Skewed Data Misleads About the Success Rate of Fertility Treatments

Few health issues are as frustrating as the inability to conceive a baby, especially when the prospective parents are otherwise medically sound. Couples keen to be parents and who need help sometimes turn to fertility centers. A new study casts a shadow over what some clinics claim are their success rates.

As reported by Reuters, fertility centers are required to report the number of in vitro fertilization (IVF) cycles they perform to the Centers for Disease Control and Prevention (CDC). They also may choose to report initiated and completed cycles to the Society for Assisted Reproductive Technologies (SART). But in some cases, the data might be misleading.

The study, published in Fertility and Sterility, used data from SART. From 2005 to 2010, the proportion of cycles that were initiated by had no reported outcome, successful or not, increased.

A disproportionate number of facilities-13 out of 341-accounted for half of the excluded cycles, but they reported better pregnancy rates than the average.

Researchers said the unaccounted cycles might result from clinics that take frozen embryos from several rounds of fertility treatments and implant only the one that looks best. That practice might be strategic-to enhance the chances of conception-or it might be an effort to skew the data to make a facility’s success rate look better.

The report suggests that that approach occurs more often with older women or those who have a lower chance of conceiving.

Each cycle of IVF costs about $15,000; sometimes it’s covered by insurance, and often it isn’t.

The researchers said the clinics that might not be reporting their full number of cycles aren’t just fringe operations-many, said Dr. Vitaly Kushnir, who led the study, “are considered leaders in the field of ART in the United States.”

“Clearly, their pregnancy rates are significantly better than those of other clinics in the whole country, and it seems that a large part of that is these clinics have been excluding poor prognosis patients from outcome reporting,” he told Reuters.

Kushnir’s team used SART data because it wanted to compare the number of started and finished cycles; SART data covered nearly 3 in 4 U.S. fertility centers in 2010, and 812,400 cycles during the whole study period.

The number of excluded cycles-those that were initiated but lacked final data-increased from about 3 in 100 in 2005 to more than 7 in 100 in 2010.

Among the 13 “outlier” centers, excluded cycles accounted for more than 1 in 3 of all those initiated. And those facilities reported higher pregnancy rates-nearly 6 in 10 for younger women who got a fresh embryo transfer versus fewer than 5 in 10 in the rest of the SART database.

Those clinics also slightly increased their market share during the study period. The researchers did not identify the 13 clinics by name.

A physician member of SART’s executive council, said the organization is aware of flaws in the reporting process that could skew success rates, according to Reuters, particularly in tracking the freezing and selective implanting of embryos. But he said that doesn’t mean clinics with lots of excluded cycles are trying to game the system, that there can be legitimate reasons for such accounting that benefit patients.

He and Kushnir said that prospective parents shouldn’t rely only on reported success rates in determining where to undergo fertility treatment.

Still, Kushnir advocates for better transparency and accountability, and says that the CDC, where he works as a consultant, could improve its reporting data by requiring clinics to disclose every initiated cycle and its outcome.

For more information, visit the patient resource pages of SART’s website where you’ll find FAQs about infertility and its treatment, ethical standards for IVF and other topics. See as well the CDC’s page on assisted reproductive technology. Both resources discuss success rates.

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