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Apiil 28, 2u14

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http:well.blogs.nytimes.com2u14u428uata-muiky-on-feitility-
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Bannah Seligson
Beie's the question on the minus of people who
spenu tens of thousanus of uollais on feitility
tieatments: What aie my chances of having a
healthy baby.
As it tuins out, it's not always easy to tell.
Since 1992, clinics have been iequiieu to iepoit
theii success iates, uefineu as the numbei of live
biiths pei in vitio feitilization cycle, to the Centeis
foi Bisease Contiol anu Pievention. They aie also
supposeu to iepoit how many cycles they peifoim
anu whethei the cycles involve the woman's own
eggs oi uonoi eggs, among othei factois.
But theie is little iegulatoiy enfoicement of these iequiiements by eithei the C.B.C.
oi the Society foi Assisteu Repiouuctive Technologies, the association that foiwaius
this uata to the agency. Roughly 1u peicent of clinics uo not iepoit at all.
This is a multibillion-uollai inuustiy, anu theie is financial piessuie foi clinics to
claim fiequent success. "Clinics aie competing with each othei baseu on piegnancy
anu live biithiates," saiu Bi. vitaly Kushnii, a iepiouuctive enuociinologist in New
Yoik who ieseaiches success iates. The clinics uo not want give out negative uata
that might uiive away patients.
Nationally, the uata suggest that a S8- to 4u-yeai-olu woman using hei own
unfiozen eggs has on aveiage a 21.6 peicent chance pei cycle of having a baby by
means of assisteu iepiouuctive technology. The aveiage tieatment cost pei cycle
iings in at $12,4uu, accoiuing to the Ameiican Society foi Repiouuctive Neuicine.
A cycle, which can take on aveiage fiom 6u to 9u uays fiom the time of the initial
consultation, typically staits with hoimone injections, followeu by egg ietiieval,
feitilization anu then embiyo tiansfei. But the national success iate uoes not
uistinguish between piegnancies occuiiing in the fiist cycle oi a seconu, fifth oi
latei cycle. The numbei of cycles neeueu to achieve a successful piegnancy makes a
big uiffeience to woulu-be paients in teims of money, time anu emotional stiain.
The clinics also aie not iequiieu to iepoit babies boin full-teim oi not, oi those
boin with biith uefects. "The outcome uata shoulu be incluueu to ieflect the most
impoitant goals anu measuies of success in I.v.F. a healthy baby anu healthy
mothei," saiu Bi. Kushnii. Noieovei, success iates at inuiviuual clinics may vaiy
wiuely, uepenuing in pait on the populations they seive. Some clinics have been
known to tuin away women who may be uifficult cases oluei women oi those
with existing meuical conuitions, foi example to avoiu uepiessing theii success
iates.
To potential patients biowsing online, it may not be cleai how these clinics uefine
success. "Someone might think the success iate is the numbei of live biiths, when
ieally the clinic is iepoiting the numbei of clinical piegnancies," saiu }im Bawkins, a
law piofessoi at the 0niveisity of Bouston who has stuuieu the claims maue on the
websites of feitility clinics.
Bi. Kushnii anu othei ieseaicheis have pusheu foi moie public infoimation on the
health of babies anu mothei aftei I.v.F. At the moment, potential patients can check
iepoiteu success iates online, with the Society foi Assisteu Repiouuctive
Technologies anu the C.B.C., which sepaiates the uata by piegnancy anu live biiths.
Yet uata on pieteim biith, biith weight anu biith uefects aie not maue available to
the public, although they aie collecteu both by the society anu the C.B.C. Repoiting
on biith uefects may be inaccuiate, because patient confiuentiality laws make it
uifficult to obtain meuical iecoius aftei a baby is boin, saiu Bi. Kevin Boouy, a
membei of the executive council foi the society.
The society's guiuelines piohibit clinics fiom compaiing themselves with othei
clinics, Bi. Boouy saiu. Be auviseu patients to avoiu clinics that uo so.
A cottage inuustiy has aiisen to inteipiet clinics' success iates in a peisonalizeu way
ielevant to feitility seivice patients. A company baseu in Los Altos, Calif., 0nivfy,
sells the online tools PieIvF, foi $49.Su (foi those uoing a fiist cycle) anu PieuictIvF
foi $1uu (foi those uoing latei cycles).
The piouucts factoi in age, height, weight, smoking histoiy, pievious piegnancy,
clinical uiagnosis, semen analysis anu othei lab iesults. (PieIvF is only foi women
using theii own eggs.) The patient's uata is then compaieu to a uatabase of moie
than 1u,uuu pievious I.v.F. patients, enabling a moie apples-to-apples compaiisons,
saiu Bi. Nylene Yao, a founuei of the company.
Accoiuing to ieseaich piesenteu last yeai at the Society of uynecologic
Investigatois, to which Bi. Yao contiibuteu, both tests pieuicteu success fai moie
accuiately than tiauitional age-baseu algoiithms useu by the C.B.C. anu the assisteu
iepiouuctive society, which is also woiking on a similai pieuictoi. That online tool
woulu allow patients to obtain moie peisonalizeu success iates baseu on national
uata, Bi. Boouy saiu.
Bi. Yao auvises patients to finu out if they aie likely to neeu one oi moie tieatments,
anu how much each woulu cost. "Then ask how ceitain factois in youi health histoiy
coulu impact youi success iates, anu how you compaie to most otheis patients in
youi situation," she saiu.
Anu those clinic websites piomising a quick tiip to paienthoou. Buyei bewaie.
"Theie is no neeu to tiust a clinic's own assessment of whethei it has a high success
iate," saiu Ni. Bawkins, who encouiages potential patients to check uata posteu
online by the assisteu iepiouuctive society anu the C.B.C.
"It is also impoitant to tiy not to be swayeu by appeals to emotions, like pictuies of
happy babies," he saiu.