Choosing a clinic and provider is one of the most important choices people on an infertility journey will make. But many find the choice overwhelming or don’t know where to start, and are surprised to learn about certain policies or expertise (e.g., no second implantation until one year postpartum; number of eggs transferred; how “aggressive” the clinic is in terms of the number of rounds of IUI before moving to IVF; etc.) until they are years into their infertility journeys. The reality is that the majority of families switch clinics due to poor experiences or poor outcomes.
We think families deserve better, starting by being aware of and empowered in their choices of clinic. As a companion to Motherfigure’s lab-accredited fertility clinic directory, here are some things to consider as you evaluate clinics.
Volumes and success rates
There’s plenty of public data about baseline volume and success rates, but it can be hard to interpret and compare success (i.e., healthy birth!) among clinics. Obviously, the patient population at any given clinic will vary, which in turn really skews outcomes. Adding to this fact is a general lack of context behind the numbers: One clinic might on the surface have better numbers because it declines certain patients or requires donor eggs, while some other clinic’s stats might be lower because it actually specializes in “harder” cases that others might turn away. So think about success rates as a starting point, or a threshold.
Volume, or total annual cycles completed: This is important to get a sense for patient volume. We list this on the Motherlode in the one of the top three key stats boxes, and you can also filter by volume thresholds. Clinics that do more than 100 cycles *tend* to have better success rates.
Success rates: Look specifically at the stats for women in your age group, and compare to the national averages. Out of 456 reporting clinics in 2018, the national averages were:
- Percentage of intended retrievals resulting in live births – nondonor eggs
- Ages <35: 52.0%
- Ages 35-37: 38.1%
- Ages 38-40: 23.5%
- Ages 41-42: 11.2%
- Ages ≥43: 3.2%
- Percentage of intended retrievals resulting in singleton live births – nondonor eggs
- Ages <35: 44.9%
- Ages 35-37: 33.5%
- Ages 38-40: 21.0%
- Ages 41-42: 10.2%
- Ages ≥43: 3.0%
You can see how a clinic stacks up on these numbers on the clinic’s profile on the Motherlode.
Overall quality: Some people recommend looking at how a clinic performs with donor eggs as a better proxy for clinic quality and comparing clinics more generally, because donor eggs are sourced from young, healthy women. You can also compare a clinic’s results for women under 35 vs. the national average. If their numbers are significantly worse, it might mean they take on more difficult cases, or that their practice is not that good. Regardless, you need to have a conversation with the clinic in that case. If they dismiss your concerns or research, it could be a red flag.
The national stats for donor eggs and embryos ( which not every clinic has) are broken down here. The percentages refer to the percent of transfers resulting in live births:
- Donor, Fresh embryo, Fresh egg: 57.1%
- Donor, Fresh embryo, Frozen egg: 44.2%
- Donor, Frozen embryo: 47.8%
- Donated embryo: 43.5%
State-of-the-art embryo lab
The lab underpins a clinic’s success. A clinic’s outcomes tell a big part of the story, but what happens in the lab helps drive it. The Motherlode only lists clinics that have accredited labs, but there are other things to pay attention to when evaluating the lab specifically.
Some questions to consider:
- Who are the embryologists and are their licenses current? It’s a red flag if they are not qualified.
- What oxygen concentrations are cultures kept at? There’s evidence of an increase in live birth rates associated with embryo culture with low oxygen concentrations (Bontekoe 2012).
- What kind of air filtration system do they have? Air quality impacts IVF outcomes (and pollution can impact fertility!). You want to know that this is a priority for the lab, too, so ask about an air filtration system controlling indoor particulate and VOCs (Volatile organic compounds). Some laboratories only focus on reducing particle counts, using high efficiency particulate air filters, which in theory makes for a safe culture environment by minimizing the risk of microbial contamination. Other labs filter out particles but emphasize VOC filtration, using solid-phase filtration or photocatalytic oxidation. Recent evidence shows that VOCs likely cause the most damage and that appropriate VOC filtration for an individual clinic is very important. The age and size of a laboratory can also contribute to air quality (newer being “cleaner,” etc.).
- How many other samples are contained in an incubator at a time, if any? Incubators are a key part of the lab, with lots of important features — gas capability, sensors, temperature control, etc. Low O2 capability and an IR CO2 probe are preferable to those units that mix the gases to permit the fastest CO2 recovery. But so far, the data doesn’t demonstrate a clear advantage of any specific incubator type (large-box, small-box, and benchtop/topload) in terms of human embryo development or clinical outcomes. Instead, more important may be how crowded the incubator is, so ask how they handle caseload.
- How are eggs and embryos transferred to and from the surgical suite to the lab? Are they right next door, or do they have to travel a farther distance? The closer the better to minimize mistakes.
- Are biopsies done by hand or are they laser assisted? Laser-assisted embryo biopsy is the method of choice.
- What is their fertilization rate (for both conventional insemination and ICSI)? For CI, look for better than 60 percent; higher than 75 percent is excellent. For ICSI, you want 70 percent or better, with 80 percent being excellent.
- What is the blastocyst conversion rate (i.e., how many fertilized eggs make it to a Day 3 or Day 5 blastocyst)? At great labs, 70 percent of blasts make it to Day 3 and 60 percent to Day 5.
- What percentage of embryo biopsies results in a genetic testing result (PGS biopsy rate)? The higher the better.
Clinical expertise
Depending on where you are in your journey, you may have a diagnosis (e.g., male factor, recurrent loss, endometriosis) or you might not. If you do, it can be helpful to look at a clinic’s patient population — namely the number of patients with your same diagnosis as a proportion of total patients — to understand how familiar your specific experience is to this clinical team. You can find that on the Motherlode. You can also look at the team’s stated specialties and research to get a better feel for this.
Insurance and cost
Some people may start here — choosing a clinic that is in network with your insurance company and plan, if you have them — which can ultimately limit your choices. We list these on the Motherlode and make it possible to filter by insurer.
Others elect to go outside their network (or lack an in-network option to begin with), knowing that many clinics offer discounts and programs for self-pay patients. Also note that some clinics will say the first cycle is diagnostic, which can really impact the price compared to a diagnosis-specific workup. Some clinics offer risk-sharing programs, which can look really compelling. But inquire about their policies for acceptance: Often, only patients whom the clinic assessed as having good/better odds will qualify.
It can be hard to assess a clinic from a financial perspective till you’ve engaged as a patient. But competent, empathetic billing departments can distinguish a good experience from a bad one. Diagnosis codes can be important here to limiting out-of-pocket costs. Check whether they have a financial counselor.
Biases: LGBTQIA+, race, and BMI
LGTBQIA+
Although queer people represent a growing proportion of those seeking fertility help, many clinics, even those that purport to support LGBT family-building, are less experienced, do not offer a full suite of services, or do not give patients positive experiences. This is on top of the fact that a heteronormative definition of infertility—the inability to conceive after a year of sex between a man and a woman—excludes many LGBTQ individuals from insurance coverage for ART.
Many people report that they have issues with using known donor sperm without a formal quarantine. Though the FDA doesn’t require quarantine, many clinics require both a six-month quarantine and sperm bank processing. Others don’t support reciprocal IVF. We are noting these on Motherlode profiles where available.
We are also actively seeking feedback from queer people on their experiences with fertility clinics in the reviews section of the clinic’s Motherlode profile.
Race
There are significant racial inequalities when it comes to infertility. Black women are estimated to have 1.5 times the infertility rate of women of other races, yet only 11 percent seek infertility treatment, compared to 16 percent of white women.
We want to hear from you about your experience, so that our reviews can be valuable to other Black families looking for supportive clinics.
BMI
Certain clinics turn away prospective patients on the basis of their BMI, or else recommend weight loss programs before embarking on a cycle. We want to hear about these experiences so that people can be made aware of these clinic policies.
Clinic hours, procedure times, and convenience
Procedure times: Because procedures are ideally timed according to your menstrual cycle and peak fertility, ideally, you will want a clinic that does procedures every day of the week, but many clinics don’t do weekend procedures.
“Batching” policies: Some clinics will administer birth control to put all their patients on the same schedule for cycles — convenient for them, but not necessarily for all patients.
On call: Is there someone on call or available 24/7 in the event of emergencies? Are messages checked on weekends?
Commuting distance: You’ll be making this trek often, many times on relatively short notice. This can become challenging to navigate amid other priorities, like work, if you’re driving an hour or need to hop on a plane, but many people choose to make such tradeoffs.
Blood work lab: Find out if the clinic has its own, on-site lab for blood work or if you’ll need to go elsewhere. This can be the difference between needing to schedule extra appointments and not.
Staff
Personnel policies: Some clinics keep you with one doctor for everything; some have you see a nurse; and some will have you see different doctors for different procedures. This comes down to personal preference, and it also depends a bit on the size of the clinic.
Bedside manner: Bedside manner might come second to things like outcomes, but treatments can present a long and bumpy road. At minimum, you want to trust your doctor. You might prefer a more empathetic doctor, or you might like a blunt style. Consider this in choosing a clinic.
Nursing and front-desk staff: You want competent care here, because you’ll be dealing with the broader team a lot.
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