For an increasing number of people1 , the process of trying to conceive will involve consulting specialists at a fertility clinic. But in an age in which we spend hours researching what kind of bread to buy, how do you even go about finding the right doctor to help you have a baby?
My journey as a single mother by choice took me to four different clinics, so I know how challenging the process can be. However, finding the right clinic totally changed my experience, taking me from anxiety and frustration to calm and hopefulness—something I hope everyone can find with their clinic and providers.
First, a quick overview: fertility clinics, staffed by doctors who specialize in reproductive endocrinology, offer a variety of services that help people create a family. These can include:
Intrauterine insemination (IUI): a minimally invasive way to inject sperm into the uterus in hopes of having a higher chance of conception
In-vitro fertilization (IVF): a process that creates embryos in a lab and implants them into the uterus
Egg freezing: a treatment done by those who want to preserve eggs for later use in IVF
Consults and assessments that help predict fertility for all genders
People might visit a fertility clinic because they have been trying to conceive for a while but have not become pregnant or have had multiple pregnancy losses, because they are single or in an LGBTQIA+ relationship, because they want to preserve fertility, or simply to find out more about their fertility health.
So how do you find a fertility clinic in the first place? Sure, there’s everyone’s good friend, the search engine, but it might be a good idea to do a bit of digging beyond Google. First, check with your insurance company to see if you have benefits, and use their web portal to find doctors who are in-network. Even if you don’t have fertility benefits, some treatments like testing might be covered. Due to the high costs of these treatments, any assistance your insurance might provide will be helpful.
Second, if you are in a specific situation, it might be a good idea to ask for recommendations from people in that network—for example, other LGBTQIA+ people in your city or other people with endometriosis.
Once you’ve found some options, what should you be looking for to make your final decision? Given that stress can affect your fertility, it’s important to find a provider that makes you feel comfortable. Here are a few things to consider when looking for a fertility clinic, and some questions to ask during your first appointment. Remember that finding the right clinic and the right doctor is a personal choice—what works for you might not work for another person.
Are You Comfortable With the Medical Team?
You and your doctor will be getting very personal over the next few months, from coming up with your treatment plan to those every-other-day monitoring appointments to sharing the good and/or bad news. You should feel comfortable and listened to rather than dismissed or railroaded.
You deserve to be treated as a person, not just a number, and your treatment plan should be individualized. Your doctor should have gone through your medical history and be prepared for your first appointment. If you don’t have success, your doctor’s plan for the next attempt should make sense. Dr. Molly Quinn of HRC Fertility2 also cautions against clinics that seem to push you directly into IVF—it’s not always the right answer for everyone. "The idea I want to convey is that fertility treatment should be personalized. It shouldn’t be a ‘one-sized fits all’ approach!” Dr. Quinn says.
If you have a specialized condition (for example, endometriosis) or are in a specific situation (using a donor egg or in a same-sex couple), make sure your doctor is informed of your treatment needs and supportive of you.
Ask:
Who is on my care team, and what does each person do?
How do you treat people with my condition or in my situation?
Ask yourself—Does my doctor make me feel comfortable?
Do the Costs Make Sense?
Unfortunately, clinics are generally not able to provide a cost estimate without an individualized consultation because they can’t anticipate what treatments you will need. (In fact, it might be a red flag if they do). Be sure to ask for an itemized cost estimate after your consultation and don’t be afraid to comparison shop, particularly when it comes to IVF or egg freezing.
If you're looking to use a fertility clinic and your insurance doesn't cover anything, you may need to prepare for a bit of sticker shock. You could be looking at a range of anywhere from $500 for a round of IUI to $30,000 for a round of IVF. Even with insurance, costs may vary wildly from clinic to clinic. For example, one clinic I talked to was able to perform genetic testing on embryos for $150 as opposed to the $3,000 I was quoted elsewhere—a huge difference in my out-of-pocket costs since my insurance coverage did not include genetic testing. Yes, it’s annoying to schedule and pay for an initial appointment at multiple clinics, but it could save you thousands in the long run.
For those who have fertility insurance coverage through an employer or from a private provider, confirm that the recommended procedures will also be covered. (An infertility specialist at your insurance or your job’s benefits coordinator can confirm coverage.) I got an unfortunate surprise at one clinic I visited that was supposedly in-network, but would not have coverage for egg retrieval because they used the facilities of a different location.
If you use an out-of-network provider, be sure to confirm those costs with your insurance provider—and make sure they’re worth it (maybe the doctor is a specialist for your situation or the clinic is much more convenient).
Keep in mind that the estimate you get from a clinic likely will not include the cost of medications, which, if you’re doing IVF, will be several thousand dollars without insurance3 , plus any additional costs for your situation (for example, donor sperm or eggs).
Ask:
Are you in-network with my insurance?
Can you give me an itemized list of my estimated out-of-pocket cost and explain it to me?
Are all the procedures performed in the clinic?
What additional costs are not included here?
Does the Clinic Communicate Well?
Fertility protocols can involve precise treatments, and timeliness is essential. Your clinic should make the process smooth and unintimidating, with clear communication and the ability to get in touch easily. This is a stressful time, and your clinic should be helping you, not leaving you feeling confused.
Personally, response time made a big difference for me. After I had a bad reaction to one of my medications and my clinic didn’t get back to me for three business days, I switched to a provider who always responded same-day.
Ask:
How do I get in touch with the care team?
How will I get my results?
What is the estimated response time?
What are your procedures if I need to get in touch on a weekend or holiday?
Does the Clinic Have a Good Reputation?
You can check clinic success rates with the CDC4 or SART (here’s a helpful guide on how to read the data5 ). However, numbers don’t always tell the whole story with a clinic.
“Different clinics may not be comparable due to disparate patient populations,” explains Dr. Quinn. “Additionally, while IVF success rates may be accessible on national databases, IUI treatment cycle success is not tracked in a standardized way.” Dr. Quinn suggests getting a sense for the volume of experience a clinic has and being cautious in considering self-reported success rates, as they may be artificially inflated or not comparable from one clinic to the next. Although the general steps of IVF or IUI are the same, different clinics and/or doctors may be more or less aggressive in terms of the interventions they provide.
Dr. Angela Kelley of Aspire Fertility6 adds, “Please also recognize that every fertility doctor has completed over a decade of medical training, in addition to multiple board examinations, to obtain the knowledge and experience needed to treat complex fertility problems.”
There are also review websites7 where patients report on their personal experiences. You can search them to find comments from someone with your similar demographics. Again, this can be helpful, but remember that everyone’s experience is unique.
If pursuing IVF, don’t forget to ask about the embryology lab’s success rates as well.
Ask:
What do you expect are the chances of success for someone in my situation?
What percentage of your successful patients are in my age range?
What embryology lab do you use?
What is the laboratory's fertilization rate and blastocsyst conversion rate?
Do the Logistics Make Sense?
If you have multiple clinic options near you, there’s a lot to be said for the clinic that’s closest to your home or work and has flexible hours—remember, you’re going to go in for monitoring every other day!
The bigger question is: What do you do if there’s only one clinic anywhere near you, and it doesn’t work for you? If you have the resources, it’s not unheard of to travel somewhere for two weeks to do an egg retrieval, although there are uncertainties involved with that as well. Ask yourself: Is this clinic absolutely the best option for you? Are you able to make the trip again if necessary?
Remember that you do have a choice in medical providers, and you also have a voice in your medical care. “If you feel like you are at a crossroads in your fertility treatment plan, please feel empowered to get second or third opinions from other providers or other clinics,” Dr. Kelley says. “Some doctors might be a better ‘fit’ for you than others, but all fertility clinics exist with the purpose of helping you to reach your family goals.”
