How to assess a fertility clinic without insider access

Clinic websites are marketing. They are not dishonest, but they are written to reassure rather than to inform, and they are strikingly similar to one another. Choosing well means asking questions the website does not answer.

Success rates: read the denominator

The single most misread figure in fertility. A clinic quoting a high number may be quoting pregnancy per embryo transfer — which excludes everyone whose cycle was cancelled, who had no eggs collected, or who had no embryo to transfer.

Ask instead for live birth per cycle started, broken down by age band, and ask what proportion of cycles reach transfer at all. A clinic that treats a difficult population honestly will have lower headline numbers and may be the better clinic for you.

The laboratory is the clinic

Patients choose on the consultant. Outcomes depend heavily on the embryology laboratory, which most patients never see and rarely ask about.

• How many cycles does the laboratory handle each year?
• Is the embryologist in-house and available if my retrieval date moves?
• What are your fertilisation and blastocyst development rates?
• What is your survival rate for thawed embryos?
• Do you track your laboratory performance against international benchmarks?

International consensus benchmarks exist for these measures. A laboratory that monitors itself against them will answer easily. Hesitation is itself an answer.

Experience with your situation

Generic competence is not the same as relevant competence. Ask how many patients like you they treat — poor responders, severe male factor, recurrent implantation failure, higher maternal age, whichever applies.

Cost, honestly

Ask what the quoted price does not include. Medication is often separate and can be a substantial proportion of the total. Then ask about freezing, storage, thaw and transfer costs, cancellation policy, and what a second cycle would cost.

Answers that should give you pause

• A success rate quoted without a denominator or an age band
• Reluctance to discuss laboratory performance
• Several add-ons recommended before your history has been reviewed in any depth
• Pressure to book quickly, or discounts tied to deciding today
• Any guarantee of a baby
• Discomfort at the mention of a second opinion

A note on regulation

Regulatory oversight differs substantially between countries. In the UK, clinics are licensed and inspected by the HFEA, which publishes verified outcome data. Elsewhere the framework varies. Find out who regulates the clinic you are considering, and what is independently verified rather than self-reported.