A recent review of in-vitro fertilisation treatment (IVF) clinics in Australia, conducted by the Australian Competition and Consumer Commission (ACCC), identified some misleading ways they present people’s chances of a having a baby on their websites.
Clinics provide IVF success rates in often confusing ways because there is no agreed format on how this information should be presented.
Our recent audit, presented at a recent conference of the Fertility Society of Australia, reviewed the success rates published on the websites of IVF clinics in Australia and New Zealand. It identified some common traps in the way these figures are presented. Below are five things consumers should be aware of when visiting IVF clinic websites.Quinn Dombrowski/Flickr, CC BY
But first, a bit about IVF.
IVF treatment involves several steps: fertility drugs to develop a number of eggs, retrieving the eggs, adding sperm to the eggs for embryos to develop and finally, an embryo transfer (ET). The ET involves an embryo being placed in the uterus, where it hopefully implants and grows into a baby.
Unfortunately, things can go wrong in each of these steps. The woman might not respond to the fertility drugs, eggs may not be recovered and embryos may not develop or implant. And even if the embryo does implant and what is known as a clinical pregnancy is established, there is still a risk of miscarriage.
1. How do clinics define ‘success’?
One clinic can look much more successful than another because of the way they measure success. It is important to know whether a clinic’s success is defined as a clinical pregnancy or a live birth. And whether the success rate figures are per started treatment cycle or per embryo transfer.
As an example, let’s say 100 women start a treatment cycle. 75 of them have an embryo transfer, 25 have a clinical pregnancy and 20 give birth. The rate of the pregnancy per embryo transfer then is 33%. But the live birth per started treatment cycle is only 20%.
Regardless how success is reported, the outcome is the same: of the 100 women who started a treatment cycle, 20 had a baby.
Our recent audit found most clinics quote pregnancy per embryo transfer rates. This does not account for women who don’t get eggs or embryos, or the 20% of women who get pregnant but miscarry.
2. Is there information about the impact of age?
The most important factor in IVF success is the age of the woman undergoing treatment. For women in their early 30s, the chance of having a baby per started treatment cycle is about 25%, but it drops to only 6% after age 40.
Most clinics mention that a woman’s age affects the chance of success but our audit found one in five clinics didn’t.Woman who has miscarried ]/Shutterstock
3. Does the website say your health matters?
There is clear evidence parental obesity, smoking and other health behaviours affect the chance of conceiving spontaneously, as well as the health of the baby at birth and in the future. But people may not be aware these factors also affect the chance of having a baby with IVF.
We were concerned to find only one in ten websites mentioned the impact of potentially modifiable lifestyle factors on the chance of IVF success. This may be a missed opportunity. People who consider IVF are highly motivated to have a baby and knowing early there are things they can do to improve their chances could be an incentive to improve their health before treatment.
4. Is it obvious you may need several treatment cycles?
While clinics advertise success rate figures in more or less transparent ways, the reality is that most IVF cycles fail. People often need several treatment cycles to have a reasonable chance of having a baby.
For most people, the ultimate chance of having a baby increases for each additional cycle, (up until five cycles).
So it’s helpful to have a series of treatments in mind rather than expecting immediate success when embarking on IVF. That way expectations may be more realistic and people may be more likely to try again if treatment fails.Empty Cradle/Shutterstock
5. Are there lots of baby images?
Many clinics use images of cute babies on the pages where chance of success is described. Linking success rate figures to such images can make people susceptible to overestimating the potential of having a baby from treatment.
People who need IVF to have a family are particularly vulnerable, as they are staring down the barrel of physically, emotionally and financially demanding treatment to have what most of us expect to achieve in the privacy of our bedroom. Ensuring they receive the most accurate and realistic information of what is possible with IVF should be every clinic’s goal.
This article was co-authored by Louise Johnson, CEO of the Victorian Assisted Reproductive Treatment Authority (VARTA). VARTA provides independent information and support to those looking into the use of assisted reproductive technologies, such as IVF. More information about how to interpret clinic success rates can be found here.
Karin Hammarberg is affiliated with the Victorian Assisted Reproductive Treatment Authority.
Authors: Karin Hammarberg, Senior Research Fellow, Jean Hailes Research Unit, School of Public Health & Preventive Medicine, Monash University