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Dr. Geoffrey Sher, MD
Executive Medical Director (SIRM)
Sher Fertility Clinic - Las Vegas

2011 IVF Success Rate Statistics at SIRM: Cumulative OBRS Report

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In a field that is virtually devoid of regulation in the U.S., there is a real need for access to accurate and reliable IVF outcome statistics. But alas, this is not readily available. In fact, for over 20 years, the American Society of Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) have ignored both consumer appeals and government demands for a verifiable reporting system of IVF outcomes.

Presently, SART member programs by and large, get away with submitting self-generated, non-audited IVF outcome statistics annually, to the Society for Assisted Reproductive Technology and/or the Centers for Disease Control (CDC), who then post these on their respective web sites as the so-called, SART and CDC Reports.

These SART/CDC reports feature these largely unaudited, unverified data and clinic-specific statistics in categories by the following criteria:

Age of the patient
Type of procedures performed (e.g., conventional [fresh] IVF, frozen embryo transfers [FET] and egg donation).

However, this format has several readily-apparent flaws: first, it does not allow for comparison based on the relative complexity/difficulty of IVF cases. Second, the reports are published about two years after the actual IVF treatment.

Sadly this “self-monitored” reporting mechanism only encourages the exclusion of “tough cases” (such as those who have repeatedly failed IVF and those who have diminished ovarian reserve) in an attempt to inflate/bolster reported success rates.

While most IVF consumers are unaware of this charade, virtually all IVF practitioners are fully aware it, but are reluctant to “rock the boat” and continue to “play the game” lest it compromise insurance reimbursement for IVF services. This is because many insurance companies will only reimburse programs that report their IVF outcome data annually through SART/CDC.

SART/CDC reports IVF outcome statistics on the basis of the number of ovarian stimulation cycles initiated. The original reasons for doing so, were largely: a) to discourage doctors from accepting patients who have a small chance of success for IVF treatment, simply for their financial gain and, b) to draw a sharp distinction between the low success rates previously reported with frozen embryo transfers (FET) and the much higher success rates with “conventional IVF” where fresh embryos are transferred.

However, the introduction 5-7 years ago of ultra-rapid embryo freezing (vitrification) virtually eliminated the high freeze/thaw embryo attrition rate previously witnessed with conventional (slow freezing) methods. As a result, transferring thawed (warmed) pre-vitrified embryos is now just as likely to propagate a baby as is the case for freshly transferred ones.

This breakthrough has facilitated the process of embryo freezing/ banking wherein we may perform several successive stimulation/egg retrieval cycles, fertilize and freeze the eggs and submit them for genetic testing via CGH. After receiving the results of the genetic testing, we are able to select the best embryos and transfer them to the patient’s uterus in a subsequent frozen embryo transfer (FET). We refer to this process as “Staggered IVF”. It allows women with poor egg quality, older women, and those with diminished ovarian reserve (who often produce a low number, but a higher percentage of “good quality embryos”) to substantially increase their odds of having a baby through IVF.

OBRS® Database Services
It was against this background that in 2008, SIRM introduced the IVF Outcome Based Reporting System (OBRS), which provides more reliable IVF outcome data per embryo transfer procedure. The data is presented in categories of age, each of which is further subdivided into 4 categories of complexity (subgroups A through D) that are based on important variables that are known to influence outcome.

Age
Ovarian stimulation protocol
Ovarian reserve measured by basal (day-3) FSH and/or AMH.
Number of eggs retrieved
Number of prior failed IVF cycles.

Ovum donation and frozen embryo transfers (FET) results are reported separately in the same table.

It is only through a process such as the one used in OBRS (though it is certainly not perfect) with accurately represented and relevant demographic, clinical, and laboratory variables (that affect IVF outcome) that a reasonable clinic-to-clinic comparison can be made regarding IVF success rates. The OBRS system gives a much more accurate picture of the complex interaction of several important clinical variables that affect IVF success rates. It is an interesting fact that by this system, we quite commonly see higher success rates in older women with less complex diagnoses than younger women in more complex categories.

You can view OBRS IVF Success Rate Statistics for 2008-2011 HERE

*For access to clinic-specific results at SIRM -Las Vegas, SIRM-New York, SIRM-St. Louis, SIRM-Central Illinois, and SIRM-NJ, please contact individual centers directly.

Rating: 5.0/5 (1 vote cast)

Posted by Geoffrey Sher, MD
May 01, 2012 04:16 am

Tags: IVF Success Rates, OBRS

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