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Question 5: Measuring clinics’ success rates

Question:

With such a big variety of diagnoses out there, how is a clinic’s success rate measured? Are the “difficult” and “unexplained” cases measured right along the “easier” ones?

Answer:

Since 2009, the South African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG) have maintained an anonymous register of assisted reproduction techniques (ART) within South African fertility clinics. Data collected includes the number of ART cycles, embryo transfers, clinical pregnancies, age of female partner (or egg donor) and fertilisation technique. The diagnoses may be recorded by the fertility clinic, but are not reported in the national data. Single term delivery per embryo transfer is the desired measure of ART success, but frequently fertility clinics do not follow patients beyond the first ultrasound scan. Clinical pregnancy rate (the presence of a fetus with cardiac impulse on ultrasound scan) per embryo transfer is thus the best surrogate marker of ART success. This is stratified according to age of female partner (or egg donor) by fertilisation technique (IVF or ICSI) into <35, 35-39 and >39 years of age. Age of female partner is the single variable with the strongest prediction of pregnancy rate. Other important factors, including diagnosis, body-mass index (BMI), co-morbidities, duration of infertility are not detailed, but do affect ART success. The number of embryos transferred is also documented. The transfer of 2 or more embryos aims to increase the chance of conception, while accepting an increased risk of multiple pregnancies. Ideally the report should record the number of fetuses detected, as twin or higher order multiple pregnancies are high risk pregnancies with associated risks for both mother & foetuses – and are consider a complication of ART. Currently the multiple pregnancy rate is not reported.

Individual clinics can report their own data and provide this to their patients.

 

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