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League tables

Explains the importance of league tables showing the success rates of IVF centres, and the limitations of their use.

The success rates of different IVF clinics

Some countries have started to publish annually the success rates of their IVF centres. These include the HFEA annual report in the United Kingdom and SART.report in the United States. However, patients are advised to contact clinics directly for further information and for their most recent results.

In our views, such publications have resulted in improving the pregnancy and live-birth rates in many centres over the last few years and have given infertile couples the opportunity to choose between different clinics. Infertile couples are entitled to know about the success rates of the different clinics.

Success rates of IVF clinics are improving. In the United Kingdom, the overall live birth rate in 2005 for all IVF was 21.6%, up from 2004 when the figure was 20.6% and 22% n 2016. The live birth rates varied between different clinics. For example, the live birth rates for women less than 35 years using their own fresh embryos after IVF or ICSI in the year 2005 varied between 61% and 15 % (HFEA 2007 report).Some clinics appear to have lower success results because they treat particularly difficult cases where the chance of pregnancy is low.

The disadvantages of such league tables include:

  • The league tables present out of date data
  • League tables do not take into account many of the factors that may affect the success rates such as cause of infertility, duration of infertility, previous pregnancy and live birth, the number of embryos replaced, the cycle number etc.
  • Lack of auditing of the data (no methods of verification).
  • It is difficult to compare the success rates in different countries. There should be a clear definition of clinical pregnancy, e.g. in the United Kingdom the diagnosis of clinical pregnancy is only made after detection of fetal heartbeats by ultrasound scan.

Reporting live birth rate per embryo transfer is increasingly viewed by many professionals as the best measure of clinical practicele and it should be applied wheever possible. However, it does masks the outcome of those patients who do not reach the embryo transfer for one reason or other. Thereby it is best to report both live birth rate per cycle initiated and per embrfy transfer in order to judge clical prectice and help to compare different clinics.