Dear Eggsperts—It’s me again. I am deep in research to choose the best clinic near me. You suggested checking out the stats for a clinic and am doing just that. I am struggling to understand what it all means. Even the page that you said was ‘more reader friendly’ is tricky. Any suggestions? –Only Best in Bakersfield
Dear Best—Unlike most medical specialties, there is a lot of data out there regarding pregnancy rates for fertility clinics. The proverbial blessing and curse, of course! It’s cumbersome & confusing, for sure. There’s a lot that goes into these reports, so we advise anyone reading them to take them with a grain of salt. Unfortunately, there is nothing simple about it. The reports can be a starting point to helping you find a clinic, but can never substitute for personally meeting with your doctor to discuss your specific needs. Before we dive into the nitty gritty, here are a few pointers for interpreting the data.
Decide how much these numbers mean to you. To do that, ask yourself a few questions:
- Do I want to go to a small, quaint office, where I’ll know everyone? Or, would I prefer a larger clinic? The more patients a clinic sees, the more reliable the reported success rates may be for helping you think about how successful they may be in helping you conceive.
- Does this clinic treat a lot of patients like me? (same age, same fertility dysfunction, etc) This may be a reflection of how successful you may be with IVF at this clinic.
- Do I care about the purity of the data, or would I be concerned if I knew that some clinics have figured out how to manipulate their patient populations to produce statistical excellence? A deep, but question worth considering none-the-less.
Always remember, statistics and data are NOT people.
The data sources are there to merely give the general public an idea of the average patient’s chances of success. They won’t tell you if YOU, specifically, will be the patient to achieve pregnancy or not. Outcomes vary for each patient depending on age, infertility diagnosis, test results, specific medical conditions associated with infertility, obstetric history, and results of any previous fertility treatment. You will never viewed by your physician as being an ends to a means. You are never viewed as just another chance to improve a stat. But, unfortunately, the governing bodies have to use an objective measure for patients to be able to compare success rates among clinics, large and small, private or equity, or old and new.
Who are the players in the statistics game?
- Since 1981, clinics have been performing In Vitro Fertilization (IVF) in the United States.
- The Society for Assisted Reproductive Technology (SART) is a membership organization of clinics that provide IVF. SART has been collecting and publishing annual reports of pregnancy success rates since 1989.
- In 1992, Congress required that clinics performing IVF report their pregnancy success rates to the Centers for Disease Control and Prevention (CDC). This will be the most complete source report of IVF clinics.
- SART and the CDC have been working together with the American Society for Reproductive Medicine to publish these reports since 1995.
- The information available, and the way it is presented, has changed many times in the past 30 years, as technology has changed the way IVF is done.
There are differences between the reports published by SART and the reports published by the CDC.
- SART is a membership organization. 82% of clinics performing IVF are members of SART, but that means nearly 1/5 IVF clinics chooses not to participate in this voluntary organization.
- The CDC reports will be most complete as clinics are required by law to report their success rates. 98% of clinics doing IVF reported to the CDC in 2017.
- The 2 organizations vary in data submission deadlines, data processing, statistical methods, and the way the data is presented. All of which can impact published results.
The available reports may not fully reflect the clinic’s success rates today.
The most current complete report available is from cycles performed in 2016, with preliminary results for cycles performed in 2017.
- Success rates rely on information about live-births. Some egg retrieval cycles may have more than one associated embryo transfer. For cycles that began in December 2017, success rates are linked to all embryo transfers completed by December 2018. For embryo transfers that were completed in December 2018, babies may be born in September 2019. Then the data has to be collected, analyzed, and validated before the final report is issued.
- Due to the large number of clinics (448 reported to CDC in 2017) and IVF cycles (284,385 reported to the CDC in 2017), the analysis of the raw data and generation of the final statistics, followed by extensive data checks takes many months to complete before a final report is generated.
- Factors that contribute to a clinic’s success rate may have changed in the time period between the last report and when a patient is seeking treatment. For example,
- Equipment and training of personnel may, or may not, have been updated;
- Success rates can vary even if all other factors remain the same, simply by chance;
- The more cycles a clinic performs, the less variability there will be in success rates due to the law of averages. Likewise, a clinic performing fewer cycles may have a wide range of success rates from year to year. If a clinic performs a small number of cycles, one more (or one fewer) successful outcome may dramatically alter their percentages.
There may be differences in clinic practices that may influence the statistics.
The data does not reflect differences in patient selection.
- Clinics that see patients with more complex problems may have lower average success rates. Clinics that discourage patients with low likelihood of success, or strongly encourage them to use donor eggs, may have higher average success rates.
- Clinics who treat patients who have had multiple unsuccessful cycles and may be more complicated, may have lower success rates. Clinics that encourage IVF in patients who may have conceived with less technologically advanced procedures may have higher success rates.
- The number of embryos transferred may impact the live birth rates favorably, but with a higher rate of multiple births, and the increased risk of complications.
The most current reports can be found at:
- Centers for Disease Control and Prevention. https://www.cdc.gov/art/index.html. In addition to the full report, the site provides patient resources including educational videos for finding a clinic and reading the reports. Clinics can be searched by state. And, there is a success rate estimator that includes age, weight, number of previous IVF cycles, diagnosis, and pregnancy history.
- Society for Assisted Reproductive Technology. www.sart.org. In addition to patient education resources, clinic specific data is available and can be filtered by cycle type, and by diagnosis, if one or more embryos were transferred, if advanced techniques were used, and even if this is the first time a patient has done IVF at the clinic. Clinics can be searched by zip code, state, or region. This site also has a patient-friendly success rate calculator.
- www.fertilitysuccessrates.com uses the CDC national report to “rank” clinics by live birth rates per cycle. Clinics are “ranked” nationally and by state and can be filtered by age and whether or not embryos are transferred fresh or after they have been frozen/thawed. Patient-specific characteristics, other than age, are not accounted for in the “rankings.”
So, now that we have made reading the tables clear as mud, our best advice, use the statistics to start out, and as one tool for deciding which clinic is right for you. But remember, statistics don’t tell the whole story. Don’t be afraid to ask questions to see how you, and your doctor and clinic, may vary from the “stats.”
We hope we met your Eggspectations—An Eggspert
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Disclaimer: All of the comments on this page are for basic information only. They are based on the opinions and expertise of the authors and are not meant to provide a substitute for medical care or specific treatment recommendations. Each person is unique and requires individualized diagnosis and treatment plans. Any specific questions should be directed to your personal healthcare provider.