Reporting in vitro fertilization cycles to the Society for Assisted Reproductive Technology database: Where have all the cycles gone?

Objective To assess the relationship between live birth rates (LBRs) and the incidence of under-reported cycles by IVF clinics. Design Cohort study. Setting Not applicable. Patient(s) All patients undergoing IVF cycles in the aforementioned clinics. Intervention(s) Not applicable. Main Outcome Measure(s) The reporting percentage (RP), defined as number of cycles with reported pregnancy rates divided by total cycles performed. Results from cryopreservation cycles are only presented by SART if an embryo transfer occurs. Thus, RP decreases as incidence of embryo or oocyte banking cycles increases. The LBRs in women aged <35 years were compared between clinics. Result(s) The median RP of all clinics was 93%-97%. Clinics with RP <80% increased from 2 in 2004 to 30 in 2012. Twenty-one clinics had an RP that fell 2 standard deviations below the mean in any year. Over the 9 years, there was a negative correlation between RP and LBR of -0.17, but for the 21 outlier clinics the correlation increased to -0.26. In 2012 alone, in outlier clinics, for every 10% drop in RP there was an associated rise in LBR of 4.3%; some clinics reported 40% fewer cycles than the median. Conclusion(s) In clinics with very low RP, the cycles that are reported have higher success rates. Regardless of intent, the reduction of reported data to SART makes it increasingly difficult for clinicians and patients to accurately assess a clinic's success rates.