Embryo Transfer Clinics - A Critical Look

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EMBRYO TRANSFER CLINICS - A CRITICAL LOOK

After years of study, and countless pages of data, a comprehensive look at clinics offering embryo transfer and related assisted reproduction technologies has finally been published. The study was conducted by the U.S. Dept. Of Health and Human Services, Center for Disease Control (CDC) in conjunction with RESOLVE, a nationwide support and educational network for the infertile population. The study examined the number of embryo transfers, success rates (defined as a percentage of live births per retrieval cycle), and many other variables in an attempt to answer the most frequently-asked question ìWhich is the best clinic?î That question, it turns out, is fairly complex because it can mean so many different things. A clinic, for example, may claim high success rates, but it may define success as the number of clinical pregnancies. That, of course, makes little difference except to researchers. You are not in this for a clinical pregnancy, you're in it for a child, so the only important statistic is the take-home birth rate.

What follows, then, is my analysis of the numbers generated by the study. A few important caveats:

The data in the study was for the year 1995. The reason for this is that about 20% of embryo transfer pregnancies end in miscarriage or do not result in a live birth. It was not until late 1996 that all of the data were received, and not until December, 1997, that the report issued. A clinic which had high success rates in 1995 may not have high success rates today. Similarly, just because a clinic was not listed here doesnít mean that it might not be one of the leading facilities in the country today.
The figures which follow represent ONLY those clinics which indicated that they work with surrogates. Other clinics may have had higher or lower success rates, but since they donít work with surrogates, they have not been included.
Clinics which were included in the CDC data, but which did not report greater than 10 cycles per year were eliminated from consideration.
This summary is arbitrary. That is to say, I have simply chosen the ìtop 10î clinics based on the statistics. The fact that a particular clinic is not included may mean that it was only a percentage point or two away from one that was included. YOU SHOULD VERIFY WITH ANY PARTICULAR CLINIC WHAT THEIR CURRENT SUCCESS RATES ARE. Plus, basing a decision purely on success rates may be unwise. For example, some clinics may screen patients out who have unusually difficult infertility problems. These clinics, therefore, may have inflated success rates.
As the study did, I have grouped the statistics into different categories: first, the top 10 facilities in each of three regions of the country, based on success rates for women <35, for women 35-39, and for women >39; next, the top 10 clinics across the country using the same age variables. For more information about these numbers or the study itself, feel free to contact SMI. To obtain a complete copy of the study, you may jump to HYPERLINK http://www.cdc.gov www.cdc.gov or through a link on Resolve's site at HYPERLINK http://www.resolve.org You also can write the CDC at 4770 Buford Hwy, MS K-34, Atlanta, GA, 30341-3714.

SUMMARY OF SUCCESS RATES OF THE
TOP TEN EMBRYO TRANSFER CLINICS

Region One - Eastern United States

Rank	Clinic	State	LBPC¹ %
	Women <35
1	Fertility Center of the Caribbean	P.R.	46.4%
2	Cornell University Center for Reproductive Medicine	NY	45.4
3	New England Fertility Institute	CT	44.4
4	Institute for Assisted Reproduction	NC	43.5
5	Long Island IVF	NY	40.0
6	Reproductive Diagnostics Center	NC	35.7
7	North Shore University Hospital	NY	35.5
8	Reproductive Biology Assoc	GA	34.5
9	John Hopkins Hospital	MD	34.5
10	First Coast Assisted Fertility	FL	33.3

Rank	Clinic	State	LBPC¹ %
	Women 35 - 39
1	New England Fertility Institute	CT	40.8
2	John Hopkins Hospital	MD	35.7
3	Cornell University Center for Reproductive Medicine	NY	28.8
4	IVF New Jersey	NJ	27.1
5	Fertility Center of the Caribbean	P.R.	26.9
6	North Carolina Center for reproductive Medicine	NC	26.1
7	Institute for Assisted Reproduction	NC	23.8
8	Hartford Fertility and Reproductive Center	CT	23.1
9	Massachusetts General Vincent IVF	MA	22.2
10	North Shore University Hospital	NY	21.3

Rank	Clinic	State	LBPC¹ %
	Women >35
1	Strong Infertility and IVF Center	NY	33.3
2	Fertility Center of the Caribbean	P.R.	27.3
3	New England Fertility Institute	CT	25.0
4	IVF New Jersey	NJ	23.1
5	Long Island IVF	NY	15.4
6	Medical College of Virginia IVF	VA	14.3
7	Cornell University Center for Reproductive Medicine	NY	14.7
8	Institute for Assisted Reproduction	NC	13.0
9	First Coast Assisted Fertility	FL	12.5
10	Shady Grove Fertility Center	MD	11.5

Region Two - Central United States

Rank	Clinic	State	LBPC¹ %
	Women <35
1	First, Inc. IVF	MI	42.0%
2	Center for Assisted Reproduction	TN	39.2
3	Center for Fertility and Advanced Reproduction	LA	36.8
4	Reproductive Health Association	MN	33.3
5	Center for Reproductive Medicine	KS	32.5
6	Ohio Reproductive Medicine	OH	31.4
7	Hinsdale Center for Reproduction	IL	30.2
8	Fertility Institute of New Orleans	LA	30.0
9	University of Arkansas IVF	AR	30.0
10	Miami Valley Hospital Fertility Center	OH	29.6

Rank	Clinic	State	LBPC¹ %
	Women 35 - 39
1	Reproductive Health Association	MN	33.3%
2	University of Alabama (Birmingham) IVF	AL	28.2
3	First, Inc. IVF	MI	27.1
4	Center for Assisted Reproduction	TN	26.5
5	University of Nebraska IVF	NE	26.3
6	Ohio Reproductive Medicine	OH	26.2
7	Hinsdale Center for Reproduction	IL	26.1
8	University of Minnesota Women's Clinic	MN	22.8
9	Center for Fertility and Advanced Reproduction	LA	22.0
10	University of Chicago IVF	IL	25.0

Rank	Clinic	State	LBPC¹ %
	Women >39
1	Reproductive Health Association	MN	15.2%
2	University Hospital of Cleveland IVF	OH	13.0
3	Fertility Unlimited	OH	12.5
4	Ann Arbor Reproductive Medicine Associates	MI	12.2
5	Sparrow Hospital Fertility Center	MI	11.1
6	Advanced Institute of Fertility	IL/WI	10.0
7	Center for Reproductive Medicine	KS	10.0
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Region Three - Western United States

Rank	Clinic	State	LBPC¹ %
	Women <35
1	Colorado Center for Reproductive Medicine	CO	58.3%
2	Pacific Fertility Center - San Francisco	CA	43.9
3	Arizona Center for Fertility Studies	AZ	42.0
4	Center for Advanced Reproductive Care	CA	40.0
5	Huntington Reproductive Center	CA	39.8
6	IVF Phoenix	AZ	36.4
7	Tyler Medical Clinic	CA	35.7
8	Center for Assisted Reproduction	TX	35.5
9	Nova IVF	CA	35.3
10	Center for Reproductive Medicine	CA	34.3

Rank	Clinic	State	LBPC¹ %
	Women 35 - 39
1	Colorado Center for Reproductive Medicine	CO	50.3%
2	Center for Advanced Reproductive Care	CA	44.4
3	Conceptions Women's Health Specialists	CO	35.9
4	Northwest Fertility Center	OR	35.7
5	Northern Nevada Fertility	NV	34.6
6	Huntington Reproductive Center	CA	33.7
7	Colorado Springs Center for Reproductive Health	CO	33.3
8	Southwest Fertility Center	AZ	31.3
9	Nova IVF	CA	30.2
10	Pacific Fertility Center at Sacramento	CA	29.9

Rank	Clinic	State	LBPC¹ %
	Women >39
1	Colorado Center for Reproductive Medicine	CO	24.2%
2	Center for Advanced Reproductive Care	CA	20.3
3	Huntington Reproductive Center	CA	18.6
4	Center for Reproductive Medicine	CA	18.4
5	Astarte Fertility Medical Center	CA	17.6
6	Nova IVF	CA	15.6
7	Reproductive Sciences Center	CA	12.8
8	Pacific Fertility Center - San Francisco	CA	11.9
9	San Francisco Center for Reproductive Medicine	CA	11.1
10	Center for Assisted Reproduction	TX	11.1

SUMMARY OF SUCCESS RATES OF THE TOP TEN
EMBRYO TRANSFER CLINICS IN THE U.S.

Rank	Clinic	State	LBPC¹ %	National Average
	Women <35
1	Colorado Center for Reproductive Medicine	CO	58.3%	25.3
2	Fertility Center of the Caribbean	P.R.	46.4
3	Cornell University Center for Reproductive Medicine	NY	45.4
4	New England Fertility Center - San Francisco	CT	44.4
5	Pacific Fertility Center - San Francisco	CA	43.9
6	Institute for Assisted Reproduction	NC	43.5
7	Arizona Center for Fertility Studies	AZ	42.0
8	First, Inc. IVF	MI	42.0
9	Center for Advanced Reproductive Care	CA	40.0
10	Long Island IVF	NY	40.0

Rank	Clinic	State	LBPC¹ %	National Average
	Women 35 - 39
1	Colorado Center for Reproductive Medicine	CO	50.3%	18.2
2	Center for Advanced Reproductive Care	CA	44.4
3	New England Fertility Institute	CT	40.8
4	Conceptions Women's Health Specialists	CO	35.9
5	John Hopkins Hospital	MD	35.7
6	Northwest Fertility Center	OR	35.7
7	Northern Nevada Fertility	NV	34.6
8	Huntington Reproductive Center	CA	33.7
9	Colorado Springs Center for Reproductive Health	CO	33.3
10	Reproductive Health Associates	MN	33.3

Rank	Clinic	State	LBPC¹ %	National Average
	Women > 39
1	Strong Infertility and IVF Center	NY	33.3%	8.0
2	Fertility Center of the Caribbean	P.R.	27.3
3	New England Fertility Institute	CT	25.0
4	Colorado Center for Reproductive Medicine	CO	24.2
5	IVF New Jersey	NJ	23.1
6	Center for Advanced Reproductive Care	CA	20.3
7	Huntiungton reproductive Center	CA	18.6
8	Center for Reproductive Medicine	CA	18.4
9	Astarte Fertility Medical Center	CA	17.6
10	Nova IVF	CA	15.6

¹Live births per cycle (multiple births count as one)

Conclusion

What follows are general conclusions for the study. They may or may not pertain to your specific situation, and they are the opinions of the author, and are not endorsed by, or in any way associated with, those who conducted the study.

Bigger is by no means better. Some of the clinics having the largest numbers of cycles had some of the lowest success rates. The smallest clinics (those with 57 or fewer cycles) had almost as high a percentage of success as the largest clinics. On the whole, however, the largest clinics (those with greater than 191 cycles) had the highest success rates.
The vast majority of women trying IVF have never had a child. 77% of all participants had not had a prior birth.
GIFT success rates are about 20% higher than IVF. ZIFT success rates are roughly 25% higher than IVF. Regardless of the procedure used, success rates average about 20%, meaning that for any given cycle, the chances are 1 in 5 that the attempt will ultimately result in live birth.
About 20% of those attempts resulting in pregnancy end in miscarriage. The chances of a multiple birth is about 30%.
Success rates drop dramatically after the age of 40. A 40 year old women stands about a 10% chance of success. A 24 year old woman s success rate is about 30%.
Women who have previously delivered are no more likely to succeed than women who have never had a child.
Regardless of the nature of the diagnosis of infertility, success rates are about the same. For example, someone suffering from endometriosis has a success rate no different that someone who has an ovarian factor involved.
Ideal success rates are achieved by transferring at least 3 embryos. Success rates do not increase by transferring more than 4 embryos.
Success rates with frozen embryos is 40% lower, i.e., only about 15% of frozen embryo transfers result in a live birth.
Donor eggs offer a significant advantage when the age of the woman is >35. A 40 year old woman, for example, has about a 10% chance of success using her oSan Fran. CA 11.9 S.F. Center for Reproductive Medicine CA 11.1 Center for Assisted Reproduction TX 11.1
The average clinic had 45 cycles in 1995. Of those, about 20% resulted in a live birth. The "best" clinic had a success rate of almost 60%.

Copyright 1998 SMI

Copyright 1998. The American Surrogacy Center, Inc.(TASC), Marietta, GA

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