Top 10 Fertility Centers
1. Colorado Center for Reproductive Medicine, Englewood
Number of ART cycles and transfers in 2002: 912 (Nearly all ART cycles use IVF. If a patient uses donor eggs or frozen embryos, the CDC labels the procedure a transfer rather than a cycle.)
Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 60% (under age 35), 51% (ages 35-37), 44% (ages 38-40), 23% (ages 41-42)
Boasts 2002 IVF success rates that are twice the national average for women ages 38 to 42 who are using their own eggs
Is researching ways to improve the chance of pregnancy for patients with endometriosis or polycystic ovarian syndrome
Attracts 40% of its patients from outside the Colorado area
For most women trying IVF, physicians return two to seven fertilized eggs, called embryos, hoping one will implant. But about 30% of women who become pregnant are carrying twins, and 7% are expecting triplets or more. "Twin pregnancies are at a three- to five-fold greater risk for pregnancy complications and perinatal mortality [death between 28 weeks gestation and a week after delivery] compared to carrying one fetus. With triplets, there's at least a seven-fold greater risk," says Eric Surrey, M.D., medical director of the Colorado Center for Reproductive Medicine (CCRM) and president of the Society for Assisted Reproductive Technology, a top group in the field.
Dr. Surrey's team recruited patients, 48 in two years, between ages 26 and 48 to study the feasibility of returning just one embryo. "This is common in some Western European countries, but the success rate is about 30% to 35%," says Dr. Surrey. "We wanted to see if we could improve on those rates."
Earlier work at CCRM paved the way for embryos, which used to be returned three days after fertilization, to develop into blastocysts, a process that takes about two more days. Waiting longer gives doctors a better idea of the embryos' quality and helps them decide which one has the best chance of survival.
Half the women in the study received one embryo, and the remainder got two. All were given the option of freezing leftover embryos for use at another time. In the group receiving a single embryo, 61% had a clinical pregnancy (a heartbeat shown on ultrasound) and there were no twins. By comparison, the ongoing pregnancy rate in the group receiving a pair of embryos was 76%, but nearly half the pregnancies resulted in twins. "The slightly lower chance for pregnancy in the single-embryo group outweighs the significant risks associated with multiples," says Dr. Surrey. "Larger trials will more carefully define just who the ideal candidates for this approach will be."
2. The Center for Reproductive Medicine and Infertility at NewYork-Presbyterian Hospital/Weill-Cornell Medical Center, New York City
Number of ART cycles and transfers in 2002: 2,012
Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 48% (under age 35), 43% (ages 35-37), 30% (ages 38-40), 18% (ages 41-42)
Is one of the most experienced centers in the U.S., with 11,000-plus babies born through conventional IVF and 4,000 through ICSI -- a technique that injects a single sperm into an egg; ICSI, invented by the center's lab director, is a must for couples with severe male factor infertility
Specializes in preserving fertility in cancer patients
Performed the first genetic testing on embryos for sickle cell anemia and retinoblastoma, an inherited eye cancer
Priding themselves on a difficult caseload, doctors at The Center for Reproductive Medicine and Infertility (CRMI) conduct more than one-third of their IVF cycles on patients who have had two or more failed attempts at other clinics. "Other fertility specialists send us their patients who haven't gotten pregnant," says the clinic's director, Zev Rosenwaks, M.D.
Because many couples who have experienced several unsuccessful cycles want to put back more embryos than they did on the first few tries, the center's triplets rate in women ages 35 to 37 is the highest of our top 10. But its live-birth rate using non-donor fresh embryos is remarkable: 30% to 70% above the national average, depending on the woman's age. How is that possible? In a word: research. Since 2002, the center has published more than 200 studies in medical journals -- the most of our survey. Among them: autologous human endometrial co-culture, which means growing a couple's embryos on a woman's endometrial cells instead of in the standard IVF liquid.
Before starting an IVF cycle, a woman undergoes an endometrial biopsy, in which a small piece of her uterine lining is removed. The sample is frozen until the next month, when the woman's eggs are retrieved, fertilized, and put on her endometrial cells to grow. A study by CRMI researchers on 1,000-plus patients, who on average had three failed IVF attempts, found the technique improved embryo quality and resulted in an impressive clinical pregnancy rate of 42%.
3. University Fertility Consultants at Oregon Health & Science University, Portland
Number of ART cycles and transfers in 2002: 505
Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 34% (under age 35), 39% (ages 35-37), 34% (ages 38-40), 7% (ages 41-42)
Reported the first live birth from an ovarian tissue transplant in a primate, paving the way for cancer patients to freeze their ovarian tissue before treatment
Minimizes high-risk pregnancies; while the center's live-birth rate for women ages 35 to 37 undergoing IVF with their own eggs is about 25% above the national average (39% vs. 31%), its percentage of pregnancies with multiple fetuses is roughly half the average in that age range
Boasts a very experienced lab staff
Some fertility centers don't allow women to try IVF with their own eggs if their level of follicle stimulating hormone (FSH) is over 10. FSH, produced by the pituitary gland, causes eggs to mature; a high level of it, measured on the third day after menstruation begins, may indicate that few eggs are left in the ovaries.
But physicians at University Fertility Consultants routinely take patients whose FSH is up to 15. In a recent study of 350 women over age 35, they found that the clinical pregnancy rate for women with FSH levels of 10 to 15 was about 33% -- below the 42% pregnancy rate when a patient's FSH is under 7, but still pretty good. "My overall success rates are lower because about 25% of the women in my caseload have high FSH levels," says the center's director, Kenneth Burry, M.D. "But I don't feel comfortable referring patients for egg donation when they have a reasonable chance of success using their own."
4. New York University School of Medicine, Program for In-Vitro Fertilization, Reproductive Surgery, and Infertility, New York City
Number of ART cycles and transfers in 2002: 1,362
Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 45% (under age 35), 42% (ages 35-37), 24% (ages 38-40), 17% (ages 41-42)
Sees many difficult cases; about 70% of patients have failed at least one IVF cycle elsewhere
Offers a patient library equipped with computers
Is developing an egg-freezing program
Thirteen years ago, Jamie Grifo, M.D., Ph.D., was the first fertility specialist in the U.S. to successfully perform pre-implantation genetic diagnosis (PGD), the screening of an embryo for a specific inherited condition, such as cystic fibrosis. "It's heartbreaking to talk to couples whose children have died from a genetic disease," says Dr. Grifo, director of the division of Reproductive Endocrinology at New York University. "They tell me they couldn't go through it again -- all they want is a healthy baby."
Dr. Grifo, who has been at NYU for the last 10 years and did his early work with PGD at Yale and Cornell, has begun to apply the technique to women who have suffered recurrent miscarriages. "We're searching for abnormalities in chromosomal numbers, and often we find them," he explains. "Last year, I started one of my patients, who had gone though five miscarriages, on an IVF cycle. She produced 11 eggs, which fertilized. When we checked them, we found that only two were normal. We put both back, one implanted, and she gave birth recently."
In fact, more than 70 babies have been born to NYU clients using the technique -- which involves making a hole in the outer coating of the embryo and removing a single cell for analysis -- and the clinical-pregnancy rate per cycle is about 40%. "If done properly, it really doesn't make the embryo much less likely to implant," he says. What about future consequences? Although long-term effects are still unknown, a recent study of 754 PGD babies suggests that they're no more likely to have birth defects than children conceived conventionally.
5. The Infertility Center of St. Louis at St. Luke's Hospital
Number of ART cycles and transfers in 2002: 176
Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 35% (under age 35), 26% (ages 35-37); there were too few cycles in women ages 38-42 to report the results as a percentage
In 2002, performed the greatest percentage of IVF cycles due to male factor infertility of any center in the country; many cases involved very complex problems
Has completed more than 4,000 microsurgical vasectomy reversals over the last 30 years, reporting in a recent study that nearly 90% of patients were able to impregnate their partners
Conducted the world's first ovarian transplant, in which an infertile identical twin was given one of her sister's ovaries; the woman had a healthy baby girl in June
Over the last 30 years, Sherman Silber, M.D., founder of the Infertility Center of St. Louis, has published more than 200 studies on infertility, pioneering or advancing techniques that help men with little or even no sperm become fathers. Much of his research has focused on the estimated 2% to 5% of infertile men with congenital absence of the vas deferens, a condition in which the tubes that carry sperm from the testes haven't developed normally. "These men make sperm, but it's not in the ejaculate," says Dr. Silber. "We do a procedure to extract sperm from the testicles."
He's usually able to retrieve sperm to fertilize eggs through ICSI (see page 3 for ICSI description). He often recommends that couples in this situation have their embryos screened for genetic abnormalities since a higher percentage of them may contain the wrong number of chromosomes even though they look normal. "By doing the testing, we can boost the chance of a live birth from about 35% to 45%," he says.
Filling his practice with extraordinarily difficult cases has taken a toll on Dr. Silber's success rates, but he doesn't mind. "For me, it's not about the numbers," he says. "It's about giving couples what they want most -- a child."
6. The Nevada Center for Reproductive Medicine, Reno
Number of ART cycles and transfers in 2002: 281
Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 52% (under age 35), 49% (ages 35-37), 38% (ages 38-40); there were too few cycles in women ages 41-42 to report the results as a percentage
Is testing a new form of progesterone -- a hormone that helps sustain a pregnancy -- to see if it's better than the types currently available
Has a successful donor-egg program; the 2004 pregnancy rate approached 70% for fresh embryos in women of all ages
Arranges travel and sightseeing for out-of-town patients
Doctors can often tell by the quality of the blastocysts -- embryos that have been grown for about five days -- how likely a patient is to get pregnant. "But in some older patients who have repeated failed cycles, the blastocysts look beautiful," says Russell Foulk, M.D., director of the Nevada Center for Reproductive Medicine.
Dr. Foulk and other researchers working with the National Institute of Child Health & Human Development may have figured out what's causing the problem for at least some of these patients. They found that at the time of implantation, the blastocyst expresses much larger amounts of a protein called L-selectin than it does beforehand. If a woman's uterus doesn't have receptors for this protein, Dr. Foulk theorizes, the blastocyst won't attach. "I've started doing uterine biopsies recently and discovered that two of my patients lacked these receptors," he says. "One of them had nine unsuccessful transfers -- all with good-looking embryos."
Future studies may confirm that checking for the receptors should be part of fertility screening. If that happens, Dr. Foulk says, some couples may avoid repeated failed cycles. Rather, they could consider surrogacy or adoption from the start.
7. Presbyterian Hospital ARTS Program, Dallas and Plano, TX
Fertility test results
Number of ART cycles and transfers in 2002: 1,180
Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 49% (under age 35), 38% (ages 35-37), 23% (ages 38-40), 12% (ages 41-42)
Is studying whether antibodies in a woman's blood affect her ability to get pregnant
Offers an incentive program for the transfer of a single embryo to patients (age 37 or under if using their own eggs) who have two or more blastocysts; 200-plus couples have signed up, and more than six in 10 have conceived on the first try
Has a policy that embryologists, in conjunction with nurses or administrative staff, give couples trying IVF a daily status report on how well their embryos are growing
Since about 90% of genetic abnormalities are caused by the egg alone, doctors in the Presbyterian Hospital ARTS Program are studying the feasibility of routine analysis of polar bodies, which are formed outside the egg after fertilization. "These are waste products -- they degenerate within one to two days -- but they provide mirror images of what's inside the egg," says scientific director Marius Meintjes, Ph.D. "With them, we can look for genetic problems, passed on by the mother, that would make the resulting embryo less likely to implant or more likely to cause a miscarriage."
Why might it be more beneficial to do that than screen the embryo for genetic problems, especially when you can't detect abnormalities passed on by the father? The test has no chance of damaging the embryo, unlike pre-implantation genetic diagnosis, which requires the removal of a small piece of the embryo.
8. Florida Institute for Reproductive Medicine, Jacksonville
Number of ART cycles and transfers in 2002: 832
Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 44% (under age 35), 40% (ages 35-37), 33% (ages 38-40), 17% (ages 41-42)
Cancels a low percentage of cycles, which suggests a good response to treatments
Is one of a handful of centers that publish comprehensive results on their Web sites
Has persuaded drug companies to donate medications for the institute's cancer patients who are freezing their eggs, saving each person about $3,000
When a woman doesn't conceive on her first IVF cycle using fresh embryos, she may be able to try again at about one-fifth the cost if she has embryos to freeze. The Florida Institute for Reproductive Medicine is a leader in freezing techniques, called cryopreservation. "Most of our patients get enough high-quality embryos to have one fresh and one or two frozen cycles, adding a great deal to their cumulative chance of conceiving at a reasonable cost," says Kevin Winslow, M.D., the center's director.
What the center has learned from embryos over the years has also helped them freeze unfertilized eggs for more than 200 patients, and they are continuing to study the technique to pinpoint the optimum environment for frozen eggs. "We have 33 babies born and nine ongoing pregnancies with this technique to date -- the most of any center in the country," says Dr. Winslow.
Egg freezing is an option for cancer patients who want to preserve their fertility or those who fear they will be too old to conceive before they're ready to start a family. "But we only do it for women 38 and under," says Dr. Winslow. "After that, the eggs aren't of high-enough quality to freeze."
9. Southern California Reproductive Center, Beverly Hills
Number of ART cycles and transfers in 2002: 217
Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 68% (under age 35), 56% (ages 35-37), 26% (ages 38-40), 21% (ages 41-42) (These numbers refer only to the practice of Hal Danzer, M.D.; occasionally, fertility centers provide the government with statistics based on the practice of individual physicians rather than the overall center.)
Reported no pregnancies with triplets or greater in 2002 for women under 35 despite the fact that the live-birth rate for these patients was nearly twice the national average
In 2002, performed 98 of its IVF cycles on patients who had at least two previous failed attempts
Constructed a state-of-the-art lab with triple-gas incubators and a sophisticated air-filtration system to promote the best environment for growing embryos
Once a couple's embryos are ready, doctors put them in a woman's uterus, where the hope is that they'll implant -- a process called embryo transfer. "Most transfers are easy. But in about 10% of patients, pinpointing the placement of embryos is difficult because of the shape or position of the uterus," says Hal Danzer, M.D., a reproductive endocrinologist at the Southern California Reproductive Center (SCRC). The center is one of the few nationwide that use four-dimensional ultrasound for every transfer; it provides 3-D images in real time. A new SCRC study on more than 100 patients suggests the new technology does slightly increase pregnancy rates.
Another way the center makes transfers smoother: "Before every transfer, women are given the option of having an acupuncture treatment to help them relax," says Dr. Danzer. "Some research suggests that acupuncture helps improve pregnancy rates in women undergoing IVF."
10. Center for Reproductive Medicine of New Mexico, Albuquerque
Number of ART cycles and transfers in 2002: 183
Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 57% (under age 35), 55% (ages 35-37), 29% (ages 38-40); there were too few cycles in women ages 41-42 to report the results as a percentage
Opened in 1986, making it one of the oldest fertility centers; at that time, there were approximately 40 centers in the U.S., compared to the more than 400 today
Is one of five U.S. facilities collaborating on the development of quality-control measures in the analysis of sperm samples
Boasts a 2002 live-birth rate of 72% for fresh embryo transfers from donor eggs, above the national average of 50%
Running the Center for Reproductive Medicine of New Mexico in a poor state that doesn't require insurers to cover infertility, Jim Thompson, M.D., focuses on giving patients value for their money. "My exam rooms and waiting areas have no frills," says Dr. Thompson, the center's director. "Instead, we try to keep our costs low and our success rates high."
He seems to be doing a good job at both: In 2002, the center's live-birth rate for women ages 35 to 37 using their own eggs was about 70% above the national average -- 55% compared to 30% -- though its price for a standard IVF cycle (not including medications) is $8,500, less than the typical charge. He also has stellar success rates for women under age 35 and those who are 38 to 40 years old.
Judging for Yours |
发表于 2015-11-14 23:04
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