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Picking the Right Fertility Clinic for You

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Picking a fertility clinic is the most important choice you will make once you decide you need ART (assisted reproductive therapy). Here are 5 things to help you narrow your search.

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Some of you may have been with your primary care physician for years. Or haven't switched gynecologists since you started going. Your dentist is the one your parents use. Or maybe your insurance carriers tell you who you can go to. For most of us once we find a physician we are comfortable with we stay put until they retire or we move. So choosing a physician or clinic is probably new to most of you. When it comes to choosing a fertility clinic there isn't a manual helping you make the choice, a choice that really is probably the most personal health choice you will make. Because the vast majority of insurance carriers do not cover fertility treatments or even the diagnostic testing I am going to safely assume asking your carrier for a referral is not an option. However, I highly recommend calling your carrier prior to diagnostic testing and finding out what part of testing if any is covered. Work with the billing department in your physician's office as well as your physician directly you'd be surprised how many other diagnoses can be used on tests other than infertility that your insurance will cover. I worked with my gynecologist and endocrinologist to make sure all lab slips and ultrasounds did not have infertility as the diagnosis and therefore they were covered by my insurance.

So once you know the next step in your infertility journey is finding a clinic where do you begin?

1) Word of mouth referrals are always a great source. Ask your friends, ask their friends. With over 10% of people of reproductive age given a diagnosis of infertility chances are you know someone who has been down the road you are beginning. This is also a time to realize that trying to keep this a private matter is both impossible and unhealthy. I admit there is still somewhat of a stigma around being infertile. But part of the reason if not the entire reason is because people who are infertile don't share and educate the people around them. A diagnosis of infertility is scary and you will need the support of those closest to you. These are the same people who will tell you, "well so and so went through this.." here's an opportunity to reach out to that person and ask which clinic they used. If direct word of mouth referrals gets you nowhere go to the online infertility community. The Nest and Baby Center websites have great resources. Use them. Ask the women if they would recommend their clinic. You'd be surprised how many have switched clinics for one reason or another. These women are a wealth of knowledge and have done a lot of the research on their own and are more than willing to help.

2) Find a physician who is accredited with ASRM (American Society for Reproductive Medicine). Visit their website to find a physician near you. Why is being accredited so important? Well in order to be accredited the physician has to complete a certain amount of continuing education hours each year. This means they are educated on current trends in infertility medicine and since it's a very new area of medicine it is always evolving and you want your physician ahead of the trends. Accreditation also means the clinic is held to certain standards and inspected on a regular basis. Fellowship is also an important quality in a physician. You want a doctor who is "friends" with other doctors in the same field. They bounce ideas off one another and they compare notes. This only helps your treatment. Accreditation facilitates fellowship.

3) Don't get caught up in the clinics success rates. What? That seems crazy right? Of course it's important to choose a clinic that actually helps patients get pregnant. But use the statistics just as a tool and not as deciding factor. Why, you ask? Statistics are flat, they are what they are. 61% pregnancy success rate for women your age seems decent right? The problem is the clinic isn't required to report the diagnoses of these women. The only reported information about the patient is their age. What if the diagnosis is more straight forward than yours making treatment "easier" and thus pregnancy more likely. Or the exact opposite and your case is "easier" is your success rate more like 70% then? It's just not that simple. Because clinics know some people use success rates as their deciding factor women with a diagnosis that makes pregnancy very unlikely might be turned away by a clinic that wants to keep their success rates high. So when you see a 61% success rate it might mean the clinic screened their patients refusing to treat patients where success wasn't likely. Look at the success rate but keep in mind there is a lot behind that number you are unaware of.

4) Interview your physician and clinic. Yes, the clinic will allow this. The downside is most likely there will be a fee. If you consider time is money and you will need at least 30 minutes with the physician it seems reasonable to pay some sort of fee. When you call to make the appointment ask if they do phone consults. I only suggest this if the clinic is quite a distance from your home otherwise it's important to see how you interact with the physician after all he/she is going to be seeing A LOT of you. If it will be over the phone make sure you have faxed or mailed your medical file a few days prior so it can reviewed prior to the consult. If you are to the point of needing a fertility specialist you most likely have had several tests and a lot of lab work ordered by your other physicians you need copies of all of these tests. I know your only real question is, "will you help me/us get pregnant?" But what else should you ask? Because of the plethora of information on the internet asking about their schooling isn't really necessary. Google the physician's name and you will get all the background information you ever needed. If you have specific questions about education after Googling make sure to get clarification. Ask if they will directly being caring for you. You don't want a physician who writes up a treatment plan and you then follow up with the nurse or physician's assistant the rest of the time. Are they available by phone or email while you are cycling? You will have a nurse who you work closely with and they will always be available but you want to know if the physician will be as well. If you have questions about their success rate, ask. But you want to know based on what they have read from your chart what they think your success rate will be. Most likely they will tell you they need more information which means more tests. Ok, so what other tests will you need? You've been waiting to get pregnant awhile so you want to start now but that won't happen. I was surprised how long my final diagnosis took to get and then it felt like forever to start treatment. Ask the fertility staff for different protocol scenarios for IUI and IVF that way you have an idea of how long treatment takes. Ask for a price list for all treatments. Is there financing or do you have to find your own? If you are commuting quite a distance can you have bloodwork and ultrasounds locally and the information sent to your clinic? My last IVF cycle I was at the clinic at least twice a week if you are commuting that can be brutal. These are just some of the questions I would recommend asking, of course you will come up with more while meeting with the physician. Remember he/she is supposed to be on our team. You need a supportive clinic and physician.

5) The clinic staff is JUST AS important as the physician. You will work with the staff more than the physician. You will see the nurse a lot. All modesty is out the window when you start treatment but you still want a clinic staff that makes you feel human. If you went in for the interview is the receptionist friendly? Was the phone answered when you called to schedule the appointment or did you need to leave a message?If you emailed the staff at some point prior to going in did they respond in a timely manner? Get a feel for the clinic at your first appointment. Is it a comfortable setting? You will be there a lot. Obviously, is it clean? Is the staff private? I have been to offices where you can hear the staff talking about patients through the walls or worse yet right in front of you. Keep in mind at some point you are likely to be the patient they are talking about. When you are cycling you will need these people often and you want to make sure that they are kind and compassionate.

Dealing with infertility is hard. No way around it. But with the right team behind you it can be less intimidating. You will spend a lot of time, energy and money on this journey make sure you choose a clinic that is worth all three. Good Luck!

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