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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.
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?
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
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.
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
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.
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.
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