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What IVF Clinic Success Rates Really Mean

So you're starting IVF and need to choose a clinic. (Here's how I found my IVF doctor). After getting recommendations from friends and family, the first thing you should do is look up a clinic's success rates.

Sounds easy, right?

I mean it should be a straightforward process, looking at the Society for Assisted Reproductive Technology's National Summary, which is divided by state, which then lists each individual clinic. So you look up your clinic and then...

Uh oh. What are all these categories on the chart?

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There are percentage of cycles resulting in pregnancies, percentage of cycles resulting in live births, percentage of retrievals resulting in live births, percentage of transfers resulting in live births, percentage of cancellations —and this is just one category (Fresh Embryos from Non-Donor eggs)—out of three!

If you're not a statistician, how can you ever figure out what it all means and which figure is important?

Basically, reporting clinics (which are the only clinics you should go to), give information on different parts of the pregnancy process—each according to an age group. Sometimes the numbers are misleading. Suppose at a certain clinic, which performed 866 cycles in a year, for the age group of 38-40, they say there were 20.8% of cycles resulting in pregnancy. But upon closer look there was only 13% resulting in a live birth.

Which do care about? Achieving a clinical pregnancy or having a real live baby?

Exactly. But the real figure you want to look at, experts say, is "percentage of transfers resulting in live birth." (Which for this cohort, is 19.6%.) That's because not every IVF cycle requires a retrieval, so you want to focus on the transfers resulting in live births. (You can compare the retrievals to the transfers to see how many retrievals might have failed to produce good embryos).

Basically, what this all means, is that the clinic reporting should be taken with a grain of salt.

Another important number to look at is how many cycles a clinic performed, and on your age group, with the procedure you plan to do. For example, if you want to do genetic testing on embryos, you should be sure to see how many that particular clinic did that year. But when it comes to total number of cycles, more is not always better! A clinic doing hundreds of cycles might feel more "factory-like" than a smaller clinic, which might afford personal attention.

But buyer beware!

Even if you focus on the one important category, there are a number of ways clinics can play with statistics in order to put their best foot forward: Some refuse to take women over 42, or women who are poor responders with low ovarian reserve, thus bolstering their success rates. Others are known for taking on "hopeless cases" and will reduce their success rates. (One

Another problem is that SART does not require counting of "excluded cycles" – because some cycles were never intended to get a woman pregnant, for example, when a woman freezes her eggs, or freezes her embryos to genetically test them or use for a future frozen cycle. But some clinics actually exclude cycles that just don't result in a transfer.

You also have to remember that it doesn't compare pregnancy rates per embryo transferred. Although clinics report the average number of embryos transferred per cycle, two clinics can claim a 40% success rate, but one may transfer on average 3 embryos and another 1.7, on average.

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Basically, what this all means, is that the clinic reporting should be taken with a grain of salt. Use it as a guideline, but together with other criterion, like cost, whether you like the doctor and clinic and your basic gut feeling.

SART must recognize this, because they recently added a new pop-up before you open a particular clinic's chart: "The data presented in this report should not be used for comparing clinics. Clinics may have differences in patient selection, treatment approaches, and cycle reporting practices which may inflate or lower pregnancy rates relative to another clinic. Please discuss this with your doctor."

Image via Flickr

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