Which clinic to choose

[Sobiaa]

Hey ladies,

I hope you are all well. I’ve had 2 failed ivf cycles and we are going Priviate. I’m very confused on which clinic to choose.I’m based in London

Please message me privately

It would be really helpful.

[Carelia]

Hello Sonia, if you would like a short answer, go first and foremost with a clinic that offers a bundle from (“insurance”) providers like “Access Fertility”, as pricing through them is cheaper that the list pricing by clinics. (They now have a lot of negotiating power!) and then from their list you will then find the baseline of good clinics. The clinic’s location will be a factor so here is a list of ones which I have either used with positive experience or have friends who have used them with positive experience (even if no pregnancy)

1) CITY FERTILITY - a small but super flexible clinic (Farrington) with good stats and a clinic that offers bundles through “Access Fertility”. They do transfers at weekends (basic requirement) and as they are small, the whole staff will get to know you. You will not feel like a piece on a factory conveyor belt which will be the experience in list places. They also do the video of embryo development so you get a much better monitoring of the embryo quality vs without. The only negative is that they push hard on genetic testing with significant additional costs (which are not yet proven) but they do hear no if you say so. City’s pricing is also most competitive out of the central London clinics. Super responsive on email - which is rare with IVF clinics. Their stats are also good if you check them out on the regulator website vs others.

2) CARE (multiple locations) - I have tried to use these guys and have heard very positive feedback but their waiting lists cancelled them off for me more than once. Also do bundles through Access Fertility “, pricing is not the highest, transfers at weekend if needed and video of embryo development. They are also responsive!Their stats are also good if you check them out on the regulator website vs others.

3) LONDON WOMENS CLINIC (multiple locations) - very responsive and not the highest price. Great central London location options that best suit you (London Bridge or Harley Street). Do transfers at weekends, bundles with Access Fertility, and have the scale to respond to anything your case might throw at them. However, you are very much just a “body on a conveyor belt”, as you will also be at Lister (the most expensive and oh don’t they know it). Their stats are also good if you check them out on the regulator website vs others.

Then you have Boston place but their stats are actually quite poor (when compared to others on the regulator website) so that alongside their expensive pricing (even with bundles) cancelled them out (for me).

Lister (West London) is the most expensive and oh boy....they treat you really badly, a definition of “body on conveyor belt” and in their large scale they unfortunately are all about improving their stats vs what would be the best method for you. They do bundles and weekend transfers and monitor you like a hawk etc but in my view there is not a justification for the huge price difference . Example, they only do day 5 transfers....with zero day 3 transfers in their published stats?!?!....which is not always the best outcome for you but which is a way for them to boost their stats in front of the regulator/ public.

[Running79 in reply to Carelia]

It’s interesting what you say about the lister!

I’ve done 3 rounds with them 2 using my eggs and 1 with my younger sister as a donor.

I’ve always found it strange that by day 3 we’ve had about 5/6 embryos left but by day 5 it’s 2/3 - I’ve always been left wondering well what’s happened to the others, they just tell you they ‘hadn’t progressed’ or ‘dropped off’

Which by what your saying I could have actually had a day 3 transfer and the pregnancy may have been successful.

I would agree it’s a conveyor belt service, quite infuriating at times as they think you have all day to wait or sit around whilst they do stuff, you are very rarely seen at your appointment time and yes you are monitored like a hawk, which can be tiring especially if like us the hospital is an hour and 10 minutes away on a good day

[Carelia in reply to Running79]

Hi Running79!

The answer is a bit more nuanced

It is normal that there is a circa 50% reduction between day 3 embryos and day 5 embryos (or blastocysts) in vitro environment, so the stats you describe above are all ok and in line with what is considered normal.

There are two aspects to the "point about day 3 transfer" argument - which many clinics would not like to admit or discuss:

1) the body is a very good incubator and can be a better incubator than in vitro

If you are on day 3 and you have say 3 embryos (and we know there is a chance of 50% reduction by day 5), day 3 transfer is a viable option. Body is a good incubator. The counter that you hear is that the "embryos were not meant to be in the womb by day 3 but in the fallopian tubes, they are only there on day 5" but still.....body is proven to be a very good incubator, specially when we look at stats for women of 38-40 years and plus. It is your choice of transfer date so if you are in this situation, make a choice that feels right for you.

2) "Give each embryo a chance" - boost the possibility for you and your embryos, not for the clinic's stats!

Secondly, and specially if you are doing a bundle deal (such as with Access fertility) where the FET transfers don't cost you any more money: If you happen to transfer the embryo(s) that would not have made it to day 5 on your day 3, this makes no difference to you, you still have given yourself a (statistical) chance of getting a blastocyst to freeze on day 5 and a chance to do a FET transfer (which today have equal chance as per fresh transfers so FET is now a very good choice, if not a better option as your body is not confused by two types of drugs at the same time). From a clinic's point of view, this is extra cost however (hence they try to avoid) and it will make a dent on their stats (which they really want to avoid). It is a fault of the clinics and the regulator that today - unfortunately - the way the stats are measured, the clinics are incentivise clinics to "try to do as few transfers as possible per cycle"..... to boost their stats!!!!...this is NOT in your embryos best interest...think "give each embryo a chance"....here

If you have 5-6 embryos of more on day 3, the above also applies if you are doing a bundle. The clinic will want to wait until day 5 as that allows them to pic the very best to transfer, knowing that you are likely to have one or more blastocysts on the day. This is very understandable. However, if you want to maximise the chance for all your embryos, ....even for the ugly ducklings (...which have proven to become swans babies very often - embryos can correct themselves hugely between day 3 and day 5)...then you don't lose by doing a day 3 transfer. If you pick the best on day 3 and they turn out to nothing, you have even more to freeze on day 5.

The only negative for day 3 transfer - and this is one I must flag - is that there is a minimum grade of blastocyst that clinics freeze. They often don't want to talk about this but do press on knowing that grade before you start your in vitro treatment. It is usually below a grade of 2CC or thereabouts...Therefore, if you do day 3 transfer and then end up with blastocysts on day 5 which are good to transfer but not good for freezing...arg, this is a bummer. You have a lose-lose scenario.

In short...the decision between day 5 and day 3 transfer is super hard, and there are no 'right answers', but you need to be the one making it. To make it, ask them to grade each embryo for you on day 3 phonecall, write them down, discuss, don't rush yourself on the phone that morning and ask as many questions as you want, and if you need time, take 10min, and then make a choice. Your past embryo development history will play a huge part in this decision too. Ask them to send you that report with grading too, both on day 3 and day 5, and day 6 if there are blastocysts which still are in development.

One way to boost egg quality is changing medication. I switched from follitropin alpa (Gonal F, Bemfola) to follitropin delta (Rekovelle) and have had much better blastocysts at age 42 than when I was 40. Going from 2CCs to 4BBs. I don't have 'more' of them but just a better quality...

[Running79 in reply to Carelia]

Interesting! I’m 41 now - we were not told we could do 3 day transfers, nor were we given the choice!

Between cycles 1 and 2 we changed medication, and it resulted in 1 extra 5 day blast. All our embryos ranged from 3BBs to 5BB’s were told they were top quality. All the ones that’s transferred failed, I MC before 7 weeks on one and the other two failed to implant

The second go one failed to implant and the other two were PGTA tested which unfortunately were chromosomally abnormal.

So I learnt in the grand scheme of things, the embryologists opinion on grading meant absolutely nothing, they could be the best grade in the world and be completely useless - which unfortunately for us older ladies we have an incredibly slim majority to find a viable egg!!

That’s why my 30 yr old sister decided to donate her eggs. She had 3, 5 day blasts left, all suitable to be frozen.

The first one they’ve put back I’m 11 weeks + 1 - hoping to make it to the 12 week scan with all being good still

[Carelia in reply to Running79]

That is great news for getting to nearly 12 weeks, keeping my fingers crossed for you for a 'less bumpy ride' for this little one 💓

(Yes, I can imagine Lister would not 'even mention' about day 3 transfer, not part of their modus operandi as per note above.)

[Sobiaa]

Thank you Carelia for you respond.

I have already used LWC. They are good but I’m under 35 and need further Tests done.

Lister was definitely not on my mind.

Thank you for reply. I will look in to your suggestion.

[Hope_1234 in reply to Sobiaa]

Hi Sobiaa I'm with with LWC

I've recently had ERA/ NK cells test / immunology testing with them. They have an implantation clinic at London bridge (it's a new clinic and treatment they offer, I don't know if they had this when you used them)

The tests weren't to expensive and give me so much information of what I need to change for my next transfer

Im also under 35, I'm 32 😊x

[Jols]

Hi there, I personally wouldn't recommend IVI London, they are not thorough and they go ahead with whatever works for most people rather than studying what is best for each person. On the other hand I would highly recommend Zita West, above all if you have had past failures, as they really get to the bottom of things and tailor the treatment.

Good luck xx

[Sobiaa]

Thank you Jols for you message. I will look into zita west.

[JenRoy]

I’ve PM’d you. There’s so many excellent clinics in London. An Access Fertility plan may help financially but aren’t offered by all clinics.

I looked on the HFEA website and checked out all the London clinics. It’s important to look at each clinic’s statistics for your age group but interpret them carefully.

And it also depends on what the underlying cause of your infertility is. Different clinics specialise in different things eg older women, recurrent miscarriage etc.

We narrowed it down to five clinics and then looked into each one in more depth.

We paid for consultations for two of them and went with the one that we felt had the best approach for us.

We were really happy with our choice even though our cycle failed. We were treated well and given a lot more advice & answers.

[Hidden in reply to JenRoy]

If my 3 rounds of IUI don't work then I'm moving on to IVF. I'm currently with The LWC but I've not been too happy with the service I've received, especially as a newbie and solo parent. So I'd be looking for a better experience with a new clinic for IVF. Please can you PM me the name of your clinic.

[Sobiaa]

Thank you Jenroy for your message, I have messaged you aswell.

[vicky7752]

Hi Sobiaa, have you been thinking about IVF abroad? You can have a look at pragamedica.com/medical-tre...

[babycometrue]

Hi there I sent message to this Access Fertility for a program for me age 44 after reading your comments. Thank you for sharing. The Multi cycle is fresh only is it less successful than frozen for advanced age? Does it mean I should not use this Programs at all as I was thinking of choosing Frozen one.