How to Choose the Best Reproductive Endocrinologist for Your Fertility Journey
Fertility practitioners, practices, and laboratories have an enormous range of experience. For patients trying to conceive, choosing a clinic often comes down to experience, delivery of care, and accessibility. Clinics with the most experience tend to be busy. While full waiting rooms and waits for appointments may be unappealing, data suggests that busier clinics tend to have higher rates of success. Smaller clinics (less than 200 IVF cycles/year) may provide excellent care, but you will want to do your homework to make sure that IVF outcomes are acceptable. A useful place to start a comparison is SART.org. SART is a national practitioner database. Check the outcomes for frozen embryo transfers since most successful clinics now employ a freeze all IVF strategy.
Reproductive medicine practices have different approaches to patient treatment and may employ different strategies for providing care. For example, there are clinics that practice “mini-IVF”, where the doctor employs a “minimal stimulation” protocol that subjects the patient to less hormone therapy, but likely delivers fewer eggs per retrieval. On the other hand, some clinics tend to aggressively stimulate in order to minimize the number of retrievals required. Most clinics fall somewhere in between but the most important guidance for treatment is not strict adherence to ideology but optimizing treatment protocol based on history, age, AMH, diagnosis, and basal follicle count. Larger centers have the ability to analyze outcomes across thousands of cases and heuristically develop protocols that optimize success.
One of the most important considerations is the number of embryos your clinic transfers. The most important recommendation a reproductive endocrinologist can suggest is to transfer a single embryo.Single embryo transfer reduces maternal and neonatal mortality and morbidity by over 50%. Oftentimes clinics report good success rates at the expense of multiple embryos at the time of transfer. Ask your practice what policy they adhere to. If they routinely transfer multiple embryos it may be because of limited laboratory or clinical experience in extended embryo culture, cryopreservation, or genetic testing.
Infertility is a complicated medical condition that is unique in the medical field. Multiple underlying issues for a man, woman, or a couple may complicate the ability to start a family. Getting to a doctor who knows how to treat your specific issues is key. Patients who suffer from male factor infertility should have access to a reproductive urologist. Patients who experience recurrent pregnancy loss should have an evaluation by a physician who has experience with all relevant testing necessary and not solely dependent on IVF. Most clinics will have experience with hormonal imbalances, anatomical issues, and most common fertility issues but making sure that your clinic has the depth to treat your particular diagnosis is an important consideration.
The fertility treatment process is complicated and takes time. Stress resulting from therapy is common so you want to make sure that your practice has a holistic approach to achieving success. Do they have ancillary services such as fertility counselling, an experienced dietician, affiliations with complementary therapies including acupuncturists and herbalists? Having access to a wide array of health care professionals may be helpful in difficult cases.
Last but not least is a helpful finance department. Most physicians may not feel comfortable discussing financial issues, but it is important that practices provide as much billing support as possible to reduce financial stress. Given the wide variety of insurance providers, financing programs, and governmental assistance, an experienced finance department may be critical in helping obtain fertility services at an economical cost.
Overall the quality of fertility care in New York City is excellent but doing a little homework is always helpful. Every practice is different in their approach to fertility care. Investing some time and finding a practice that meets your particular needs will pay huge dividends. RMA is New York is committed to helping all our patients succeed by providing top notch care in multiple locations administered by caring, professional, and dedicated medical staff members.