10 essential questions to ask during your IVF consultation
The questions you ask in the first few meetings with a fertility clinic can help you decide whether you feel comfortable to proceed. So here is my very honest take on what you need to ask, to get the information you need, and it’s probably not what you think!
Thanks to everyone who attended a recent webinar with my podcast co-host husband. Watch or listen: IVF 101 – A beginners guide to the world of IVF and assisted reproduction
The webinar taught me that there needs to be an honest, unfiltered list of questions. A list of questions that, not only you need to know the answer to, but a list of questions that you should be free to ask and should receive reasonable and honest answers to allow you to feel informed.
The questions you ask in the first few meetings with a fertility clinic can help you decide whether you feel comfortable to proceed with the information you have been given. You are going to spend a long time in this clinic and it’s important that you feel supported and informed.
So here is my very honest take on what you need to ask, to get the information you need, and it’s probably not what you think!
The take home message here, is never do anything that makes you feel unheard, without seeking a second opinion. For example, just because one clinic can’t or won’t offer you treatment with your own eggs and sperm does not universally mean that you have to move to a donor option. If that is not what’s right for you seek advice.
Don’t forget to advocate for your family plans for the future. No matter what age you come to this, you will be older as treatment progresses and pregnancies are had. Have you managed to plan for all future situations with the clinic?
Please share with people about to go through this, or returning to do this again.
As always we are stronger together and all of our experiences will help each other become better informed and less anxious.
1. Will you treat me?
This is the most important starting question.
- With my circumstances, my AMH, my age, and my context, will you offer me the treatment I need/want to have?
Can the clinic support your personal medical context? i.e. anaesthetic support, certain embryo genetic testing? There are clinics that won't treat you if your AMH is below a certain number.... or if your egg collection numbers look low. It affects their success rates too much! A hard truth.
2. What are your success rates?
Clinics publish pregnancy rates and live births. Pregnancy rates and babies born are important yet chances of developing embryos that can be transferred are more important, as without this you don't fall into the published statistics. A good question to ask:
- How many patients do not have embryos to transfer when having treatment?
Be mindful of clinics that cherrypick the results they choose to show you. Remember you went there for a baby, not a pregnancy. They are not the same thing!
3. What is your multiple birth rate?
There are many potential medical complications that come with multiple pregnancies, for both mother and babies. It puts strain on the NHS when babies are born prematurely. The risks are 10x compared to a singleton pregnancy.
You should ask why if a clinic relies on putting multiple embryos back to achieve good results. It's not medically sound and it's not ok to put you at risk without clear discussion.
A multiple birth rate above 4% is worrying. Rates above 8% raise big red flags!
4. Do you run a 7-day service?
Your treatment should not be affected by the work patterns of the clinic staff. The human body does not have an in-built calendar and embryos do not know it's the weekend, or a bank holiday.
If you are told you can't have a blastocyst stage transfer at the clinic because it falls on a Sunday then the clinic should not be offering blastocyst culture, full stop.
Equally, if you go to a clinic for a particular treatment e.g. PGT-A, this plan can't be changed because the biopsy falls on the weekend — that's not your fault.
5. How is the embryology team set up?
- What technology do you have in the lab? What do you do with atypically fertilised embryos, 1PN's, 2.1PN's, OPN's?
- Do you have timelapse and can you see the embryos developing?
- How do they know if they are normal or not?
- How experienced are the lab team?
- Are the lab team available to speak with?
The embryology team play a huge part in the success of your treatment — you should be able to know more about them.
6. How much will it cost?
This has to be outlined from the beginning. Everything you are going to need to pay for should be shown to you. This includes if you need to have a "freeze all" embryo collection cycle, and a follow up frozen transfer, typically not included in a cycle of treatment.
7. How long will it take?
- What does the timeline look like? Is there a waiting list?
- What stimulation protocol will I be put on, long, short? and why?
- How will this impact my work schedule?
- How can your clinic reduce disruptions for me?
- Are early appointments an option?
8. What do we need to do before we start?
- Will your clinic run thorough investigations and planning before ploughing into treatment?
- If there is a male partner, will he be properly evaluated?
A semen analysis is simply not good enough in most persons contexts. Has there been recurrent miscarriage? Has this been checked appropriately?
- How will you take into account our aspirations for having a family?
- How do you connect this to the treatment advice?
- What standard tests do I need to have before?
- Can I have them elsewhere and do any of them expire?
9. What support do you offer?
- How do you take my/our needs into consideration?
- Will the nurses be available for injection teaching or are we expected to watch a YouTube video?
- I'm a needle-phobe, how will this be respected and supported?
- I have a medical condition, will I need extra anaesthetic support?
- Is there an emergency number if required?
- What counselling support do you have and how do you tell me/us how to access it?
- How will you ensure I am listened to?
10. What can I do to increase my/our chances?
The process of having treatment should be collaborative. There are things you can do to help make the outcome better.
- Does your clinic have holistic therapists that can help?
- Are there any lifestyle changes that are advised, or supplements that should be taken?
- Is there a potential situation where there needs to be a pause and delay before I/we start?
It shouldn't all be GO GO GO!
- Will you treat me?
- What are your success rates?
- What is your multiple birth rate?
- Do you run a 7-day service?
- How is the embryology team set up?
- How much will it cost?
- How long will it take?
- What do we need to do before we start?
- What support do you offer?
- What can I do to increase my/our chances?