The lastest publishing of the US SART IVF clinic success rates for 2011 has led to some interesting discussions about how to best use the SART or CDC data. It also identified a few scenarios where the data simply isn’t relevant for a patient’s clinic or doctor selection process.
This chart of 2011 data shows the significant disparity between average national data and top clinics results in each age bracket – so it is only natural that patients would want to use success statistics to help them select the clinic that will give them the best odds for success. But it isn’t so simple.
Many doctors have complained about the weaknesses in the current reporting systems, but many patients really don’t know much about the scenarios where the data just isn’t relevant for their treatment. Also, many times patients are just looking at one or two stats pulled from the data to create their short list of possible clinics for their treatment – when it really pays to look at the bigger picture. It is often only after a failed cycle (or two, or three) that patients begin to really scrutinize all of the data and start analyzing and comparing various statistics between clinics.
First, let’s talk about a few scenarios where the SART data of IVF success rates by clinic might not be entirely helpful if used alone in selecting a clinic – and probably not even for coming up with a short list of clinics:
1) CCS. Comprehensive chromosome screening is becoming more prevalent and is boosting success rates at many clinics. BUT, for the majority of clinics who are doing the day 5 biopsy, freezing and transfer in a frozen cycle, suddenly it impacts how their live birth rates are reported. The fresh live birth rate per transfer is the one statistic that is probably used most often, yet for clinics using CCS, using just that one statistic, you would have a skewed view of the clinic’s overall success.
Here’s an example of this. In 2011, the very well respected clinic CCRM did nearly twice as many frozen transfers in almost every age category. We can assume that many of those were CCS transfers. As a result, you will see that their frozen transfer live birth rates are consistently higher than their fresh live birth rates (which is usually unheard of). In fact, in each of the age categories from 35 – 42, their live birth per transfer stats were over 20% higher with the frozen transfers than with fresh transfers. Not so surprising when we understand that they are using CCS to pick competent embryos for transfer. But, that now means that the most often reported statistic (live birth for fresh transfer) is no longer a good measuring stick for that clinic.
Yet, many patients may initially only look at fresh live birth per transfer rates when deciding what clinics to contact – and in this case, they might not ever talk to CCRM.
2) Frozen eggs. Currently, the CDC and SART do not publish separate statistics for frozen donor eggs (egg banks) or for eggs frozen for fertility preservation. So, there is no meaningful audited method for an apples to apples comparison of the live birth rates of clinics who are offering fertility preservation, or offering frozen donor eggs either through their own donor egg bank or an affiliation with an egg bank.
Since frozen donor eggs are a lower cost option for donor egg IVF and they remove some of the risk factors, we can expect the demand to increase. Also, now that egg freezing is no longer considered experimental, it’s difficult for consumers to compare results between clinics offering this option.
More importantly, now that frozen donor eggs are becoming more widely available and appealing for various reasons I talked about here, there is demand for being able to see the outcomes data compared on a clinic by clinic basis. Not surprisingly, the fact that the technology is still newer, means that the success rates with frozen donor eggs vary widely between clinics. Some are reported live births as low as 40% others over 70% – depending on the clinic and the egg bank. It’s certainly a big enough difference to warrant serious research and comparisons between clinics offering this option.
3) Donated Embryos. SART does not publish separate statistics for frozen donated embryos, and whether those results are reported at all, or in which category may vary by clinic. In researching an article I was writing on embryo donation a few months ago, I was a bit surprised at how little information is available on the number of donor embryo cycles in the US each year and outcomes from those frozen donated embryos. I do agree it is difficult to have a meaningful comparison of frozen, stored embryos due to factors such as embryo quality, underlying infertility diagnosis, age of the individuals providing the eggs and sperm, type and length of freezing/preservation that all play into the likely outcomes. But, to my knowledge, there currently are no standardized methods for even trying to reporting the cycles and results from donated embryos. Donated embryos are in high demand because they are often one of few low cost IVF options for family building.
4) Last, but certainly not least, (and not a new complaint) is the fact that statistics are reported by clinic rather than by doctor. This makes it difficult – if not impossible – for patients to identify which doctors are having good success and which may be less successful for a specific age range or treatment/diagnosis. The end result is a great doctor may not be recognized if there is another doctor in the practice bringing down the overall clinic stats. And conversely, a patient may select a clinic based on the overall stats, only to find out later on that their treating physician’s stats are significantly lower than the combined clinics stats.
I know that many doctors keep their own individual stats and will share them with patients upon request. Rarely do we find this information on clinic websites though, and typically it is not readily available prior to scheduling a consultation. Although there may be very valid reasons for why a doctor’s statistics aren’t the highest, I think that patients should not be shy in asking a physician for his or her own personal statistics, and I would hope that clinics and physicians are willing to share this information upon request and provide meaningful answers about the data.
In this way, the patients can be informed consumers and go into their final decision making about clinics and treatment choices armed with relevant information. Can you imagine buying a house or car without doing the research? Yet, many patients are spending as much on fertility treatments as they would on a car or house, and are doing it with precious little information aside from a referral from a friend or OB.
Once again, I will say that the statistics aren’t the only thing to consider, but I do believe that they are a relevant part of the overall decision making process. And making that data more accessible and easier to understand only aids in making better informed patients making well reasoned decisions.