One of the most important decisions you will face when starting or expanding your family through egg donation is where to go for treatment, and who provides your treatment. You want a clinic where you feel honored, respected, and cared for–and with that comes a physician or team of physicians who have your best interests in mind.
The rapport and relationship you develop with your physician is critical. Look for a doctor who is going to be kind, caring, compassionate, and above all, willing to partner with you during your treatment. We can’t tell you how many times we’ve heard patients say, “My reproductive endocrinologist doesn’t listen, he’s so rushed. He acts as though I have no idea what I am talking about, and I feel stupid each and every time I leave his office!”
Even armed with the list of questions below and a working knowledge of clinic statistics and success rates, we can’t encourage you enough to search for a practice that you feel comfortable with. You can go to the best clinic in the world from a success-rates standpoint, but if you don’t feel good about where you are and how you are being treated, it can make for a stressful and negative experience. We cannot overstate the importance of feeling confident and positive about wherever you choose to seek treatment.??
While this may all seem time consuming, overwhelming, and daunting, just remember that you are in the driver’s seat. The clinic is a service provider designed to meet your needs. You, the patient, have the very last say in your treatment–this is your body! And remember, above all, keep your eye on the prize: a baby!
DIFFERENCES DO MATTER
First, keep in mind that no two treatment programs are alike; each clinic has its own set of statistics (success rates), protocols, and procedures. As consumers, we want to get the most value for our money (after all, no matter how much we might come to love our reproductive endocrinologists, clinics are running a business). Because in vitro fertilization (IVF) using donor eggs is expensive and not always covered by insurance, it’s important to be educated about the process and to have a list of questions prepared to ask your physician, business office, and insurance specialist so you can make an informed decision.
Clinics performing fertility treatments are required by law to send statistical information each year to the Society for Assisted Reproductive Technology (SART) and the Centers for Disease Control and Prevention (CDC), who then compile that information into reports that are released to the general public. The reports contain percentage-based success (pregnancy) rates for IVF cycles and IVF-with-donor-egg cycles at every clinic. Also included are the number of cycles performed, which makes it easier to put success rates into perspective.
SART releases a report each year, whereas the CDC releases its report every other year in order to record a live birth rate (as opposed to a clinical pregnancy rate). So it is important to know that, for example, CDC figures published in 2008 reflect 2006 success rates. Becoming familiar with SART and CDC statistics is instrumental in choosing a treatment program. They are a good place to start, and can help you narrow down your choice of potential clinics.
As you conduct research, keep in mind that statistics fluctuate from year to year for many reasons. That’s why it is important to look for success rate trends: is a clinic generally improving its success rates each year? Are they growing the number of donor egg (DE) cycles completed each year? Do the statistics illustrate an overall consistency of success?
QUESTIONS TO ASK POTENTIAL CLINICS
After you’ve familiarized yourself with the statistics and narrowed down your choice of potential clinics, the next step is to pick up the telephone. Don’t be afraid to call to ask questions of every fertility clinic you're considering. This can help rule out some clinics at the outset—if you call a clinic and are told they're too busy to answer your questions, run the other way.
If a clinic’s staff is too busy to answer your questions when you call, they probably aren’t going to have the time to answer your questions once you’re a patient. Since you’ll already know something of your potential clinic’s success rates, don’t hesitate to ask about them and what they mean. Different clinics have different criteria for what they consider to be fertility treatment “success.” Some clinics define success as achieving a pregnancy, while other clinics define it as achieving a live-birth delivery. Make sure to ask how the clinic compiles its figures and, in particular, how it treats different age groups in its statistics.
Here are additional specific questions to ask:
Questions For Your Physician
How does the clinic communicate with its patients? Is it primarily by telephone or e-mail? Will I have access to your e-mail address?
How does your on-call rotation work?
What additional resources does your clinic provide (counseling or support groups, acupuncture, etc.)?
Where did you receive your medical training? When?
Are you a board-certified reproductive endocrinologist?
How long have you been treating infertility?
Do you or your nurse have a call-in time so that I can ask questions?
Whom can I call if I have a problem after office hours?
Can procedures be done on weekends? Is the clinic open every day, including weekends and bank holidays?
Are you affiliated with a hospital?
Does the clinic perform many blastocyst transfers, or are its transfers mainly day-three transfers?
What kind of lab does the clinic maintain? Is it a clean lab? Does the clinic regularly perform ICSI, assisted hatching, or PGD?
Does the clinic perform egg vitrification?
How many donor egg cycles are performed annually?
If the clinic performs many cycles each year, ask how it prevent patients from feeling like a number on a production line. If the clinic performs few cycles each year, ask about the reason and the clinicians’ comfort level with the procedure.
Does the clinic perform shared cycles?
Does the clinic participate in embryo donation?
Make sure that the clinic you select has a wide repertoire of infertility procedures and remedies and that its staff is comfortable and familiar with the latest technology. Because every clinic is operated by human beings, mistakes can occur. This leads to horror stories of misplaced embryos, lost sperm, embryos transferred to the wrong uterus, or ugly legal battles over a patient’s frozen eggs or embryos. To make sure this doesn’t happen to you, ask your future clinic about its quality control and ethics policy.
In-House Donor Pool
Does the clinic offer an in-house donor pool?
If your future clinic has an in-house door pool, it’s important that you don't feel rushed when selecting your donor. Another important point to remember is that no matter how intelligent, gifted, beautiful, talented, athletic, or artistic the donor you select may be, there is absolutely no guarantee that the child you have will share those traits.
In addition, if an agency or a clinic with an in-house donor pool charges up-front fees in order for you to view their donors, walk away. And whatever you do, don’t fall victim to the idea that “If I pay a lot of money, I will get a first-class donor.” Paying in excess of $10,000 isn’t going to produce or create a better ovum (egg) or enhance your chances of becoming a parent any more than an egg donor whose compensation rate is $5,000. Your clinic, its treatment protocol, its statistics, and your uterus will determine your success in becoming a parent, not the cost of the egg donor.
What is the medical director’s tenure?
What is the clinic’s staff turnover like? How long have its other doctors and the technicians been there? High staff turnover can be a big red flag for many reasons. It can mean faulty management from a practice perspective, which can contribute to mistakes that can make or break your cycle. Will the doctor I meet for a consultation be the one I see on an ongoing basis? Many clinics have a team approach, meaning you may see a different doctor each time you have an appointment. Assess your own level of comfort with this type of process.
Does the clinic maintain age limits for treatment?Some people feel that if a clinic does not institute age limits on IVF procedures, it must not be concerned about ethics. This is a controversial issue; ask for an explanation of the clinic’s age guidelines or its decision not to restrict treatment. Ideally, each clinic should treat its patients on a case-by-case basis instead of approaching patients in a cookie cutter, one-size-fits-all manner.
Who makes the decision regarding how many embryos to transfer back into the uterus? Is this something the doctor and patient decide together, or does the clinic have its own guidelines? ?
PVED does not recommend seeking treatment from a clinic where the doctor has complete control regarding embryo transfer. The choice about how many embryos to implant should be made in collaboration with the patient.
Does the clinic offer a money-back guarantee? Is the clinic part of a shared risk program?
Does the clinic provide a printed cost sheet for all procedures from donor egg retrieval through the transfer of embryos into the patient’s uterus?
It’s important that you know the costs ahead of time so there are no surprises along the way. Don’t forget to ask about ultrasound costs, lab costs, extra office visits, and the cost of after-hours calls if needed.