Using CDC reports to find a good fertility doctor…part two.

May 6, 2010Carole 8 Comments »

The CDC website has the complete listing of programs that reported to the CDC every year since 1996. The CDC even maintains a list of non-reporting programs (for year 2012, for example). On your browser, go to the CDC ART reporting home page to get started. On the home page, you can select the most recent year’s Assisted Reproductive Technology Success Rates:  National Summary and Fertility Clinic Reports. This page will provide you both a national summary of how all the reporting US clinics performed (previous National Summary Reports) and also specific clinic data (Fertility Clinic Tables) for the practices you are interested in. Links on this page will take you to 2013 data, the most recent available as of today’s updated post. Individual clinic results are available in a pdf report which is not as user friendly as the nice look-up feature here if you know what state or clinic you are interested in.

Checking out the national table first gives you an idea of what average success rates look like. The national report sets the minimum standard for everyone. Why choose a clinic that performed worse than the national average? Granted , there will always be clinics in the below average group. But I wouldn’t advise my sister go to one so why should you?  The preface to the most recent report has some frequently asked questions about the report; for example- how data is collected, how it is validated, why the report on 2013 data is published in 2015, that 7% of reported stats are validated by on-site inspection.

Other useful information on the CDC site:

You will find a section called “Questions to ask when choosing a clinic”   which has some useful tips as you narrow down your choices and interview your top clinics.

Understanding the data in the clinic tables:

For instance, “success rate”  is defined and reported in several different ways. The percentage of IVF cycle starts or the percentage of transfer events that result in a pregnancy or a live birth, singleton or twin birth are all presented. Singleton birth rate is provided because medically speaking, singleton pregnancies are more likely to result in full term healthy births than multiple births. Even twin pregnancies are more problematic than single pregnancies. So the “best” birth is a singleton birth, as far as the CDC –and most obstetricians!- are concerned. The pregnancy rate is not as important as the live birth rate because almost 20% of ART pregnancies do not result in a live birth because of early or late miscarriage or infrequently, a still birth.

A note about pregnancy rates and how fractions can be abused. A pregnancy rate is a fraction with a numerator (top number) and a denominator (bottom number). The pregnancy rate can be expressed using different types of denominators such as the total number of treatment cycles, the total number of retrievals, or the total number of transfer procedures. The absolute number of pregnancies (or live births) that occurred in the clinic can’t be changed (the numerator), but the percentage of pregnancies would steadily increase as the size of the denominator decreases. This means that the pregnancy rate will be different depending on the number of pregnancies expressed as a fraction of cycles, fraction of retrievals or fraction of transfers.

How can this be? Because there is a loss rate (some patients drop out of treatment) at each step of the treatment cycle. Some women who start a treatment cycle have a poor hormonal response and are cancelled before the retrieval, but if their cycle lasted at least three days, it must be reported. Eggs recovered at retrieval may fail to fertilize so that no transfer can occur. So the number of started ART cycles in every clinic is greater than the number of egg retrievals which is greater than the number of embryo transfers. By convention, most providers  skip over these distinctions and simply express their success rate as per embryo transfer (coincidentally the largest numerical pregnancy rate they can have). As long as you are comparing apples with apples, that’s okay. So if your cycle or retrieval or transfer doesn’t get cancelled, and you are in the age group the statistic came from, then the pregnancy rate per transfer is a decent estimate of how you might do in that program.

The CDC report makes the distinction between pregnancy rate and live birth rate, so you can see if the 50% pregnancy per transfer rate for a clinic is actually only a 25% live birth or “take home baby “ rate. After all, you could care less about getting pregnant if you aren’t going to have a baby to take home at the end of it. Interestingly, in all the years of going to annual ASRM meetings, no one ever lays claim to the less than 50% pregnancy rate, but clearly they exist, based on the CDC reported rates.

You may be wondering who verifies the data that is reported to the CDC? The medical director (or other designated physician in the group)  is responsible for verifying the data. You’ll see on the clinic report the statement “Data verified by physician name”.

A sample of the annual reports are audited every year for accuracy by comparing actual medical charts with reported outcomes. Almost 10% of  reporting practices are audited by the CDC or by SART.  In addition, the reporting software looks for data entry errors and alerts the practice to check the numbers. For instance, the software will flag having more egg retrievals than cycle starts. The patient can never have a birth date later than a procedure date. Also, the practice  must register every new cycle start within three days of starting medication so the patient is “logged in” before the outcome is know. This helps to keep the reporting honest.

When you are looking at clinic reports, you will notice that pregnancy rates are split out by maternal age. You will also notice that the pregnancy rates for the youngest age group (under 35 years of age) is usually the highest pregnancy rate. The pregnancy rates for the 35-37 and 38-40 age group are usually less and the over 40 age group rate is dismally low. Perhaps the most heart-breaking thing for me personally is when I encounter the energetic 40+ year old who has successfully achieved all her professional and personal goals, has taken very good care of herself and now, finally!- is ready to have that baby, only to be told that her chances of getting pregnant with her own eggs is less than 10% and may actually be closer to 2%. Shock doesn’t even begin to do justice to the reaction from these very successful women. And to be honest, if they aren’t biologists and they listen to all the media out there crowing about “40 being the new 30” and the parade of forty something (or even fifty something) celebrities who just had twins, they might be excused for being blindsided by this one. What the media reports don’t say is that most, if not all, of those celebrities used donor eggs to have their kids. They may never admit that and shouldn’t have to because it’s their private business but you shouldn’t be fooled into false expectations based on the celebrity birth parade.

The lab should be accreditated unless they are so new that they haven’t had a chance to do that yet. Which begs the question, do you really want to go to a place that has only been doing ART for a few months? And if they have been in business for a while, they should be accredited by either Joint Commission or the College of American Pathologists (CAP).

You’ll be able to find out if a clinic will perform ART using donor eggs, donor embryos or with gestational surrogates. Not all clinics do. Some clinics won’t treat single women and some clinics won’t cryopreserve excess embryos. Depending on your treatment needs, this information may eliminate some clinics for consideration and you won’t waste time and money on a new patient appointment with them.

The last thing I want to say about CDC reports is that they are a decent starting point for identifying the right ART clinic for you but they aren’t the endpoint. The CDC refuses to rank the clinics because they point out that rankings alone can’t identify the best clinic for you (though I would argue they could help rule out the real stinkers!). The best clinic for you may be one that has more experience in treating really hard patients with multiple issues or has more experience in treating older patients and so their success rate may not truly reflect their medical excellence. The CDC suggests and I would agree that you should use the reports to identify doctors you want to meet with personally to discuss your specific treatment issues and needs.

© 2010 – 2015, Carole. All rights reserved.

8 Responses to this entry

  • Amanda Says:

    I totally believe and agree that patients shouldn’t go blindly by numbers. Is their an easy way to find “the best clinic for me that has more experience in treating really hard patients with multiple issues”? The way CDC lists diagnoses as male factor or female factor(s) is not really helpful.

    Thanks so much,
    Amanda

  • Carole Says:

    I would use the CDC to identify the best clinics near you- hopefully you will find at least one with pregnancy rates over 50% in the youngest age group. Then you can weed out any clinics who don’t provide special services you might want (for example donor egg or insemination of single women). You’ll probably need to have a face-to-face interview with your “candidate” physician about your diagnosis, proposed treatment plan (and his experience with patients just like you) to evaluate whether that clinic is the best for you.

  • Anonymous Says:

    Carole,
    Similar to the CDC reports for clinics in the US, are there agencies that compile ART success rates from clinics in Europe and Asia?

  • Carole Says:

    It varies a lot. In the United Kingdom, they have a national system of ART oversight which has a licensing and reporting requirement that is more strict than in the US called the Human Fertilisation and Embryo Authority. You can learn more about this organization at http://www.hfea.gov.uk/ The site has a searchable database to find licensed clinics in the UK. Other countries, especially if they provide IVF under a national health care system typically have a means to regulate ART but how and what is required varies.

  • How do you know if your IVF clinic is good? | Fertility Lab Insider Says:

    […] book sales directly pay the web hosting fees. Thanks!!!Finding a good fertility doctor- part one.Using CDC reports to find a good fertility doctor- part two.Common practices of the best IVF clinics For those of you who want to look below the hood of your […]

  • Summer Says:

    Thank you so much for this article. I had no idea this data was available. What an incredible resource! Thank you for the guidance in interpreting the data. I wish I had done more homework on my current RE before selecting her. I will be promptly breaking up with her due to below average data & have chosen a new RE thanks to your article. I could kiss you!
    Thanks again & bless you!

  • Carole Says:

    Hello Summer,
    You are very welcome. I am so pleased that you could use the information to make more informed decisions about your infertility treatments. That’s the reason for the blog. Wishing you much good luck going forward!

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