IRMS Infertility Clinic Success Rates 2000 Report
Comparing Infertility Programs
Couples should consider many factors when choosing
an infertility program; however, many rely only on outcome statistics
related to assisted reproductive technology (ART). Although the
number of babies born as a result of ART can be an important indicator
of program quality and proficiency, this number is affected by many
variables and, therefore, is not an accurate predictor of a couple’s
chance for having a baby.
These statistics also do not capture pregnancies
that result from other, "low-tech" procedures and many
patients at IRMS conceive after surgery, ovulation induction and/or
insemination. The ability to achieve pregnancy with ART, or any
infertility treatment depends on many clinical and other factors,
including but not limited to:
- The woman’s age
- Her FSH (Follicle Stimulating Hormone) level
- The couple’s history of prior treatment,
- The reason for the couple’s infertility
When using ART statistics to compare infertility programs, remember
that pregnancy rates are affected by patient mix, guidelines for patient
acceptance or rejection and cycle cancellation policies, among other
things. Programs accepting women over age 41 or those with a history
of multiple prior ART failures may experience lower pregnancy rates.
However, our high level of clinical quality and scientific expertise
has allowed IRMS to achieve some of the highest success rates in the
world while treating some of the most difficult infertility cases.
Consider your age, the cause of your infertility and other personal
factors as you review ART program statistics. Also remember that your
chance for individual success is best determined by an experienced
reproductive specialist, following a thorough medical history and
Reviewing the Statistics
IRMS is a member of the American Society for Reproductive Technology
(SART) and the American Society for Reproductive Medicine. ART cycle
statistics are reported annually for publication by SART and the federal
Centers for Disease Control and Prevention (CDC). Visit CDC's web
site for the complete 2000 report.
SART uses a standard reporting format to ensure
data consistency. However, outcomes can be measured in different
ways, which can affect the statistics programs report to prospective
patients. These statistical subtleties are important when reviewing
and comparing ART "success
rates." They result from the fact that data is collected at different
stages of an infertility cycle. Because cycles fail at various points
for different reasons, successes reported at one stage may not be
carried over to the next. For example, not all initiated infertility
cycles result in egg retrieval and fewer result in embryo transfer.
Of the total cycles initiated, only a percentage result in pregnancy,
and even fewer in a live birth. The percentage of live births reported
by a program will differ when it is calculated against all cycles
started, instead of the number of egg retrievals or embryo transfers.
As a result, the percentage of live births per cycle is lower than
live births per retrieval due to cycle cancellations.
When reviewing the statistics as an indicator
of infertility program quality, it also is important to consider
the number of cancelled cycles – those that start and fail
or are abandoned for some other reason during the process. Also
pay attention to the average number of embryos transferred and the
multiple birth rate. Our experience shows that more embryos do not
increase the chance for a pregnancy but they do increase the risk
of multiple births.
Understanding the Terms
ART Cycles: ART cycles reported to SART can include IVF, ICSI, GIFT
and ZIFT; however, IRMS performs only IVF. These cycles include those
- Fresh embryos from non-donor eggs: Embryos
are created when the woman’s eggs are retrieved and
fertilized in our laboratory. Fresh embryos are returned
to her uterus during the same IVF cycle.* Fresh embryos
from egg donation: Eggs are retrieved from an egg donor
when a woman cannot produce her own or the quality is poor.
The embryos created from the donor egg and sperm from the
partner or donor, are transferred into the uterus of the
- Frozen embryos from egg donor or non-donor eggs: When more embryos
are created than are transferred back during a fresh or donor
IVF cycle, the extras can be cryopreserved (embryo freezing)
for future embryo transfer.
Age Categories: Age is often the single most
important factor affecting a woman’s chances for success with
IVF. The probability of having a baby diminishes after age 35 and
falls dramatically after age 41. In addition, miscarriage rates
increase with age. Although positive results are possible for women
over 41, the chance of success is substantially decreased without
the use of donor eggs. In consideration of age-related variations
of infertility, statistics are reported in the following age categories:
- 35 and younger
- Over 40
Live Births Per Retrieval: The number or percentage
of live births resulting from the total number of successful egg retrievals.
This percentage is higher than the percentage of live births resulting
from initiated cycles because of cycle cancellations.
Cancellations: Cycles are cancelled for many
reasons, including the patient’s desire to discontinue treatment
or treatment failure. These cancellations affect outcome statistics
and, therefore, they must be reported to ensure an accurate picture.
Multiple Births: IVF uses hormones to stimulate
the production of multiple, healthy eggs for retrieval and fertilization.
As a result, multiple births (twins, triplets and higher order pregnancies)
are more common in ART infertility patients than in couples who
conceive without treatment. Multiple birth rates are related to
the number of embryos transferred, as well as to the clinical factors
affecting a woman’s ability to achieve and sustain multiple
pregnancies. Also, some couples choose multi-fetal pregnancy reduction
to reduce the total number of fetuses being carried, improving the
clinical outcome for both the mother and babies.
Average Number of Embryos Transferred: Quality embryos result in
greater success with IVF. Our scientific research and clinical practice
focus on ways to improve clinical quality and maintain high outcomes
while routinely transferring fewer embryos than many other programs.
On average, our patients under age 38 currently receive two or three
embryos during an embryo transfer. More are transferred as indicated
by specific clinical infertility factors, or in older patients to
compensate for the age-related decline in fertility.