The first table in this section is the national summary of combined data from all clinics. Individual clinic tables follow, with each clinic’s data presented in a one-page table that includes the types of ART used, patient diagnoses, success rates that each clinic reported and verified for 2001, and individual program characteristics. Clinics are listed in alphabetical order by state, city, and clinic name.

Many people considering ART will want to use this report to find the “best” clinic. However, comparisons between clinics must be made with caution. Many factors contribute to the success of an ART procedure. Some factors are related to the training and experience of the ART clinic and laboratory professionals and the quality of services they provide. Other factors are related to the patients themselves, such as their age and the cause of their infertility. Some clinics may be more willing than others to accept patients with low chances of success or may specialize in various ART treatments that attract particular types of patients. These and other factors to consider when interpreting clinic data are discussed below.

Important Factors to Consider When Using These Tables to Assess a Clinic

• These statistics are for 2001. Data for cycles started in 2001 could not be published until 2003 because the final outcomes of pregnancies conceived in December 2001 were not known until October 2002. Additional time was then required to collect and analyze the data and prepare the report. Many factors that contribute to a clinic’s success rate may have changed, for better or for worse, in the 2 years since these procedures were performed. Personnel may be different. Equipment and training may or may not have been updated. As a result, success rates for 2001 may differ from current rates.

• No reported success rate is absolute. A clinic’s success rates will vary from year to year even if all determining factors remain the same. However, the more cycles that a clinic carries out, the less the rate is likely to vary. Conversely, clinics that carry out fewer cycles are likely to have more variability in success rates from year to year. As an extreme example, if a clinic reports only one ART cycle in a given category, as is sometimes the case in the data presented here, the clinic’s success rate in that category would be either 0% or 100%. For further detail, see the explanation of confidence intervals.
   

• Some clinics see more than the average number of patients with difficult infertility problems. Some clinics are willing to offer ART to most potential users, even those who have a low probability of success. Others discourage such patients or encourage them to use donor eggs, a practice that results in higher success rates among older women. Clinics that accept a higher percentage of women who previously have had multiple unsuccessful ART cycles will generally have lower success rates. In contrast, clinics that offer ART procedures to patients who might have become pregnant with less technologically advanced treatment will have higher success rates.
  
  A related issue is that success rates shown in this report are presented in terms of cycles, as required by law, rather than in terms of women. As a result, women who had more than one ART cycle in 2001 are represented in multiple cycles. If a woman who underwent several ART cycles at a given clinic either never had a successful cycle or had a successful cycle only after numerous attempts, the clinic’s success rates would be lowered.
   

• Cancellation rates affect a clinic’s success rate. Cancellation rates for cycles using fresh nondonor eggs or embryos vary among clinics from less than 1% to approximately 42%. A high cancellation rate tends to lower the live birth per cycle rate but may increase the live birth per retrieval rate and the live birth per transfer rate.
   

• Success rates for unstimulated (or “natural”) cycles are included with those for stimulated cycles. In an unstimulated cycle, the woman ovulates naturally rather than through the daily injections used in stimulated cycles. Unstimulated cycles are less expensive because they require no daily injections and fewer ultrasounds and blood tests. However, women who use natural or mild stimulation produce only one or two follicles, thus reducing the potential number of embryos for transfer. As a result, unstimulated cycles are less successful, and clinics that carry out a relatively high proportion of unstimulated cycles will have lower success rates. Nationally, fewer than 1% of ART cycles using fresh nondonor eggs or embryos in 2001 were unstimulated. However, in a very few clinics, more than 10% of cycles were unstimulated.
   

• Success rates are calculated per cycle rather than per patient. Therefore, for patients who undergo both fresh and frozen cycles, success rates are calculated separately for each cycle. Clinics that have very good live birth rates with frozen embryos would have higher ART success rates if these births were included as successes from the original stimulated cycle. Consumers should look at both rates (for cycles using fresh embryos and for those using frozen embryos) when assessing a clinic’s success rates.
   

• The number of embryos transferred varies from clinic to clinic. In 2001, the average number of embryos that a clinic transferred to women younger than age 35 ranged from one to five for fresh–nondonor cycles. The American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology discourage the transfer of a large number of embryos because it increases the likelihood of multiple gestations. Multiple gestations, in turn, increase both the probability of premature birth and its related problems and the need for multifetal pregnancy reductions.

In addition, success rates can be affected by many other factors, including

• the quality of eggs.

• the quality of sperm (including motility and ability to penetrate the egg).

• the skill and competence of the treatment team.

• the general health of the woman.

• genetic factors.

We encourage consumers considering ART to contact clinics to discuss their specific medical situations and their potential for success using ART. Because clinics did not have the opportunity to provide narratives to explain their data, such conversations could provide additional information to help people decide whether to use ART.

Although ART offers important options for the treatment of infertility, the decision to use ART involves many factors in addition to success rates. Going through repeated ART cycles requires substantial commitments of time, effort, money, and emotional energy. Therefore, consumers should carefully examine all related financial, psychological, and medical issues before beginning treatment. They also will want to consider the location of the clinic, the counseling and support services available, and the rapport that staff members have with their patients. See an explanation of how to read a fertility clinic table for more information.