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Conquering infertility takes more than one couple’s determination. It takes the expertise, cooperation and sensitivity of a small army of doctors, nurses, laboratory specialists, and support staff. That’s why choosing a fertility center is one of the most critical decisions you’ll make in your quest to have a baby. These professionals will be your most important allies.

The hard part is getting all the information you need to make the right choice for you.

Many patients base their selection of an IVF center entirely on limited input-a referral from a friend, new word about a clinic’s success rates, or a clip on TV. Certainly those are valid points to consider. But there is a range of other crucial issues that patients should keep in mind before deciding. This AFA Fact Sheet provides you with some insights about the most basic considerations as well as many other less obvious factors to include in your research.

Common Factors Used in Choosing an IVF Center

Success Rates: Every two years, the Centers for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technology (SART) together publish statistics on the results of almost all of the IVF centers in the United States. This information is quickly assessed and shared with patients around the world via Internet postings and chat rooms. While patients should be aware of success rates, they should also recognize some important issues that these statistics don’t cover.

According to the CDC, many people considering ART will want to use this report to find the “best” clinic. However, comparisons between clinics must be made with caution. Many factors contribute to the success of an ART procedure. Some factors are related to the training and experience of the ART clinic and laboratory professionals and the quality of services they provide. Other factors are related to the patients themselves, such as their age and the cause of their infertility. Some clinics may be more willing than others to accept patients with low chances of success or may specialize in different ART treatments that attract particular types of patients. These and other factors need to be considered when interpreting clinic data.

For example:

• Does the center deal with patients in your age group? Is it successful because it deals primarily with younger couples who typically have a greater chance of achieving a pregnancy?
• Can you review and compare diagnosis-specific success rates?
• What is the rate of multiple births for women your age? How many embryos are transferred on average?
• Does the center specialize in the treatment of specific causes of infertility?
• Will they treat patients with fluctuating levels of FSH?
• Have there been changes in personnel at the center since the period reflected by the success rates?
• Unless you understand the reasons why a center’s success rates are high-or low-choosing a center based on these statistics can be very risky.

Reputation: Many IVF centers have a national or even international reputation, some good and some not so good. Those reputations are fragile. They can be burnished or destroyed by one high-profile case or situation-the announcement of a successful new treatment, a tragedy involving mixed-up embryos, or stolen eggs. Sometimes, just a chat room posting from a former patient is enough to tilt the scales. Be judicious when weighing this type of information. You must assess the truth of any news you hear about a center from the media, other patients, or even the center itself. If an advertisement or newspaper story claims that a center is the best in your city or state, how are they substantiating that claim? If a center is involved in a lawsuit or scandal, are you sure that the details you have about the situation are accurate? You must then determine whether the information you have about a center is relevant to you.

Recommendations: If someone you know well had a baby at a center and raves about the experience, what should that news mean to you? If your friend’s profile is very different from yours, it may mean little. But if many patients with profiles similar to yours had a good experience, that information should play a bigger role in your decision. A referral from someone you do not know well-perhaps through the Internet or from a friend of a friend-may not be very helpful because you do not know how the opinion was formed. Patient advocate organizations such as AFA that offer referrals, not recommendations, to board-certified reproductive endocrinologists and urologist, are good places to start. For any information you receive about an IVF center, first consider the source and then find out how closely the information relates to your specific case and needs.

Convenience: You’ll be spending a good deal of time at the IVF center, including daily visits for your blood work. Make sure you choose one that you can get to easily and that can accommodate your schedule. For instance:

• Is the center open seven days a week, with doctors on call 24 hours a day?
• Is there a waiting list?
• Are all areas of the office comfortable and clean?
• How much time does it take, on average, for office visits for blood work or sonograms?

Be certain, though, that you do not choose convenience over the ability of a center to provide all of the services you may need.

Cost: Infertility treatment is costly and prices can vary from center to center. You should determine whether or not your treatment will be covered by insurance. If you’re going to pay out of pocket, find out whether a center is affordable and has a payment plan option that fits your budget.

Inquire about the many different types of shared-risk programs that offer partial refunds if a cycle is not successful. Bear in mind that fertility medications are not included. Furthermore, not every patient is eligible: age and diagnosis, for instance, are among the many qualifying factors. For some, such a program is a boon, a financial hedge that may make it affordable to try again after a failed cycle. The terms of the plans are often complex and vary from one center to the next. You should understand all of the conditions and details of a center’s shared risk “money-back guarantee” before signing on. This is one area where you may want to consult with patients who have used a similar guarantee in the past.

Although patients rarely choose medical care based on cost, the price and payment plans offered by centers can differ dramatically. Infertility treatments can be break-the-bank expensive. Even patients fortunate enough to have insurance find most companies put a cap on coverage. Thus, it’s essential for every patient to have a firm grasp of treatment costs and a pragmatic game plan for footing the bills.

Other Factors That May Be Important

Once you’ve covered the “basics”-success rates, reputation, recommendations, convenience, and cost, you’ll find there are many other issues that may be significant to you. Unfortunately, most patients do not even know that these issues exist until they’ve begun treatment when it’s difficult, if not impossible, to do anything about them.

Consider the following list of less common questions to ask an IVF center. For many people these are the kinds of inquiries that could make the difference between a wonderful choice and a miserable experience:

• Does the center have any restrictions that affect patients? For instance, many centers will not treat patients over a certain age. Others may not to treat single parents, gay or lesbian couples, or patients who want to use a specific donor or a gestational carrier.
• What resources does the center offer? For instance, how many doctors, nurses and embryologists are on staff? Is all laboratory work done in-house? If not, how is it provided? Is the center affiliated with a research institution, a teaching hospital or is it a private program? In some cases, this may affect access to certain treatments
• If you are seeking treatment involving a specific procedure, does the center offer that procedure? If so, how much experience does the staff have in that area?
• Are patient information education materials available in the waiting room or offered to you by program personnel?
• How comfortable and clean are the facilities? How private and accommodating is the sperm sample production area? Can the sample be brought from home? Are the bathrooms stocked with personal hygiene items that women may need while cycling?
• Is the program able to accommodate religious considerations?
• Is there a therapist on staff to emotionally support patients? If not, does the center readily offer referrals?
• Does the center offer support groups?
• Is staff accessible to answer questions about treatment, forms, or payment?
• Do they offer donor eggs and sperm? How is it arranged? Is there a waiting list for donors? If so, at what point in your treatment are you added to the wait list?

Following are some specific issues associated with the IVF procedure that could be of particular significance:

• Will the program allow you to cycle with variable levels of FSH?
• Do they offer cryopreservation?
• Is the program using the latest embryo transfer technology, such as blastocyst transfer?
• Are there set guidelines used for canceling cycles?

There are also many questions you should ask your doctor directly, including:

• What is the doctor’s hospital affiliation?
• Is the physician a board-certified (or eligible) reproductive endocrinologist?
• How accessible is the doctor-office hours, waiting list for appointments, etc? On average, how long does it take to receive a return phone call?
• Who performs the tests and procedures you will need (including ultrasounds or IUIs), and how involved will the doctor be in each stage of treatment?
• What should you do if you have a problem with a staff member?

Every question you have is legitimate. It’s part of your treatment to know as much as you can, so don’t hesitate to ask.

Conclusion

Each year, thousands of patients begin treatment at IVF centers without getting all of the information they need. They may learn too late that the center they’ve pinned their hopes on is not the best for them medically or financially. The result is often a failed effort to have a baby and the loss of hard-earned dollars. Most IVF centers work very hard to help patients get to learn everything they need to know, but the ultimate responsibility for this decision rests with the patient.

By asking the right questions and using many different sources for information, you can get more of the information you need to choose an IVF center that will give you the best possible chance of having a baby and building your family.

This AFA Fact Sheet was funded by a friend of The AFA who wishes to remain annonymous.