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Fertility, IVF and Egg Donation
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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