5. Age of woman
   Because a woman’s fertility declines with age, clinics report lower success rates for older women attempting to become pregnant with their own eggs. For this reason, rates for women using nondonor eggs or embryos are reported separately for women younger than age 35, for women 35–37, for women 38–40, and for women 41–42. Clinic-specific outcome rates are not shown for women older than 42 who undergo ART using their own eggs because the number of women in this age group at each clinic is small; therefore, a calculation of the live birth rate in older age groups may not be meaningful. Readers are encouraged to review national outcomes for these age groups. The sample clinic table illustrates the decline in ART success rates among older women. For example, for cycles that used fresh embryos from nondonor eggs, the percentage of cycles resulting in live births among women younger than 35 was 37.4%, whereas the percentage of cycles resulting in live births among women aged 38–40 was 20.6%.
    
6. Confidence interval
   The tables show a range, called the 95% confidence interval, that conveys the reliability of a clinic’s demonstrated success rate. This range is calculated only if 20 or more cycles are reported in an age category. (When fewer than 20 cycles are reported in a given category, success rates are shown as fractions rather than percentages; see paragraph 4, Success Rates by Type of Cycle.) In general, the more cycles that a clinic performs, the narrower the range. A narrow range means we are more confident that a clinic would have a similar success rate if it treated other similar groups of patients under similar clinical conditions. On the other hand, a wide range tells us that a clinic’s success rate is more likely to vary under similar circumstances because we had less information (fewer cycles) on which to base our estimates. Even though one clinic’s success rate may appear higher than another’s based on the confidence intervals, these confidence intervals are only one indication that the success rate may be better. Other factors also must be considered when comparing rates from two clinics. For example, some clinics see more than the average number of patients with difficult infertility problems, whereas others discourage patients with a low probability of success. For more information, see important factors to consider when using the tables to assess a clinic.
   
   See Appendix A for a more detailed explanation and examples of confidence intervals.
    
7. Clinic services and profile

• Current name. This name reflects name changes that may have occurred since 2003, whereas the clinic name at the top of the table was the name of the ART clinic as it existed in 2003. Some clinics not only have changed their names but have reorganized as well. Reorganization is defined as a change in ownership or affiliation or a change in at least two of the three key staff positions (practice director, medical director, or laboratory director). In such cases, no current name will be listed, but a statement will be included that the clinic has undergone reorganization since 2003. Also, in such cases, no current clinic services or profile will be listed.
   
• Donor egg program. Some clinics have programs for ART using donor eggs. Donor eggs are eggs that have been retrieved from one woman (the donor) and then transferred to another woman who is unable to conceive with her own eggs (the recipient). Policies regard-ing sharing of donor eggs vary from clinic to clinic.
   
• Donor embryo. These are embryos that were donated by another couple who previously underwent ART treatment and had extra embryos available.
   
• Single women. Clinics have varying policies regarding ART services for single (unmarried) women.
   
• Gestational carriers. A gestational carrier is a woman who carries a child for another woman; sometimes such women are referred to as gestational surrogates. Policies regarding ART services using gestational carriers vary from clinic to clinic. Some states do not permit clinics to offer this service.
   
• Cryopreservation. This item refers to whether the clinic has a program for freezing extra embryos that may be available from a couple’s ART cycle.
   
• SART member. In 2003, 377 of the 399 reporting clinics were SART members.
   
• Verified lab accreditation. If “yes” appears next to this item, the ART clinic uses an embryo laboratory accredited by one of the following organizations:
   
  • College of American Pathologists (CAP)/American Society for Reproductive Medicine (ASRM), Reproductive Laboratory Accreditation Program.
     
  • Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
     
  • New York State Tissue Bank Program.

  If “pending” appears here, it means that the clinic has submitted an application for accreditation to one of the above organizations and has provided proof of such application to SART. “No” indicates that the embryo laboratory has not been accredited by any of these three organizations.

  CDC provides this information as a public service. Please note that CDC does not oversee any of these accreditation programs. They are all nonfederal programs. To become certified, laboratories must have in place systems and processes that comply with the accrediting organization’s standards. Depending on the organization, standards may include those for personnel, quality control and quality assurance, specimen tracking, results reporting, and the performance of technical procedures. Compliance with these standards is confirmed by documentation provided by the laboratory and by on-site inspections. For further information, consumers may contact the accrediting organizations directly, as follows:

• CAP/ARSM, Reproductive Laboratory Accreditation Program: For a list of accredited laboratories, call 800-323-4040 and ask for Laboratory Accreditation.
   
• JCAHO: Call 630-792-5000 to inquire about the status of individual laboratories.
   
• New York State: Call 518-485-5341 to find out which laboratories are certified under the tissue bank regulations.

Further information on laboratory accreditation is provided in Appendix C.

Previous ART Reports

Implementation of the Fertility Clinic Success Rate and Certification Act of 1992

Assisted Reproductive Technology: Embryo Laboratory