ASRM: Selecting an IVF/GIFT Program

When selecting an ART program, information is crucial. Important points for consideration include the qualifications and experience of personnel, types of patients being treated, support services available, cost, convenience, live birth rates per ART cycle started, and multiple pregnancy rates. Older programs have established live birth rates based on years of experience. Small and new programs may still be determining their success rates, although their personnel may be equally well qualified.

Every couple wants to use the most successful ART program, but many factors contribute to the overall success of a program. For example, some clinics may be willing to accept patients with a low chance of live birth . A clinic may specialize in certain types of infertility treatment. Costs may vary between programs. A couple may prefer a program based on interpersonal interactions with the ART team, or may feel more confident in the recommended treatment plan. Consequently, it is not appropriate to compare programs based only on the published pregnancy rates.

Credibility is important too. Does the program adhere to the guidelines set forth by the American Society for Reproductive Medicine (ASRM)? Is the program a member of SART, a society affiliated with the ASRM? Is the IVF lab accredited by the College of American Pathologists or by the Joint Commission? These organizations require ART programs to have personnel on their staff who have been trained in reproductive endocrinology, laparoscopic surgery, sonography, hormone measurement, tissue culture technique, and sperm/egg interaction. Are the physicians board certified in reproductive endocrinology and infertility? Does the program report its results to SART/CDC? The compiled results are published in Fertility and Sterility, the ASRM journal, and results are available on the SART Web site at www.sart.org and the CDC's Web site at: www.cdc.gov/art.

The above considerations and answers to the following questions, which may be asked of each program, will help you make an informed decision when choosing an ART program.

Cost and Convenience

What pre-cycle screening tests are required, how much do they cost, and will my insurance provide coverage for these tests?
How much does the ART procedure cost, including drugs per treatment cycle?
Do I pay in advance? How much? What are the methods of payment?
If applicable, will you submit any bills to my insurance company?
How much do I pay if my treatment cycle is canceled before egg recovery? Before embryo transfer?
What are the costs for embryo freezing, storage, and transfer?
How much work will I miss? How much will my partner miss?
Do you help arrange (low-cost) lodging, if needed?

Details about the Program

Is the program a member of the Society for Assisted Reproductive Technology?
Does the program meet and follow ASRM/SART guidelines?
Does the program report its results to SART/CDC?
How many physicians will be involved in my care?
Are one or more physicians board certified in reproductive endocrinology?
To what degree can my own physician participate in my care?
What types of counseling and support services are available?
Whom do I call day or night if I have a problem?
Do you freeze embryos (cryopreservation)?
Is donor sperm available in your program? Donor eggs? Donor embryos?
Do you have an age or basal FSH cut-off?
Do you perform ICSI? If so, when? What is the cost?
Do you perform assisted hatching? If so, when? What is the cost?
How many eggs/embryos would be transferred in my case?
Who makes the final decision to cancel the cycle if my response to stimulation is sub-optimal?

Success of the Program

SART is a very good source of information from which to to obtain ART outcomes for each member program in the United States. This information may be a year old, so it is important to find out if there have been any significant changes in the program since the most recent report including:

Personnel changes.
Changes in the approach to ovarian stimulation, egg retrieval, embryo culture, or embryo transfer.
Change in the number of cycles.
Change in the miscarriage rate, live birth rate per cycle started, or the multiple pregnancy rate.

If a program cites a live birth rate for each procedure, be sure that the program representative counts twins as one successful pregnancy, not two. When discussing recent ART program outcomes, keep in mind that the live birth rate may vary depending on the denominator used - i.e., per cycle started, per retrieval, or per embryo transfer. For example, live birth rates per egg retrieval do not consider cancelled cycles, and rates based per embryo transfer do not include cancelled cycles or fertilization failures. Therefore, live birth rates per cycle are higher per egg retrieval and are highest per embryo transfer.

For more information on the live birth rates of IVF/GIFT programs in the United States, please click here.

To get information on clinics which perform Assisted Reproductive Technologies, please visit the Society for Assisted Reproductive Technology (SART).

The above information was taken from the American Society for Reproductive Medicine Patient Information Series Booklet entitled: "Assisted Reproductive Technologies", copyrighted 2008 by the American Society for Reproductive Medicine.

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