Choosing a fertility clinic

800px-Woman-typing-on-laptopThose of you who came to my talk at the Fertility Show will know that I promised to put up some notes from my talk on the blog this week – here they are at last!

The HFEA website

We begin with the HFEA website which is the best place to start. You can search for your local clinic using the Choose a Clinic tool – just type in your postcode or local region and you will get a shortlist of local clinics.

You can see more about the treatments they are licensed to carry out, services, facilities and staff. It will tell you whether they take NHS patients, the opening hours, whether there is a female doctor and links to a map.

Of course, the one thing you really want to know is how likely am I to get pregnant there? Which is the one thing no one can honestly tell you. The HFEA publishes success rates for all licensed clinics, but they may not be as clear cut as you imagine. Most clinics have broadly similar success rates and the majority of clinics in UK have success rates which are consistent with national average. Don’t forget, the patients treated affect the success rates.

You may want to look at the success rate for someone of your age, and make sure you are comparing like with like. The HFEA also gives the multiple birth rate, but a high rate doesn’t suggest a good clinic which has your best interests at heart. Naturally multiple births occur in 1 in 80 of all pregnancies, it’s around one in six after IVF. That may sound positive, but in fact multiple birth is the single biggest risk after fertility treatment. 1 in 12 multiple pregnancies ends in death or disability for one or more babies, and it is also more risky for mothers. Good clinics should not have very high twin rates. A really good clinic will have good success rates and low multiple rates.

When it comes to success rates, don’t get bogged down in fairly small percentage differences – in general they’re probably not that meaningful.

NHS Funding 

You will also want to know if you qualify for NHS funding. The guideline from NICE recommends 3 full cycles (fresh and transfer of any frozen embryos) for women of 39 and under and one full cycle for women of 40-42 who have had no previous treatment, who have a good ovarian reserve and who have spent 2 years trying)

In England funding comes from your local CCG (Clinical Commissioning Group) not your clinic so you need to find out their rules – and unfortunately they all make their own up as the NICE guideline is only a guideline. You can find out what your CCG is offering by visiting the Fertility Fairness website. The CCG will also set eligibility criteria – and each will have their own

Location 

Think about how close the clinic is to your home or workplace. Be realistic as a long journey is fine as a one-off, but think about doing it three or four times a week. Ask the clinic how often you will have to visit as some will want you in every day of the cycle, but others just a few times a week.

Think about how you will get there and how long the journey will take? Are you going to use public transport or drive? Will you be travelling in the rush hour? Can the clinic offer early morning appointments or will you need to take time off work? Will it fit around your job?

Cost 

Fertility treatment prices are not regulated and can vary hugely. Clinics that charge more are not necessarily better so do look into prices. The headline figure on clinic websites is rarely the total cost of treatment  – ask instead what the average person actually pays

The HFEA does require clinics to offer you a personalised costed treatment plan, but check what is included – drugs, counselling, scans and bloods, freezing and storing spare embryos, follow-up consultations etc.

Unproven treatments 

Many clinics offer unproven additional treatments. Many are not scientifically proven. The HFEA has advice on some of these . Additional treatments can be very expensive, and you may risk paying a lot for something that may not make a difference – and may even bring additional risks.

Support

Will there be someone you can call with any problems/concerns? You should be given a contact to call if you are concerned about anything at any time. And is counselling included in the cost of treatment? You may think you don’t want or need it, you may may find it helpful once you have started treatment. So check if you are going to have to pay for counselling, and if it is included, ask how many sessions.

Is there a counsellor based at the clinic? Some counsellors also offer telephone counselling and you can find a list of fertility counsellors on the British Infertility Counselling Association website. Is there a patient support group?

Waiting 

How soon could you get an appointment and when could you start treatment if it is recommended ? How long are waiting times for donor eggs or sperm? At some clinics,
there are still waiting lists for donor eggs and sperm but others have plenty of donors, so do check.k

Do you like the clinic?

I think this is far more important than you might initially think.

Talk to anyone else you know who has been there, look online for views – but remember that everyone is different. Go to any open days or meetings for prospective patients and think if the clinic feels right for you. It may sound ridiculous, but it matters.

Trust your instincts, and don’t hink they don’t matter. Make sure that you have chosen a clinic that you will be happy with.

Treatment isn’t always easy, but it is certainly much easier if you are being looked after by people you like and trust.

Can people without fertility problems be infertile?

flag_of_who-svgWhen a story about the World Health Organisation apparently deciding to revise their definition of infertility to include single men and women without fertility problems who wanted to become parents, there was an inevitable media flurry of stories about the NHS having to offer them fertility treatment.

The Daily Mail heralded the story with a headline shouting “Single, childless but want a baby? You could be labelled infertile“, while The Telegraph told us that “Single men will get the right to start a family under new definition of infertility” and The Sun went one better with “Gay couples and single men who want kids will be branded ‘INFERTILE’ – to make accessing IVF easier“…

In reality, the chances of this happening in the UK in our current fertility funding climate is very slim. It is already hard for couples with proven fertility problems to access treatment in many parts of the country, let alone those without them. We have seen cuts to fertility services in recent months and fewer and fewer fertility patients are now being offered the treatment that NICE recommends – which is three full cycles of IVF for those who are 39 and under. So the idea that commissioners are going to rush to start offering treatment to single men and women is far from likely…

Do people “deserve” fertility treatment?

So, let’s take two very cute children who need operations to help them walk, an obese man and a couple who can’t have children and ask who is most “deserving” of NHS treatment. Last night Channel 4 aired a programme on the NHS which started from the premise that we need to ration treatment and used some figures seemingly calculated on the back of an envelope to decide how much funding different treatments might cost the NHS and then put them against one another.

The couple featured who needed IVF had fertility problems due to the woman having an STI when she was younger, and they were being denied treatment because the male partner had a child from a previous relationship – so already value judgements were being set when it came to deciding who should and should not receive medical treatment. We were told that their treatment would cost the NHS £10,000 – in fact as this was a younger woman with blocked tubes, it was far from certain that she would need three cycles of IVF – but it didn’t stop the programme makers showing us what other vital tasks the NHS could use £10,000 for. The team were very well aware of the fact that we don’t actually know how much IVF costs the NHS as this varies hugely from area to area and we have no national tariff- but the real issues weren’t a story they were covering here.

Most of the ire on Twitter about the programme was directed at the obese man who needed weight-loss surgery, and there were some angry tweets suggesting that NHS spending should be reserved for ‘life-threatening” conditions – quite bizarre as the vast majority of us only use the NHS for non life-threatening conditions and I suspect these same people would object fiercely if they were told they were not allowed to visit their GP unless their life was at risk. And of the cases featured it was the obese man who probably had the most life-threatening condition, not the sweet children.

It’s hugely depressing that anyone should feel a need to put different patients up against one another to decide who is most “deserving” of medical treatment – and what we should be asking is not who we should allow to be treated, bur rather where this kind of debate takes us.

Want to know more about fertility and treatment?

Wales-Info-day-Lottery-logoI’ve just been looking through some of the presentations for the Infertility Network UK information day in Wales tomorrow, and they really are absolutely fascinating – great stuff on different types of treatment, on NHS funding, on acupuncture – and that’s just the ones I’ve seen already… I’m going to be there with Andrew from Infertility Network UK, and lots of expert speakers – so do come and join us if you can,

It’s not too late to book if you are anywhere remotely near Cardiff and would like to come along tomorrow – and you can actually just turn up on the day although it’s preferable to book so that we have some lunch for you!

Here’s the link to the booking form – http://www.infertilitynetworkuk.com/regional_network_2/infertility_network_wales/fertility_information_day_2

Would you be affected by cuts to fertility services in mid-Essex?

If you live in mid-Essex and need fertility treatment, would you be prepared to talk about it?  Could you help highlight and hopefully stop the proposal to reduce funding for IVF treatment from three cycles to practically zero other than for a minority of cancer patients? Help is urgently needed to help show what these proposed cuts in services would mean to real people… If you can help email susanseenan@infertilitynetworkuk.com – thank you!

Fertility information day in Scotland

If you live anywhere near Edinburgh, Infertility Network Scotland are organising a fantastic fertility information day on April 5.  There are speakers on a wide range of topics including

  • Current Criteria for NHS Treatment
  • Going to the Clinic what happens next
  • What are my treatment options EEVA – the selfie that can help me get pregnant
  • Male Factors – Diagnosis and treatment
  • Stress and its impact on infertility
  • Nutrition – Boost Fertility and Prevent Miscarriage
  • The fertility rollercoaster

The day begins at 9.30 and ends at 4.30.  Tickets are priced at just £5 and include tea and coffee and a buffet lunch.  Do go along if you can get there – it promises to be a really interesting day – more details here