How To Select A Clinic or Egg Donor Program

Marna: This is part of our "How To Series"

Selecting a Treatment Clinic that’s Right for You

At PVED, we understand how overwhelming beginning the process of creating or adding to your family through egg donation can be. There are many decisions to think about, and one of the most important is where to go for treatment. With that in mind, we’ve put together an informational “How To” to help guide you as you start the process.

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 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.

Success Rates and Statistics

You will often hear around PVED: “Make sure you ask about their success rates!” So what the heck are these success rates, anyway?

Clinics performing fertility treatments are required by law to send statistical information each year to SART (Society for Assisted Reproductive Technology) and the CDC (Center for Disease Control), who then compile that information into reports that are released to the general public. The reports contain percentage-based success (pregnancy) rates regarding in vitro fertilization (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 their 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 to choosing a treatment program. They are a good place to start, and can help you narrow down your choice of potential clinics. As you’re doing your 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 they complete each year? Do the statistics illustrate an overall consistency of success?


Just Ask! (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 NOW to answer your questions, they probably aren’t going to have the time to answer your questions once you are 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.

Ask your future clinic about their technology – do they perform many blastocyst transfers, or are their transfers mainly day-three transfers? What kind of lab do they have? Is it a clean lab? Does the clinic regularly perform ICSI, assisted hatching, or PGD? Does the clinic perform egg vitrification? Make sure that the clinic you select has a wide repertoire of infertility procedures and remedies and that they are comfortable and familiar with the latest technology.

Because every clinic is run 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 quality control and their ethics policy.

Ask your future clinic about the tenure of their medical director. What is their staff turnover like? How long have their 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.

Ask your future clinic about age limits for treatment. Some people feel that if a clinic does not institute age limits on IVF procedures, they must not be concerned about ethics. This is a controversial issue; ask for an explanation of the clinic’s age guidelines or their 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.

Ask your future clinic if the doctor you see for a consultation will be the doctor you will 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.

Ask your future clinic about their determinations on transferring of embryos back into the uterus. How many are embryos are transferred? Who decides how many embryos are transferred? 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 – ethically, the choice about how many embryos to implant should be made in collaboration with the patient.

Ask your future clinic how many donor egg cycles they perform annually. If the clinic in question performs many cycles each year, ask how they prevent patients from feeling like a number on a production line. If they perform few cycles each year, ask about the reason and the clinicians’ comfort level with the procedure.

Ask your future clinic if they perform shared cycles.

Ask your future clinic if they participate in embryo donation.

Ask your future clinic about the cost of treatment. Do they offer a money-back guarantee? Are they part of shared risk program? It’s important that you know the costs ahead of time so there are no surprises along the way. Ask the clinic for a printed cost sheet that has every single procedure outlined, from donor egg retrieval through the transfer of embryos into the patient’s uterus. Don’t forget to ask about ultrasound costs, lab costs, extra office visits, and the cost of after-hours calls if needed.

Ask your future clinic how they communicate with their patients. Is it primarily by telephone or e-mail? Will you have access to your doctor’s e-mail address? How does the doctors’ on-call rotation work?

Don’t be afraid to ask your doctor:

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?
Who 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?

Ask your future clinic about other resources they may provide, including counseling or support groups, acupuncture, and other non-medical support.

Ask your future clinic how they communicate with their patients. Is it primarily by telephone or e-mail? Will you have access to your doctor’s e-mail address? How does the doctors’ on-call rotation work?

Finally, ask your future clinic if they have an in-house donor pool. If your future clinic has an in-house door pool, it’s important that when selecting your donor you don't feel rushed. 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 have 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 ten thousand dollars ($10,000 US) 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 five thousand ($5,000 US). Your clinic, their treatment protocol, their statistics, and your uterus are what are going to determine your success in becoming a parent, not the cost of the egg donor.


Go With Your Gut

Even armed with the list of questions above 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.

Look for a physician 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 have heard patients say, “My RE doesn’t listen, he’s so rushed, he acts as though I have no idea what I am talking about, I feel stupid each and every time I leave his office…” The rapport and relationship you develop with your physician is critical. 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 interest in mind.

While this may all seem time consuming, overwhelming, detail oriented, 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 – which is a baby!