New Leaders In Fertility & Endocrinology

What are true chances of successful IVF outcome?
Medical science is often a mystery to the lay public but in an effort for honest disclosure about ART (assisted reproductive technologies) statistics, the U.S. government legislated a centralized and standardized CDC reporting system in 1992. ART statistics are confusing for even the educated and for many others, they can be misleading at best. By having fertility practices report outcomes, it was hoped to be a step toward patient advocacy but in retrospect, it has left as many questions as answers.

A new broad-reaching and authoritative textbook, Infertility and Assisted Reproduction, editors: Rizk, Garcia -Velasco, Sallam, Makrigiannakis, was published in 2008. Drs. Ripps and Minhas were asked to contribute a chapter that addresses the evaluation of ART statistics as presented to the public in the CDC database (Chapter 60, pp570-575). Their findings were quite revealing. The following entry offers some pertinent conclusions.

As advances in reproductive laboratories have increased successes, the techniques have become relatively standardized as well, producing little variation in outcomes between lab settings. However, the list of other factors that influence the outcome statistics is diverse and astonishing and these factors are not reported to the CDC.

Perhaps the greatest non-reported influence is patient selection. If a physician at a fertility program encourages the better prognosis couples to complete IVF, and shuns those with poor prognosis, this artificially elevates its pregnancy rates above the average. This deception is apparently widely practiced, particularly in highly competitive metropolitan markets where pressure to achieve pregnancy is an incentive for this and for excess embryo transfer and high multiple pregnancy rates. There are many publicized cases that illustrate what are otherwise invisible phenomena.

There are also, unfortunately economic influences that encourage practices to move quickly to the more expensive ART options when in many cases other less costly and less invasive treatments would suffice. Some patients with less patience go along with such management when dealing with prolonged infertility. So there is public pressure on practices as well.

The authors’ research revealed that even the best intentions for disclosure and consumer advocacy, are trumped by clinical practice patterns leaving patients in search of something more. Those programs that report pregnancy rates far above the national average are likely manipulating their numbers by selecting better patients. Those practices well below the average, likely need improvement. A general recommendation about IVF statistics that may be valuable to consumers is to seek fertility programs with “average” pregnancy rates as they are probably practicing consistent, cost-effective, quality medicine.