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Fertility Road Magazine 46 - September/October 2018

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  • Fertility
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  • Embryo
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The latest issue of Fertility Road Magzine brings you our latest Fertility Journeys update, a closer look at stress and infertility, natural approaches to endometriosis and a how your weight can affect your chances of getting pregnant plus lots, lots more.

FERTILITY 360

FERTILITY 360 compensation and potentially travel reimbursement, as well as possibly egg donor agency fees and screening costs that may need to be paid again. Depending on when this step would need to be repeated, and possible scheduling considerations, (e.g. egg donor availability) it could lengthen your timeline from a few to several months. Unfortunately, for intended parents, the public databases for clinic success rates (such as SART and the CDC in the USA) do not report the statistics, namely the average number of viable embryos that each cycle type has achieved at a clinic, which could help inform intended parents’ decisions. Though each cycle is unique and some factors cannot be controlled, IVF clinics should have this type of success data, particularly in the case of egg donor cycles. You should be sure to ask about this, as well as the factors that contribute to successful egg retrieval and embryology cycles, including stimulation and egg retrieval medical protocols, the quality of the embryology laboratory, and the role of ovarian reserve. This will help you in making decisions that may help you increase the chance of first time success. Embryo Transfer Beneficially for intended parents, the public databases for clinic success rates generally focus on the statistics that help them understand the chance of success with an individual embryo transfer. Live Birth Rate Per Transfer, is the relevant success rate to focus on as it represents your ultimate goal. Where more than one embryo has been transferred, a Live Birth Rate Per Transfer will refer to the birth of at least one child. Sometimes, clinics may instead quote Pregnancy Rate Per Transfer. This represents the percentage of embryo transfers that had an ongoing pregnancy when the rate was calculated. This is not the same as Live Birth Rate Per Transfer as some pregnancies that were ongoing when the success rate was calculated will not progress. As a result, this measure will be a few to several points higher than the one that matters most for you. Occasionally some clinics may report their success rates on a cumulative rather than a per transfer basis. Cumulative success rates calculated over multiple embryo transfers will be higher in comparison to per transfer success rates. Cumulative rates can be helpful if understood correctly, but intended parents may be confused in thinking that a Live Birth Rate presented on a cumulative basis is comparable to one presented on a per transfer basis. For example, a 67% Live Birth Rate Per Transfer will represent a much greater chance of success on the first transfer attempt (and therefore a lower cost and shorter timeframe) than a 67% Cumulative Live Birth Rate calculated over say three transfers. Generally speaking it takes more than one embryo transfer to achieve a live birth. So from a practical point of view you may want to translate the Live Birth Rate Per Transfer into an estimation of the number of embryo transfer attempts you may actually need in order to achieve a live birth. It is this number of expected embryo transfer attempts that will influence the number of viable embryos you should hope to obtain from your egg retrieval and embryology cycle. It will also impact how you plan your budget and timetable. If an embryo transfer needs to be repeated then this will add to your timeline and costs. Extra costs may include the transfer procedure itself and related medications, pre and post transfer monitoring, as well as other costs such as travel. You can estimate the potential number of embryo transfers you may need to achieve a live birth. Using the Live Birth Rate Per Transfer, you can calculate the cumulative probability that you will have a live birth within a certain number of transfers. In the example below, using a Live Birth Rate Per Transfer of 50%, intended parents would have a 88% chance of having a live birth within 3 transfers. They may get lucky and have a live birth on the first or second transfer, and there still remains a small chance that they will not have been successful by the third transfer. This type of calculation can help intended parents plan for the possible implications to their budget and timeline of their IVF clinic’s success rate. 46 | fertilityroad.com | fertilityroadmag | follow us @fertilityroad

FERTILITY 360 Indicative Added Costs of Having to Repeat an Embryo Transfer Live Birth Within n Embryo Transfers Cumulative Probability of Live Birth 1 Indicative Added Months 2 Indicative Added Cost 3 1 50% - 2 75% +2-4 ,000 – 5,000 3 88% +4-8 ,000 – 10,000 4 94% +6-12 ,000 – 15,000 1. Based on the SART-reported US National Live Birth Rate Per Transfer in 2016 for all donor egg + surrogacy frozen embryo transfers. 2. 2-4 months in an indicative period of time to prepare for and undergo a repeat embryo transfer. 3. ,000 – 5,000 is an indicative additional cost of elements associated with a repeat embryo transfer. If an additional egg retrieval and embryology cycle were needed these costs would be extra. Success the First Time In my family’s own journey, we found that this type of understating of success rates helpful. It focussed us on the factors that would help keep our journey on track, namely obtaining the highest number of viable embryos and minimising the number of required transfers. It also allowed us to plan our budget and timeline, accounting for the probability that we might have to repeat either step in the IVF process. Thankfully, we had the first-time success that we were hoping for and I believe that the decisions we made, armed with this understanding, played a big part in this. US IVF Success Rate Resources For those intended parents looking at IVF treatment in the USA, there are two online, public databases that contain national and individual US IVF clinic success rates - The US Society for Assisted Reproductive Technology (SART) at SART.org and the US Centers for Disease Control (CDC) at cdc.gov/art. SART has been recording US IVF clinic success rates since 1988. Additionally, since 1992 all US IVF clinics have been mandated by the US government to report their success rate data to the CDC. SART membership is voluntary for US IVF clinics. About 80% of US IVF clinics are SART members and about 95% of US IVF cycles are captured in the SART success rate database. Both SART and the CDC have now released the 2016 live birth success rates for US IVF procedures and this represents the most current US live birth success rates. The 2016 data is available alongside the 2015 data for year-on-year comparisons. The 2017 live birth rate data will be known and reported in the Spring of 2019. The SART database allows for easy filtering by clinic for specific procedure types – surrogacy, egg donation, PGS/PGD testing, and more – as well as for the specific number of embryos transferred. Craig is a regular contributor to Fertility Road on third party reproduction. Look for his upcoming articles on egg donation and surrogacy in future issues of Fertility Road or contact him at oregonreproductivemedicine.com. This functionality is a real benefit for intended parents considering US IVF clinics as they can now search for live birth success rates for the exact procedure they are seeking to undergo by clinic, as well as US national averages for comparison. It also allows them to view consistently prepared and presented data and live birth success rates for every clinic they may be considering. It allows them to reference a clinic’s 2016 data to its 2015 results as well to national statistics for both periods. | fertilityroadmag | follow us @fertilityroad fertilityroad.com | 47

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Fertility Road Magazine 46 - September/October 2018

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