Top Tier IVF Clinics in the United States

I have identified a group of world renowned, top tier IVF clinics in the United States that year after year report live birth statistics that are among the highest in the world. These elite centers staff some of the most highly regarded physicians and embryologists in the world of assisted reproductive technology. They are responsible for helping some of the most challenging IVF patients achieve parenthood, and are also responsible for many of the most important scientific advances in the world of IVF. With laboratory and clinical standards of the highest calibre, these centers should be known to anyone who is in need of IVF, and would like to increase their odds of having a baby.

I have visited these clinics, and have researched them exhaustively through interviews with their directors, physicians and embryologists. I conduct follow-up visits, and maintain regular contact with them by phone to ensure that I remain current. I am familiar with their cultures and philosophies, and with both the obvious and subtle ways in which they differ from one another. I can help you consider the factors that will permit you to choose from among these outstanding clinics the one that is best suited to your particular needs.

During a consultation I will provide a critical comparative analysis of the published live birth rates of these clinics, taking into account the factors that can skew them. You will learn about each clinic's entry criteria, i.e. which ovarian reserve screening tests are the female partner expected to satisfy (FSH? E2? Clomid Challenge? Resting follicle count?). I will also provide information about whether each clinic grants access to some of the most challenging IVF patients (i.e. women over forty, those with a history of multiple IVF failures, and/or diminished ovarian function: fluctuating FSH levels, high FSH, poor responders). You will learn about the technology offered at each program (e.g. blastocyst transfer, assisted hatching, ICSI, embryo co-culture, pre-implantation genetic diagnosis, etc.), and in what circumstances.

If you are forty or over I will provide information about the treatment options at each clinic for women over forty. You will learn about the age cut-off in the over forty category at each clinic. Does the clinic automatically exclude women older than forty-two regardless of their hormonal status? Or does over forty mean up to age forty-four (provided the female partner can satisfy the program's entry criteria)?

I will also provide information about the practicalities of accessing each clinic. How long you will have to wait to obtain a consult with a physician at each clinic? Which physicians at each clinic can you get an appointment with most quickly? Are there any physicians at the program who are willing to conduct long distance telephone consultations? Approximately how long will it be before you can expect to be cycling at each program? How much time will you have to spend at each clinic if you are from out of town, and what types of accommodations are available? What is the cost of IVF at each clinic?

Finally, I will provide referrals to physicians at each clinic who are well suited to your specific needs. If you would like me to, I will also make an introductory contact with the physician on your behalf.

Treatment of Male Infertility

In the last few years there have been dramatic developments for the treatment of male infertility by the use of intracytoplasmic sperm injection (ICSI), and advanced surgical epididymal and testicular sperm retrieval techniques. These advances provide the potential for fertility treatment where the only options several years ago were donor insemination or adoption.

Certain IVF centers are particularly experienced in the evaluation and treatment of male factor infertility, and attract a high volume of patients with this problem. Because they work closely with world-renowned specialists in male reproductive medicine and microsurgery they are able to provide coordinated, collaborative care for both the male and female partner.

If a couple is faced with male factor infertility, it is crucial that they not limit their options for treatment by attaching themselves to an IVF clinic that is itself constrained by its own technical limitations. I can help direct couples who require treatment for male infertility to centers that have a particular strength in this area.

Egg Donation

Egg Donation is an alternative means of building a family for couples who are unable to use the eggs of the female partner. It requires that both parties find emotional comfort with the notion that while the female partner will be the baby's biological mother, the child will have only the male partner's genetic background. For those who are comfortable, egg donation provides an opportunity for the female partner to experience pregnancy and the bonding that occurs during this time, and also offers the couple the opportunity to share the birth experience.

Many factors are involved in the choice of an egg donation program. I have carefully researched the options in egg donation in the United States, and it is clear to me that some programs' concept of egg donation is healthier than others.

During a consultation I will provide comprehensive information about some of the best egg donation programs in the United States. These are programs that report live birth statistics with egg donation that are well above the average, rigorously screen their donors, provide appropriate psychological counselling to both their donors and recipients, and also make strong efforts to match their donors and recipients appropriately.

You will learn about the most rigorous standard of donor screening. I will also provide information about egg donation programs that permit anonymous egg donation only, and about those that will arrange for you to meet your donor should you wish to. If you have a donor that is known to you, I can point you to those programs where known donor scenarios are welcome, and I will alert you to those programs that limit their known donor scenarios to "sister to sister" donations only.

You will learn about the upper age limit for the female recipient at each program, and whether the age cut-off relates to the age of the recipient on the date of the initial consultation, or on the anticipated date of the match. I will provide information about programs that offer shared donation, exclusive donation, or both, and about the implications of the choice to go either way. You will learn about the average wait at each program for matching, about the information you will be offered about a donor, and about what will happen if you choose to decline a donor that is offered to you. Finally, you will learn about how many times you will have to visit with the clinic before you will be matched with a donor? Will the clinic require that the female recipient have a "prep" cycle to ensure uterine receptivity? And finally, what will the cost of the egg donation cycle be?

Success Rate Interpretation

In the United States patients have access to an annual published report developed by the Centers for Disease Control and Prevention (the CDC). The most recent CDC Report was made available in January 2000. It is the third such report and is based on the 1997 calendar year.

The CDC Report is a useful tool as it tells the IVF consumer which clinics are not performing particularly well. However, it is a mistake to simply review the CDC publication, look for the clinic with the highest live birth rates, and assume that it is the "best" clinic. A comparison of live birth statistics in a vacuum will not result in a meaningful comparison of "apples with apples."

As many factors can skew a clinic's live birth rates, success rate interpretation requires critical thinking, insight and analysis. I can teach you how to interpret a clinic's live birth rates with an understanding of how they can be impacted by many factors, some of which are not particularly obvious.

If You Are Accessing IVF in Canada

In Canada there is currently no central registry to which IVF clinics report their live birth rates, and patients do not have access to adequate information about the past performance of most clinics. Most Canadian clinics do not openly provide their live birth rates to their patients. It is therefore extremely important that patients understand how to analyze the "success rates" that are provided to them. Without such an understanding it is easy to be led astray, and the formation of realistic expectations and meaningful comparison of your options becomes impossible. During a consultation with me, you will learn what questions to ask so that you will have a more realistic understanding of your odds of having a child with IVF at a Canadian clinic. I can also make referrals to Canadian IVF clinics.

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