CHR's Year To Date pregnancy rate represents ongoing clinical pregnancies that were signed out into Ob-care. A comparison of clinical success rates may not be meaningful because patient medical characteristics and treatment approaches may vary from clinic to clinic.The listed pregnancy outcomes reflect ongoing clinical pregnancy rates and not delivered pregnancies. The pregnancy rates are calculated as a percentage of embryo transferred, and not as a percentage per cycles started. Delivered pregnancy rates will be somewhat lower than clinical pregnancy rates and percentages, based on numbers of cycles started, will be lower than rates based on the numbers of egg retrieval performed.

We are now presenting pregnancy outcomes in smaller age groupings because the majority of cycles, performed at CHR-NY in 2008, were in women with diminished ovarian reserve, either due to advanced female age or in women with prematurely aging ovaries.

CHR-NY, Clinical Pregnancy Rate/Per Transfer including all IVF cycles at CHR
(January, 2008 to December, 2008)

* The patients in these age groups in our practice almost uniformly suffer from prematurely aging ovaries (POA) and often were elsewhere referred into egg donation before consulting with CHR.
** The patients in the 44 plus group represent 48.9% of all cycles in women aged 40 or more years and 21.9% of all fresh IVF cycle activities.

INTERPRETATION OF 2008 IVF OUTCOMES

Please note that here presented data represent pregnancy rates for women who reached embryo transfer. Even though cycle cancellation rates at CHR have always been low, pregnancy rates per cycle start would, obviously, be somewhat lower. These data are nevertheless remarkable, considering the patient population CHR served during 2008. Adverse patient selection continued in parallel with a significant increase in cycle volume. Please note that 46% of all IVF cycles at CHR in 2008 were in women > 40 years of age. Indeed, a full 27% were in women at ages > 43 years. CHR’s clinical pregnancy rate in women > 40 years was 16% per embryo transfer, in women > 43 it was 8%.

It is, however, important to note that over 85% of CHR patients above age 42 consulted with CHR  after receiving advice to go into egg donation. Indeed, close to 50% of women  under age 40 had previously received the same advice. To achieve such pregnancy rates in women, who at other, often very prominent, IVF centers had been refused further treatment with use of their own eggs
is rather remarkable.

The latter number is, of course, a reflection of the rapidly expanding number of younger women with prematurely aging ovaries (POA), CHR has been serving during 2009, based on increasing awareness of CHR’s exceptional outcomes in such women. The here presented 2008 outcome data, demonstrating an average clinical pregnancy rate of 38% in women under age 40, considering CHR’s patient population with a very high percentage of POA, is nothing but spectacular.   

Comments to 2008 Statistics Listed Above

The here quoted pregnancy rates are 2008 results and do not necessarily reflect on future performance. Since patient populations vary between fertility centers, the here presented outcome data should not be used for comparisons between different centers. This is best demonstrated by the exceedingly high prevalence of women with premature ovarian aging (POA) and, therefore, diminished ovarian reserve, in CHR patients, as recently reported in detail (Barad et al. Obstet Gynecol 2007;109:1404-10).

Considering the very unfavorable patient population at CHR, 2008 pregnancy rates, therefore, have to be considered excellent. CHR’s IVF outcome statistics during YTD 2008 remain excellent. It is noteworthy to point out that the shift towards older female age continues. Quite remarkable, almost a quarter of all fresh cycle activities involved women at age 44 or older. Not only experienced these women (who at most other IVF centers would not even be admitted into IVF) a remarkable clinical pregnancy rate of 13.0% but, considering CHR’s very low miscarriage rate in DHEA supplemented women (15.1%), most can also be expected to deliver.

Almost all women above age 40, undergoing IVF during 2008, were supplemented with DHEA.

Since outcome data are presented in small age increments, cycle numbers are at times small. Individual percentages should, therefore, be viewed with caution and the program should be assessed based on its overall performance, rather than small, individual age groups. Moreover, outcomes are not only dependent on female age. Past outcome data may, therefore not apply to individual patients. Please, therefore, consult with a physician at CHR about your own, individual cycle expectations.

The Future

We are, of course, very excited about our 2008 outcome data. This, however, does not mean that we intend to sit on our laurels. Very much to the contrary; As already noted above, as of 2008 we have expanded the utilization of DHEA to all women above age 40. We fully expect further improvements in our outcomes in older women, following this change. Our goal for 2009 is a first pregnancy in a 46-year old (or older) woman. This is currently the holy grail of infertility care. We have also introduced further individualization in stimulation protocols for the most resistant women to stimulation who, even after DHEA supplementation, do not respond.

Most importantly, CHR will continue to drive knowledge forward. By further expanding our clinical research during 2008, we are convinced that we will continue to improve patient care results and our patients are always the first to benefit.