Finding your “Best Fit” IVF Program

May 30, 2013Carole 12 Comments »

Choosing the right IVF program for you can make all the difference between a successful and relatively straightforward IVF experience and true hell. Not all programs are created equal. You can’t rely on advertising campaigns to find the best program for you because advertising campaigns only speak to the programs dedication to spending money to bring patients in, not necessarily the quality of their services. Here is a short list of ideas to help you find the best program.

1. Look up the success rates for the clinics that interest you. You can find them here at the Society for Assisted Reproductive Technology (SART) webpage.  You might miss a few clinics if your clinic is not a SART member. For those, look up results directly on the Centers for Disease Control (CDC) webpage.  Now compare their rate to the National Summary Report for the same year. This is the AVERAGE results for all clinics in the US, segregated by age of the female patients. Unless you have no other options, don’t go to a program that has less than the average success rate. Just don’t. I have heard lots of excuses for sub-optimal performance. It is all BS.The labs I directed in Indiana and Pittsburgh easily achieved above average results every year because we knew how to do IVF. We hired good lab people and trained them well. Our docs could do a good stim and transfer an embryo properly. It wasn’t rocket science. The only downside to  reviewing the CDC and SART data is that it is two years old always so be sure to follow up and ask for current not-yet-published rates to make sure the clinic hasn’t taken a nosedive since the last official report.

2. Interview the program directly .

Find out how patients are “managed” in the clinic. Will you meet with the doctor or nurse at each appointment? Who calls you back to provide instructions, set up appointments or give you results? How easy is it to get in touch with the doctor, nursing staff or lab after hours if you have a question or concern? Do clinic staff answer emails or send text messages?  Keep in mind that there is no “right” way to handle any of this, but some methods may be more comfortable for you. Some people (patients and providers)  love the greater internet connected-ness, others hate it and prefer a “face to face” or even phone conversation.

Ask about costs. You should receive a written estimate of all the expected charges for your treatment plan and also if you have insurance, how much will be covered and how much is your responsibility. Keep in mind that sometimes your IVF “team” is composed of different business entities. Your ultrasounds may be performed and billed by a different company than your clinic. Lab may be billed from a different company than the physician fees. Anesthesia is often handled by a separate company. Make sure you ask about ALL the parts of your care. Ask if all IVF fees must be paid up before you start treatment or whether you can make installment payments. Ask about any cash or other discounts that may be offered to you. Sometimes clinics offer discounts to patients in the military or public service sector. Ask about your anticipated cost of medications, realizing that if your ovarian stimulation response is weaker than expected, it may cost more. Two pharma companies, Serono and Ferring,  still offer discounts on ovarian stimulation medications. Serono offers different discounts for self pay patients through their FertilityLifelines program . Ferring offers discounts through their HEART program.

3. Interview the program indirectly.

What are other patients saying about the program? There are lots of patient support groups on the internet which you can join anonymously and post questions. You can ask for respondents to reply to you privately to get the most honest feedback. Here are links to some of the best-known support groups :RESOLVE and INCIID.  Some lesser known support groups are listed on this webpage. You can find local chapters for many of these if you want face-to-face meet-ups. The key is getting feedback from lots of sources and looking for common themes.

Look for physician reviews.  Even Angies list now has a section for physician reviews where patients can describe their experiences with a specific provider. Keep in mind that most reviewers usually take the time and trouble to write a review if they are either exceedingly happy or unhappy with the service they received. What is telling in these reviews is common themes like long wait times or feeling rushed at the encounter which may be significant to you.  Ask people you know what they liked best and least about their program or doctor. keep in mind that most patients can forgive almost everything if they brought a baby home.

Google your doctor’s name. You might be surprised (and horrified) by what comes up. I have found news articles about law suits pending in other states or FDA warning letters regarding non-compliance. If your doctor seems to move around a lot from state to state or clinic to clinic, there might be a reason that has nothing to do with restless feet.

4. Use both your mind and your gut to analyze what you find. If your gut is still uneasy even if the doctor “seems so nice”, listen to your gut. Likewise, if he has a “Dr. House”-like bedside manner (meaning no bed-side manner) consider putting up with it if his results are stellar. When you visit the clinic, listen for signals that the staff is miserable, stressed-out or experiencing lots of staff turn-over. That is a really bad sign.  If the team doesn’t function well, the odds of your care being above average, let alone exceptional, go way down. You need to trust and respect your IVF team to do what is best for you and do it well. They need to be able to interact well with and respect each other for that to happen. You deserve nothing less.

 

 

© 2013 – 2015, Carole. All rights reserved.

12 Responses to this entry

  • Jean Says:

    Does a bad result for overnight recovery rate of a sperm sample (and no sperm surviving freeze for sperm donation) mean that my partner and I have a very small window for the sperm to stay alive and reach the egg?

    I guess what I am asking is, do we have a chance with these kind of results with natural conception and does this mean we have to hit the day of ovulation for any chance?

    I am 46 and we have been trying for 6 years since we met. Been through 2 IVFs here in the UK and no more funds to try again. Both IVFs resulted in grade one embryos (2 the first time , 1 the second time with natural modified IVF).

    I know the main issue is my age but as there is not a lot I can do about that (!) we are exploring if we can better time intercourse. We have done all the usual cutting out coffee, taking supplements, stopping a driving job. wearing looser underpants etc which really helped an initially poor sperm test result.

    Any advice greatly appreciated. I know soon I will have to come to terms with the fact that I probably won’t ever be a mum with my own eggs.

    Thank you

  • Carole Says:

    Hi Jean,

    I am sorry you are having such a hard time. Sperm usually last a few days while the egg has a “shelf=life” closer to 24 hours so timing usually tries to ensure the sperm is around when the egg ovulates. Honestly, even if you get sperm and egg together at the right time, you still face hurdles, the greatest being that your risk of aneuploidy in your eggs is extremely high. Aneuploidy or an abnormal chromosome number is more common in older eggs because the genetic machinery that insures correct chromosome replication and assignment to daughter cells gets faulty with age. If an egg has aneuyploidy, even if it fertilizes, there is no chance of a healthy child. Having a child with Downs syndrome is likely if you have Trisomy 21. This is the “best” possible outcome. All other trisomys or aneuploidies result in early embryo death, failure to implant or miscarriage. This has everything to do with age, unfortunately and there is no “cure” for that currently. Stem cell therapy may hold some promise but if it works to “rejuvenate” older eggs,but it is still years away from implementation as routine care- if it ever reaches that point. It may be time to sit down with your man and think about what you want the next 2-3 decades to look like. You have options but as you note, having a healthy child with your own eggs is not likely. With IVF in the US, the CDC reports that 1% or 1 in 100 women aged 44 and older have a live birth with IVF. http://apps.nccd.cdc.gov/art/Apps/NationalSummaryReport.aspx That statistic is with all the advantages of IVF for egg and embryo selection, I would expect the success rate (pregnancy and live birth) with intercourse to be much lower than 1% in this age group. You have options that lead to parenting but it is up to you to decide what you can live with and what you want. Wishing you all the best.I know this is very hard. Good Luck!!

  • Jean Says:

    Thank you for your reply Carole. I appreciate your frankness. I think I was given false hope by the fact that my mum was 44 when she had me.

    I’m having a very hard time coming to terms with egg donation, the implications for the resulting child, my grief at not being to have my own child and the looming shadow of more debt for an uncertain outcome.

    As I don’t have any other hope I don’t feel prepared to stop trying just yet. I have read that sperm can survive for several days, however, my partner’s 24 hour survival test left very few of the critters functional. So does that mean we have to hit the day of ovulation to have ‘any’ chance of success? Apologies, I couldn’t find the answer to this above. The ovulation monitoring system we are using has a helpline and they say to try the day of ovulation and the day after but I thought the day after was next to useless for conception. Nothing seems to be very concrete in the field of conception except the fact that I am too bloomin old!

    Thank you

  • Carole Says:

    Hi Jean,
    As far as timing goes, the usual rule of thumb is to have the sperm there first, before the egg gets there rather than have the egg waiting for sperm, so have intercourse before or on the day of ovulation. If you wait to have intercourse after ovulation has occurred, the egg’s “clock” is ticking. If we don’t see signs of fertilization the next morning after coculture with sperm overnight, we can try a rescue ICSI that morning (24 hrs post retrieval) but the fertilization rate is perhaps only 10% or less of what it could have been the day before if we’d used ICSI right away- we attribute this to the egg losing viability over that 24 hours. SO get the sperm there early and often. The simple stupid way to do it is to have intercourse every other day after your period is done until mid cycle plus a couple of days.
    The results of the sperm survival test suggest that viability falls off so quickly in less than 24 hours for your husband’s sperm, success with intercourse is unlikely. You probably need ICSI and IVF and genetic analysis of embryos to identify abnormal embryos before transfer. After all that, you may well find no normal (normal =embryos without aneuploidy) embryos to transfer. Donor egg is another expensive, emotionally difficult alternative. It is a lot of money and emotional turmoil for an extremely low chance of success. That could describe gambling as well, couldn’t it? Repeated treatment cycles that are increasingly futile are a form of addiction. How to tell if you are addicted- some questions to ask yourself here http://www.webmd.com/infertility-and-reproduction/guide/addicted-hope
    Regarding the emotional difficulties of this, have you reached out to support groups on-line or in your area? Other people are having the same questions you have. You might find insight and encouragement from them. Here is just one quick example – there are hundreds of support groups out there- http://www.experienceproject.com/groups/Am-Childless-Not-By-Choice/84054 I know this is a very difficult time for you but you will find answers –it does get better! Good Luck!!

  • Kim Tidwell Says:

    I found your post very informative. I have recently been having doubts about my clinic. I am having a hard time determining if this is just nerves or should I go with my gut and switch clinics. One red flag is that the clinic’s stats for my age group is 10% lower than the average for only 2011. The previous years are at average or above. What stinks is that this is one of the best in the state so I would need to go out of state. Do you have any advice?

  • Carole Says:

    Hi Kim,
    You could always ask them for their unpublished pregnancy rates so far for 2012. Not everyone will have given birth yet but if there are enough cycles, you might be able to tell if the 2012 results so far are on the way up or continuing to be below average or actually getting worse. If there was major staff turnover in 2011 that could account for some problems that may have stabilized by now. Some patients do end up traveling out of state for treatment but I realize that is not possible for everyone. Good Luck!
    Carole

  • Anonymous Says:

    Thanks for your response! I did ask about the 2012 rates and they did not say they were not available yet. What is so crazy is the 38-40 age bracket above my age group success rates are around 50%! This is 22% highler than the stats for my age bracket. Does that happen often? I am currently on bcp and about to start meds in a few weeks and just had this freak out! I am looking into another clinic in another state that could start monitoring the next cycle. Of course it would be alot easier to just continue with my current clinic that is a minute from my house in a few weeks. I just don’t want to regret not going to a clinic with better stats. Thanks!

    Kim

  • Carole Says:

    Hi Anonymous,
    Percentages can be somewhat deceiving. A 50% rate in one age group may mean that one patient of two patients in that age group got pregnant or it could mean that they cycled 100 women in that age group and 50 became pregnant. The second percentage would have more weight in my eyes as a better estimate of a “true” rate. So when percentages are provided, especially for few cycles, both numbers (#successes and # attempts) should be disclosed. Actually, if you look at the CDC reports, if fewer than 20 or 50? cycles are reported in a particular age bracket, the rate is reported as a fraction just for this reason. In stats from my labs, I have noticed this blip before and it may be due to patient recruitment. Women who are basically fertile but with diminished reserve (older age group) can do just fine with the hormonal boost from IVF. Sometimes the younger age group may have more individuals in it with more serious problems- they came earlier to treatment because they knew that had multiple hurdles. This could explain the discrepancy of a higher pregnancy rate in an older age group. With larger numbers of cycles, these statistical blips tend to even out. Good Luck!

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  • Sophie Says:

    Another thing to consider befroe getting pregnant is how if will change your life. Are you ready for everything that not only comes with being pregnant, but with having a child? It is such a blessing, but such a HUGE, life altering responsibility. We are sooooo blessed to be able to conceive with minimal effort, but I wish someone would have told me ALL of the changes that come with this decision.

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