Choosing a fertility clinic

One in every six couples experience some difficulty having a child. 80 per cent go on to conceive in the first year of trying and 90 per cent within two years but for the remainder, the only option is assisted conception procedures or surgery.

Before couples even embark on the emotional, and financial, commitment of infertility treatment they need to make the important decision of choosing a fertility clinic.

• Where do I start?
• Success rates
• Location, location, location
• Cost of treatment
• Treatments offered
• Counselling and support
• So, what questions should I ask?
• News story: Free fertility treatment for under 40s

If you are seeking IVF treatment then you will probably have already discussed your fertility problems with your GP and perhaps had tests to try and determine the cause. Now that you have decided to seek further help, the first decision you need to make is what clinic is best for you.

Jenny and her husband David have been trying for a baby for six years since their first pregnancy ended in miscarriage. "I thought when people had IVF it was just a little fortnight out of their time. Wow, I was wrong! I don't think you are warned just how stressful it is from the start. I think I spent as much time choosing the clinic as I spent deciding to go for IVF in the first place!

There are a number of factors to consider when choosing a clinic and your personal preference will let you decide which factors are more important for you. The Human Fertilisation and Embryo Authority (HFEA) recommend that you do not base your choice solely on the 'live birth rate'. "You should also consider the treatments offered, how comfortable you feel with the staff and the surroundings, what information and counselling is offered, the cost, and the location of the clinic. Take your time before you make a final decision and explore all the available options."

Many couples choosing a clinic will consider the success rates or live birth rates. Fertility expert Dr Marcus suggests that a good rate is about 30 per cent. "Not all clinics will have the same success rate so you do need to check this out. You want to make sure you are getting what you pay for."

However, many live birth rates are misleading as clinics will record their rates differently and you do need to be aware of how they compile their statistics.

Jenny searched for clinics on the internet before settling on the one she felt most comfortable with. "I did look at the success rates, but didn't get too carried away with it as some clinics only select younger women, for example, which makes their success rates more impressive."

"One of the major factors for Dave and me was the proximity of the clinic," Jenny says. "We eventually chose one close to home as we felt that the journeying to and fro would only add to the huge amount of stress."

During a treatment cycle you will need to visit your clinic regularly and it is important to decide how you will get there and how long it will take. Dr Marcus agrees. "Fertility treatment is very stressful, so you do not want the added stress of travelling too far. Also, if anything goes wrong - if you start bleeding for example - you want to be able to get back to the clinic quickly."

It is also a good idea to visit the clinic to get a feel for the environment. Does it seem friendly? Are the staff helpful and willing to answer questions? Do you feel comfortable there? At such an emotionally and physically stressful time, it is important that you are happy with the clinic you choose.

This is often one of the deciding factors for many couples. Every clinic must give you clear information on its current charges, including the cost of any 'extras' such as drugs or surgery.

Each cycle of IVF - taking the drugs, collecting the eggs and implanting the embryos - can cost between £3,500 to £4,000. On average, most women become pregnant after three cycles of IVF, a total cost of nearly £12,000. But prices will vary from clinic to clinic.

Jenny says, "The money angle was a major factor and was different in all the clinics we looked at. I didn't know until it was too late that there is the option to donate your eggs and then get the treatment half price. However, there are restrictions such as the age limit of 36 and it's not for the faint-hearted as it means going through 2 lots of egg collection!"

In the UK about 25 per cent of IVF treatment is funded by the NHS, although the Government has now launched plans to offer one free attempt to women under the age of 40 years, starting in April 2005.

There are several treatments available for couples looking for assisted conception but not all of the 88 clinics registered in the UK offer all the treatments. If your GP or specialist has suggested a certain type of treatment it is worth asking your prospective clinics if they carry out the procedure.

Typical treatments available are;
1. In Vitro Fertilisation (IVF)
2. Donor Insemination (DI)
3. Intra-cytoplasmic Sperm Insemination (ICSI)
4. Embryo freezing
5. Pre-implantation Genetic Diagnosis (PGD)
6. Pre-implantation Genetic Screening for Aneuploidy (PGS)
7. Gamete Intra-fallopian Transfer (GIFT) with donor sperm 8. GIFT with donor eggs.

It is also worth finding out what storage facilities the clinic has if you decide to freeze eggs or embryos and if it has access to donor sperm, eggs or embryos.

By law all HFEA licensed clinics must offer therapeutic and implications counselling before you consent to treatment. This is where a counsellor can talk to you about the treatment you are having, or plan to have, so that you understand exactly what it involves and how it might affect you and those close to you - now and in the future. It will also cover the legal implications.

Jennifer Hunt is an infertility counsellor. She says "Counsellors don't set out to tell people what to do, and they don't need to because most people are very resourceful. They just need the right kind of support from someone who can be trusted and who has the skills to help them explore feelings and thoughts that are often difficult to share."

Some clinics also offer a Patient Support Group(PSG) but not all so it might be worth looking into this before you decide.

Jenny and Dave wished that their choice of clinic had offered a PSG. "They all offer counselling but its reassurance that you need more. I felt a nuisance phoning the clinic to mention anything such as pains and feeling unwell."

It might seem daunting choosing the right clinic for you but it helps if you prepare a list of questions in advance before visiting any units.

Jenny and Dave had a "list of questions as long as your arm" but they feel they needed answers to make the right choice. Happily for them, after a few scares Jenny is now expecting twins in early 2005.

Mr Adrian Lower, Consultant Gynaecologist and assisted reproduction and IVF specialist says: " You are likely to place an enormous investment, both financial and emotional in the clinic you settle on and so it makes sense that you should talk to more than one before deciding." When visiting potential clinics Mr Lower recommends the following questions should be considered:

• Do you feel confident and comfortable with the people you meet?
• Do they have time to spend with you showing you around and answering your questions?
• What are the facilities like for patients?
• Is there a support group - and what facilities are available for counselling (see Counselling and support above)
• What are the success rates compared to the national average? While success rates are important, makes sure you also look at the variety of treatments undertaken at each clinic and ask your consultant to provide an assessment of your own chance (see Success rates above)
• Ask for a copy of the 'Statement of Purpose'. This is a document required by the National Care Standards Commission to be available for inspection by patients at any time.

• For further information about finding a clinic visit CHILD : The National Infertility Support Network website www.child.org.uk
• Get the answers to your top fertility questions
• Be inspired by other couples' success stories
• Read more about infertility in Infertility Issues