Choosing a fertility clinic: understanding outcomes quality
When considering where to go for fertility care, there’s no one-size-fits-all. You might want a clinic close to your house; you might not have a fertility benefit and choose to look for more affordable options; whether it’s availability, overall feeling, cost, or any of a dozen other things, the right clinic for you is a personal decision to make.
Some of these factors can be easy to understand. Google Maps can tell you how far a clinic is, and the clinic can tell you how far out they’re booked. But one of the most important factors is also one of the more complicated ones: what if you want to go to “the best” clinic? Fertility treatment is not guaranteed to work every time, but you might want the best shot at a treatment that gets you a baby. Unfortunately every clinic will say they’re the “top clinic,” and understanding what that means can be extremely challenging. Fortunately, there are tools that can help you really understand the medical quality of a clinic.
What’s SART?
SART stands for the Society for Assisted Reproductive Technology. They are the main organization of fertility professionals in America, and they agree that patients should be able to get all the information they need to choose a clinic. That’s why most fertility clinics in America have a profile where they report outcomes. The SART Clinic Report is a standard report showing the total outcomes of a clinic for a given year, including how many cycles they completed, what percent led to a live birth, how often they resulted in twins, and more. These reports are searchable online and are totally free, giving you the power to understand your options fully.
Understanding the report
Let’s look at a report to better understand this. The table below shows total data from all reporting clinics, but any individual clinic report will follow the same structure.
This table tells you for a given age group, how many retrievals a patient did, and what the outcome of each cycle was. The main metric is “singleton births” which means the percent of egg retrievals that ended in the birth of a single baby, but not twins. It’s important to note that this is per retrieval, not per patient. That means if a healthy patient decides they want to do two retrievals, followed by one transfer that results in a live birth that would be considered a 50% success rate, even though it was a perfect outcome. In this table, we can see nationally 54,005 retrievals were reported for women aged 35-37. Their singleton birth rate is 40.7%. If a single clinic has the same success rates, but only did 54 retrievals, we would know that 54*40.7%, or 22 babies, were born. However, this could have been for 22 separate patients, or 14 patients, many of whom chose to do two cycles.
Below the singleton line you’ll see a live births line. That includes kids that are twins, triplets, or more in addition to singleton births. This is important because some circumstances will lead to a clinical recommendation of transferring >1 embryo at a time to improve likelihood of success. You can see the breakdown in the next lines: 41.7% live birth rate means 23 cycles in our single clinic ended in a birth, so one couple had twins or more. We see 0% triplets, and 2.3% twins, so that couple we can see had twins.
So far, we have a pretty good sense of how well this clinic does with retrievals, but that’s only half the story. If a patient retrieves 10 eggs and eventually has a baby, did she need one transfer, or three? SART provides some more information on this in the next two tables below.
As you can see, this table is structurally identical to the one above with some different numbers. It tells us, of all those retrievals, how many led to a baby with exactly one transfer. Nationally, 34% of the 54,005 cycles did. In our mini example, that would be 18 births! You’ll also see the one transfer that led to twins here.
Subsequent tables will tell you success rates from a second transfer or a cumulative number of three or more transfers. The total births in each of these tables will all add up to the first table.
Ok, so what’s a good number?
It depends. You might notice that success rates tend to decline as the patient’s age increases. Achieving a live birth rate of 40% for women aged 41-42 is much harder than doing so for patients under 35. You can compare a single clinic to these national results to get a sense of their performance.
Things to consider
SART data is a powerful tool to help you choose a clinic, but it’s not perfect, and there are a few things you should be aware of that can impact this data.
The first one is how sample size plays in. Some clinics may do over 1,000 cycles a year; others might do less than 200. When you look at age groups, the data may not mean much at all. A clinic may have done two cycles for women older than 42, and delivered one baby. That would be a 50% singleton birth rate, or nearly twenty times higher than the national average! But, with only two cases, it’s virtually impossible to rely on that data – if that one transfer went differently, their success rate would be 0%. That’s why they report total counts, and it’s always important to check that. A good rule of thumb is to remember that for any group with less than 100 retrievals, that “true” success rate is whatever you see plus or minus 10%.
The other thing to remember is that not all cases are equal, and that might inform which clinic you go to. Some clinics are more likely to see complicated cases or patients who have tried and not had a baby in the past; those clinics are more likely to see lower success rates as a result. It doesn’t mean that they’re worse – in fact, it might be that they are better than an average clinic, which is why patients with more difficulties choose to go there. There are a few other details that get lost, like if a clinic sees a patient for research or if a patient wants to freeze their embryos for multiple years as well.
Lastly, note that while most clinics will report their outcomes to SART, not all do. Some of that is due to timing – data is two years delayed, so new clinics may not have data to report – but some of it is clinics who just choose not to. If you are considering a clinic and don’t see their SART data, it isn’t necessarily a bad thing, but it should be viewed with caution and you should ask that clinic why they don’t report.
The bottom line
The data in these reports should not be considered perfect or infallible; success rates are just one factor of the many that might make a clinic the perfect fit for you. Clinics offer different services, prices, customer experiences, commutes, and more that all help make one a good fit for you over another. Still, they’re a powerful and useful tool in helping to make your decision and we believe patients should have it at their fingertips. That’s why we’re also excited to make our clinic finder available for you to easily see clinics near you, their success rates for a given age group, and how that compares to other clinics. When evaluating data, either through SART’s website or this tool, always keep in mind:
- Volumes matter! A success rate is much more reliable if it comes from 200 cases than 20.
- Treat the results as a guide. A clinic with a 50% rate isn’t necessarily better than one with a 46% rate, as there are multiple things that might impact how results get reported.
- Most clinics report their outcomes to SART. If your preferred clinic doesn’t, that’s not a reason not to see them, but it’s always worth a conversation with them to understand why they don’t report.
Most importantly, a clinic should meet your needs, no matter what they are, and outcomes are only part of the equation. What is right for someone may not be right for everyone, and your choice on which clinic to visit is a truly personal one with no wrong options.
