麻豆传媒

IVF is more popular than ever. As the average age of first-time , so has the .

To help those who are choosing where to have a procedure, organisations in the UK and US collect data from all fertility clinics in those countries, providing success rates for each. Prospective patients say these stats are the . They also influence whether those clinics receive hospital contracts or business from health insurance companies in the US.

But those success rates aren鈥檛 all they seem. Evidence suggests that at least some clinics are finding ways to boost their scores 鈥� even if it means 鈥渉iding鈥� some IVF cycles, changing the way they treat patients, or turning away people with a low chance of success.

In other words, clinics are giving us a false impression of how successful their procedures are 鈥� potentially leading to huge financial losses and years of physical suffering and heartbreak for many individuals. So who can you trust?

The US Centers for Disease Control and Prevention (CDC) compiles on fertility clinics. The collects and from the 80 per cent of US fertility clinics that are SART members.

Over in the UK, the Human Fertilisation and Embryology Authority (HFEA), which oversees and regulates fertility treatments, .

鈥淔ertility clinics are giving us a false impression of how successful IVF and similar technologies are鈥�

All three organisations have been taken to task over the way they report 鈥渟uccesses鈥�. Until very recently, both the CDC and SART didn鈥檛 factor in IVF cycles in which eggs and embryos were frozen, rather than implanted right away.

This might have made sense around a decade ago, when freezing was primarily used for young women about to undergo damaging cancer treatments, in order to preserve their fertility. Now, freezing is being used far more, both to preserve fertility for medical and social reasons, but also as an attempt to boost success rates in people who want to conceive immediately.

In a typical IVF treatment, a woman is first given hormone drugs that cause her to release multiple eggs, which are collected and fertilised. Usually, the healthiest embryo is implanted while the others are kept on ice. But some researchers suggest that freezing all the embryos and waiting a month before thawing and implanting one allows the uterus to recover from the drug treatment. It can also help certain at-risk women avoid ovarian hyperstimulation syndrome, which can be caused by IVF drugs.

It isn鈥檛 clear if this 鈥渇reeze all鈥� approach does actually help women conceive, but that hasn鈥檛 stopped it soaring in popularity. 鈥淎 decade ago there were almost none,鈥� says of the Center for Human Reproduction in New York. 鈥淣ow around one in four cycles are freeze-all.鈥�

Could this increase have anything to do with the fact that these cycles are hidden from success reports? Kushnir thinks so. He and his colleagues have evidence that clinics seem to be offering the freeze-all approach to patients who are less likely to have a successful pregnancy.

In these cases, women might have all of their embryos frozen, and then have each assessed before they are reimplanted. If none are found to be suitable, the woman鈥檚 IVF will have failed. If freeze-all cycles don鈥檛 count, the failure goes unrecorded.

Kushnir鈥檚 team has also that clinics offering more freeze-all cycles 鈥� which thus have more of their IVF treatments hidden from success reports 鈥� have higher scores and more customers. 鈥淚n practice, many freeze-all cycles are done in older, poor prognosis patients,鈥� he says. 鈥淭he more frozen cycles they do, the better they look.鈥�

Stats on ice

鈥淪ome are only reporting 40 per cent of their cycles, and reporting a success rate 15 per cent higher than everyone else,鈥� says , a reproductive endocrinologist at Genesis Fertility in New York, who has also . Add the hidden cycles back and these clinics鈥� success rates fall into line, he says.

These figures give people the wrong impression about how successful IVF treatments are (see Diagram). 鈥淵ou might be being misled into thinking that your chances are 40 to 50 per cent, when it鈥檚 more like 5 per cent,鈥� says Kushnir.

Kushnir published some of his first results in 2013, and shared them with SART and the CDC. SART took note and from 2014 if a clinic intended to implant an embryo within a year of fertilising an egg 鈥� whether frozen or not 鈥� that cycle had to be included in the calculation.

The CDC has not changed its reporting practices and declined 麻豆传媒鈥檚 requests for an interview to explain why.

It seems that the clinics have caught on to SART鈥檚 changes, at least. It published its final version of the 2014 data earlier this year, and a preliminary analysis reveals that for the first time, the number of freeze-all cycles offered to women intending to get pregnant straight away had dropped dramatically.

鈥淭he 鈥榟idden cycles鈥� went from 22,000 to 5000,鈥� , president of SART, told the in Texas in October.

The implication is that fertility clinics change how they treat patients to improve their stats. 鈥淵ou can鈥檛 monitor something in a certain way without changing practice,鈥� says Doody. 鈥淵ou鈥檇 like to think that all these freeze-all cycles are done with the patient鈥檚 best interest in mind, but鈥︹��

The UK鈥檚 HFEA has been plagued by similar problems. Its previous way of calculating success rates inadvertently encouraged clinics to implant more than one embryo at a time. This practice is thought to increase the chance of success, but also raises the odds of twins, which can put the health of the mother and babies at risk.

This year, the HFEA changed the way it measures success 鈥� instead of referring to live births per cycle of treatment, it now refers to live births per embryo transferred, penalising clinics that transfer two embryos instead of one.

Some clinics saw success rates drop. One in London brought a legal challenge against the HFEA, arguing that the new system was 鈥渋llogical鈥� and 鈥渦nreasonable鈥�. The claim .

But there鈥檚 a problem with the new measure, says at the University of Manchester, UK 鈥� it ignores women who don鈥檛 get as far as embryo transfer, perhaps because of a problem with their eggs or embryos.

鈥淐linics may simply refuse to treat women with a lower chance of conceiving鈥�

Wilkinson says this could give clinics an incentive to offer aggressive drug stimulation treatments, which may up the risk of ovarian hyperstimulation syndrome. This would improve success rates under HFEA criteria, because if it fails, no embryo transfer takes place.

The other concern is that, in order to protect their success rates, clinics in both countries will simply refuse to treat women with a lower chance of conceiving. 鈥淚t鈥檚 not the way you鈥檇 want your doctor to practice, but it鈥檚 human nature,鈥� says Kulak.

Any changes in the definition of success will provide an incentive to alter practice one way or another, says Doody. 鈥淚t will be a mix of deliberate manipulation of figures, subconscious bias and statistical incompetence,鈥� says Wilkinson.

How can we stop this from happening? Ending reporting of success rates probably isn鈥檛 the answer. They tell clinicians and patients what they can expect from fertility treatments, and provide an incentive to clinics to maintain standards.

A better approach might be to ban clinics from using success figures in their advertising. In the US, SART members aren鈥檛 allowed to compare their figures with other clinics, but they can pit their scores against the national average. And in the UK, clinics bend over backwards to come out ahead. In a , Wilkinson and his colleagues found that 53 clinics had used 51 different outcome measures between them, many accompanied by claims such as 鈥渁mong the highest success rates in Britain鈥�.

鈥淚t shouldn鈥檛 be allowed,鈥� says Wilkinson. 鈥淚n the UK, we don鈥檛 allow direct-to-consumer advertising for drugs because it incentivises bad behaviour and profit over what鈥檚 best for patients.鈥�

In the meantime, anyone using these reports to choose a fertility clinic should be wary of what they are reading. In reality, there is little difference between most fertility clinics, and factors like age and health are much more likely to influence the success of IVF. 鈥淲e need to make people aware that the figures are misleading, so they can equip themselves with scepticism,鈥� says Wilkinson.

This article appeared in print under the headline 鈥淧laying with the odds鈥�