Advocating for Yourself: Finding a Good IVF Clinic
(Carole C. Wegner, PhD, Fertility Lab Insider, http://fertilitylabinsider.com; previously published in an extended version)
As an infertility patient, you have one thing going for you that other patients don’t have in your search for good health care- public data. Infertility clinics are required to report their annual pregnancy outcomes to the CDC, either directly or via an intermediary, namely the Society for Assisted Reproductive Technology (SART). You can use this data to find the best clinics in your area.
CAP or Joint Commission Accreditation is not a guarantee of quality. Accreditation is a good sign but not enough by itself. Would you be shocked to know that at least one lab obtained accreditation without even having their own written procedure manual containing their actual protocols? Or that a current ART lab inspector expressed their frustration to me that their inspection agency asked them to go easier on labs during inspections? These incidents suggest to me that the voluntary accreditation system where labs pay inspection agencies for the privilege of applying for accreditation has become a business- customer relationship–where the customer is always right– rather than an oversight relationship. So I have become rather cynical about the value of accreditation as a sign of high quality. It is a minimal bar, that’s all.
The best labs are not necessarily the biggest- or the smallest. Size is only significant at the extremes. Really low volume labs (less than 100 cycles a year) can have statistically unreliably rates because even a few negatives or positives can magnify the rate so it looks better or worse than the actual rate over more cycles. Extremely large programs with very high volumes (thousands of cycles a year) have the challenge of maintaining consistent quality over a large lab system with dozens of technicians. CCRM in Colorado is arguably one of the best labs in the country with consistently high rates, reporting a 67% live birth rate per transfer in 2011 for its youngest age group. It is a medium sized clinic, reporting 394 cycles in 2011.
The best labs are those who consistently deliver better than average live birth rates for their patients year after year. You have several public websites that offer this information to you. The CDC maintains a website for the public to review ART outcomes. All US reporting programs can be found here. You can also find a list of non-reporters who failed to comply with the law here.
You can also go to the Society for Assisted Reproductive Technology (SART) website which includes only SART-member IVF clinics. The SART site is easy-to-use with a interactive map of the US to quickly find info on clinics in your state.
A good success rate is better than the national average, by definition. Compare your clinic’s success rate to the national average rate from all clinics in the same reporting year here: 2011 SART Clinic Summary Report for US Clinics. The AVERAGE live birth rate for young women (under 35 years of age) who used IVF with their own eggs was 42.9% per retrieved IVF cycle and 46.3% in cycles that had embryos transferred in 2011. I wouldn’t go to a worse than average clinic. Would you? If your clinic reports below average results, ask for their own more recent in-house results. Maybe they have improved. Make sure that you are comparing apples with apples. Ask for the outcomes for women your age using the procedure you are considering. If the clinic doesn’t answer your questions or is vague about results for different age groups, maybe it is time to interview another clinic.
(My blog Fertility Lab Insider is written for patients and the public and describes what happens behind the IVF lab door.)
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