How to select your reproductive specialist Part 1 - Location
One of the first things that you will have to do is locate the clinics that are accessible and close to you. One way is to look at google, but most likely you will be flooded by advertisement with the most paying clinic showing on the top and it may be a little difficult to find out who is where. One less known way is to use a zipcode search of on the Society for Assisted Reproduction (SART) and entering the maximum distance you are ready to travel. Here is the link to the website: http://www.sart.org/find_frm.html . The inclusion of centers into this database can not be purchased, is unbiased and lists only qualified fertility clinics that have passed the scrutiny of meeting stringent regulation imposed by the Society for Assisted Reproduction (SART) and government regulations imposed on fertility clinics. Another source is the CDC website with their ART report, however the search option to find clinics is not that good (http://nccd.cdc.gov/DRH_ART/). If you only like to look for a doctor that may or may not provide the full range of fertility treatments, you can go the American Society for Reproductive Medicine (ASRM) homepage and search for a professional in your vicinity on this website https://www.asrm.org/FindAMember/ and you will see the list of physicians that are members of the society (almost) all reproductive specialist in the United States belong to. The equivalent to this would be the European Society for Human Reproduction and Embryology (ESHRE) for european patients, but they do not provide the search option for the general public.
Depending on the individual situation, there will be more or less trips to see your fertility specialist, thus it is much easier to pursue treatment locally than travel long distance. The efficiency of your treatment and overall satisfaction will benefit if you do not have to worry about time and money spent on long distance travel. Many patients underestimate the need for repeat ultrasounds (yes, female reproductive organs are dynamic and there are profound changes in ultrasound appearance and hormone levels at different times in the female cycle) and sometimes we want to capture and evaluate those changes. Today, skype software enables convenient face to face conversations, but can not replace the ultrasound in the office and does not provide hormone levels in your blood. I have seen many patients getting frustrated with the treatment due to long distance travel.
So, do I claim you should just pick the closest clinic and that is it? Of Course not, but the priority in case of similar clinics, should always be given to your local provider. It also depends what kind of therapy do you require. If you just want to be evaluated and have a consultation or a basic workup, then you should look for an office nearby. If you are in a position where certain special therapies are needed, like you are looking for a surrogate mother to carry your child or a uterine transplantation (yes, it is possible today!) or seeking a natural cycle IVF or tubal reversal specialist, you might find yourself travelling out of state or to a different country to have this treatment performed.
One thing that is not always apparent and particularly important for patients utilizing advanced reproductive technology that the location of the office and the reproductive laboratory might not be at the same site. So if you decide to to undergo minimal stimulation or natural cycle IVF that might require monthly egg retrievals, the location of the laboratory is very important to you since you will be a frequent visitor there. Some clinics may maintain a very close satellite office, but the laboratory visit turns out to be quite a stretch. Again, this point might not matter to a young fertility patient that can retrieve a high number of eggs in one cycle and has a high probability for success per cycle and therefore will less likely end up visiting the laboratory multiple times. It is also important for patients undergoing intrauterine inseminations (IUI) since these have a high chance that multiple treatments will be necessary.
I remember a patient couple of mine, they lived in Poland and they have seen me in my clinic in northern Germany, since they have been family friends of ours. They had fertility issues for several years, the woman did not have periods regularly (ovulatory dysfunction) and the semen count was normal. The husband was very impressed by a reputable fertility clinic in Valencia, Spain and had already established contact with them and they suggested IVF treatment. The couple however did not even attempt looking for a local fertility specialist in Poland, they did one cycle of clomid with a doctor they did not like and were very focused on this “fancy” clinic abroad. By doing that they were missing the chance to to attempt a very simple therapy with clomiphene - that is more “visit intensive” and should be done locally since it can stretch over multiple months, but does not require the high-tech approach. They wanted me to treat them, but I was also long distance and I advised them to find a local doctor to help them out explaining them that they may not need much to become pregnant. It turned out the patient was already pregnant not knowing it when they saw me, she apparently randomly ovulated and was not even aware of the early pregnancy. This is a good example, how things can get twisted and patients sometimes end up doing expensive unnecessary treatment far away from home not even looking or considering their local resources.
The important thing is to have a thorough consultation and assessment and this is a step that can be done even long distance. Many clinic will offer a reduced charge or even free initial consultation and that is something you should think utilizing in parallel besides seeing your local fertility specialists, it is almost like double checking if you do have a proper treatment plan developed for you.
Although there are give or take about a 1000 certified fertility specialists in the United States, the distribution is very skewed. While some states have less than 10 certified specialists, some areas like New York City, Chicago or Southern California will have numerous certified specialist to choose from. Patients living in the highly populated areas have the luxury to pick and choose their clinic, while others have to sacrifice long travels to seek care.
In my next blog I will elucidate on some views what type of center to choose and the pro’s and con’s of academic vs. non-academic centers, small or big groups. Please feel free to contact me if you have any questions.
I wish you all the best on your quest!