Understanding Clinic Data & SART: What It Can (& Can’t!) Tell You About IVF Success Rates

Unfortunately, there are still no standardized measures of clinical success that are both reported and independently verified. This leaves even fertility specialists with uncertainty about how to refer patients, friends and family members to a new center. When REI doctors want to understand “how good” a lab or IVF center is, in terms of their success rates, there are a few important metrics that we ask each other.

SART, or the ‘Society for Assisted Reproductive Technology’, is a voluntary professional organization of fertility clinics around the country. SART collects and publishes birth outcome data from their member clinics in an attempt to provide objective, reliable information for patients. It was established in the 1990s and was a noble effort to empower patients with information at that time.

Unfortunately, the metrics and process that SART uses have not kept pace with changes in technology, clinical advances and patients desires. As SART has tried to update, without a wholesale change, it has become increasingly challenging to interpret, whether you are a physician or a patient. As reporting currently stands, it often creates more confusion than clarity and even encourages physicians to make choices that are not in their patients’ best interests (in order to optimize their reported rates per egg retrieval).

What is SART helpful for today? 

The most helpful metric is the reported  cycle volume at your center. This is an indicator of the size of your clinic. Do you prefer to work with a smaller clinic or one with experience treating hundreds to thousands of patients a year? Smaller clinics may offer a more intimate and warmer experience, but may lack the resources to keep pace with important scientific improvements.  Larger clinics may have you feeling like a number in a big machine.  At Spring Fertility, our goal is to provide the superior scientific resources with the most advanced labs that can accommodate thousands of cases using the latest technologies, while still providing individualized care through close physician  care teams around each patient so that patients experience the intimacy and warmth typically seen at a smaller practice.

SART cannot be used to compare clinic quality (even SART includes a disclaimer and requires an acknowledgement that their tool cannot compare quality between clinics).  This has only become more complicated in the last decade.  While helpful to see how busy a clinic may be, it lacks insight into the true quality of the IVF care and clinical outcomes because SART still reports on pregnancies and live birth rates per initiated cycle. This creates real potential conflicts for patients and clinics, since reporting per cycle or per retrieval data, does not account for patients with differing ovarian reserves (or potential egg yield).

Here are some of the patient populations this outcome data could unintentionally harm as they make decisions based on their unique cases and family-building goals:

• Hurting patients with diminished ovarian reserve: This reporting encourages clinics to deny care to “poor responders” or prematurely suggest moving to donor eggs, especially in younger patients with low ovarian reserve
•  Prematurely recommending donor eggs: We find many patients were recommended to use donor eggs rather than discussing their actual probabilities and potential to have a biological child if they were to batch or complete multiple cycles.  We have seen innumerable patients have biological children after being advised to use donor eggs for this case.
• Ignoring desire for multiple children. This structure encourages clinics to advise transfer of the first usable embryo created, rather than encouraging women to bank additional embryos if they want more than one child.  A 41 year old with one normal embryo who wants two children, should certainly obtain at least one more good embryo for baby #2 at age 41, rather than getting pregnant, delivering a baby and coming back to start IVF again at age 43.  Because SART makes clinics include additional retrieval cycles, a clinic will be incentivized to encourage that 41 year old woman to transfer her single euploid embryo rather than bank additional, as this may take a 100% success rate down to 33% if that patient does two more retrievals to achieve 2 additional good embryos.

SART lacks any data on egg freezing and warming outcomes, which means it’s hard for patients who are preserving fertility for the future to understand their likelihood of success when they actually come back to use those eggs at that clinic to grow their family. Spring Fertility created our Egg Freezing Outcome Estimator as a way to help improve that transparency and create realistic expectations for patients.

It’s important to also understand that IVF outcome data are currently self reported and not verified.  Some progress in this is being made. Hats off to Progyny, a fertility benefits company that actually requires reporting on data for every patient outcome.

Important considerations that are not accurately reflected by SART reporting:

• Variability of follicle counts, and therefore the number of mature eggs collected per egg retrieval. If you have an antral follicle count that is outside the “average” for your age, you should speak with your clinic to understand your likelihood of success. Unfortunately, based on the way SART reports, clinics are de-incentivized to cycle individuals with low ovarian reserves.
• The rise in patients choosing to complete multiple egg retrieval cycles and bank embryos before completing a frozen embryo transfer. Oftentimes if a patient desires multiple future children from IVF, it is in the patient’s best interest to complete several egg retrievals at their current age and bank embryos with the intention of transferring those embryos later. However, SART publishes live birth per retrieval, a methodology that negatively impacts clinics that perform a high volume of embryo banking cycles.
• Lack of egg thaw data. SART does not currently report on cycle volume and success rates from frozen, then thawed eggs. This is a tremendous area of opportunity within the field of fertility.

While success rates are absolutely not the end-all-be-all for selecting a fertility clinic, these treatments can be expensive, especially for those with limited or no insurance coverage.  Minimizing that expense by optimizing success is key to achieving a positive outcome. What is most important is for patients to find a fertility doctor and care team that they feel comfortable with. Fertility-specific review sites like Fertility IQ are a great resource for choosing a clinic. Additionally, many clinics offer free info sessions where you can learn more about their specific approach to fertility care. We encourage patients to inquire about the care team process, communication, as well of course as outcomes and how to think about success rates.