Hopkins has best rate in area in high-technology fertilization CDC warns against making comparisons since a clinic may handle difficult cases

December 19, 1997|By Jonathan Bor | Jonathan Bor,SUN STAFF

Couples stood roughly a 1-in-5 chance in 1995 of taking home a baby each time they attempted in-vitro fertilization and other high-tech methods of overcoming infertility, according to a federal report released yesterday.

The report is the first giving consumers a way to evaluate a clinic's track record. It was prepared by the U.S. Centers for Disease Control and Prevention and two organizations representing fertility doctors and consumers.

"For many couples, the dream of having a child is not easily realized," said Dr. Lynn Wilcox, director of the CDC's Division of Reproductive Health. "Our hope is that this report will help these couples make a more informed decision."

Couples often spend $5,000 to $7,000 for in-vitro fertilization -- and many will attempt three or more times in hopes of beating the odds.

In metropolitan Baltimore, "take home birth" rates at six fertility centers ranged from 31.3 percent at Johns Hopkins Hospital to 10 percent at the University of Maryland Medical Center.

The report used self-reported data from 281 fertility clinics that used technological methods of joining a sperm and an egg to achieve a pregnancy. All told, the clinics attempted 59,142 procedures, resulting in 11,315 live births.

In-vitro fertilization (IVF) accounted for the vast majority of these procedures. This is a method -- also known as a test-tube conception -- in which a woman's eggs and a man's sperm are retrieved and placed in a dish.

Several of the resulting embryos are implanted in the woman's womb in hopes that at least one will "take" and set a normal pregnancy in motion.

In 1995, 37 percent of all live births resulting from so-called "assisted reproductive technology" were multiple births, compared with 2 percent in the general population. The report also found that age was the most important factor determining success.

The success rate for women aged 21 to 34 was approximately 25 percent, the CDC said. It gradually fell to zero for women 47 and older. Women aged 36 and older were more likely to have success using donor eggs.

Rates varied greatly from center to center, and the CDC warned that clinics accepting couples with the most difficult fertility problems might have a lower success rate than those that select the most likely to succeed. This could have little bearing on the skill or training of the medical staff at the hospital with the lower rate, the agency said.

"We're really emphasizing not to compare the numbers," said Linda Swenarski, a CDC spokeswoman. "Some clinics treat the most difficult cases and some refuse to treat the most difficult cases. This is not a ranking at all. It is a real useful tool, so somebody can go in and interview a provider and ask, 'Why is your rate so low?' "

In metropolitan Baltimore, the "take-home baby" rates were: Johns Hopkins Hospital, 31.3 percent.

Fertility Center of Maryland, Towson, 21.5 percent.

Sinai Hospital, 18.6 percent.

Greater Baltimore Medical Center, 15.6 percent.

Union Memorial Hospital, 15.5 percent.

University of Maryland Medical Center, 10 percent.

These are adjusted rates, reflecting the the fact that some centers treat a disproportionate number of younger -- or older -- women. The resulting "age standardized" rate reflects what would happen if all the clinics had the same distribution of patients across the age spectrum.

The report is bound to arouse controversy. Already, some doctors were saying that the report unfairly penalizes some centers for taking on difficult cases.

Dr. Eugene Katz, director of in-vitro fertilization at the Greater Baltimore Medical Center, said GBMC's program suffers in a superficial comparison because 30 percent of its couples had trouble conceiving because of male infertility.

These patients tried a method, known as intracyctoplasmic sperm injection (ICSI), in which a single sperm cell is injected directly into the egg.

Success rates among these patients are generally about one-third lower than among couples whose problem stems from female infertility, he said.

Several programs in Maryland didn't accept any patients who were having problems with male infertility.

"Other hospitals didn't handle the very severe cases that needed ICSI," Katz said. "They were sent to us."

Katz said the CDC has promised to subject these cases to a separate analysis, so the overall success rates are not pulled down by these cases.

The CDC noted that the rates can be affected by several factors that are outside a center's control, including the length of time its couples have had trouble conceiving and the number of times the couples have tried and failed to conceive by high-tech measures.

Pub Date: 12/19/97

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