There's been a lot of chatter this week about a new website comparing success rates of IVF clinics in Australia (if you haven't found it yet, I've linked it at the bottom of this piece).
As an embryologist, success rates have long been something I have been very interested in. Up until now, it has been virtually impossible to compare 'success rates' from different IVF clinics - each clinic has presented their data in subtly different ways which has meant that even though you THOUGHT you were comparing apples with apples - you were actually comparing apples with a cow.
I can almost hear you saying that surely 'success' is a baby, right? Surely what I'm looking at here, what these numbers are telling me is 'if I come to your clinic, how likely is it that I will end up with a healthy baby'... and yeah, that seems obvious doesn't it? but it actually isn't.
Here are just some of the ways clinics could present their 'success rates':
Number of positive blood tests per embryo transfer
Number of heartbeats on ultrasound per number of embryos transferred
number of positive blood tests per egg collection
number of positive foetal heartbeats per egg collection
number of babies born per embryo transfer
number of babies born per number of embryos transferred
number of positive blood tests per cycle started
You can see that comparing 'success' rates has been pretty fraught ...
so, yes, it's great that with the launch of this new website - we have managed to streamline the WAY that clinics report their data and have compiled it all into one place so its easier to compare...
But what about the fact that one clinic might have 40% of their cases with a female partner over 40 and the next one might have only 20%?.... or maybe one clinic has an amazing genetic screening program so they see lots of people who aren't actually infertile - they are having IVF so that they can have Pre Implantation Genetic Testing to screen for a familial condition....
or what about the clinic that has a couple of Drs who have been in the game for a really long time and get ALL of the 'hard-to-treat' cases for a second opinion? Or the young and groovy Dr who gets all of the 28 year olds (who have a much higher chance of getting a baby than the over 40's)?
It's not all that hard to see how the data easily gets very skewed...
Now, with the launch of this comparison website, you can actually compare apples with apples.. which would be great if you KNEW that apples were what you needed....
by Apples I mean IVF... and what if you don't actually NEED IVF??
The statistic I would love to see is: Number of babies born per referral to a fertility specialist - how many people who get a referral to a fertility specialist actually get a baby at the end of the process - whatever the process is - not just IVF!!
What is often-times presented as a 'success rate' by an IVF clinic is their live-birth-rate per egg collection. So this success rate is only useful to you if you are actually having IVF, and you make it as far as egg collection. Statistics tell us that roughly only 50% of people referred to a fertility specialist will end up having IVF - so what happens to the other 50% who don't have IVF? How do you know whether the Dr you are choosing to see is going to fast-track you to IVF, or if they're going to try others things first? are you even eligible for other things? would they even be suitable to your situation? Do you even know what your situation really is??? So.Many.Questions!!!
Choosing your fertility specialist based purely on the cumulative success rates* of the clinic they work with is also a little flawed. Melbourne IVF for example have over 30 fertility specialists working with them and there is considerable between Dr variation in their success rates. This is averaged out for the purposes of ANZARD data (the data used to compile the information on this new website), so the Dr that you choose could be significantly 'better' or even possibly 'worse' than that reported success rate...
So, do I think you should use this tool to help you choose a fertility specialist? well, I've spent a bit of time today on there - and boy oh boy is there a LOT of information there! Even with my 20+ years experience in the fertility space, I found it overwhelming and a bit disorientating trying to work out what I was actually reading - I can only imagine what that would be like if I were approaching all the acronyms of fertility treatment for the first time. But the information is sound, well researched and well referenced.
It's also pretty heavily covered by disclaimers
A lot of money and a lot of time has gone into preparing this website... leaving a lot of the 'trying to conceive' community wondering if that is actually money well spent by the government? or if perhaps it might have been better spent on research into why the average time to diagnose endometriosis is still more than 10 years, or the causes of PCOS, or perhaps on insisting companies that continue to produce products containing chemicals known to interfere with our hormones stop producing them or find alternatives, or maybe funding some education programs about fertility in schools - or any other research projects aimed at reducing the incidence of infertility!
I feel a little bit like this new website actually isn't that helpful to people trying to conceive - just creating more stress, fear, anxiety and overwhelm, but it is actually yet another marketing tool for the big business IVF clinics... I'm keen to hear your thoughts!
You'll find the website here: www.yourivfsuccess.com.au
and information about ANZARD here: https://npesu.unsw.edu.au/data-collection/australian-new-zealand-assisted-reproduction-database-anzard
and the list of contributors to the website here: https://www.yourivfsuccess.com.au/about
Some of the disclaimers from the website:
Caution is needed when comparing success rates between clinics. A clinic's success rates might be higher or lower relative to another clinic, based on the types of patients it treats and its diagnostic and treatment strategies. The success rates reported here are average chances and do not necessarily apply to a particular patient. The information on this Website is best understood in consultation with your fertility doctor and is not a substitute for professional advice.
Or this very long one: www.yourivfsuccess.com.au/terms?s=disclaimer
*Cumulative success rate is the live birth rate from one egg collection - including any and all of the fresh and frozen embryo transfers resulting from eggs collected in that one egg collection