Judging for Yourself
Do you have to go to one of the fertility centers on this top 10 list to have a successful IVF cycle? Probably not. If you don't have a highly complex diagnosis, shop locally first because many centers have strong programs and traveling may add unnecessary stress. Here, six things to keep in mind during the interviews.
1. Talk in the same terms
Once a couple's embryos are ready, doctors put them in a woman's uterus, where the hope is that they'll implant -- a process called embryo transfer. "Most transfers are easy. But in about 10% of patients, pinpointing the placement of embryos is difficult because of the shape or position of the uterus," says Hal Danzer, M.D., a reproductive endocrinologist at the Southern California Reproductive Center (SCRC). The center is one of the few nationwide that use four-dimensional ultrasound for every transfer; it provides 3-D images in real time. A new SCRC study on more than 100 patients suggests the new technology does slightly increase pregnancy rates.
2. Inquire about your specific condition
Your chance of a successful IVF cycle depends on your diagnosis. For example, in 2002 only 14% of IVF cycles in the U.S. in women who were diagnosed with diminished ovarian reserve resulted in a live birth compared to 32% when endometriosis was to blame. While male factor infertility has a high live-birth rate of 34%, the success rate for specific conditions within this category can be much lower.
3. Review the center's experience
Ask about the number of patients your age with the same diagnosis. Also make sure the doctors and lab staff responsible for the success rates you're being quoted still work there, says Thomas Pool, Ph.D., scientific director of the Fertility Center of San Antonio in Texas.
4. Consider the rate of multiple births, especially triplets or greater
New guidelines suggest the number of embryos transferred shouldn't exceed two in women under 35, two to three in 35- to 37-year-olds, and four in women 38 to 40 if a patient's chance of success is favorable. Implanting more embryos may slightly boost success rates, but it may also create dangerous pregnancies and complications for both mother and child. For instance, the rate of cerebral palsy is 17 times higher in a triplet birth than a single one.
5. Speak to the lab staff
These employees handle your eggs, sperm, and embryos, so you have to be as confident of their competence as you are of the physician's, says Dr. Pool.
6. Calculate the value
The cost of IVF even within the same city can vary widely; charging up to $35,000 per attempt isn't unheard of, but prices don't necessarily reflect quality. Request a written estimate including the price of the medications, testing, and special techniques you need, and factor it into your decision. If your insurance covers IVF, ask if the center accepts it.
Do You Need IVF?
The majority of couples who have trouble conceiving don't require in-vitro fertilization (IVF). Fertility drugs, interuterine inseminations (where washed sperm is placed in a woman's uterine cavity to bypass the cervix, which stops a lot of the swimmers), or a combination of the two will do the trick in many cases. "IVF is indicated as a first-line treatment only in women with severe tubal disease, men with an extremely low sperm count or no sperm present in the ejaculate, or couples who need their embryos screened for a genetic condition," says Kenneth Burry, M.D., director of University Fertility Consultants at Oregon Health & Science University in Portland. However, he notes that if other treatments don't work in six cycles (three if you're over age 35), you should talk to your doctor about whether it's time to move on to IVF.
Centers That Didn't Cooperate
The Centers for Disease Control and Prevention in Atlanta is required by law to collect data on fertility centers. More than 90% of centers supply the information. But the following centers either failed to supply data for 2002 (the most recent year for which data are required) or didn't provide enough proof that the information was accurate.
- Advanced Reproductive Health Centers; Orland Park, IL
- Thomas Annos, M.D.; Short Hills, NJ
- Appalachian Fertility & Endocrinology Center; Kingsport, TN
- Beach Center for Fertility, Endocrinology & IVF; Virginia Beach, VA
- Brandeis Center for Reproductive Health; New York, NY
- Center for Advanced Reproductive Medicine; Springville, UT
- Center for Women's Care; Chicago, IL
- Center for Women's Medicine; Houston, TX
- Chapel Hill Tubal Reversal Center; Chapel Hill, NC
- Fertility Associates of Idaho; Boise, ID
- Gynecology & Infertility Associates; Baltimore, MD
- Abraham Halfen, M.D.; East Setauket, NY
- IVF Hawaii; Honolulu, HI
- IVF Reproductive Services; Manhattan, KS
- IVF South Bend; South Bend, IN
- Kentucky Center for Reproductive Medicine; Lexington, KY
- Luana J. Kyselka, M.D.; Troy, MI
- La Jolla IVF; La Jolla, CA
- Life-Women's Health Center; Berwyn, IL
- MetroHealth Medical Center; Cleveland, OH
- Mid-Missouri Center for Reproductive Health; Columbia, MO
- Brenda Moskovitz, M.D.; Troy, MI
- New England Fertility Institute; Stamford, CT
- Siu Ng-Wagner, M.D.; Potomac, MD
- The Reproductive Center; Youngstown, OH
- Reproductive Genetics In Vitro; Denver, CO
- Reproductive Genetics Institute; Chicago, IL
- Reproductive Health Institute; Orlando, FL
- Reproductive Institute of South Texas; McAllen, TX
- ReproTech IVF Program; Allentown, PA
- San Antonio Fertility Center; Upland, CA
- Issa Shamonski, M.D.; Santa Monica, CA
- Sher Institute of Reproductive Medicine; Chicago, IL; Creve Coeur, MO; and Sacramento, CA
- James A. Simon, M.D.; Washington, DC
- Tyler Medical Clinic; Los Angeles, CA
Centers We Commend
In 2004, Child magazine sent an extensive survey to more than 75 fertility centers that had very good success rates. The majority of centers didn't return the form. But we commend the following centers for doing so.
- Bethesda Center for Reproductive Health and Fertility; Cincinnati, OH
- The Center for Advanced Reproductive Services; Farmington, CT
- The Center for Fertility & Reproductive Endocrinology at Virginia Mason; Seattle, WA
- Center for Human Reproduction, North Shore University Hospital; Manhasset, NY
- Center for Assisted Reproduction; Bedford, TX
- Center for Reproductive Medicine; Minneapolis, MN
- Fertility Center of San Antonio; San Antonio, TX
- Fertility Treatment Center; Chandler, AZ
- The GBMC Fertility Center; Baltimore, MD
- Henry G. Bennett Jr. Fertility Institute; Oklahoma City, OK
- Infertility and IVF Center; St. Louis, MO
- Institute for Reproductive Health; Cincinnati, OH
- IVF of North Jersey, PA; Clifton, NJ
- Long Island Fertility and Endocrinology IVF Associates; Melville, Port Jefferson, and Lake Success, NY
- McFarland Clinic PC; Ames, IA
- Pennsylvania Reproductive Associates; Philadelphia and Plymouth Meeting, PA
- Reproductive Medicine & Infertility Associates; Woodbury, MN
- The Reproductive Medicine Group; Tampa, FL
- Reproductive Partners-UCSD Regional Fertility Center; La Jolla, CA
- South Florida Institute for Reproductive Medicine; Miami, FL
- Strong Fertility & Reproductive Science Center; Rochester, NY
- West Coast Fertility Center; Fountain Valley, CA
- Women & Infants' Hospital/Tufts-New England Medical Center; Providence, RI, Boston, MA, and six satellite locations