When a couple begins their search for a fertility clinic, they naturally look for a common basis by which to compare the practices.  As it turns out, one of the few quantifiable indicators of the quality of a Reproductive Endocrinologist or infertility practice is its success rate statistics.  So whether or not this is an accurate indicator of clinic reputation and quality, it has become the default standard of comparison.

Before we discuss some of the specifics of the current IVF success rate reporting system and the potential pitfalls, I think that it is important to draw the focus to the most important factor in the whole process – the patient.  Unfortunately, the success rate discussion has a tendency to shift focus from the patient to the clinic, the reporting process and the agencies involved. Where is the patient in this discussion?

Isn’t the real goal of the success rate reporting process to improve transparency and provide information with the ultimate result of aiding patients in finding a program that will help them conceive? Indeed it is, which makes it all the more ironic that it seems to have muddied the waters rather than clearing them.

The motivation of a clinic to boost their success rates should be to improve their ability to help EVERY patient that comes to them for care, rather than for the sake of having a glowing statistic that they can paste across all of their advertising.  When a clinic strives to find the best protocols, technology and techniques for their entire patient population, a serendipitous thing happens – their success rates tend to improve across the board.

At Caperton Fertility, our foundational philosophy is built on our commitment to providing the highest level of care for every patient that comes through our doors.  We are not bound by the quest for success rates for their own sake, but only as a by-product of our efforts to focus on patient care and explore new techniques and protocols. This has led us to paths that have dramatically improved our understanding and proficiency across the full range of patient circumstances and diagnoses – and correspondingly boosted our success rates. They have even led us to treatment breakthroughs that we have added to our standard protocols. These include:

• Our focus on Single Embryo Transfer to optimize the health and well-being of the baby and the mother (and dad!). Believe it or not, our pregnancy rates are among the highest in the country – even among clinics that routinely transfer 2 or more embryos.
• Our optimization and refinement of embryo vitrification (flash freezing) methods that have enabled us to achieve a 99% freeze/thaw survival rate for embryos.
• Our “Freeze and Rest” approach to embryo transfer that provides patients a fuller recovery period after egg retrieval and allows their body to return to complete balance before embryo transfer. Because of our advanced freezing techniques and technology, we lose virtually no embryos in the freeze/thaw process, and the additional recovery time for the patient increases pregnancy rates.
• Our “clean room” certified lab environment that eliminates virtually all contaminants to optimize fertilization success and embryo development. From our advanced air filtration system to our cleanliness protocols to our equipment and culture techniques, an absolutely pure lab environment has a measurable impact on IVF success rates.
• Our meticulous customization and individualization of stimulation and treatment protocols for every patient that we treat. This is not figurative – we literally customize our approach based on each patient’s background, treatment history, age, diagnosis and personality.
• Our “Concierge” approach of assigning every patient a coordinator that holds their hand through every step of the diagnosis and treatment process. We know that uncertainty and stress are some of the most unpleasant aspects of treatment, so we do all we can to make patients feel like they are a part of the Caperton Fertility Family.
• Our non-discriminatory environment that welcomes patients of all ages, backgrounds, diagnoses and circumstances. Because our concern is first for the well-being of the patient, we rarely turn a patient away. Though this may have an occasional effect on our success rates, it is more than compensated by the connections we make with our patients and the sense of belonging and comfort they feel while in our care.

Now, on to the facts about the current IVF success rate reporting system. To understand the potential pitfalls with the current success rate reporting system, it’s important to understand the process by which IVF success rates are reported and recorded.

The body that oversees IVF success rate reporting is the Centers for Disease Control (CDC). Fertility clinics are required (without any enforcement) to report their success rates to the CDC on an annual basis. There are some other intermediary agencies and parties involved, but we will keep it simple for the purposes of this discussion. Every year, about 10% of clinics are actually visited by representatives of the CDC, who review the clinic’s treatment statistics and compare a sample of the data to the numbers that they have reported.  The remaining 90% of clinics audit their own success rates and report the data to the CDC. Their success rates are verified by someone at the clinic – usually the medical director.

Though the majority of clinics are honest and forthright in their reporting, the system does lend itself to manipulation by the small percentage of clinics that are seeking to boost their published success rates. Unfortunately, the assumption that other clinics are padding their success rates has a tendency to further perpetuate the practice.

Here are a few examples of the more common ways that clinics can improve their reported success rates:

• Turning away patients in high-risk, low success categories like patients over 40 or those who have been unsuccessful in one or more prior IVF cycles.
• Cancelling cycles prior to retrieval when a patient doesn’t reach a particular threshold number of follicles/eggs.
• Increasing the number of embryos transferred to a patient – especially those in categories with statistically lower expected success rates. This increases the “births per embryo transfer” rates, but results in more multiple-births (twins or greater).
• Taking a “less-than-random” sample of patient success rates for submission to CDC. A clinic may submit a pre-selected sample that shows higher pregnancy/birth rates.

Unfortunately, the biggest losers in this game are patients. When clinics are overly focused on boosting and maintaining their success rates, they may either turn patients away, or pursue treatment approaches that they know are not in the best interest of the patient.

In the meantime, what can patients do to gauge a clinic’s fit – especially for their specific circumstances?  Nothing beats meeting with a doctor, touring a clinic, and interacting with their clinical and administrative staff to get a feel for their approach and their attention to patient care. Don’t be shy about getting second, third and fourth opinions. A physician that is confident in his/her abilities, protocols, staff and technology shouldn’t discourage you from shopping around. On the contrary, they should encourage it.

Next, solicit feedback and recommendations from patients of the clinics you are considering for treatment. There are online forums, boards and social media pages where you can read unedited reviews and opinions on your target clinics. The infertility community is close-knit and supportive. There are thousands of people that are happy to share their honest opinions and experiences regarding nearly any clinic in the country.

Success rates can be useful in making an initial determination on what clinics to explore in more depth, but remember that they don’t tell you everything about a clinic. The clinic’s approach to patient care, their focus on new techniques and technology, their level of personalized attention and communication – all of these can contribute to both your treatment experience and your chances of a successful outcome.

At Caperton Fertility, we firmly believe that when we put patients first, good things will follow.  Our practice has been built literally and philosophically around this belief, and the advances that we have made in this pursuit have indeed benefited our patients in the form of both a better experience and improved success rates.  The feedback we have received in the form of positive outcomes and more importantly, happy and satisfied patients, demonstrate that you can really have the best of both worlds!