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Published IVF Success Rates And Why They Vary
Not all published IVF success rates reflect the same information. In this video, Dr. Gleicher explains why you should be cautious when researching center success rates and make sure that you're paying attention to the "intent to treat" numbers, not just the live birth rates.Want to Consult Dr. Gleicher?
Hello, I want to talk to you today a little bit about how it is possible to know that whatever outcome information you're receiving from from different IVF centers can be trusted. In the US, under the federal law, IVF centers have to report their annual IVF outcomes to the Centers for Disease Control (the CDC). Most IVF centers comply and participate in this process because there are really no penalties for not complying. There's a small group of IVF centers that do not report and I would obviously advise that that should be viewed as a point of caution. So, in principle, you can go to the CDC and indeed also to the American Society for Reproductive Medicine combined with the Society for Assisted Reproductive Technology (SART) Registry, which in contrast to the CDC is a voluntary registry. Both report on the vast majority of IVF centers and from both of these data sets you can get important information. But how you interpret this information is even more important because you need to understand what those registries really offer. And the information that is offered, if you do not understand the background --how the data is gathered and how it is interpreted-- can lead to significant misunderstandings. So, in principle, all reporting IVF centers report how many pregnancies and life births they achieve in their IVF programs. But it is very important that when looking at those data, you recognize that some of the outcomes are reported based on cycle starts (meaning it involves only women who have started an IVF cycle and have gone through the whole process of IVF) and that is of the denominator. Yet others report (and this is where the problem comes in) in reference to embryo transfer and that is a completely different world and it is extremely important that you as a consumer --you as a patient-- understand the difference. If a center reports the results simply based on how many pregnancies are live births they have achieved in reference to embryo transfers, it means that in their data are not the patients who don't even make it to embryo transfer. And this is of crucial importance because those are obviously the poorer prognosis patients and unfortunately, that is what is happening many, many times. Now, there is nothing wrong in reporting outcomes in certain patient populations per embryo transfers because there are, for example, much older patients who very frequently know that their chance to make it to embryo transfer is extremely low and they consider that in their considerations whether to proceed with a cycle or not. But the average patient who looks at outcomes reported by various IVF centers is not such a poor prognosis patient. The average patient is an average-to-good prognosis patient and those patients can be gravely misled by outcome reports that only report on patients who reach embryo transfer. Therefore, please be very careful when assessing national reporting and educate yourself whether those reports are based on what we call "intent to treat," which means that every patient who starts an IVF cycle is considered in the statistics or whether those outcomes refer only to add those patients who reached at least embryo transfer with one embryo. Why is this important? Here are a few examples. Imagine a patient who goes through IVF and has 10 eggs retrieved, but only 3 of those 10 eggs fertilize. And let's further assume that those 3 eggs that fertilized become good embryos and let's assume that in that IVF Center those embryos are still being tested for chromosomal abnormalities and suddenly none of these embryos are reported to be normal and therefore not transferable. As a consequence, that cycle will never show up in statistics that refer only to embryo transfer. This is just one example. Another example is: imagine another new fashion in IVF which suggests that embryos should not be transferred in fresh cycle, but should uniformly be frozen and then transferred in a subsequent frozen cycle. We here at CHR think that this is a quite ridiculous approach towards IVF and that there is no convincing evidence to support this kind of a practice, but think for a moment what it does to national reporting or potentially does to national reporting. Because if you freeze embryos, there's no transfer on the same cycle and those patients will not be showing up in statistics that are then reported to those national reporting sites. We here at CHR published not too long ago a study in which we reviewed how those almost 500 centers that are reporting in the US would look if indeed all of their outcome reporting was based on "intent to treat," meaning including all patients who start the cycle rather than just those patients who reach transfer, and we had some rather surprising findings. The most surprising finding was that when we took those IVF centers that had the highest rate of so-called, "embryo banking cycles," in other words cycles where they did not immediately transfer, we found that those those centers very frequently where amongst those IVF centers that reported the highest rates amongst all those 500 reporting centers in terms of live birth rates. But when we corrected their data and really looked at their data based on an, "intent to treat," we found that the vast majority of those so-called, "best outcome centers," actually fell in their life birth rates below the median of the remaining four hundred-plus IVF centers. That shows you how misleading national IVF reporting outcomes can be. Therefore, be very careful and remember how important it is to differentiate between reports which are based on a "intent to treat," i.e. "cycle start," and reports that tell you only how well those patients do who indeed reach embryo transfer. Thank you.
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