The Fertility Guide: The ART Procedures

A great deal has been written in both the medical and general press about success rates with the ART procedures. The information couples get concerning success rates is often confusing and, unfortunately, sometimes misleading. It is also somewhat difficult to compare success rates between the various procedures. There are many reasons for this confusion and difficulty.

Some centers don't offer certain procedures. For example, some centers may not do GIFT and ZIFT procedures, preferring instead to do only IVF. There are even programs that offer GIFT only.

Selection criteria differ from center to center. Female age is a tremendously important factor in determining success rates with these procedures. Centers that do not accept women over 40 will obviously have a higher success rate than do centers that will attempt these procedures with someone over 40.

Some centers may have more success with a certain procedure than with others. If, for example, a center has the best success rates with GIFT, their IVF rate may appear lower because only the more difficult patients have IVF rather than GIFT.

National average success rates do not translate into success rates for a given center or even for a given physician. While national average success rates are higher for GIFT than for IVF, this does not mean that it is clearly a better procedure. A given center or physician may be able to achieve IVF success rates that exceed the national average for GIFT.

National average success rates for the ART procedures are determined from data submitted by all of the ART programs throughout the country to the IVF Registry. The IVF Registry data is very carefully defined, and the results reported to the Registry are subject to audit. This data is reported annually on a clinic-by-clinic basis and is an excellent source of information for any couple considering an ART procedure. At the time of this writing, the most recent year for which this data were available was 1995. The national average percentage of successful pregnancies per number of egg retrievals performed were:

IVF - 22.3 percent

GIFT - 26.8 percent

ZIFT - 27.7 percent

Cryotransfer - 13.3 percent

Any physician offering ART procedures should be able to provide a couple with detailed information concerning the success rates of her center. The numbers above are simply national averages. Success rates from center to center vary greatly, with some centers now reporting IVF success rates of 40 percent or higher, while others may have little if any success. The physician should also be willing to give the couple some indication as to how their individual circumstances will affect their chances of success. Age is one very important factor in this regard, but there are certainly others to be considered as well.

A couple should also check the experience and qualifications of the individual physician and the center offering the procedures:

• Is the center a member of the Society for Assisted Reproductive Technology, and do they furnish data to the IVF Registry?
• Is the center staffed by board certified reproductive endocrinologists?
• How long has the center been doing ART procedures?
• How many procedures has the center done?
• Does the center meet the minimal criteria for an ART program as established by the American Society for Reproductive Medicine?
• Does the center offer a full range of services including cryopreservation, assisted hatching, and ICSI?