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Fertility, IVF and Egg Donation
I see a lot of couples that fail IVF at other in vitro fertilization programs and then come to us for their 3rd or 4th or 5th IVF attempt. They seek an IVF clinic that can give them a better outcome. Recently I’ve been hearing a similar story from couples that have failed at certain other IVF clinics in the Chicago area.
These couples asked their fertility doctor why our clinic (Advanced Fertility Center of Chicago) has higher IVF and donor egg success rates than they have. They have been told that “Dr. Sherbahn cherry picks the best patients and does not treat patients with a low chance to get pregnant”. In other words they are accusing me of turning patients away with a low chance for pregnancy in order to cherry pick only the best patients and thereby artificially pump up our success rates.
It is a total crock. Patients that fail IVF again and again are likely to do IVF related research on the internet. They will find the CDC and SART websites where they can see if another clinic in their area has better pregnancy rates than the program where they failed.
- People are often motivated enough at that point to drive farther to a clinic that might give them a better chance for success.
- Therefore, people that fail and often have egg quality problems or other issues holding back their success will tend to switch to programs with higher success rates after they have done research.
- This results in programs like ours with higher than average success rates getting more patients with previous failures – which tend to be the most difficult cases.
- As a result, we will get relatively fewer “easy” cases
We do not send patients away or tell them we will not do IVF on them unless they are menopausal or otherwise clearly have a very low chance of success. I believe that if the couple has about a 5% or better chance of success and has been educated about their chances – we should allow them to cycle here. Taking patients with a 5% chance of success is certainly not “cherry picking”
- Some fertility specialists with big egos and poor quality IVF programs either just can’t accept the fact that their IVF programs aren’t very good – or perhaps they’re in denial and really believe that other programs have better success rates because they “cherry pick”
- Either way it’s pitiful
The clinics with low success rates often say that the reason IVF success rates are different between clinics is because:
- Patient populations are different between clinics
- Criteria for canceling IVF stimulation cycles are different
- The number of embryos transferred is different
- The percentage of single embryo transfer cases performed is different
Because these things can be different between clinics they claim that comparing success rates is not valid. However, just because comparisons are not perfect does not mean that comparisons should not be made. We cannot expect 100,000 IVF patients coming to 500 clinics across America to all have equal potential for a successful pregnancy. Every case is different, every egg and every sperm is unique and even the uterus can vary to some extent.
- However no clinic gets all the good cases, and no clinic gets only bad cases
- A mix of patients will present themselves to every clinic for treatment
If we look at success rates of clinics in the US according to the CDC and SART 2008 data sets (see graph below), we see a range of live birth success rates for cycles using fresh donor eggs from 25% to 81% per transfer. The national average for 2008 was 55% per transfer.
Egg donation cycles should be homogeneous with little chance for “cherry picking”. This is why I use donor success rates here for comparison.
- Egg donors are generally quite young – usually under 35 years old
- The recipients tend to have an a normal uterus – a low percentage of patients have uterine problems
- It is therefore unlikely that uterine problems would be a significant factors affecting a clinic’s overall egg donation success rates
- So how can we explain the dramatic differences in success rates between clinics doing egg donation?
- The differences are not due to the quality of the donor’s eggs or the recipient’s uterus or the number of embryos transferred
- These variations in success rates are a result of differences in treatment protocols and quality control in the IVF labs
Execution from beginning to end is critical:
- Proper regulation of IVF stimulation of the egg donor and the recipient properly
- Performing the egg retrieval procedure expertly and at the right time
- Many variables exist in the in vitro fertilization laboratory which impact the quality of the embryos
- Choosing the proper high quality embryos for transfer
- Properly performed embryo transfer using ultrasound guidance is critical for a good outcome
Can there be differences in patient selection and other factors for egg donation cycles?
Will these differences have a substantial impact on success rates?
- No. This is why egg donation is an excellent model for comparing IVF clinics.
Consumers of fertility services should go to the CDC and SART websites and study egg donation success rates of the programs that they might consider going to for IVF or for egg donation. This is a way to compare IVF clinics which pretty much eliminates the “cherry picking issue.
- So to the fertility doctors that accuse other doctors with higher success rates of “cherry picking”, I say:
- Stop whining and put your energy into fixing the problems in your own IVF program instead of making excuses for why another clinic is doing better than you are.
- Or consider quitting IVF and focus on artificial inseminations and infertility surgery
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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