How to Choose an IVF Program
How do you select from the hundreds of in vitro fertilization (IVF) programs across the country?
“First, choose an IVF program that reports its pregnancy and live birth rates to the Centers for Disease Control (CDC), and The Society for Assisted Reproductive Technology (SART),” says Dr. Mark Hornstein, Director of the Center for Infertility and Reproductive Surgery at Brigham and Women's Hospital (BWH).
In vitro, meaning "in glass" in Latin, involves fertilization of an egg by sperm in a Petri dish.
More than 90 percent of programs report their statistics to the CDC and SART. It would be a red flag if a program isn't, according to Dr. Hornstein.
SART members are also required to adhere to clinical and ethical guidelines, which assures a high standard of care within the program.
Focus on Live Birth Rates
Dr. Hornstein advises couples to pay attention to live birth rates, as a woman might become pregnant, but she could miscarry or have a tubal pregnancy which doesn’t result in a live birth. An IVF program should display this statistic on their website.
In patients under 35 you want to see a live birth rate of at least 40 percent per cycle initiated. The chances for a live birth are reduced for more advanced reproductive ages (over 40).
Keep in mind that IVF programs with the highest birth rates are not necessarily the best choice. According to Dr. Hornstein, some programs
won’t treat patients with less-than-optimal odds of success, as these “challenging cases” might negatively impact success rates.
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Scanning the Website
Most couples start their search on the Internet. Here are five things to consider as you browse an IVF program's website:
- Reputation: How long has the program been established? Are the specialists board-certified? In order to obtain a subspecialty certification in Reproductive Endocrinology and Infertility, a physician must complete three years of additional medical training and pass a written and oral exam.
- Affiliations: A program that partners with an academic medical center is committed to advancing research and education in the field. Such programs are often up-to-date on the latest technologies and treatments.
- Does the program conduct research? Programs with academic affiliations may conduct clinical trials. IVF programs that conduct research can enroll patients in trials that may offer innovative therapies often not available elsewhere.
- Infertility services: Does the program offer a range of infertility treatments? While IVF is a well-established treatment for infertility, there may be situations where other therapies are more appropriate.
- Is the program conveniently located? Does it offer several locations and convenient hours? Can they see patients on weekends? How close is the program? Even if a facility is far away, a top program or specialist with whom you trust can be worth the trip.
Hospital-based Programs vs. Freestanding Clinics
IVF treatments can be more complicated for those with medical conditions, which can impact a woman’s fertility. Such patients typically require a hospital-based program as opposed to a freestanding clinic.
"Egg retrievals in medically complicated patients, for example, require coordination of care between fertilty specialists, anesthesiologists, nurses and often other health care professionals," says Dr. Hornstein.
The advantage of a hospital-based program is that it can provide comprehensive services as well as consultations with experts such as a high-risk obstetrician. In addition, hospital-based programs are often involved in research and teaching, which means they can usually offer patients the latest technologies and treatments.
Some hospital-based programs, such as BWH’s in vitro fertilization program, also offer counseling, support groups and alternative treatment options (e.g., acupuncture).
Finding the Right Infertility Specialist
Your relationship with an infertility specialist should be similar to your relationship with your primary care physician. You should be able to engage in thoughtful discussions that address your concerns, preferences and treatment options.
Also, try and determine the specialist’s competence and level of experience. Find out how long he or she has been practicing and confirm that your physician is board-certified in reproductive endocrinology.
Questions to Ask an IVF Specialist
When you meet with an IVF specialist don’t be afraid to ask questions, including:
- What is my diagnosis?
- What is causing my infertility?
- What particular infertility treatment do you recommend and why?
- Do you offer other infertility treatments besides IVF?
- Are there any clinical trials exploring new treatment options?
Options for Advanced Reproductive Age
If you are a woman over 40 considering IVF, your chances for pregnancy are lower, so do your research and find out if the program offers IVF with donor eggs.
Most programs will not use a woman’s own eggs if she is over the age of 44. In that case, you could explore donation if a donor program is available. Most IVF programs receive their eggs from donor agencies. Alternatively, a woman could use eggs from a relative or friend.
- By Dustin G.
In this video, Mark Hornstein, MD, Director of Center for Infertility and Reproductive Surgery at BWH, explains what you need to know about in vitro fertilization and other fertility treatments.