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How
do you know that a Fertility Center
is good?
Michael
Alper, MD,
Medical
Director, Boston IVF,
Waltham, MA
Clinical Associate Professor of OBGYN,
Harvard Medical School,
Boston, MA
So, you have been advised to undergo in vitro fertilization (IVF). How do you
know where you should go for treatment? If your OBGYN says that a program
is good, is that enough? If your friend conceived at a particular IVF Center,
is that enough of a recommendation for that Center? If your friend stated
that the doctor was nice, is that enough? If an IVF Center says they have
the highest statistics, is that important?
Stressful
situations often cloud the intellect and it is therefore
critical to make the right choice for the right reasons.
This article is meant to give you some tools to help navigate
through the infertility ‘maze’ and choose the
right IVF Center for you. Here are some important questions.
Are
the doctors trained in infertility?
Any OBGYN
can call themself a fertility specialist. But is the doctor
trained in the field. Reproductive endocrinology is a recognized
subspecialty in OBGYN with a three year training requirement
following residency at an approved fellowship program. Are
the doctors board-certified in reproductive endocrinology?
This information is typically available on the Programs website
or with State authorities. Being part of the American Society
of Reproductive Medicine (ASRM) does not equate to training
in the field of reproductive medicine.
Are
the doctors experienced?
As with
any field, experience counts. Has the Program been around
for some time and does it have a good reputation? Does the
Program have a track record? One should be weary of a new
IVF program claiming excellent results with less than ideal
numbers of cases treated.
There is
a balance between experience and longevity in the field.
If someone has been practicing for 30 years does not mean
he or she is good at their work. But it does mean that they
have a reputation behind them as opposed to those who may
be new on the block (and unproven).
Do
the doctors and other professionals contribute to the field?
Fertility
care including IVF is a technical field that is constantly
changing. In order to stay on top of the field, one needs
to continuously evaluate methods and techniques. One method
to know if an IVF Center is constantly ‘thinking’ is
to see if the clinicians and scientists publish in medical
journals. You or your patients can do a reference search
on any one of the physicians or scientists. Do a literature
search on your doctor. Have they any publications to their
name? Do they present abstracts at scientific meetings? Do
they lecture to colleagues?
And don’t
stop with the clinicians. Check out the laboratory director.
The scientists in the lab should be well recognized as experts
by others in the laboratory field. Make sure that the lab
is ASRM certified.
Are
patients happy with the service?
IVF requires
an integrated team of scientists, physicians, ultrasongraphers,
nurses and administration. It needs to be a well-managed
team to work well. The most common complaint of patients
with a fertility center is usually not with the doctor but
rather the non-medical staff. Therefore, feedback from your
friends who have attended the clinic is critical. IVF Centers
should continually survey their patients to see if their
needs are met. As with any business, customer focus is essential.
But try
not to get caught up in ‘war stories’. For every
patient who successfully undergoes IVF, there are more that
fail treatment. So, not everyone will be successful and not
everyone will be satisfied if they fail treatment. And everyone’s
story is a little different and may not be applicable to
your situation or relevant to your case.
What
about pregnancy rates?
All IVF
Centers are required by law to report their statistics (via
the Society of Assisted Reproductive Technology – SART)
and they are available to the public. Although it is clearly
stated by SART that this data cannot be used to
compare programs, it is unfortunate that many do use them
for this purpose. It is a bad mistake. There are too many
differences in patient selection, treatment philosophy and
other factors that greatly affect the statistics of a particular
center. In fact, the higher the pregnancy rate for a given
IVF Program, the more they must exclude patients with less
than average expectations of conceiving. This is good for
statistics but not patients. So, be very careful to not get
in the comparative game of statistics.
What
about the laboratory?
The laboratory
is an important part of the Fertility Center – its
credentials are important. Is the laboratory SART approved?
Does the laboratory have a PhD scientist in charge? What
are the credentials of the senior scientist(s)? Does the
laboratory staff publish in peer journals? Do the scientists
lecture at postgraduate courses. Etc?
Does
the IVF Center address the emotional needs of the couple?
Studies
have shown that the stress associated with infertility can
be enormous, akin to that associated with the diagnosis of
cancer. Sometimes, the stress can overwhelm the couple and
it is important to have support structures in place. The
nurses play a key role in identifying the emotional needs
of couples. A fertility center should have access to well-trained
social workers or psychologists. Also, it is an asset to
have access to stress reduction programs such as the Mind
Body Program or similar methodologies to help couples deal
with the anxiety that often accompanies infertility.
Does the IVF Center focus on quality?
An IVF
Center must be well-run and continually improve. IVF Centers
around the world are adopting ‘Quality Management Systems’ to
assure that systems and procedures are developed and followed
so that the customer (patient) needs are met. The International
Standards Organization (ISO) is one such standard and has
recently been adopted by IVF Centers around the world. (Boston
IVF is the first IVF Center in North America to be ISO-certified).
The FDA is planning to implement similar quality management
requirements for IVF laboratory in 2004. Whatever methodology
used, the better IVF centers have high quality and continually
improve.
Conclusions
When you
need IVF, you deserve it to yourself to do the necessary
homework to make the right choice for you.
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