Not a week goes by when a couple asks during a consultation "Why should we come here instead of clinic X." I know that many fertility books advise patients to ask this question but what response are they looking for....
This question always takes me back to my college, medical school and internship/residency interviews and to tell the truth I usually interviewed badly. My Harvard undergrad interview was particularly memorably bad and I remember my high school guidance counselor shaking his head slowly and asking what happened. I blew it. In retrospect it was the best thing that ever happened to me at that point because I ended up at another school which is pretty well known located in Princeton, NJ. Then after a wonderful 4 years at Princeton I found myself back at Harvard for a medical school interview and I screwed up again. Meanwhile I had great interviews at Duke, Michigan and Rochester. Again fate steered me, this time south to Durham and if that hadn't happened I would not have met my lovely wife the first week of classes (introduced by my classmate, her next door neighbor). Years later I was actually really sought after to do my Fellowship in REI at Harvard but we elected to stay on the Left Coast and I went up the road from Stanford to UCSF.
So....when a patient's husband leans forward over my desk and says "OK, so why should we come here" it seems like old times. Many glib answers rise to the surface:
- because I am such a great guy. - because I am an Eagle Scout. - because I am such a sensitive guy and like rainy days and walks on the beach. - because I can recite the entire script of Monty Python and the Holy Grail. - because I am God's gift to reproductive medicine.
...and on and on.
But seriously, I never know what to say. How do you inspire confidence and yet not come out as an arrogant SOB? How do you appear to be a nice, compassionate, caring doctor and yet not get labeled as "not aggressive enough." Who knows? Not me, that's for sure.
So with that intro here is today's Question of the Day from the book that the B&N at Clarendon down the street says is coming this fall to their shelves. Just remember that this is advice from the idiot who left his laptop overnight in an unlocked car.....
7. How do I choose a fertility clinic?
Choosing a fertility doctor for your care may be the single most important factor that leads to a successful pregnancy, so choose carefully.
Many patients are referred to us by their OB/GYN, friends, relatives, former patients, news articles, or through the Internet. But the one common denominator we have routinely observed with the sophisticated patient is that she is well prepared before coming for her initial office visit or she quickly becomes informed and knowledgeable before we begin any treatments.
Patients often say to us, “I checked you out before making this appointment.” Of course, we are always flattered by such comments, but we know that this patient will ask all of the important questions and make an intelligent decision regarding her treatment options. She will also probably experience less stress during the evaluation and treatment process, as she has developed a better knowledge base and understanding of what to expect.
All fertility clinics come with a unique flavor of their own. Some clinics are run by a solo practitioner, others by 2 to 6 member groups, while others are “mega” clinics with over 15 doctors. Regardless of the size of the group, be sure you are getting the attention and treatments you desire and deserve. You should never feel like a number with a revolving door of doctors. Of course, patients are not doctors and will not have the knowledge or experience of a reproductive endocrinologist, but a caring doctor will always welcome any and all questions and will take the time to answer them in a way that you can understand. We view patients as our partners, and once we understand what they are willing or not willing to do, we can devise a treatment plan that offers hope without subjecting them to any unnecessary additional stress.
Other things to consider:
Statistics, statistics, statistics: You want a baby, so choose a fertility clinic with good success rates. However, a wise man once said: “There are lies, damn lies and statistics” So how does one determine what to make of these statistics? In truth, there is no easy answer. Clinics that are more selective can inflate their success rates while those that have a different philosophy may suffer the consequences eventhough they have an excellent program. When considering a clinic it is important to know what your specific chances for success will be within that clinic. If there is one yardstick to compare clinics, then that is the pregnancy rate using donor eggs. In this patient population the pregnancy rates should be very high. A low donor egg pregnancy rate may be concerning. Individuals should evaluate the clinic statistics and obtain a good understanding and feel for what their specific chances for pregnancy will be per treatment. Patients may also evaluate the clinic success by reviewing IVF statistics at the Centers for Disease Control and Prevention (www.cdc.gov).
Experience: Experience of the clinic, in our opinion, may be one of the most important factors when deciding which doctor and which clinic to seek for fertility care. One should ask how long the doctors have been performing various treatments and whether cutting-edge procedures are either being offered or are being developed in the practice.
Subspecialty board certification: Most doctors practicing in the field of in vitro fertilization and infertility are subspecialty board certified in reproductive endocrinology and infertility. This certification can be found by going to the Society of Reproductive Endocrinology’s Web site, which lists doctors who are subspecialty certified in reproductive endocrinology and infertility. Additionally, patients may find it beneficial to see that their doctor has a faculty position at one of the local medical universities or actively participates in the teaching of the medical students and residents in their locality.
Availability and accessibility of doctors: It is important that you have access to your doctor in order to have your questions answered and needs addressed. Evaluate whether or not the availability and accessibility of the doctor is an easy process or a difficult one when making decisions as to where to seek care. The friendliness and helpfulness of the staff will also give you a feel for the character of the practice.
Cost: It is always important to get the total cost. Factor in extra expenses such as the fertility drugs, which can cost thousands of dollars; ICSI; assistedembryo hatching; embryo cryopreservation; and preimplantation genetic diagnosis (PGD). These drugs and procedures can quickly increase the overall cost for treatment.
Finally, he is a word of caution. In general, Internet chat rooms may be a dangerous place for seeking advice regarding finding an infertility doctor. Be careful what you hear online, as it always represents just one half of the story. It is far better for you to do your own homework and research than to rely on information provided from others, which may be based on misimpressions or experiences.