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2006 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 2006, 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 2006. Data for cycles
started in 2006 could not be published until 2008 because the final
outcomes of pregnancies conceived in December 2006 were not known
until October 2007. 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 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 2006 may differ from current rates.
- No reported success rate is absolute. A clinic’s
success rates vary from year to year even if all determining factors
remain the same. 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, practices that result 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 2006 are
represented in multiple cycles that cannot be linked. 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, in a few cases, more than
30%. A high percentage of cancellations tends to lower the
percentage of cycles resulting in live births but may increase the
percentage of retrievals resulting in live births and the percentage
of transfers resulting in live births.
- 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 2006 were unstimulated. In a very few
clinics, more than 2% 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 a very high percentage of cycles resulting
in live births 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 2006, the average number of embryos that a clinic
transferred to women younger than age 35 ranged from two to six 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.
Undergoing 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.
Explanation of how to read a fertility clinic
table.
Previous ART Reports
Implementation of the Fertility
Clinic Success Rate and Certification Act of 1992 Page last reviewed: 12/3/08
Page last modified: 12/3/08
Content source: Division
of Reproductive Health,
National Center for Chronic Disease
Prevention and Health Promotion
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