Success Rate Comparison
IVF Success Rates-Compare Apples to Apples
Nearly forty years have passed since the birth of the first “IVF” baby and approximately 5 million in vitro babies have been born world-wide since then. Yet scientists are still seeking the elusive holy grail of 100% success rate per in vitro fertilization cycle attempt.
To be sure, today’s IVF procedure bears little resemblance to the original IVF treatment that produced Louise Brown (the world’s first IVF baby) in 1978 and which heralded in a new era in medical science. Drs. Robert Edwards and Patrick Steptoe created the first IVF baby during a natural ovulation cycle. At that time, this “exotic” therapy was only offered to infertile couples with severe tubal factor but the procedure had very low success rates. Since 1978 indications for IVF have vastly expanded from its original narrow treatment focus and success rates have increased dramatically. “Mind boggling advances in clinical practice, pharmaceuticals, laboratory techniques and technologies have made IVF a dependable treatment option” for the entire gamut of infertility etiologies including male infertility.
Improved Success Rates
At the beginning of the IVF era, success rates for this new, still “primitive” technology were less than 5% per attempt. Today IVF success rates can routinely approach 40-50% (in good prognosis patients depending also on maternal age and infertility diagnosis). It can certainly be attested to that IVF success rates have vastly improved since the early days of this treatment. Having made this statement with some alacrity however, still begs the observation that probably no topic in the complex field of infertility is as confusing and misleading as a clinic’s IVF success rates. According to an article written by the highly respected Joseph D. Schulman MD of the Genetics & IVF Institute…
Success rates in an IVF program can be made to be almost any number that is desired for public image, without accomplishing anything of value for individual patients.Joseph D. Schulman MD
Genetics & IVF Institute
Understanding Success Rates
While this is well known and privately acknowledged by many of the leaders in the IVF field, the public does not generally understand this. Hence the most commonly asked question of patients contacting IVF programs, at least in the United States is still “What’s your success rate?” The honest answer, of course, is “less than 1% to about 50% (or even more in some cases), once we understand what type, duration, and severity of infertility problems you have” but this is not the answer necessarily provided.”
For the purposes of the framework of discussing La Jolla IVF’s statistics the following is a brief summary of the central thesis of Dr. Schulman’s article. The paper points out the following: While there are talented individuals in the IVF field, there are no individuals that possess supernatural powers. Even major newspapers from time to time run articles about some IVF centers achieving pregnancy rates twice that of other IVF centers in the same geographic area. Some programs even claim they have the “best success rates” in the area and support this assertion with comparative data from publicly available data sources. To start off with, unfortunately, this is a misuse of the public data sources and in fact possibly the manner in which the data is collected for the “publicly available data” is questionable.
Individual Circumstances, Not Population
All statistics are based on the premise of assessing data from populations which are sampled and averaged. However, a couple is not a population. Each individual and/or couple who is diagnosed with infertility has/have a unique set of circumstances that defines their own chances of achieving pregnancy if they receive treatment at an experienced IVF center. In reality “the key to making IVF success rate statistics look good is to control the population data.” Some IVF centers systematically do this. Therefore patients need to understand that populations (as opposed to individual patients) cannot be equalized between IVF centers and this manipulation of IVF statistics (known technically as “selection”) is not apparent in published or advertised statistics. IVF statistics as they are currently compiled cannot prevent manipulation and patients need to understand that population statistics will always be grossly incorrect measures of an IVF center’s quality of care.
Success Rates are Misunderstood
The issue of IVF “success rates” has been (since the first IVF cycle was performed) and probably will remain one of the most emotionally charged, controversial and misunderstood aspects in the field of Assisted Reproductive Technology (ART). Many factors influence the outcome of an ART cycle and each individual and /or couple may or may not fit into the current somewhat arbitrary statistical categories and format currently utilized to collect and report clinic specific success rates. At the present time the only parameters taken into consideration for collection of clinic specific success rates is the age of the egg giver and whether the embryos are transferred in a fresh or frozen cycle. The problem with this overly simplistic approach is that there are many factors which can contribute to an individual’s or a couple’s infertility besides the age of the egg giver. Issues such as FSH level, semen parameters, multiple miscarriages, uterine factors, systemic health and multiple failed IVF cycles are not taken into account when reporting in the current clinic specific success rate format.
Our Patients Come First
La Jolla IVF, for example, believes it is our ethical obligation to accept “poor prognosis” patients many of whom have been turned away from other IVF centers or have failed multiple IVF cycles before they have ever come to us for treatment. If patients such as these would be classified in the gathering of the publicly reported IVF statistics as “poor prognosis” patients and not simply be lumped in with other patients who are considered “good prognosis” patients, then perhaps these IVF statistics would have some validity in terms of what a patient could realistically expect their individual success potential to be based upon their individual prognosis profile.
It has always been this center’s philosophy not to turn away patients regardless of how we think they may affect our success rates.
The Ethics Committee of the American Society of Reproductive Medicine published a report in the October 2004 Fertility and Sterility Journal entitled “Fertility treatment when the prognosis is very poor or futile
In this report the Ethics Committee stipulated the following:
1. Protecting fertility center’s success rates is not an ethical basis for refusing to treat patients with very poor prognosis.
2. Upon request, clinicians may treat patients in cases of futility or very poor prognosis provided the clinician has assessed some benefit and informed the patient of low odds of success.
At La Jolla IVF this sub-population of patients are indeed carefully counseled as to their pregnancy potential and alternatives such as egg donation, gestational surrogacy and adoption are explored. If however, a patient still wishes to undertake an IVF cycle they are not denied access to this treatment. The problem in terms of statistics however, is that there is no differentiation in terms of how the success rates are reported for the poor prognosis patients. They are simply lumped in with the average or good prognosis patients and depending on the profile of patients undergoing treatment in a clinic this lack of differentiation can make a marked difference as to how the statistics of a clinic look. In addition, to this problem, at La Jolla IVF we often perform accumulation or banking cycles whereby we collect and freeze embryos for the poor prognosis patient until we have a sufficient number of embryos to do PGD on and/or to grow to blastocyst and thereby perform a reasonable embryo transfer. In the present reporting format of the clinic specific success rate report, there is no place for us to put these egg retrievals that we know ahead of time will not result in an embryo transfer in that cycle but are specifically being performed to freeze and bank the resulting embryos.
Although La Jolla IVF is a moderately sized clinic in terms of number of ART cycles performed annually, we perform quite a few gestational surrogate and embryo banking cycles per year. It is unfortunate that at this time, the present clinic specific success rate report format does not accommodate reporting these types of cycles. This is disconcerting especially in light of the fact that the goal of the official report is to help potential ART users make informed decisions about ART by providing some of the information needed to answer the following questions:
- What are my chances of having a child by using ART?
- Where can I go to get this treatment?
There is no clinic specific success rates for gestational carrier cycles although 77% of clinics stated that they offered this treatment but only 1% of cycles that were performed were with a gestational surrogate. Success rates for gestational carrier cycles were included in the 2005 ART Success Rates Report as pooled data on a graph. This data does not enable potential patients to look at the success rates of different clinics. Obviously clinics that do more of these types of cycles would be more familiar with the particularities of this treatment and would most likely produce better results than those clinics that only perform a few such cycles a year.