What medical conditions can IVF help treat?
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Robert Winston

Fertility expert and one of the world's pioneers of IVF and Fertility Medicine. BAFTA award-winning television presenter and Member of The House of Lords in the UK.
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IVF

How to choose the best fertility clinics

The most important thing to remember is you need to have all the right tests done to ascertain whether IVF is the right treatment for you. Don't go to a clinic that offers only IVF, or that is what you'll be offered - whether it's the right treatment for you or not.
Video Tutorial
In Short
There are many things you should look for when choosing a clinic. It's good to have clear and independent advice on how to make the best choice for your particular situation. You can print this lesson out and take it with you when you visit - it will help you remember what you need to be assessing.

Choosing the best fertility clinic for you and your fertility problem

The first thing that must be said is that British IVF is of a very high standard. Most clinics are honest, caring and competent. Over the last years, there have been remarkable improvements in reproductive medicine. There is a training programme, in this relatively young speciality, and there are more doctors practising in it than ever before. The HFEA (Human Fertilisation and Embryology Authority) has also played its part. Whatever the limitations of regulation, the HFEA has consistently helped to make improvements in the information given to patients and the standard of treatment and counselling they receive. The HFEA website has a list of licensed clinics in the UK so this can be a good place to start.

If you are lucky enough to have funding and a choice of the clinic, you may wish to consider a number of points when deciding where to go for treatment, whether in the UK or abroad.

Communication

Did you like and feel confident with the clinic’s team of doctors and nurses? Did they seem like a team? If so, the chance of good communication, so vital to feeling happy about the treatment, is likely to be adequate. Do patients regularly see a doctor rather than a member of the paramedical staff? Do you always see the same person during treatment; a good unit try to ensure good continuity of care and communication, otherwise it can be very confusing.

Diagnostic procedures

Does the clinic carry out full range of tests to establish a clear diagnosis before treatment? Start by asking if they offer every patient a uterine X-ray (hysterosalpingogram / HSG) when needed, or do they examine X-rays taken earlier at another hospital. Does the clinic take hormone tests at the beginning of the menstrual cycle, detailed scans and proper sperm function tests before committing a patient to IVF? They should. Beware of the clinic that only offers you the expensive (more lucrative) tests.

Counselling services

Does the clinic provide an independent counsellor at no extra costs? Undergoing IVF can be very stressful, patients need the opportunity to talk to someone who is not been involved in their day-to-day treatment and so, therefore, offer them objective advice. This person should not be there to help couples to find out how they feel about what is happening to them.

Range of treatments offered

Does the clinic provide a comprehensive range of fertility treatments? Avoid a clinic that offers IVF as its chief or only course of action; it may be convenient for them, but might not be in the best interests of their patients.

How much does the clinic charge?

Costs should be inclusive of everything for the IVF cycle apart from drugs. If a clinic charges much more than others it may be overcharging. Be wary of clinics that bill for extra ultrasound examinations, additional consultations, and/or pregnancy tests; IVF is expensive enough already.

How is each treatment cycle monitored?

Generally, clinics that do regular hormone tests throughout the cycle, for example, get better results and may have fewer complications. The results will also give a better idea of what went wrong if the treatment fails.

Ovarian stimulation regime

Does the clinic have a fixed drugs regime for stimulating egg production, or does it tailor the treatment to suit the circumstances of the particular individual? This treatment should be tailored for your specific requirements.

Sperm tests regime

Are repeated assessments of sperm quality made before IVF treatment is begun? A good unit will have a set of precisely worked-out values for sperm quality, and will cancel a cycle if it thinks that there is no chance of fertilisation.

Making appointments

Can the clinic offer egg collections and inseminations on most days of the week? If they can only do these treatments two or three times a week, your success may well be jeopardised. Is it possible to see a doctor or member of staff at the weekend if you have any concerns?

Egg collection

Is there a choice of local or general anaesthesia and is an anaesthetist always present during egg collection to ensure the patient’s safety?

Embryo transfer

How many embryos does the clinic routinely put back into the uterus? Clinics putting more than one embryo back most of the time in women under 35 years are possibly taking risks in attempts to improve pregnancy rates.

Failed cycles

If the treatment fails, can you make an appointment to the clinic director to find out why? In a good clinic, the director or somebody who holds the equivalent of an NHS consultant post should be available, even if he or she was not the person in charge of your care. The director should be aware of the progress of the cycle, and have an understanding of what, if anything, went wrong, where improvements might be made and be able to advise on whether a further IVF attempt should be made or if other treatment should be considered.

Assessing a clinic’s published results

Comparing the IVF results between most clinics is almost meaningless. Even if one clinic reports a success rate of around 27 percent and another say only ten percent, there is likely to be no statistical difference between them, unless they are publishing results from a very large number of patients (over 500 to 1,000 a year). The results from any clinic depend primarily on the kind of patient they are treating – their ages, the cause(s) of infertility, the length of time couples have been trying, the number of cycles with ICSI*, the number of cycles of IVF they have already failed and the ability of their ovaries to respond to drugs. These factors vary hugely from clinic to clinic and even between different areas of cities. Data collection and publication take a long time and any figures reported are on average over two years out of date.

Note
*ICSI – Intracytoplasmic sperm injection – a technique where a single sperm is injected into the centre of an egg.

Bear in mind that some clinics have quite high cancellation rates before egg collection if it is felt that there is a poor chance of success. In most cases, this will be to try to save its patients money because a cycle stopped before egg collection is generally charged at a fraction of the total cost. However, a high cancellation rate may result in published success rates looking rather better than those in another clinic not cancelling so early.

Large clinics with more than around 600 cycles tend to be a bit more successful. They may also have enough data to be able to provide a computerised breakdown of your chance of success for a particular circumstance – based on results from other similar patients under their care. If you are seeking egg donation – you may find it best to go one of the clinics with a high figure – as they are more likely to be able to find a suitable donor.

The Genesis Research Trust

Despite countless breakthroughs in medical science, we still do not understand why some pregnancies will end in tragedy. For most of us, having a child of our own is the most fulfilling experience of our lives. All of us can imagine the desperation and sadness of parents who lose a baby, and the life-shattering impact that a disabled or seriously ill child has on a family.

Professor Robert Winston’s Genesis Research Trust raises money for the largest UK-based collection of scientists and clinicians who are researching the causes and cures for conditions that affect the health of women and babies.

Essential Parent is proud to support their wonderful work. You can learn more about them here.

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.