Tuesday, April 27, 2010

Finding Doctor Right: The Art of Picking Your IVF Doctor

Once you've made the decision that you need to call in the big guns, it's time to pick an IVF clinic and a reproductive endocrinologist (RE). Before getting into the specifics, two key things will play a big role in your selection: (1) which doctors, if any, does your insurance cover and  (2) how many IVF clinics are in your area?

Get your researcher cap on and get to work -- you research before you buy a car, right? Well this is a far greater investment, so don't use any shortcuts. If you have the opportunity to chose between a few clinics, it's very important that you look into them and not simply go for the closest one to your house (we eventually flew from NY to Denver). After all, you are going to be spending a lot of time there between appointments, procedures and follow-ups. And you might not know this yet, but you will look up to your RE as though he/she is now your new god. I certainly did -- I looked at my RE for answers, for guidance and to just make this miracle finally happen for us (more on RE/patient relationships soon).

First, look at hard fact, and by facts I mean statistics. Visit the Society of Assisted Reproductive Technology (SART) to find the clinics in your area and compare each clinic's success rates to the national average. Where does the clinic you're considering rank? The results are broken into 3 main categories: Fresh IVF cycles, Frozen cycles (FET) and Donor cycles. Then look under your age group (under 35, 35-37, 38-40, 41-42 years old). At a glance, the three main results you should focus on when making your decision are:

  • Number of cycles: This will give you an idea for how many patients cycle at that clinic. The number only represents the cycles that took place during that year, so for instance, one patient could have done 2 or 3 fresh cycles in the same year.
  • Percentage of cycles resulting in live births: This percentage is very important. Unlike "percentage of cycles resulting in pregnancy," live births will tell you more about the final results.
  • Average number of embryos transfered: This is also very important to take into consideration. With today's technology, doctors are able to reduce the number of embryos transfered and still keep their success rates pretty high. This is partly why the Octomom story was so appalling to those of us in the infertility world; what credible doctor would be willing to transfer 6 embryos?! People like that give infertility patients a bad rep.

A big caveat here is that the numbers don't give you the full picture: some clinics take on more challenging cases and therefore might have slightly lower success rates, some may be more open to doing certain tests that others won't and most importantly, not a single number will tell you where you will be most comfortable and find success.

Once you've compared numbers/statistics and have picked your clinic it's time to research the RE you'd like to have guide you through your cycle(s). While all REs can help any case of infertility, some have areas of specialty -- donor egg, male factor infertility, polycystic ovaries, high FSH, etc. Of course, going into your very first visit appointment you might not yet know what your specific reason is, but sometimes you do (if you had your OB/GYN run the initial tests I mentioned earlier, you may already have some answers).

There is usually a head to the department and while your first instinct might be to go straight to the top, that's not always the best idea -- he/she might be way too busy for you. When cycling, you want your RE to have time to communicate with you, return calls or emails. But sometimes, that RE might be the best suited person for your case and well worth the wait. You need to make that call.

Once you've picked an RE, he/she will be your point person for the whole time you're at that clinic. He/She will determine your protocols. Be warned that it will be very difficult to change doctors. Having said that, you will meet and interact with the rest of the doctors at the clinic for your check-ins, your egg retrieval, embryo transfer and (hopefully) your initial pregnancy monitoring.

Going into your first appointment, write down all the details about your conception journey thus far, obtain copies of all of your records from your OB/GYN and have your questions ready. Most importantly, do not go there without your partner. This is the beginning of what might be a long journey and it's time for you and your partner to become a team. You will not get through it without being each other's rock. It's time to step up and leave the tension from the sex-on-demand days at the door.


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