Guest post by Carole Wegner PhD, HCLD, blogger at Fertility Lab Insider
I recently was lucky enough to connect with Carole Wegner, a board certified High Complexity Laboratory Director (HCLD) who has been the director of several fertility labs since 1995. She has an amazing blog and has also published scientific publications about basic reproductive research, clinical research and reproductive ethics in various peer-reviewed journals.
Choosing an IVF clinic and deciding when to start IVF is a big decision and I thought Carole would be the best person to answer this important question so I hope you guys get a lot of value from this post! xo Kym
When should I see a doctor?
Most couples don’t get pregnant on the first try, but the majority of fertile couples can get pregnant within a year of trying to conceive, assuming that they are having sex during fertile times each cycle and also assuming that the woman is relatively young – under 35 years of age. But if you are a young woman and have been trying to conceive for a year without success, experts recommend seeing a doctor for some lab work and a physical exam to rule out some obvious causes of infertility. If you are over 35 years of age, you might want to shorten the “trying to conceive” period to six months before seeing a doctor. Frankly, if you have had irregular periods or other reasons to be concerned, it is always better to have a fertility check-up sooner rather than later.
A typical first step is for the couple to consult the woman’s ObGyn for the initial work-up. An ObGyn can also order a semen analysis for the male partner or refer the male partner to an urologist who specializes in male infertility. Many ObGyn’s also offer basic infertility services like low dose ovulation stimulation and insemination with partner or donor sperm. I probably would not spend too much time with your ObGyn unless they are also board certified in reproductive endocrinology/infertility, because you’ll want to see a specialist who spends ALL their time providing infertility diagnosis and treatment services and can offer you a complete range of treatment options. If you like your ObGyn, you will see more of them when you are pregnant so don’t worry about hurting their feelings by going to a specialist sooner rather than later.
What about insurance?
My experience with infertility insurance is all US-based – so these observations may not apply elsewhere. Very early in the process, you will want to find out exactly what is covered under your insurance plan. Plans vary all over the place. Some will pay for diagnosis of infertility, but not treatment. Some will offer every treatment short of IVF. Others will offer IVF treatment – after you have failed a number of insemination cycles. Some will pay for the stimulation drugs, but not the actual IVF procedure. Some have lifetime limits. So you can ASSUME NOTHING about what might be covered. Ask for the coverage details in writing and find out if your insurance limits your access to certain doctors or certain medical systems. If you have no insurance, be sure to ask for estimates of the cost of all medical services before you agree to them. Ask your healthcare providers if they offer discounts for cash payments or discounts to certain groups – eg. military veterans.
Choosing your best possible doctor/ fertility clinic
All doctors are basically the same, right? Unfortunately, no. Question: What do they call someone who graduated at the bottom of their medical class? Answer: A medical doctor. This is not a funny joke when you are still not pregnant and have mountains of medical debt or have wasted your relatively fertile years with a below average physician/clinic. Sadly, the success rates vary widely by clinic. In 2012, live delivery rates reported by The Fertility Society of Australia and National Perinatal Epidemiology and Statistics Unit (NPESU) ranged from 4.0% to 30.9%. In 2013, the range went from 14.4% to 44.8%, in part due to reporting on pregnancy rates instead of live birth rates. Two things – live birth rates are always lower than pregnancy rates because miscarriages claim many pregnancies before birth. The statistic most important to you is the percent of IVF attempts that result in a “take home” baby – the live birth rate.
Finding the best clinic/doctor in your area is critical but you may have to do a little detective work to find them. A little advance research can mean the difference between success and failure. The US, the UK and Australia all keep public databases on clinical pregnancy success rates which allow patients to compare clinics in their country.
Comparing national summaries to individual clinic results. You can identify the best doctors/clinics in your area by looking at the national summary to get an idea of what an “average” clinic looks like, then look at individual clinic outcomes to find clinics with better than average outcomes for your age, and treatment. Avoid going to a below average clinic! Also since results are several years out of date, you will want to look at several years of past data and also ask clinics for more up-to-date outcomes– even if they are not yet published –to feel confident that the good results you found on the last published year are not an aberration.
(Database links in three countries)
How to use these US databases is described in these posts:
If you are in the UK: Human Fertilisation and Embryo Authority publishes IVF stats
If you are in Australia: National summary data can be found here
However, in the Australian database, I could not find data on individual clinic rates, so you may need to ask each clinic for their reported rates. With any national database, the pregnancy and live birth rates are several years behind because it takes 9 months for delivery and even longer to get the data collected and posted on-line. You will need to ask your provider specifically about their most recent success rates for women in your age group who have undergone the same treatment as you (eg. fresh IVF with your own egg vs. a frozen embryo cycle).
A cautionary note about statistics
- Compare apples with apples. For example, if you are 38 years of age, don’t look at the outcomes for the patients under 35 years of age to estimate your chances at a particular clinic. Likewise, if you are using your own eggs, do not look at the outcomes for women using donor eggs. Donor egg outcomes are useful only to assess the best possible outcomes that a particular clinic can deliver- so if this is low- then run like hell. If the clinic can’t deliver better than average outcomes with their donor egg cycles- they will be likely deliver even worse results with their other patients.
- Clinics like to quote their pregnancy rates per transfer because this is their best case scenario. It excludes all their patients that reach retrieval but didn’t get to transfer and also excludes all their patients who got pregnant but didn’t make it to a live birth. The most useful statistic for choosing a clinic is live births per retrieval because this gives you an estimate of your chances of bringing home a baby with all the patients included, not cherry picking the data from the most successful time points and patients. Once you get to transfer, then pregnancy rates per transfer become relevant, but they are not much use for choosing a clinic.
- About difficult patients. Clinics and organizations that collect statistics stress to consumers that clinic statistics are also affected by the number of “difficult” patients the clinic has. While this is true on the face of it, it ignores the fact that smart clinics quickly guide difficult patients to treatments like ICSI or donor egg that are more likely to work- precisely so it will not hurt their clinic statistics! Because of this, I think the effect of “difficult” patients is a wash at the end of the day- and in some cases, unfortunately, may be used as an excuse for underperforming clinics.
After statistics – other factors to consider
After you have found one or more good clinics in your area, the next step is to schedule an introductory appointment with the physician you want to hire. You will probably be charged for this appointment so be sure to ask what the fee will be up front.
You will want to ask your doctor how the clinic staff communicates case results on a daily basis. Will the nurse call you or the embryologist? If you want to talk to the embryologist, is that encouraged? Is the lab accredited?
The take home message is please take a moment to make an infertility treatment plan and gather the information you need to make smart fertility choices that are right for you and your family.
I wish you MUCH GOOD LUCK! – on whichever path to parenthood you choose.