By MD, FACOG, FACS, FACE (reproductive endocrinologist), MD, MSc (gynecologist) and BSc, MSc (embryologist).
Last Update: 12/21/2018

People with infertility issues, either due to infertility problems in the partner, single women or lesbian couples, have no alternative but to turn to Assisted Reproductive Technology (ART) to fulfill their dream: becoming parents.

It is the first step of a long journey that, depending on each patient and what is causing infertility, can even take several years. For this reason, choosing the right fertility center for you is crucial.

There exists no fertility clinic that can be considered the best. There are multiple top clinics in countries like the United States or Spain, with consistently high success rates. The final choice is up to each patient, based on criteria such as comfort and trustworthiness.

We want to help you make a well-informed decision based on key criteria to keep in mind when looking for a fertility clinic.

Facilities

There are larger or smaller clinics, with a longer trajectory, recently founded, integrated in a hospital, private consultations, etc.

In any of these cases, there exist a series of factors to consider as regards the facilities:

Location

All patients must take into consideration the fact that, once they get started with the treatment, they may need several visits to the clinic if it is located near their area.

Diagnostic tests, ultrasound scan monitoring, hormone checkups, semen collection, egg retrieval, embryo transfer… These are some examples of procedures that require the presence of the patient in the clinic. For this reason, one should consider the average number of visits that will be required as well as the distance from our place of residence.

If you decide to undergo IVF abroad, even if some visits can be done remotely, others like the embryo transfer or egg retrieval must be done in the clinic, so you should consider your travel options and the cost of each journey.

Oftentimes, the clinic that you like the most due to its personnel, facilities, or success rates, is the least accessible of all clinics available. In that case, our advice is that you follow your instinct and choose the one you feel most comfortable with.

Recommended for you: What Is Fertility Tourism? – Costs, Benefits & Best Countries.

Quality

First and foremost, before choosing a fertility clinic, you must make sure that it is a licensed center, that is, it has official recognition.

To determine if a clinic meets certain quality standards, patients should keep close attention to aspects such as if it has been audited by an independent entity.

For instance, having the ISO 9001 quality certificate is a seal of quality that guarantees a minimum quality standard and can be considered a factor when making the final decision.

Normally, fertility clinics have a section in their websites where they show all their official certificates.

Services

A highly valued aspect for IVF patients when it comes to selecting a fertility clinic to work with is if they offer comprehensive programs. By comprehensive programs we refer to packages that include a treatment cycle from beginning to end, with diagnostic tests and additional testing included.

Some of the main aspects to bear in mind are:

Diagnostic tests
A correct anamnesis is an essential step to find the cause of infertility and determine the most adequate treatment option. Some routine tests include ultrasound scans, hysterosalpingography (HSG), semen analysis, karyotyping, etc.
In-house laboratory
It is crucial for IVF treatments, since embryos are cultured in the lab under strict conditions of humidity, temperature, etc. Transporting human embryos from one place to another to perform the embryo transfer is not recommended.
In-house operating room
As in the previous case, it is important for clinics to have an in-house operating room, as it is the place where the egg retrieval and embryo transfer procedures will be conducted. In fact, at modern clinics, the lab and the operating room are connected so that they are kept under the maximum sterilization conditions.
Hours
Even though most reproductive endocrinologists and infertility specialists (REI) do not see patients on weekends, an important aspect to consider is whether they perform key procedures such as egg retrieval and embryo transfer on Saturdays or even Sundays. In order to guarantee the success of this process, delaying or advancing these procedures is not recommended.
Emergency department
Usually, few fertility clinics offer an emergency service 24/7. But fortunately, the number of clinics offering an emergency phone service is increasing. This service is normally used by patients to ask crucial questions as regards medication, too annoying symptoms, unusual bleeding during two-week wait, etc.
Other specialties
Some clinics offer other medical specialties, such as psychological support or urology services.

Available treatments

Not all fertility clinics offer all assisted reproductive technologies available nowadays. Based on their resources, they may just offer simple techniques, like Intrauterine Insemination (IUI).

But patients who are unable to achieve pregnancy after several IUI attempts may need to try with an IVF cycle, which offers higher success rates. Should this service be unavailable, the patient may need to look for another clinic that offers IVF.

Another crucial aspect is the availability of egg and sperm donors the clinic has. Some clinics encounter significant issues when it comes to recruiting donors, which generates endless waiting lists for the recipients.

In accordance with the Practice Committee of the American Society for Reproductive Medicine (ASRM), there are three aspects considered minimum quality standards for practices offering ART services: the concept of informed consent, recordkeeping, and other ethical considerations.

Informed consent
This concept is considered a legal principle. All ART patients have the right to self-determination and must take the final decision as to what is appropriate and acceptable treatment. To comply with this, each patient or couple must be provided with all relevant information necessary for them to make an informed decision. The communications process should be documented in the medical record and, finally, the patient must provide full written informed consent.
Recordkeeping
All ART practices must participate in the Centers for Disease Control and Prevention (CDC) registry data collection, releasing identifiable, clinic-specific success rates. The embryology laboratory must retain records of all of its policies, procedures, personnel employment, training, evaluations… Also, there should be documentation of the proper identification, outcome, and disposition of all eggs and embryos.
Ethical and experimental procedures
All ART procedures should be performed in accordance with the guidelines published by the ASRM’s Ethics Committee. For example, procedures considered experimental must be conducted under the supervision of a properly constituted Institutional Review Board or equivalent committee.

On the other hand, if you are going to undergo IVF abroad, you should consider the legal requirements of the country in particular.

Related post: Assisted Reproduction in Spain – Everything You Should Know.

Personnel

As we have already explained above, a fertility treatment encompasses various steps that, in some cases, involve different specialists: gynecologists, embryologists, anesthesiologists, urologists, etc.

All of them must be duly qualified professionals with a long experience in their particular field. Moreover, there are other aspects that are crucial for patients when it comes to choosing a fertility clinic:

First impression

Couples are recommended to attend the initial consultation together. This allows both members of the couple to get an overview of the clinic and have an individual opinion.

During the first consultation, patients pay close attention to the facilities, patient flow, care, etc.

Considering seeing a fertility specialist? Don't forget that, in the field of Reproductive Medicine, as in any other medical area, it is crucial that patients rely on the doctors and staff that will help them through their treatment cycle. Logically, conditions vary from clinic to clinic. For this reason, we recommend that you generate your Fertility Report now. It will offer you a list of clinics that have passed our rigorous selection process successfully. Furthermore, the system will make a comparison between the fees and conditions of each clinic so that you can make a better-informed decision.

Once patients get into the doctor’s office, they see an infertility specialists, who will tell them about essential aspects such as the clinic’s work methodologies. He or she will review their particular case, recommend potential treatment options and their approximate costs, and let them know about the first steps to take. Also, it is a chance for patients to raise any doubts they may have.

The first visit to the clinic is a great opportunity for patients to determine aspects such as kindness, comprehension, empathy of the personnel. IVF patients want to be treated individually.

Some key aspects you can take into consideration during this initial visit are: if they care about learning your name, if they consider previous tests you have performed important, if they give you clear answers with patience, etc.

Initial evaluation

Valeria Sotelo, MD explains what a first consultation to a fertility clinic should involve:

When evaluating an infertile or sterile couple, we should assess both members of the couple. During a fertility evaluation, we can find different types of pathologies, including endocrine disorders, chromosomal abnormalities, uterine abnormalities, etc. For this reason, we start with a basic study that includes a complete anamnesis for both the man and the woman, a study of the medical and family history, history of surgery, toxic habits, exposure to environmental factors, etc.

After the first basic evaluation, the next step is to conduct a detailed evaluation of infertility, Dr. Sotelo states. How long they have been trying to conceive, previous treatments… these are all crucial aspects to consider before rendering a diagnosis.

Doing a physical exploration that includes an assessment of the male and female phenotypes and their secondary sex characteristics is highly helpful. Then, in the case of the woman, a transvaginal ultrasound helps to dismiss the presence of cervical or uterine pathologies, including polyps, fibroids, Müllerian abnormalities, cysts, polycystic ovaries, endometriomas…

Clear, transparent information

The functions of the male and female reproductive systems are usually unknown for couples who visit a fertility clinic for the very first time.

Thus, a well-trained REI should clarify what is the specific infertility issue that affects the couple, as well as the fertility treatment step by step, including the medications to be taken and their function, why egg quality can decrease, the minimum sperm parameters to consider a sample as normal, what happens while embryos are in culture, and so on.

When a couple or person gets into the world of Reproductive Medicine for the very first time, they encounter a great deal of information all of a sudden, and parsing everything quickly might be hard for them.

Nonetheless, the personnel of the clinic must explain as many times as necessary what is the treatment they need about, and be there to clarify any doubts the patient or patients may have. A patient should not return home with doubts as regards the hormone medications the doctor has prescribed to them.

Personalized care

All fertility treatments should be individualized, as each cycle depends on the causes of infertility in the woman or couple, age, hormone analyses, medical history, etc.

For this reason, IVF patients appreciate the fact that a single doctor is in charge of the cycle from beginning to end, monitoring each one of the different parts of the process.

Unfortunately, two doctors may have different viewpoints as regards the same case, and give different instructions or contradictory opinions to patients, which can increase their anxiety levels while on treatment.

Patients should consider that their health and the baby’s will be in the hands of the medical professional of the clinic. For this reason, he or she must be someone that is able to build trust and make them feel totally safe.

Success rates

A frequently asked question amongst IVF patients is the following: What are my chances of getting pregnant?

And the answer is that it basically depends on the woman’s age, the cause of infertility, and the type of treatment. Most fertility clinics publish their results annually. In the case of the USA, SART member clinics report their data in order to create national statistics.

However, understanding these statistics is not an easy task. For this reason, we are going to describe the differences between each one of the success rates clinics publish:

Live birth rate
One of the most important aspects of infertility treatments is the fact that the intended mother achieves a full term pregnancy, that is, one that ends with the birth of a healthy baby. For this reason, parsing the live birth rates is more important than the implantation or pregnancy rates.
Single pregnancy rate
Nowadays, both patients and specialists should be aware that multiple embryo transfers can lead to severe complications during pregnancy. The ultimate goal of fertility treatments is to make it possible for all patients to get pregnant and give birth to a single, healthy baby.

Broadly speaking, the success rates if IUI is 10.1%, while the success rates with IUI using donor sperm reach 14.6%. On the other hand, the live birth rate of IVF with ICSI is 25.7%, and it rise to up to 30.2% with donor eggs, etc.

As explained above, these figures may vary from patient to patient to a large extent based on age.

Cost

As long as it is possible for the patient or couple, the cost of a fertility treatment should not be a determining factor when it comes to choosing a clinic. However, and given the expensiveness of reproductive technologies, this factor has become a limiting one.

The following are key aspects to consider when dealing with the fees involved in fertility treatments.

Initial quotation

All clinics offer an initial quotation to their potential patients. In fact, if they do not do so, you are recommended to ask for it at the different clinics that you visit.

A fertility treatment cycle includes many different procedures, tests, complementary tests, etc. that not all patients need. For this reason, we strongly recommend that you clarify what’s included and what’s not when asking for an initial quotation.

For instance, some clinics include the costs of a semen analysis, hormone tests, embryo vitrification or pregnancy tests, while other do not include any of these fees. This is precisely the reason why some quotations seem, a priori, cheaper than others.

Medication fees are never included in quotations for fertility treatments, since the dosage and the type of drug needed varies from patient to patient. So, you should include about $1,000 or more to the initial quotation.

In general, all fertility clinics offer financing plans for fertility treatments and other fertility services.

Depending on each clinic and the sperm and/or egg bank the collaborate with, there might be extra fees or not.

Get more info: Overview of the Main Costs of Fertility Treatments.

FAQs from users

Is there a maximum age for assisted reproduction treatment?

By Mark P. Trolice MD, FACOG, FACS, FACE (reproductive endocrinologist).

The American Society for Reproductive Medicine (ASRM) recommends the upper age limit for a woman to carry a pregnancy should be no greater than 55 years due to increasing pregnancy complications. Using her own eggs, a woman’s success with IVF drastically declines wtih age throughout her 40s. As a result, women in their mid 40s and beyond, typically utilize and egg donor.

Is fertility treatment cheaper abroad?

By Zaira Salvador BSc, MSc (embryologist).

It basically depends on the destination country. However, seeking cheaper or low-cost fertility treatment is one of the most common causes why patients decide to pursue IVF or any other procedure abroad. In fact, that is the reason why patients from the USA, in spite of having one of the most permissible and well-developed fertility care systems, travel to countries of similar characteristics but with lower prices.

You can learn more about the cost of IVF and egg donation treatments by visiting the following post: Donor-egg IVF cost in the USA.

When should I visit a fertility specialist to achieve pregnancy?

By Zaira Salvador BSc, MSc (embryologist).

A couple should consider infertility when, after one year of unprotected intercourse, pregnancy does not occur. From this moment on, it is time for them to visit a fertility specialist in order to go through a fertility evaluation. The goal is to find what is preventing them from achieving pregnancy and start the most adequate treatment based on it.

When should you see a fertility specialist after miscarriage?

By Zaira Salvador BSc, MSc (embryologist).

Anyone who has experienced 2 or more miscarriages should visit a fertility specialist (reproductive endocrinologist). The goal is to detect what is causing you to miscarry and apply the most adequate treatment. Common causes include problems like diabetes, genetic abnormalities in the embryo, thyroid disease, advanced reproductive age, structural problems in the uterus, etc.

Suggested for you

To get more info about international fertility clinics as well as a review of their services, we recommend that you visit this section: International Fertility Clinic Directory.

To delve deeper into the world of Assisted Reproduction, learn about the different fertility treatment options available and their indications, click here: What Are Infertility Treatments? – Definition, Types & Costs.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Alberto Reche y Manuel Martínez Moya. Manual de Buena Práctica Clínica en Reproducción Asistida. Sociedad Española de Fertilidad (SEF).

Alper M, Brinsden PR, Fischer R, Wikland M (2002). Is your IVF program good? Hum Reprod; 17: 8-10.

ASRM, American Society for Reproductive Medicine. Guidelines for advertising by ART programs. (October) ASRM Practice Committee Report. American Society for Reproductive Medicine, Birmingham, AL; 1999.

ASRM, American Society for Reproductive Medicine (2002). Revised minimum standards for in vitro fertilization, gamete intrafallopian transfer, and related procedures. A Practice Committee Report. Guidelines and Minimum Standards.

Brian, K. (2010). The Complete Guide to IVF: An Insider’s Guide to Fertility Clinics and Treatments. Published by Hachette Digital, London.

Fernández A, Castilla JA, Martínez L, Núñez AI, García-Peña ML, Mendoza JL, Blanco M, Maldonado V, Fontes J, Mendoza N (2002). Indicadores de calidad asistencial en un programa de FIV/ICSI. Rev Iberoam Fertil; 19: 249-52.

Gianaroli L, Plachot M, van Kooij R, Al-Hasani S, Dawson K, DeVos A, Magli MC, Mandelbaum J, Selva J, van Inzen W (2000). ESHRE guidelines for good practice in IVF laboratories. Committee of the Special Interest Group on Embryology of the European Society of Human Reproduction and Embryology. Hum Repro; 15: 2241-6.

González E, Castilla JA, Magán R, Ortiz A, Ortiz-Galisteo JR, Aguilar J, Maldonado V, Fontes J, Martínez L, Mendoza N (2004). Consentimientos informados de reproducción asistida y legibilidad lingüística. Rev Iberoam Fertil; 21: 69-74.

ISO 9001, 2000. Quality management systems –requirements International Organization for Standardization, Geneva.

Lyneé Madiera, J. (2018). Taking Baby Steps: How Patients and Fertility Clinics Collaborate in Conception. By The Regnets of the University of California. University of California Press, Oakland, California

Marcus, H.J., Marcus, D.M., and Marcus, S.F. How do infertile couples choose their IVF centers? (An Internet-based survey) . Fertil Steril. 2005; 83: 779–781

Reproducción Asistida ORG. Video: ¿En qué consiste la primera visita en la clínica de fertilidad? (What does the first visit to a fertility clinic involve?), by Valeria Sotelo, MD, Apr 7, 2015. [See original video in Spanish].

The Practice Committee of the American Society for Reproductive Medicine. Revised minimum standards for practices offering assisted reproductive technologies: a committee opinion. Fert Steril, No. 3, September 2014; 102: 682-686.

Wikland M, Sjöblom C (2000). The application of quality systems in ART programs. Mol Cell Endocrinol; 166: 3-7.

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Authors and contributors

 Mark P. Trolice
Mark P. Trolice
MD, FACOG, FACS, FACE
Reproductive Endocrinologist
Mark P. Trolice is the Director of Fertility CARE – The IVF Center and Clinical Associate Professor in the Department of Obstetrics & Gynecology (OB/GYN) at the University of Central Florida College of Medicine. He is Board-certified in REI and OB/GYN, and maintains annual recertification. His colleagues select him as Top Doctor in America® annually, one among the top 5% of doctors in the U.S. More information about Mark P. Trolice
License: ME 78893
 Valeria Sotelo
Valeria Sotelo
MD, MSc
Gynecologist
Bachelor's Degree in Medicine from the University of Buenos Aires. Specialist in Gynecology & Obstetrics. Master's Degree in Video-laparoscopic Surgery, and Certificate of Specialist in Gynecology. Associate Member of the Spanish Fertility Society (SEF) and the Spanish Society of Gynecology & Obstetrics. More than 10 years of experience in the field of Reproductive Medicine. More information about Valeria Sotelo
License: 030309166
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV

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