Few subjects are as confusing or misleading as IVF success rates - they can be easily manipulated to enhance a particular programs public image. Therefore, reported IVF statistics provide little meaningful guidance for an individual patient hoping to achieve pregnancy with IVF. While experts in the field and statisticians have acknowledged this, the public does not generally understand this and places increasing emphasis on the statistics from individual programs.
A common question in fertility programs is, "What's your IVF success rate?" The quick answer is somewhere between 0% to as high as 50%. Unfortunately, a meaningful answer is a lot more complicated. Obviously, success rates depend on how you define success and calculate the total population. Do you mean clinical pregnancy rate (implantation seen on ultrasound), or ongoing pregnancy rate (fetal heart beat seen by ultrasound) or delivery? Will the denominator in this calculation be the number of couples entering treatment, or those going to oocyte retrieval, or those having pre-embryos replaced into the uterus? But it's even more complicated than that. You are a unique individual with a unique medical history that affects your chance of having a baby. That is why any calculation requires additional information, such as: duration of infertility, severity of infertility, your age, and a host of other factors.
"Success rates" are often advertised or heralded by the media showing that a particular program has the "best success rates" in a given area, supporting their claims with comparative data from publicly available data sources. Unfortunately few reporters or patients ask "How is this really calculated?" and instead choose to believe in miracle workers. While there are many talented individuals in the IVF field, there are no individuals, neither physicians nor embryologists, with supernatural powers.
What is really going on? To understand, we must keep in mind one of the essential principles of statistics - statistics report data from POPULATIONS. Samples are taken, and averages are calculated. But you are a PATIENT, not a POPULATION. You have a UNIQUE set of circumstances that will determine your own likelihood of achieving a pregnancy if you receive your medical care in an experienced IVF center. So, the key to good statistics is to have more ideal patients than difficult patients enter the program. To a large degree, the difference between a program with good statistics and one with less favorable pregnancy rates is more often due to the given mix of patients who present for treatment. Yet by excluding or wait-listing individuals who've failed in other programs, are over 38 years old, have borderline FSH values, have prolonged unexplained infertility, or are low responders, certain programs can improve their statistics. By encouraging ART treatments for patients who are young, have had previous normal or ectopic pregnancies, regular menstrual cycles, limited or no prior treatment, and have normal sperm factors, the advertised pregnancy rates can also be increased. The pregnancy rates also depend on the number of pre-embryos transferred. A program that transfers a larger number of pre-embryos will likely report a higher pregnancy rate than one that judiciously restricts that number, but the latter program will also experience far fewer complications due to multiple births.
So, how can couples with complex fertility problems make an informed choice? Unfortunately, the answer is not simple. You cannot rely solely on published statistics when seeking professional care. The misguided focus on "success rates" has created strong incentives, economic and otherwise, for IVF programs to maximize IVF statistics by adopting some of the "gaming" tactics noted above. A better approach might be to take the following steps:
Look for experience and track record. Participation in SART and CLIA, as well as embryology certification and state licensure, should be considered.
Make your own opinion of their integrity, intelligence, responsiveness and compassion
Learn as much as you can. Review the reputation of the organization and its professionals.
Try to contact former patients. Talk to your friends with infertility problems.
Refuse to be directed anywhere by a healthcare plan. Fight for your right to choose. Insist upon alternatives.
Be willing to spend your own money wisely to get the best health care.
Lastly, think hard and trust your own judgment. Your health care is very important, and the final decisions are yours!
Patient Success Stories
I first came to Georgia Reproductive Specialists in October 2003 at age 37 after having two miscarriages. I was diagnosed with PCOS and put on Metformin. After adjusting my diet and sticking with the Metformin, I got pregnant in Feb 2004, but then miscarried in March...for the 3rd time in a year. The GRS staff was great and by May I was pregnant again. I think of Metformin as my miracle pill - with a few diet and exercise changes along with the medication, I lost 34 pounds and was able to get pregnant without the help of fertility drugs!
I just can't say enough about the GRS family - it seemed like they wanted us to have a successful, healthy pregnancy as much as we did! They were so excellent in answering all of my questions and "babysitting" my pregnancy for the first several weeks. The checking of the hcg levels was so reassuring as we waited (for what felt like months!) to see our baby's heartbeat. During our 6 ½ week ultrasound, I asked our physician if what we saw and heard was the baby and he said "That's something you save for college for!"
Well....we are now saving for college for our son, Cooper Mason Craig. Cooper was born on January 30, 2005 and weighed 8lbs 13oz. He did loose a little over a pound by 4 days old but as we approach the 6 week mark his weight is fine and everything is great! I developed gestational diabetes in the last two months of my pregnancy because I had gotten sloppy with my diet - it was hard to fight all of those pregnancy cravings! But once I got back on the diet GRS originally gave me and began exercising again I was able to keep my blood sugars in healthy range and never had to be on insulin.
Thanks again to GRS for all of their help. I feel like becoming a mother has been the greatest experience of my life! We definitely want more children and we're looking forward to working with our GRS family again!