How Do You Choose An IVF Clinic?

I’ve written before about my doubts about my fertility clinic. I can’t change clinics until January 2018 when I change my health insurance. See, it’s complicated. I work at a university that offers its own free health insurance. The only caveat is that you have to use their health center that is only for students, staff, and faculty, and for specialists you have to use their practices which are located all over the state. You also have to use their hospital. The other option is you can get an Aetna plan with the same coverage but you have to pay a premium but it gives you more options.

Why am I on the university plan? Well, I like free, and since I only became eligible for the Aetna recently, and in January when I enrolled I didn’t foresee a fertility specialist in my future (denial ain’t just a river) and the university health center already had my medical history, I didn’t see a reason to change. Also, this is an Ivy League university and I just assumed their fertility center would be good, should I ever need it. Now I’m stuck and my ovaries are trying to close up shop so I’m not too keen on waiting until next January.

If my weight check goes well on June 29, I will get an IVF consult and presumably start cycling in July. I want to bank as many embryos as my four covered cycles will allow me. A cancelled cycle does not count toward my coverage, but a cycle resulting in no embryos does count. Since I’m stuck with my current clinic, I want to see at least how one cycle goes here. In theory, I could get in all four here by January, but realistically I know that not only do cysts happen, but my ovaries do not respond to stimulation very well so I won’t be surprised if cancelled cycles happen, either.

After one attempt, I want to have my AMH retested to see if it really is <.03 or if it was falsely lowered by low vitamin D, just to see if my reserve is as bad as we think it is. I doubt that even if it were falsely lowered by low vitamin D that it’s true level is anywhere near where it should be, but knowledge is power, right? Or knowledge is disheartening. Same difference.

So that’s my game plan right now, but my obsessive thought process* will not allow me to stop thinking, “what if I’m at the wrong clinic?” *I am diagnosed bona fide OCD. I really do have obsessive and cyclical thoughts and behaviors. While these thoughts are not in the realm of my OCD thoughts and behaviors, I do believe that my OCD makes me prone to obsessive and repetitive thoughts that do intrude on my basic functioning and daily life.

In doubting my clinic, I have set my sights on another university clinic within the state that I have deemed my possible Dream Clinic. Then again, it may be a figurative factory farm IVF cycles masked by a skilled marketing team and website designer.

Here are the factors that are fueling my decision process for a decision I can’t even make until January. Let’s call my current clinic Y and my potential other clinic U.

Website

Y’s website looks like it was constructed 10 years ago on Windows 95. It has the addresses of their locations, a page for each doctor listing their photo, credentials, list of publications, and research interests. There is a link to an outdated patient intake form. There is a page for each reproductive issue they treat and services offered. They don’t say what insurance plans they accept; they don’t say anything about price or payment plans. Half of Y’s site is dedicated to reproductive endocrinology vs fertility, because they aren’t just a fertility clinic.

U’s website is very sleek and up to date. They have a page for success rates and stories. They have information on payment plans and what insurances they accept. They have one page listing all the doctors but they do not list their publications. The site is very self-promoting, with a page listing awards and accreditations, but none of the awards are within the past 10 years. Many references to it being a world class facility and such as well.

Resources

Y posted on their Facebook page once this year, once last year, and before that in March 2014. On their FB page I found a bunch of older videos about vitamin D, BPA, PCOS, etc. It looks like they were really into updating with information in 2009. The one post from this year was for an info session they had which I really would have liked to attend but I missed the post, because I didn’t like the page, because I thought it was defunct. Y offered for my nurse to teach me med injections, or for me to watch videos online. I chose the videos and that worked for me but I did have access to the nurse. They did not offer a med class.

U has both a regularly updated Facebook page and a blog. They have also produced many higher budget informational videos on good topics like AMH and day 3 embryos vs. blastocysts, but also way too many videos on what each staff member does, clearly part of a promotional campaign. They publish their own quarterly mini magazine but the information here is pretty basic.  What I really am impressed with is that they have an acupuncturist on staff and free yoga classes. U also has a holistic nurse who does reiki, plus a nutrition and weight loss program. They have no support groups.

Doctors

Y’s doctors are professors at one of the top 10 medical schools in the country. I’m not a snob but that must count for something. My doctor in particular runs her own genetics lab, is the head of the recurrent pregnancy loss program, and there are two doctors there at least who list diminished ovarian reserve as a clinical or research interest.

Most of U’s doctors also teach at a medical school. None of them are interested in diminished ovarian reserve, and one is interested in recurrent pregnancy loss.

Location

Y’s location is great. It’s near my work so I don’t have to miss much work. When my husband goes to appointments with me, he can take the train from work (2 hour ride) and I can pick him up at the station and take him to my appointment. Or we go to my appointment early and then I drop him at the station and he goes to work from there. I work 30-40 minutes from home, and he works 90 minutes from home, so nothing but a NYC clinic will be close to his work.

U is an hour and 15 minutes away from home, and 45 minutes from my work. So for monitoring appointments I’d have to leave the house by 5:30 am and then I’d be up to 2.5 hours late for work. My job is flexible, so this isn’t a total deal breaker, but it’s a potential problem to deal with. U is ridiculously far for my husband to get to from work. He’d have the long train ride back and then another hour drive, so going to an appointment would wreck his whole work day.

SART statistics

In 2015, Y did 639 cycles. They did 30 frozen embryo transfers for women under 35, and 56% of them resulted in a live birth. They did 8 FETs for women between 35 and 37, and 37% of those resulted in live births. I’m planning on doing FETs so this matters to me. Percentage of patients with diminished ovarian reserve: 19%.

In 2015, U did 1275 cycles. They did 119 FETs for women under 35 and 63% resulted in live births. They did 47 FETs for women aged 35-37 and 59% resulted in live births. These numbers are a lot better BUT: percentage of patients with diminished ovarian reserve: 10%.

Reviews

Y has a 7.2 on FertilityIQ. On the ratings for Y, one DOR patient rated 10, one DOR patient rated 6, and one DOR patient rated 0. I’ve scoured message boards, Facebook groups, and Fertility Authority for reviews and Y has a bunch of bad reviews that refer mostly to the nurses, the facility, and a crappy doctor who is no longer there. No reviews about my doctor. There were good reviews, too.

U has a 9.1 on FertilityIQ. On the ratings for U, one DOR patient rated 8, and the other DOR patient rated 5. I’ve searched for reviews like I have for Y, and they are mostly good, but there are some that complain you feel like cattle here.

 

Two factors remain as points of concern for me switching to U. First, the location. Convenience shouldn’t be a deciding factor in something so major but the travel will be a big stumbling block for me and a major disruption for my husband who forfeits vacation days every year, rather than miss work. The second factor is that U has such a lower percentage of patients with diminished ovarian reserve. I’m not sure if they do mini IVF (Y does) and none of their doctors seem interested in DOR from a clinical or research perspective.

What is interesting to me is that Y’s SART numbers from 2015 are significantly better than they were in 2014. It makes me wonder if something has changed for the better at Y, even though 2015 numbers are preliminary. Also, my doctor has told me that she thinks I have a 40% chance with my own eggs. This was before she was surprised by my spectacularly poor ovarian response, but I don’t know that the doctors at U will even want to treat me.

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8 thoughts on “How Do You Choose An IVF Clinic?”

  1. In my well versed experience ( 4 clinics and 10+ ivf cycles) the best way to choose is success rate followed very closely by personal experience. If the clinic has a reliable lab and up to date technology and doctors and also has short wait times, nurses who are on it and a nice atmosphere that makes ALL the difference. Can you go to an informational session at each?

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    1. Your experience makes your opinion valuable to me. I think I’m going to need to switch. I just need to look into their DOR protocols and find out how DOR friendly they are. I’m also going to consider a third clinic that is large, local, has a DOR friendly doctor, and better stats than my current clinic. Seriously I have no idea how women got through this without the support and resources we have online!

      Liked by 1 person

  2. However amazing and experienced the doctors are, and however state of the art the lab is, you have to keep this in mind: infertility is a HUGE business. And most of those amazing clinics with their amazing doctors will handpick patients to match their success rates expectations. The higher the success rate, the more profitable the business. Hence, advantage to those “easy” patients: under 35, fertile, male factor.
    Not to bash the big famous clinics, but WE are not the typical IVF patient. Let us not forget that IVF’s main quality is to surpass male factor. As for female fertility issues, the best patient is the PCOS patient, cause in IVF it all comes down to narrowing chances, therefore the more eggs the better (better outcome in general but not necessary better quality)
    So…I would rather go for a smaller clinic, less success driven, but with a more personal approach. Big clinics are so overrated and so crowded that most of them gather women in batches, put them on birth control so that they can all get started the same day. Sort of like cattle….
    Once, in one of the FB groups I am administering, I made a comparison: imagine you have a problem with your feet, wearing a 6 on your feet and a 7 on the other one. You can’t just buy your shoes where the rest of the population goes. Cause the shoes won’t fit you.
    You will have to order custom made shoes. You might be tempted to go to Louboutin, cause he’s the best, right? Will Louboutin accept to make a pair of shoes just for you, knowing he sells tons and there is a waiting list? Most probably not, unless your name is Angelina Jolie or Madonna.
    So you would be better off to a small shoe maker, happy about your order, and taking his time to create THE perfect pair for your feet.
    Same with IVF
    At the end of the day it is not about the quality of the lab or the doctor’s credentials.
    It is about the protocol. Especially for us, the ones who have fewer eggs, and possible worse quality ones.
    Your best clinic is not THE best clinic, but the best clinic FOR YOUR NEEDS

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    1. So true. I go back and forth mentally between clinics. The good news is I live close to NYC with access to some great ones, the bad news is my insurance doesn’t cover them. So that’s my “if all else fails” back up plan.

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      1. My experience was amazing with Dr Rachel Bennett at Westchester reproductive, even if I never met her, just sent my papers over email and had phone conversations twice with her. She is super DOR friendly and runs a small clinic, very detail and patient oriented. AND she discusses thing over with patients……I was referred to her by my friend who had a baby there after 12 failed cycles in different big guns clinics around NY.

        Liked by 1 person

      2. That’s good to know. Westchester is actually an even more convenient location for me. I am lucky in that regard to live so close to have access to so many doctors.

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