What do consistently high-performing in vitro fertilization programs in the U.S. do?

ObjectiveTo identify common clinical and laboratory practices among consistently high-performing IVF programs.DesignQuestionnaire study of selected IVF programs.SettingAcademic and private practice IVF programs.Patient(s)Ten of 12 programs identified as having consistently high singleton delivery rates per cycle.Intervention(s)None.Main Outcome Measure(s)Common clinical practices.Result(s)Common clinical practices identified among these programs included testing all patients for ovarian reserve, endometrial defects, and hydrosalpinges; use of a mixed LH and FSH stimulation protocol with step-down dosing; and use of ultrasound guidance for ET. Common laboratory practices included selective use of intracytoplasmic sperm injection, group culture of embryos in microdrops, and use of blastocyst ET in selected cases. Common laboratory features included good air quality using filtration and heated stages for oocyte and embryo work.Conclusion(s)Although a number of factors were identified in this best-practices questionnaire, programs often differed in many aspects of care. However, high-performing programs cited experience of physicians, embryologists, and staff members as well as consistency of approach, attention to detail, and good communication as being vital to excellent outcomes.