Fertility stories are always filled with emotion, uncertainty, and controversy -- childless couples who would make great parents, thrifty insurers who refuse to pay for treatments even though infertility stems from a medical problem, and ethical dilemmas that would make Hippocrates' head spin. So when we embarked on the search for the best fertility centers in the country almost two years ago, we were prepared for challenges. But we didn't expect that they would be nearly insurmountable.
Our goal was to rank centers based largely on their success rates with in-vitro fertilization (IVF), a form of assisted reproductive technology (ART) that involves removing eggs from a woman's ovaries and combining the eggs with sperm. We asked medical experts for advice, as we always do for our 10 Best investigations. But top fertility groups, unlike organizations in other rankings we've undertaken, didn't cooperate.
Still, with the help of several doctors and a pile of studies, we persevered and in 2004 sent an extensive survey to more than 75 of the nation's 400-plus centers that met our initial criteria, which included having a certified laboratory and maintaining at least average live-birth rates without high rates of triplets. Our data on these centers came from the Centers for Disease Control and Prevention (CDC), which publishes success rates for most clinics at www.cdc.gov/reproductivehealth.
The problem: Just a handful of centers returned the form. While some claimed they didn't have time to fill it out, others said they didn't want to release the information. A representative of one well-known center wrote: "They [the administrators] felt that they needed to reveal too much info about the clinic. They felt that a lot of the questions in the survey ask for things that they don't even have to provide to the CDC."
Our response: Wasn't that the point? The CDC's report gives consumers only a partial picture -- for instance, it doesn't publish success rates at individual fertility centers by diagnosis even though the chance of bringing home a baby ranges from 14% to 34% depending on the reason for infertility -- and it doesn't tell consumers whether a center handles a large or small percentage of difficult cases, which influences its success rates. "A huge number of clinics select the most favorable cases to make their success rates look good," says Sherman Silber, M.D., author of How to Get Pregnant With the New Technology.
We felt the public deserved better, given that treatments for infertility are emotionally draining, financially devastating, and may even pose a risk to a woman's health because there hasn't been a definitive assessment of the long-term consequences of taking fertility medications (although studies thus far have been reassuring). So this spring we sent smaller surveys to centers that had achieved high live-birth rates without high triplets rates. Like the initial questionnaire, this one examined the complexity of the cases, research endeavors, and range of services. Between the two surveys, nearly 40 centers replied.
While lack of cooperation put limits on this special report, it's nevertheless the first-ever data-driven comparison of fertility centers. Read on to learn about our 10 winners, where medical breakthroughs happen routinely. (If your case isn't difficult, a local facility may be best for you. For guidance on evaluating your options, see "Judging for Yourself").