By Adnan Catakovic, Chief Executive Officer and Scientific Director of City Fertility Centre.
There is currently a great deal of public debate and discussion about IVF success rates in Australia. City Fertility Centre supports any action to standardise information provided to patients to allow them to make a personal choice about their treatment.
City Fertility Centre understands that the fertility journey for couples and single women can be difficult and confusing and believes that clinics bear a great responsibility to treat all patients as individuals and provide optimal and necessary care.
City Fertility remains a doctor- and scientist-owned service focused on rates of pregnancy and live births.
Recently, a statement in one of our information brochures was questioned in the media.
The statement was: “Of the people who do require IVF treatment and have had a baby through City Fertility Centre, 90% fall pregnant in one to three cycles.”
The statement clearly states “have had a baby through City Fertility Centre”; it does not claim “all patients”.
Through this statement, City Fertility Centre aims to let people know that if they are going to fall pregnant with the help of IVF and City Fertility Centre, our statistics state it is most likely to occur in the first three cycles (90% chance).
A common question City Fertility Centre receives from patients is: “Will we be entering an endless cycle of IVF?” We want them to know that, at City Fertility Centre, if they are medically capable of a pregnancy, we will help them achieve a pregnancy as quickly and efficiently as possible and that is within the first three cycles. After that, their chances of falling pregnant are clearly reduced and therefore further medical intervention and specialised screening, such as genetic testing, may be required.
City Fertility Centre wants to be realistic with patients and empower them with the facts so they can make their decisions, in conjunction with thorough consultation with their fertility specialist, nursing and scientific team, to ensure we are always optimising their chances of achieving a pregnancy during their fertility journey.
Regardless, at City Fertility we have a passion for maximising pregnancy outcomes for all of our patients and pride ourselves on focusing on live-birth rates and creating families rather than on the “share price”.
It is important to note that all statistics in IVF are generalised to standard patient populations; however, each patient has to be treated as unique and their true pregnancy potential can only be ascertained with a thorough discussion and investigation by a trained specialist.
City Fertility Centre continues to be owned by the doctors and scientists who work in the clinics and laboratories treating the patients.
Related articles: IVF success rates: to publish or not to publish?
IVF success rates: to publish or not to publish?
IVF is a subject that triggers deep emotions, particularly in would-be parents desperate for a baby.
Yet the fertility field also has a strong scientific basis, and this “clinical” side of IVF brings to the fore questions about performance. In recent weeks there has been renewed debate about measurement of IVF success rates, which indicate the number of treatments carried out by a clinic in a particular year, and the number of resultant pregnancies or live births.
IVF in Australia is a sophisticated and highly competitive industry, and there are differing opinions about whether patients should have access to comparative performance data to help them choose a fertility provider.
There is a well-maintained record of IVF outcomes and trends, published by the Australian and New Zealand Assisted Reproduction Database (ANZARD), which provides an overall annual report.
The latest report, Assisted Reproductive Technology in Australia and New Zealand 2012*, showed the live delivery rate from 40,000 fresh IVF treatments at 35 fertility centres that performed at least 90 fresh treatment cycles ranged from 4 per cent at some clinics to 30.9 per cent at others.
Some of the biggest IVF providers have recently called for the publication of success rate data. They argue that there is a large gap between the best-performing and worst-performing clinics, and that patients – and taxpayers, who help fund IVF through Medicare rebates – should have an objective picture of “success rates”.
The current situation is that some fertility providers use their own data, and couple this with information taken selectively from ANZARD, to demonstrate their success rates, and publish this on their websites.
Comparative tables are complex, and a fair and accurate comparison must take into account individual patient factors, including cases where patients move to smaller, specialist clinics after numerous IVF failures with large providers.
One of the most influential factors affecting IVF success rates is female age. When presenting pregnancy rates from an IVF unit, it is critical to make allowance for the age of the patients. There are several ways of doing this. One can quote the average or median age of the patients or break down the results for certain age ranges: for example, under-35s, over 40s and so on. The higher the proportion of “older” patients having treatment, the lower the apparent pregnancy rates will be.
The way data is presented can also skew “success”. Some providers quote pregnancy rates only for patients whose embryos have survived to day 5, eliminating poor-prognosis patients whose embryos may not reach the day-5 stage. If one were to calculate the pregnancy rate according to the numbers of cycles initiated (i.e. including the patients whose embryos did not reach day 5), the success rate would be much lower.
Overseas, there are varying approaches to publication of success rates. In the UK, the British Human Fertilisation and Embryology Authority (HFEA) publishes annual data for all clinics, but warns against a “league table’’ approach to success rates**, arguing that these rates can be affected by the type of patients treated by clinics, and individual treatments and practices.
Whether patients rely on IVF providers’ websites, or whether in future in Australia success rates are made publicly available, these reports should only be used as one piece of useful information.
Every patient is different. Factors such as female age, cause and duration of infertility and the number of previous unsuccessful cycles all have an impact on whether fertility treatment, including IVF, results in the birth of a healthy baby.
Fertility medicine is a complex area, and oversimplifying “success rates” in marketing material should be approached with caution. As a medical community we need to keep the patient at the centre of our minds at all times.
Image courtesy of Shutterstock.com
