Comparing IVF Clinic Success Rates

Published: 12/10/2015

Let’s face it. When researching potential IVF clinics, patients should be paying close attention to their chosen clinic’s success rates. IVF clinics are required to report their outcome data to the Center for Disease Control (CDC). Many clinics also pay for voluntary membership in the Society for Assisted Reproductive Technologies (SART) and report their statistics there. Both organizations caution that their data should not be used to compare clinics, but the fact is that they are used by patients and clinics alike for that exact purpose even though there are some serious problems in doing so.

ACFS currently reports only to the CDC because we were early adopters of IVF with PGT, embryo banking, and frozen embryo transfer and did not agree with SART's methodologies for presenting our data. We opted out of SART because it required us to report any patient who started fertility medications for IVF as a “cycle” whether she had an embryo transfer or not, and we almost never planned to do a fresh embryo transfer. This meant that, until most recently, these IVF/PGT embryo banking cycles were reported as an unsuccessful cycle with a pregnancy rate of zero. We did not feel that this reporting strategy accurately reflected the intentions of the cycle or the high level of success that we were achieving with planned frozen embryo transfer. You will also note that the data are approximately 2 years behind at any given time. This is due to the time required to collect live birth outcome data from patients who have long-since left the treatment of the fertility clinic.

Despite some limitations inherent to the reporting process, however, both the CDC and SART reports are extremely useful for gaining a general idea of the typical success rates for specific age groups and infertility diagnoses on a national level. They can also be useful for seeing the number and types of IVF cycles that a clinic is performing and how many of their patients are getting pregnant for each age group and type of IVF treatment. If a clinic has few or no pregnancies in women over 40 years of age, that may be telling you something. If a clinic’s donor egg IVF success rates are well below 40 or 50%, then that may also be a red flag. Pregnancy rates from frozen eggs are important to look at if you are considering egg freezing. The CDC and SART data should generally be interpreted with caution, however, because the numbers are only as valid as the data provided by the reporting clinic.

Some clinics will unfortunately try to game the system to make their program appear better. This can be accomplished by refusing to treat patients outside of specific age, weight, FSH, or AMH cutoffs or by encouraging patients with milder infertility issues who may have conceived with lesser treatment to do IVF instead. Some particularly dishonest clinics may even pull unsuccessful cycles out of their reported data and classify them as “experimental.” We’ve also seen clinics market themselves directly to patients, advertising deceptively high success rates by touting the percentage of patients achieving a positive pregnancy test over multiple treatment cycles as their “success rate” and hoping that prospective patients do not recognize the important distinction between a live birth after a singe embryo transfer and a positive pregnancy test and pregnancy loss after multiple egg retrievals and embryo transfers in the same patient. The clinic can state that she was 100% pregnant, but the reporting method seems disingenuous to us. Ultimately, any and all of these manipulative strategies can make a clinic’s capabilities appear better than they truly are. On the other hand, clinics that report accurately and accept a disproportionately higher number of patients that are older, heavier, have poorer ovarian function, or have failed treatments elsewhere may appear to have a lower success rate per cycle start when they are actually achieving respectable or remarkably good success rates for their given patient population.

We will acknowledge that the live birth rate per cycle start and per patient (over more than one treatment) are valid and useful measures, but they do not lead to a true apples-to-apples comparisons of performance between clinics. Yes, clinical and laboratory expertise impact the probability of obtaining the eggs and embryos needed to complete a successful IVF cycle. If a clinic does not obtain eggs that it should have due to poor cycle management, damages eggs during ICSI, has a larger than normal proportion of embryos fail to survive blastocyst culture, embryo biopsy, cryopreservation, or thaw, then it should not offer or recommend IVF with PGT to its patients. Those clinics should stick to the basics if that’s what they do well. On the other hand, among high-performing clinics and laboratories using newer IVF/PGT technology, patient characteristics will play a huge role in the probability of obtaining healthy embryos for transfer. This is why donor egg IVF or IVF with PGT and frozen embryo transfer, two treatments that take some of the upfront egg factors out of the equation, can really start to reveal how the IVF program (and even the individual physician) can impact the likelihood of success.

Patients are cautioned regarding making comparisons of success rates between IVF clinics based on the clinic-specific data reports released by the Society for Assisted Reproductive Technology ( SART ) and the Centers for Disease Control ( CDC ). Although SART issues a statement that specific clinic data should not be used for comparison, the fact is that they are used by patients and clinics alike for that purpose. There are many factors that influence IVF success rates and many variables exist among individual clinics that make comparisons almost impossible based on the released data. Some of these problems of the clinic-specific data reports include:

• The SART data are not divided into repeat and new IVF patients. This matters because multiple previous IVF treatment failures may lower the chance for success with future treatment attempts. Some clinics thus reject patients with previous failures to maintain the appearance of higher success rates. ACFS DOES NOT DO THIS.
• The population mix of individual clinics is totally unaccounted for in the SART-released data. For example, a clinic that pushes IVF treatment ( which may be justifiable in many circumstances ) as the primary treatment modality for unexplained infertility may have higher success rates than a clinic that offers IVF to its patients only after they have been unsuccessful with "low" tech treatments like IUI (intrauterine insemination). The different population of patients being treated may largely account for the higher success rates. ACFS DOES NOT DO THIS.
• The criteria for patient acceptance and for cancellation prior to egg retrieval vary among clinics and, as such, influence pregnancy rates tremendously. For example, a clinic that does not accept patients beyond certain age, weight, FSH and AMH cutoffs may, report higher success rates than a clinic that does not exclude these patients. Again, the higher success rates will be largely attributed to the patient population. ACFS DEFINITELY DOES NOT DO THIS.
• The policy for fresh embryo transfer and embryo cryopreservation is very different among clinics and greatly influences the pregnancy rates. For example, clinics that culture all the embryos and transfer only the morphologically best embryos may have better fresh pregnancy rates than clinics that culture only the desired number of embryos for transfer and freeze all the rest at the pronuclear stage. There are many advantages in freezing excess embryos that include giving patients another chance for embryo transfer without repeating stimulation and egg retrieval and reducing the incidence of a multiple pregnancy. ACFS ONLY DOES FROZEN EMBRYO TRANSFERS WE HAVE FOUND UP TO A 30% HIGHER PREGNANCY RATES THAN TRANSFERRING ON A FRESH CYCLE THAT IS PHYSIOLOGICALLY OVERSTIMULATED. ACFS STRONGLY BELIEVES THAT PGT (preimplantation screening) SIGNIFICANTLY IMPROVES PREGNANCY RATES, ONGOING CLINICAL PREGNANCIES AND DECREASES MISCARRIAGE RATES. PGT TESTING REQUIRES THAT ALL EMBRYOS BE FROZEN WHILE YOU AWAIT THE RESULTS. THIS WORKS OUT PERFECTLY SINCE ACFS DOES NOT RECOMMEND FRESH TRANSFERS.

These are only some of the examples that can be listed that clearly invalidate comparisons between IVF clinics based on the released SART clinic-specific data reports.