Abstract
BackgroundTo assess whether an objective performance criterion for in vitro fertilization (IVF) centers can be established.MethodsA retrospective analysis of 2011 National ART Surveillance System data for 451 U.S. IVF centers, 137 of which were included in the analysis since they performed >20 fresh embryo transfers per age group and >20 fresh oocyte donor transfers. The analysis of autologous cycles was restricted to women under age 40. The main outcome measure was correlation between center-specific live birth rates (LBR) in autologous and donor oocyte cycles.Results55.6% donor and 46.7%, 39.1% and 28.7% (for ages <35, 35–37 and 38–40 years) autologous cycles resulted in live births per fresh embryo transfer. Donor LBR predicted autologous LBR (< 35 years, P < 0.001; 35 – 38 years, P < 0.001; 38 – 40 years, P = 0.015). Clinics with high prevalence of patients with diminished ovarian reserve had lower autologous LBR per age group (P = 0.015). Every 10% increase in donor LBR increased odds of autologous LBR above the age-adjusted national average by 68% (OR 1.68; 95% CI 1.36 – 2.07; P < 0.001).ConclusionsSince center-specific donor and autologous IVF cycle outcomes correlate, and as donor cycles reflect fewer patient covariates, they represent a first comparable performance measure between centers, allowing for internal as well as external quality control.
Highlights
To assess whether an objective performance criterion for in vitro fertilization (IVF) centers can be established
We reviewed center-specific outcome data from U.S National Assisted Reproductive Technology Surveillance System (NASS) reported by 451 centers for IVF cycles initiated in 2011, which progressed to fresh embryo transfers [1]
Clinics performing more than 20 fresh transfers from autologous oocytes per age group in women up to age 40 and more than 20 fresh oocyte donation cycles were included in order to focus on statistically meaningful live birth rates (LBR) data
Summary
To assess whether an objective performance criterion for in vitro fertilization (IVF) centers can be established. Center-specific national reports of IVF cycle outcomes, published by the Centers for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technology (SART), allow patients limited insights into center performances. Both reports, emphasize in introductory materials that center-specific outcomes should not be used to directly compare centers since severity of infertility in treated patient populations can greatly vary [1,2]. In contrast to autologous IVF cycles, donor oocyte cycles, reflect fewer covariates, as age and ovarian reserve of oocyte donors can be assumed to be quite uniform between centers, while still maintaining the important variability of clinical cycle management and IVF laboratory performance, both very basic quality parameters for IVF centers
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