Melanie Cole (Host): Will IVF work for you? What are your chances of getting pregnant during an IVF cycle, and how do you even know if your IVF treatment will be a success? Today we’re talking about how fertility success rates are determined. My guest is Dr. William Ziegler. He’s a specialist in reproductive endocrinology and infertility and he’s the medical director of the reproductive science center of New Jersey. Dr. Ziegler, what actually are IVF success rates?

Dr. William Ziegler (Guest): There are many variables that go into determining whether IVF is going to be successful for a patient, or even how to interpret the IVF success rate in which patients can access online. No one can tell a patient whether or not IVF is going to be the answer for them, but they need to understand the different factors in which play a role in determining their success rate. It’s not just based on their age and on the internet when the patients look up success rates, it’s always broken down and then by age or by diagnoses, but there’s other things in there that play a role in a patient’s success in any fertility treatment.

Host: Then let’s talk about some of those. What are some of the more important factors that can affect the probable outcome of IVF treatment?

Dr. Ziegler: Well there are – and then as I look at it, I look at the top 6 factors that play a role in the success of an IVF cycle. One of them is age. We know that as a woman gets older that the age – that the age and just the eggs become older and that the success rates do decrease, and I’m not just talking about chronological age, I’m also talking about biological age. So even though a patient is, let’s say 35 years old, their ovaries may not be acting 35, they may be acting 45. So that’s what we really need to really assess is what is their biological age, as well as keeping and keeping their chronological age in adjusted mind. The others are fertility issues. Why are they being seen? And based on those issues, sometimes that IVF is successful, and sometimes it’s least successful. Like in those patients that have an ovulatory issue such as polycystic ovarian syndrome, or if they have endometriosis or had endometriosis, if they have tubal issues or even male factor, that IVF is pretty successful in those patients. The ones where IVF is least likely to be successful are those that have uterine abnormalities such as a unicornuate uterus, fibroid uterus in which where the fibroids are just enlarged, then if they’re more than 5 cm, they should really be removed, or if they’re deviating the uterine cavity. Also if patients have severe ovarian dysfunction, as I was mentioning before about biological age. We can’t turn back the hands of time, so we get blood work on them, and we look at an anti-Mullerian hormone, which is called AMH. If that’s really reduced, then it tells us that in which IVF may not be the best option for them, and they need to really look at some other options. Also if they’ve had, it depends on how long they’ve had infertility. If it’s been a very long period of time, that’s worrisome, and as well as dual factor infertility. If both the partner and the patient in which they both have issues, then that could be a factor. One thing that is a positive factor for IVF success is if a patient’s been pregnant before. If they’ve been pregnant before in which they do have a higher rate of becoming pregnant again. Those pregnancies that end in miscarriages may indicate there’s some other issues that we need to address, and that is where a patient’s physician will – which they need to narrow down the possible causes for pregnancy loss and kind of address those. Another factor is if a patient is using donor egg and/or donor sperm, and that may lead to a higher success rate in couples that are experiencing particular fertility issues and that’s a way of helping increase their success rate. One of the other things is looking at the clinic, which is probably the most personal decision that a patient needs to make. Depending on the type of clinic in which they go to or the way the clinic runs, the patient really needs to feel comfortable and confident about the staff, making sure the staff are experienced, and making sure in which they accept those patients that have specific conditions. I’ll go into success rates in just a little while, but the other thing is there are two factors that are kind of out of our hands, and these are two lifestyle choices. Smoking as well as weight. We know that smoking can affect sperm and can affect eggs. We know that sperm and then of male smokers have been found to reduce fertilizing capacity and the embryos that we get from these patients, in which the male partner smokes have lower implantation rates, as well as with the female smokers. We do know that nicotine does age the ovary so it does advance the biological age, and it can also affect the receptivity of the uterus for an embryo to implant. When we take a look at weight, whether a patient is underweight or overweight, both of these things could compromise the success of invitro fertilization. We do know that women that are overweight metabolize fertility medications more aggressively, and therefore need more medication to help them get to retrieval, and those that are underweight have also similar issues where the medication really needs to be tailored to what their body needs. So these are the areas in which we need to take a look at and then determine how successful we are going to be at helping this couple get pregnant and not just looking at their chronological age and saying well this is the percentage. There’s other factors which do play a role and patients need to be aware of that so when they are Googling or Yahooing success rates, they know that okay these are just plain numbers but every patient is different.

Host: That was a great description Dr. Ziegler. You’re such a great educator, really you make it so understandable. Now for one of the tougher parts. How are these all calculated? How are these factors all come into play for a calculation that somebody could look up online and how are they reported into whom?

Dr. Ziegler: Well in 1992, the federal government put forth what then was called the Fertility Clinic Success Rate and Certification Act, and what this was supposed to do was to make success rates transparent so that if a practice is reporting they have a 70% success rate, well do they really have a 70% success rate? So back when all this began, it was basically we reported all of our data, and the federal government in which there was a regulatory board, it kind of monitors clinics to make sure that in which those that have a zero success rate were kind of looked into. Since that time, things have really changed, especially with the internet. We do need to still report our cycles and the outcomes to the CDC as well as to the Society of Assisted Reproductive Technology. However, these are now available online for the public to look at, and when they do look at this data, it’s quite confusing, and that is where – there is a disclaimer there that this data should not be used as a way of selecting the clinic because you really don’t know what patients are included into their data. Over time, there have been clinics that have realized that patients do use this to select clinics to go to, and from 2005 to 2010 there was a study out that actually showed that there were a significant amount of clinics in this country that excluded cycles so it increased their success rate. The excluded cycles increased from around 3% back in 2005 up to close to 10% in 2010. In doing so, now the data is not as transparent. That clinics that do this, do this knowingly, so it increases their success rates online so patients come to them, so they’re using it as a marketing tool and collectively it has increased the share of IVF cycles in this country by 20% and this was going out to 13 large clinics within this country, and it’s probably larger than that. So at this point in time when you take a look at success rates online, you have to take them with a grain of salt. That they are not accurate and the Society of Assisted Reproductive Technology is in the midst of trying to address that affect. Also, clinics are not supposed to use those statistics as a marketing tool. It specifically says that in our regulation; however, there are clinics that do, do that, and it’s very hard to keep track of all the clinics within the country, so clinics do get away with using that data, which is quite skewed. I think what a patient really needs to look for is the reputation that the clinic has from their providers and their OB/GYN, their primary medical physician, as well as prior patients. If prior patients had a good experience, then that’s a positive thing. It tells you something about the office, that it’s passionate, that it cares; that it’s their whole fertility journey. Whether it was successful or not, how did that patient feel going through the process? Yes, we want everybody to be successful, but there are some patients who have issues that we try to address and medicine is not working for those patients. That is the best way to find any physician is word of mouth, but looking at numbers online as I mentioned before, the data that’s out there currently and just number one, it is outdated. If you go to the SART statistics, it’s basically reporting preliminary data from 2016; well now we’re in 2019, that data is quite old and some of those practices that are reported there are not even around anymore, so it is quite outdated. Even the CDC data is also outdated because it takes time to accumulate that data and publish it. So just keep in mind the data online is usually around two or three years old and a lot of things change within our profession with regard to laboratory techniques, to media, to medication, some of the adjunctive therapies which we use, so success rates online are not live updates. It doesn’t keep on changing. It’s static, but keep in mind that those statistics that are out there currently are quite skewed and we do know that but the public does not.

Host: Dr. Zeigler, as we wrap up and what interesting information, what an interesting topic this is. Since you don’t really want patients necessarily to use these success rates to choose an IVF center, how do you want them to interpret what is published, knowing that some of it is outdated, to make that educated decision when selecting an IVF center for treatment? Give us a few things you would like people to keep in mind as we wrap up, and your best advice.

Dr. Ziegler: Well I think the ultimate decision is based on the patient’s comfort level in the facility they go to, their physician, and their staff. Those are the most important factors. If you are referred to a practice from a patient that conceived, that is testimonial that that practice does have success. By talking with the physician, you can kind of get an idea of whether or not they’re comfortable in treating patients that have a specific condition or specific issues. Using the data online as kind of a guideline is fine, but if a patient looks at the statistics and they statistics are for a certain center are so far out in left field, you need to question whether or not they’re reporting all of their cycles, so you can get an accurate representation of what that practice is like. What I tell patients is that you can go to another center, but if I take a look at the statistics, if they are so far out of range, whether they’re very low or very high, you have to really question that clinic because most of us are in a certain area and that varies based on other factors besides chronological age, which can affect their fertility.

Host: Wow, thanks again, that is really great information Dr. Zeigler and important for listeners to take and use what you’ve told us today to make that educated decision when they’re searching for an IVF center. Thank you so much for coming on with us. This is Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. For more information, please visit fertilitynj.com, that’s fertilitynj.com. This is Melanie Cole.