April 26, 2000 (Atlanta) -- Infertility experts offer some near-universal advice for couples trying to select a clinic: Start with SART.
Clinics that belong to the Society for Assisted Reproductive Technology (SART) follow specific guidelines to limit the chance of such things happening as multiple births. And couples shouldn't have too much trouble finding one.
"About 95% to 97% of the clinics that offer ART [assisted reproductive technology] -- essentially, in vitro fertilization -- are members of SART," says Debra Crawford, of the American Society for Reproductive Medicine. "We're actually about to start a campaign so that when patients come into a fertility clinic, they'll know it has the SART 'Good Housekeeping' seal."
Still, that's just a starting point. Experts also advise that couples educate themselves, ask questions, study clinics' success rates -- and, ultimately, follow their instincts.
All U.S. fertility clinics are required by federal law to supply the Centers for Disease Control and Prevention with "success rate" statistics, including the rate of twins and triplets born. The CDC compiles this information into a report available to the public at https://www.cdc.gov/nccdphp/drh/art.htm.
The problem is that by the time consumers get the information, it's about two years old. That's because successful pregnancies usually last nine months, and then there is the time it takes to review, validate, and approve all the data.
Another problem is that the data don't necessarily tell the whole story behind a particular clinic.
"Don't just look at the bottom line," advises Margaret Hollister, director of the help line at RESOLVE, a national infertility education group based in Somerville, Mass. RESOLVE can be reached at (617) 623-0744. "Some clinics are actually selecting for better rates," by, for example, taking on only younger infertility patients, Hollister says. "Other clinics may take all comers. That's something that may not show up in success rates."
Still, the report is a good place to start. "It's the only oversight committee we have," says Pamela Madsen, executive director of the American Infertility Association. "They are audited success rates, and it does give patients a lot of good information," including a clinic's skill at dealing with the many causes of infertility. Her guidance on this point: "The more practice you have baking a cake, the better the cake will be." In other words, find a well-experienced clinic.
Madsen says that any doctor can hang out a shingle that says "Infertility Specialist," but patients should check the fine print for the words "reproductive endocrinologist."
Then it's time to schedule a consultation, and, to a certain extent, let instinct take over.
"Infertility treatment is very different than getting treated for a stomachache by an internist. You need to feel like you're part of a team," Madsen says. "You've got to feel comfortable with that staff and physician, that you are cared about. If, for some reason, the pit of your stomach is saying, 'This is not the right place for me,' it's probably not."
You'd also better make sure there actually is a team, Madsen says: "Does the program have support? A psychologist on staff, a social worker, support groups. It will certainly help the couple survive this."
Another consideration is making sure the clinic is open seven days a week, because, as Madsen puts it, "a woman's ovulation waits for no man." It's important to select a clinic that's convenient to reach, as infertility treatment requires sometimes-daily office visits.
Assisted reproductive technology enabled Stephanie Plaut, 37, of Irvington, N.Y., to give birth to twins two years ago. She says it helps to know what kind of relationship you're looking for before settling on an infertility doctor.
"I knew I was going to be very involved," she says. "I wanted to be able to get a straight and direct answer. So it meant for me having a doctor who was kind and caring, and one who was not going to get his back up if I had a question."
She found one, but at points during her treatment it hardly mattered. "It really is a clinic. You have to be willing to accept the fact you're not always going to see that doctor. You're going to interact with other members of the staff."
It took many interactions with the medical community before 39-year-old Ellen Bender found a successful infertility treatment. The New York lawyer saw two obstetrician/gynecologists and a reproductive specialist before getting the news that she harbored poor-quality eggs.
She had a disorder called polycystic ovarian syndrome. Through Internet research, Bender says, she found the recommended infertility treatments for the disorder -- which didn't match the treatments she'd been put through. She eventually contacted a British doctor who had written a paper on the subject. He supplied the names of three doctors in New York who specialized in treating her condition.
Two lessons she learned from the ordeal: know exactly what you're dealing with, and don't waste time.
Bender says there's a tendency for women with infertility problems to stay with their obstetrician/gynecologists too long, and in turn, for some of these doctors to hang on to patients longer than they should before turning them over to a specialist. She's married, by the way, to an obstetrician. Three years ago, she gave birth to a daughter.
Madsen has a final bit of advice: "Read the books. You've got to learn how to become your own best advocate. Because no one cares the way you do about whether you bring home a baby."