Like any profession or service, not all health care providers are created equal. Since it’s your future we’re talking about, let’s find a doctor in the better than average side of the bell curve. You have probably seen the “rate your doctor” websites and even Angies list now offers ratings on doctors for their membership. These sites have some value but are entirely subjective. The two types of people who are motivated to rate their doctor are those who are really annoyed or over the moon about their doctor, sometimes for reasons that may not apply to you. You’ll want to ask friends and family for recommendations, especially for obstetrician/gynecologists, since there is no objective data available.

However, when you look for a fertility specialist to do a complete fertility work up and assisted reproductive technology (ART) procedures like in vitro fertilization (IVF), then you have something besides subjective data to help you choose a doctor.

Assisted Reproductive Technology (ART) is the only type of medical practice that is required to report annual outcomes (pregnancies and live births) to the national government. The 1992 Fertility Clinic Success Rate and Certification Act made the CDC responsible for collecting outcome data and creating an annual report to track the success rates of ART laboratories/practices.

It is important to understand what is tracked. Insemination cycles are NOT tracked so there is no way to find out how successful your doctor’s insemination treatments are. Assisted Reproductive Technology includes procedures in which eggs and sperm and embryos are used, so exclusively higher tech interventions like in vitro fertilization (IVF), gamete intrafollicular transfer (GIFT) and zygote intrafollicular transfer (ZIFT) are tracked. GIFT and ZIFT were transiently popular but the vast majority of current procedures are IVF procedures. IVF involves the collection of eggs and sperm in the lab, fertilization in the lab, growth of embryos in the lab and finally transfer to the patient. Since the CDC began tracking ART data the number of ART practices tracked has varied between 300 and 500 practices annually, due to clinics opening, closing and merging. These practices range from solo physician practices to very large multi-physician practices. These practices can be located in a university or hospital setting or may be independent small businesses.

The next thing you need to know about these reports is that they are practice based. Interestingly, the original law required that laboratories report their rates but that was later changed to a prectice-based reporting system. Why? Because the purpose of the law was to aid health care consumers and since consumers choose a doctor and not the lab when they seek out health care, reporting by practice is more useful for the consumer. If your doctor is in solo practice, the reported rates are due to his efforts alone. If he is part of a ten-doctor practice, his rates are the average reported rate for the ten doctors. His personal success rates may be significantly better or worse than the average rate reported for his clinic.

A limitation of the  CDC reports are that they are at least two years behind, and sometimes three. When you consider that it takes 9 months for the last baby to be born from the last transfer procedure performed on the last day of the year, it is easy to understand why the report lags the procedures by two years. But a lot can happen in two to three years. Practices form and break up. Technicians come and go from the laboratory and pregnancy rates may suffer or improve for many reasons during this time. But if you find a program with above average rates for several years in a row, it is more likely that this ART program is probably a good one. One the other hand, if pregnancy rates have been below the national average consistently or swing widely from year to year, that is probably a bad sign.

The cliff-notes version of CDC-reported pregnancy rates can be found on the The Society for Reproductive Technology (SART) website (www.sart.org) which is a user-friendly alternative to the massive CDC website. You can simply click on your state on the map of the US, then find the fertility program you want to review and click on it. That click takes you to the summary report for that program.  The only down side with using the SART website is that clinics are not required to use SART to report their results to the CDC and not all programs use SART because it has been more expensive than using the data collection firm that the CDC uses. So the SART database is a subset of all the providers. The clinics you are interested in may or may not appear on SART list.

Next post, we’ll navigate the more complicated CDC site.

© 2010, Carole. All rights reserved.

Posted on May 5, 2010 at 2:34 pm
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