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