Key Messages:

ANZSREI is the society of specialist obstetricians and gynaecologists who have undertaken further training in reproductive endocrinology and infertility and therefore considered to be experts in the assessment and treatment of infertility.

The ANZSREI Executive supports transparency of information to consumers who are making decisions about assisted reproductive technology.

The information measures on YourIVFsuccess website are heavily influenced by clinic and patient characteristics (often called confounders in scientific literature). These patient and clinic characteristics can differ substantially between clinics as clinics service different patient groups and offer different services. Therefore comparison between clinics is potentially misleading to consumers – it is like comparing apples with oranges.

The data is several years old and does not reflect current pregnancy rates or practice.

ANZSREI Executive is concerned that this website in its current form will create disadvantage for couples with a reduced chance of success (poor prognosis). Such couples are already disadvantaged by infertility with reduced chance of success and experience high degrees of distress. Couples with a poor prognosis in regional areas will be particularly disadvantaged. Clinics may be reluctant to offer treatment to such couples in order to maintain good pregnancy rates and Australian couples may experience reduction of choice in their treatment options.

ANZSREI Executive looks forward to improving the measures recorded on this website to truly produce comparable measures which are of concern to consumers. These include measures of patient centred care, accreditation outcomes and most importantly measures of clinical outcomes on “standardised patient/s” accessing a defined type of treatment. Use of these measures will allow consumers with infertility to be well served by public reporting.

When patients are choosing fertility clinics or if they have had unsuccessful cycles, ANZSREI Executive does not recommend solely using the YourIVFsuccess website in their decision. Instead we recommend patients are aware of the current limitations of the website and consider other aspects such as patient centred care, cost and importantly the experience and qualifications of their doctor. A doctor with a CREI is an expert specialist in infertility and we suggest couples consider seeking one out by visiting www.anzsrei.com.

ANZSREI Executive recommends that consumers do not use YourIVFsuccess rate to compare clinics.

Detailed Messages

This government initiative will result in confusion, misinformation and potentially lead to reduction in access to treatment. Clinics with lower measures will scramble to change their statistics which may compromise access of some patients to care.

Clinics in regional areas do not have large numbers and therefore greatly influenced by invalid statistics which may be based on numbers as low as eleven (11) patients. These clinics, if valid comparators, were used, such as those proposed by ANZSREI may in fact be good performers, offering good services to their patients. If closure of a clinic occurs in a regional area it is particularly regrettable.

The data is several years old and does not reflect current practice. Some clinics will have had lower measures in 2017 and having taken action to address these. These clinics will be inappropriately represented as “underperformers” despite having improved in the interim.

Here are some specific examples of why consumers should not use the information on this website are as follows:

Patients using donor sperm are not specified but are included in the measures. Women accessing donor sperm are likely to have normal fertility and will have a higher success rate in IVF. Some clinics have a special interest in offering donor sperm and will therefore have a high success rate. Some clinics do not offer donor sperm at all or infrequently. The latter clinics when compared to the former clinics may have a lower success rate for the same age of woman. It does not mean the former clinic is better – just different.
Some clinics take a sample from embryos to ensure the embryo is genetically normal – this is called PGT-A . Embryos subjected to this technology have a higher pregnancy rate – 60% compared to 40% for embryos not tested for genetic normality. Clinics which have a high rate of using PGT A will have a higher pregnancy rate than those who offer PGT A infrequently or not at all. It does not mean the former clinic is better – just different.
We know that the number of eggs collected at an egg collection parallels the chance of pregnancy – up to a sweet spot of around fourteen eggs. Some women have a low ovarian reserve and If a woman has less than four eggs her chance of pregnancy is roughly half that of women who have eight or more collected. Some clinics cancel egg collections where there are three or less eggs. Others proceed with less than three eggs as this may be the best chance that the woman. The pregnancy rate of the clinic which cancels egg collection when there are three or less will be higher than the clinic which collects eggs in low numbers. This does not mean the former clinic is better – just different.
Some clinics offer IVF to women who are not ovulating and are otherwise normal because they do not have expertise in inducing ovulation (and there are many options for ovulation induction). Expert specialists in fertility who have a qualification called a CREI are often particularly skilled in this area of ovulation induction. Women who only need ovulation induction have a high chance of success with IVF but may not need IVF. The clinics who offer IVF to women who need ovulation induction may appear to have a high chance of success. Again it does not mean that former clinic is better – just different.

Comments About the Predictor Tool

The development of a predictor tool is potentially useful to consumers to provide a rough estimate of the
chance of success. The difficulty with the tool developed is that it is based on data collected but not audited and the classification of cause of infertility may not have been accurately defined and/or submitted. As the diagnostic classifications are improved and audited this has promise for the future. The predictor tool is not a substitute from an opinion from a specialist with a CREI qualification.

Prepared and approved by ANZSREI Executive
Contact: Dr Clare Boothroyd
President
Tel 0418883577
Email:fertility@ivfmed.com.au