Choosing an IVF clinic

Better microscopes? Cooler hairnets? How do you choose?

Did any of you have to make a choice about which clinic to go to for IVF?

My husband and I live smack-dab between two of the major IVF clinics in our state — each is about a half-hour drive away.  Our RE is affiliated with one, which is at the big-name teaching hospital (BNTH) in the area.  But once I knew we’d be starting IVF, I took a look at the SART data for clinics in our state.  The results surprised me.

Based on the SART data alone, there’s no contest — the other clinic (I’ll call it the IVF Factory) has live birth rates for both fresh and frozen cycles that are significantly above the national average, and does many more of both kinds of cycles than BNTH.  The fresh cycle rates are different only at the margins of statistical significance, but the frozen rates are miles apart — with BNTH way below the national average, and they hardly do any to begin with (we’re talking single-digit numbers of FET cycles in the 2013 data).  So, why the difference?

I could think of several possible explanations:

  • Maybe the IVF Factory haphazardly transfers more embryos, resulting in more multiple births.  Nope — both the average number of embryos transferred and the twin pregnancy rate are lower than BNTH.
  • Maybe the IVF factory is more choosy about who they accept as patients.  If BNTH helps anyone who walks through the door while the IVF Factory turns unlikely-to-succeed patients away, that could artificially lower their IVF success rates.  This is harder to figure out, but I think there might be some truth here — proportionally, the IVF Factory only does half as many transfers for women over 42 as BNTH.
  • Maybe BNTH is more open to using cutting-edge and experimental techniques.  Sometimes these will work and sometimes they won’t, so their success rates might be more variable.

We’re also going by feel, to some extent.  IVF factory seems to run like a well-oiled machine.  Last night we went to their required 2.5-hour seminar, which was led jointly by one of the five doctors and their staff psychologist.  I had… mixed feelings about this seminar.  On the one hand, I felt like a cog in a wheel, not an individual.  With well over 800 cycles per year, you know they’re cranking through patients every day.  On the other hand, IVF is clearly their focus — they do it a lot, and they do it well.  Their seminar was really well organized, and if that organization carries over into their desk staff… well, that would be an enormous relief.

At BNTH, the operation is a little smaller and a little more varied.  The doctors are all professors and do research and training in addition to patient care. I like the idea of being part of a teaching hospital, as a teacher myself, and I like being advised by people who are actively working on research… but at the same time, I’m also feeling like I’ve had a lot of mistakes and crappy medical care throughout this process and I’m worried about some sleep-deprived medical resident making even more of a mess of my reproductive system (especially since we’d be starting in July!).  It also might be a case of the devil you know vs. the devil you don’t.  I am constantly frustrated by the inefficiency of the front desk staff at BNTH, and while I love their scheduler (seriously, she’s amazing), at our last appointment we had to wait an hour for a 10-minute conversation with the doctor, and it always takes at least 10 minutes just to check in.  There’s a lot going on there, and they just feel sort of disorganized about it all.  That said, maybe I’d get into the IVF Factory and would wind up feeling like there was a lack of flexibility and responsiveness.

This is probably also going to sound a little precious, but IVF Factory does seem to do a really good job (at least as far as we’ve seen so far) with streamlining the whole experience for you.  Their seminar did a fabulous job of laying out important issues that we need to discuss as a couple — embryo freezing, banking semen, ICSI, etc. — and laid out some of the ethical and scientific pros and cons of the various options.  At BNTH, by contrast, we were handed a thick paper packet of extremely technical medical information and were told to read it and bring any questions to our appointment with our doctor next time.  The IVF Factory also hosts one of the few Resolve support groups in the state, and their staff psychologist both takes my insurance and explicitly offers to help identify good local therapists who specialize in infertility and pregnancy loss.  BNTH’s social worker was useless when I tried to find a therapist who took my insurance, and after picking a name at random off my university’s mental health resources web page I wound up with a not-so-awesome therapist who I just sort of stopped seeing after two sessions.

If you can’t already tell, at the moment we’re leaning towards the IVF Factory, even though it makes me feel like a little bit of a sell-out.  I think the frozen transfer rate difference is the biggest factor, along with the generally rosy SART numbers, but like I said, a lot of it is feel.  And I’m irrationally worried about offending my doctor.  It’s not as though I feel any great loyalty for her, as I’ve probably only had about six or seven total appointments with her over the last two years, but I really like that she’s listened to my concerns and that she found the problem with my tubes right away.  A good relationship with a doctor is something that I’ve come to really value through this whole process.

So, we’ll see.  We have an appointment set up for a consult with one of IVF Factory’s doctors in a couple of weeks (they wouldn’t let us do a consult before attending the 2.5-hour seminar, which was annoying).  In the meantime, I need to go back to BNTH for an ultrasound at the start of my next period to see if I require surgery to remove my “partial hydrosalpinx” before starting IVF (my doctor says she doesn’t think so, but wants to check just in case).  And then we’ll have to do some thinking and evaluating — but we can’t wait too long.  I’d really love to get through one cycle before classes start again in the fall!

Anyway, that’s where we are.  Any thoughts, insights, or stories of how you made your own choice of IVF clinic would be much appreciated!

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9 thoughts on “Choosing an IVF clinic

  1. My Perfect Breakdown

    We just went to the clinic that we were refereed to until things weren’t going well. Then we found ourselves research the very best doctors and finding a way to get to the specialists we needed (for RPL, not for IVF). Anyways, I would say do you research, which you clearly are. And if you cannot make a decision based on facts, then go with your gut – you don’t have to commit for life, just for your first (and hopefully last) cycle.
    The only thing I’ll add is that my family doctor is at a teaching clinic and I adore the clinic. I love just how on top of everything they are because the student’s require that their teachers are informed of the newest facts and techniques.

    Reply
    1. lyra211 Post author

      That’s some good advice right there. I do need to remember that this is not a life commitment, but just a first cycle commitment. I’m really working on psyching myself up for three cycles, since that’s about how many it takes on average if it’s going to work at all. So I think I’ll start trying to think about the choice of clinic as a first-cycle-only decision. Thank you!

      Reply
  2. theskyandback

    There are no sellouts in IVF! In many things, ok, I’ll give it to you, but I think that in IVF you want the well-oiled machine and you want the place that has their shit the most together. You want the higher success rates. Before I went to the clinic where I did my IVFs, I was with a large University clinic for my IUIs. All of my other doctors in all areas of life were through that same University health care system, so I liked that they already had my file and blah, blah, blah. But they were disorganized and came across as scatter-brained, and the doctor was rarely available. I really think that when you do IVF, you want to go to a place where all they do is fertility. In a large organization, like the place I was before, it wasn’t their specialty and it showed. In the place we switched to, that was all they did and they had their process DOWN. I was lucky that they were also generally awesome and I never felt like a number, but even without that I would have been glad we did our two IVFs there. In the end you just want a baby, and yeah, how you feel during the process is important, but I don’t think it’s as important as that damn baby — so I say go wherever you feel gives you the best shot! And like, I love the clinic where we did our IVFs, but I no longer feel like they are my best shot, so I left them too. This new place is definitely not personal at all, and I might never even meet the doctor in person. This is definitely weird for me because I generally need a personal connection, but when it comes down to it, I’ll sacrifice all of that ten times over if they can give me a good chance. Good luck and keep me posted on what you decide. Either way, this is very exciting!

    Reply
    1. lyra211 Post author

      I thought you might have some great advice. 🙂 Your experience sounds a lot like mine so far — I didn’t start out at the large university clinic, but I got there pretty early on in the process when I realized I was going to need something other than my local OBGYN. And indeed, they do come across as a bit disorganized, and it’s been really hard to reach my doctor when I’ve needed advice — thanks for reminding me of that. After our daughter died I had two questions for her (a couple of months apart), both of which I submitted through their electronic messaging system (as they had requested). It took two weeks to get a response to the first one, and I never got a response to the second one. Even after my bad HSG, I had a relatively urgent question, and it still took five days to get a response (the nurse messaged me back next day to say that my doctor was out of the country for the week and would get back to me as soon as she got back… but… there are other doctors in the practice, after all!). That alone is telling me that I want a place that’s going to be more responsive and where it’s going to be easier to reach the doctors, and I think that that’s going to be the place that specializes in IVF. During the seminar, they mentioned that they will always have a doctor call you back the same day if you have an urgent question, and that’s clearly not true at my current clinic — I’ve never been able to reach the doctor by phone, and the electronic messaging system is fairly useless.

      I also hear you on the wanting a personal connection but getting to the point where it’s all about the damn baby. I felt like I had a personal connection to the midwife at the first practice, but then she screwed up and it lost me my fallopian tubes, so I should really be beyond personal connections by now. You’re right that it’s all about what gives me the best chance at this point, and I’m starting to think that that’s the IVF Factory. Since this is all they do, day in, day out, and since they have success rates well above the national average, I think I can probably trust their process whether or not I have a personal connection. And like your experience, they seem to have the process DOWN. You’re right that there’s value in that.

      Thank you! You’ve been hugely helpful!

      Reply
    1. lyra211 Post author

      Thanks — you’re right that at some level it comes down to gut feel. I could do the old “flip a coin, and see how you feel about the answer — if you’re disappointed, then go the other way!” … but that never seems to work for me when I’m really torn. 🙂 That said, in this situation, at least for now, I don’t feel particularly torn… I think it’s clear that my gut is pushing me in the direction of the IVF Factory. I think we’ll go that way for now, at least.

      Reply
  3. Wifey

    I don’t have a lot of helpful advice because we didn’t have a choice. So I’ll just say, wherever you end up, I hope you feel comfortable and at peace with your choice. But, at least you know you have a back-up if you ever feel that you aren’t at the right place. Either way, stats and research are good (I love pro/con lists) but I think you’ll know in your heart.

    Reply
    1. lyra211 Post author

      Thank you! Yes, we’re very lucky to have a choice — and to have a choice between two very good facilities, no less. I hope things are going well for you these days!

      Reply

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