Beyond the SART Statistics How to Choose a Good IVF Program

The Fertility Clinic Success Rate and Certification Act (HR 4773) was signed into law in 1992. The Act requires IVF programs to report their success rates to the Center for Disease Control. The CDC, in turn, makes this information available to the public via their website (http://www.cdc.gov/ART/ART2006/index.htm). Because the Act also required IVF programs to submit their success rates to an external validation process, the Act reduced the number of clinics advertising unsubstantiated and highly inflated success rates. Unfortunately, the validation process takes more that two years to complete. This year (2009), consumers of infertility services can view validated success rates from 2006. Preliminary rates are available for 2007.

Couples seeking assisted reproductive technologies must consider several important factors when comparing clinic success rates. The CDC has provided a guide for patients (http://www.cdc.gov/ART/ART2006/ifct.htm#Important Factors). Furthermore, reproductive medicine is renowned for the speed at which new methodology, technology, and drugs are incorporated into clinical treatment. Therefore, the success rates from two years ago are of limited value to the patient. Some clinics advertise more recent success rates, but these rates are unverified and should be interpreted with caution. So how do you determine your chances of success at a given clinic? The truth is you cannot. Thats why there is a disclaimer on every clinic-specific report stating that programs cannot be compared based on success rates.

However, there is a way to generally compare programs using the SART clinic-specific report. The great equalizer in IVF is the use of donated eggs. Many of the confounding variables such as diagnosis, maternal age, egg number and quality are eliminated and the entire IVF process is optimized when eggs from a young donor are used. Therefore, the best way to compare programs is to compare the live birth rates for cycles in which donated eggs are used. This will give you a pretty good idea of the competency of the physicians and the quality of the laboratory.

Beyond the SART statistics, there are several factors to look for when choosing an IVF program. One very important factor is the credentials, experience and personality of the physician. SART recommends that a board-certified or board-eligible Reproductive Endocrinologist (RE) act as the Medical Director of the IVF program. A board-certified RE has successfully completed a 2-3 year fellowship training program, a written examination and an oral examination. A board-eligible RE has completed the fellowship training program, but has not yet completed the written and/or the oral examinations. Some doctors who are board-certified in obstetrics and gynecology also offer infertility treatments, but they have not completed subspecialty training in infertility. In addition to formal training, the number of years of experience the doctor has will also play a part. An RE just out a fellowship program may be up to date in the theoretical aspects of infertility treatment, but lack hands on experience. On the other hand, an RE who has been in practice many years (and remained up to date) likely possesses the knowledge and experience to suggest the best treatment option for you. Finally, the doctors personality will also play a role in your choice of programs. During your initial consult and in subsequent treatment, you should feel free to ask as many questions as you like and be satisfied with the depth of the answers you receive. A doctor that appears hurried or dismisses your questions with quick answers can leave you anxious and stressed. The more information you have, the more relaxed you will be throughout your treatment.

The IVF laboratory will also play a very significant role in determining your success, but assessing the quality of the laboratory can be tricky. The quality of the laboratory will depend on the credentials and experience of the laboratory staff and the effectiveness of the laboratory procedures and technology employed. According to the CDC guidelines, the Director on an IVF laboratory must be a doctoral level scientist (Ph.D.) or physician, board-certified in clinical embryology. However, the law does not require that the Director perform the procedures or, for that matter, be physically present in the laboratory. In most large programs, the Director provides administrative oversight and does not actively participate in the day-to-day operation of the laboratory. This means that, in many cases, the IVF procedures (insemination, ICSI, embryo culture, assisted hatching, embryo biopsy, etc) are being performed by embryologists. This is not exactly a comforting thought, so you should inquire as to who performs the laboratory procedures and what are their credentials and experience before choosing a program.
The technology utilized by the laboratory is very important. There is no standard IVF method and every IVF laboratory has its own protocols and methods. Some protocols work better than others, but most protocols work reasonably well. Beware of programs offering brand new (and untested) technology, as you may end up being an unwitting research subject. You should also be aware that IVF technology has developed rapidly during the past few years and so programs that have not changed their technology to keep up may not have the highest success rates. Recent advances in the composition of culture medium now make it possible to routinely culture embryos to the blastocyst stage of development prior to embryo transfer. There are several advantages to transferring blastocyst stage embryos. Although programs differ in deciding which patients should have a blastocyst stage embryo transfer, any program that discourages transferring the embryos at the blastocyst stage should probably be avoided.
What should you do if you were referred to or choose and program and now you are not happy with the treatment you are receiving? Simple change programs! Having established a relationship with a doctor, some people find it very difficult sever that bond of trust. However, one of the biggest mistakes a patient can make is staying with a program that is not meeting their needs. If you are unhappy with your treatment, seek a second opinion or change to a program that meets your needs. When seeking a second opinion, it is important to obtain all the pertinent medical records, lab reports and embryology records.
When choosing an IVF program, the SART-verified success rates, the credentials of the physicians and laboratory staff and the quality of the laboratory should weigh significantly in your decision.