Finding a good egg freezing clinic.August 31, 2010Carole 4 Comments »
A reader recently asked me how to identify the best egg freezing clinic in the US. Specifically, she wanted to find an ART lab or egg bank that would freeze her own eggs for future use. It turns out that this simple request does not have a simple answer because neither the CDC nor another regulatory body collects data on the success rate for freezing eggs. (This might be a fruitful area for political activism —to have the CDC collect data on egg freezing results too!)
Consumer Tip: The fact that data on pregnancy rates and live birth rates from ART procedures are submitted to the CDC and available free to the public is a huge asset to health care consumers who are considering ART treatments. In contrast to how we choose all our other health care providers, choosing an ART provider can be done using actual medical outcome data. So, take advantage of this consumer tool and use the CDC reports when selecting an ART clinic. Even though egg freezing is not tracked directly by the CDC, once you identify ART clinics that also provide egg freezing, you can check out their pregnancy and live birth rates using fresh eggs to get an idea about how good they are at routine IVF and by extension, suggest they might be good at egg freezing. Or put another way, having good IVF rates does not guarantee good egg freezing rates but being a below-average clinic for IVF does not lead one to expect exceptional egg freezing rates.
If you don’t know how to get this public information on ART success rates, check out these two early posts on choosing a good doctor: Finding a good fertility doctor…part one and Using CDC reports to find a good fertility doctor…part two. You will find a disclaimer that CDC reports shouldn’t be used as the basis for selecting a good clinic because all these other variables play a role. True, every patient or couple comes to the clinic with their own set of issues but considering that every clinic gets a mix of patients with a variety of problems, as long as you are looking at your age group for comparison, you will likely get a decent idea of how you might do at a particular clinic.
If you find an ART clinic that consistently has live birth rates above the national average, it’s more likely to be a good clinic than one that consistently has live birth rates below the national average. For comparison, the National Rates for the entire US for 2007 shows that the average percentage of transfers resulting in a live birth from all reporting clinics is 45.9% for the under 35 year age group, 36.9% for the 35-37 age group, 27.1% for the 38-40 age group, 16% for the 41-42 age group and an appalling 8.4% for the 43-44 age group.
My personal opinion is that good clinics should have a 50% pregnancy rate or better for the under 35 age group in 2010, three years later. The best clinics in the nation have rates in the 60-70% range.
The down side of the CDC reports is that they are always at least two years behind. Many clinics will post their current ART rates on their website as well, but these aren’t audit-able in the same way as the CDC reports. In order to validate reported data, a percentage of ART clinics are inspected annually (without warning) by CDC (or SART) inspectors who look at the medical charts of patients and compare this data with reported data.
Not all ART clinics offer egg freezing for patients. A first step in your search might be to identify clinics or egg banks that freeze eggs. A simple Google search will bring up both ART clinics and also egg banks. Places that don’t advertise their egg freezing services probably don’t do a lot of it. Egg freezing is done in both places (clinics and banks) but be careful to distinguish the types of services offered. Some banks or clinics freeze donor eggs and offer them to patients for IVF cycles and some places offer egg freezing for patients who want to use their own eggs in the future. Some places offer both. This distinction is important because success rates for egg freezing are generally better for donor eggs than for patient eggs. The reason is that egg donors are typically in their twenties, not thirties and freezing younger eggs yields better results.
When a clinic or bank quotes you their success rates, make sure they are talking about rates for patients (not donors) in your age group. If they quote you their pregnancy rates with frozen donor eggs, you can expect that your own pregnancy rates will likely be significantly lower, because most patients who freeze eggs are not only older than egg donors but often have other underlying fertility issues that donors are less likely to have.
Many clinics are just starting to offer egg freezing in response to growing patient demand for egg freezing. There is still a lot of clinical debate about the best method (slow freezing or vitrification) for freezing eggs because different clinics achieve widely different success rates with different methods. This is all pretty normal for a clinical procedure that ASRM still considers experimental. Freezing eggs and putting them in storage looks like the easy part because getting them to thaw well and create a healthy baby is the challenging part, right? Eggs in the freezer. Mission accomplished. Not really. You might think- okay, I’ll let clinic A freeze my eggs and by the time I thaw them, everyone will be better at using them, so I should be able to enjoy better pregnancy rates in the future. The problem is that a bad freeze protocol can’t be repaired by a great thaw protocol by a better IVF clinic in the future. It is essential that the eggs are frozen correctly to begin with.
So what kind of freezing facility is likely to have better pregnancy and most importantly, proven outcomes in terms of live birth rates?
Higher volume clinics. For a clinic to know what their pregnancy rates and live birth rates are with frozen eggs, clinics have to have the opportunity to freeze lots of eggs so that a meaningful percentage of those patients have had a chance to come back and actually try to use the eggs. So avoid the small clinics which do less than 200 IVF cycles a year because you can be sure they are doing even less egg freezing than clinical IVF cases. In the future, even small clinics may have accumulated enough numbers (over a decade) to be able to demonstrate good pregnancy rates but in these pioneering days, the bigger clinics will gain the necessary experience more rapidly.
Egg Banks. Egg banks which specialize in freezing eggs (and possibly sperm too) shouldn’t be overlooked, just make sure that they are doing a decent volume of patient egg freezing too, not just donor egg freezing so they can tell you about their success specifically with freezing a patient’s own eggs.
Look for clinics/banks which have been doing patient egg freezing for several years and have generated live birth rates. As I mentioned before, many clinics are starting down the egg freezing road and although their initial results may be promising, they need to prove to you that they have moved beyond the ‘Wow- we got our first birth!” to the goal of achieving the same or nearly the same birth rate consistently from frozen versus fresh eggs. Otherwise, you are participating in the clinic’s learning curve. If you are lucky, great. It’s like gambling on a start-up company compared to buying blue chip stock. Feeling lucky?
After you have identified several clinics that meet minimal criteria, you need to personally interview them. ASRM has provided guidance to clinics to outline the minimal information that patients considering egg banking should be given before the clinic asks for their consent to freeze eggs. These elements of the consent form can be used as a template for patients regarding what questions they should ask when interviewing a prospective clinic or egg bank to evaluate clinical competency.
How many women have cryopreserved oocytes with your facility?
Of this stored number, how many women have thawed all or some of their oocytes at your facility?
What is the survival rate of all the oocytes thawed at your facility? What is the probability that none of my eggs survive the thaw based on data from patients like me?
What is the fertilization rate of oocytes thawed at your facility and used for IVF?
What is the embryo development rate for thawed oocytes at your facility?
What is the live birth rate per oocyte thawed?
What is the live birth rate per embryo transferred. (Compare this to their live birth rate for fresh eggs).
When possible, ask about results for your age group. Know that the older you are, your chances are less that egg freezing will result in a live birth for you in the future. Some clinics refuse to freeze eggs for older patients (for example, 38 years or older) because the success rates are so low. Live birth rates from fresh eggs are also much less with advancing age so older age will reduce, sometimes dramatically, the success rate of any ART intervention. There are other questions that should be asked regarding cost of the freezing procedure, risks of the procedure etc. but as far as identifying the best lab for the procedure, the above list of questions speaks to the lab’s experience and success with egg freezing.
ASRM suggests that from the scientific literature, you might expect an approximate overall 2% live-birth rate per oocyte thawed for cryopreservation using slow-freeze methods and an approximate overall 4% live-birth rate per oocyte thawed for cryopreservation using vitrification. These numbers are from 2008 and it is possible that the more current estimates of success from the literature may be better. It is interesting to note that ASRM also appears to support vitrification of eggs as the more successful method for freezing oocytes.
A simpler statistic for patients to use might be to see if the clinic’s pregnancy and live birth rate for a statistically significant number of cases is similar using either fresh or frozen eggs. And isn’t that what you are looking for as a patient? You are trying to put your fertility “on hold” for a period of years and that only works if you can get the same results down the road with your frozen eggs as you can expect today with your fresh eggs. The bottom line, as always, is how much financial, physical and emotional risk are you comfortable taking. Every patient should be aware that egg freezing is a new procedure at many clinics and clinics vary widely in the pregnancy and live birth rates they are achieving using frozen eggs.
© 2010, Carole. All rights reserved.