When choosing a new fertility clinic either for the first time or because you have decided to move on from your old clinic there is always a sense of urgency, a bit of a rush. After all, you wanted your baby, like, yesterday. If you have got any patience left in you at all though it pays to take a little bit of time and try and suss out the answers to at least some of these questions. Not only will you know what to expect but it could save you a lot of hassle and time if you decide before you even attend that first appointment that a particular clinic is not going to be right for you.
Having fallen into the trap of going to the first clinic that crossed my path here is my list of the top 8 things you need to ask any prospective new fertility clinic…remember although we are thankful to them for hopefully helping us make that baby, they are also lucky to have us as their patient!
- Will I see the same doctor for each of my appointments and procedures?
Quite often the doctors in fertility clinics work in teams. The doctor who you sit down and have your initial appointment with often is not the doctor who will make the day to day decisions to change your medications as you go through your cycle and may not be the doctor who does your egg pick up or embryo transfer. Instead, the doctors seem to work on a rotating roster and which doctor is doing what on the day is pot luck (well, it seems that way!). I get it. This is understandable and with so many patients and some clinics being open 7 days a week, your one doctor can’t be waiting for you to ovulate all the time.
Having a team of doctors should be ok though as long as they have good handover procedures and regular review meetings. When they are just making the day to day standard clinical decisions as long as these procedures are in place you should be in safe hands and they should have a good understanding of your medical history.
In my opinion, what isn’t ok though is when there is no continuity of who you see for your review appointments. I have heard of some fertility patients who see a different doctor every time they go for a review appointment. Although we are not kidding ourselves into believing that we are all best friends, it is important to have that therapeutic relationship build over time and more importantly, you also you need to know who is responsible for your care when things don’t work out the way you wanted it to. Additionally, by having one key doctor you should also be able to discuss the ‘next steps’ and both be on the same page knowing when it is time to try a different protocol for example and for what reasons. For these reasons and many more, I think that having just one doctor carry that clinical continuity is one of the most important things over the course of your ‘journey’.
- Who can I contact with clinical questions during my cycle?
Often the only people you will actually see whilst you are taking your medications during the first half of your cycle is the receptionists and nurses. Although the nurses are incredibly knowledgeable they do not make the clinical decisions. If it is important to you to be able to speak, or email, the decision makers directly ask your clinic if direct contact with your doctors is possible (HINT: it should be 😉 obviously not on a stalking, daily basis, and don’t expect to get a response all the time, but you should be able to feel like your concerns are being heard by those making the decisions). Saying that though, some clinics are set up so that you have a main nurse to contact throughout your cycle, she (forgive the gender role pronouns used here – has anyone actually encountered a male fertility nurse?!) ends up acting as a kind of case manager. In this instance you have more reassurance that your direct concerns will get to your doctor but its still a question you need to consider.
How long do I need to wait to get a review appointment?
Some clinics operate so that there are ring fenced appointments only for new patients. This is great for the new patients as it means that they can get in and get those initial questions answered (and also great for the clinic who are bringing in those new patients) but not so great for down the track when you want to see your doctor again for a review appointment. After every cycle (and hopefully you won’t have to do too many) you will need to see your doctor to decide on what the next treatment options are. It can be incredibly frustrating and will hold up your treatment considerably if you need to wait a couple of months just to get this review appointment.
- Where and when are bloods collected?
During the cycle you will be visiting the clinic first thing in the morning 2 – 3 times a week. It is important that you are able to make the blood collection times as, at the risk of sounding dramatic, it could significantly impact on the success of your cycle if you don’t attend for blood collections as required. This is because depending on your blood test results your medication may need to be increased or decreased to optimise those, hopefully numerous if doing IVF, follicles that are developing. People who do shift work or need to travel for work need to pay particular attention. Some clinics have arrangements with various pathology labs allowing for the bloods to be collected at centres other than at your fertility clinic which could make it a lot easier for you to get to work on time. The downside to this though is that the results are often delayed in getting to your clinic and could delay any medication alterations.
- How much does it cost?
This seems like an obvious one and one that you should be able to pin down pretty quickly. Depending on the clinic, your type of cycle and your level of health insurance though, there could be little ‘extra’s’. These extras may include use of an EmbryoScope, special sperm preparation, medications and possible hospital fees.
- Do you have counsellors attached to your clinic?
Although you may feel like you have it in the bag and are emotionally strong there will inevitably be a day when you just want to talk it out with someone who ‘gets it’. Although you could quite easily find an independent counsellor to talk to finding one that understands the unique challenges that being a fertility patient brings and understands the way your clinic works is another story. And then they often have waitlists anyway – not helpful when having a nervous breakdown! Having a counsellor that you know you can easily book into is a relief and reassurance that you aren’t going to be wasting your money on someone who just doesn’t have the experience. What’s even better is when clinics have counsellors you can easily get into for FREE!!
- Is your doctor open to new research and ideas?
This is a bit of a funny question and obviously, no doctor is going to answer ‘no’. For some women though the road to motherhood is a bit more twisted and long winded than anticipated. If this happens it is important to know that your doctor is up to date with the latest evidence based research and isn’t just trying the same thing on you that he has been doing for the past 20 years. Though saying that, 20 years of clinical experience can also be a good thing! What is key here is making sure that you feel your doctor is respecting your situation and is willing to try new approaches as is appropriate for you.
- If we need to use a donor is there a waiting list?
Like the wait times on needing to get review appointments, some clinics will have different waiting times for donor egg, sperm and embryo. If you know in advance that this is something that you need to consider it definitely does not hurt to ask the question. Similar to this is needing to know if there are certain ‘start times’ for your cycles. Some clinics prescribe the contraceptive pill so that they can control when ‘Day 1’ is and then start a batch of women cycling at the same time. Easier for the clinic but is it better for you?
These are only some of the major questions that you should ask before signing up with a clinic. Other questions might include where does the egg pickup take place and is it under general anaesthetic, does my partner always need to come to my review appointments and what is the process for freezing ‘left over’ embryos?
Although it might delay your first appointment by a week or two whilst you are collecting the answers to these questions it is much easier and less stressful to cover these questions early than randomly choose a clinic only to find it isn’t going to work for you and to have to move clinics in the future.