Posted by: DD | September 24, 2007

no. 529 – Take It Or Leave It

I don’t do this but hardly ever, but I’m going to complain about a blog.

Some of you might read it: Infertility Blog by Dr. L1cc1arbi (sp). If you don’t read it but want to have something to refer to after you’re done reading her, you can find it at infertility blog (one word) dot blogspot dot com.

If you do decide to read the post by Dr. L., yes you will see I submitted my response anonymously. That’s why I didn’t provide any links.

He had a post recently which contained an article written by one of his former patients that will be published in a book to be released in a couple of months. This patient basically states to find the best IF treatment centers go online to sart dot org and do a comparison of success rates for the clinics near you.

For the uninitiated, this sounds like excellent and sage advice. If I’m lucky, I will find 2-4 clinics within my area; I can follow those links, and BAM! have my comparison for success rates for all the different kind of procedures each clinic provides. FYI: the Centers for Disease Control and Prevention publishes the same info to which I add this side note: anyone else find it particularly insulting that while the CDC tracks infertility treatment under the heading of Disease Control and Prevention, most insurance companies, family members and friends still consider ART elective and having children a "lifestyle choice"…I’m just saying….

The problem with the "comparisons" is there is no control group or requirements that detail anything more than the patient’s age when submitting data. My SIL tried to convince my husband we should get a consult with the clinic in Denver because their success rates are impressively sky-high Here’s what most people don’t know: many of these physicians maintain higher success rates by excluding women who have hormone levels over/under their "acceptable" ranges.

Admittedly, my clinic had us go through CD3 FSH testing (elevated levels of follicular stimulating hormone indicate limited reserves of eggs), a HCG (hysterosalpingogram to check for tube-blockage and uterine anomalies) and a SA (sperm analysis). These tests were not performed in order for us to be accepted as patients with my clinic, but to provide the most efficient treatment plan possible depending on our level of infertility, even if that meant referring us to other options including foster parenting or adoption.

That’s what a physician is expected to do when treating an Illness or Disease.

Instead you have these clinics who place limitations on who they accept and suddenly and effectively they have taken the word Disease and made it a mockery by declining treatment to someone who truly needs it. On the other hand, if he takes on this difficult patient, he risks lowering his standings with SART.

Imagine if an Oncologist was allowed to do the same. "Oh, your cancer has spread into your central nervous system and liver. Yeah, well, the possibility of remission is rather slim so you will have to seek treatment elsewhere as you don’t pass my minimum level of success." I’d have my pitchfork at the ready if I heard of something so shameful and disrespectful to another person’s illness just for the sake of a bottom line and reputation.

The better advice to couples about selecting their RE is really no different than how you should select any medical specialist: by both your physician’s suggestion and opinions and by word of mouth. I didn’t know of the CDC or SART reports before I made my final choice of the two clinics available in Nebraska. It’s no coincidence that the clinic that came highyl recommended is also the clinic that has the higher success rate overall. It’s too easy to "doctor" the stats to make a reproductive clinic more appealing on paper. Go with the recommendations. Go with your gut. And if you walk in the door and something doesn’t feel right, walk out. It’s your time. Your dollars.

Sometimes it’s easy to ignore the flaws when you’re looking at your RE and the staff through baby-colored glasses, but if you can’t stand your doctor; or trust him/her to have your best interests at heart; or if you feel they are taking you on (or rejecting you) because of how you fit into their fiscal spreadsheet, move on. That’s my advice.

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Responses

  1. Very good advice.

    When I first started researching IVF 15 years ago, the only doctor in my direct area also had a very high success rate for the very reason you stated – he picked and choosed his patients. (choosed? yes I know it’s not a word) He didn’t tell us that, but MFH picked up on it. We chose not to pursue that route, obviously, even though he was willing to work with me. Gee, I felt so lucky.

  2. The statistician in me seconds your public warning! Always remember the first rule of statistics: Figures lie, and liars figure. You can make the numbers say anything you want them to say if you spin them the correct way.

  3. As usual, very good point. I’ll be interested to see what Licciardi’s response is. (I had a consult with him a few years ago. He’s a great doctor and a really nice guy.)

  4. Exactly what you said.

    And by the way, did you read the 4th comment on that post? Let me quote it in part:

    “I suffered with infertility for over a year. I’m 24 and had hypothalamic amenorrhea presumably related to weight loss but my doctor wasn’t exactly sure. My FSH was normal, LH low and E2 extremely low (below 20). After one cycle of follistim + HCG + timed intercourse I’m 15 weeks pregnant with quadruplets.”

    Yeah. I know that we try to stay away from the “suffering Olympics,” but . . . wow.

  5. THANK YOU! You took the words right out of my mouth. Everyone really should know and understand this!!

  6. I stupidly didn’t even research my REI before I went. My GYN highly recommended him so I made the appointment. It was a tip-off that he was very popular that it took three months before they could get me in for my initial consult. Only later did I find out he was the most popular REI in Dallas. But I still didn’t pay much mind to his statistics – I simply trusted him when he said he thought we had an excellent chance and that he could help us. I just thought there were too many different factors – how could I compare with the others when I didn’t know if our situations were remotely similar?

  7. I thought the same damn thing when I read that post.

    Plus I find him irritating. He’s just that tiiiinnny bit too snug in how good he is and how RE’s elsewhere are falliable creatures.

    Clinics here do the same shit, pardon my french, expressing their ‘success’ rates in different ways so they can ALL claim to be the best in the country. Clearly not possible.

    ARgh.

  8. Not only that, he gets his stupid math wrong! Guess what, 52% success out of 356 patients doesn’t equal 52 babies out of 100 women. Note that he also doesn’t mention who Clinic X accepts, could be anyone, with any problem.

    Of course a clinic who only takes women under 35 is going to have a higher success rate – you don’t need to be a rocket scientist to figure that out!

    My clinic has some pretty frickin’ good stats and they accept just about everyone…

  9. Stats can be very misleading at the best of times.

    If I had it to do over, I would have gotten at least gotten a second opinion after a years worth of failed cycles. Sometimes a different point of view is in order even if a doc is good. I was too frantic about “time” to “waste time” looking for a new clinic. A bit shortsighted in hindsight.

  10. Disturbing indeed! In my field there is something similar. I teach at a public school with a lot of issues… and in TEXAS. Not to get political, but the Republican leadership is basically trying to get rid of public education. They cite “charter school” data where students outperform public school peers. They neglect to include that these charter schools can remove students for any reasons (learning disabilities, behavior problems..etc.), whereas we must teach the students that walk through the door. Sorry for the OT comment. But yeah, that data should include the ages of the women and their particular reproductive challenge.

  11. Yes this is one of the disadvantages of having “choices” with health care, that eutphemism for “competition in inappropriate settings”.

    I am always astounded by how many people take the success rates on board.

  12. You don’t think the SA wasn’t just for the sheer fun of having your hubby spank in a cup? I know it is “standard procedure” for REs, but if I have been pregnant twice in a year, does he really need an SA? The problem pretty much is ME, ME, ME right?
    He wanted to shoot dye up my bajingo, too. Big surprise: everything was perfectly normal.

  13. You don’t think the SA wasn’t just for the sheer fun of having your hubby spank in a cup? I know it is “standard procedure” for REs, but if I have been pregnant twice in a year, does he really need an SA? The problem pretty much is ME, ME, ME right?
    He wanted to shoot dye up my bajingo, too. Big surprise: everything was perfectly normal.

  14. Good advice. I remember being so nervous about what my RE would think of me that I didn’t stop to worry about what I thought of him. (Fortunately, I thought he was great.)

    I will say this though: here in NYC, I’ve had friends who’ve chosen not to go to the big clinics because they found them too large and impersonal only to wind up at truly substandard clinics that did things like recommend a year on Clomid (a year!) or never ran an HSG.

    I think the most important thing about the CDC stats is not the success rates (which, as you say, are almost meaningless), but the number of patients served.

  15. interesting! I never realized that this happens. Makes sense of course, but since there’s only one RE here and the nearest clinic at a teaching/research hospital we didn’t have to worry much.

  16. I completely agree with you. I think those statistics are only useful up to a point and there is some information in there that’s useful (such as the percentage of the types of patients they see) but there’s certainly no guarantee of YOUR success rate just because you go to a clinic with a reported high success rate.


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