How Some Clinics Manipulate Their Fertility Success Rates

Fertility success rates are confusing, partly because they can be manipulated by using different time frames of measurement and by starting out with the most aggressive—and most expensive—treatments when they may not be necessary. Starting with the most effective fertility treatments, not the most aggressive or expensive ones, ensures your success, not just the clinic’s success rates.


First try the least invasive fertility treatment

I’d like to talk about success rates in fertility clinics. This is a confusing subject, and many patients don’t feel that they truly understand what leads to a successful outcome and what are some of the factors that can be controlled and what are those that can’t be controlled.

First of all, it’s really important to individualize your care. In other words, when you come in, we’ll look at many different factors that are associated with success rates. We will first, of course, try to figure out why it is that you are having difficulty becoming pregnant.

Our general goal is to try the least invasive, least aggressive therapies first, because these are less invasive and less likely to cause complications. However, it’s always good to know that later on if you don’t get pregnant with the more conservative, less expensive, less invasive procedures, then you will be able to get pregnant with more aggressive therapies. And generally, we have very good success rates as you progress.

Manipulating fertility success rates by start & end points

You can actually manipulate success rates based on what you use as the starting point and then the outcome. For instance, if you start with just an embryo transfer—by which point you’ve gone through many steps and many patients have fallen out by that point—and if you look at just getting pregnant rather than taking home a baby, your success rate may appear higher.

Many patients have miscarriages. And many patients don’t actually get to the point where eggs can be retrieved, fertilized and embryos developed.

Therefore, the conservative approach that we like to take is to identify patients who start a cycle and take home a baby. That’s really the most rigorous way of doing it, because those patients have a realistic expectation that when they come into a cycle how likely it is that they will become pregnant.

Manipulating fertility success rates by using aggressive treatments first

The other way to manipulate data is to actually use more aggressive therapies sooner than you need to. For instance, most of our patients start off with conservative approaches using oral agents to stimulate ovulation and what we call superovulation, where we try to achieve multiple eggs to be ovulated.

However, if you start off with in vitro fertilization (IVF) as an aggressive approach, you may take patients who would have gotten pregnant with the easier approach and certainly get them pregnant with the more aggressive approach—even though that was not necessary to do the more aggressive approach from the very beginning.

So you can certainly try to move patients through quicker, but what we try to do at Advanced Reproductive Medicine is to individualize your care. When you come in, we’ll look at your data, we’ll get more data, if needed. For instance, if you have ovarian reserve screening, which tells us the number of eggs that you have and how likely it is that you are going to ovulate, then in most cases we will use that data if it is recent. But if it’s more remote, we will try to get it again, because this is something that changes over time.

Start with most effective treatments, not the most aggressive, expensive ones

Similarly, if there are other tests that have been done but were not completed, we’ll complete those if necessary. But if everything has been done, we’ll identify what your chances of getting pregnant are and individualize your care—using the most cost-effective, least-invasive approach first, recognizing that we can move on to more aggressive therapy if the need arises.

So you can be assured that coming here to Advanced Reproductive Medicine we will individualize your care and use what we think is going to be the most effective, but not necessarily the most aggressive or expensive therapies at the very beginning. And hopefully you can get pregnant with those easier techniques, but recognize that we can get more aggressive later on.

Thanks, and I look forward to meeting you.