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 The American Society of Reproductive
Medicine is "Infertility's" self-governed body. The Society for Assisted Reproductive Technology is where
fertility centers must report their statistics. Both societies state that any advertisements of comparative pregnancy
rates include the following:
"As entry criteria are highly variable for each program,
a center-by-center comparison of results is not valid."
As a patient, you are interested in selecting
the right fertility center. We are a very experienced fertility center. We understand what you are looking for
but we also understand how confusing and frustrating it can be. Although we have great statistics, we encourage
you to look beyond statistics to get a total assessment of which center you will trust with this important decision.
The statistics may indicate the competence of a fertility center, but we regret to inform you that they may indicate
something else. Please be careful.
The following provides you with insight
to 5 ways in which a fertility center can increase their apparent pregnancy rates without increasing the care provided:
1. The Right Type of Patient
Regarding patient selection, who are
the ideal patients? They are young patients, with normal clomiphene challenge tests, with a previous pregnancy,
no prior IVF or gonadotropin IUI failures, no prior pregnancy loss, short duration of unexplained infertility,
known tubal blockage, low FSH values, and have a partner with normal sperm. These are just some of the criteria
an initial consultation/screening process may include. From two different centers, a couple with a more complex
problem may hear two different responses:
a) "I'd only be taking your money."
b) "Your chances are lower, but we are willing to help."
"Higher pregnancy rates" will
then be used as a marketing tool to lure the right type of patients, while simultaneously provided difficult patients
to the competing fertility center.
2. The Right Classification of Patient
There are two main ways to classify patients
to improve pregnancy rates. The first is research. If a center has a difficult patient, that patient can be a research
patient. The statistics from research patients are not reported. The other method is to convert cycles mid-stimulation.
If an IVF cycle stimulation does not look good, it can be converted to an IUI cycle and avoid reporting. Conversely,
if an IUI cycle looks good, it can be "enhanced" as an IVF cycle and be reported. The patient may have
gotten pregnant anyway.
There are proper times to convert cycles,
it is the frequency of this occurrence that could be alarming.
3. The Right Type of Therapy
There are basically three types of advanced
infertility therapy. They are gonadotropin IUI, IVF and donor IVF. Patients can be encouraged to accept a therapy
that is beyond their current need. A patient likely to get pregnant on a simple Ovulation Induction cycle is even
more likely to conceive with an IVF cycle. This drives IVF pregnancy rates up, and makes the choice between the
two therapies even more distinct and confusing for future patients. The same holds true for IVF patients with somewhat
questionable egg quality and the choice to pursue donor IVF.
4. The Right Time to Stop Therapy
There are two strategies to improve pregnancy
rates regarding stopping therapy. The first is canceling a cycle mid-stimulation and thus avoiding the reporting
requirement. Although canceling a cycle is sometimes necessary, it is important to know a fertility center's cancellation
rate and how often IVF cycles are converted to Ovulation Induction cycles.
The second strategy is to encourage difficult
patients to quit therapy. Although there is a time for this, typically the pregnancy rates stagnate after the third
or fourth attempt. Most pregnancies take place during the first or second attempt. If a center can avoid the third
and fourth attempt, their rates will not be compromised.
5. The Right Embryos
The chance of becoming pregnant increases
with the number of embryos transferred. Therefore, some physicians are more aggressive, and often carry a higher
multiple birth rate. (With the existence of selective reduction, it is important to know multiple rates before
reductions.) Sometimes couples are encouraged to transfer more embryos because of their "poor quality".
Sometimes this "poor quality" embryo discussion leads to another strategy. Frozen cycle pregnancy rates
are not as high as fresh cycles (or as expensive). Overall pregnancy rates improve with fewer cycles that are frozen
embryo transfers. Therefore, there are subtle ways to discourage freezing embryos.
The Right Thing to Do
There are many other ways pregnancy rates
can be improved. One can just look at a specific time period. We hope that you will look at all the factors that
ultimately make up success. Our experience speaks for itself. We encourage you to speak to medical professionals
about our character, philosophy and treatment. We are here to help.
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