Alta Bates IVF Program

510-649-0440 Info@ABivf.com

This is our second round at IVF following the successful birth of our first daughter, now age 4. I have nothing but praise and admiration for the venerable Dr. Chetkowski and his staff, and consider ourselves fortunate to have such expertise available in the East Bay.

Call Us: 510-649-0440 or Schedule an Appointment Online

Required links for Alta Bates IVF Program results in national reports:
SART Clinic Summary Report: https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=1959
CDC Assisted Reproductive Technology Data Report: http://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&ClinicId=95&ShowNational=0
A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches, and entrance criteria for ART may vary from clinic to clinic.
graph

 

Figure 1. The bar graph above summarizes the total live birth rates per retrieval for both fresh (light blue) and frozen (dark blue) embryo transfers at the Alta Bates IVF Program from 2006 through 2013 in five age groups of women using their own eggs on the left, as well as the total live birth rate per both fresh and frozen embryo transfers for women of all ages using donor eggs on the right side. This consumer-friendly graph allows current and prospective patients to estimate at a glance their chance of having a baby from one egg retrieval cycle. The numerical data on which the graph is based are listed in Table 2 and the rules for the calculations are explained in detail below.

 

Table 1. Alta Bates IVF live births per cycle start for 2006-13 in the traditional format used by SART and CDC for national and clinic-specific reporting.


Fresh Embryos Births/Cycle

Under 35

35-37

38-40

41-42

Over 42

 

All Ages

Egg Source

Own

Own

Own

Own

Own

 

Donor

2006

6/18

5/10

3/17

3/13

0/4

 

8/15

2007

3/9

5/17

16.7%

3/9

0/2

 

7/15

2008

3/12

4/8

1/10

0/15

1/4

 

8/12

2009

1/7

4/14

2/10

0/4

1/8

 

6/14

2010

4/11

3/12

4/17

1/2

0/4

 

7/17

2011

4/8

2/10

3/7

2/4

0/3

 

43.9%

2012

3/7

3/13

2/13

1/7

2/8

 

12/18

2013*

1/15

2/11

2/11

4/15

0/5

 

7/14

                           

Under    35

35-37

38-40

41-42

Over 42

 

All Ages

 

 

Frozen Embryos

 

Births/Transfer

 

Egg Source

Own

Own

Own

Own

Own

 

Donor

2006

0/5

3/9

2/4

2/8

0/0

 

40.9%

2007

5/12

2/6

1/12

0/4

0/0

 

3/14

2008

3/12

4/8

1/10

0/15

1/4

 

29.6%

2009

3/5

2/4

1/3

0/2

0/0

 

6/12

2010

1/12

3/5

3/7

0/0

0/1

 

24.1%

2011

8/15

1/4

0/3

1/3

0/4

 

30.4%

2012

4/5

2/7

1/7

0/3

0/1

 

7/17

2013

9/16

4/13

1/3

2/3

1/1

 

6/17

*In 2013 cycles with short-term embryo banking (in which no fresh transfer was planned or done) were listed together with cycles in which fresh embryo transfer was actually done.  In prior years, cycles with short-term and long-term embryo banking were listed together but separately from cycles with fresh embryo transfer. As a result of this change, the per cycle live birth rates from fresh embryos in 2013 were much lower than in previous years because these cycles were added to the denominator without contributing to the numerator.

Table 2. Alta Bates IVF data for 2006-2013 used in calculating the total live birth rates portrayed in the graph above. The particulars of this consumer-friendly reporting format are explained in detail below.

Age Group

Under 35

35-37

38-40

41-42

Over 42

 

All Ages

Egg Source

Own

Own

Own

Own

Own

 

Donor

 

 

 

 

 

 

 

 

Cycles

114

108

120

91

48

 

129

Retrievals

107

100

104

78

43

 

 

Transfers

 

 

 

 

 

 

127

 

 

 

 

 

 

 

 

Births from Fresh Transfers

25

29

21

12

7

 

    66

Births from Frozen Transfers

31

16

7

2

0

 

27

Birth Rate per Cycle Start*

49.1

41.7

23.3

15.4

14.6

 

72.1

 

 

 

 

 

 

 

 

Birth Rate per Retrieval

52.3%

45.0%

26.9%

17.9%

16.3%

 

 

Birth Rate per Transfer (see graph above)

 

 

 

 

 

 

73.2%

*In 2006 and in 2009 two patients conceived and achieved live births as a result of IUIs in “cancelled” IVF cycle without egg retrieval. Logic dictates that these 2 births should be counted in the per-cycle numerator because their cycles are counted in the denominator. Since no egg retrievals took place, these deliveries are logically excluded from both the per-retrieval numerator and denominator. However, in compliance with the long-standing reporting convention adopted by SART and CDC, these two live births are not included in the above Birth Rates per Cycle.

General principles underlying all calculations of success rates
All success rates are fractions, i.e. they consist of 2 numbers: a numerator and a denominator. For convenience the success rates are usually reported as percentages, i.e. fractions with a fixed denominator of 100. By convention, SART and CDC report percentages only in categories where the denominator is equal to or greater than 20 which puts smaller clinics at a disadvantage because fractions are harder for consumers to process than percentages.         
The standard numerators are clinical intrauterine pregnancies and live births. We report just live births because they are the only outcome which really matters to consumers. Thus early “biochemical” pregnancies, miscarriages, ectopic pregnancies, elective pregnancy terminations and stillbirths are all excluded from the numerator.
There are 3 legitimate denominators: cycle start, egg retrieval and embryo transfer. Each has its advantages and disadvantages. Since egg retrieval is the defining and most invasive step of IVF, we believe that it is the single best denominator for reporting IVF results. Patients who start a cycle but whose treatment is cancelled before the egg retrieval never actually undergo in vitro fertilization. However, Tables 1 and 2 list cycle starts as an alternate denominator because this metric is explicitly required by the Clinic Success Rate Reporting Law of 1992.
In many donor egg cycles in our program, two infertile recipients are matched to a single donor rendering retrieval an awkward denominator. Therefore, the donor egg IVF live birth rates are usually reported per transfer, a practice which is in agreement with the traditional format used by SART and CDC.
Differences in patient populations treated in different fertility clinics remain the major confounding factor in all reporting formats and render comparison of success rates across clinics and between a clinic and national results unreliable.
No reporting format is ideal but each approach offers a different perspective on a complex area of medicine. The validity of one reporting format does not invalidate another reporting system which may bring out important aspects of the practice of assisted reproduction.
The major differences between traditional and consumer-friendly reporting
Traditional reporting focuses on separate treatment cycles in isolation without linking frozen embryo transfers to a retrieval cycle or multiple treatments to a single patient. Therefore, it provides a comprehensive compilation of all the ART treatments nationally within a single calendar year which is very useful to ART providers and monitoring organizations such as SART and CDC. These reports include multiple outcomes and endpoints which might be of interest to select consumers.
However, the traditional reporting is of little help to an average infertile consumer because it does not clearly answer her main question: what is my chance of having a baby from a single IVF egg retrieval? Our consumer-friendly reporting is focused exclusively on answering this all-important question in a way which is accessible to the largest number of consumers with different backgrounds and variable grasp of numbers. The graph above is our primary tool but we are currently working on other visual representations to aid consumers unfamiliar with probability really understand their chance of success. Such understanding is key to informed consent.
Rules underlying consumer-friendly reporting
All transfers are linked to the retrieval which provides the eggs. Retrieval cycles are only entered in the denominator after at least one transfer has taken place. Only the first live birth resulting from that retrieval is included in the numerator regardless of whether it follows transfer of fresh or frozen embryos. If a cycle is canceled before egg retrieval, it is included in the denominator for cycles but not for retrievals. If more than one birth results from one egg retrieval, only the first delivery is included. Multiple births are counted as a single live birth. Live births which occurred during the years 2006-2013 through transfer of frozen embryos generated from retrievals before January 1, 2006 are excluded. Live births which occurred since 2013 through transfer of frozen embryos generated from retrievals during 2006-2013 are included. The recently developed SART reporting of “cumulative” clinical outcomes is roughly similar to our consumer-friendly format.
As assisted reproductive technologies have evolved, embryo transfers have increasingly become uncoupled from the retrieval procedures because more and more patients undergo no fresh embryo transfers but only frozen embryo transfers. For this reason combining live births from transfers of both fresh and frozen embryos from a single retrieval procedure reflects the current practice of A.R.T. better than traditional reporting.
Furthermore, achieving a high live birth rate is no longer our only goal. We strive to combine satisfactory live birth rates with avoidance of high order multi-fetal deliveries and complete elimination of severe OHSS (ovarian hyper-stimulation syndrome). Thus emphasizing total live birth rates per retrieval rather than results with just fresh embryos helps patients select a safer treatment option. While this method of reporting requires more effort than the traditional approach, it provides consumers with more relevant information.
Comparison of traditional and consumer-friendly reporting
Consider a sample of 9 cycle starts for IVF using the women’s own eggs leading to 8 egg retrievals, 4 transfers of fresh embryo, 12 transfers of frozen embryos, and resulting in 6 singleton live births to 4 unique women as listed below:


Case number

1

2

3

4

5

6

7

8

9

 

 

 

 

 

 

 

 

 

 

Cycle Start

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

 

 

 

 

 

 

 

 

 

 

Egg retrieval

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

ND

 

 

 

 

 

 

 

 

 

 

Fresh transfer

    LB

No LB

No LB

ND

ND

ND

ND

No LB

ND

 

 

 

 

 

 

 

 

 

 

Frozen transfer #1      

LB

LB

No LB

No LB

LB

LB

No LB

No LB

ND

 

 

 

 

 

 

 

 

 

 

Frozen transfer # 2           

No LB

ND

No LB

No LB

LB

ND

ND

ND

ND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Abbreviations:  LB = live birth; ND= not done 

 

 

 

 

 

 

  Traditional Report for fresh embryos:
LB/cycle start = 1/9 (11.1%)
LB/retrieval = 1/8 (12.5%)
LB/fresh transfer = 1/4 (25.0%)
Traditional Report for frozen embryos:
LB/frozen transfer = 5/12 (41.7%)

  Consumer-friendly Report:                
Total LB/retrieval = 4/8 (50%)

While there is no doubt that, even in this simplified example, traditional reporting provides a great deal of additional information, the relevance of this information to an average consumer is questionable.  The value of consumer-friendly reporting lies in its ability to distill a large number of data points into a single statistic which is accessible to all patients.

                                                                                                 Our Results 2016; 11/13/2016

Itís All About Creating Families

"Patients are my partners. Together we have been making their dreams come true since 1984." ~Dr. Richard Chetkowski