Speaking of the best, part of choosing a fertility clinic is personal and subjective. The best clinic for your friend may or may not be the best for you. So ask your friends, doctor, insurance company, and local support group for recommendations, but be sure to investigate any clinic you consider yourself. When researching clinics, you can find information:
On their websites On the CDC’s fertility clinic statistics report page (more on that below) On the Society for Assisted Reproductive Technology website (includes outcome stats for clinics) By speaking to a clinic representative over the phone or in person By speaking with current or former patients (found through local infertility support groups) By meeting and interviewing your potential doctor at a consultation
Considering the Fertility Specialists
A fertility clinic is only as good as its doctors. Depending on how the clinic operates, you may be assigned one particular doctor, or you may see a few different doctors on a rotating basis. There are advantages and disadvantages to both setups, but usually, you want one doctor as your main contact and case manager. Questions to consider when choosing a doctor are:
Do they take time to answer your questions? Can you ask questions via email during testing and treatment? If they aren’t willing to meet with you before you choose them, then they may not have time for you when you’re a patient. Not being willing to answer your questions up front isn’t a good sign. When and where were they trained? Are they board-certified reproductive endocrinologists? Are they members of the American Society for Reproductive Medicine (ASRM)? How long have they been working with infertility patients? Does your clinic have an andrologist on staff? A urologist? Reproductive surgeons? If you’re dealing with male infertility issues, having an andrologist and/or urologist is important, so they can work in tandem with a reproductive endocrinologist. If you’re dealing with endometriosis or any structural issues, a reproductive surgeon is a plus and possibly a must. Which hospitals are they affiliated with? Does that hospital take your insurance? Even if your insurance doesn’t cover fertility treatment, if you need to be hospitalized due to complications of treatment, you’ll want to be covered. How long has the director been with the clinic? What about the other staff members? The longer people stay with the clinic, the more likely the working environment runs smoothly. How many reproductive endocrinologists work at the clinic? Will your case be handled by one doctor or a team, and who will you see on your visits? If your case is complicated, having a team can be beneficial. On the other hand, needing to deal with a different doctor at every appointment can feel impersonal.
Questions to Ask About Financing Testing and Treatment
Most clinics have staff who will handle the financial aspects of testing and treatment. They should be able to answer your questions about fees and payment plans, and you should sit down to discuss your options and ask questions on your first visit to the clinic. It may feel odd to be considering price when looking at clinics, but considering the fee is practically important. Some treatments cost thousands of dollars, and a less expensive clinic that offers everything you need may be better than the fancy-schmancy clinic around the block that offers more than you need, especially if you won’t be able to afford as many cycles at the expensive clinic. Questions to consider regarding financing include:
What insurance is accepted, if at all? And will staff handle insurance claims? If not, will they provide you with the necessary paperwork to pursue insurance coverage for yourself? What pricing are various tests and treatments? Are any tests or treatments covered by your insurance? And what do the quoted prices include? For example, when quoting the price for IVF, does that include medications and monitoring? Embryo storage? If not, what can you expect the total fee? Do they have a payment program? Will you have to pay anything in advance? How much? If you’re doing IVF, what do you pay if your cycle is canceled before egg retrieval? What if it’s canceled before embryo transfer? Do you recommend or offer any finance programs? Does the clinic work with any national infertility financing programs, like the Attain Fertility Centers network or the ARC Fertility Program? Do any doctors or staff members receive kickbacks or financial incentives if you sign on with a certain fertility financing programs? (If yes, be extra careful that the finance program is truly the best option.) Do you offer an IVF refund program? These are programs that require a large upfront fee but promise some of your money back if you don’t get pregnant after a set number of cycles. One thing to be cautious about these kinds of programs in the clinic may treat you more aggressively, by pushing for more ovarian stimulation or transferring too many embryos, in order to raise the possibility of success. Make sure the refund program allows you a say in how many embryos are transferred and allows you time to take a break between cycles (more than just one month) to recover physically and emotionally. How much does embryo freezing and storage cost? What about a frozen embryo transfer (FET) cycle? If the clinic is far from home, does the clinic offer any discounted options for lodging? Maybe deals with local hotels.
Questions to Ask About Procedures and the Fertility Clinic’s Lab
Questions to discuss with the doctor include:
Is there an age cutoff for treatment? What about a cutoff for FSH levels? Where are procedures and tests done? Does the clinic have an on-site lab, or will you need to go elsewhere? If elsewhere, how far away is it from the clinic? What procedures are possible at this clinic? Do they do IVF? ICSI? Blastocyst transfer or other assisted reproductive technology options? Are the procedures performed at the clinic or elsewhere? If at a hospital, which hospital? If you live far from the clinic, can certain tests and procedures be done closer to your home? What donor or surrogacy options are available? Does the clinic run a donor program or must you use an agency? If they have a donor program, are you limited to donors from their program, or can you use an agency if you want? Do they offer embryo donation services? What if you decide to donate any of your leftover embryos, either to another infertile couple or to science? Can they help you with that? What procedures are they recommending for your particular case? Will they consider ovarian stimulating drugs alone, or IUI before moving on to IVF? How many cycles of IUI will they agree to try? Different clinics may recommend different treatment plans, and one may be more favorable to you. How many embryos are transferred in one cycle? And who decides how many embryos are transferred: the doctor or the patient? For women under 35 years of age with a good prognosis, the ASRM strongly recommends transferring just one embryo per cycle, and no more than two. For women aged 35 to 37 with good prognosis, they recommend transferring two embryos, and no more than three. For ages 38 to 40, they recommend transferring three, and no more than four; and for ages 41 and 42, they recommend transferring no more than five. If transferring embryos at the blastocyst stage, then they recommend even fewer embryos transferred per cycle, no more than three even at age 42. Every individual case should be considered, of course. Who decides whether or not the cycle is canceled if the response is less than optimal? Can you request that the cycle is continued anyway, even if the possibility for success is low? Is the clinic a member of the Society for Assisted Reproductive Technology (SART)? Do they adhere to ASRM guidelines? Do they report their IVF success statistics to SART/CDC? If yes, you should be able to find their success statistics with this SART fertility clinic finder. You can also look up statistics on the CDC’s website. Is the lab accredited by the College of American Pathologists or by the Joint Commission? You can confirm accreditation on the College of American Pathologist’s website, searching by the zip code of the clinic you’re investigating. Does the lab perform cryopreservation of embryos? What about eggs and sperm? Where are the embryos, eggs, or sperm stored? What emergency procedures do they have in the case of a power outage or earthquake?
Things to Consider About the Fertility Clinic
Other factors to consider before choosing a clinic include the following:
Where is the clinic? Not everyone is lucky enough to live next to the clinic they need. Travel time is an important factor to consider, especially if you’re doing IVF, as you may need to be at the clinic almost every day for part of your cycle. If you need to travel, remember you’ll need lodging and time off from work. Is the staff pleasant? You’ll likely be working with the clinic for months, and possibly years. Do they answer your questions? Are they courteous and helpful on the phone? Or do you feel like they are rushing you along? What days and hours is the clinic open? Are there extra early hours or evening hours, so you can have monitoring appointments before or after work? Are they open for the weekend? If not, how do they handle IVF or IUI transfers that need to occur on a Saturday or Sunday? Are there particular hours you can call to ask questions or get updates from your doctor or a nurse? How are calls handled that are outside of office hours? Do they offer any special services beyond basic fertility treatment? Do they have an on-staff counselor to help you work through your options? Do they have support groups? Mind-body workshops? Acupuncture on-site, available right after embryo transfer?
Considering Success Rates
Another important factor to consider is the clinic’s success rate. As mentioned above, you can see a clinic’s IVF success rates at the SART or CDC’s websites. Having the highest success rate doesn’t necessarily mean the clinic is the best. Some clinics avoid taking on hard cases or refuse treatment to women above age 40 with their own eggs. This can obviously skew the statistics. What you should be looking for is: are the clinic’s success rates greater than the national average? (Check out the national IVF success rates here.) You should look at the live birth statistics for your age, and not just the pregnancy statistics (which will include miscarriages). You should also compare their multiple pregnancy statistics to the national average. If you’re not doing IVF, ask about the live birth success rates particular to your situation and particular to the treatments being suggested. (Remember that only IVF success rates are reported to SART and the CDC, so for other treatment success rates, you’ll need to ask your doctor.) Your doctor should have the experience to help you decide if the treatments are worth the financial and emotional investment. If a clinic promises you success, especially success in just one cycle, walk away. There’s no such thing as a 100% guarantee with IVF, no matter what reason for your infertility.
