title: What do consistently high-performing in vitro fertilization programs in the U.S. do?
abstract: OBJECTIVE
  To identify common clinical and laboratory practices among consistently high-performing IVF programs.
  
  
  METHODS
  Questionnaire study of selected IVF programs.
  
  
  METHODS
  Academic and private practice IVF programs.
  
  
  METHODS
  Ten of 12 programs identified as having consistently high singleton delivery rates per cycle.
  
  
  METHODS
  None.
  
  
  METHODS
  Common clinical practices.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa. Electronic address: brad-van-voorhis@uiowa.edu.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Van Voorhis
authors.affiliation: Dallas-Fort Worth Fertility Associates, Dallas, Texas.
authors.forename: Mika
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Colorado Center for Reproductive Medicine, Lone Tree, Colorado.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Surrey
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Amy
authors.initials: A
authors.lastname: Sparks
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003625:Data Collection; D017598:Efficiency, Organizational; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008503:Medical Staff / Q000600:supply & distribution; D011247:Pregnancy; D018873:Pregnancy Rate; D011364:Professional Practice / Q000706:statistics & numerical data; D027724:Reproductive Techniques, Assisted / Q000295:instrumentation; D011795:Surveys and Questionnaires; D014481:United States