How To Grade A Clinic

Considering all our issues, E and I need to evaluate our potential fertility clinic a little differently than you might evaluate a clinic if you just needed standard IVF.

For us, and possibly other genetic carriers, I think the biggest questions are:

• How much experience do they have with PGD? How many cycles do they do per year?
• How skilled are their embryologists?
• Do they biopsy day 3 or day 5? 
• What genetics lab do they use and how skilled are they? 
• Would they do a fresh or frozen transfer?
• Have they worked with many patients with our mutation/condition? 
• What kind of protocol would they put me on?
• Do they have a multi cycle program? Will they accept me into it?
• Money - how much will it cost, with all the extra things added?

Thus far we're looking at two different clinics. The clinic my doctor uses, which is smaller and probably more intimate, and a larger clinic that is part of a chain but that does many, many cycles. 

Clinic 1 - USC - My doctor, Dr. K

• How much experience do they have with PGD? How many cycles do they do per year?

They do about 25 PGD cycles every year. Since there is risk involved when you biopsy an embryo, they don't recommend it unless it's needed. 

• How skilled are their embryologists?

They have excellent embryologists but they do not keep an embryologist on staff that does PGD. They use the embryologist from the PGD genetics lab, and they do biopsies all day every day. 

• Do they biopsy day 3 or day 5?  

 Day 5 biopsy

• What genetics lab do they use and how skilled are they?  

They use Reprogenetics, one of the oldest genetics labs out there. 

• Would they do a fresh or frozen transfer? 

Likely a frozen transfer, though it would be at the discretion of the genetics lab, how long they need to get results for my embryos, and my body, am I overstimulated or am I in a good place to transfer the embryos. 

• Have they worked with many patients with our mutation/condition? 

They see about 3-5 patients with my mutation every year. 

• What kind of protocol would they put me on? 

This is still being decided, but my doctor knows how I respond to medication. 

• Do they have a multi-cycle program? Will they accept me into it?

They have no multi-cycle or risk sharing plans, I have to pay for each cycle straight up. 

• Money - how much will it cost, with all the extra things added?

One cycle would run about $16,000 plus $2,400 for biopsy for a total of $18,400 for one cycle or $36,800 for two. This includes $5,000-6,000 for medication each cycle, two biopsies, ICSI twice, anesthesia, and freezing and strong embryos for a year. Kaiser will cover the PGD.

Clinic 2 - HRC

• How much experience do they have with PGD? How many cycles do they do per year?

They do about 500 PGD cycles every year. This seems to be a fairly large number.

• How skilled are their embryologists?

They have 7 excellent embryologists on staff and have pioneered laser technology for embryo biopsy. They do their own PGD biopsy.

• Do they biopsy day 3 or day 5?  

 Day 5 biopsy

• What genetics lab do they use and how skilled are they?  

They use Reprogenetics, one of the oldest genetics labs out there. 

• Would they do a fresh or frozen transfer? 

Likely a frozen transfer, though it would be at the discretion of the genetics lab, how long they need to get results for my embryos, and my body, am I overstimulated or am I in a good place to transfer the embryos. 

• Have they worked with many patients with our mutation/condition? 

I'm still waiting on this answer, but the nurse said all the doctors at the practice get several patients with my mutation every year.

• What kind of protocol would they put me on? 

The doctor wants to review all of my records and see how I responded to my past cycles before suggesting a protocol. Regardless of the protocol, the doctor wants me to complete two cycles and batch my embryos for PGD to give us the best shot at having a healthy baby.

• Do they have a multi-cycle program? Will they accept me into it?

They have a multi-cycle program and although they usually wouldn't because I'm guaranteed to need both cycles if we're batching embryos, they will accept me into it.

• Money - how much will it cost, with all the extra things added?

Two cycles in the mutli-cycle program would cost me about $33,000. This includes an estimate of $5,000-6,000 for medication each cycle, $3150 for biopsy each cycle, $1200 for ICSI each cycle, anesthesia, freezing and thawing embryos and storing them for a year. Kaiser will cover the PGD.

I have absolutely no idea which clinic is the right fit for us. I love my doctor and was inclined to stay with her but the bigger clinic does more PGD cycles per year and is a little bit less expensive.  I'm not sure how I'm supposed to make this decision without ever having done IVF with either clinic. This is so difficult!