Monthly Archives: August 2015

How to choose an IVF clinic – part III

 

Donors

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Let’s face it, if you’re having a baby in your 50’s then you’ll be using an egg donor at the very least, you may also need sperm or embryo donation. So before you choose your clinic you need a do a bit of research on how they find their donors, how old they are and the tests the clinic asks them to complete.  Age is particularly important for the egg donor as it’s maternal age that is the main risk factor for Down’s Syndrome so the younger the better. UK guidelines say all egg donors should be aged 35yrs or younger. Overseas clinics will vary and some have lower age restrictions. Although the UK has many generous women who are altruistic donors (they can only claim up to £750 in expenses), a growing number of egg donors are women undergoing fertility treatment themselves. These may decide to share their eggs with another woman to offset the costs of their own treatment. Women overseas are more likely to be paid for their egg donation, although some countries limit the amount. Although I can’t find any research to back this up, my feeling is that egg donors overseas tend to be younger than those in the UK as they are less likely to be donating eggs to offset the cost of their treatment. This was one of the reasons I went overseas and my donor was 23yrs old. The other advantage, of course, is that with an exclusive donor, you should get more eggs.

Confidentiality

In the UK, all donors are placed on a register managed by HFEA and must agree that identifiable information will be available to any children once they reach 18yrs. I couldn’t find any other country that offers this so if you go overseas the donor will remain anonymous. This is a key reason some people choose to go overseas. You may wish to keep the fact you used a  donor secret and perhaps you would prefer for your child to have no way of contacting their donor. Personally, I preferred the UK option and this was the only reason I seriously considered the UK for my treatment. In the end, however, knowing I would probably need three rounds of treatment and the higher cost and lower success rate in the UK compared with overseas meant I reluctantly decided that overseas was a better option for me. Perhaps European legislation will change in the future and my child may have access to their donor if they wish.

For me, making this decision was the hardest of all and I agonised over it for some time.

Guarantee

Some clinics offer guarantees around treatment which I felt showed confidence in their abilities and some degree of peace of mind for me. But, as always, the guarantees differ so look around. My clinic, for example, guaranteed two embryos of the highest quality available on the day of embryo transfer for people using donor eggs. But another clinic I looked at guarantees a minimum of four eggs from the donor. Well, there’s a big difference from four eggs (do they guarantee maturity?) and two embryos. And there may be other guarantees depending on the treatment you choose, for example, reductions off the third cycle or the third cycle free of charge. The guarantees can be very important. Someone going through treatment at the same time as me received no eggs from her donor so was not charged at all for the treatment. Check out that small print!

 Online Reviews

I used online forums extensively when looking for a clinic. I felt the best source of information was the fertility friends forum, although as I started to narrow down my list of clinics I Googled each of them to see what other women were saying.  Fertility Friends is a UK based forum with members from all over the world. The forum has a thread specifically for women over 50yrs as well as boards for most of the well used clinics in the UK and overseas. There’s tons of information on there and I found this the best source of information on recent treatment successes. Yes, it’s purely anecdotal but it’s up-to-date and I found it the best place to get specific questions answered and get a real feel for what the clinic is like. I can’t recommend it highly enough.

Gut Instinct

I started out trying not to let anything other than logic and the results of my research influence my choice of clinic but, after reading other women’s opinions, I came to the conclusion that you must let your instincts lead the way and you will eventually find yourself drawn to a clinic which will be right for you. Perhaps there really is something in female intuition after all so we might as well use it!

 

How to choose an IVF clinic – part II

Success rates

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Success rates are really important when choosing an IVF clinic but it can be difficult to compare like with like. Most clinics publish their success rates on their websites and, for UK clinics, you can also use the HFEA. Often the data is over a year old, however, and more recent success rates can be hard to quantify. I also found clinics tend to lump together their success rates for donor eggs rather than categorising them by age of the recipient. Perhaps it doesn’t make a difference how old you are? Look out also for the difference between reporting positive pregnancy tests, pregnancies that make it to a heartbeat at a scan (around the 6 week mark) and live births. And if possible look into the treatments the clinics use so you can compare specific results for the treatments you want. And, if the results you want aren’t published on the website…then ask!

Quality of the clinic

This is hard to establish. I spent a lot of time looking at the training and experience of the IVF consultants and also, crucially, the embryologists who are often forgotten. It’s fascinating the differences between clinics on how many eggs are fertilised and how many develop to blastocyst stage and a lot of this is down to the skill of the embryologists. The better clinics are comfortable showing photographs of their treatment rooms and their laboratories. I checked out their policies too. Although some women are looking for clinics that will transfer more than two embryos, this goes against current UK guidelines and it made me think twice about using those clinics. A further option is to look for an overseas clinic that has a link to a UK clinic. This is becoming more popular as UK clinics seek ways to offer more cost effective treatment. If they have a link with an overseas clinic then you can be pretty confident the consultants here will have done the research for you.

Communication

How long does it take the clinic to get back to you? Have they answered all your questions to your satisfaction? Can you communicate directly with your doctor or is everything done through a co-ordinator? Do they offer free initial consultations? Perhaps via Skype? (highly unlikely in the UK but surprisingly common overseas) Are there contact phone numbers on their website and can you get hold of them out of hours? Do they employ an English speaking co-ordinator? Or do they work with a third party agency that can guide you through the process?

As you go through your treatment communication with your clinic becomes increasingly important, it’s worth checking how they work before you proceed with them.

Logistics

I spent a bit of time thinking about how easy, or not, it was to get to my various clinic options. UK was obviously the most straightforward but, for the overseas clinics, I checked out how easy it would be to travel to the country, the local accommodation, is the clinic central or would I be relying on taxis, does the clinic offer any discounts with local hotels, or do they provide a shuttle service ? If like me, you’re heading for treatment having reached menopause then the logistics are much more straightforward but, if you need to work with your monthly cycle, then flights can often only be booked at the last minute which adds to the costs. Thankfully, if you look around, you should be able to find accommodation with last minute cancellation policies.

Waiting times

There’s a general perception that the UK has a shortage of donors and long waiting lists but this isn’t necessarily the case. The UK clinic I approached was able to fit me in almost immediately but one of the popular overseas clinics has a 6 month waiting list for treatment. If you’re rushing to fit in treatment before you hit one of the age cut-off points then don’t forget to check out waiting lists before you commit.

How to choose an IVF clinic – part 1

When I first decided to have IVF, I had absolutely no idea where to start. I realised there are literally hundreds of clinics all over the world who offer treatment. How was I ever going to choose a clinic?

Age

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As I was rapidly approaching 50 I knew I was also likely to be rapidly running out of options. I knew from my research into women giving birth in their 50’s, that overseas was a possibility but was the UK? Turns out the UK is an option up to the age of 55 but only a few clinics (for example GCRM in Glasgow and the London Women’s Clinic) will treat anyone over the age of 50.

I also knew from online forums that some EU countries were popular but, surprisingly, some are stricter about age than the UK. To my knowledge popular IVF destinations such as Spain and Czech Republic will only treat women before their 50th birthday. Greece will treat you up to your 51st birthday. After the age of 51, most UK based women go to one of the clinics in Cyprus who don’t seem to have a formal cut-off. India and Russia are also popular amongst older women.

Cost

This is real biggie. Thankfully I read some advice early on that most people need 3 cycles of treatment to be successful and I compared prices on this basis. Perhaps the easiest way to compare costs is to factor in initial consultations, the treatment itself, travel and accommodation and ignore medication costs, scans and blood tests. These can vary so much person to person, cycle to cycle and you can look for suppliers other than your main clinic.

A lot of clinics have price lists on their websites but I also emailed a couple for quotes. Also a good opportunity to see how long it takes for them to get back to you.

I did have to work quite hard to ensure I was comparing like with like with treatments. For example some clinics automatically included ICSI (intra-cytoplasmic sperm injection), for others it was an additional cost.

In my case, I worked out that the cost of a donor egg cycle would be in the region of £8000 in this country but overseas I could get the same treatment for around £5000. Do shop around, a clinic I contacted in Spain was surprisingly around the same cost as the UK. When you’re budgeting for three cycles, that price gap became increasingly prohibitive for me.

Not surprisingly, Professor Robert Winston has spoken repeatedly about the inflated costs of IVF in the UK and I found it hard to shake the idea that I was being ripped off compared to going overseas.

Range of Treatments

Clinics vary in the range of treatments they offer. I had to do quite a lot of reading around some of these – ICSI, assisted hatching, embryo glue, embryoscope, 3 or 5 day (ie blastocyst) transfer, endometrial scratching – to try and work out which, if any, may be important to me. I ended up prioritising ICSI and blastocyst transfer as I thought these were the most likely to lead me to success.