How to choose fertility clinic?

That’s the magic question, isn’t it? It’s all down to personal patient preference. You should never go based on success rates because each clinic will specialize in different things so some clinics may specialize in pre-implantation genetic testing, some clinics may specialize in same-sex couples, some clinics may respond in patients who have a poor ovarian response so, every clinic will treat a different set of demographics and because of different demographics, the success rates will always vary so as long as they’re in line with national averages you shouldn’t pick based on success rates, you should pick somewhere that works for you. When you walk in, you just have that feeling. A lot of clinics now will do free tours or patient evenings just go along to a bunch of different ones and see where you feel comfortable, how easy it is to get to the clinic, how much time you’d have to take off work, what are the reviews like, what the staff like, what’s the experience of the staff levels – it’s just one of those things when you walk into the right place – you will know it. If you know people that have had previous IVF and where did they go, don’t necessarily pick it just because it didn’t work for them or did work for them, they’ll tell you about the quality of care because your chances of pregnancy is not their chance of pregnancy. So certainly go with what it was, what the clinic was like and I think that’s the best thing you can do so that you have no regrets based on where you went.

The best place to look is on the HFEA website and on the site, choose a clinic you can set it to sort of fresh egg collections, frozen embryo transfers, fresh egg donation, frozen egg donation but the numbers are going to be so small between each clinic at present there’s not going to be a huge amount of data there to show a significant difference between clinics so, you’re going to be mainly relying on each clinic’s individual websites which should be compliant with the new market guidance coming out. It’s just having to make sure you research your clinic well enough.

I think, in order to select a clinic, you have to know a lot of details that are not easy to know about them. Practically for me, the best option is, the best criteria is the personalized approach in everything: in dealing with embryos, in dealing with your body, in dealing with your ovaries. I believe that the personalized approach is the one that makes the difference in modern medicine. We are trying to industrialize some of the services but to be honest with you, the difference that you can get by having a good embryologist that will deal specific with your eggs and with their characteristics, will give you a much better fertilization rate, will give you higher chances so your embryos will not be affected by conditions that we don’t control – somebody to leave the lid open for one hour and then to realize that the lid from the incubator it was open or to leave the embryos outside for 20 minutes and then to realize “oh I should have put them in the incubator” – I’m not saying that this happens but imagine on a large clinic where they have hundreds of eggs every day to fertilize, to culture, to monitor. I think this is a reason for low quality services so I believe that if we want to improve the services ourselves we must select the personalized approach. I think this is what is missing and this is what makes the difference in clinical practice.

It’s a difficult question to answer because there are many specialist, sub-specialists in endocrine, many subspecies can do ICSI and IVF but how many of them are fully aware of these dilemmas of endometriosis – what kind of information will deliver to to the ladies. In our practice, in our clinic, what we are doing is giving advice about healthy diet – a proper healthy diet for a couple of months or three months and will find that even women start to feel better and some women actually can come pregnant without anything. So just modify a single thing – you are aware, you diagnose that your problem is endometriosis, you have instead of saying “unexplained infertility” – go a little bit through the patient’s history and understand what’s her problem and then ask her about her life. If she needs later on to do IVF and ICSI, you know exactly what kind of protocol will suit her because it’s a different kind of protocol, different kind of practice, different kind of recommendation. How you will deal with the embryos itself is another story. So it needs to be a center fully aware of endometriosis dilemmas. Not any center can treat endometriosis, otherwise you’re just creating embryos putting it back in a toxic environment and we are waiting for a good result or we’re giving her unsafe medication. This is a huge dilemma and actually needs some experience in this field.

That is unique and personal. My spontaneous answer would be wherever you feel trust, confidence, comfort and at ease. Choices regarding where to have treatment and which medical and therapeutic team to trust is idiosyncratic.
The way you decide is also very personal – for others it may be a very structured process of evaluating pros and cons – a SWOT analysis of options, comparing success rates, lab capabilities and scientific validity of different centers, and for others it may be more of a gut feeling – ‘it feels right for me’ approach.
It is very important to feel your doctors and IVF center as being part of your team, being on your side. It is important to be working together for a common goal which is the best outcome for you and your wellbeing.
Think of it as a project. You are the project leader, and you are building your team of experts. Would you want in your team somebody you don’t trust, or you don’t believe to be reliable and congruent to the purpose and mission of your project? Not really!
That is exactly how we work on many occasions with the women and families I counsel and support, evaluating the ecology of different options before they conclude on a choice that is right for them at that time, given their circumstances and priorities as a person and a family.

I think the first thing I’ve always said to couples, I think there’s so much information out there that I’m always conscious that clinics themselves will present their data in a way that makes them look favorable – that’s common sense, isn’t it so, in terms of where I’ve directed patients when they’re researching, I think the first port of call in the UK is I always tell them to go on to the HFEA website because that’s independent, they inspect every clinic in the country, if clinics are not following the rules that’s made in public knowledge, the data on their website, I think is cleaner than any individual clinics data because they’re not interested in putting forward one over another. I think that’s the best initial start point to go into the data that’s available but I think clearly, I would say to people and I have done over the years, look at the the local clinics that are available to you, look on their websites but be aware that that the way they present their data isn’t always the same, you can look on three different websites and think you’re looking at the same cumulative pregnancy rates etc etc. It’s very easy to present those statistics in ways that make one look better than the other. I think the problem is it’s very unlikely that their GP, wherever they are, is going to be able to advise them in terms of where the better outcomes are from. Well, the GPs may have experience of previous patients who’ve been there, who can feed back that satisfaction that the patients whether they’ve been happy or unhappy or whatever but it necessarily relates to how well the clinic is operating so, I think it’s very very challenging and I think for some patients it’s nearly impossible for them to make that decision because of the way that the complexity of analyzing that data, unless you’re used to looking at data and some people are, some people are very savvy these days and they can quite quickly see through the chat but even at government levels, the way the government has presented covid data, half the time is utter nonsense so, it’s not restricted to the level of clinics and things like that national data can be very very poorly presented and I think, the challenge is getting information that you can rely on. I think I’ve always said to people and where I’ve worked as a GP within a relatively short distance you can drop south to Nottingham across the Sheffield up to Leeds three very big centers and I’ve always said to patients have a look but if they’re having to go privately, get a bottom line figure, make sure you understand whether they’re going to encourage you to have extras, to have add-ons which actually have no scientific validity, look on the HFEA website, there is a traffic light system, if the add-on is a red, don’t do it, don’t waste your money, have another go at the treatment rather than paying for x y or zet so but again, I suppose that’s different for me, I’m aware of that, I think my worry is in most places around the UK when someone goes and asks those questions of their GP, they’re probably going to say have no idea, I’ve absolutely no idea that’s probably just the simple truth of it. I think, I mean, I always say when I’m talking to groups of GPs that same thing look if you’re not sure and you want to understand a bit more about infertility, go on the HFEA and the other thing, I do increasingly recommend the BFS has got a lot of very very good, I mean again it’s not going to direct you to one clinic or another but in terms of information for patients who want to understand about the types of treatment that are available I think it’s those nationally accredited websites, HFEA is the inspection authority, RCOG you have a lot of very useful stuff on infertility and British Fertility Society which is not looking to promote anybody over anything else, is looking at responsible, evidence-based practice but I think, for the individual patient, it’s a massive challenge and I mean last week in in manchester in the same afternoon I had one lady who had come down, flown down from Aberdeen to Manchester to have embryos put back um had previously had NHS treatment in Edinburgh I think and another lady had driven from virtually the Isle of Skye six and a half hours to have embryos replaced with us in the afternoon so, that kind of illustrates to me that and again both of those ladies had chosen clearly horrendously unsatisfactory from a geographical point of view but they’d chosen to come for varied reasons, often related to previous dissatisfaction and they’d almost both of them took the view I don’t mind. The lady who was coming all the way from Sky was was essentially going to stay, obviously the following night so, you’re looking at accommodation costs and huge amount of transport costs but I think that kind of illustrates that people will travel, if they feel that they’re getting looked after in a way that that justifies that and it surprised me really how many having I’ve used to being seen people from all over our sort of York and Yorkshire and Humber region when I was in Sheffield but certainly we wouldn’t have had ladies coming hours and hours away, I mean, that’s that’s just not something I recognize but I think it just illustrates just how difficult it can be and the lengths that ladies will go to end up in the clinic that they’re comfortable with, that they feel perhaps listens to them or perhaps offers treatment options which aren’t widely available but I think in terms of trying to get an idea, as I say, I would stick to the those independent websites, the three that I’ve mentioned and in terms of stepping off into the internet use links from within those websites rather than Dr google because I think that just it causes so much wasted effort and energy and complexity and confusion really so, try and stick with the relatively unbiased as internet sort of access points really.

In order to choose a clinic, there are a lot of factors and it is a very difficult question as you would understand for me to answer. I would become biased and would not wish to answer in a biased way as I would say our clinic is the best and that you should all come to City Fertility. But I would not suggest this I would say you need to choose a clinic and go firstly go to FHC website where they have the choose a clinic link and you can go into it and get the proper information about all of the clinics and see the success rate, patients comments which can help you choose the clinic.
Other things I may say you would want to look at are the patient reviews to see how patients have felt and how they feel when they are at the clinic. Do they feel looked after, do they feel that the people in the clinic know them, understand them, support them. Of course you are looking at the success rate over all and the facilities of the clinic but along with that the very important thing that I believe a patient needs during their journey of IVF or fertility treatments is support. Continuous support, a friendly face and somewhere where they think that the people and clinic as well as medical team are approachable and can reach them when they need them. We have patients sometimes who feel that when they go to a bigger clinic, that with a big clinic, you have a success rate of 40 % and the other one is 37%. Then I myself would think that the 40% is better so I should go there. However the clinic is so large that if you go there you don’t feel that you are attending as a patient, there is no personal feeling and you may feel lost there in that, as we say, conveyor belt. I think that personalisation, personal touch and care, that support is very important too in your journey. So when you are choosing a clinic look for those things as well.

Generally, I direct all my couples to the HFEA website here in the UK where they can have a little browse about all the fertility centers in the country, in the region so, if they go to each center they can look at the facilities that are available and the success rates of the treatments. Generally most of them have the success rates which are in the national average. The reasons why are part of the HFEA license that they get regular monitoring. I generally tell the couples that fertility and fertility treatment is a big emotional rollercoaster so, I would say generally, advise them, to go to their nearest center to at least to take away the physical side of things because the IVF treatment involves lot of regular visits to the department, though, they are quite short (for a quick scan or a blood test) but it can be physically exhausting as well with several visits. So, a nearer center would be better but yes, the patient’s preference and generally they have heard higher success rates of one center compared to the other, they could prefer to go further.

Well one of the things that always surprises me in the UK is that couples don’t really understand that there is a difference in the success rates between clinics and if you would ask a couple how did they choose the clinic it would be possibly convenience or the speed at which the telephone was answered when they made the first telephone call or the staff nice to them and those are absolutely crucial, there’s no doubt about that but to my mind, one of the most important factors is the success rates. In the UK and I’m sure this is true of all the countries of Europe, it’s possible to find out what the live birth rates are, what the miscarriage rates are, what the pregnancy rates are within the clinic. In the UK we have the Human Fertilization and Embryology Authority (the HFEA) and everything is online and it’s very simple to find out what’s what. So I would recommend any couple who’s starting their journey in fertility to check out each clinic that they’re considering, find out what the success rates are because clearly you would want to go to the clinic with the the best success – at least I would but as I’m saying there are many other factors as well which couples take into consideration and of course conveniences is a really important one. If you were to live in the Shetland Isles of Scotland you would probably want to go to a clinic in Edinburgh rather than a clinic in London and the same is true for everyone you’ve got to fit in hospital appointments with your lifestyle.