A Boom for In Vitro Fertilization Programs

A decade ago, there were just two in vitro fertilization programs in the United States to help infertile couples conceive. Today, the American Fertility Society reports there are 192 IVF programs across the nation.

But nowhere, says the society, is the baby-making boom bigger than in Southern California, home to at least 18 IVF centers, most based in hospitals or universities.

“If you’re suffering from infertility, this is the place to be,” said David Hill, laboratory director of the Center for Reproductive Medicine at Century City Hospital.

But with the multitude of choices comes a dilemma: how to select the best center?

Often, patients are sent to a particular center by a gynecologist, usually when a couple has not conceived after a year of intercourse without birth control. Sometimes, couples search for a center on their own.

Either way, experts agree, couples should prepare themselves for the search as seriously as they would prepare for parenthood.

To make an informed choice, couples should ask many questions about the programs they are considering. Here are some basic ones to ask:

* What are the qualifications of the physicians? “The ideal is to see a board-certified reproductive endocrinologist or someone with comparable training,” said Joyce Zeitz, spokeswoman for the American Fertility Society.

* Does the center devote full-time to fertility patients? “Timing can be vital in infertility treatment,” said Zeitz. “You want to be sure someone is available for you when you need a particular procedure.” It may be psychologically easier to go to a specialized fertility center, she added, since many infertile women may be uncomfortable sharing a waiting room with pregnant patients.

* What is the range of services? Most IVF centers offer a wide range of services, collectively known as assisted reproductive technology, or ART. In IVF, for instance, the egg and sperm are combined in the laboratory and incubated before the embryos are transferred into the woman’s uterus. In another procedure, GIFT (Gamete IntraFallopian Transfer) the eggs and sperm are transferred to the woman’s fallopian tube to allow fertilization to take place there.

* What is the success rate? Experts agree this is the trickiest question and consumers need to ask it very specifically--and in different ways.

Ask: What is the overall success rate? “The national delivery rate for the IVF technique is 12%,” said Zeitz. “Reproductively normal couples, in comparison, have a 30% chance of conceiving and carrying to term in a single cycle.”

Ask: “How many patients have you treated with my particular problem in my age group?,” Zeitz suggested. “What are their success rates?” Be aware that many factors influence success rates. A woman under 35, for example, whose partner has no fertility problems will probably do better than a woman over age 40 whose partner has sperm problems, Hill said. There is yet another way to ask about success rates, said Dr. Arthur Wisot, staff physician at the In Vitro Fertilization Center at South Bay Hospital, Redondo Beach, and co-author of “New Options for Fertility”: “How many pregnancies and live births have you achieved in how many tries over one year’s time?”

* Does the program include psychological support services? “This is an extremely stressful treatment,” said Wisot, “and the couple needs ongoing emotional support.”

* What are the fees? Cost is a factor, experts agree, especially since insurance often does not reimburse for costs of fertility treatments. But fees should not be the overriding factor in the selection process.

* Where is the center located? Consider how far the center is from work or home. “During the first few weeks, there are many tests and procedures,” said Hill. So, if two centers seem equally efficient, he suggests choosing the closer one.

Choosing an IVF center may one day be easier. Last month, Rep. Ron Wyden (D--Ore.) introduced legislation to regulate the nation’s IVF centers. His proposed Fertility Clinic Success Rate and Certification Act is under preliminary review, according to Wyden’s Washington office.