We are living in an age of consumerism, and healthcare has also been affected by it. In India, several Infertility clinics and IVF centers have come up over last few years. While this has helped fill in the demand supply gap in this field bringing in much needed competition and has given more options to the patients, this has also prompted aggressive marketing by these clinics is in order to attract more patients, thereby confusing patients on how to go about choosing their doctor and treatment center. Healthcare is a very sensitive subject and we have to be able to filter the right information from all the noise in order to be able to make the best decisions for ourselves.
In my own clinical experience, I have had several couples who have consulted me for their inability to have a child, and who were confused due to information overload on the subject and vastly varying offers and claims from infertility clinics. Patients often ask me how should a patient decide which infertility clinic is best for them and what parameters should they consider when selecting an Infertility clinic for treatment. I suggest my patients to ask these five questions before selecting an infertility specialist doctor and an IVF clinic for treatment.
Question 1 – What is the real cost of IVF treatment at the center?
Nowadays there is a flurry of ads on radio, newspapers and digital platforms, several of which try to attract patients by advertising the lower cost of IVF – at times claiming to do an IVF cycle for as low as Rs 25,000 only, while at others offering one IVF cycle free with one paid cycle. The lower cost of treatment is always better for the patients. However, it is important that patients also understand the “conditions apply” clause and read in between the lines to understand the overall cost implication before making their choice on the basis of low cost alone, so that they are not taken for a ride!
It’s important to understand that a typical IVF cycle includes several steps, namely investigations of the couple, hormone injections for 10-11 days in order to stimulate maturation of eggs, the procedure of egg retrieval and finally transfer of embryo into the lady’s uterus. Patients should understand and take into consideration the overall cost of treatment, as at times the advertised cost may not include cost of hormones and investigations which contribute significantly to the overall cost of a cycle.
Question 2 – What is the success rate of IVF at the clinic?
Another very important parameter to check is the success rate of the clinic and also understand how the claimed success rate was calculated. While the success rate for IVF do vary from one center to another, and the patients should certainly go for treatment at centers with superior pregnancy rate, it’s important to do an apple to apple comparison of success rates.
The pregnancy rates are generally much higher in younger women undergoing IVF. Similarly, success rate for IVF is much higher among infertile couples using donor eggs as compared to the ones using their own gametes. Therefore, the claimed success rates at clinics doing a lot of donor egg cycles can actually be higher than centers with a more balanced distribution of cases.
My simple advice on this point is – if a clinic offers donor egg option without any justification or declares the patient to be having poor quality of eggs based on an ultrasound report and without doing an IVF cycle, the patient should get alert and seek a second opinion before making a decision. As such there is no way to assess the egg quality based on ultrasound or blood reports, which, at best, can estimate the ovarian reserve. There is no way to evaluate the egg quality other than to take the eggs out and check them for quality in the lab.
Question 3 – What is the incidence of multiple pregnancies with IVF at the center?
The aim of any infertility treatment is to enable a couple have a healthy child. So, one should always ask what is the protocol for the maximum number of embryos transferred in a cycle at the clinic.
There is a tendency to transfer more than one embryos in a cycle, which is based on the assumption that the chances of pregnancy in a cycle increases by transferring multiple embryos. However, the best outcome of a cycle can be achieved by transferring 1 or maximum 2 properly selected embryos. Not only does multiple embryo transfer not increase the chances of pregnancy, it, in fact, increases the risk of multiple pregnancies, thereby increasing the risk to both mother and child. Multiple pregnancy is the biggest complication of IVF treatment and the risk of multiple pregnancy is directly proportional to the number of embryos transferred in a cycle.
Question 4 – How good is the IVF lab at the center?
This is an often ignored aspect while choosing an IVF center over the other. But, a well-equipped and maintained lab is a crucial factor differentiating a good IVF center from a not-so-good center. Patients should understand that a well-equipped lab with strong quality control and quality assurance program will always do more justice to their eggs, sperms and embryos and maximize their chances of pregnancy. A good IVF clinic needs to have a good embryo freezing program in order to properly manage the extra high quality embryos from an IVF cycle for possible use for the same patient in future. This helps in preserving the precious embryos and also reduces the cost of possible IVF interventions in future. Many centers claiming a low cost IVF often don’t have a good embryo freezing options for the patients.
Likewise, a properly trained and experienced embryologist also plays an important role in success of the IVF program. So, patients should inquire about the background and competence of the embryologist also while they do the background check on the treating clinician.
Question 5 – Does the center have patient support program?
This is another lesser investigated aspect while choosing an infertility clinic for one’s treatment. In my view, availability of a good support team including fertility counselors is as important a factor as having a good infertility specialist doctor in improving the success of IVF treatment. Good counselors help the patients understand their issues holistically and helps them overcome the stress associated with infertility. This, combined with the skills and personalized attention of the treating doctor, plays an important role in improving the outcome of IVF treatment.
So, next time you see an enticing, “too good to be true” offer for IVF treatment at an infertility clinic, stop and ask yourself these five questions before falling for it. Always remember, choosing the right infertility expert and the right infertility clinic for your treatment will largely decide the outcome of your treatment!
Do write to me at email@example.com if you have any questions about IVF.