Consumer-friendly reporting of in vitro fertilization outcomes

29 10 2013

To the Editor:

Dr. David Meldrum proposes a revision of the clinic-specific Society for Assisted Reproductive Technology (SART)/Centers for Disease Control and Prevention (CDC) reporting format to better reflect the current practice of in vitro fertilization (IVF) by combining the outcomes of fresh and frozen embryo transfers in the numerator while making transfer procedure the denominator of choice (1). I concur with the first but disagree with the second part of his proposal, making transfer the preferred denominator without regard to the number of retrievals contributing embryos to the transfer. In addition to accuracy, a reporting system needs to be readily accessible to potential consumers.

With accumulation of eggs from multiple retrievals for a single transfer, this metric fails to differentiate between two distinct scenarios: A) one live birth from one transfer and one retrieval; B) one birth from one transfer following, say, four retrievals (2). Both scenarios generate 100% delivery rate per transfer, but the delivery rate per retrieval is 100% for scenario A but only 25% for scenario B. Such a reporting system would be misleading and leave patients vulnerable to exploitation by volume-driven clinics.

In the case of high responders, a single retrieval may lead to more than one live birth from sequential frozen embryo transfers (FETs), thus elevating the delivery rate per retrieval above 100% unless all births after the first one are censored—a crucial point the author does not address. Read the rest of this entry »

Letter to the editor regarding “The status of public reporting of clinical outcomes in assisted reproductive technology”

23 07 2013

To the Editor:

We commend Kushnir et al. for their detailed analysis of the publicly available Society for Assisted Reproductive Technology (SART) report in the article “The status of public reporting of clinical outcomes in assisted reproductive technology” (1). SART continues to believe that any use of the ART report to make direct comparisons of outcomes between clinics is not valid and is inappropriate. The goal of the report is to facilitate reasonable estimation of the success rate at a given clinic. Unfortunately, recent evolution of clinical practice has made the reasonable estimation of success per cycle start much more difficult.

The exclusion of “banking” cycles from the denominator of the report is an unintended consequence of our common sense handling of true “fertility preservation” cycles. The outcomes report would be misleading if it included cycles with no intention for embryo transfer in the near future (for example, cycles conducted to obtain eggs or embryos prior to chemotherapy). SART has identified the need to distinguish fertility preservation from “short-term” banking. The indications for short-term banking (such as PGD, endometrial receptivity) are outlined in the manuscript; however, other indications for short-term banking exist (for example, risk for OHSS, polyps, etc.). We fully agree that the outcomes of these cycles should be accounted for in the Clinic Summary Report. The SART Registry Committee and SART Executive Council have discussed this at length, and we have sought input from our members. We do not believe that simply indicating the number of embryo banking cycles is adequate. SART has met with the Centers for Disease Control and Prevention (CDC), with whom we have a long-standing collaboration, to discuss what our options are for including banked cycles in outcome reports. Read the rest of this entry »