Sample Exam - Statistics University Of Missouri: Fill & Download for Free

Students aged 16–18 are almost exclusively high schoolers. Keep in mind that the American education system is one of the most decentralized in the world, so content and class hours vary wildly from state to state, or even school district to school district. My accounts are limited to my own experiences, as a student at a public suburban high school in Missouri.In the four years of high school, pretty much every student has to complete four years worth of English classes (literature and composition) and three years each of mathematics (Two years of algebra, one year of geometry, then additional precalculus/trigonometry, calculus, or statistics as so desired), social studies (World and American history, civics/government, and electives like economics and psychology), and science (Physics, Chemistry, Biology, and electives like anatomy and astronomy). You’re better off taking four years of each of these “core” subjects for college admissions, so most people take those elective additions, as well as four years of a language (We offer Spanish, French, German, and Chinese. Other schools might only have Spanish or French, and others offer more, like Russian, Latin, and Arabic). We round out our schedules with classes in fine arts (drama, choir, band, orchestra, drawing, painting, sculpture), “practical arts” (encompassing business classes like accounting and marketing, as well as home economics like sewing and cooking), and gym (weightlifting, aquatics, sports). This giant block of subjects can be overwhelming even for the students taking it, so I’ll take you through my own schedule as a sample.First thing in the morning, AP French! This is relatively easy as my classes go. I’ve had the same classmates and teacher for the last several years, so the class dynamic is warm and familiar. By the time you reach AP level (in our district, that’s the fifth year of studying French), you’ve mostly gotten past extensive grammar and vocab memorization, and have moved into practical uses of the language. We read news articles about current events, read and answer questions about book passages, write essays and letters, and practice conversational and presentational speaking. We all “adopt” a French-speaking country at the beginning of the year, and thorough out the class we get to do projects about the culture of that country. Mine is Morocco, so I’ve gotten to do projects on architecture , cuisine, and religion there, among other things.Second I have an independent period, or IP. I’m free to do as I please during this time, so I’ll go outside, hit the library to catch up on homework, or head to the deli down the street for a cup of coffee. In order to fit this free period into my schedule I had to take an online class, but we’ll get to that later.Next up is AP Lang (short for English Language and Composition). AP Lang is all about nonfiction reading and writing. We spend a lot of time studying the art of argumentation, writing our own argumentative essays or analyzing the rhetorical choices of other people’s work, including essays, letters, and political speeches. There are frequent ICEs, or in-class essays, where we have to write complete essays in under an hour, as preparation for the AP test. We have frequent in-class debates, as well as short readings. We have to read at least one nonfiction book of our choice every quarter, and we frequently have additional projects. This quarter we’ve been writing research papers: mine is on the media’s impact on political polarization, but I have friends writing about everything from euthanasia, to internalized misogyny, to picket fences (yes, really! Fences!).After that, AP Calculus AB. Does what it says on the tin. It’s calculus, about the same the world over. First semester were limits and derivatives, now we’re getting into integrals. Simple enough, at least to describe it if not to learn it.My fifth class of the day is AP Biology. This is about equivalent to a first-year biology lab sequence at most universities. We’ve covered macromolecules, structure and function of the cell, cellular respiration, genetic inheritance, gene replication, and protein synthesis, and now we’re on evolution. The emphasis is on breadth, not depth, but there’s a ton of processes and vocabulary to memorize. Normally there would be loads of labs, but due to COVID-19 restrictions the school needs to do contact tracing, so moving all around the lab stations would be a recipe for disaster. Instead, the teacher records himself doing the lab work, and we analyze the data.Next we’re headed into AP US Government and Politics. This is my social studies credit for the year, discussing the structure and function of the American government, from its creation to the present. We’re currently on the Executive branch, talking about the powers of the President and the role of the federal bureaucracy.My last class of the day is Improv, an arts class where we do improvisational acting. It’s fun and pretty low-stakes, a stress reliever where nothing matters all that much. We get a setup for a scene, sometimes as little as a single word, and we’re left to act out the rest of the scene on the spot, working collaboratively with our scene partners to figure out what happens and try to make an entertaining show for our audience. It gives students an opportunity to flex their acting muscles, and it’s mostly good-natured fun, a nice contrast from the rest of my schedule.Not to be forgotten is my online gym class. It’s not technically part of my school day, but I still have to complete the work. I need a certain number of gym credits to graduate, and I don’t fancy taking gym classes during school hours and having to go about my day all sweaty, so this is the solution. The district provides a wristband that monitors your heart rate, and you have to exercise five hours a week to get full credit. There are also some online assignments (who on Earth writes essays for gym class? Apparently, I do), but they’re not too bad. Since I get plenty of exercise during sports, I can count that towards my workout totals for the week, which makes things much easier.Based on what I’ve heard of other countries’ education system, there are two things that stand out about the American process: the breadth, and the individualization of rigor. In countries like the UK, at 16 most people choose just a few subjects to specialize in, whereas if you’re at an American school, you take all subjects until you’re 18 at least. Science whizzes still need art credit, and virtuoso musicians take math. At least theoretically, every person has a baseline level of competence in every subject upon leaving high school. In addition, in American high schools there’s a lot of personal choice in the amount of work you want to take on. I’m in advanced classes, so I have hours of homework every night, as well as rigorous national exams at the end of the year. Students are also perfectly free to not take on that burden, and take easier “on-level” classes with less material and lower expectations. All these different levels of students remain in the same buildings, and often switch depending on the subject: you might be in advanced math and ordinary English, or vice versa. You have to take all the subjects, but how difficult they are is up to the student in question.

This answer may contain sensitive images. Click on an image to unblur it.Q. How do I contact an ob-gyn in the US for an IVF consultation?A. 10 Best Fertility CentersIn the first-ever investigation of its kind, find out which of the nation's centers offer the greatest chance of success.By Karen CiceroLaura StojanovicFertility 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 searnodch 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").Top 10 Fertility Centers1. Colorado Center for Reproductive Medicine, EnglewoodNumber of ART cycles and transfers in 2002: 912 (Nearly all ART cycles use IVF. If a patient uses donor eggs or frozen embryos, the CDC labels the procedure a transfer rather than a cycle.)Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 60% (under age 35), 51% (ages 35-37), 44% (ages 38-40), 23% (ages 41-42)Boasts 2002 IVF success rates that are twice the national average for women ages 38 to 42 who are using their own eggsIs researching ways to improve the chance of pregnancy for patients with endometriosis or polycystic ovarian syndromeAttracts 40% of its patients from outside the Colorado areaFor most women trying IVF, physicians return two to seven fertilized eggs, called embryos, hoping one will implant. But about 30% of women who become pregnant are carrying twins, and 7% are expecting triplets or more. "Twin pregnancies are at a three- to five-fold greater risk for pregnancy complications and perinatal mortality [death between 28 weeks gestation and a week after delivery] compared to carrying one fetus. With triplets, there's at least a seven-fold greater risk," says Eric Surrey, M.D., medical director of the Colorado Center for Reproductive Medicine (CCRM) and president of the Society for Assisted Reproductive Technology, a top group in the field.Dr. Surrey's team recruited patients, 48 in two years, between ages 26 and 48 to study the feasibility of returning just one embryo. "This is common in some Western European countries, but the success rate is about 30% to 35%," says Dr. Surrey. "We wanted to see if we could improve on those rates."Earlier work at CCRM paved the way for embryos, which used to be returned three days after fertilization, to develop into blastocysts, a process that takes about two more days. Waiting longer gives doctors a better idea of the embryos' quality and helps them decide which one has the best chance of survival.Half the women in the study received one embryo, and the remainder got two. All were given the option of freezing leftover embryos for use at another time. In the group receiving a single embryo, 61% had a clinical pregnancy (a heartbeat shown on ultrasound) and there were no twins. By comparison, the ongoing pregnancy rate in the group receiving a pair of embryos was 76%, but nearly half the pregnancies resulted in twins. "The slightly lower chance for pregnancy in the single-embryo group outweighs the significant risks associated with multiples," says Dr. Surrey. "Larger trials will more carefully define just who the ideal candidates for this approach will be."2. The Center for Reproductive Medicine and Infertility at NewYork-Presbyterian Hospital/Weill-Cornell Medical Center, New York CityNumber of ART cycles and transfers in 2002: 2,012Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 48% (under age 35), 43% (ages 35-37), 30% (ages 38-40), 18% (ages 41-42)Is one of the most experienced centers in the U.S., with 11,000-plus babies born through conventional IVF and 4,000 through ICSI -- a technique that injects a single sperm into an egg; ICSI, invented by the center's lab director, is a must for couples with severe male factor infertilitySpecializes in preserving fertility in cancer patientsPerformed the first genetic testing on embryos for sickle cell anemia and retinoblastoma, an inherited eye cancerPriding themselves on a difficult caseload, doctors at The Center for Reproductive Medicine and Infertility (CRMI) conduct more than one-third of their IVF cycles on patients who have had two or more failed attempts at other clinics. "Other fertility specialists send us their patients who haven't gotten pregnant," says the clinic's director, Zev Rosenwaks, M.D.Because many couples who have experienced several unsuccessful cycles want to put back more embryos than they did on the first few tries, the center's triplets rate in women ages 35 to 37 is the highest of our top 10. But its live-birth rate using non-donor fresh embryos is remarkable: 30% to 70% above the national average, depending on the woman's age. How is that possible? In a word: research. Since 2002, the center has published more than 200 studies in medical journals -- the most of our survey. Among them: autologous human endometrial co-culture, which means growing a couple's embryos on a woman's endometrial cells instead of in the standard IVF liquid.Before starting an IVF cycle, a woman undergoes an endometrial biopsy, in which a small piece of her uterine lining is removed. The sample is frozen until the next month, when the woman's eggs are retrieved, fertilized, and put on her endometrial cells to grow. A study by CRMI researchers on 1,000-plus patients, who on average had three failed IVF attempts, found the technique improved embryo quality and resulted in an impressive clinical pregnancy rate of 42%.3. University Fertility Consultants at Oregon Health & Science University, PortlandNumber of ART cycles and transfers in 2002: 505Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 34% (under age 35), 39% (ages 35-37), 34% (ages 38-40), 7% (ages 41-42)Reported the first live birth from an ovarian tissue transplant in a primate, paving the way for cancer patients to freeze their ovarian tissue before treatmentMinimizes high-risk pregnancies; while the center's live-birth rate for women ages 35 to 37 undergoing IVF with their own eggs is about 25% above the national average (39% vs. 31%), its percentage of pregnancies with multiple fetuses is roughly half the average in that age rangeBoasts a very experienced lab staffSome fertility centers don't allow women to try IVF with their own eggs if their level of follicle stimulating hormone (FSH) is over 10. FSH, produced by the pituitary gland, causes eggs to mature; a high level of it, measured on the third day after menstruation begins, may indicate that few eggs are left in the ovaries.But physicians at University Fertility Consultants routinely take patients whose FSH is up to 15. In a recent study of 350 women over age 35, they found that the clinical pregnancy rate for women with FSH levels of 10 to 15 was about 33% -- below the 42% pregnancy rate when a patient's FSH is under 7, but still pretty good. "My overall success rates are lower because about 25% of the women in my caseload have high FSH levels," says the center's director, Kenneth Burry, M.D. "But I don't feel comfortable referring patients for egg donation when they have a reasonable chance of success using their own."4. New York University School of Medicine, Program for In-Vitro Fertilization, Reproductive Surgery, and Infertility, New York CityNumber of ART cycles and transfers in 2002: 1,362Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 45% (under age 35), 42% (ages 35-37), 24% (ages 38-40), 17% (ages 41-42)Sees many difficult cases; about 70% of patients have failed at least one IVF cycle elsewhereOffers a patient library equipped with computersIs developing an egg-freezing programThirteen years ago, Jamie Grifo, M.D., Ph.D., was the first fertility specialist in the U.S. to successfully perform pre-implantation genetic diagnosis (PGD), the screening of an embryo for a specific inherited condition, such as cystic fibrosis. "It's heartbreaking to talk to couples whose children have died from a genetic disease," says Dr. Grifo, director of the division of Reproductive Endocrinology at New York University. "They tell me they couldn't go through it again -- all they want is a healthy baby."Dr. Grifo, who has been at NYU for the last 10 years and did his early work with PGD at Yale and Cornell, has begun to apply the technique to women who have suffered recurrent miscarriages. "We're searching for abnormalities in chromosomal numbers, and often we find them," he explains. "Last year, I started one of my patients, who had gone though five miscarriages, on an IVF cycle. She produced 11 eggs, which fertilized. When we checked them, we found that only two were normal. We put both back, one implanted, and she gave birth recently."In fact, more than 70 babies have been born to NYU clients using the technique -- which involves making a hole in the outer coating of the embryo and removing a single cell for analysis -- and the clinical-pregnancy rate per cycle is about 40%. "If done properly, it really doesn't make the embryo much less likely to implant," he says. What about future consequences? Although long-term effects are still unknown, a recent study of 754 PGD babies suggests that they're no more likely to have birth defects than children conceived conventionally.5. The Infertility Center of St. Louis at St. Luke's HospitalNumber of ART cycles and transfers in 2002: 176Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 35% (under age 35), 26% (ages 35-37); there were too few cycles in women ages 38-42 to report the results as a percentageIn 2002, performed the greatest percentage of IVF cycles due to male factor infertility of any center in the country; many cases involved very complex problemsHas completed more than 4,000 microsurgical vasectomy reversals over the last 30 years, reporting in a recent study that nearly 90% of patients were able to impregnate their partnersConducted the world's first ovarian transplant, in which an infertile identical twin was given one of her sister's ovaries; the woman had a healthy baby girl in JuneOver the last 30 years, Sherman Silber, M.D., founder of the Infertility Center of St. Louis, has published more than 200 studies on infertility, pioneering or advancing techniques that help men with little or even no sperm become fathers. Much of his research has focused on the estimated 2% to 5% of infertile men with congenital absence of the vas deferens, a condition in which the tubes that carry sperm from the testes haven't developed normally. "These men make sperm, but it's not in the ejaculate," says Dr. Silber. "We do a procedure to extract sperm from the testicles."He's usually able to retrieve sperm to fertilize eggs through ICSI (see page 3 for ICSI description). He often recommends that couples in this situation have their embryos screened for genetic abnormalities since a higher percentage of them may contain the wrong number of chromosomes even though they look normal. "By doing the testing, we can boost the chance of a live birth from about 35% to 45%," he says.Filling his practice with extraordinarily difficult cases has taken a toll on Dr. Silber's success rates, but he doesn't mind. "For me, it's not about the numbers," he says. "It's about giving couples what they want most -- a child."6. The Nevada Center for Reproductive Medicine, RenoNumber of ART cycles and transfers in 2002: 281Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 52% (under age 35), 49% (ages 35-37), 38% (ages 38-40); there were too few cycles in women ages 41-42 to report the results as a percentageIs testing a new form of progesterone -- a hormone that helps sustain a pregnancy -- to see if it's better than the types currently availableHas a successful donor-egg program; the 2004 pregnancy rate approached 70% for fresh embryos in women of all agesArranges travel and sightseeing for out-of-town patientsDoctors can often tell by the quality of the blastocysts -- embryos that have been grown for about five days -- how likely a patient is to get pregnant. "But in some older patients who have repeated failed cycles, the blastocysts look beautiful," says Russell Foulk, M.D., director of the Nevada Center for Reproductive Medicine.Dr. Foulk and other researchers working with the National Institute of Child Health & Human Development may have figured out what's causing the problem for at least some of these patients. They found that at the time of implantation, the blastocyst expresses much larger amounts of a protein called L-selectin than it does beforehand. If a woman's uterus doesn't have receptors for this protein, Dr. Foulk theorizes, the blastocyst won't attach. "I've started doing uterine biopsies recently and discovered that two of my patients lacked these receptors," he says. "One of them had nine unsuccessful transfers -- all with good-looking embryos."Future studies may confirm that checking for the receptors should be part of fertility screening. If that happens, Dr. Foulk says, some couples may avoid repeated failed cycles. Rather, they could consider surrogacy or adoption from the start.7. Presbyterian Hospital ARTS Program, Dallas and Plano, TXNumber of ART cycles and transfers in 2002: 1,180Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 49% (under age 35), 38% (ages 35-37), 23% (ages 38-40), 12% (ages 41-42)Is studying whether antibodies in a woman's blood affect her ability to get pregnantOffers an incentive program for the transfer of a single embryo to patients (age 37 or under if using their own eggs) who have two or more blastocysts; 200-plus couples have signed up, and more than six in 10 have conceived on the first tryHas a policy that embryologists, in conjunction with nurses or administrative staff, give couples trying IVF a daily status report on how well their embryos are growingSince about 90% of genetic abnormalities are caused by the egg alone, doctors in the Presbyterian Hospital ARTS Program are studying the feasibility of routine analysis of polar bodies, which are formed outside the egg after fertilization. "These are waste products -- they degenerate within one to two days -- but they provide mirror images of what's inside the egg," says scientific director Marius Meintjes, Ph.D. "With them, we can look for genetic problems, passed on by the mother, that would make the resulting embryo less likely to implant or more likely to cause a miscarriage."Why might it be more beneficial to do that than screen the embryo for genetic problems, especially when you can't detect abnormalities passed on by the father? The test has no chance of damaging the embryo, unlike pre-implantation genetic diagnosis, which requires the removal of a small piece of the embryo.8. Florida Institute for Reproductive Medicine, JacksonvilleNumber of ART cycles and transfers in 2002: 832Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 44% (under age 35), 40% (ages 35-37), 33% (ages 38-40), 17% (ages 41-42)Cancels a low percentage of cycles, which suggests a good response to treatmentsIs one of a handful of centers that publish comprehensive results on their Web sitesHas persuaded drug companies to donate medications for the institute's cancer patients who are freezing their eggs, saving each person about $3,000When a woman doesn't conceive on her first IVF cycle using fresh embryos, she may be able to try again at about one-fifth the cost if she has embryos to freeze. The Florida Institute for Reproductive Medicine is a leader in freezing techniques, called cryopreservation. "Most of our patients get enough high-quality embryos to have one fresh and one or two frozen cycles, adding a great deal to their cumulative chance of conceiving at a reasonable cost," says Kevin Winslow, M.D., the center's director.What the center has learned from embryos over the years has also helped them freeze unfertilized eggs for more than 200 patients, and they are continuing to study the technique to pinpoint the optimum environment for frozen eggs. "We have 33 babies born and nine ongoing pregnancies with this technique to date -- the most of any center in the country," says Dr. Winslow.Egg freezing is an option for cancer patients who want to preserve their fertility or those who fear they will be too old to conceive before they're ready to start a family. "But we only do it for women 38 and under," says Dr. Winslow. "After that, the eggs aren't of high-enough quality to freeze."9. Southern California Reproductive Center, Beverly HillsNumber of ART cycles and transfers in 2002: 217Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 68% (under age 35), 56% (ages 35-37), 26% (ages 38-40), 21% (ages 41-42) (These numbers refer only to the practice of Hal Danzer, M.D.; occasionally, fertility centers provide the government with statistics based on the practice of individual physicians rather than the overall center.)Reported no pregnancies with triplets or greater in 2002 for women under 35 despite the fact that the live-birth rate for these patients was nearly twice the national averageIn 2002, performed 98 of its IVF cycles on patients who had at least two previous failed attemptsConstructed a state-of-the-art lab with triple-gas incubators and a sophisticated air-filtration system to promote the best environment for growing embryosOnce a couple's embryos are ready, doctors put them in a woman's uterus, where the hope is that they'll implant -- a process called embryo transfer. "Most transfers are easy. But in about 10% of patients, pinpointing the placement of embryos is difficult because of the shape or position of the uterus," says Hal Danzer, M.D., a reproductive endocrinologist at the Southern California Reproductive Center (SCRC). The center is one of the few nationwide that use four-dimensional ultrasound for every transfer; it provides 3-D images in real time. A new SCRC study on more than 100 patients suggests the new technology does slightly increase pregnancy rates.Another way the center makes transfers smoother: "Before every transfer, women are given the option of having an acupuncture treatment to help them relax," says Dr. Danzer. "Some research suggests that acupuncture helps improve pregnancy rates in women undergoing IVF."10. Center for Reproductive Medicine of New Mexico, AlbuquerqueNumber of ART cycles and transfers in 2002: 183Percentage of ART cycles from non-donor fresh embryos resulting in live births in 2002: 57% (under age 35), 55% (ages 35-37), 29% (ages 38-40); there were too few cycles in women ages 41-42 to report the results as a percentageOpened in 1986, making it one of the oldest fertility centers; at that time, there were approximately 40 centers in the U.S., compared to the more than 400 todayIs one of five U.S. facilities collaborating on the development of quality-control measures in the analysis of sperm samplesBoasts a 2002 live-birth rate of 72% for fresh embryo transfers from donor eggs, above the national average of 50%Running the Center for Reproductive Medicine of New Mexico in a poor state that doesn't require insurers to cover infertility, Jim Thompson, M.D., focuses on giving patients value for their money. "My exam rooms and waiting areas have no frills," says Dr. Thompson, the center's director. "Instead, we try to keep our costs low and our success rates high."He seems to be doing a good job at both: In 2002, the center's live-birth rate for women ages 35 to 37 using their own eggs was about 70% above the national average -- 55% compared to 30% -- though its price for a standard IVF cycle (not including medications) is $8,500, less than the typical charge. He also has stellar success rates for women under age 35 and those who are 38 to 40 years old.Judging for YourselfDo you have to go to one of the fertility centers on this top 10 list to have a successful IVF cycle? Probably not. If you don't have a highly complex diagnosis, shop locally first because many centers have strong programs and traveling may add unnecessary stress. Here, six things to keep in mind during the interviews.1. Talk in the same termsOnce a couple's embryos are ready, doctors put them in a woman's uterus, where the hope is that they'll implant -- a process called embryo transfer. "Most transfers are easy. But in about 10% of patients, pinpointing the placement of embryos is difficult because of the shape or position of the uterus," says Hal Danzer, M.D., a reproductive endocrinologist at the Southern California Reproductive Center (SCRC). The center is one of the few nationwide that use four-dimensional ultrasound for every transfer; it provides 3-D images in real time. A new SCRC study on more than 100 patients suggests the new technology does slightly increase pregnancy rates.2. Inquire about your specific conditionYour chance of a successful IVF cycle depends on your diagnosis. For example, in 2002 only 14% of IVF cycles in the U.S. in women who were diagnosed with diminished ovarian reserve resulted in a live birth compared to 32% when endometriosis was to blame. While male factor infertility has a high live-birth rate of 34%, the success rate for specific conditions within this category can be much lower.3. Review the center's experienceAsk about the number of patients your age with the same diagnosis. Also make sure the doctors and lab staff responsible for the success rates you're being quoted still work there, says Thomas Pool, Ph.D., scientific director of the Fertility Center of San Antonio in Texas.4. Consider the rate of multiple births, especially triplets or greaterNew guidelines suggest the number of embryos transferred shouldn't exceed two in women under 35, two to three in 35- to 37-year-olds, and four in women 38 to 40 if a patient's chance of success is favorable. Implanting more embryos may slightly boost success rates, but it may also create dangerous pregnancies and complications for both mother and child. For instance, the rate of cerebral palsy is 17 times higher in a triplet birth than a single one.5. Speak to the lab staffThese employees handle your eggs, sperm, and embryos, so you have to be as confident of their competence as you are of the physician's, says Dr. Pool.6. Calculate the valueThe cost of IVF even within the same city can vary widely; charging up to $35,000 per attempt isn't unheard of, but prices don't necessarily reflect quality. Request a written estimate including the price of the medications, testing, and special techniques you need, and factor it into your decision. If your insurance covers IVF, ask if the center accepts it.Do You Need IVF?The majority of couples who have trouble conceiving don't require in-vitro fertilization (IVF). Fertility drugs, interuterine inseminations (where washed sperm is placed in a woman's uterine cavity to bypass the cervix, which stops a lot of the swimmers), or a combination of the two will do the trick in many cases. "IVF is indicated as a first-line treatment only in women with severe tubal disease, men with an extremely low sperm count or no sperm present in the ejaculate, or couples who need their embryos screened for a genetic condition," says Kenneth Burry, M.D., director of University Fertility Consultants at Oregon Health & Science University in Portland. However, he notes that if other treatments don't work in six cycles (three if you're over age 35), you should talk to your doctor about whether it's time to move on to IVF.Centers That Didn't CooperateThe Centers for Disease Control and Prevention in Atlanta is required by law to collect data on fertility centers. More than 90% of centers supply the information. But the following centers either failed to supply data for 2002 (the most recent year for which data are required) or didn't provide enough proof that the information was accurate.Advanced Reproductive Health Centers; Orland Park, ILThomas Annos, M.D.; Short Hills, NJAppalachian Fertility & Endocrinology Center; Kingsport, TNBeach Center for Fertility, Endocrinology & IVF; Virginia Beach, VABrandeis Center for Reproductive Health; New York, NYCenter for Advanced Reproductive Medicine; Springville, UTCenter for Women's Care; Chicago, ILCenter for Women's Medicine; Houston, TXChapel Hill Tubal Reversal Center; Chapel Hill, NCFertility Associates of Idaho; Boise, IDGynecology & Infertility Associates; Baltimore, MDAbraham Halfen, M.D.; East Setauket, NYIVF Hawaii; Honolulu, HIIVF Reproductive Services; Manhattan, KSIVF South Bend; South Bend, INKentucky Center for Reproductive Medicine; Lexington, KYLuana J. Kyselka, M.D.; Troy, MILa Jolla IVF; La Jolla, CALife-Women's Health Center; Berwyn, ILMetroHealth Medical Center; Cleveland, OHMid-Missouri Center for Reproductive Health; Columbia, MOBrenda Moskovitz, M.D.; Troy, MINew England Fertility Institute; Stamford, CTSiu Ng-Wagner, M.D.; Potomac, MDThe Reproductive Center; Youngstown, OHReproductive Genetics In Vitro; Denver, COReproductive Genetics Institute; Chicago, ILReproductive Health Institute; Orlando, FLReproductive Institute of South Texas; McAllen, TXReproTech IVF Program; Allentown, PASan Antonio Fertility Center; Upland, CAIssa Shamonski, M.D.; Santa Monica, CASher Institute of Reproductive Medicine; Chicago, IL; Creve Coeur, MO; and Sacramento, CAJames A. Simon, M.D.; Washington, DCTyler Medical Clinic; Los Angeles, CACenters We CommendIn 2004, Child magazine sent an extensive survey to more than 75 fertility centers that had very good success rates. The majority of centers didn't return the form. But we commend the following centers for doing so.Bethesda Center for Reproductive Health and Fertility; Cincinnati, OHThe Center for Advanced Reproductive Services; Farmington, CTThe Center for Fertility & Reproductive Endocrinology at Virginia Mason; Seattle, WACenter for Human Reproduction, North Shore University Hospital; Manhasset, NYCenter for Assisted Reproduction; Bedford, TXCenter for Reproductive Medicine; Minneapolis, MNFertility Center of San Antonio; San Antonio, TXFertility Treatment Center; Chandler, AZThe GBMC Fertility Center; Baltimore, MDHenry G. Bennett Jr. Fertility Institute; Oklahoma City, OKInfertility and IVF Center; St. Louis, MOInstitute for Reproductive Health; Cincinnati, OHIVF of North Jersey, PA; Clifton, NJLong Island Fertility and Endocrinology IVF Associates; Melville, Port Jefferson, and Lake Success, NYMcFarland Clinic PC; Ames, IAPennsylvania Reproductive Associates; Philadelphia and Plymouth Meeting, PAReproductive Medicine & Infertility Associates; Woodbury, MNThe Reproductive Medicine Group; Tampa, FLReproductive Partners-UCSD Regional Fertility Center; La Jolla, CASouth Florida Institute for Reproductive Medicine; Miami, FLStrong Fertility & Reproductive Science Center; Rochester, NYWest Coast Fertility Center; Fountain Valley, CAWomen & Infants' Hospital/Tufts-New England Medical Center; Providence, RI, Boston, MA, and six satellite location

“Is homeschooling better than our current educational systems?”That depends entirely on how you qualify the word “better.” Is it better in what respect? I'll try to list a few categories in which one might make comparisons.SocializationPublic school provides plenty of socialization experiences, of every stripe and color—the good, the bad, and the ugly. If you want quick, easy socialization opportunities, public school provides it.A very old stereotype of homeschooling students is that they are socially backwards misfits who don't socialize. For a handful of them, I would say this was true (though I must add that one might meet socially backwards misfits in public school as well). But on the whole, this stereotype is a very inaccurate one. Many homeschooled kids participate in 4-H programs, book clubs, community sports, homeschool co-op groups, etc. “Jeffrey Koonce, a school superintendent in Miller County, Missouri, who wrote his doctoral dissertation on how homeschool students fare when they transition into the public schools, says that the students he interviewed were, in many cases, more 'socially adept' and mature than their peers.”[Brian] Ray [president of the National Home Education Research Institute] cites a July 2000 study by the Seattle-based Discovery Institute in which counselors watched videotapes of homeschooled and schooled children playing. The counselors, who did not know which children were from each category, noted that the homeschool students demonstrated fewer behavioral problems than their peers, a result that Ray attributes, in part, to homeschoolers' main role models: “Public school children have, as their main role models, peers, while homeschool students have as their role models, adults,” he explains. (See PBS article for both quotes above, Socialization: Tackling Homeschooling's "S" Word.)One must also define “socialization” and have some idea of the benefits one is seeking from it. It could be argued that socialization that confines itself solely to peers of one's own age group is somewhat forced and unnatural (in the real world, we don't all eat, and live, and study, and work, with those of our own age group, exclusively). Making friends and role-models of those older than ourselves (in addition to having friends our own age), is healthy and wise. If one's goal in socialization is to make positive, meaningful friendships, homeschooled students are capable of doing this as well. If one's goal is to be sure children are not socially awkward and immature, then the stats should give some peace of mind on this, since homeschooled students have demonstrated in studies to be on par with their public-schooled peers in this area—or to have surpassed them.All in all, homeschoolers must work harder at socialization than their public-schooled peers. It takes more planning, and more effort on the part of the parent, because it doesn't “just happen” automatically the way it does for public-schooled children. The result of this effort, however, can be more meaningful and positive socialization than is available in a single classroom of peers—a number of which may be little more than bullies.SportsIf your dream is for your child to play in the future World Series or Super Bowl, you are more likely to find sports opportunities in public school. That's not to say that a professional career in sports is impossible for homeschooled kids (just ask Tim Tebow). But overall, homeschoolers are less likely to participate in sports than their public-schooled peers. Many schools these days are letting homeschooled students participate in their sports programs, however. But like socialization, homeschoolers will have to work harder to pursue sports (if they are interested in them), than their peers. Ironically, a few parents actually list sports as one of the reasons they homeschool, because they are able to be more flexible with their schedule so their child can spend more time honing their skills.Custom-tailored educationIn this case, homeschooling wins hands down. This is, after all, the reason many parents home educate their children: to tailor their instruction to the needs and interests of the child. In fact, many have pulled their children out of public school in order to do so, after watching their children flounder and struggle in the system for years. I know of one such family. The teenage son had a terrible time with academics in public school. When his mom pulled him out and homeschooled him, his grades rose. In fact, when she later talked of putting him back in public school, he begged her not to send him there: “Mom, I wasn't 'getting it' in school; now I'm actually learning and doing well. Please don't send me back there! I like learning, and I won't learn anything if I go back!” Even kids with learning disabilities often do better in a homeschooled setting: it's more relaxing, familiar, and such children will get more one-on-one time with their “teacher” than they will in a public school.Another reason many parents homeschool their children is so that they can help their child pursue his/her personal interests and dreams. Home education gives families a lot of flexibility to do this (this is one instance where homeschooled students may actually get the edge on sports). See The Pros and Cons of One-on-One Learning for HomeschoolersReligious InstructionNot all parents homeschool for this reason (many homeschoolers these days are even secular), but if your desire is to incorporate religious instruction into your child's education, homeschooling is really your only option in most cases (other than some private schools, of course).SafetyWith bullying, child suicides, school shootings, and sexual violence making the headlines more and more these days, safety does become a bigger consideration. I am not suggesting that any parent make a decision to homeschool based on fear (fear-based decisions are rarely healthy or wise), but if we are making a blow-for-blow comparison between the “safety” of a public school environment, and the “safety” of a home school environment, it's probably not hard to figure out which one will come out on top...Student-to-Teacher Ratio and One-on-one Instruction TimeGuess I don't need to say much here. ;)AcademicsIt's a widely touted that homeschoolers typically score higher on standardized tests than their public-schooled peers (on average, 15 to 20 percentile points higher). It has been shown that the academic scores of homeschooled students fluctuate very little between those who spend more on their child's education, and those who cannot spend as much on it. The wealthier homeschoolers, in a higher socio-economic class, who spent more on their children's education only saw their children outperform their poorer homeschooled peers by a small margin of a few percentile points. (Children of parents with an income of $35,000 to $49,000 scored at the 86th percentile, and children of parents with an income of $70,000 scored at the 89th percentile). Same thing turned up with the education level of the parents: homeschooled students whose parents had a college degree only did slightly better than those whose parents did not (86th percentile versus 83rd percentile; where both parents had a college education, the students scored at the 90th percentile). A 2015 study found that Black homeschooled students scored 23 to 42 percentile points above Black public school students. In all these cases, the homeschooled (rich or poor, black or white, with parents with college degrees or without) outperformed their public school peers, scoring above average on achievement tests. It might be worth pointing out, too, that the disparity between rich and poor homeschooled students, versus the disparity between rich and poor public-schooled students is pretty broad: poor homeschooled students do quite well in relation to their wealthier counterparts, whereas poor public-schooled students performed significantly under their wealthier counterparts. See https://www.usnews.com/news/articles/2015/10/19/schools-exacerbate-growing-achievement-gap-between-rich-and-poor-a-33-country-study-findsSignificantly, homeschooling would appear to be one factor that greatly lessens the gap in academic performance between rich and poor.Some skepticism has remained, of course, over the sampling of those tested in the homeschool community. Only about 52% of homeschoolers take standardized tests, so do only parents of students who are doing well get their students tested, thus affecting the scores? (This question is of course based on the assumption that parents could somehow know how their students would perform in advance of the actual test.) Well, the jury is out on that one yet. But one thing is conclusively proven: homeschooled students have the ability to outperform their peers. To homeschool—even as a poor, “uneducated” parent—does not automatically mean that your child will under-perform; in fact, there is every reason to believe that he still has the capacity to academically outperform his peers, with a little motivation and effort on the part of the parents. The studies have at least well-proven this much. Does that mean that the quality of each homeschooled child's education is the same? Certainly not. Again, it takes effort and commitment on both the part of the teacher and the student. A study was conducted which, after carefully selecting both homeschooled and public-schooled participants who shared similar educational and socio-economic backgrounds, went on to demonstrate that homeschooled kids whose learning style was structured, outperformed their public school peers, while homeschooled kids who were “unschooled” (they received little to no formal instruction) under-performed their public-schooled peers. Many homeschooling parents employ a mixture of book study and a more hands-on, “unschooling” approach to their child's education. On either end of the spectrum, some only do one or the other almost exclusively. In defense of a less-rigorous, less test-driven academic approach, however, one might consider the turn-out of a K-8 public school in Sacramento, California which has achieved outstanding results among its students. The Alice-Burney Waldorf-inspired elementary school takes a completely different approach to education, one which is closer in philosophy to a homeschooling style, than a public school: they emphasize hands-on, play-based learning, and include a wide variety of activities such as "folk dancing, singing, gardening, and woodworking," as a core part of their curriculum. The results have been outstanding for this wildly popular and successful school.Parents magazine, in the October 2013 edition, comment,There is a short-term cost: Since Alice Birney doesn't teach to the test, its statewide exam scores are notably low in second grade. However, faith in the approach pays off in the long-term. "Our eighth-graders consistently score just under 90 percent proficient or advanced, which is significantly higher than most schools," says Horning, who credits inventive play during the early years with developing higher-level thinking skills later on...This school uses an approach and philosophy very similar to homeschoolers. This means that in the younger grades, they don't even test well. This is, however, no indication of their massive success rate, as can be readily seen, as their students graduate 8th grade near the 90th percentile.Similarly, homeschoolers tend to excel academically. Statistically speaking, they are far ahead of their public school peers. This a well-known, and well-documented fact. But, like the Alice Burney school, they often take a very different approach to education than public schools--one which is far more custom tailored to the learning style and ability of each individual student. Even though, statistically speaking, homeschoolers tend to do very well on standardized tests, where they do not appear to do as well, there are also many nuances which should be considered, particularly in the elementary grades where homeschooled students may not perform as well as their peers because their education has not centered on "teaching to the test," but on educating the whole child--"head, heart, hands," as the Waldorf saying goes.The pay-off is big.Approximately 50% percent of homeschooled students and 50% of public-schooled students attend college. Dr. Michael Cogan found that the homeschooled students were more likely to graduate college, less likely to drop out, and to have higher first semester, first year, and last year grade point averages than their peers (he published his study in the Journal of College Admissions). Dr. Gary Knowles, University of Michigan Assistant Professor of Education found that nearly 2/3 of the 50 adults who had been homeschooled (whom he surveyed), owned businesses, while none of these adults were unemployed or on welfare.There are certainly instances in which parents do poorly with their students—through laziness, indifference, whatever. But those who have the time, patience, and self-discipline to put the effort into it succeed—completely regardless of their own level of education, their racial ethnicity, or their socio-economic status, none of which should be considered inhibiting factors for homeschooling. (See HOME-SCHOOLING: Outstanding results on national tests and Do Homeschool Kids Really Rate Better on Standardized Tests? And Statistics on Public School Vs. HomeschoolCostHomeschooling costs more, depending on how you look at it. But in the day when academic resources and options are readily available, and many programs and books can be accessed for free online, the cost in itself should not be prohibitive. I'm a bargain hunter myself. I decide what books I intend to use for the school year, then find bargain buys on as many as I can. There are many, many free resources out there for homeschoolers as well. While one could spend thousands of dollars every year on a homeschool education, it is entirely possible to do it for a few hundred dollars (or less) a year. I've learned tips and tricks from other homeschool veterans, and for my two children (now 6 and 5), I only spend an average of about $500/year—not per child, but altogether. That covers history, science, reading, math, art, literature, language arts, critical thinking, etc. A year ago or so I read in our local paper that parents, on average, spend well over $1,000 in back-to-school supplies and clothes for their public-schooled children each year. I'm spending less than half that for my kids’ whole education for the year. So if you look at it like that, homeschooling is cheaper. ;)Parent time and effortThis is where a lot of the consideration must go. Homeschooling is not a light and easy decision. Homeschooling requires a lot of time, thought, emotional energy, and work from the parents. The parents themselves must be diligent and self-disciplined. I don't mean perfect—nobody is. But dropping your kids off at public school from 8:00 to 3:00 is much easier, while homeschooling is a cost that must be counted.In ConclusionI'm 31 years old. I was homeschooled, and I am now homeschooling my own two children. My feelings about my personal experience? I wouldn't trade being homeschooled and having the opportunity to homeschool my own kids for anything. Personal feelings, experiences and anecdotes aside, the hard data statistics stand pretty favorably in homeschooling's favor on many fronts. But homeschooling as a philosophy only represents potential, not results...YOU have to make it work. ;)