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Choosing the right clinic for your treatment: One of the most important decisions you’ll ever make

Professor Alan Thornhill
Fertility Expert & Coach, The Fertility Guy

Category:
Emotions and Support, IVF Abroad, IVF process, Lifestyle and Fertility

choosing-the-right-clinic_Alan-Thornhill
From this video you will find out:
  • What factors should individuals consider when choosing an IVF clinic?
  • How should I interpret and evaluate success rates provided by IVF clinics?
  • What financial factors should I consider when deciding on an IVF clinic?
  • How important is the location and accessibility of an IVF clinic?
  • Where to find trusted and factual information, what to watch out for?

Choosing the right clinic for your treatment: One of the most important decisions you’ll ever make

In this session, Dr Alan Thornhill, Fertility Expert & Coach, and Founder of The Fertility Guy shared insights on navigating the world of fertility clinics and finding the perfect fit for your unique needs and preferences. Dr Thornhill discussed key factors to consider, questions to ask, and the importance of personalized care.

Right vs. best clinic: making the distinction

In a perfect world every clinic that you would talk to would give you the same level of service, the same types of treatments, the same experience of staff, the same prices, success rates would be the same, and the legal and regulatory things that are in place would be the same, so you wouldn’t find that there’s something you can’t do in a particular country. It’s not the case, so you have to learn a lot before you even start treatment, a clinic is one of the big decisions you’re going to make.

‘Best’ clinic is usually considered the one with the highest success rate, in order of importance, next comes cost and location. One of the reasons why ‘best’ as the success rate isn’t always the best metric to use is because there might be age limits at particular clinics that are so-called ‘best’ that have the high success rate for, let’s say, women under 35; they may not have the best success rates for women who you feel fit into that age group, maybe you’re in a different age group, and they may not have the best rates for that. You’ve got to consider the success rates of the treatment type. Do they have the best success with using your own eggs, but they may not have the best success with donor eggs, or they may have very little experience with that?  Consistency and experience are really important. Do they have a waiting list? You’ve got to think about that particular factor very seriously. Then, flexibility, and this can mean lots of different things. One thing it can mean is, do they work around you, or do you have to work around them?  Do they consider patient well-being, or is it really just a case of it’s a transaction, or we just want to get a result?

Understanding Success Rates

Success rates are always put in terms of percentages, but there’s a lot more subtlety to it, and you do have to understand what’s above the line, and what’s below the line. Imagine that somebody’s looking at 2 clinics, and they’re even in the same town, you live in that town, and you see on their website “Our pregnancy rate is 62%” and on the other clinics’ website it says: “our pregnancy rate is 45%.” You’ll be drawn to the higher one, however, you need to remember that when you scrape beneath the surface a bit more, one thing that’s missing is your age. You have your age, and so you want to know what’s relevant to you. Furthermore, you also need to make sure whether they are providing ongoing clinical pregnancy rate and ask them for every egg collection that’s done, how many ongoing clinical pregnancies are there? That’s what they result in that number or that percentage, 45%. Always understand what you’re looking at, if you don’t understand something, ask the question.

Understanding costs and financing

You have to plan for more than one cycle. Speaking to a financial planner, advisor might be quite useful.  Check what kind of treatments they offer, if you still have an option of having free treatment or partially funded treatment, definitely consider it. Always query add-ons and non-routine medications, that list can get very, very long.  Make sure that this is something you need, and ask for explanation when the clinic’s staff is suggesting any additional options. It’s really important to get a costed treatment plan because there’s a very big difference between having basic IVF and a fully loaded cycle, it’s not only about add-ons; but sometimes there might be more monitoring during that cycle.

You might also consider multicycle packages, however you should consider what value that might have for you and what money-back plans are available. Another thing is to buy medications from a pharmacy where possible.

Considering treatment locations

You have to consider whether it’s going to be local, national, or even international. It might be useful to do a proper spreadsheet of all the potential costs that it might have for you.

Why do people go overseas? Sometimes there are treatment types that are available overseas that aren’t in their country. Local laws and regulations differ, donor anonymity is a good example of that. A lot of overseas clinics now have people speaking multiple languages, but don’t forget, that’s the coordinator. You might want to be speaking to a doctor in your own language. Going abroad for your treatment is not just about money, it’s also about the time and the energy that’s required to do this.

Starting with your wish list

List your priorities and rank them, that’s going to help when you actually start coming to clinics and seeing that they match e.g. 9 out of 10 of your requirements, but the 10th one might be the most important one.

The most important things to list are:

  • success rates, cost, location
  • treatments and services offered
  • no waiting list
  • supportive environment
  • flexible timing for scans and tests

Key considerations

When seeking information about potential clinics, it’s essential to consult reputable, non-commercial sources as your primary source of information. While input from friends, family, and online forums can be valuable, it’s important to critically evaluate this information and consider multiple perspectives. Online search engines like Google can also be useful tools for gathering information, but it’s crucial to approach search results with a discerning eye. Search engine optimization techniques may influence the visibility of certain clinics, so it’s important to verify the relevance and credibility of the information provided. Ultimately, conducting thorough research from a variety of sources will help you make well-informed decisions regarding your fertility treatment journey.

Regarding reviews and ratings, focus on the comments and be aware of bias look for red flags, 1 negative comment doesn’t necessarily mean the clinic is bad. Don’t forget that clinics are businesses, and they have to put themselves in the best light.  But it means you’ve got to have that filter. Try to differentiate between pure marketing and opinion and fact.

Think of ratings not as arrows toward the clinic choice, but signposts toward the questions that need to be asked.

Assessing the credibility and independence of review sites is crucial. Factors such as the number of users and the presence of paid reviews should be considered.

Recognize red flags, although they may not always be obvious. Investigate, check multiple sources to make informed decisions.

Conclusions

In conclusion, empower yourself through informed decision-making, which is key when looking for the right IVF clinic. By understanding success rates, the nuances of reviews, recognizing red flags, and staying proactive, you can increase your chances of finding a clinic that aligns with your needs and expectations.

- Questions and Answers

Can you please compare general clinics in the Czech Republic, Spain, Portugal, and Cyprus? A lot of people from my country go to the Czech Republic and Cyprus if they are not successful at home.

I would say all of these countries have good IVF, so I wouldn’t pick out one and say, “Oh, you know, I wouldn’t go there; it’s terrible,” not at all. They all have good IVF. Some of them have more access to particular treatments than others.  I’m not excluding Cyprus and Portugal when I say this. I just know these two countries, Czech and Spain, are very well known for doing a lot of egg donation as a percentage of their cycles. So that tells you something straight away. It tells you they have an abundance of egg donors, and it also tells you that they have a lot of experience with egg donation. Those two things alone are really valuable. Regarding pricing, while specific cost details may vary, these countries generally offer lower prices compared to patients’ home countries, at least in terms of the initial sticker price. However, it’s essential to consider that success rates may not necessarily be higher in these countries, as obtaining up-to-date and comparable statistics can be challenging. Another factor to consider is the regulatory environment. Procedures that might be restricted or not allowed in countries like the UK, Germany, or Sweden may be permissible in Spain and Czech, among others.

Can we trust clinics that offer guarantee programs?For example, they say that you get back 80% of the money if pregnancy wasn’t achieved.

I’ve got two things to say about this. I personally know some patients who got their money back, and they even got their money back. However, it’s always important to read the small print because there will be things saying, “You only get 80% back if this happened,”, etc. so be absolutely sure what’s happening. A more important point is: Why do these systems exist? These systems actually are a bit of a quality measure of you as a patient. And I hate saying it that way because you’re an individual who’s got the dreams and ambitions and everything else. However, if you talk about it in actuarial terms, where you’re trying to work out chances, probabilities of things happening, someone has done calculations based on the success rates of this clinic and all the factors that go into that and said, “This patient in front of me, from all the things I know, has this chance of succeeding within 1 or 2 cycles.” So, it’s in their interest to do this type of scheme properly because they will make more money if they do it properly if they pick the right patients, which kind of means you’re a good bet. If you get picked for one of these, you’re probably a good bet because if you’re not a good bet, and you’re going to fail 3 times, they’re going to get money, but they’re not going to get success. What they want is to get success on the first cycle and bank the rest of the money. That sounds really cynical, but if it works for you, that’s good news.  I don’t think it’s a sort of scam type of scheme.

We live in Hungary, but our only option is donor embryo transfer, so we have to go abroad. We have only tried clinics in Slovakia and the Czech Republic. Do you think we could consider other options in Europe?

Of course, but it’s kind of treatment-specific. Most clinics around Europe offer most things. I’ll give some notable exceptions if that’s helpful because I’m not quite sure what treatment you’re actually looking for. Some examples of things that I know for sure aren’t done: in Germany, it’s difficult to get embryo testing, for example. In Sweden, it’s difficult to get embryo testing. So, it’s worth finding out in the country-wide part what isn’t allowed or what isn’t done because that might be a red line for you. Find out, be sure what you need, that wish list and the red lines, and then try and match that to the country. I was working with a patient who was over in Singapore, and she said she was doing her treatment in two different countries, and the doctors couldn’t speak to each other. So, it wasn’t that she couldn’t speak to the doctors; they couldn’t speak to each other, and that became a problem. All the success rates in the world aren’t going to fix that problem.

After a known egg failure in the UK, travelling to Europe from the UK for donor egg IVF is our only real option due to the waiting list, cost, and my availability as a teacher. What kind of hidden costs should I be asking about? Do you think travelling distance affects the success of IVF?

Let’s start with the second bit first. Do you think travelling distance affects the success of IVF? I would say if you are going to have to travel or do anything out of the ordinary, try to make it as least stressful as possible because that’s going to have an effect. I don’t think travelling per se, in itself, is a problem. It’s the sort of things that are the result of travelling that usually end up being issues. Like timing, so I know people who’ve travelled overseas, and they’ve had to have a procedure on a suboptimal day because of the travel.  So, it’s not the travel itself; it’s the fact that they were travelling and what that meant in terms of timing. You’ve got to make the experience as least stressful and as similar as if you had done it in a clinic in the next town, or close by. I know that’s easier said than done, but that’s the mindset you have to have. The hidden costs are very similar to what they would be in the UK because, honestly, there aren’t many clinics that you would go to, and you go, ‘What’s the price?’ And they go, ‘It’s this,’ and you never have to pay anything else. All I would say, though, is it’s the things that happened later or the things that happened before. So, you might see a sticker price of, ‘Okay, egg donation guaranteed 6 eggs, 6 embryos, it’s X thousand Euros.’ But if your partner didn’t travel with you, or you had to have sperm sent or something like that, there’s an additional cost to that. And they’re not the treatment itself; they’re an extra piece in front. It’s the kind of before and afters that you want to think about more.
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Authors
Professor Alan Thornhill

Professor Alan Thornhill

Professor Alan Thornhill is a fertility expert with over 25 years of experience and more than 100 scientific publications in IVF. Specifically, he’s a clinical scientist (specialising in embryology and genetics). Uniquely, he’s worked in IVF and diagnostic laboratories, research, clinical and business management, and even with the UK’s fertility regulator. Working in US and UK-based IVF clinics and consulting globally, he’s been involved in the IVF journeys of thousands of couples (both professionally and personally). He’s helped and advised patients, friends and strangers with issues including low sperm count, sperm and egg donation, genetic testing, surrogacy, treatment overseas and more. He currently works in the biotech industry, and his personal mission is to provide his unique brand of fertility coaching to people in need of help.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.