The staff at Reproductive Science Center understands that the decision to seek fertility treatment can be difficult. For a couple considering fertility treatment, it is important to ask the right questions such as: success rates, costs, medical services, and financial options. Also, consider your personal relationship with, and trust in, your physician.

Our advice to patients considering fertility clinics is to be certain they understand all aspects of their decision, and to make certain they receive understandable answers to any questions they may have. Understanding these issues before beginning treatment can save time, energy, frustration, and money. It may also increase your chances of achieving a successful pregnancy.

Factors to consider when choosing a treatment program:

•     Success rates
•     Full range of procedures performed
•     Program flexibility and customization
•     Program stability and "track record"
•     Financial options, including insurance participation and financing
•     Staff accessibility and response
  

Frequently Asked Questions:
   1. Is it possible to evaluate clinics objectively?
   2. How do I evaluate clinics based on their current statistics?
   3. How important are the statistics?
   4. How do I know that the center I am considering offers a full range of services?
   5. Does it matter how long a program has been in existence? Isn't newer better?
   6. How much does treatment cost?
   7. Will my medical insurance cover infertility treatment?
   8. What other financial matters should I be considering?
   9. Who will be on my fertility treatment team, and how will I know what's going on?
  10. What other online resources are available for evaluating a fertility program?

1. Is it possible to evaluate clinics objectively?
Interpreting statistics of fertility programs requires patience and care. Individual ART programs do not use a standard format for reporting their own success rates in advertisements and promotional literature, making comparison among clinics difficult. The Centers for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technologies (SART) publish clinic-specific data on most of the ART programs in the U.S. Each clinic reports its annual outcome data to SART in a standardized format.

The SART report is comprehensive and provides valuable information about each clinic including: the number of cycles performed, pregnancy rates by age (with or without male factors), miscarriage rates, and average patient age. You may be able to see trends or patterns that will help you understand the quality, stability, and experience of the programs you are considering, especially if evaluated over time. The SART reports are available online on a clinic by clinic basis:

• 2005 Assisted Reproductive Technology Success Rates (latest statistics published at the Centers for Disease Control) 2005 and 2006 Assisted Reproductive Technology Success Rates for Reproductive Science Center of the San Francisco Bay Area. We encourage you to visit the American Society for Reproductive Medicine Web site for information on objective criteria.
  

2. How do I evaluate clinics based on current statistics?
While recent advances in fertility treatment are improving patients' chances for success, it can also mean that the most recently published statistics available from CDC/SART may not reflect your actual odds. Ask the clinics you are considering for current statistics . Be sure to ask for documentation on the statistics, as well as for statistics for your age range and infertility diagnosis.

Since beginning an IVF program, the Reproductive Science Center of the Bay Area has published a comprehensive statistical analysis.  of all ART cycles performed in its center and outcomes. We strongly encourage anyone considering advanced fertility treatments to obtain the same information from each clinic they are considering. To view our most recent statistics go to the ART Success Rates page.

3. How important are the statistics?
Couples with normal fertility have a 20- to 25-percent chance of conception each month if they have intercourse at the proper time of the cycle. Therefore, a normal, fertile couple has at least a 93 percent chance of achieving pregnancy within a year.

To help you understand how important success-rate statistics are, we'll compare two theoretical clinics, Clinic A with a 30-percent delivery rate per cycle and Clinic B with a 12-percent delivery rate. From the chart below, you can see that the average couple undergoing IVF can expect:

    * Clinic A (30 percent delivery rate): a 65 percent chance of delivery after 3 cycles
      
    * Clinic B (12 percent delivery rate): a 31 percent chance of delivery after 3 cycles

You may also notice that you have nearly the same odds of success in one cycle at Clinic A as you have with three cycles at Clinic B. So, even if Clinic A's fees are higher than Clinic B's, you may save money with treatment at Clinic A.

4. How do I know that the fertility center I am considering offers a full range of services?
First, ask a lot of questions and listen carefully. Some centers specialize in one form of treatment, and all patients receive that form of treatment; unfortunately, other, more effective treatments may be overlooked. At Reproductive Science Center, we offer a full range of fertility treatments, and each patient undergoes a comprehensive assessment to assure that all options are considered.

Secondly, we encourage patients to ask about all possible treatments including surgery, insemination, in vitro fertilization, egg donation, embryo freezing [Click here], and a full range of embryology services including ICSI, embryo hatching, and PGD.

 5. Does it matter how long a program has been in existence? Isn't newer better?
At the Reproductive Science Center of the San Francisco Bay Area, we believe one of our strengths is our stability and longevity. Our physicians have been working together for almost 20 years, and we have worked with the same embryology laboratory director for over 10 years.

We recommend that anyone considering fertility treatment ask each clinic under consideration about stability and years of experience of the physicians and the embryology staff. Infertility treatment, particularly IVF, requires a great deal of timing, coordination and communication between doctors and embryologists. The longer teams have worked together, the more effective they are in assuring a well-executed treatment plan.

6. How much does treatment cost?
The costs for infertility treatments vary widely among clinics. The best way to assess your ultimate cost is to ask each clinic for a copy of its fee schedule. It is important to determine if there are any additional fees not included in the fee schedule such as hospital charges, drug costs, and testing.

At Reproductive Science Center of the San Francisco Bay Area, we recognize that cost is an important factor when selecting an ART program. Our financial options page provides information related to our refund and discount programs, as well as financing options.

In the San Francisco Bay Area, the costs for one cycle of IVF range from $10,000 to $13,000, plus medications. The fees for IVF at the RSC of the San Francisco Bay Area are near the lower end of that range, approximately $9,700.

The cost of medications is a significant portion of the total IVF expense, and can vary. RSC has developed a relationship with a pharmacy offering competitive prices and the convenience of shipping to your home. There is the added benefit of verifying your insurance coverage for medications.

7. Will my medical insurance cover infertility treatment?
Approximately one-half of insurers provide limited coverage for intrauterine insemination services. Reproductive Science Center participates in many local physicians groups that represent the many commercial health plans in Northern California.

It is not highly likely that your insurance plan will provide coverage for in vitro fertilization, although some of the initial diagnostic examinations, and the medications, may be covered. In most cases, you will be covered for pregnancy resulting from fertility treatment. There are a few insurance plans that do cover IVF services.

Insurance companies usually have hundreds of plans to offer employers, each with different benefits. Contact your insurance provider and ask them what your insurance plan benefits are for infertility treatment. Our practice can investigate insurance benefits for you. We can also provide you with the necessary forms so that you may submit claims for reimbursement by your insurance company.

You may wish to consult the ASRM State Infertility Insurance Laws Web page for additional information.

8. What other financial matters should I be considering?
When choosing an ART program, look for flexibility and evidence of programs designed in response to patients' needs. The Reproductive Science Center has many financial options for patients, including a refund program, a discount program, and financing options that cover medication costs. See our financial options page for additional information, or contact one of our financial counselors at (925) 867-1800.

9. Who will be on my fertility treatment team, and how will I know how I am progressing?
Communication  is a vital element in successful fertility treatment. The physicians at Reproductive Science Center are joined by a highly qualified team of nurse case managers, working collaboratively to coordinate your care. All of the physicians in our center may be involved in your care, along with IVF nurse case managers, operating room nurses, and embryologists.

At RSC, we have one of the most experienced teams around. Every IVF patient is assigned a nurse case manager, who will provide an overview of IVF, assist in communications, provide instructions, and make certain that any questions you may have are addressed.

We encourage individuals considering several clinics to ask about the availability of nurse case managers, and methods of care coordination and communication.

10. What other online resources are available for evaluating a fertility program?
The American Society for Reproductive Medicine (ASRM) has a helpful online publication "Selecting an ART Program" – a consumer's guide to evaluating a fertility clinic, including a review of how success rate claims are calculated by providers.

Success Rates: What Are the Odds?
Once a couple become patients at a fertility clinic, what are the odds they will someday take home a live baby? The answer depends on several factors, including the woman's body, the man's body, the clinic's success rate, and luck. Below is a more detailed look at the influences.

Physiological Factors – No matter how good a fertility clinic is, some couples will never have a biological child. On the other hand, many couples become parents before treatment starts. Some factors are known to improve the likelihood of pregnancy, while others decrease it. (link)

Comparing Clinic Success Rates – In addition to statistics on the Web site of the Centers for Disease Control and Prevention , the Society for Assisted Reproductive Technology (SART) collects data from fertility clinics across the U.S. The SART statistics allow you to compare different fertility clinics. The CDC's Web site also explains how to read a fertility clinic's statistics table.

Success Stories --A few heartening stories of fertility clinic successes.

Physiological Factors for Success
Consider your own conditions when looking at clinic success rates for any procedure. If you have many of the positive factors on your side and no negative factors, your probability of a successful pregnancy is higher. Of course, a high number of negative factors gives you poorer chances.

Positive factors:
Younger age of woman (age is not relevant with donor egg services)
Previous pregnancy with IVF
Non-smoker

Negative factors:
Age – the older a woman, the less likely she will become pregnant (age is not relevant with donor egg services)
History of recurrent miscarriage
Both male and female partner infertility
Previous history of assisted reproduction (three or more cycles) without success
Uterine abnormality (DES, fibroids)
Certain types of ovarian dysfunction (high FSH level)
Hydrosalpinx – an excessive dilation and fluid accumulation in the fallopian tube.

Measuring Clinic Success Rates
Fertility clinics use several ways to measure success, depending on which stage of treatment the couple reaches. For that reason, published success rates can be misunderstood and misleading in comparing clinics. The best picture of a clinic's success comes from examining the pregnancy rates for all three stages of treatment.

Even these statistics do not tell you exactly what you want to know – the number of women who ultimately take home a baby based on the number of women who start treatment. Tip: ask each clinic whether its statistics refer to cumulative cycle data or current cycle data. And always ask for documentation and a breakdown of the data by age, so that you can compare the statistics to your own situation.

The third column in the table below gives an example of varying success rates that a clinic would report for each measurement.

Example and Explanation
Let’s take an example of a clinic that initiated 100 cycles—they started 100 women on an ART procedure by prescribing fertility hormones to stimulate multiple egg production. Some women will be counted in more than one cycle.

Of those women, 20 responded poorly to the fertility drugs and ended the cycle, and 80 responded well and proceeded to egg retrieval. In a retrieval, the physician removes eggs from the woman’s ovaries. Physicians cancel some cycles before retrieval -– usually because the woman responds poorly to fertility drugs and does not develop enough eggs.

Of the 80 egg retrievals, 20 women did not have enough eggs to fertilize and develop properly into embryos for an embryo transfer. The transfer is the final IVF treatment stage, in which the physician transfers embryos into the woman's uterus.

Of the 60 women who did have an embryo transfer, 15 became pregnant.
Of those same 60 women, 5 lost the pregnancies to miscarriage or other problems, and 10 gave birth.

Therefore, the percentage of women who took home babies after starting an ART cycle (for this fictitious sample clinic) is 10 percent.

Comparing Clinic Success Rates – SART Statistics
A program's success rate depends upon the quality of its laboratory, practitioners, and staff. It also depends on factors beyond the program's control, such as physiological factors that include the age of the patients and the cause of infertility.

Evaluating a clinic's success with hormone treatments and surgery is difficult because of the unique conditions and treatment of each patient and the lack of standardized data collection.

You can compare Assisted Reproductive Technology (ART) services by examining each clinic's statistical data. Be sure to compare similar statistics, since fertility clinics calculate success rates in different ways.

SART/CDC Statistics
Most U.S. fertility programs follow the guidelines of the Society for Assisted Reproductive Technology (SART) to report success rates. Each year, SART and the Centers for Disease Control and Prevention (CDC) [link here] collect and publish this comprehensive, clinic-specific data. Results are organized by state and by procedure. The data includes information on pregnancy outcomes, such as the rate of miscarriages, twins, and other multiple births.

The most current national report of fertility clinic success rates is on the SART Web site, based on ART procedures performed in 2004. The CDC's Web [link here] site includes an explanation of how to read a fertility clinic's statistics table.

You can request more recent SART reports directly from each fertility clinic that you are considering. Also, ask for reports from previous years to look for trends in the data over time. Year-to-year data can reveal information on the quality, stability, and experience of the program. It’s a good idea as well to ask each clinic to provide its most recent SART statistics for your age based on delivery rate per embryo transfer.

Which ART? 
The ART procedures that a clinic uses may reveal more information about its experience. Recent studies have shown that IVF can be as successful as the theoretically superior, but more invasive procedures of GIFT and ZIFT. These studies support the idea that excellent embryology laboratories can have pregnancy rates for IVF equal to or better than those for GIFT and ZIFT. Laboratories that can maintain high rates with IVF will usually choose it over GIFT and ZIFT procedures.