Don’t do IVF at a University!

IVF at a University? Bad Idea

In vitro fertilization is a very emotional and scary time for people who just want to be parents. The deep yearning for a child can stir up feelings of self-doubt and fear of failure. Concern about the high cost of procedures that have no guarantee adds to the worries. Future parents just want to go to a place where they believe it will be successful. They want to make the best choice. Universities seem like a safe bet because, well, they’re houses of learning. The truth is they typically are not your best programs and a closer examination is warranted. You really should put some time into choosing the right place for you.

Many are drawn to the “Ivory Tower” or university programs because they believe that there is something superior happening there. I’m writing this blog to let you know that that just is not the case. In fact, most times they are significantly less successful at IVF than small, privately run IVF programs. I want to explain and try to convince you that the University should not be your-first-choice and the desire to go there is misguided.

This blog, exposing the weakness of university programs has been long in coming. I have held back because of any number of reasons. However, an incident occurred this week with a patient of our clinic who recently interacted with a university program that has set me off. I have bitten my tongue for too long and I think I have a duty and responsibility to inform patients why you shouldn’t undergo IVF cycles at a university-based program. At the end of this blog, I will let you know what set me off. That incident truly illustrates what I am trying to prove here.

You should not choose university IVF programs because they just aren’t as successful as smaller, private IVF programs.  The data from the Center for Disease control supports that statement. Also, the patient experience that patients have at a University clinic is usually far inferior to that of a private clinic.

The belief that universities do IVF better is based on the assumption that in vitro fertilization is a high-tech, extremely sophisticated process that is best done at a research center. That just isn’t true. To prove my point, please go to an independent website such as WWW.Fertilitysuccessrates.com. This site, like others, goes through the CDC-Center of Disease Control data and ranks every program in the country. All programs must submit their data to the CDC. You will see that there are very few university programs in the top 25. The few university programs that are there have almost all been spun off the University campus and function like independent programs. Why? The answer is obvious. IVF is a very straightforward process that is best delivered in a warm and friendly, caring environment. It is not rocket science to keep it straightforward. Just think, most doctors would not recommend that you have your appendix or gallbladder removed at a major university hospital. I’d rather not mention all the things that could go wrong in that setting during such simple procedure. On the other hand, I will admit, if you needed a heart-lung transplant then there is no place better than a university. But IVF is an uncomplicated process that requires individual, personalized care to be most effective.

IVF is performed around the world and even in Third World countries. It is so common that 2% of all the babies born in the USA last year were from IVF cycles. You should know that IVF on animals is performed in the back of a pickup truck. (The FDA will never let that happen on humans!). The University offers no advantage to the typical couple who needs IVF-ICSI-PGS or any of the alphabet soup procedures we offer. The fact is most labs and doctors are quite competent at these basic procedures.

So why are university clinics generally less successful? One thought is that the doctors who have stayed behind after training to practice at a University have multiple agendas. Most must conduct research either in the lab or clinical studies. They also have teaching responsibilities to students. These doctors, protected by their tenure have absolutely no need or desire to win a personality contest. Bedside manner is not a priority. Not only doctors, many nurses are tenured and cannot be let go or fired. Patients will typically meet a doctor at University clinic just one time and then be handed over to the nurses or even maybe even…trainees. The bewildered, emotional couples often do not even know who they will see when they go in for a visit. In my opinion, a private clinic where patients see the same doctor and staff every time they arrive is much better suited to calm, reassure, and guide patients through the stressful process.

Smaller personable clinics offer better continuity of care. At our clinic, I personally perform all the ultrasounds in the office. This gives me a huge advantage over a large university clinic where the doctor gets a written report at the end of the day when they are rushing home. I know in real time what is happening to the ovaries and uterus. I make decisions in a timely fashion that affect care. Doing my own scans allows me to get to know my patients and can address their worries and concerns as they pop up. The whole process is less stressful when the same people continuously take care of you.

It is very hard to measure stress. One way is the use of questionnaires and another is to measure metabolites in urine. But, it doesn’t take a university professor to point out how important stress is to the process. Any woman who saw her menstrual cycle change while studying for final exams knows what stress can do to her hormones. It has been shown that the fertility rates drop with animals and even amoebas if you change the temperature, introduce loud noises, etc.

So how do you pick a program? Choose a program that has excellent success rates (the information is available at third-party websites) and then go to the social media to find the private clinics have warm and caring people. Read the reviews of former patients. I would also add to find a program that is fairly priced, but I will admit I am biased. I personally believe that fertility care should be moderately priced as possible and not represent a financial windfall to the doctors in Reproductive Medicine.  At the end of the day, programs that charge abusively high fees, well, it gives you a clue to the character of the people running the place. We are helping people make families here, not performing artistic plastic surgery. Keep it affordable as possible.

If you are curious as to why I finally wrote this blog then read on.  An established patient showed up this week and told me this story.

The woman had undergone one round of fresh IVF with Fertility partnership. Saint Peters, Missouri.  We collected 15 mature eggs, M2 oocytes, and made 11 beautiful, day five blastocyst embryos. ( for those who do not know that is an excellent blastocyst formation ratio). We did a Single Embryo Transfer, SET, and she gave birth to a beautiful baby boy two years ago. She has 10 more, day five embryos in storage with us. She is ready for baby #2 but her insurance changed and they told her she had to go to the University program. She would need to have the embryos shipped from us to the University program. The University Clinic doctor, who shall remain nameless, informed our patient that “they don’t accept embryos from our clinic because they never had any luck with them”. She would need to go through another fresh cycle to make even more embryos. Needless to say, the patient called the insurance company who finally agreed to cover costs with us. She came back.

I was dumbstruck. What a horrible thing to say and do to a patient. It is wrong on so many levels. With 10 stored embryos that have a successful pregnancy, there are several options. For example, they could have offered her to PGS, or genetically test them. By making her do a new, fresh round of IVF they add cost, were needles time and effort, and also create a dilemma as to what to do with the embryos stored with us.  It is just cruel and callous and I can’t even imagine what kind of frail personality could have generated such a comment.

Perhaps the funniest thing about the whole thing is that our clinic, Fertility Partnership, has never, during our entire nine years of existence, sent that University program a single embryo. So, it was also a barefaced lie.  What is also funny is that our lab director was hired to teach other programs by the very same company that makes the special fluid or media for rapid freezing/vitrification. Our lab director actually taught that University program’s laboratory how to freeze/vitrify embryos. That is just funny that doctor tried to suggest our lab has issues freezing embryos.

So what was the motivation of that university physician to be so cruel and dishonest to that innocent patient? I’m going to leave that question open and let levelheaded people figure it out.

In conclusion, there is absolutely nothing in a university program that is inherently superior to that of any other program that is not in an academic center. I would argue that the affiliation of a clinic to a university may be to the detriment of patients. That’s why the most successful university programs have had themselves spun off so they can be, or try to be, warm and caring like us.