By Hannah Saunders, co-founder at The Fertility Circle. Hannah underwent five rounds of IVF at three different hospitals/clinics (including one in Hong Kong). You can read her story in her Path to Parenthood, here
It might sound glaringly obvious, but choosing the right fertility clinic for you is really, really important.
You’re going to spend many hours with that clinic’s doctors and nurses – and most likely many thousands of pounds, too.
But how do you know if they’re the ‘right’ one?
If you’re just starting out, you might be feeling a little overwhelmed, especially if you’re having to pick a private clinic. [If you’ve been granted NHS funding, you’ll usually be given a more limited choice of hospitals based on your location, but even so, you should still compare hospitals so you can feel confident in your final choice]. With 100+ fertility clinics in the UK alone, it can feel a bit like finding an elusive needle in a haystack.
Rather than rushing to commit to a clinic, though, take your time and do your homework. Drawing up a shortlist of your preferred clinics and ‘interviewing’ them (see also our IVF Tips: 10 Questions to Ask a Fertility Clinic feature) will help put you back in the fertility driving seat and enable you to make an informed decision.
Here are some things to consider when choosing a fertility clinic:
1. Success rates
The data each clinic publishes on its annual live birth rates is a useful gauge, but provided they are performing at, or better still, above the national average then don’t use the data as your sole clinic selection criteria.
Success rates vary between age groups, can fluctuate year-on-year within clinics, and can also be skewed by clinics’ different patient eligibility criteria (for example if a clinic stipulates a preferred FSH level in female patients).
You’re broadly looking for consistent results including a strong live birth rate and completed cycle rate.
Success rates can be found on the HFEA website, on clinics’ own websites and on the clinic pages in the listings database here at The Fertility Circle. Do question a clinic that is still quoting headline figures on their own site from several years ago, however, as it could imply a downward trend in recent years and you need to understand why this is.
It’s also advisable to understand your clinic’s policy on single vs multiple embryo transfer. Some clinics favouring multiple embryo transfer may have marginally higher live birth rates as a result, but it’s important to be aware of the risks multiple transfers can present to mother and child if they develop into a multiple pregnancy, and it must always be your choice how many embryos you put back at transfer.
When you visit one of your shortlisted clinics for the first time, be sure to probe your consultant on their data and don’t be afraid to ask them to clarify any statistics you don’t understand or which seem out of step with comparable clinics.
2. Range of treatments offered
If you’ve been trying for some time and/or have had some basic diagnostic blood tests (to check hormone levels and other markers such as FSH, AMH etc), it’s possible you might start with fertility drugs or less invasive treatments like IUI.
If these don’t work, or you have a more complex diagnosis, you might need to progress to IVF or consider other paths to parenthood, such as donor IVF treatment. Finding a clinic that can not only offer you the highest standard of the treatment you need right now, but might potentially need in future, is an important consideration, depending on your age and/or medical history.
Think of it a bit like a job interview. You’re the ‘employer’ with several applicants to consider. Which CV has the skills and experience that best matches your needs, now and in future?
In addition to the range of treatments offered, ask about the clinic’s ethos. For example, some clinics favour gentler treatments (some even specialise in ‘natural’ or ‘mild’ IVF, working with your own cycle, for example); at the other end of the spectrum are clinics which are highly forensic in their approach and will often prescribe multiple drugs, sometimes including steroids and immune treatments. Ultimately, we are all different, and knowing where you are on the spectrum of treatment required – often affected by age; or whether your fertility issues are ‘unexplained’ or have been pinpointed – will help you to decide whether the clinic offers the right treatment type(s) for you.
3. Cost (and cost transparency)
Having to fund fertility treatment yourself can be a really expensive business and the need to keep going if it fails can become something of an addiction.
Agree your maximum budget with your partner at the start and do everything possible to stick to it. The physical and emotional stress of fertility treatment is tough enough without financial worries, too.
Budgeting - and also comparing clinics - can be complex, though, since clinics aren’t able to provide one fixed cost per treatment type: treatment plans will need to be tweaked and tailored to the individual.
So while some clinics may quote an IVF cost of £2,500, for example, this price can quickly escalate once you’ve added in multiple blood tests, scans and any other ‘add-ons’ you might need such as ICSI (intracytoplasmic sperm injection); PGS (pre-implantation genetic screening) etc.
Ask your shortlisted clinic to break down the total cost and walk you through their proposed treatment plan before you go ahead.
Fertility treatment often requires a degree of trial and error and protocol tinkering, and some of the new elements your clinician might want to throw into the mix further down the line can be eye-wateringly expensive. Whilst your consultant won’t have a crystal ball to foresee everything you might need, tell them budget is a concern and ask them to give you a worst-case picture so there are no nasty shocks if you do need more treatment later on.
Some clinics also offer packages such as ‘multi-cycle IVF’ or ‘Refund IVF’, which means you pay an upfront fixed fee for your treatment package for say, 3 cycles of IVF, and if you don’t get pregnant with that clinic after the three cycles, you are refunded part or even all of your initial cost.
The downside is you end up paying slightly over the odds if you’re lucky enough to get pregnant with your first cycle (but hey, at that point you won’t care about the money you spent – you’re pregnant). But given some recent studies suggest the average couple take 2.7 IVF cycles before getting pregnant, it's worth considering, particularly if you’re the type of person who likes to have a plan in place and keep a tight rein on your finances.
4. Location/travel time
If you’re doing an IVF cycle, you’re likely to need to go into your clinic for blood tests and/or scans at least every couple of days during the stimulation phase, and a few clinics even ask you to come in as much as twice daily for blood work (so they can minutely tweak your treatment according to your daily response to the drugs).
Being reasonably close to your chosen clinic is therefore an important factor, particularly if you're working and need to minimise time away from the office.
Most clinics appreciate patients may need to travel for their appointments and will try to offer flexible appointment times, for example very early mornings or late evenings, and some are open at weekends, too.
While we’re talking location, it’s also worth checking whether the laboratory where your eggs will be developed following egg retrieval is on site at your clinic or somewhere else. [Although my first round of IVF was at my local hospital, my embryo transfer took place at a lab in Central London. When we originally chose our clinic, it seemed like a minor detail, but when it came to embryo transfer day and we had to navigate our way to a new location, to undergo the final stage of our treatment with a new team, in a new environment, it definitely added to our (already heightened) anxiety levels].
5. Patient reviews
Although no two fertility journeys are identical, talking to someone who has had treatment at your prospective clinic is always useful.
What were the staff like? Was the clinic welcoming? Were the facilities good? How long were waiting lists? Did appointments run to schedule or were waiting rooms overflowing? Were treatment plans and costs clearly communicated?
You can also search forums for honest (sometimes brutally so!) patient reviews and ratings of most UK clinics.
6. Rapport with your consultant
It’s extremely important you feel you can trust and communicate well with your consultant.
Do they put you at ease?
Do they explain things clearly and in terms you understand, rather than blinding you with science?
Again, back to the job interview analogy: if you were recruiting this person could you work well with them? Are they a good ‘fit’?
You want to be able to confidently answer ‘yes’.
Do remember though, clinics are businesses and they want you to choose their clinic, not their competitors. So keep a cool head and don’t be charmed into submission with promises of having ‘seen it all before and we’ll sort you out in no time’. If they don’t have the stats to back up their promises, or aren’t willing to clearly explain the treatment plan they have in mind for you – including ALL costs – then don’t feel pressured into going with them. It’s your body, your money, and your choice of consultant.
And a final piece of advice?
Try before you buy.
Most clinics host open days, evening talks and lab/site visits, enabling you to get a good feel for the people and the place well before you have to hand over your credit card.
Many clinics will also have someone who can answer your queries via email or phone and some will happily arrange a free initial consultation via Skype.
Clinics are competing for your business so it’s your prerogative to ask them any questions you might have – don’t worry that you’re wasting their time.
The right clinic is out there for you, so shop around and make an educated choice. Having trust and confidence in your clinic and consultant will help you to embrace your fertility treatment with a much more positive mindset.
Other good sources of clinic information include:
The HFEA www.hfea.gov.uk
Fertility Network UK www.fertilitynetworkuk.org