Pregnancy Rates
The best way to see if a fertility clinic you are considering is a good one is to look at their egg donor success rates. Egg donors are used by couples when the woman either has no eggs (ovaries removed) or has very poor egg quality (very high FSH.) An egg donor is generally a healthy young woman with excellent egg quality. The eggs are retrieved from the donor, fertilized with the sperm of the embryo recipient's choice and then placed into the recipient. These patients should have a high probability of becoming pregnant. National rates are about 65% between fresh and frozen transfers. For 2010, our egg donor cycles have an 82% success rate. 82% of the embryo recipients are now at least 16 weeks pregnant after either their fresh or frozen transfer from one egg donor cycle.
In addition, our UltraIVF program has a 70% take-home baby rate per transfer with just one UltraIVF cycle! You can read more about UltraIVF here. UltraIVF combines precise medical management, stringent laboratory conditions, and genetic screening to produce a very high probability of pregnancy.
At Red Rock Fertility Center, we specialize in treating challenging patients. Many centers across the country are focused on getting patients into their center who have the highest chance of success, so that they can publish high pregnancy success rates. This leaves a 40 year old woman with an FSH of 14, who has a low likelihood of success, without many treatment options. Most centers would tell her that she has to use donor eggs in order to have a successful conception.
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The fact is that women over 40, or those with an FSH over 12, statistically have about a 10% chance of delivering a baby with a single IVF cycle. At Red Rock, we have been able to get that number up to approximately 18%. Going from 10% to 18% may not sound that great, but it is an 80% higher chance of pregnancy, which is a big accomplishment. If a woman in this predicament tries three times at my center, they have over a 50% chance of having a baby.
Unfortunately, there is no magic technology or medication protocol that is going to reverse the hands of time or improve the genetic composition of embryos. But, as a woman, I think women deserve the right to try with their own eggs. I have donated eggs myself back when I was in college and believe egg donation is an excellent option. But, if a woman or couple absolutely wants their own biological child, I understand that and I will do everything in my capacity to make that happen. I am very honest with my patients that they may have to attempt IVF multiple times to accomplish success and if I believe success is not a possibility I will not hesitate to inform my patients of this.
Originating from Duke University, "Home of the Duke Blue Devils," I often phrase things in terms of basketball competitions. Just like there are different basketball leagues with varying degree of schedule difficulty, there are also different "Fertility Clinic Leagues." Some basketball teams are very successful when they are playing in their regional conference because they may be playing other teams which are easy to beat. However, when they make it to the NCAA tournament, they frequently are out after the first round. This is in contrast to Duke who frequently makes it to the final four on an annual basis. Similarly, when looking at a center's pregnancy rates, a person has to compare centers with the same philosophy/skill. You cannot compare a center that rejects any patient with an FSH over 10 with a center like ours that has treated patients with an FSH of 31. In other words, easy patients in = high success rates out, because the degree of difficulty is consistently low.
A number of clinics have devised strategies to skew the type of patient that is included in their data. Some clinics have policies that if you fail a clomid challenge test that you will not be allowed to undergo IVF therapy at their center unless donor eggs are used. Other clinics, create an obstacle course for embryos (consisting of freezing, thawing, or extended culture to blastocysts), so that weaker embryos/lower probability patients never receive an embryo transfer and therefore are not included in calculation of pregnancy rates. Despite exclusion from data, these patients count in my book and they deserve a chance at having their own child. I am more than willing to sacrifice my clinic's success rate than to sacrifice am embryo/potential life.
I also trained at Stanford University located in Northern California. At Stanford, we frequently saw numerous patients that had either failed or were rejected from other centers in the Bay Area (there are about 10 centers in close proximity.) As you can imagine, Stanford has an excellent facility and one of the most pre-eminent and respected laboratory directors, Dr. Barry Behr. From word of mouth, patients knew that Stanford was the place to go if they were rejected from other centers. We did not turn anyone away. As a result, the success rates at Stanford are seemingly low when compared with other centers. But, Stanford plays in a different league than most other centers. Most other centers will not let a 39 year old woman try with her own eggs if she has failed two cycles at another center. Statistically, that patient has less than a 15% chance of getting pregnant.
It is challenging to compare pregnancy results just based on age. If a friend of yours succeeded at IVF at another cliinic and she is your same age, there are many other variables to consider. Here is an example of how complicated this can be.
I have tried to maintain the same philosophy that I learned at Stanford and Duke. I have never taken the easy road in my life and I did not undergo such rigorous training/experiences at Duke and Stanford only to treat easy patients. That would be a good utilization of my skills. I have that same philosophy with my Advanced Reproductive Surgery Program. Most fertility specialists do not want to operate, as it does not make as much money as IVF, but I do not think that is acceptable. I enjoy working with challenging patients and it is that much more satisfying to visit a former surgical patient in the hospital who has delivered that went through three or four IVF cycles at another center and became pregnant at Red Rock.
Due to our Ultra IVF strategy, we have been able to treat a similar group of patients as I saw at Stanford and have even better success. Stanford’s IVF lab is not a certified clean room and they do not have the same level of daily quality control that exists at Red Rock Fertility Center. In addition, patients at Stanford are frequently seen by residents and fellows, whereas I coordinate all of the care of my IVF patients. I believe attention to details in the lab and in the actual care is what makes the difference. I also continue to practice all aspects of fertility care. Most fertility specialists do not want to invest the time in operating on patients anymore due to the low reimbursement from insurance companies, however, I would argue that Reproductive Surgery can still play a major role in accomplishing a pregnancy and I have published Journal articles on how surgery can improve a patient's chance of success on their own or with the help of assisted reproductive technologies.
In conclusion, when it comes to pregnancy success rates, the most "reliable" number is the egg donor cycle success rate, given that "most" of these women are suppose to be inherently fertile due to young age. Even though lately I am finding that even some of the donors suffer from fertility problems. Nevertheless, our cumulative donor cycle success rate last year was approximately 90% which is excellent. The cumulative success rate represents both the fresh and frozen embryo transfers for one egg donor cycle. Please view the rest of our pregnancy success rates here.
Again, there is not one individual component that I can say gives us this extraordinary success rate. It is simply, the combination of all the above-mentioned factors that have allowed us to produce conceptions on a daily basis and is what has given us the opportunity to offer a challenging patient population a chance at success.
An Excerpt from my favorite poem....
