When the Centers for Disease Control and Prevention recently released its report on advanced reproductive technology (ART) success rates, it laid the groundwork for healthcare communicators to educate millions of women on how to best select fertility clinics. The report outlines the success rates of the 335 fertility clinics nationwide. While the report goes to great lengths to explain how the statistics are calculated and to position the information as an important starting point in selecting a clinic, it inevitably will cause consumer confusion. It is up to clinics and other healthcare providers to fill in the blanks with messages that educate women about how to interpret the report and what they can realistically expect from various fertility treatments.
There are approximately 60 million women of reproductive age and about 2% who had an infertility-related medical appointment within the previous year, according to 1997 CDC data - the most recent information available. Another 13% of women received infertility services at some time in their lives.
The American Infertility Association has been among the most vocal advocacy organizations calling for a cautious interpretation of the report. While the AIA believes the report is useful, it recommends that patients become educated about other important factors when choosing a fertility center, like:
- The number of patients a center treats that are in the same age range as the interested couple.
- The center's experiences with treating infertility problems similar to the interested couple.
- The center's ability to treat male and female infertility problems.
- The waiting list for required infertility services.
- The availability of other services like psychotherapy and insurance screening.
AIA also underscores the need for making patients aware of what might cause lower success rates, like clinics that treat a higher percentage of patients with more severe forms of infertility.
The report, released on Jan. 13, is based on 1997 data and is published every two years. The report has three major sections and is based on the number and outcomes of ART cycles performed in U.S. clinics. An ART cycle begins when a woman starts taking fertility drugs or having her ovaries monitored for follicle production. ART procedures performed at the participating clinics resulted in 17,054 deliveries and 24,582 babies (which included multiple births), according to the report.
The report is a "double-edged sword," according to Pamela Madsen, AIA's executive director, because while it informs the public of important clinic information it also "breeds competition based on success rates and not necessarily patient needs." She also contends that clinics may be discouraged from seeing patients who might adversely affect their success rates, like older women and patients who have had poor success with infertility treatments in the past.
The CDC and Society for Assisted Reproductive Technology (SART), a co-author of the report, maintain that the report does not inspire unethical competition or prompt clinics to deny patients with undesirable risks. "We've never heard of clinics turning away patients," says Deborah Crawford, who heads up communications for SART.
To minimize unethical use of the report, Laura Schieve, a CDC epidemiologist in the division of reproductive health, says that the agency purposely avoids ranking clinics based on success rates. "The report is simply meant to help the public better understand the ART process," says Schieve.
In addition, clinics that belong to SART are asked to adhere to specific advertising guidelines, put forth by the American Society of Reproductive Medicine, when using success rates.
On a broader health advocacy level, fertility issues have been omitted from the radar screen of women's health issues, says Madsen.
Earlier education is needed to make women aware of basic fertility and reproduction so that they may avoid some of the painful and frustrating experiences with infertility.
"We have been so focused on abortion rights, birth control and other reproductive rights, that women are often unaware of their reproductive potential," says Madsen. Gynecologists, in particular, should be more forthright about consulting patients on fertility issues by asking about family plans and educating about infertility risks. "Many women are resentful because their gynecologists never asked them about when they wanted to start a family and they wind up putting off having babies until it's too late," says Madsen.
In addition, more targeted messages about fertility should be integrated into school-based sex education. Teenage girls, for instance, are often unaware that contracting certain sexually transmitted diseases can affect their ability to get pregnant.
(AIA, Pamela Madsen, 212/764-0802; CDC, Laura Schieve, 770/488-5250; SART, Deborah Crawford, 205/978-5000)
ART Advertising Guidelines
When clinics that are part members of SART promote their success rates, they are expected to adhere to the following advertising guidelines, found at www.asrm.org:
- If comparisons are made or implied, the method of calculating success rates must be the same and cover the same time periods.
- The advertisement must not lead patients into believing that the chances of success are greater than they really are. The preferred way to avoid misleading patients is to report live birth data per cycle initiated and per egg retrieval procedure.
- The non-reporting of cycles, which are part of research protocols, is unacceptable.
- The method used to calculate success rates must be clear, i.e., the numerator and denominator must be reported (such as live births per cycle initiated).
- The practice director is held responsible for the content of all advertisements.
- The following statement must be included when quoting program statistics: "As entry criteria are highly variable for each program, a center-by-center comparison is not valid."