THE BLOG
06/08/2015 03:31 pm ET Updated Dec 06, 2017

The Ultimate Guide to Choosing a Fertility Clinic... and Knowing When to Get a Second Opinion

It's not easy coming to the realization you probably need help conceiving or staying pregnant. Guys tend to be a bit more chill, but many women secretly wonder, What if they tell me I can never have a baby?

I get it, trust me. But I'm a firm believer in exploring every avenue and uncovering as many answers as possible. And the fact is, most problems, once identified, are fixable. Not all, of course, but even then you have options.

After a year of trying to get pregnant on our own and experiencing two early miscarriages, my husband and I decided it was time for a medical opinion of our situation. But in our grief and haste, we did the wrong thing: made an appointment at the first clinic we found on Google that was closest to our house.

Because infertility is so often a private struggle, most couples don't know whom in their lives to ask for referrals -- if they feel comfortable asking at all even if they did know. Just because a friend or family member is "out" about their infertility doesn't mean you want to be.

My husband and I are now in our fourth year of trying to start our family. Since that initial fertility clinic appointment, we've had two more miscarriages, six IVF transfers, two IVF egg retrievals, and lost twins during delivery. We are also no longer with our original fertility clinic.

As a veteran of "the system," I'm here to share with you some valuable insights I've learned over the years, even as recently as this week, about choosing the right fertility clinic on the first try, or at least knowing when it's time to look for a new one:

Learn what your insurance does and doesn't cover.

Hopefully you're one of the lucky ones who lives in a state with mandated infertility coverage. Even if you're not, it's possible your insurance still covers something. Mine, for example, covers all diagnostic procedures, including ultrasounds.

Does your insurance only cover certain clinics? If so, let me give you some counter-intuitive advice: Don't become a patient at a clinic just because it's covered (in part or in full) by your insurance.

One of our friends is a patient at a clinic because it's the only one their insurance covers. But I truly question what went into the decision to cover this clinic in the first place because their medical practices are not even questionable -- in my opinion, they are downright fraudulent.

Free or discounted infertility treatments will be of little comfort when you've been unsuccessful over and over again at the fault of the clinic. Do your due diligence and consider cost as only one of many factors when making your decision.

Understand how fertility clinics work.

Unless you live in a really remote location, chances are you have multiple fertility clinics from which to choose. However, I cannot say this enough: Not all fertility clinics are created equal.

At the end of the day, they are businesses. While your doctor hopefully lives and breathes your case, there's a big chance a board is pulling the strings behind the scenes.

What this means: If they find something in their initial testing that makes you a less-than-optimal candidate for the most invasive (and expensive) procedure, in vitro fertilization, you might be turned away.

If this does happen, I consider it a good thing. Why? Because you didn't want to be a patient there anyway. A fertility clinic that turns down a patient just because that patient might impact their success rates is one you want from run away from as far as possible. While I applaud a fertility clinic for wanting to be successful on the first try, it should be for the right reasons.

Digest their success rates... but with a grain of salt.

If you cannot easily find the clinic's success rates directly on their website, do not bother investigating further. The clinic is not worth your time. Ideally, the clinic should list both IUI and IVF success rates, broken down by age, number of embryos transferred, etc.

As someone who's experienced multiple miscarriages and lost twins after I went into labor, I highly recommend paying special attention to live birth rates rather than the percentage of cycles that end in pregnancies. If you've never seen those two pink lines, you might think getting that far is better than not being pregnant at all, but let me tell you, that's just not the case.

When it comes to the actual numbers, the fertility clinic with the highest percentages probably seems like the logical best choice, but that's not necessarily true.

Did you know that all clinics are required to report all outcomes on all cycles to the Society for Assisted Reproductive Technology (SART)...but many selectively choose what to report? I didn't either, until just this week.

Dr. Allison Rodgers, a physician board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility who practices at the Fertility Centers of Illinois, explained in an interview that while these clinics are not necessarily trying to defraud patients, it's quite possible the numbers you're seeing are not entirely comprehensive.

Then there's the fact that some clinics turn away "hard" cases -- while others accept them with open arms. As you might imagine, both practices impact success rates in different ways.

So, educate yourself on the clinic's public success rates, but understand they might not tell the whole story.

Investigate the number of single embryo transfers (eSET) performed versus double embryo transfers (2BET).

Tally this one up in the "things I didn't know until this week" column. I honestly hadn't even thought about it before, but as Dr. Rodgers explained in our interview, eSETs are evidence that the clinic follows currently accepted best practices and has the latest and greatest equipment.

My clinic tried to convince me of the benefits of eSET... I just didn't listen. Having now lost twins, I've become the unofficial spokesperson for the eSET movement.

I understand the appeal of twins after struggling with infertility. But having one live, healthy baby is a much better alternative than what I've been through. I wouldn't wish this on anyone.

Make sure IVF isn't the only treatment option.

After looking at their website, does it seem like they only offer IVF -- or at least push it much, much harder than other, less expensive treatment options? Many infertility cases don't even require IUI -- just some Clomid and timed intercourse. If the clinic seems to jump straight to IVF without a really good reason, that's a major red flag.

Size (sometimes) matters.

Like with all things, there are pros and cons to both small and large practices. Large practices tend to have more and better technologies. Small practices tend to have a more personal feel. Weigh the pros and cons, and choose the clinic that best aligns with your needs.

Location, location, location... should not be a top priority.

Dr. Rodgers disagrees with me on this point, but I personally think location shouldn't be a top priority. It should be a factor but not the factor.

If you have to travel an hour (or two) to see the top specialist in your area versus 15 minutes to see your second or third choice, to me, the answer is obvious: go the distance. Yes, it's a pain. No one hates driving, especially long distances, more than me. And yes, you will have to do some explaining at work. But it will be worth it in the long-run.

Board certification is a must.

In order to obtain a general Obstetrics and Gynecology board certification from the American Board of Obstetrics and Gynecology, physicians must complete four years of training, plus two years in clinical practice. In order to obtain a subspecialty certification in Reproductive Endocrinology and Infertility, a physician must be board certified and complete additional training as specified by the board. That's a lot of training, and you only want the best.

Critically analyze your consultation appointment.

Once you've found a fertility clinic that looks good on paper, schedule an initial consultation -- but go in with a critical mindset. Think of it as a job interview where you are the employer. Your main duty is to yourself, your partner, and your future child(ren) -- not the clinic.

I made this mistake. Because I immediately felt a great rapport with my first doctor, I stayed for seven months, ignoring the fact that she didn't put forth a treatment plan. At the time, I didn't know anyone else struggling with infertility I could ask about what to expect, so I truly didn't think anything was out of the ordinary. Great rapport, while extremely important, isn't enough.

Beyond a connection with the doctor, what else should you look for?

  • How you're greeted. Does the staff seem warm and welcoming?
  • Whether or not they see patients seven days a week. To me, this is non-negotiable. The ideal time to perform an IUI or IVF transfer doesn't always happen during non-holiday weekdays.
  • How they define "success." Going back to what I said before, you should consider live births a success -- and so should your clinic.
  • How they communicate with patients. Because my clinic is a large practice, I'm extremely lucky to be assigned a nurse I can reach during normal business hours via both phone and email. Probably unfortunately for her, she hears from me a lot!
  • How accessible they are after-hours. While I don't expect my nurse to personally take care of my needs at all hours of the day, it's nice to know my clinic has an answering service for evenings and weekends. There have definitely been times when I used it.
  • What other services they provide. Do they offer support groups or counseling? What about acupuncture?
  • Their hospital affiliation. If you experience a complication that requires hospitalization, you want to make sure they plan to send you to a hospital covered by your insurance. This doesn't happen often, but it does happen -- happened to me just a few months ago.
  • Their financial options. Most clinics require you to pay for procedures 100 percent upfront, but they should have programs to help you with the burden.
  • What diagnostic tests they plan to perform. My first clinic did very little, but of course I didn't know that. Educate yourself on the many female and male tests that should be performed.
  • If you were to require IVF, how many embryos they recommend transferring. Again, look for something that falls within the American Society for Reproductive Medicine's guidelines.
  • They are hopeful for you -- and make you feel hopeful for yourself. You should walk away from this appointment feeling energized. A little overwhelmed perhaps, but definitely energized.

This list could go on and on, but that's enough for the initial meeting!

Demand a sense of urgency.

Let's say you've found a clinic that passed the initial consultation test and you've just completed the diagnostic phase, which can take up to a couple cycles depending on how deep they need to go to uncover your underlying issue(s).

At this point, the only person who should be more excited and ready to get started with a treatment plan than you and your partner should be your doctor. If they have no sense of urgency and don't prompt you with a clear plan of action immediately after testing is complete, take your results and transfer to another clinic.

Look for them to laugh and cry with you.

I don't need to tell you how emotional this process is. And I get that sometimes medical professionals have to turn off their emotions a bit or they won't make it through the day. But if your team isn't truly happy for your success or saddened by a setback, it's time to move on.

Be your own advocate.

I highly recommend taking copious notes during every appointment and researching more on every topic when you get home. Then, write down a list of questions that result from your research to either email your main contact or save for your next appointment.

There is no such thing as a dumb question. Expect nothing less than to be taken seriously. Don't be afraid to challenge your doctor's thinking if you've found a study that contradicts his plan. Make him make you understand everything at every step of the process.

Again, if you ever reach a point where you feel you cannot trust your doctor or are questioning his advice after you've raised valid concerns, at a very minimum get a second opinion. You will always know your body better than your doctor does.

Trust your gut.

I'll conclude with this: Never feel like you don't have options when it comes to your fertility clinic. You don't owe them a long-term relationship. If you're having doubts, trust your instincts.

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Click here to listen to my full interview with Dr. Rodgers.