Few subjects are as confusing or misleading as IVF success rates - they can be easily manipulated to enhance a particular programs public image. Therefore, reported IVF statistics provide little meaningful guidance for an individual patient hoping to achieve pregnancy with IVF. While experts in the field and statisticians have acknowledged this, the public does not generally understand it and places increasing emphasis on the statistics from individual programs.

A common question in fertility programs is, "What's your IVF success rate?" The quick answer is somewhere between 0% to as high as 100%. Unfortunately, a meaningful answer is a lot more complicated. Obviously, success rates depend on how you define success and calculate the total population.

Do you mean clinical pregnancy rate (implantation seen on ultrasound), or ongoing pregnancy rate (fetal heart beat seen by ultrasound) or delivery? Will the denominator in this calculation be the number of couples entering treatment, or those going to oocyte retrieval, or those having embryos replaced into the uterus? But it's even more complicated than that. You are a unique individual with a unique medical history that affects your chance of having a baby. That is why any calculation requires additional information, such as: duration of infertility, severity of infertility, your age, and a host of other factors.

"Success rates" are often used to indicate that a particular program has the "best success rates" in a given area, comparing their claims with comparative data from publicly available data sources. Unfortunately it is not indicated how the data was calculated and instead they want us to believe in miracle workers. While there are many talented individuals in the infertility, none can do miracles.

What is really going on? We must keep in mind one of the essential principles of statistics - statistics report data from POPULATIONS. Samples are taken, and averages are calculated. But you are a PATIENT, not a POPULATION. You have a UNIQUE set of circumstances that will determine your own likelihood of achieving a pregnancy if you receive your medical care in an experienced IVF center. So, the key to good statistics is to have more ideal patients than difficult patients enter the program. To a large degree, the difference between a program with good statistics and one with less favorable pregnancy rates is more often due to the given mix of patients who present for treatment. Yet by excluding or wait-listing individuals who've failed in other programs, are over 38 years old, have borderline FSH values, have prolonged unexplained infertility, or are low responders, certain programs can improve their statistics. By encouraging ART treatments for patients who are young, have had previous normal or ectopic pregnancies, regular menstrual cycles, limited or no prior treatment, and have normal sperm factors, the advertised pregnancy rates can also be increased. The pregnancy rates also depend on the number of embryos transferred. A program that transfers a larger number of embryos will likely report a higher pregnancy rate than one that judiciously restricts that number, but the latter program will also experience far fewer complications due to multiple births.

So, how can couples with complex fertility problems make an informed choice? Unfortunately, the answer is not simple. You cannot rely solely on published statistics when seeking professional care. The misguided focus on "success rates" has created strong incentives, economic and otherwise, for IVF programs to maximize IVF statistics by adopting some of the "gaming" tactics noted above. A better approach might be to take the following steps:

- Look for experience and track record. Participation in proficiency testing programs and proper certification credential and state licensure, should be considered.
- Make your own opinion of their integrity, intelligence, responsiveness and compassion
- Learn as much as you can. Review the reputation of the organization and its professionals.
- Try to contact former patients. Talk to your friends with infertility problems.
- Refuse to be directed anywhere by a healthcare plan. Fight for your right to choose. Insist upon alternatives.
- Be willing to spend your own money wisely to get the best health care.
- Distrust waiting lists. Avoid apparent economic bargains. Ignore gimmicks.
- Do not forget YOU are the boss! We appreciate your choosing us to be your health care provider.

Lastly, think hard and trust your own judgment. Your health care is very important, and the final decisions are yours!