How to choose; is the emphasis on pregnancy rates justified?

I read an article in the SMH the other day about IVF pregnancy rates. It was pretty on the ball, but the comments from the doctors quoted got me wondering about the reality of this issue. What’s going on is some medical politics in relation to IVF marketing and if you’re in the know, it’s easy to see the manoeuvring for position. Steve Jobs once said; “A lot of times, people don’t know what they want until you show it to them."

Steve Jobs once said; “A lot of times, people don’t know what they want until you show it to them.”  I actually think Jobs was right but perhaps this often only applies in narrow categories. For Jobs it was where his products, such as the Mac, iPod, iPhone and iPad, either redefined or created product categories. And also he backed up his unique insights with an enormously expensive creative process populated by world-class designers.  Let’s face it, without Jobs’ talents and the unparalleled creative team and processes that he built around himself, most of us won’t get away without doing market research and not listening to customers. OK, so how important is it to know a specific IVF Clinic’s pregnancy rate?

One of the really interesting facts about IVF pregnancy rates is the similarity in rates that can be seen in the worldwide published data. Pregnancy rates vary with age, highest in early 20s, lowest in early 40s and basically almost 0 from the age of 44, although I’m delighted that occasional exceptions do occur. The conglomerate of the world data suggest that women in their twenties make eggs that make babies on average, every 2-3 months. Obviously some women will make eggs that make babies more often - the;" OMG, he just has to look at me and I get pregnant”, and others less often, but most women in this age group will have conceived within a year of having regular unprotected intercourse. From the age of 40, most women will likely only be making one egg a year that can make a baby, perhaps at best two. And part of the problem is with a woman having a regular cycle, she is only making one egg a month. It seems that Mother Nature is placing a limit on the background rate at which humans can conceive, and the reality of the situation is, IVF can only maximise the chance of an egg that can make a baby, making a baby. Unfortunately with our current medical technology, IVF can’t turn an egg that can’t make a baby into one that can.

So where does this leave us with IVF clinic pregnancy rates? Well, there are things that can decrease chances. Poor attention to the IVF process (this is all in the public domain, so everyone really has access to the same stuff) will detrimentally affect outcome. Larger IVF clinics are attuned to a mass production approach to address process. This has some advantages, it saves time and it is cheaper, but it also has disadvantages in that it is less flexible, and in the end this doesn’t sound to me like the sort of approach that I would like in relation to my medical care.

Here are some parts of fertility treatment that I think are important.

1. With any type of service, service is important. Service is knowing your name, responding to your problems, queries and requirements within the ability of the Company to provide this. Service is about preventing problems with good communication and fixing problems if they occur without any resort to blame. I love hearing my staff listening and then saying, “now I understand what is going on, let’s see how we can make that happen for you.”

2. Transparency is a bugbear for our society. In many ways it exists because we don’t actually know what to ask, and most of us have preconceived notions as to how something works, which is usually sparse or even wrong. So transparency must be driven by the individual IVF Clinic. Transparency goes to many aspects of treatment. Cost is an obvious one. The IVF industry in Australia is appalling in providing understandable cost structures, as a quick review of Australia’s IVF websites will show. Cost displays vary from nil or rudimentary, to quite extensive, but so difficult to interpret that a true fee is beyond most consumer’s ability to discern. (See Demeter Fertility’s Comparing Costs page)

3. Framing treatment expectations is another area where IVF Clinics are not realistic. Most people are led to believe that the more eggs collected per egg collection cycle, the better their chances are of having a baby, and that frozen embryos are spares, mainly to use for later to have another child. Frankly, this is just an unreasonable expectation as that background chance of having more than one baby from one egg collection is around 1 in 60. In fact, if the background chance of a baby from an egg collection is 1 in 3 (a good/average chance that is seen in age group 25-30 years), then the average number of egg collections required to have a baby is three. The average number of egg collections performed per year in Australia in women under the age of 35 is only one! The published literature says that the average number of cycles that people undergo is only 2-3 egg collections and this figure tells us that most people cease treatment before they have really had a chance to get an egg that might make a baby. When we chose to do IVF, we decided we would do six cycles, and then reassess what to do next if we hadn’t conceived by then. As it turns out, happily for us (and some others) we did, and therefore that reassessment wasn’t required. The point here is, the most important aspect is how many times we can get the best egg in a cycle, not the number of eggs that can be collected in one cycle.

4. Convenience is really important. It’s hard enough having to deal with undergoing any medical treatment, let alone undertaking an ongoing series of tests that can hurt or be uncomfortable, especially if they aren’t required. High dose treatments might sound impressive, but unless these improve outcomes, what is the point of this? In fact, this type of treatment can just make things worse by increasing the side effects and risks without actually improving the chances of having a baby. 

Let’s get back to the Steve Jobs quote, and here we are where the common treatment is with high doses of hormones, more side effects, costs that can’t be seen, promises that can’t be kept, being treated on an assembly line with an approach of basically one size fits all, and well, you might want some idea of pregnancy rates, but what you probably really want to know is - Why you are being treated like this in the first place?

For more information;

Dr David Knight
Medical Director

Demeter Fertility

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