By: Mr Edward Coats | 13th May 2024
Mr Coats is a Consultant Gynaecologist and Specialist in Reproductive Medicine and Surgery with 18 years medical experience. He is Medical Director at a West London fertility clinic. He is a member of The Royal College of Obstetricians and Gynaecologists, The British Fertility Society and The British Menopause Society. Ed tailors treatment according to the needs of his patients using an evidence-based but holistic approach.
When heading to your first fertility consultation with a specialist, it’s helpful to think about the questions you wish to ask in order to have the situation, options and next steps clear in your head. Here Mr Ed Coats lists those questions, some of which only apply to you if you know already that you need IVF, but all of which are helpful to know the answers to so that you have an overview of the clinic, prices and proposed plan.
1. Is my egg reserve normal?
A woman’s egg reserve can is either assessed by ultrasound counting the very early antral follicles in the ovaries, or with a blood test called Anti Mullerian Hormone (AMH). It is important to understand your ovarian reserve and the impact this may have on your treatment outcome.
2. Will we use IVF or ICSI to fertilise the eggs?
Depending on sperm quality a clinic will usually opt for insemination of eggs (IVF). If sperm quality is poor then Intracytoplasmic Sperm Injection (ICSI) confers an advantage, as this helps sperm to enter the egg and help fertilisation occur. Check what the specialist feels is the best approach for you and why.
3. Will I use a short or a long protocol?
Different clinics use different treatment protocols based on research evidence and experience. There are many ways to stimulate the ovaries in an IVF cycle, to harvest mature eggs. A number of factors, such as a woman’s egg store for example may influence the type of protocol used. Understanding your protocol is essential before starting treatment.
4. What days of the week do you collect eggs and perform embryo transfer?
Clinics differ in their approach to follicle tracking scans and some will use a combination of blood tests and ultrasound to track follicle progress during ovarian stimulation. Not every clinic will collect eggs every day of the week. A busy clinic will need to undertake daily egg collections and in some cases they will collect eggs on weekends too. As a patient this may influence the timing of your egg collection. Most clinics transfer embryos 7 days a week to allow patients to have an embryo transfer on a Saturday or Sunday.
5. What are your live birth rates per embryo transferred?
Understanding success rates is important when selecting your clinic. The HFEA and Total Fertility display official data. It is important to understand what is meant by success so do question your specialist what they mean by success. Do they mean a live birth as a positive pregnancy test result following implantation does not always lead onto a live birth, as ectopic pregnancy and miscarriage can occur.
6. Is the price of IVF on your website a package or are there additional costs?
Clinics all display prices of IVF treatment in different ways. It can be rather confusing. Total Fertility initially was set up to help break down the costs of treatments and helps you find this information more easily. It is important to understand when considering moving forwards with a clinic what the total cost of treatment will be. Clinics must be transparent here so don’t be afraid to ask what the total cost will be
7. Does the price of treatment include my medication?
Often headline or advertised prices on colourful websites do not explain the full breakdown of costs. It is standard that in most clinics the cost of IVF medication can add £1000-2000 to your treatment cycle. Always ask for the cost of medication and if this is included in the advertised price
8. Will I have all my treatment in this clinic or do I need to travel to other clinics for my egg collection and embryo transfer?
Several fertility clinics across the UK operate a hub and spoke service with IVF laboratories based in the main clinics. Different doctors may refer you into the main clinic but a number of services such as appointments, scans and blood tests are completed in the Satellite clinic. This may be an advantage for patients reducing potential travel time to appointments but it may also come as a shock to understand that the clinic you are being seen in will not carry out all stages of your IVF treatment cycle.
9. What continuity of care will I have with the doctors and nurses?
Continuity of care is becoming harder to guarantee in modern medicine, whether that is with your GP or in secondary care. Reproductive Medicine is no exception but as a patient it is important to understand who is going to have overall responsibility for your care during the treatment. Many clinics have shared care between doctors and nurses with great success but do check what your clinic offers.
10. How many cycles a year does the clinic perform?
Some clinics perform thousands of IVF cycles each year and others are much quieter. Obviously it is important to understand how busy your clinic is and how much experience they may have to treat you. All clinics are licensed and inspected by the HFEA and have reviews and reports that can be studied on the HFEA website. If you want to dig a bit deeper into your clinic then visit www.hfea.gov.uk and use the clinic finder tool.