Navigating Fertility Clinic Success Rates in the United States
Did you ever wonder if there was a way to rank fertility clinics in terms of their success rates? Meaning, how would you know if a clinic had good outcomes for assisted reproductive technology (ART) procedures like in vitro fertilization (IVF), intrauterine insemination (IUI), and pregnancies with gestational carriers (GCs)?
Well, the U.S. Federal government actually mandates that fertility clinics report these data to the Centers for Disease Control (CDC).
Even better, the CDC analyzes the data and has created a public dataset (National Assisted Reproductive Technology Surveillance System [NASS 3.0]) for anyone to use.
In this article, I wanted to go over the dataset, briefly describe its history, what it does and does not include, and how it could evolve in the future to be even more inclusive and useful for queer intended parents (IPs).
National ART Surveillance in the U.S.
In 1992, the U.S. government passed the Fertility Clinic Success Rate and Certification Act (FCSRCA) (1). This act mandated that all ART cycles such as IVF performed in the United States must be reported to the CDC.
The goal of this act was to provide consumers with information about national and clinic-specific success rates, and allow for safety monitoring and trends in ART.
There are about 500 fertility clinics in the U.S. that report their data to the CDC. Given that the dataset provides information on outcomes of reproductive cycles, there is a lag in the data available.
(2)
The figure above shows that data reported is about 2 to 3 years behind the current date, and this is because ART cycles started in one year then have to wait at least 9 months until delivery, with additional time to collect outcome information, and then finally more time to clean and validate the data.
While this means the dataset is not a perfect picture of the fertility clinic landscape at this moment, it still can provide useful information and trends for intended parents.
Information Easily Available at the CDC Website
The CDC has built a fairly user-friendly website for consumers to navigate the data set, which is available here: https://www.cdc.gov/art/artdata/index.html.
Some interesting national statistics from the most recent data in 2021 (2):
238,126 patients had 413,776 ART cycles performed at 453 reporting clinics.
91,906 live births (deliveries of one or more living infants) and 97,128 live born infants.
Approximately 2.3% of all infants born in the United States every year are conceived using ART.
The website also allows you to quickly search for fertility clinics by state or zip code.
(2)
Once you navigate to a fertility clinic’s specific webpage, you can then search through the detailed data. This is a screenshot from my husband and my fertility clinic, Pacific Fertility Center-Los Angeles.
(3)
This fertility clinic home page provides an overview of the clinic; the services provided; and overall statistics on cycles, pregnancies, deliveries, and infants born.
You can then drill down into any of the tabs to see more information on patient and cycle characteristics, success rates, and the clinic data summary.
For the detailed tabs, there are drop down menus that allow you to select and visual clinic-specific data. Here is a visual of the figure generated for Pacific Fertility Clinic-Los Angeles with regard to the success rate for live-birth deliveries for patients using their own eggs:
(3)
You can see there is a way to easily filter the data based on the diagnosis (left side), and then the figure will update with the success rates by age range of the patient.
There is a great deal of information that can be explored with the CDC’s dataset. It’s particularly useful if you are a heterosexual couple or single person with a known medical diagnosis of infertility who is looking for a clinic within a specific geographic location.
However, this level of specification is very heteronormative and has a great deal missing in terms of data for queer intended parents or utility for those looking for a broader search or compare clinics more efficiently.
Data Missing from the CDC Surveillance
One of the biggest things missing from the dataset is demographics information with regard to sexual orientation or same-sex relationships. There is simply no data collected on this, so queer intended parents - whether they are single or in a relationship, lesbian women or gay men - are grouped with all other intended parents.
This is important for several reasons. The first is that LGBTQ+ people have historically had challenges with the healthcare system, and so we often seek out clinics and services who have a track record of providing inclusive care. This could be represented in clinics who have a larger LGBTQ+ identified patient population, but there is no way to know this from the current CDC data.
The second reason is LGBTQ+ reproduction is drastically different compared to heterosexual people pursuing ART, and the success rates are also presumably different given the context for the procedures, although this is an area where more data is needed.
As shown above, the diagnoses in the CDC dataset only include ‘medical’ infertility. There are no options for ‘social’ infertility, or infertility due to someone’s sexual orientation or relationship status. Last year, the American Society of Reproductive Medicine (ASRM) updated its definition of ‘infertility’ to include ‘medical’ and ‘social’ reasons into one, inclusive description (4):
The inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
The need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner.
Therefore, there is no reason for the CDC to not include ‘social’ infertility in its reasons for pursuing ART.
Also, as stated above, the success rates for queer IPs will be very different compared to heterosexual IPs. This is because ART for queer IPs is often more ‘optimal’ than ART for heterosexual IPs. For example, gay men are often using healthy sperm; a young, healthy egg donor; and a medically optimized GC. There are still challenges with the process and everything does not always go according to plan, but the success rate would be very different compared to a 40 year old woman with endometriosis who is trying to use her own eggs to have a child. Even if this hypothetical female patient uses a GC, the chances of success will be less than that for queer intended fathers, but there is no way to use the current CDC database to differentiate these processes.
While the CDC states there are limitations in the database, I believe these oversights with regard to sexual orientation and ART for queer IPs is a significant gap. With more and more queer people pursuing ART for rainbow family formation (https://www.babymoonfamily.com/original-articles/rainbow-family-planning), this gap will only continue to grow, and more data is needed on ART cycles for queer IPs as well as the success rates for these journeys. This could be a rich source of data for researchers and the public to utilize to understand this changing landscape and then provide better care to the population as a whole.
BabyMoon Family’s Dataset for Queer IPs
I did take it upon myself to email the CDC to let them know about the gap in the dataset.
To my pleasant surprise, they responded very quickly and were open to looking into this for future data collection. It felt good that my American tax dollars were being spent on quality ART surveillance, and I encourage anyone to email them at artinfo@cdc.gov with questions or comments.
However, I still wanted to make the current database more user-friendly to queer intended fathers.
In order to do this, I downloaded the raw dataset in Excel, which is available here: https://data.cdc.gov/browse?category=Assisted+Reproductive+Technology+(ART).
I then cleaned up and reformatted the data into a simple table that includes the following information:
City, state, name, address, and phone number for all fertility clinics in the U.S.
Total number of cycles at each clinic
Percentage of transfers with a GC at each clinic
Total number of transfers with a GC at each clinic
My goal with this reformatted database was to allow queer intended dads to filter and sort by geography, but also to see which clinics do the most or highest percentage of their cycles with a GC.
I chose this metric as it was the best surrogate (pun-intended) for clinics that have the most experience working with queer intended fathers. It’s not an ideal metric, and there is no way to compare success rates with this specific population given the limitations I discussed above, but I think it could be a good starting point for men who are looking to have children through IVF and surrogacy. Once you identify a clinic you want to learn more about, I would recommend then going into the CDC database to look more at the detailed metrics on the clinic-specific website, as discussed above.
I plan to have the BabyMoon Family clinic database available for free on the BabyMoon Family website (www.babymoonfamily.com). Also, please reach out to bryan@babymoonfamily.com if you have any questions or suggestions as to how to make it more useful.
In the future, I hope the CDC will collect all the data that queer intended fathers need to search and make informed decisions on what fertility clinic is best for them, but until that time, we can continue to navigate the information available, and BabyMoon Family is here to provide additional support and guidance.
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