Understanding Fertility Stats for the 40+ age bracket

[Anonymous]

These are the stats for 2018

CCRM

SART https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=1902#patient-subsequent-attempt
CDC https://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&ClinicId=49&ShowNational=0&islCycleTypes=T002

RSC

SART https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=2351#patient-subsequent-attempt
CDC https://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&ClinicId=18&ShowNational=0&islCycleTypes=T002


When I look at the SART data, with own eggs and frozen cycle, I am surprised at how successful RSC seems to be for the 40+ age bracket. Practically on par or better than CCRM, even going back a few years. This makes me wonder what they both might have in common.

So then I check out their donor egg statistics in SART, and I find that RSC has better statistics across fresh and frozen eggs as well as fresh and frozen embryos (CCRM seems less likely to use fresh eggs per their stats though).

When I jump to the CDC data for the two, in the success with own eggs section, again RSC and CCRM seem to be on par with each other with less that 5% point difference. RSC has an edge with % of egg retrievals resulting in live births, while CCRM has an edge with % of transfers resulting in live births. So I'd assume CRRM has better implantation success?

Jumping to the Donor egg stats for both from CDC, it appears that CCRM has a clear preference for using frozen embryos and has a slightly more success rates than RSC in this category. But RSC has a really high success rate across all 4 sub-categories of donor eggs.

I am planning on talking to both of them, but the appointments are more than a month away. Will update here once I do.

But meanwhile, if it were you, just based on these statistics, which clinic would you choose?

PS. Cornell statistics were much lower across all categories compared to RSC and CCRM.

[Anonymous]

FWIW, in my conversation with both CCRM as well as RSC, I intend to ask/probe into how they report their statistics.

Two potential issues I came across on DCUM, that could skew statistics were

- rejecting a certain pool of candidates outright based on their diagnostic profile
- not including a certain pool of 'difficult to treat' candidates in the SART/CDC stats, indicating them to be as participants research studies


Are there any other ways data can be skewed?

[Anonymous]

It’s really depends on if you’ve given birth or not.

[Anonymous]

Stats can be manipulated- mainly by cancelled cycles or not taking on “harder” patients. The most important thing is how they decide protocols and if they are willing to zig/zag/try new things (like mini stim or estrogen priming) for women over 40. Many will not and take your money over and over again and shrug when you fail.

Secondly is lab quality. I am now convinced after many many years of cycling and days away from having my second DD that the lab is essential. If you arent making blasts it could be lab quality - i was always told nope it was a me problem.

[Anonymous]

Anonymous wrote:Stats can be manipulated- mainly by cancelled cycles or not taking on “harder” patients. The most important thing is how they decide protocols and if they are willing to zig/zag/try new things (like mini stim or estrogen priming) for women over 40. Many will not and take your money over and over again and shrug when you fail.

Secondly is lab quality. I am now convinced after many many years of cycling and days away from having my second DD that the lab is essential. If you arent making blasts it could be lab quality - i was always told nope it was a me problem.

OP here. What do you look for when evaluating lab quality? Is it a lab with its own donor program, and good stats related to it (like some posters on DCUM say)? To me though, it seems like donors are usually young and have a good diagnostic profile, so the stats would be better by default if you have an extensive donor program.

So should we look at successful transfer rates? In this case, I would want to know how many cancelled cycles they have.

How else would you evaluate for a good lab?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Stats can be manipulated- mainly by cancelled cycles or not taking on “harder” patients. The most important thing is how they decide protocols and if they are willing to zig/zag/try new things (like mini stim or estrogen priming) for women over 40. Many will not and take your money over and over again and shrug when you fail.

Secondly is lab quality. I am now convinced after many many years of cycling and days away from having my second DD that the lab is essential. If you arent making blasts it could be lab quality - i was always told nope it was a me problem.

OP here. What do you look for when evaluating lab quality? Is it a lab with its own donor program, and good stats related to it (like some posters on DCUM say)? To me though, it seems like donors are usually young and have a good diagnostic profile, so the stats would be better by default if you have an extensive donor program.

So should we look at successful transfer rates? In this case, I would want to know how many cancelled cycles they have.

How else would you evaluate for a good lab?

PP here - honestly you need to search fb groups and message boards like this. Also really press for protocol answers - i have only had success when I went to places that would work outside the box. I’ve been DOR since the age of 34 (i’m now 42 and 38 weeks along w #2) and i started at a clinic that was a literal factory. I was a tough case even at 34 and they wasted 2 cycles and used all my insurance allotment at the time. I have a weird issue where my body LOVES so ovulate thru suppression (even on an antagonist cycle) and the bigger places would not listen. We moved to NYC after a job transfer and luckily had DD with Sher Fertility there after they agreed to give me double doses of centroide - it worked. Due to covid with #2 we lost a few years and went again to another bigger factory that was fully up and running and same thing again - ovulated thru stims twice / got the the run around about how they don’t believe thats a thing (um well it is for me). Went to Gen Next as a last ditch, they were open to mini stim and had me monitored twice a day the last few days and low and behold they caught a surge 24 hours before i was supposed to trigger. They had me in for an emergency retrieval the next day and got 5 of 7 follicles (they all would have been long gone) and here i am 38 weeks. It is trial and error but you must be someplace that will listen and try things out. Just my 2 cents.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Stats can be manipulated- mainly by cancelled cycles or not taking on “harder” patients. The most important thing is how they decide protocols and if they are willing to zig/zag/try new things (like mini stim or estrogen priming) for women over 40. Many will not and take your money over and over again and shrug when you fail.

Secondly is lab quality. I am now convinced after many many years of cycling and days away from having my second DD that the lab is essential. If you arent making blasts it could be lab quality - i was always told nope it was a me problem.

OP here. What do you look for when evaluating lab quality? Is it a lab with its own donor program, and good stats related to it (like some posters on DCUM say)? To me though, it seems like donors are usually young and have a good diagnostic profile, so the stats would be better by default if you have an extensive donor program.

So should we look at successful transfer rates? In this case, I would want to know how many cancelled cycles they have.

How else would you evaluate for a good lab?

PP here - honestly you need to search fb groups and message boards like this. Also really press for protocol answers - i have only had success when I went to places that would work outside the box. I’ve been DOR since the age of 34 (i’m now 42 and 38 weeks along w #2) and i started at a clinic that was a literal factory. I was a tough case even at 34 and they wasted 2 cycles and used all my insurance allotment at the time. I have a weird issue where my body LOVES so ovulate thru suppression (even on an antagonist cycle) and the bigger places would not listen. We moved to NYC after a job transfer and luckily had DD with Sher Fertility there after they agreed to give me double doses of centroide - it worked. Due to covid with #2 we lost a few years and went again to another bigger factory that was fully up and running and same thing again - ovulated thru stims twice / got the the run around about how they don’t believe thats a thing (um well it is for me). Went to Gen Next as a last ditch, they were open to mini stim and had me monitored twice a day the last few days and low and behold they caught a surge 24 hours before i was supposed to trigger. They had me in for an emergency retrieval the next day and got 5 of 7 follicles (they all would have been long gone) and here i am 38 weeks. It is trial and error but you must be someplace that will listen and try things out. Just my 2 cents.

OP again, just curious. How does mini stim/suppression align with double doses of cetrotide? How does that work - I thought low stim was all about lower dose medications.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Stats can be manipulated- mainly by cancelled cycles or not taking on “harder” patients. The most important thing is how they decide protocols and if they are willing to zig/zag/try new things (like mini stim or estrogen priming) for women over 40. Many will not and take your money over and over again and shrug when you fail.

Secondly is lab quality. I am now convinced after many many years of cycling and days away from having my second DD that the lab is essential. If you arent making blasts it could be lab quality - i was always told nope it was a me problem.

OP here. What do you look for when evaluating lab quality? Is it a lab with its own donor program, and good stats related to it (like some posters on DCUM say)? To me though, it seems like donors are usually young and have a good diagnostic profile, so the stats would be better by default if you have an extensive donor program.

So should we look at successful transfer rates? In this case, I would want to know how many cancelled cycles they have.

How else would you evaluate for a good lab?

PP here - honestly you need to search fb groups and message boards like this. Also really press for protocol answers - i have only had success when I went to places that would work outside the box. I’ve been DOR since the age of 34 (i’m now 42 and 38 weeks along w #2) and i started at a clinic that was a literal factory. I was a tough case even at 34 and they wasted 2 cycles and used all my insurance allotment at the time. I have a weird issue where my body LOVES so ovulate thru suppression (even on an antagonist cycle) and the bigger places would not listen. We moved to NYC after a job transfer and luckily had DD with Sher Fertility there after they agreed to give me double doses of centroide - it worked. Due to covid with #2 we lost a few years and went again to another bigger factory that was fully up and running and same thing again - ovulated thru stims twice / got the the run around about how they don’t believe thats a thing (um well it is for me). Went to Gen Next as a last ditch, they were open to mini stim and had me monitored twice a day the last few days and low and behold they caught a surge 24 hours before i was supposed to trigger. They had me in for an emergency retrieval the next day and got 5 of 7 follicles (they all would have been long gone) and here i am 38 weeks. It is trial and error but you must be someplace that will listen and try things out. Just my 2 cents.

OP again, just curious. How does mini stim/suppression align with double doses of cetrotide? How does that work - I thought low stim was all about lower dose medications.

Two different cycles - years apart. When i was 36 i was on high dose stims 300 gonal/2 menopur every day. I needed the double centroide not to ovulate. Was successful and had DD. When i was 40 and 41 was also put on high dose stim protocols but not given extra suppression. Ovulated early both times - was very angry was brought to ER anyway even though E2 had plummeted.

Last cycle and only mini stim at 42 - was double MONITORED twice a day to rule out a natural early surge. And low and behold it happened. ER was moved up immediately to align with that surge, not the trigger shot. That cycle I am currently expecting with.

Two different clinics but who listened. The factories were before and in the middle of my successful cycles.