What determines the success of IVF? Personal factors (your age, your diagnosis, general health for you +/- a partner- among other personal factors) + the IVF clinic itself. Not all clinics are created equal — but it can be hard to navigate finding a clinic you can trust will give you the best chance of success. I get asked about what I think matters all the time – here is a list (my opinion) of some of the most important things I would consider before choosing where to do IVF (aka why I chose to work @rmaofny). 

-Location– if doing IVF you will need to be available often for check in visits- so choosing a location closer to home/work is ideal.

-How does the doctor/clinic make you feel? This is your gut feeling – if you feel heard, listened to, supported – those are good signs. If you don’t – advocate for yourself and communicate how you are feeling. If no change occurs, you should find a team who makes you feel cared for.

-Is your doctor a double board-certified OBGYN and Reproductive Endocrinologist and Infertility Expert? I have heard of many patients who had prior IVF treatments that were navigated by NPs, PAs, or general OBGYNs. Board-certified REIs (or fertility doctors) have done 3 additional years of focused training and have the necessary understanding of your reproductive biology to safely and effectively navigate your ovarian stimulation, egg retrieval, embryo transfer and everything in between. I would strongly advise against having a consult or doing your IVF with anyone with lesser qualifications or experience. Confirm credentials before taking fertility advice from anyone.

-Availability- what days/times is the clinic open? At @rmaofny we start morning monitoring any 6:45-7:15am depending on location, which means you can definitely fit your visits in before work/school hours – at least 1 main office is open 7 days a week, satellite locations are open 5-6 days/week.

-What happens after hours/holidays? We have a 24/7 access to nurses or doctors who carry the pager and are available for urgent questions/issues.

-Ethics– if a clinic does not have age cut offs (ie. no limit to when someone can pursue donor egg, or IVF with their own eggs (ie. they would do IVF on a patient who is 49yo without hesitation, despite the negligible chance of success), or if they would willingly transfer multiple embryos in young, good prognosis patients, or those using donor egg – without counseling or question – that is a bad sign that there is lack of regulation and oversight in what they do.

-Lab quality – this can be hard to gauge as a lay person – but from my perspective any IVF center doing slow freezing (rather than vitrification) or routine day 3 embryo freezing/transfer instead of growing embryos to day 5-7 (the blastocyst stage) is old fashioned and needs to get with the times. All labs are not created equal – quality control and good equipment and a well-controlled environment is necessary to facilitate the modern way that IVF is done. Good labs should be able to offer ~60% average rates of fertilized eggs turning into day 5-7 embryos (of course this also depends on egg quality etc – but you can ask for average stats to get a sense of how well they grow embryos in the lab). Another metric you can ask about is thaw survival rates for eggs/embryos. Thaw survival rates in the high 90s% for embryos indicates comparable success to the best clinics around.

SART.org is a third party that most clinics report they data to. The data is subject to audit so it should be accurate. You can glean and compare facts about different clinics like how many embryos they typically transfer (the best clinics vector towards single embryo transfer, especially under 35). The numbers can be hard to figure out and compare because different clinics have different cut offs for who they will actually let cycle (some clinics have AMH cut offs below which they will not do IVF (we do not). Also live birth rate per retrieval is not an accurate assessment of success because it doesn’t account for patients who do multiple egg retrievals before a transfer because they want a certain # embryos before getting pregnant from transfer # 1. I think the best measure to compare is Live birth per patient in the <35 year old group – when that hovers between 70-80% that is a good sign re: success rates.

-Support services– Always ask if there is mental health support or a nutritionist – these added benefits provided to patients can help support you during your treatment and make for a more successful journey and outcome. At @rmaofny we provide both to all of our patients at no additional cost. 

-Reviews (from friends/online)– A recommendation from a trusted friend is probably better and less biased than online reviews. Online reviews that are plentiful and consistent are probably more trustworthy than scant, polarizing ones. Keep in mind some doctors/clinics are better than others re: asking patients to leave reviews.