Grand Rapids Fertility & IVF assisted reproductive program results and research

Board Certified in Reproductive Endocrinology and Obstetrics and Gynecology

Women's Health Center
555 Midtowne St.
Suite 300
Grand Rapids, MI 49503
(800) 695-5941
(616) 774-2030

RESULTS AND RESEARCH The following results are from 2000 to 2008 and includes all patient cycles. While we include pregnancy rates in the data, it is Delivery Rates that are the most important outcome. Pregnancy is defined as a visualized intrauterine pregnancy with a fetal heart noted on vaginal ultrasound. Delivery is defined as the birth of a viable child. As IVF has become more successful over the years there has been a disturbing trend to triplet, quad or higher embryo number in some programs. We have always tried to avoid pregnancies with these "higher order" multiple embryos. In 2001 we recognized that our cryo embryo pregnancy rates were approaching the success rates of our fresh transfers. Based on this information we decreased the number of embryos transferred and increased the number and quality of the embryos cryo preserved. It is our goal to maximize the successful pregnancy rate per retrieval while avoiding higher order multiples. It is this number, live births per retrieval, we suggest patients pay closest attention to. It is not a statistic reported in the CDC data. We also attempt to avoid hyperstimulation syndrome (large ovaries and fluid imbalance) during pregnancy. In patients at risk for hyperstimulation syndrome we recommend cryopreserving all embryos and not doing a fresh transfer. In the 50 patients we have selected to cryopreserve all the embryos, the total pregnancy rate/retrieval was HIGHER than in similar patients who had a fresh embryo transfer. This data was presented at The Pacific Coast Reproductive Society in 2008. It is important to choose a program with a long term history of success and large enough to offer a full range of services. It is also important to choose one small enough to pay attention to you.

2010 - 6 month Preliminary Data (will only get better)

Data from all age groups

Retrieval - 31 (3 cancelled - 34 IVF starts)
Transfers - 27 Positive pregnancy test - 19 (79%) Ongoing fresh transfer pregnancy rate/Transfer = 12/27 (45%) Ongoing fresh transfer pregnancy rate/Retrieval = 12/31 (39%) Reasons for the 4 non transfers No viable embryos 1 (3%) Hyperstimulation /Symptoms 3 (10%) Subsequent Pregnancy from cryo embryo transfer (to date-incomplete) - 4 (22% to date) From the 3 no transfer patients - 2 transferred 2 ongoing pregnancies From the 15 patients without ongoing pregnancy - 2 ongoing pregnancies (10 patients with cryo embryos - 5 with transfers to date)
All cryo embryo transfer cycles
Thawed		24
Transferred		24
Positive Pregnancy Test		12
Ongoing Pregnancy		09
2000-2008 IVF Cycle Results
The 2000 to 2007 data includes all patient cycles regardless of prognosis. Prior to a cycle patients are evaluated as excellent (better than average), good (average) fair (below average), and poor (should not do IVF) prognosis (Prognosis is determined after evaluation). Some poor and many fair prognosis patients will elect to do an IVF cycle. These results are included. In general, an excellent prognosis patient, less than 35 years old, can anticipate a higher pregnancy rate than shown in the data. However, even in the best of circumstances there is no guarantee of pregnancy. Pregnancy is defined as a visible intrauterine pregnancy with a fetal heart noted on vaginal ultrasound 30-32 days post retrieval. This excludes many early non-viable pregnancies including the rare ectopic. Delivery is defined as the birth of a living child. I feel the most important information is the Delivery rate per Retrieval calculated from fresh and cryopreserved (cryo) embryo transfers (not collected in CDC data). This is the probability a patient will have a delivery from the embryos generated from one retrieval cycle. This data is presented in bold. There have been no triplet (or higher) pregnancies in 2006-2007

Patients <35 years of age	2000-2008

Cycles initiated	594
Retrievals (11.1% cancellation rate)	528
Pregnancy/retrieval (fresh transfer only)	197 (37.3%)
Delivery/retrieval (fresh transfer only)	181 (34.3%)
Delivery/retrieval (fresh and cryo embryo)	260 (49.3%)
Second Delivery from cryo embryos	32


Patients 35-37 years of age	2000 - 2008

Cycles initiated	185
Retrievals (17.3% cancellation rate)	153
Pregnancy/retrieval (fresh only)	54 (35.3%)
Delivery/retrieval (fresh only)	45 (29.4%)
Delivery/retrieval (fresh and cryo embryo)	67 (43.8%)
Second Delivery from cryo embryos	10


Patients 38-40 years of age	2000 - 2008

Cycles initiated	100
Retrievals (16% cancellation rate)	84
Pregnancy/retrieval (fresh only)	22 (26.2%)
Delivery/retrieval (fresh only)	17 (20.2%)
Delivery/retrieval (fresh and cryo embryo)	25 (293.8%)
Second Delivery from cryo embryos	2


Results from cryo transfer cycles in all age groups excluding embryo donation and donor oocyte cycles from 2000 to 2008:

Transfers 446	Pregnancies 153 (34.3%)	Deliveries 129 (28.9%)
We feel that the success of cryo embryo transfers equals the success of fresh embryo transfer for equivalent embryo quality. We therefore are less aggressive with fresh embryo transfer which means less risk of triplet and quadruplet pregnancy. While this lowers the immediate fresh pregnancy rate, the overall success rate is equal to or higher than in previous years. We believe more pregnancies are achieved with less risk. For the same reasons when significant ovarian hyper-stimulation occurs during the induction of the cycle we may elect not to transfer any fresh embryos and cryo preserve all the viable embryos. We will then rely on the cryo embryo transfer to achieve pregnancy. This approach has allowed us to establish more pregnancies at less risk to the mother.

Results from Donor oocytes cycles 2001 - 2008

Patient cycles 104	Deliveries, fresh and cryo embryo transfers 63 (60.6%)	Second deliveries 2004 - 2008 10


Results from Embryo donation cryos transfers 2001 - 2008

Cryoembryo transfer cycles 2001 - 2008 100	Deliveries 31 (31.0%)
Ultimately each patient/couple is unique and has their own prognosis. We try to counsel each couple about their chance of success and propose other options when expected success is less than ideal. Frequently for older women/couples this means consideration of donor oocytes (eggs). The success rate for donor oocytes is about 50%. The decision to use one's own oocytes at 10% versus a donor at 50% is not always an easy one.
Please Note: the availability of donated embryos is limited. Embryo donation using embryos from our program is only available to established patients at Grand Rapids Fertility & IVF We are happy to work with couples wishing to pursue embryo adoption who are not patients at Grand Rapids Fertility & IVF IF they can identify embryos from another source that meet FDA criteria.

Research Over the last 15 years our program has presented 15 papers at regional and nations meetings. Residents working with Dr. Daly have won 3 local, 1 regional and 2 national "best research" awards. We are presently one of two clinical sites enrolling patients in a study evaluating the impact of environmental pollutants, such as Dioxide, on sperm quality. This study is sponsored by Wayne State Medical School Dept. of OB-Gyn and the MSU College of Human Medicine Dept. of Epidemiology and is funded by a grant from the Epidemiology section of the NIH. We are actively recruiting participants for the study from our patient population. We continuously monitor our outcome data and try unique protocols in an attempt to improve outcome. Recently we developed a unique protocol for ovulation induction in patients with limited ovarian reserve. The data suggests that on average this protocol does not increase oocyte number but results in better quality oocytes. This results in more and higher quality embryos and higher pregnancy rate. Study A Previously we had established 17-OH Progesterone as a monitoring tool that we find helps predict the chance of success of an individual cycle and to a degree, the of risk of multiple pregnancy. We wish all patients with type 4 cycles would allow us to cancel the retrievals because of the low chance of success.

	cycles	cancel	trans #	pregnancy	delivery	miscarriage	implantation
type 1	120	0	3.95	66 (55%)	58 (48%)	8 (12%)	25.3%
type 2	50	2	4.65	17 (35%)	9 (19%)	8 (44%)	12.5%
type 3	36	3	3.70	17 (51.5%)	12 (36%)	5 (29%)	20.5%
type 4	62	22	3.00	2 (5%)	1 (2.5%)	1 (50%)	1.5%
			p<.05	p<.001	p<.001	p<.05	p<.001

Study B
We have recently evaluated the live birth rate/retrieval for patients we elected to cryoperserve all of their embryos rather than pursuing a fresh transfer. The "control group" were patients who had similar hormonal stimulation but whom we felt were at less risk for hyperstimulation syndrome. This study was presented at the Pacific Coast Reproductive Society in April of 2008. The results indicate that the patients who had all of their embryos cryopreserved had as good or better outcome (higher long term delivery rate from retrieved oocytes/embryos). Click Here for the presentation of this study

Click Here for printable Cost Form Click On a title for more Research Information (This information is included in a PowerPoint Show - If you are unable to view this presentation click here to download a free copy of PowerPoint Viewer) Donor Embryo and Oocyte Research Day OHSS Research Research Present Sperm Impact on Embryos Twin Study Presentation

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To our visitors: Dr. Daly has presented the material included in this website in the hopes that it will enlighten you on the subject of infertility. The contents of this website are meant for educational purposes only and are not meant to be construed as a guide for the treatment of an individual patient. Therefore, the suggestions that you read here may not apply to your own situation and do not take the place of advice from your doctor. Dr. Daly presents this information as is, without any warranty of any kind, express or implied, and is not liable for mistakes, errors, omissions, or for the results of any event that occurs based on direct reliance on this information.

RESULTS AND RESEARCH