A good starting point is to ask your GP about the clinics that are available in your area and whether they can provide a full range of fertility treatments. You will then want to know:
• what types of services the clinics offer
• what types of patients they see (private only or NHS and private?) It’s not unusual for the same clinic to provide NHS and private treatment using the same facilities and laboratories
• if your GP is able to support any treatment you have, particularly if it is being carried out on a private basis, with the costs of drugs or tests
• the success rates of treatments at the clinics
• the location of the clinics and if they have satellite centres
• what their policy is on the number of embryos they transfer
• how often multiple pregnancies occur with each type of treatment
• if they have special features, such as sperm and egg donation programmes or preimplantation genetic diagnosis
• how long you will have to wait before being seen, and then how long it will take for your treatment to be carried out if you go ahead
• your elegibility for treatment. For example, some clinics only treat women under a certain age, even though there is no legal limit on the upper age limit. In addition, clinics can have different policies about treating same sex couples or single women
• if your treatment is being carried out privately, how much it would cost and what is and isn’t included for that price. This can vary considerably from clinic to clinic.
Clinic success rates
Age is very important with regard to the success of fertility treatment so when considering success rates, take into account the age of the women treated. The HFEA website shows the results for different treatments in various age groups, breaking it down into women below 35 years, those aged 35-37 years, those aged 38-39 years, and, those aged 40-42 years of age.
Assisted conception success rates can also be gauged according to what part of the treatment process it is based on. For example, is the live birth rate based on the number of treatment cycles, the number of egg collections or the number of embryo transfers? The live birth rate is lower if it is based on cycles started rather than embryo transfers as not all treatment cycles lead to an egg collection. Sometimes the cycle has to be abandoned if the ovaries do not respond and too few or too many eggs develop.
did you know?
Reducing costs
Egg sharing is a scheme operated by some clinics where, if you choose to donate some of the eggs collected from you following an IVF cycle to another woman who is unable to produce eggs, the price of your treatment can be reduced. Check if your clinic operates a scheme such as this as it is usually specified on the patient information for the clinic.
In addition, not all eggs are fertilized successfully with a process like IVF and so treatment is also expressed as the number of live births for every embryo transferred back into the womb. Whether the embryo is fresh or frozen can also make a difference to the success rates with slightly lower success rates when the embryo has been frozen and stored.
Clinic location
Fertility treatment can be very stressful for both of you and it can be a time-consuming and emotional process that seems to take over your every waking thought. A clinic far from your home or workplace can add to the stress. Treatment involves frequent clinic attendances for the various procedures and by their very nature, they are not always carried out at the most convenient times. So travelling a long way to a clinic can add to the strain and make fertility treatment even more difficult to cope with.
To try to ease this, some clinics have so-called satellite units, based in local hospitals or clinics, which can carry out some of the tests or treatments without the need for you to visit the main centre for all components of your treatment.
The costs
There are different components to assisted conception treatment and costs are associated with each of them.
These include:
• the first clinic attendance and follow-up visits
• investigations, including hormone tests and sperm analysis
• ultrasound or X-ray examinations
• the cost of drugs, which can be very expensive
• blood tests and ultrasound examination to check on the egg development
• recovery of the eggs
• the fertilization procedure used, such as IVF
• the need for egg or sperm donation
• storage of embryos
did you know?
Twin success rates in the UK
• For women under 35 years of age, the rate of twins in successful IVF pregnancies is 25-30 per cent.
• This declines to 18-19 per cent for women aged 38-39 years and even further for women over 40.
This might add up to a significant total, but will vary from clinic to clinic. So if cost is a consideration, enquire whether there are any ways to reduce them.
The risk of twins
In the UK, fertility clinics only replace one or two embryos. Obviously, if two embryos both successfully implant, then you will have twins. You should, however, be aware that twin pregnancy carries a much higher risk of complications than a singleton pregnancy and because of this, some clinics are now performing only a single embryo transfer. Replacing only one embryo reduces the risk of a successful pregnancy compared to replacing two, but this is traded off against a lower risk of complications during a subsequent pregnancy. Your spare embryos can be frozen, stored and replaced at a later date.
Special features that clinics might provide
You may want to know if the clinic provides access to sperm donors or egg donors or special services, such as preimplantation genetic diagnosis.
A clinic’s assessment of your circumstances
In the UK, the Human Fertilization and Embryology Act, which was passed in 1990, requires clinics to consider the welfare of any baby that may be born by assisted conception therapy and the welfare of other children that might be affected by the birth of a new baby. So the clinic you opt for will have to ask you a number of personal questions to confirm your ability to meet the needs of a new baby as well as any medical factors that may be relevant. This may include the clinic contacting your GP to obtain relevant information from your medical records. However, before the clinic can do this, they must obtain consent from you.
Obtaining NHS treatment
There is some variation with regard to what treatment is offered on the NHS through different regions in the UK. However, in general, the NHS aims to offer women up to the age of 39 years at least one cycle of IVF without charge. Indeed, the National Institute for Clinical Excellence (NICE) recommends that IVF treatment should be offered to couples: in which the woman is aged between 23 and 39 years at the time of treatment; who have an identifiable cause for their fertility problems; and who have been infertile for at least three years. They should be offered up to three stimulated cycles of IVF. Despite these national guidelines, some criteria may be determined locally