The Saga of Becoming Fruitful

Posts Tagged ‘live birth’

SIRM’s IVF Outcome Based Reporting System

Written by Arpee on September 30, 2008 – 10:48 pm -

As mentioned in my earlier post re More Research About IVF in SIRM, SIRM locations do not report to SART (except for the Dallas, TX location). 2 locations - Las Vegas and New Jersey - report to CDC instead; and the rest, are not listed in SART.

I also mentioned that the SIRM website has an article criticizing the current reporting system for lacking the verifiability of a clinic’s self-reported IVF statistics and for its inability to compare “complex” vs straightforward IVF cases.

Instead, SIRM has the Outcome Based Reporting System (OBRS) which breaks down the stats into Category A-D based on relative categories of complexity (# failed IVF cycles, FSH level, #IU gonadotropin/day, # eggs retrieved) broken down by age. This is useful then when comparing case complexities.

Here is the latest OBRS for 2007-Q1-Q4.

Now, patient-me will try to eyeball where I fall under and what the table is saying…

- I think I am Category A since I have no IVF experience yet and thus no retrieved eggs yet as well. Also, I have FSH 3.5<9 and I needed 150-75<600IU/day Follistim to stimulate me.

- The stats are 58% clinical pregnancies, 8% miscarriages, 57% ongoing pregnancies and 25% multiple pregnancies based on 62 cycles. The average age from the 38-40 yo patients is 38 which means that all those who cycled are 38 years old. So I guess, this is not who I should compare myself to.

- Going worse case to the 41yo column - the stats are 25% clinical pregnancies, 33% miscarriages, 16% ongoing pregnancies and 0% multiple pregnancies based on 12 cycles. Not too different from TFC stats…

……

One disadvantage I see on the OBRS is that live births are not updated even for the earlier years where there is already sufficient time to gather information already.

Also, it is not clear which clinic/s is/are included in the stats. Having OBRS for each clinic could be more helpful for consumers like us.

Eventually, numbers are just that - numbers. Each case will be unique on its own. To me though, it does not hurt to know the numbers!

Whaddaya think?

Tags: IVF, live birth, OBRS, pregnancy, sirm, stats
Posted in IVF, In Between Cycles, Infertility Learnings | 4 Comments »

Detailed SART IVF Stats Comparison

Written by Arpee on September 30, 2008 – 9:02 pm -

I’ve been looking at IVF stats from SART for sometime now and just like last Saturday’s post, I thought that was it. This weekend was the only time I stared at it long enough to discover that the IVF stats can be sliced further according to the diagnosis of the IVF patients. The per Diagnosis-sliced data was very interesting.

I lined up our known diagnosis to the Diagnosis Types in the SART database:

• Tubal Factor
• Ovulatory Dysfunction - Anovulation
• Diminished Ovarian Reserve - Advanced Maternal Age
• Endometriosis
• Uterine Factor
• Male Factor
• Other Factor
• Unknown Factor
• Multiple Female Factors - Anovulation, PCOS, Advanced Maternal Age
• Female and Male Factors -Anovulation, PCOS, Advanced Maternal Age, Low Sperm Morphology
  

I used 2006 SART IVF data from:

• TFC - Texas Fertility Center
• CCRM - Colorado Center for Reproductive Medicine
• SIRM-D - Sher Institute of Reproductive Medicine in Dallas, TX (since they are the only ones who publish to SART among the various locations of the SIRM. I’m showing how SIRM stats are presented later.)

Anyhow… Using these Diagnosis Types, I went to Select Diagnosis on the upper right corner of the SART stats (under the Diagnosis Frequency). For each of the related Diagnosis above, SART gives the stats for that particular Diagnosis alone. Here are the captured images of each clinic’s start for each of the related Diagnosis.

I summarized what I got from these captured images below:

CCRM had the most patients (91 vs 47 TFC) aged 38-40 years old with potentially related cases as mine. It might be a long shot, but this comparison may mean that CCRM has more experience on cases similar to mine. And perhaps may be able to help me more???

CCRM had the highest % cycles (78% vs 36% TFC) and most number of patients (964 vs 243 TFC) of all ages who had ICSI. This may be an indication of how much ICSI opportunity/experience the embryologists have for the clinics and thus how skillful they are.

CCRM also had the most # of cycles where PGD was used AT 234. Although TFC has 5X more cycles than SIRM-D, they have almost the same # of cylces where PGD was used (about 20). This may be an indication of how much biopsy and freezing/vitrification opportunity/experience the embryologists have for the clinics and thus how skillful they are. This may also be an indication how cutting edge or on top of technology the clinics/labs and doctors/embryologists are.

CCRM has the highest live births per cycle, followed by TFC and SIRM-D

Of course, doing this is tricky because:
1) Without clear knowledge on how each of the SART Diagnosis Types are defined, I am guessing what my diagnosis corresponds to.
2) Unless the SART Diagnosis Types are defined clearly with a common standard reference to be used by different clinics, different clinics may have different interpretation of the SART Diagnosis clinic and thus categorized their cases differently. This would be a major error in assumption when making “apple-to-apple comparison.

This is all I’ve got, so I’m going to use the information for making the comparison anyway. It is better than nothing at all.

Tags: ccrm, Diagnosis, ICSI, IVF, live birth, PGD, SART, sirm, stats, tfc
Posted in IVF, In Between Cycles, Infertility Learnings | No Comments »

Consultation re IVF - STATS AND RECOMMENDATIONS (Part 3)

Written by Arpee on September 23, 2008 – 11:30 pm -

STATISTICS
DrH said that normal (fertile) couples chances of getting pregnant are 20% in 1 month, 50% in 3 months, 75% in 6 months.

She said that an infertile couples chance of getting pregnant is still even less than that with IUI - which I have seen different numbers from various websites ranging for 6-17%.

DrH showed us national stats on live births, miscarriages, own vs donor egg  - all by age ranges. She believes though that 40 year old stats are closer to the next age range of 41-42 (than with 38 where it is in the same age range).

She said that their clinic’s stats are generally much higher than the national stats, except for the advanced maternal age where they are still higher than national stats but not much higher.

(I’ve actually seen their stats from SART so I knew what she meant when she made relative comparisons of their stats to the national stats.  Their clinic is by no means the highest in the US though…)

IT TAKES ONE GOOD EMBRYO
DrH mentioned 2 successful advanced maternal age cases.
- One was 45 years old with 20 retrieved eggs that resulted to 19 fertilized embryos. PGD on all embryos showed that only 1/19 was normal and that was transferred. Now that patient has a daughter.
- One was 40 years old who had 1 failed IVF (without PGD). She went for a second IVF and out of the retrieved eggs and fertilized embryos, there was one lone embryo that tested well in PGD and was transferred. The lady’s beta is now being monitored.

OTHERS
DrH echoed back that some studies showed acupuncture to help but she would stay away from herbs.

She said that the meds would have no effect on my breast cysts.  (I still am not 100% on that.)

POSTMORTEM ON RECENT IUI
DrH said that our recent IUI (second Follistim stimulation) was perfect according to her - but it still did not succeed.

Regarding the first Follistim stimulation which got cancelled due to OHSS (did not push through for IUI)… DrH said that it could not be converted into an IVF anymore since that decision should have been made in Day 8 so that antagonists are prescribed in order to convert into IVF. We were already past Day 8 when the impending OHSS was suspected.

DrH also clarified that they make calls until 6pm (only their incoming phones are turned off at 4pm so that they can do their housekeeping and return calls within 4-6pm). So I would have received a call re my results by 6pm.

She also said that she typically has post-mortems after failed cycles.

RECOMMENDED NEXT STEPS
I am on Day 50, so DrH said that when we are ready…. She would give me
- Provera to induce a period
- Skip the usual birth control pills (since I have irregular periods)
- Start me with Lupron
- Then proceed stimulate.

If IVF failed despite high fertilization rate, DrH said that she would not not recommend another cycle of IVF.
If IVF failed and there was low fertilization rate, she would say 2 things - 1) go for PGD or 2) go for donor eggs.

DrH recommended that we go through the IVF Seminar which is scheduled on Oct 8.

LASTLY…
DrH hugged me! I did not expect that but it felt good that she had no qualms on hugging.
DH thinks that mentioning the hug in this post is sooo trivial.  Man, are men clueless…

Well … that’s a lot for now… more data, getting a clearer picture, still need to dig more on specific topics.

Then need to digest info, step back, reflect and weigh, pray and decide.

Tags: consultation, embryo, IUI, IVF, live birth, miscarriage, pregnancy, stats
Posted in Conversation, IVF, In Between Cycles, Infertility Learnings | No Comments »