Choosing a Clinic
There are many factors to take into consideration if you are choosing a fertility clinic.
These include factors like cost, success rates, multiple birth policy and the support they offer. You will also want to consider location of the clinic, and whether they can offer you appointments to suit perhaps early morning or after work. Have a look at the patient literature the clinic provides, as this can be an indicator of the thought that goes into patient care.
If you are having private treatment, you will be able to choose the fertility clinic you wish to attend. It is important to remember that individual needs and preferences are all very different. What suits one person may not be right for another so take your time and do as much research as you can before making your decision.
This information is designed to help you if you are trying to find a specialist fertility clinic offering assisted conception services such as in-vitro fertilisation (IVF) or intra-cytoplasmic sperm injection (ICSI). However, it can be used as a guide to the questions to ask when looking into clinics for other forms of fertility treatment.
The Human Fertilisation and Embryology Authority (HFEA) website has a list of all clinics licensed to offer IVF and ICSI in the UK and this is a good place to start if you are trying to find out which clinics may be suitable for you. The clinics are divided by region or you can search by putting in your postcode and this will produce a list of the closest centres to your home.
What you need to do
Before you can be seen at a fertility clinic you will usually require a letter of referral from your GP, or hospital doctor if you have already been referred to a local hospital for tests. If NHS treatment is offered in your area, your GP is likely to refer you to one of the clinics which have a contract to provide the treatment. You may be given a choice if there is more than one clinic providing NHS treatment for your area. Most fertility clinics, whether in NHS hospitals or private units, treat both NHS and private patients and you can ask to be referred elsewhere but it may be difficult to get NHS funding if you choose a clinic that doesn’t have a contract to provide fertility services for your area.
Will I be able to access NHS treatment?
The National Institute for Health and Care Excellence (NICE) says that women should be able to access three full cycles of IVF if they have been trying unsuccessfully to conceive for two years or more and are under 40. For women of 40 to 42 who have not previously had IVF and who have a good ovarian reserve (stock of eggs in their ovaries), one full cycle should be made available. In practice, however, the availability of NHS treatment for infertility is patchy and your eligibility will depend on where you live.
In Wales and Scotland decisions about fertility funding are made centrally, and in Northern Ireland the Health and Social Care Board is responsible for commissioning fertility services. In England, the Clinical Commissioning Group (CCG) for your area decides whether they will fund treatment and sets the eligibility criteria. This leads to different decisions being made all over the country and the criteria to decide who is eligible for treatment, vary from one area to another too.
Fertility Fairness (FF) lobbies for fertility treatment to be funded by the NHS on an equal basis. If you would like to know more about funding, you can visit their website – details can be found on the right hand side of the page.
How much will private treatment cost?
Private treatment can be very expensive. The charges vary from clinic to clinic, and it is important to think carefully about how you will finance private treatment before you start on this route. The headline figures you will find quoted on fertility clinic websites are often considerably lower than the sums patients end up spending. The headline figures do not include the cost of the drugs used in treatment, which is usually a substantial additional fee, and do not always include all the tests and appointments that you will need either. Some clinics will suggest that you should have extra tests or treatments, and again this can cause the bill to mount rapidly.
It is important to remember that every patient has different needs and that the treatment cost for each patient will vary. The HFEA requires clinics to give patients an individually costed treatment plan before you start so that you can have a realistic idea of how much you are going to spend.
Which is the best clinic for me?
It is a good idea to begin with the list of licensed clinics on the HFEA website, and identify those which you feel may be possible choices. If you are eligible for NHS-funded treatment, you may not have a range of options.
Make a list of the questions you want to ask before ringing the clinic or paying a visit. You should ask all the clinics you are considering the same questions so that you can compare information. You are likely to be making a large investment, both financially and emotionally, in the clinic you settle on and you want to be sure you are happy with your choice. Many clinics have open evenings or open days so go along to as many as you can and get a feel for the different clinics before making a decision. There are some questions you may want to consider:
• Are the staff friendly?
• Did you feel confident about the team?
• Do they have time to answer your questions?
• What are the success rates for patients of your age?
• What is the clinic’s multiple pregnancy rate?
• Does the clinic offer the type of treatment you think you will need?
• What facilities are there for patients?
• Will there be a wait for treatment?
• Can the clinic offer early morning, weekend or early evening appointments?
• Is counselling included in the cost of treatment?
• How long is the wait to see the clinic counsellor?
• Is there a support group at the clinic?
Have a look at the patient literature the clinic provides, as this can be an indicator of the thought that goes into patient care.
If you feel that you may require sperm or egg donation, check how long you might expect to wait for the clinic to find a suitable donor. The waiting times vary considerably from one clinic to another, so it is a good idea to check a number of clinics before making a decision about where to go.
Think carefully before choosing a fertility clinic which is a long way from your home. Sometimes this can work very well and it may be the only option available to you, but remember that you will need to visit the clinic frequently during your treatment and do take this into consideration.
What support does the clinic offer?
Counselling should be offered in all licensed clinics, but they don’t all have a counsellor available on site. Find out whether counselling is included in the cost of treatment as some clinics include it while others expect you to pay for any counselling support that you need on top of the price of your treatment. You may want to enquire what facilities are available for men to produce semen samples as this can be an important matter for male partners
If you think that you may need to use donor eggs, sperm or embryos, ask how long you might expect to wait for the clinic to find a suitable donor. The waiting times vary hugely from one clinic to another, so it is a good idea to check a number of clinics before making a decision about where to go.
You will want to find out the success rates for treatment at any clinic you are considering. The HFEA website gives the success rates for IVF and ICSI for each of the individual licensed clinics in the UK. Success rates are inevitably based on past treatments so will date back a while, and can vary from year to year. The success rates are broken down by age range, and you will want to check the rates for someone of your age. Small percentage differences in success are not always meaningful, but the important thing to check is consistency with the national average as this shows how each individual clinic compares with all the others.
It is also important to look at the multiple birth rates for the clinic. Although the idea of twins or triplets may sound attractive when you are trying unsuccessfully to conceive, multiple births is the biggest health risk from IVF treatment and can lead to miscarriage and cause serious health issues for mother and babies. A really good fertility clinic will have low multiple birth rates with good success rates. Fertility Network UK produces a factsheet on single embryo transfer which you should read to inform yourself about the risks of a multiple birth.
Some people now travel overseas for fertility treatment, but you must do your homework if you are considering this. Some UK clinics have links with clinics overseas and although this may cost more than finding a clinic yourself, it can be reassuring to know that your UK clinic has done all the research for you. If you are having donor treatment overseas, remember that the rules on anonymity vary from one country to another.
When looking for a clinic overseas, do your homework first. Try to find other people who have experience of treatment at the clinic, and make sure you ask lots of questions. Check how many English-speaking staff works at the clinic, and ask about communication between appointments. Find out how long you will need to spend in the country and how much notice you will have before you need to be there. Look into travel and accommodation, and don’t forget to include the cost of these when you are planning your budget. Success rates for overseas clinics are not provided by a regulatory body such as the HFEA but are published by the individual clinic, so look carefully at these. Some may publish the pregnancy rate rather than the live birth rate and you want to be sure that you are comparing like with like.