Secrets of success
A number of major IVF clinics have made changes to claims about success rates published on their websites following an investigation by the Australian Competition and Consumer Commission (ACCC).
The investigation looked at all of the major Australian IVF clinics for potentially false or misleading representations. The ACCC found that some clinics made success-rate comparisons without adequate disclosure or explanation of the data used to make the claims.
For example, "some IVF clinics used 'clinical pregnancy rate' data to compare their success rates where that data reflected the clinic's success in creating an embryo, rather than live birth rates. These comparisons were sometimes accompanied by photographs of newborn babies," the ACCC said in a statement.
It was the view of the ACCC that such claims, without further explanation, could mislead consumers with regard to the rates of successful pregnancies achieved by the clinic.
ACCC commissioner Sarah Court warned IVF clinics not to continue with the practice, saying: "The ACCC expects that all IVF clinics will take care to ensure that success-rate comparisons are clear and accurate, and based on data that is explained in non-technical terms so that consumers can rely on it to make informed choices about which IVF clinic to use."
The ACCC will continue to monitor the situation.
CHOICE investigates IVF
In vitro fertilisation (IVF) is a growing industry. In 2014, 12,962 babies were born in Australia and New Zealand through IVF.
Before deciding to undergo IVF, prospective parents have a lot to consider; they must weigh up the options, costs, and procedures provided by various clinics. This can be an overwhelming experience, as patients try to gauge which option gives the greatest chance of success.
Our research shows that shopping around for the right clinic is neither simple nor straightforward. A clinic may reveal their IVF success rates to reflect the chance of conceiving, but patients aren't always given access to the clinic's full results. And as there's no industry standard for how results are displayed, it's impossible to compare statistics from clinic to clinic.
In our investigation, we look at:
The problem with IVF statistics
Many IVF clinics make claims on their websites about their high success rates. One Queensland clinic we contacted told us they were currently updating their success rates due to the controversy around interpretation of results. Another clinic in Western Australia said they were trying to be clearer with their results.
Comparing statistics is also difficult as clinics use different metrics, and display their results slightly differently in their marketing material.
For example, some clinics only present data for women under 35; some only advertise 'live birth rates', and others only advertise their 'pregnancy rate'. However, not all pregnancies will result in a live birth – especially for women over 40, who have higher miscarriage rates.
Loretta Houlahan is a former embryologist with eight years' experience working in fertility clinics. She says one reason clinics will only display a pregnancy rate is because it's much easier to achieve a clinical pregnancy than live birth, and she agrees patients will find it difficult to interpret results. "There is a difference between clinics. I've worked in both research and clinic roles. There are lots of different procedures available with different results."
National database reveals wide-ranging success rates
The Fertility Society of Australia and National Perinatal Epidemiology and Statistics Unit (NPESU) collate data across every fertility clinic in Australia and New Zealand. This is known as the Australia New Zealand Assisted Reproductive Database (ANZARD) report and it's designed to assess the effectiveness of IVF treatments.
Last year's report (data from 2012) showed huge success rate gaps between fertility clinics, revealing a live delivery rate of just 4.0% at the lowest performing clinic, and 30.9% at best for fresh cycles (embryos that have not been frozen).
This year's report released in September (data from 2013) only reveals pregnancy rates, which ranged from 14.1% to 44.8% for fresh cycles.
Associate Professor and NPESU director Georgina Chambers says that one of the reasons the team decided to report pregnancy rates in the latest report (rather than live births) was due to a small number of cases where they didn't know the outcomes of the pregnancies because a clinic couldn't make contact with the patient.
The pregnancy rate for 2013 is also reported as per embryo transfer, instead of per cycle. Dr Chambers says this change in reporting is due to changes in clinical practice. "The intention of an increasing number of cycles is not to progress to embryo transfer, but to freeze the embryos for transfer in a subsequent cycle," she explains. "Some clinics do this more than others; therefore it would be misleading to include all initiated cycles in the denominator."
While the ANZARD report is publicly available, results for individual clinics are not disclosed in the report. There is currently some debate around the public release of these results, as well as what can be done to improve poor-performing clinics and potentially give the public access to the results when choosing a clinic.
What causes infertility?
IVF success rates vary depending on the type of treatment and the cause of infertility. For most couples there are standard tests to establish the potential causes of infertility, but in about 10% of couples, no obvious causes can be found.
We spoke to Dr Harvey Ward, a fertility specialist from IVF clinic Genea, who gave us an overview of what IVF doctors will investigate to determine the causes of infertility.
- Doctors will first investigate natural fertility, which is only proven by a history of being able to conceive (female) or impregnate (male). If a woman has never tried before, or suppressed her fertility by measures such as being on the pill, she may not know if she can become pregnant.
- The second factor they look at is age. A woman's age is critical, says Ward, as her fertility drops after the age of about 35. He says the average fertility chance per cycle for a 21-year-old would be 25%, compared to 12% once she's 36. Women are born with a set amount of eggs, and over time they decrease in both quantity and quality, impacting the chance of conceiving both naturally and with IVF. Age is not as critical a factor for men.
- A fertility specialist will investigate a couple's reproductive health. For men, this means checking for adequate numbers of normally shaped and motile (active and healthy) sperm. For the couple, it's about regular intercourse timed for the days of the woman's ovulation. Women need an open and unobstructed pathway through the cervix, uterus, and fallopian tubes for sperm to travel and meet the egg after ovulation, and a healthy tube to transport the embryo back into the uterine cavity after fertilisation.
- Finally, a woman must be ovulating regularly, and have a healthy womb lining for the embryo to embed and grow into.
Based on these factors, the doctor will then decide on the need and urgency of treatment. The success rate of the suggested technology would depend on the woman or couple's particular problem. Some patients might come with one problem, such as age; other couples might have multiple issues to overcome, such as sperm quality as well as age.
What questions should patients ask clinics?
Dr Richard Henshaw, medical director of Repromed IVF and chairman of the IVF Medical Directors of Australia and New Zealand, says it's important to do as much research as possible before choosing a clinic. He suggests talking to patients who've had treatment before, and asking GPs and specialists for recommendations.
Another important factor is where the clinic is located, as IVF requires many visits to the clinic for tests and procedures.
He says the basic but important questions to ask are:
- Have you investigated all the possible causes of our infertility?
- Do you know what the problem/s are?
- What are the chances of conceiving and carrying a baby to delivery with your treatment?
- What are the initial and ongoing costs of fertility treatment?
More detailed questions to ask and things to consider:
- Ask the clinic what range of services they provide, as technologies and treatment protocols are not standardised across all clinics. Do they provide advanced techniques with greater success rates? Does the clinic provide donor sperm and donor eggs, if needed?
- Don't be afraid to ask for a second opinion from another clinic – it's a good way of comparing a couple of IVF providers.
- Specifically request the live birth rate for your age group in both fresh and thaw cycles. Note, though, that clinics are under no obligation to provide this information.
- A couple should ask a clinic, "What factors in our situation would make that statistic (in regards to the one advertised) a likely outcome?" or "What are our chances given our problems, and why?"
It's also important to be aware that while a clinic's success rate is a broad indicator of its performance, it may not necessarily reflect your own individual chances of success. However, this information does allow patients to make an informed choice about where they choose to receive treatment.
Dr Henshaw says the more information patients have, the more empowered they are and the better their chance of a successful outcome.
How much does IVF cost?
Information about costs can be just as hard to get as information on success rates. The experts we spoke to say it's almost impossible to work out how much clinics charge as they may not include all charges in the initial quote. Once patients know what treatment is required, they can ask the following:
- What will the costs be after the Medicare rebate?
- What procedures or treatments are covered by private health insurance?
- What possible additional costs may arise?
- Does the cost include tests, drugs, treatment, anesthetist, counselling, surgery, embryo freezing, and storage?
- How and when are payments required?
Want to know more?
Read more about the costs of IVF in our article IVF clinics and costs. The website of Access Australia, a non-profit infertility network, also has further information.