 and 38-40) using a woman’s own eggs and fresh embryos.
- The SART report allows couples to compare success rates of clinics they are considering with national averages and with other clinics in their area.
- If a clinic you are considering has low success rates compared to the national average, I suggest going somewhere with better success statistics.
There is a video on our website showing how to research IVF success rates using the SART report.
To see the 2011 SART report and check IVF success rates:
- Go to the SART website
- Click on the state that you want on the US map
- Click on any clinic you want to see IVF results for
- Click “ART Data Report” and the clinic’s IVF statistics for 2011 will come up
Our website has links to the CDC and the SART reports and discusses them in more detail with examples showing how to interpret clinic-specific and national average tables.
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.
Ideal treatment of the poor responder for in vitro fertilization is problematic. Over time, I see more and more patients that have failed multiple IVF attempts at other clinics. The majority of these patients fit into the poor responder category.
Generally, the poor responders should be identified by the fertility doctors before starting an IVF cycle. At our fertility clinic we use ovarian reserve testing to evaluate a woman’s expected response to the stimulating medications. As our basic ovarian reserve screening, we do:
- Antral follicle counts by ultrasound
- Anti-mullerian hormone (AMH) blood tests
- Day 3 FSH, LH and estradiol blood tests
These tests will identify the vast majority of poor responders before they get to an IVF attempt. Identifying the problem in advance allows us an opportunity to do something to improve the response (and the outcome) with the first IVF attempt.
The definition of a poor responder is variable. Regardless of the definition one uses, the basic idea is that poor responders do not respond well to the IVF ovarian stimulation protocol by making a good number of mature follicles. Less mature follicles means less eggs retrieved which results in lower numbers of embryos and less chance to have one that is a “marathon runner” (baby).
For example, women under 35 years old give an average of 12 eggs with IVF. However, poor responders would only produce about 1 to 6 eggs. The chances for success with IVF are very much dependent on two variables – the quantity and the quality of the eggs.
Therefore, if we could come up with a treatment that would help the poor responders to give either more eggs or better quality eggs or both, we would be able to positively impact the chance of having a baby.
Various types of supplementation protocols have been used to try to improve outcomes for IVF poor responders. In this article I want to discuss the use of growth hormone for this purpose.
Growth hormone has been used for poor responders for many years. However due to the very high cost of growth hormone in the past it was rarely utilized. However, over the years with more competition in the pharmaceutical marketplace the cost of growth hormone has come down. During this same time frame, more studies have been published showing benefit from treatment with growth hormone for IVF low responders.
20 years ago, growth hormone treatment added about $5000 to the cost of IVF. That was too high. With the drop in the market price for growth hormone the cost has come down to about $1000 currently. This price change has made it more feasible and potentially a cost-effective addition to the IVF stimulation protocol.
Although all of the studies that have investigated this had small sample sizes, several of them showed significantly improved IVF success rates in poor responders that supplement their stimulation with growth hormone. For the most part, the studies all showed the same thing. Adding growth hormone to the ovarian stimulation protocol for poor responders significantly increases the chances for a pregnancy and a live birth.
The mechanism by which growth hormone would improve IVF success rates is not clear. However, based on animal and human studies it has been shown that growth hormone is involved in production of steroid hormones in the ovary and in development of ovarian follicles. Studies have shown that if mice are lacking the growth hormone receptor and growth hormone binding protein there is a significant reduction in the development of ovarian follicles.
It is also thought the growth hormone could increase the production of insulin-like growth factor 1 (IGF-1) in the ovaries. IGF-I is thought to be involved in regulating follicle development, estrogen hormone production and maturation of eggs.
Several studies have shown improved IVF live birth success rates after supplementation of growth hormone in poor responders. Although the success rates are still not as high as seen in normal responders to stimulation, they are significantly improved over the baseline success rates expected in poor responders.
For this reason, I have been using growth hormone supplementation for many of my poor responding IVF patients. Whether the additional cost of the growth hormone supplementation is worth it is a more difficult question.
Of course, if we knew that the growth hormone would get the patient to a successful pregnancy and a live birth – it would be a no-brainer. However, this is not magic and many women who use growth hormone supplementation will still have unsuccessful IVF attempts.
Some couples will move on to egg donation because of the high success rates with donor eggs instead of continuing to attempt low-yield IVF with their own eggs.
The most effective dosage and duration of growth hormone has not been clarified yet. The published studies have used:
- Doses between 4mg – 24mg, given daily or every other day
- Used it for the first several days of stimulation, or for the entire stimulation phase
Poor ovarian response to stimulation is a difficult problem without a perfect solution at this time. Supplementation with growth hormone is one way we can try to improve the odds for poor responders.
Larger randomized controlled trials are needed to figure out how much improvement in outcome we can expect by using growth hormone as well as which subgroups of patients could benefit the most.
Welcome to the
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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