How to Choose the Best Clinic For You

Treating infertility can be a complex and drawn out process, so it's important to have the right clinic and specialist working with you. It's a good idea to interview several to ensure you find one who is qualified, with whom you are comfortable talking, and who is sensitive enough to help you through what can be an emotionally and physically intense experience.

Before you visit any fertility clinic, learn about common fertility treatments and procedures to find out what may lie ahead for you, and discuss with your partner how far you are both willing to go. ART (advanced reproductive technology) can cost thousands of dollars and require you to take strong drugs and hormones which can have dramatic physical and emotional side effects. If you know your limits ahead of time you can avoid being talked into a procedure you don't want and can't afford.

You and your partner should be present for the initial visit at the clinic. Use this opportunity to interview the prospective specialist and make sure you are comfortable with this person. Be aware of how receptive he or she is to your questions and concerns. If the specialist seems impatient or dismissive, you may be better off elsewhere. The attitude and openness of the support staff at the clinic is an important component as well, since you will be dealing with them over the phone and during appointments, sometimes more often than the specialist.

Things to Look For

Any fertility specialist you consider should be an American Board of Medical Specialties certified reproductive endocrinologist (RE). An RE has completed the standard OB/GYN training, as well as an additional two to three year fellowship in infertility treatment, two years of clinical experience, and has passed both oral and written exams.

The lab associated with the clinic should be accredited by the College of American Pathologists, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) or the state. The fertility program should also follow guidelines for IVF established by the American Society for Reproductive Medicine (ASRM). While membership in the Society for Assisted Reproductive Technology (SART) is not necessary, it is a sign of the clinic's quality.

It's a good idea to also find out the clinic's success rate, if possible. You can find many fertility clinics' success rates in the Centers for Disease Control's (CDC) publication "The Assisted Reproductive Technology Success Rates in the United States: National Summary and Fertility Clinic Reports". Not every fertility clinic reports to the CDC; however, even if your prospective clinic is not included, this will give you enough information to ask informed questions and understand success rates in your region. Many factors contribute to a clinic's success rate, so it is important to understand all the data.

Questions to Ask

It's a good idea to go into the initial appointment armed with questions for the specialist. The following is some information you should find out about the RE and the clinic before you agree to proceed with treatment:

About the specialist:

• How long have you been treating infertile patients?
• How long have you been at this clinic? Where were you before and why did you leave?
• Where did you receive your medical training? When? What is the educational and professional background of the rest of the staff?
• Can you prepare a treatment plan, including which tests and treatments I will undergo?

About the clinic:

• How many reproductive endocrinologists are on staff? How many will I see?
• Who can I call if I have a problem after office hours?
• How long has the medical director been here? How long have the other doctors and staff been here? (High turnover can be a sign of bad management and can contribute to mistakes.)
• Are you affiliated with a hospital? Which one(s)?
• What insurance plans do you accept?
• How much will treatment cost? Does that include lab work, procedures and medications?
• Do you offer any financing options or payment plans?
• What kind of advanced reproductive technologies (ART) do you offer?
• Do you have a donor sperm/egg program?
• Is there a laboratory on site?
• How many babies have been born to women 40 and older? 30 to 39?
• How many treatment cycles of IVF have been initiated by this program in the past two years?
• How many pregnancies have resulted from the program in the last two years?
What percentage of those pregnancies resulted in live births?
• How many deliveries were multiple births? Singletons?
• Does the clinic offer psychological counseling?
• When you do an advanced procedure that involves fertilizing eggs outside the woman and the planting them inside her, who decides how many eggs are implanted - the woman or the doctor? (Look for clinics that give the patient more control.)
• Do you have transvaginal ultrasound equipment on site? (You should not be undergoing medicated treatments unless this equipment is available for routine monitoring.)

Warning Signs

Once you have found a clinic and specialist, continue to evaluate their performance and how you feel under their care. Any of the following may indicate it's time to find a new doctor:

• Your specialist suggests you continue a course of treatment even though you have been through three or four cycles without success.
• You can't ask questions freely, or your doctor dismisses your concerns.
• You have to remind the doctor constantly about your treatment plan or ask to have certain tests.
• Your drug treatments are not being carefully monitored with blood tests and ultrasound exams.