Wednesday, January 24, 2001

Success rates improve for fertility clinics


Good grades for Cincinnati facilities

By Tim Bonfield
The Cincinnati Enquirer

        Tristate fertility clinics, much like their competitors nationwide, are getting better at producing successful pregnancies while reducing the risk of multiple births.

        However, local clinics are not keeping up with national growth in service to people seeking high-tech fertility treatments.

[photo] Steve Johnstone looks over embryos kept frozen in liquid nitrogen at Christ Hospital.
(Tony Jones photo)
| ZOOM |
        “Improvements in lab systems have really helped improve success rates,” said Dr. Michael Thomas, co-director of the University Hospital program. “In 1988, a good success rate was about 12 percent. Now you're starting to see 50 percent or better at some centers.”

        Success rates for three Greater Cincinnati fertility clinics (which have since merged into two) were included this month in a national report from the Centers for Disease Control and Prevention.

        The CDC posted details on the Internet on 360 fertility clinics that helped produce more than 28,000 babies conceived in 1998.

        The 1998 data is the most recent available. That's because the report tracked births in 1999 from fertilization attempts made in 1998. The CDC then took several months to compile the report.

        Among the national trends:

        • Use of in vitro fertilization — when a woman's egg is fertilized with a donor's sperm outside the body, then implanted in the woman's uterus — rose 12 percent, to 77,013 attempts in 1998, up from 68,615 in 1997.

        • Success rates for the biggest group of clinic users (women under 35 seeking lab help getting pregnant with their own eggs) improved from 35.9 percent in 1997 to 37.3 percent in 1998.

        • Multiple births involving triplets or more declined from 13.7 percent to 12.5 percent.

        On the local front, the report included data for clinics at Christ, Bethesda and University hospitals. In recent months, the Christ and University programs have merged, with patients visiting separate offices in Christ Hospital but with both programs using the same fertility lab.

        • Christ Hospital's program was the busiest in town, performing 693 “cycles” or attempts to generate a pregnancy. Bethesda's clinic performed 227 cycles while University's program did 130.

        • University Hospital, however, had the highest success rates, with 56.3 percent of attempts in women under 35 leading to live births. Christ Hospital posted a 41.5 percent success rate in this category while Bethesda reported 30.5 percent.

        “It wasn't our best year,” said Dr. Glen Hofmann, director of the Bethesda program. ""We lost our lab director, Chad Johnson, in 1998. The change had a temporary effect. But our numbers are looking better for 1999 and 2000.”

        “Overall, everybody did well,” Dr. Hofmann said. “The number of embryos transferred is down. Multiple births are at or slightly below national average and triplets are down substantially.”

        While many parents would prefer multiple babies to no baby at all, most fertility clinics consider sets of triplets or more to be failures of control.

        High multiple births can be dangerous to the mother during pregnancy and typically result in premature babies that require weeks of expensive intensive care.

        Not only can the immediate medical bills reach into hundreds of thousands of dollars, but many extremely premature babies have lifelong medical problems.

        Caring for three, four or more infants at once also presents daunting social and financial burdens for parents.

        A year ago, higher-than-average numbers of triplets and quadruplets prompted the Health Improvement Collaborative of Greater Cincinnati (a coalition of health providers, insurers and business interests) to sponsor monthly joint medical meetings between the three programs to find ways to reduce multiple births.

        Scientific advances have allowed fertility specialists to reduce the number of embryos used while still improving success rates.

        The advances include using better lab materials for growing embryos and waiting more often to implant embryos at a more advanced stage, called a blastocyst, which makes them more likely to survive pregnancy.

        In 1995, clinics routinely placed four or more embryos in hopes of getting one birth. Now the average number is closer to three, with some women receiving only two embryos per attempt.

        Bethesda's program showed the most dramatic change in this area, dropping its triplet birth rate from about 13 percent to just over 3 percent in a single year. Christ Hospital reduced its triplet rate from nearly 18 percent to 10 percent.

        Although success rates sometimes exceed national averages, Cincinnati's fertility programs have not been growing at the same pace as the national average. Combined, fertilization attempts at the local clinics grew 3.6 percent in 1998, compared to 12 percent nationwide.

        Two factors may explain the slower growth, doctors say.

        As more fertility clinics open and grow in the Midwest and nationwide, fewer people need to travel to Cincinnati for service, Dr. Thomas said.

        Also, local insurers and employers may be more reluctant than most to cover fertility treatments.

        “In some states, like Illinois and Massachusetts, coverage is mandated and that allows more people to receive care. (In the Tristate) third-party reimbursement is weak,” Dr. Hofmann said.

        CDC officials who released the 1998 fertility clinic report urged caution for consumers who seek to compare success rates head to head.

        Success rates at a given clinic can vary widely based on the age of the woman, the type of treatment and whether embryos were frozen or provided by a donor.

- Success rates improve for fertility clinics
Some get financial help from foundation
       



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