Finding a Clinic to Suit Your Needs

How do I know what doctor to choose?

A common question asked by patients who want to explore fertility treatment as well as patients moving to other parts of Queensland is how they find out if a doctor has a particular specialty or indeed if the doctor they have heard about does fertility treatment as well as obstetrics.

The Australian Health Practitioner Regulation Agency (AHPA) will allow you to search for health practitioners to find out their registration status and details.  All you have to do is enter a doctors surname and/or given names and State. The search will also give you other details on the doctor including their qualifications, contact details and any other relevant information.

Give it a try and log onto: http://www.ahpra.gov.au/Registration/Registers-of-Practitioners.aspx

View our complete list of IVF Treatment Programs or call us to have a free talk about your individual situation!

Today there are many fertility clinics to choose from, so many that it is often difficult for patients to know which program is the best for them. Below are a few ideas that should be explored and considered when searching for a unit that suits both your requirements.

It is important to look at the following areas when investigating a fertility clinic:

High Quality Laboratory

The laboratory must be of a high quality. “High Quality” means that the laboratory strives to achieve and maintain optimal results. This success however, is dependent on a large number of factors, including physical facilities, equipment, supplies and laboratory staff.
Most important however, is that the clinic has sufficient numbers of well-trained and experienced laboratory personnel who can cover each other for leave or emergencies without interrupting your schedule.  Fertility Solutions Laboratory Manager has a PhD which examined embryo implantation and the molecules involved in the initial attachment of embryos to the uterus.  The laboratory team also needs to be able to communicate clearly not only with each other, but with the medical team, nurses and with the patient.
With no exceptions, patients should utilize a fertility clinic that has met all the certification requirements for their professional organizations and governmental bodies. It is appropriate for patients to ask programs if they have met such standards.

High Quality Clinical Care

A fertility clinic must have high quality clinical care.  This requires fertility specialists who not only have had adequate education and experience (Fertility Solutions has the only doctor on the Coast with a Masters in Reproductive Medicine).  It is also extremely important to ensure that the clinic you chose has a sufficient number of doctors who can cover each other for leave or emergencies without interrupting your planned schedule.

An especially important component of high quality clinical care is the fertility clinics policy on multiple births.  This policy includes the number of embryos that a program recommends for replacement in the uterus, the availability of cryopreservation of embryos, the use of blastocyst culture and their adherence to professional guidelines regarding number of embryos to replace.

It is important to establish the role patients play in making decisions regarding the number of embryos to replace or have cryopreserved. In some clinics this might be left entirely up to patients, but most clinics have guidelines they follow to reduce high order multiple births, and some clinics have policies limiting the number of embryos to transfer.

Extensive Services

Fertility clinics should provide extensive services. At the very least, laboratory services should include intra uterine insemination (IUI), in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).

Patient Choice

Quality fertility clinics must provide consultation services that explain all possible options so that patients can make the most appropriate, informed choice for themselves. This includes discussion of the advantages and disadvantages of no treatment, standard treatment such as controlled ovarian hyperstimulation and operative procedures, standard IVF and ICSI, use of donor gametes, adoption and childfree living. The benefit of these different options, including an understanding of what is involved with the different choices and the chance of them occurring over what time interval, need to be reviewed. The financial, physical and emotional costs must be discussed and made specific for patients’ financial and insurance situation, age, physical condition and psychological status. Complications that especially need to be discussed include the risks of ovarian hyperstimulation, multiple births, problems of prematurity, congenital anomalies, and the relationship between the numbers of embryos replaced, pregnancy rates and multiple pregnancy rates.

The best choice is the one the couple makes for themselves after they have been fully informed about the possible options.  Referrals for second opinions to other health care professionals should be freely offered and encouraged. Patients should be provided with consent forms in advance to read, that meet the legal requirements and are detailed and comprehensive enough to ensure that the patient can choose wisely. Furthermore, consent forms need to be signed, witnessed and dated at the appropriate times.

Excellent Documentation

Quality fertility clinics have excellent documentation of their clinical and laboratory care.  Accurate and detailed documentation is essential to decrease the risk of error, understand prior care, benchmark outcomes and do clinical research.  Careful documentation can be enhanced by standardized protocols and forms, as well as by information systems, but the most essential ingredient is commitment by the clinical, nursing and laboratory staff. Patients should how their care will be documented and about access to their medical records.

Cost-Effective Care

Fertility clinics should be aware of and practice cost-effective medicine. This requires that clinics only provide services that are clinically appropriate for the patients. It also means that clinics constantly strive to reduce their costs and always provide best practice services for their patients.

Patients should compare costs among clinics, but should be careful that they are comparing the cost of similar services when they do so.

Psychological Support

Fertility clinics must recognize that individuals and couples require emotional support as they pursue infertility care.  Infertility is a life crisis for many patients and represents a loss of self-esteem, loss of security and loss of self as a woman/man, wife/husband/partner, and mother/father. The fertility challenged individual/ couple’s overall quality of life is often adversely affected, with work schedules, vacations, sex life and ability to socialize with friends all being impacted. Serious stress is put on the marital relationship.

It is important that fertility clinics recognize this aspect of infertility and help couples deal with it. This assistance includes giving the patient an accurate prognosis, discussing ways to increase control for the patient, reviewing stress-relieving activities, identifying alternative forms of affection and sexual communication and facilitating access to information and emotional support, such as that provided by patient support groups, and also on the Internet. Health care professionals need to counsel couples about problems associated with success, including the changes in lifestyle that occur with parenting, and the need not to have unrealistic expectations for themselves or their child.

Ethical Care

Another attribute of a quality fertility clinic is that it practices medicine ethically. Fertility procedures today are at the center of several of the major ethical dilemmas. These dilemmas include the use of fertility treatment in couples for whom there are religious implications; use of donor gametes (sperm or eggs) and embryos; single parenting; sexual orientation’s role in parenting; insurance funding of infertility; preimplantation genetic diagnosis; embryo research; cloning; and more recently in Queensland the issue of surrogacy.

There are almost no “correct” or “right” answers to most of these issues. Some of what seemed “wrong” twenty years ago is accepted today (e.g., IVF), some of what was accepted five years ago is seriously questioned today (e.g., intergenerational egg donors, that is daughter to mother), and some of what is questioned today may become commonplace in the future (e.g., gender selection). It is important for reproductive specialists and their team to familiarize themselves with the role ethics play in the development and application of the assisted reproductive technologies if they are to counsel their patients competently.

Evaluation of Success Rates

All patients want to know what the chances are that they will have a baby if they undergo fertility treatment. In Australia, the results of fertility clinics are published collectively according to States or Territories but not for individual clinics.

It is only natural that patients will want to use these results to determine which clinic they should choose. However, often the published success rates are over-interpreted by patients who give them accuracy and meaning greater than they actually have. There are many difficulties and problems in measuring pregnancy rates from fertility treatments.

Summary

Many factors affect the quality of a fertility clinic. These include the quality of the laboratory and clinical services, the availability of comprehensive services, documentation of care, patient choice, research and teaching commitment, cost-effectiveness of care, psychological support, professional management and ethics. Patients should review clinic-specific reports of pregnancy rates when they are available, but recognize their serious limitations. In the final analysis, the availability of the care and the rapport with the fertility specialist and the team must also be considered in deciding where to undergo treatment.

Adapted with permission from the original article by David Adamson, MD, Fertility Physicians of Northern California