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- CDC Report on Fertility Clinic IVF Success Rates
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- Prelude Fertility
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Fertility, IVF and Egg Donation
The Society for Assisted Reproductive Technology (SART) has recently released its Preliminary 2017 IVF success rate reports. The Centers for Disease Control and Prevention (CDC) has not yet released data for 2017. SART and CDC release their reports annually and they are available online for the public to view.
These reports provide critical information about fertility clinics throughout the United States in terms of their IVF and Egg Donation success rates, including 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. IVF treatment requires a huge emotional and financial investment, so it is important for patients to be educated and informed about the differences between clinics’ success rates before choosing a fertility clinic.
Advanced Fertility Center of Chicago (AFCC) is proud that our success rates for 2017 are well above national averages. Our success rates have been higher than average every year for 21 years in a row.
Federal law requires that all in vitro fertilization centers in the United States submit their data annually to the CDC. There is a small percentage of IVF clinics that refuse to report their data most likely because they do not want the public to see their success rate data. If you are considering a fertility clinic that does not report its data, it’s wise to look at other clinics that do report.
There is no legal requirement to report success rate data to SART. Membership in the organization is voluntary, however, members must report their data to SART pursuant to stringent guidelines and rules.
Both the SART site and the CDC site allow visitors to download spreadsheets with data from clinics for purposes of comparing results. However, the SART spreadsheet format is a bit more user friendly and intuitive for those not accustomed to dealing with spreadsheets.
Obviously, some people might only have one fertility clinic within traveling distance of their home so it may not be as important to compare success rates among clinics across the country. However, some patients will travel to another state to have the IVF or egg donation services performed based upon the success rates of a clinic. Every year many couples travel to AFCC from distant states and other countries to have fertility treatments at our clinic.
Superior quality control throughout the entire process results in success rates that are substantially above average. Clinics that have poor quality control will generally report lower than average success rates. Common quality control issues involve problems with ovarian stimulation regimens, IVF procedures (egg retrieval and embryo transfer) and the laboratory embryo culture systems.
Another way to evaluate all aspects of an IVF program’s quality is to view their success rate with egg donation, both fresh and frozen. Since all programs should have equal access to young healthy egg donors, programs having the best success rate reflect the quality of the program, including the ability to grow healthy embryos.
AFCC is proud to once again have one of the most successful egg donation programs in the country.
The Physicians and Embryology team at Advanced Fertility Center of Chicago wanted to address the recent news article regarding an embryo mix up at a large fertility clinic in California. This was a tragic story that touches close to home for us and the important work we do for our patients. We want to reassure you and help ease your mind that we work diligently and meticulously at every step of the procedure to prevent such an instance from occurring in our lab. The team at Advanced Fertility Center of Chicago follows a strict tissue handling protocol:
- Each patient specimen is assigned two (2) unique identifiers.
- Specimens are labeled with a color-coded labeling system for each container and patient specific documentation.
- Each specimen is independently verified and signed off by two (2) embryologists at each step throughout the process.
- Every patient specimen is handled in a “one patient” work space. Meaning only one patients specimens can be in the work space at a time, avoiding the potential for an accidental patient mix up.
Our team places a top priority on the training of and the strict enforcement of these policies. We continually update our training and processes as necessary to ensure our patients are receiving the best care possible. We believe that with these strict processes in place, that we will prevent a similar situation at Advanced Fertility Center of Chicago.
Our hearts go out to the families affected by this event in California. The teams at Advanced Fertility Center of Chicago are honored that you have entrusted us to assist you on your journey to build your family and want you to rest assured that we are handling your eggs, sperm and embryo’s with the utmost care and concern for a healthy pregnancy.
If you have any questions, please don’t hesitate to contact your home office nurse directly and they will assist you.
Michelle Catenacci, MD
Advanced Fertility Center of Chicago
Studies show that lifestyle factors have a profound effect on fertility. One of these critical factors is body weight.
Not only does body weight impact a woman’s ability to conceive a child naturally, a high BMI puts a woman undergoing assisted reproduction, such as in-vitro fertilization, at risk.
BMI is a measure of body size that is calculated by combining height and weight. It is often used as a health screening tool. A BMI that is out of range, either too high or too low, puts a person at risk for serious medical conditions.
A person with high BMI may experience insulin resistance, type 2 diabetes, or high blood pressure. Women with low BMI may suffer from anovulation, osteoporosis, and anemia.
High Body Weight Puts Women Undergoing IVF At Risk
Studies show that significantly overweight women are at greater risk for medical complications during treatment cycles and after conception.
- Require high doses of medication to stimulate their ovaries
- Are less responsive to treatment, which means fewer eggs upon retrieval.
- Have eggs of lesser quality, and a lower rate of fertilization.
High BMI Affects Outcome
IVF data from our laboratory indicates that increased body weight (BMI > 30 kg/m2) has a significant negative effect on IVF pregnancy success rates. Published studies have also shown a higher miscarriage rate and lower live birth rate with women that have a BMI greater than 30 kg/m2. For ongoing pregnancy, there is an increased risk of many complications with obese moms; including diabetes, hypertension, early delivery, stillbirth, birth defects and need for cesarean delivery.
A Little Weight Loss Can Make A Big Difference
A 5%–10% weight loss can improve fertility outcomes. Studies have shown that 5% weight loss results in improvement in hormone regulation, such as decrease in free testosterone, reduction in fasting insulin levels, and improved ovulation.
I am often asked by my OB/GYN physician colleagues about the BMI requirements for IVF patients. At Advanced Fertility Center of Chicago, we take an individual approach to each case; however, we follow guidelines set by the American Society for Reproductive Medicine, and impose limits to ensure the safety of our patients. At this time, we have a BMI limit to undergo egg retrieval set at 42 kg/m2. Besides the risks previously stated above, women with a higher BMI may be at increased risk of complications with the anesthesia used for the egg retrieval procedures. In an office-based setting, with IV sedation, we are conservative in who we put under anesthesia so minimize these potential risks.
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.
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.
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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- SART Success Rates – 2017 Preliminary Reports
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