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2003 Assisted Reproductive Technology (ART) Report: Introduction
to Fertility Clinic Tables |
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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 2003, 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 2003. Data for cycles
started in 2003 could not be published until 2005 because the final
outcomes of pregnancies conceived in December 2003 were not known
until October 2004. 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 2003 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 2003 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 about 48%. 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 2003 were unstimulated. However, in a very few clinics,
more than 5% 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 2003, the average number of embryos that a clinic
transferred to women younger than age 35 ranged from two 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
- Quality of eggs.
- Quality of sperm (including motility and ability to penetrate the
egg).
- Skill and competence of the treatment team.
- 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.
Previous ART Reports
Implementation
of the Fertility Clinic Success Rate and Certification Act of 1992
Assisted
Reproductive Technology: Embryo Laboratory
Date last reviewed:
03/23/2006
Content source: Division
of Reproductive Health,
National Center for Chronic Disease
Prevention and Health Promotion
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