Question 6: How do I choose a fertility clinic?

Well Washingtonian magazine has published its annual "Top Docs" issue and I was pleased to report to my parents that I made the cut again (as did Dr. DiMattina). Yet, several excellent Ob Gyn physicians that I know were not on the list this year. Did they suddenly become terrible doctors? No. However, probably they will lose some patients because of the fact that they were not voted in this year.

Popularity contests are probably not the ideal way to choose a physician. Neither is the internet. So how should a patient make such an important decision.? I would go with whatever clinic has the best candy at the front desk...but seriously, this is an important question to consider. So important that it is the Question of the Day for this rainy Monday in March.

6. How do I choose a fertility clinic?

Choosing a fertility doctor for your care may be the single most important factor that leads to a successful pregnancy, so choose carefully.

Many patients are referred to us by their OB/GYN, friends, relatives, former patients, news articles, or through the Internet. But the one common denominator we have routinely observed with the sophisticated patient is that she is well prepared before coming for her initial office visit or she quickly becomes informed and knowledgeable before we begin any treatments. Patients often say to us, “I checked you out before making this appointment.” Of course, we are always flattered by such comments, and we anticipate that this patient will ask all of the important questions and make an intelligent decision regarding her treatment options. She will also probably experience less stress during the evaluation and treatment process, as she has developed a better knowledge base and understanding of what to expect.

All fertility clinics come with a unique flavor of their own. Some are run by a solo practitioner, others by 2 to 6 member groups, while others are clinics with over 15 doctors. Regardless of the size of the group, be sure you are getting the attention and treatments you desire and deserve. You should never feel like a number with a revolving door of doctors.

Of course, patients are not doctors and will not have the knowledge or experience of a reproductive endocrinologist, but a caring doctor will always welcome any and all questions and will take the time to answer them in a way that you can understand. We view patients as our partners, and once we understand what they are willing or not willing to do, we can devise a treatment plan that offers hope without subjecting them to any unnecessary additional stress.

Other things to consider.
Statistics, statistics, statistics: You want a baby, so choose a fertility clinic with good success rates. However, a wise man once said: “There are lies, damn lies, and statistics.” So, how does one determine what to make of these statistics? In truth, there is no easy answer. Clinics that are more selective can inflate their success rates, while those that have a different philosophy may suffer the consequences even though they have an excellent program. For example, clinics that encourage elective single embryo transfer (eSET) or that offer unstimulated or Natural Cycle IVF may demonstrate lower clinical pregnancy rates as fewer embryos are transferred. Yet, in fact, such clinics that routinely transfer one or two embryos may have the best IVF programs. When considering a clinic, it is important to know what your specific chances for success will be within that clinic.

If there is one yardstick with which to compare clinics, then we recommend examining the pregnancy rate using donor eggs. In this patient population, the pregnancy rates should be very high. A low donor egg pregnancy rate may be concerning. All clinics should have a good pool of young egg donors and a recipient population that is fairly similar allowing for better comparison of clinics.

Advertising may be misleading. Obviously, a practice with 10 to 20 doctors will produce more total babies than a medical practice with only 2 to 6 fertility doctors, but the pregnancy rates may be equivalent (as can be seen in Figure 37 of Appendix B). Individuals should evaluate the clinic statistics and obtain a good understanding and feel for what their specific chances for pregnancy will be per treatment. Patients may also evaluate the clinic success by reviewing IVF statistics at the Centers for Disease Control and Prevention (www.cdc.gov/ART/index.htm/).

Experience: Experience of the clinic, in our opinion, may be one of the most important factors when deciding which doctor and which clinic to seek for fertility care. One should ask how long the doctors have been performing various treatment procedures. It is also important to know whether or not cutting edge procedures are either being offered or are being developed in the practice.

Subspecialty board certification: Most doctors practicing in the field of in vitro fertilization and infertility are subspecialty board certified in reproductive endocrinology and infertility. Evidence of this certification can be found by going to the Society for Reproductive Endocrinology’s Web site, which lists doctors who are subspecialty certified in reproductive endocrinology and infertility. Additionally, patients may find it beneficial to check if their doctor has a faculty position at one of the local medical universities or actively participates in the teaching of the medical students and residents in their locality.

Availability and accessibility of doctors: It is important that you have access to your doctor in order to have your questions answered and needs addressed. Evaluate whether or not the availability and accessibility of the doctor is an easy process or a difficult one when making decisions as to where to seek care. The friendliness and helpfulness of the staff will also give you a feel for the character of the practice.

Cost: It is always important to get the total cost. Factor in extra expenses such as the fertility drugs, which can cost thousands of dollars; intracytoplasmic sperm injection (ICSI); assisted embryo hatching; embryo cryopreservation; and preimplantation genetic diagnosis (PDD). These drugs and procedures can quickly increase the overall cost for treatment.

A word of caution: In general, Internet chat rooms may be a dangerous place for seeking advice regarding finding an infertility doctor. Be careful what you hear online, as it always represents just one half of the story. It is far better for you to do your own homework and research than to rely on information provided from others, which may be based on misleading impressions or experiences. Patients reporting on their experience with a given clinic or doctor may represent both extremes of the spectrum.