| The criterion to offer ART alternatives to patients is not uniform among
clinics. Some patients may be moved soon to advanced reproductive technologies at the
outset of their treatment bypassing "lower technology" treatments like IUI if
applicable. For example they may be offered IVF instead of IUI, or they may be offered
ICSI when again IUI or IVF would have been the first choice! Other groups offer "special
deals" to qualified (selected) patients. These policies ensure that the patients with
higher probability of pregnancy will end up pregnant utilizing techniques that perhaps
they did not need.
The criterion for cycle
cancellation is not uniform among IVF centers. Some institutions are going to cancel a
cycle at the first sign of trouble so the success rates will not be affected. Others will
put the interest of the couple first to give them the chance of having a child of their
own provided that there is a reasonable chance of success.
The number
of embryos transferred. This is a variable not controlled when providing success rates.
The number of embryos transferred affects not only the success rates but also the
probability of a multiple pregnancy. Published information shows that the number of
embryos transferred increases the probability of pregnancy, and reaches a plateau beyond
the transfer of 3-4 embryos. We consider it to be highly unethical to enhance the
probability of pregnancy at the expense of increasing the chances of a high order multiple
pregnancy. Potential injury to the fetus associated with brain damage and immaturity of
other organs are some of the consequences of a multiple pregnancy. There is also the
economic stress and the added pressure of taking care of several infants of the same age.
Fresh vs. Frozen embryos. Since
frozen embryos tend to have a lower pregnancy rate than fresh embryos, there is pressure
to transfer as many fresh embryos as possible so the "statistics" are not
affected.
Selective information. Some
patients may be offered selective information to encourage them to enroll as patients
(positive selection), others are given a less bright environment to encourage them to go
somewhere else (negative selection). However, under the present medical ethical standards
ALL patients, regardless of their probability of pregnancy, should be given the medical
treatment they deserve. It should be the patients' choice to select a clinic and not vice
versa.
As it stands right now, delivery
rates provided to you by ANY clinic reflect circumstances that occurred at least NINE
months ago. The 1995 statistics were just published in March of 1998! If a
particular clinic had an event 12-18 months ago that affected their pregnancy and delivery
rates positively or negatively, such a circumstance may no longer be present. Therefore,
you are making a decision based on events that may not reflect the current status.
Current statistics, as reported to CDC, are a snap picture
of events that occurred in a twelve month period. They do not reflect the life-time
performance of the clinic you are scrutinizing. Would you rather make investment decisions
based on a 12 month performance or on the historic performance of a particular portfolio?
We firmly believe that the cumulative
performance of the clinic offers a more stable picture than just a 12 month period.
The statistics offered by a
particular clinic are a combination of different factors: staff experience, patient
demographics, clinic policies, etc... that may not apply to your particular case. It is
not always the case that the clinic with the best statistics provides the best overall health care. It does not mean that the
statistics given are your real chances of success. They represent just a fraction of ALL
the patients treated in a given year in the whole US. Therefore, if you are using
statistics use them to evaluate YOUR probability of pregnancy and do not utilize the
statistics as a main criterion to choose a clinic. Yearly national statistics about ART
are more reliable than those from an individual clinic. National statistics that involve
lifetime records are even better and more solid. Remember, the greater the population
where data is gathered from, the more reliable that information is.
 Most couples fix their attention
on their desire to have a baby. However, in addition to help you expand your family, it is
the responsibility of your physician to help you pay attention to the REASONS for your
infertility. In some cases, the causes may be too irrelevant to make an impact on your
life or in your offspring. An example of this may be a previous tubal ligation or a failed
vasovasostomy (re-attachment of the vas-deferens after a vasectomy). However, you may be
in a category where the underlying cause of your infertility may have a negative impact on
your offspring. It is your physician's responsibility to bring those facts to your
attention so you can make an informed decision.
Should I be put on a waiting list? No!
Waiting lists are utilized in a way to place patients with low probability of pregnancy at
the end while moving rapidly patients with higher probability of conception to the top of
the list. Of course, two years later you simply give up and go to another physician. If
you are a typical infertile woman, in your mid 30s, you cannot afford to spend 2 years on
a waiting list. Even one year may be too much for you. One of the main determinants for
you to achieve a pregnancy is your age. The younger you are, the higher the probability
you may have to have your own child(ren). As you approach the late 30s your chances of
pregnancy with your genetic child drop dramatically, forcing you to consider donor eggs
for pregnancy. |