Not really. Different practices take care of different types of patients. The CDC and SART both specifically instruct all clinics to remind patients that it is not scientifically valid to compare the results of different practices to one another.
Since all clinics use basically the same clinical and laboratory techniques, it is primarily the patient mix that influences success rates.
At the Wisconsin Fertility Institute, we do not turn away any patient who wants to undergo IVF, regardless of how poor their prognosis is. This is not universally the case; many clinics will exclude patients with low chances of success in order to keep their published success rate high.
In addition, because most of our patients do not have IVF insurance coverage, we are very aggressive with treatments less costly than IVF: oral fertility drugs, injectable drugs, and artificial insemination. Many of our patients most likely to get pregnant with IVF in fact get pregnant with less costly therapies, resulting in only the most difficult to treat patients needing IVF. This also lowers success rates.
As stated above, we do not turn away any patient from IVF, no matter how dismal their chances. We also suggest much longer courses of other therapies in the hopes of saving our patients money. Finally, we stimulate ovarian follicular growth very aggressively in order to maximize the number of eggs (and therefore embryos) obtained; this allows us to freeze extra embryos often and give patients initially unsuccessful, additional attempts at conceiving. This approach insures the best chance of a pregnancy from having gone through the experience and expense of an egg retrieval. It is not, however, reflected in SART or CDC statistics, which count only the first embryo transfer after a retrieval (2014) or only the transfer of embryos that have not been frozen (2013 and earlier).
Yes. Prior to 2014 only the transfer of fresh embryos counted as a success. However, many patients aggressively treated will have a poor uterine lining during the IVF cycle. Data show that these patients should not get an embryo transfer, but rather freeze their embryos and transfer in the next month to maximize pregnancy rates. We have done this consistently for many years, but prior to 2014 it counted against us, with each “freeze-all” appearing as a failed IVF cycle. This has been modified in the 2014 data, where the first transfer of frozen/thawed embryos is also counted as a success.
We believe the best indicator of a quality program lies in the egg donation program. Patients undergoing this treatment generally have good sperm, good eggs, and a good uterus. The resulting success rate should indicate the ability for a laboratory to grow good embryos in the absence of most mitigating patient factors. At the Wisconsin Fertility Institute, in 2013, 86% of couples undergoing IVF with donor eggs were able to take home a baby using the embryos created from a single retrieval of the donor. This, unfortunately, is also not reflected in the statistics provided by SART and the CDC, which only include the first “fresh” embryo transfer.
Couples wishing to have only one child and/or avoid risks of twins should opt for a single embryo transfer. However, in couples that desire more than one child in the future, transferring two embryos is reasonable. Much has been made of the fact that twin pregnancies are riskier to both mother and baby than a pregnancy with a single fetus. However, a twin pregnancy is not significantly riskier than TWO pregnancies with a single fetus. If a couple desires multiple children, it may make sense both timewise and economically to try to produce two children in a single pregnancy. Furthermore, with infertile couples there is no guarantee that when attempting a second pregnancy they will be able to succeed. At the Wisconsin Fertility Institute we discuss all these issues with you and then allow you to make your own decision regarding number of embryos to transfer.
Historically, when women were given large doses of medication to produce many eggs for retrieval, there was a risk of producing a disease called ovarian hyperstimulation syndrome (OHSS). This disease, when it occurs in its severe form, can be life threatening. Fortunately the last few years have brought several important advances in our ability to avoid this disease; today, with the use of specialized techniques commonly used at the Wisconsin Fertility Institute, we have virtually eliminated severe OHSS. This maximizes the chances of taking a baby home from a single egg retrieval while keeping the mother healthy and safe.