From our guest speaker Aleksander Wiecki you will know:
• HOW to choose ‘THE BEST’ IVF Clinic
• What to focus on while searching
• what QUESTIONS to ask before you go.
How to choose “the best” IVF clinic abroad?
Trying to find a suitable IVF clinic abroad takes a lot of research and time. Fortunately, we have a shortcut for you! Here is the webinar in which Aleksander Wiecki, Chief Marketing Officer at IVF Media, helps you to narrow your choice by giving you tips about most important factors to focus on, questions needed to be asked and tricks that IVF clinics use to attract patients.
At the beginning of his presentation, Alexander admits that his real aim is to show patients how not to choose the best IVF clinic abroad. Why does he stress the word ‘not’? Simply because there is no such thing as ‘best IVF clinic’. Every patient is different, they have their own medical issues and various expectations so it is impossible to choose one clinic that would suit us all. Additionally, there is no easy and ready recipe for finding the clinic tailored to our needs either.
The most important conclusion that Alexander and his team draw from conversations with IVF patients, is that the latter do not ask right questions while searching for the clinic they would like to have their treatment at. At this point, Alexander uses a quotation from HFEA (Human Fertilisation and Embryology Authority), the national body that stands behind IVF clinics in the UK:
A great fertility clinic isn’t just one that can give you effective treatment, it’s one with compassionate staff, clear pricing, seamless administrative processes and exceptional emotional support.
The quotation perfectly summarises what patients should indeed focus on in order to assure themselves safe and satisfying treatment experience. However, the reality is generally far less than ideal.
Alexander says there are 3 most common aspects of treatment that patients pay attention to before deciding on an IVF clinic abroad. The price is the issue they are mostly interested in. Secondly, it is the treatment time, and thirdly – the successful outcome. However, these three things rarely go together. According to Alexander, it is impossible to find a clinic that would support patients in all these three parameters equally. If you’re looking for low-cost treatment, it surely won’t be successful and quick. If your aim is short treatment, it is not going to be cheap and satisfying. If, on the other hand, you are interested in the positive outcome (meaning ‘live birth’), your treatment will neither be cheap nor done quickly.
Alexander goes on to explain in details the most popular questions asked by patients. While analysing them, he wants us to understand why most of these questions are being asked in a wrong way. The first question is ‘What are your success rates?’ . It’s understandable from a patient’s point of view but one has to realise that success rates are not comparable in any way. Different clinics will always present them differently. For example, you never know what age group they use or how many patients they calculate their rates on – is it 100% or maybe just 50%? There might be cumulative success rates, success rates per embryo transfer or per whole IVF cycle. They can represent only fresh transfers or both fresh and frozen ones. There are many factors that may influence the treatment outcome. Additionally, there is always marketing involved – it is in every clinic’s business to present itself in the most beneficial way. Fortunately, Alexander has some helpful advice on how to approach the subject of success rates. What every patient should do is to present their own medical history and ask about their own individual prognosis for successful treatment. That makes a whole lot of difference as in this way, you are not asking about the average for all clinic’s patients anymore – you’re asking about the average for patients with a similar case to yours. Such an approach obliges the clinic to prepare a more personalised offer and show if they really care for patients – thus, helping them immensely to narrow their choice.
While the average success rates presented by IVF clinics are often misleading, there are some more reliable sources that allow us to compare treatment outcomes between different destinations (and thus, the clinics). One of them is ESHRE (European Society of Human Reproduction and Embryology), the biggest fertility organisation in Europe that collects data from national regulators for IVF treatment. ESHRE publishes annual reports (with a 4-year delay) with the IVF success rates as an average per country. And although Alexander does not think ESHRE reports are of great help to patients either (again, it is difficult to determine the basis for calculating success rates in each country), they are the only source of comparable success rates in Europe. What is more, they lead to one very important conclusion: IVF treatment outcomes in different destinations are, in general, not very much different.
Alexander also presents one useful tool for patients interested in their own success rates. It is online calculator by SART (The Society for Reproductive Technology) for predicting individual chances for the positive outcome of IVF treatment. SART is the main national body regulating IVF treatment in the United States. They have collected data from nearly 500,000 cycles of therapy performed to more than 320,000 women in the USA since 2006 and used it to create a calculator that helps patients understand their chances of having a live birth – based on their personal situation. Of course, it is impossible to show the exact values for each particular situation – not even the SART tool can do that. However, thanks to the huge database and well thought-out questionnaire (asking for information such as e.g. patient’s height, weight and diagnosis), it is much closer to the truth than any IVF clinic has ever been to. The tool can be easily googled by using the terms ‘SART predictor’ or ‘SART calculator’.
The second most common question patients ask IVF clinics at the first contact is ‘What is the IVF/egg donation cost?’ According to Alexander, this is not the right way of thinking either. In fact, prices are as difficult to compare as success rates. It happens so because every clinic has different treatment options on offer as well as hidden extra costs that patients are very often not aware of. At least – not before they start the treatment. At this point, Alexander presents the comparison they created for the purpose of ‘IVF Abroad Guide’ that was published in November 2019. Instead of presenting the average treatment costs per country, they showed price ranges (both minimum and maximum prices) in each of 8 IVF destinations in Europe (Spain, Czech Republic, Greece, Ukraine, Poland, Latvia, Russia and North Cyprus). There are both cheaper and more expensive options to choose from. However, one should realise that the presented costs do not include add-ons (meaning additional tests, procedures and medications) or travel and accommodation expenses. What Alexander advises is to always ask clinics about the approximate IVF treatment cost in our own individual case – the one that will ensure the highest possibility of success. And again, as in case of success rates, the way the clinic responds to our request may say a lot about their professionalism and reliability. Only when they want to know more about our individual case, they are able to prepare a personalised treatment offer. And that is what we all should look for when choosing the best IVF clinic abroad.
Apart from success rates and prices, patients want to know the length of their journey to parenthood. ‘How long does the treatment take?’ is the third most often question they turn to IVF clinics with. Alexander says it is a tricky one as – from the clinic’s point of view – the quicker means the better. But it is not the way patients should think at all. IVF treatment is a complex and complicated process that requires a lot of medical knowledge, detailed analysis and involvement on the doctors’ part. At the end of the day, it is the quality of the treatment that is the most important – and not how short and fast it is. In Alexander’s opinion, the right way to approach the subject of the treatment duration is to inquire about the optimal solution for you. Only on the basis of your medical history and diagnosis, the clinic is able to estimate how many times you will have to visit them personally.
Summing up, Alexander says there are three most important things each patient should remember about when looking for IVF clinic abroad. Firstly, you should not compare ‘advertised’ success rates, as knowing how they were calculated is simply impossible. Secondly, comparing IVF treatment costs is very difficult because of all additional expenses clinics never mention at the beginning. In fact, one should always add 30% on top of what is officially communicated. Thirdly – and probably the most importantly – the attitude clinics have towards patients is what counts the most from the start. Clear information, transparency and honesty in communicating prices and treatment possibilities are things we should always pay our attention to. Additionally, the relationship between doctors and patients is of great significance. Alexander says that a great way to get a feel of it is to have an online consultation with a doctor before visiting the clinic personally. If during such a conversation, a doctor manages to win your trust, it is a good and promising first step of your future treatment together. Additionally, you do not have to travel few thousand kilometres to have a meeting in person – so you save your time and money. And this is always of great advantage in planning a costly and time-consuming process that IVF treatment undoubtedly is.
More information about IVF treatment abroad, the efficacy of IVF procedures and applicable IVF legislation in top European IVF destination can be found in ‘IVF Abroad Guide’ created by Alexander and his team. The Guide is free and can be downloaded from whereivf.com .
Questions from the event
I found one clinic in Turkey. They are asking to provide my marriage certificate. Is this correct to ask a patient for that?
To be perfectly honest, we haven’t covered Turkey in our Guide. I know that in Turkey there are a few things that may look weird from patients’ perspective. However, if they treat only married couples, they probably need a proof that you and your partner are married. So if this is what the Turkish law says, it is correct to ask patients for that. They have to check somehow if what they’re doing is according to the law.
I have a problem because my diagnose says that my chances to have a kid are almost zero with my uterus. Therefore I have these questions: 1. What are the best criteria for choosing a surrogate mother when egg retrieving is difficult? 2. Do you have suggestions of good surrogate mother agencies? 3. Can you recommend a country for the surrogacy process, if we live in Germany? I mean the legal aspects.
Unfortunately, I cannot give answers to the first two questions. I’m not really into the subject of surrogacy. Of course, we are not against it but we just don’t deal with surrogacy. We have sometimes patients who are looking for this kind of solution. That’s why I can only answer to the third question. In fact, it’s not the recommendation – it’s just the common knowledge that we get from our experience. We know that there are two countries, Greece and Ukraine, where you can try to use the surrogacy solution. There is also Georgia with very good law. However, I’m not an expert in surrogacy and I don’t want to cause misunderstandings or share false information. But if you contact our consultants, they will get back to you with this information. They are working closely with the clinics that are supporting patients with this kind of needs. If you write at the email address: firstname.lastname@example.org, Elisabeth or Caroline will get back to you and help you by sharing the knowledge on the legal differences. I’m sure that the three countries I mentioned are ok for some kind of patients but there are differences in the legislation – and not every patient is allowed to undergo this kind of treatment.
What about asking about sperm/egg donor information, such as their medical history and tests? What is important to know when you choose your embryo?
If you’re talking about the information on donor sperm or donor oocytes, you can always ask as many questions as you want. The basic question would probably refer to the way the donors were qualified and the kind of tests that they had to go through during the qualification process. This is very important because in this way you can check if the tests were done according to the law or if the clinic is doing something on top of that (some clinics do perform more tests than required). There is always an option of getting the donor sperm from some external sperm bank as there are a few of them in Europe. All of them would be happy to share any information they have about the donor. But you may encounter some problems with sperm banks in the countries where there is open sperm donation. In case you want to transport the sperm in, it may not be possible because of legal issues. You may simply not be able to transport the sperm because non-anonymous genetic material is not allowed in your country. When it comes to choosing the right embryo for the embryo transfer, there is one thing to remember about the embryo quality. There should be a doctor and an embryologist involved in the process. And some clinics are offering consultations with embryologists at that point – sometimes they are free of charge, sometimes they charge you for that. It is very important to consult the embryologist. This a doctor and probably it is on the basis of your conversation that you would make the decision on which embryo is better and should be qualified for the embryo transfer.
Do you know if there is a difference in success rates if an egg donor is 33 rather than below 25 years old?
In most countries, the maximum age for an egg donor is 34. Let me put it this way: it all depends on what kind of a donor is qualified for the process. You can imagine a woman who has had two pregnancies, two live births and two healthy kids and now she is a donor. This is the donor with proven fertility and whatever her age she is – as far as her oocytes are ok – she will probably be ok, too. And you can imagine a donor who is 21. She is very young and probably healthy – as she was throughly checked during the qualification process. However, she’s never been pregnant so you never know. I do not know if this way of thinking is ok – I just want you to see how points of view can differ when you are looking at egg donors. I can give you another example and this is something you may find at some clinics: they tell you that they have a proven fertility donor but it does not mean that this woman was pregnant at some point of her life. It means she is a donor for the third or the fourth time and they had successful pregnancies and live births from the genetic material retrieved from her. And even though this donor is 30, it does not mean that she is worse than the donor who is 21 or 24. I think there is no straight answer to this question, it’s not black and white – as almost everything in IVF treatment. Everything is complicated by genetics, age and many other factors. What we know and what you can find in many publications is that the oocytes’ quality is getting worse as women’s age is increasing. I’m obviously not a doctor so I do not know for sure if these 8 years of difference really makes a difference here. But bear in mind all the examples I gave you and remember it is not easy to compare these two ages. I think we need to have more information on the donor, the qualification process, the medical history, etc.
We live in Dublin (Ireland) and there is only 1 clinic doing PGT (and test results are actually sent to the UK). PGT is pretty new in Dublin so I am worried how good it will be. It is very expensive… Is there a country that is well-known for PGT success & quality?
This is a very good question. We need to be aware that, in any kind of this treatment, the embryos need to undergo a biopsy. And this is where the problems start. It is not a question of PGT, PGS or whatever technique it is – it’s the embryology lab at the clinic that you are treated that is of most importance. They are doing a biopsy and the question is: are they well-experienced in doing that? In most cases, it would be done on the fifth day of the embryo development. Then the embryos would be frozen (‘vitrified’) and the samples would be sent to a place that you mentioned, no matter if it is one country or another. This is the first part of the process. Doing an embryo biopsy is not an easy thing – it needs knowledge, experience and very good embryologists. So the first question would be: is the clinic in Ireland, that undertakes your treatment, well-experienced at doing this? Probably, if they’re the only clinic, they deal with many treatments of this kind ( PGD, PGS). However, it’s connected with doing the biopsy and this is what needs to be done to have proper samples to be sent to any laboratory in the world. Referring to the second part of the question: I do not know if PGT at the clinic you chose would be good because I do not know what laboratory it is. However, I can tell you there are hundreds of clinics in Europe that are working in the exactly the same process. You can find such clinics in Spain, the Czech Republic, in the UK. Not all the clinics are doing it in-house because it is pretty expensive to cover all the costs. You need to do a lot of testing in order to make it profitable. That’s why there are external laboratories or clinics that have these laboratories on-site and are specialised in giving this kind of services to other clinics as well – and thus, making it accessible to patients like you. And referring to the last part of your question – I’d say it would be every country: Spain, the UK, Ukraine, Poland, the Czech Republic and Greece. In all of these countries, you’ll find the clinics that are doing this on-site and are specialising in it. I cannot really say which country is better in terms of PGS results. I don’t think there is a big difference between them. Doing PGS is a huge responsibility – and this responsibility is on people who are signing the documents with the results. At the end of the day, they are confirming that the particular embryo is free of what you were looking for in it, e.g. single gene disorder, a translocation or any chromosomal abnormality. As this is such a huge responsibility, I cannot see a country that would do it in a wrong way. They would all employ the best geneticists and other laboratory specialists to make sure everything they do is right for the patient.
In Ukraine, some of the clinics are showing photos of the donors on their websites. How can you be sure that the donor you’ll select is the one from a photo?
This is the first time I encounter such a question. If it is a well-known IVF centre with good reputation, I would believe that what they are showing is true. I cannot see a reason to be suspicious about such kind of a situation. Obviously you need to be careful when choosing an IVF centre and check it before going abroad. Ukraine is one of these countries where you can contact directly UARM (Ukrainian Association of Reproductive Medicine). This is the organisation behind the IVF clinics. You can always ask them about your chosen clinic. If you download our Guide at whereivf.com or eggdonationfriends.com , at the end of the Ukraine section, you’ll find the information about this organisation and the people you may write direct emails to. These people also speak English, you’ll find their email addresses there so you can write to them and ask about particular IVF units. This is what I would advise you to do if the clinic you’re thinking of looks suspicious from your point of view.
We were about to proceed with a clinic in North Cyprus couple years back and then they stopped communicating. We got to know that they were closed down and the owner went to jail… We hear so many rumours about this location but the price is good there. How can we make sure that a clinic is operating legally?
Again, downloading our Guide would be a good starting point here. There is a section about North Cyprus and you can find a lot of information there. Just to make sure – we are not talking about Cyprus, we’re talking about North Cyprus. What you are saying is right, we know that situation. Unfortunately, there is a problem with the law in North Cyprus. It’s not the problem of the lack of the law. The IVF law exists there and it is not bad – in fact, it allows the clinics to do a lot of things that are not possible in other countries. However, the problem is the lack of control over the clinics – if they are working according to the law or not. The Ministry of Health changed the certification process of IVF clinics in North Cyprus in 2016. If you are trying to find the right IVF unit for you, ask them about the certification issued after 2016. Apart from the clinic’s certification, all doctors should be certified as well. You can also ask about that – it is a document that they can scan and send you by email. As far as we know, there are 5 certified IVF centres in North Cyprus today – unless something changed during last month. And altogether there are 15 or 16 IVF centres over there. What I mean by ‘a certified clinic’ is the clinic that meets the new certification process criteria issued after 2016.
When I choose my embryo profile, what medical tests are important to be done on the sperm/eggs? In addition, I find it difficult to find out what the donors’ medical history is. And is there any website where I can find more information on this?
I understand you are referring to the donors’ background, the qualification process, their medical history, etc. The problem is that there are some restrictions in some countries. For example, in Spain, you can easily get the information about the tests that have been done during the qualification process. However, you won’t get any information about the donor’s characteristics as clinics are not allowed to share them with patients – simply, because egg donation is anonymous in Spain. But they always try to do the phenotype matching of the donors and the recipients – it means that the donor will be very close to your basic parameters, such as race, height, weight and the colour of the eyes. At the same time, there are countries that allow you to see more information about the donor, sometimes it’s even the picture of a donor as a baby or the picture of a baby that has been born from the donor. There is also some more information about the donor, including their hobbies, special skills, education, etc. as well as their medical history from the genetic point of view. However, if you are asking about important medical tests that need to be done, I do not really know. Again, if you download our Guide at whereivf.com or eggdonationfriends.com , you’ll find the information on what tests the candidates have to undergo in order to qualify as donors in particular countries. However, you need to know that there are clinics that are doing a lot more than is required by the law. They do so because they believe it’s important from patients’ and donor’s point of view. The popular thing today is the genetic testing of the donor – in order not to let the inheritance of genetic disorders to happen. Obviously, there are many more tests that should be done – however, I cannot just give you the list because there is always some doctor somewhere in the world who can tell me I’m missing something important. If you take a look at the Guide, you’ll see what the country’s requirements are in popular destinations in Europe.
I’m 41. I have recently failed my 1st IVF cycle. I have a fibroid 2×2 cm right outside the uterine lining. My AMH is 1.1. Should the fibroid be removed? What can I do to increase my chances of success?
I wish I was a doctor to answer your question, but unfortunately I’m not one. The only answer I can give you is to contact our consultants Elisabeth and Caroline at email@example.com . They may arrange a free consultation with a doctor from one of the clinics we’re cooperating with. As I said, these consultations are free but you have to have a chat with one of our consultants to find the most suitable solution for you. We need to know what you’re looking for and then we will be able to support you with this kind of consultation. I think a doctor is the best person to answer to your question.
Can you please give the name, email and telephone number of the organisation you spoke about in relation to Ukrainian clinics and their reputation?
I can give you the address of the website where you can download our Guide from – it’s whereivf.com .The Guide is free. If you go to page 37, you’ll find two names: Irina Babenchuk and Natalia Silina and the email address (firstname.lastname@example.org) . If you want to learn more about Ukraine and IVF, just download the Guide because there you will find a lot of interesting information about this destination – as well as other countries.
I’m looking into clinics in the Czech Republic. Will it be appropriate to ask if they specialise in adenomyosis and endometriosis?
This is a good question. In the presentation, I showed you three questions that patients very often ask the clinics. However, in most examples they’re asking the questions in a wrong way. But what you’re asking about – namely the specialisation of the clinic and its doctors – is something that patients very rarely ask about. There are not many patients asking questions this way and I’d highly recommend to do that. If you have any issue connected with infertility, I’m sure there are clinics that already specialise in this kind of treatment – the ones that treat 20-50 patients in a similar situation a month. At the same time, there are clinics that treat monthly only 1 patient with a similar case to yours. So I would definitely chose a clinic of the former type. So I’d say it is very good to ask the clinic questions the way you want to do it. If you have e.g. low ovarian reserve or other such issues, just put them on the list and ask the clinic about it in a first place. Then you can judge which clinic is more experienced or less experienced in the matter. Ask the same questions to a few clinics – it’s always good to have something to compare. What I would also recommend is to try to get an online consultation before you go to the chosen clinic. Even if you have to pay for that, remember it’s money well spent. You don’t have to travel I don’t know how many kilometres to meet a doctor. It’s easier and cheaper to spend – let’s say – 120 Euros for a consultation rather than few times as much for plane tickets. Even if afterwards you decide not to go to that clinic, the doctor there may help you to understand different options. It might be a person thinking out of the box who can give you some hints on what to do with your treatment in the future. Then you may use this information in other clinics when asking for advice. So definitely yes – you should ask about the specialisation of the clinic. What is more, ask about doctors who are dealing with your kind of patients and try to get a consultation with them.
If we make a trip to Russia, do you know if my husband and I will be the legal intended parents when a child is born? I was told an egg donor has the right to change her mind after embryos are made – just like a surrogate has the right to change her mind within a month or so and keep the baby after it is born. Same in Georgia – I’ve heard both an egg donor and a surrogate have the right to change their mind and keep embryos and/or baby?
I’m sorry but I just don’t know. But again, if you contact Elisabeth or Caroline at email@example.com , I’m sure they can get back to you with this information. They may check with a few clinics just to make sure that the information we are sharing with you is correct. There might be some different rules or other things that have to be taken into consideration. Our girls have various possibilities so please ask them about it – you can always have WhatsApp or Skype consultation with them. I’m not sure but maybe they know these things already.
After many failed IVFs with my own eggs and egg donation, now we have decided to do embryo donation to give ourselves another chance. Which is the best way to go about it?
It’s difficult to say. It probably depends on your budget and expectations. However, you may find embryo donation as an option in most of the countries which are popular in Europe. But what you need to know is that there are different kinds of embryo donations. This is something that many patients do not understand in a proper way. For example, you can have the embryo donated from the patients who had their own IVF treatment and had one or few embryos left that they didn’t use – for different reasons, such as because they did not want it or did not need it as they got pregnant. At many clinics, there is a possibility to donate such an embryo to the embryo bank in this particular IVF unit. Then the recipient, who is thinking of embryo donation, can be supported with the embryos from the embryo bank. The embryos are obviously of good quality. There is also a second possibility of embryo donation. This practice is more and more popular because it is easier to manage. In fact, there are not many embryos left from the former IVF patients. Most of them keep their embryos and vitrify them in case they want to have a second child in the future. The most popular name of the second option I’m mentioning is double donation. It means you get the oocytes from an egg donor and the sperm from a sperm donor. Obviously, eggs and sperm are fertilised and then you get the embryos. I believe this option might be more expensive – however, it’s the most popular and you can find it in many countries in Europe. If you want to know exactly which clinics offer this kind of solution, please ask Elisabeth and Caroline (firstname.lastname@example.org) and they will be more than happy to get back to you with this information.