Short communication: Validity of the in vitro fertilisation league tables: influence of patients’ characteristics

Abstract

We tested the hypothesis that restricting comparison of the live birth rate following in vitro fertilisation (IVF) treatment in those couples having their first IVF cycle in whom the female is under 35 years of age and has a normal follicle-stimulating hormone level would improve the validity of comparing IVF clinics' success rates. We analysed all cycles performed over a 2-year period in patients who fulfilled these criteria and divided the study population according to the referring primary care trusts: group A (n = 90) were referred from Lambeth, Southwark and Lewisham and group B (n = 134) were referred from Brent and Harrow. There was no significant difference between the two groups with regard to their IVF cycle characteristics. The two groups differed in their ethnicity, cause of infertility, prevalence of uterine fibroids and smoking and alcohol consumption habits. Group A had a significantly lower live birth rate (OR = 0.45, 95% CI 0.21-0.95, P = 0.02) compared with group B. This study confirms the impact of the non-IVF-related patient characteristics on treatment outcome and the poor validity of comparing IVF clinics' success rates based on the sparse data published by national IVF registries.

Direct-to-consumer advertising of success rates for medically assisted reproduction: a review of national clinic websites

“…Clinics compete for patients, who are encouraged to consider performance when choosing a clinic. 32 There is therefore an incentive to potentially modify the treatment delivered in order to optimise a particular performance indicator. This sort of gaming can lead to perverse behaviour which might not guarantee the best outcomes from a patient perspective.…”

Endometrial thickness, Caucasian ethnicity, and age predict clinical pregnancy following fresh blastocyst embryo transfer: a retrospective cohort

“…In our multivariate models, Caucasians were almost three times as likely to achieve CP despite producing fewer blastocysts available for transfer and cryopreservation after adjusting for age, FSH, and number of blastocysts transferred. Other literature supports associations between ethnicity and successful ART outcome, although the exact nature of this association remains elusive [ 21 , 22 ]. Previous disparities in outcome by ethnicity despite similar patient and embryological status have suggested genetic differences as a potential etiology [ 22 ].…”

Organizational adaptation to interdependence shifts: The role of integrator structures

“…Clinic capacity, measured as the number of patients treated in the year of observation, was used as a control for clinic size . As suggested by the medical literature on fertility, which identifies patient age as the most important dimension for characterizing the patient mix of each clinic (Sharif and Afnan, : 484; Johnson et al ., ), we include a measure accounting for the percent of patients who are 36 years of age or older ( complex cases ). Finally, to control for the nature of the IVF technology used at the clinic ( technology ), we include the percent of treatment cycles performed in the current year that involved the more invasive procedure of intra‐cytoplasmic sperm injection (ICSI); ICSI is an innovation introduced in the IVF industry during our period of observation, with clinics adopting it at different points in time.…”