Choosing a clinic
Choosing a fertility clinic can be fraught. If you are lucky enough to have NHS funding, you may have no choice about where your GP refers you. Most fertility treatment happens in the private sector and the options may seem confusing and daunting. The possibility of treatment abroad further complicates the decision.
In the UK we have a regulatory body, the Human Fertilisation and Embryology Authority (HFEA) The HFEA provides enormous amounts of information about all UK fertility clinics (www.HFEA.gov.uk). Check out the clinics nearest to you or those that specialise in the particular treatment you require.
You will find that success rates are pretty similar for most clinics, though those which do a great deal of one particular treatment often do better at it – for instance clinics that see a lot of older women may have better results than those who rarely treat anyone over 40. Convenience, approachability and efficiency are important, as you will be visiting and communicating with them a lot. You can tell a lot from a ‘phone call and even more by visiting. Behave like an assertive consumer and take a list of all the questions you want answered. They are providing a service you are paying for at a vulnerable time of your life.
You might consider going abroad, either because the supply of sperm or eggs in your local clinic is poor or the waiting list is long, or because the choices seem preferable. Remember that what is true for one clinic may not be true for another. It is worth checking with other clinics, or giving us a ring at the office, to see whether waiting times are shorter elsewhere. Often there are clinics in the UK that can offer short waiting times, with the advantage of staying in the UK for treatment. There is no one body that can give information about the standards and success rates in overseas clinics. Some countries have regulatory bodies and others do not. Most overseas clinics have doctors and staff who speak English but information, particularly independent information, may only be available in the local language. It may be worth trying to get some information from the local infertility patient organisation. See our guidance document on Donor Conception Treatment outside the UK for an overview of the issues to consider when planning treatment abroad.
What can help when choosing a clinic:
- Contacting Infertility Network UK to find out what funding is available in your area -http://www.infertilitynetworkuk.com/FundingforFertility/?id=52
- Checking out the Human Fertilisation and Embryology site www.hfea.gov.uk and then contact the clinics that interest you. Have a pre-prepared list of questions for the donor co-ordinator
- Talking with others who have made these decisions before you. Forums like the one on this site for DCN members or www.Fertilityfriends.co.uk are a quick way of getting unofficial information and impressions from others. Remember that these are individual experiences and views, and you may find it different when you get there.
- Making a spreadsheet to record clinics you have contacted and information they have provided can be a useful tool for keeping things clear.
Most clinics offer a choice of treatments which can be ranked in order of complexity, with the simplest unmedicated DI or IUI at one extreme, and high dose medicated IVF with ICSI, and egg donation, egg sharing or embryo donation at the other. Many will only offer some of these options, but you should be allowed to choose to start at a moderate level of intervention before upping the stakes if you don’t succeed, or to go straight to the top level if that’s what you prefer. At all stages, the risks and the pricing should be clearly explained, including all the extras and options. If you need donated eggs, you can consider the option of egg-sharing or embryo donation, which are not available everywhere. The clinic staff should be willing to discuss all the options so you can make an informed choice.
Choosing a donor
UK clinics have varying supplies of egg, sperm & embryos: some have been successful at recruiting as many donors as they need, and others no longer recruit their own donors. Most UK clinics have arrangements to import sperm and eggs from abroad, or they might have links with a clinic abroad where you would go for part or all of the procedure. There are varying categories of donors, the main being as follows:
Anonymous donors: these donors have been promised that the recipients and their offspring will never be given identifying information. This is no longer allowed in the UK, but is an option in the USA and the rule in many other countries
ID release donors: ID release donors are those whose identifying details will be released at a certain age to the offspring. This is now the law in the UK, with 18 being the age at which the offspring have a right to the identifying information. It is important to note here that this information does not guarantee that the donors can be found, as they may have moved, maybe abroad, or even no longer be alive. There can’t be any guarantee that they will be available or willing to meet your child. Any egg or sperm imported to the UK must meet UK legal requirements, so the donors will also have agreed for their details to be released.
Known donors: a known donor is someone whom you may have known for some time, or met with the intention of using as a donor. It is important in these situations to familiarise yourself with the legalities, as the courts will generally give precedence to the child’s right to contact with both parents, and a known donor, unless they have used the clinical process, will have the status of parent whether they are on the birth certificate or not. Any agreement you prepare beforehand will not be accepted as signing away your child’s rights.
Family donors: this is where a family member donates their gametes. In the case of single women it would usually be a sister, cousin or niece donating her eggs. These arrangements can provide a happy compromise when everyone is well prepared and supported.
Egg-share donors: some clinics will offer younger women the option of donating some of their eggs in exchange for reduced charges or free fertility treatment.
Donated embryos: donated embryos are usually embryos that have been frozen when too many were produced in one cycle of treatment. At a later date, the parents decide they will not be using them to increase their own family, and opt to donate them. In this situation, your child might later discover that they have full genetic siblings.
Altruistic donors: this is the term used for egg donors who are not going through a cycle of treatment themselves . In the UK, eggs donors are compensated to the tune of £750, and sperm donors at £35 per donation. Iimported gametes should also meet this requirement but this is hard to police. If you are going abroad, the providers of sperm or eggs may have been paid significant sums of money, which bears two risks: it may entice the donor to exaggerate their desirability (e.g. education & achievement) or minimise their flaws (e.g.family illness), or it may encourage vulnerable people to donate when they do not fully accept the implications of their action e.g. young women donating eggs without taking heed of the risks of the treatment.