You alone decide, but you are not alone in informing your decision.
I've been writing a lot for clinics recently and I owe a lot more content to you, especially when you have big choices to make about which fertility specialist you're going to see. It's not an easy decision and it's not one a referring doctor or even a close friend can make for you. The choice is yours. This is the value that I've proposed all along; help practices improve so they can attract more patients and help patients be wise and clear with their decisions so that practices have to continually improve. Though I haven't created much content for you in the last several weeks, I have been doing a lot of listening. I really appreciate the feedback you've given me on Instagram about how you found your fertility clinic and what factored in to your decision making process.
Frequently, people choose their reproductive endocrinologist (RE) because he or she was the closest to home, their OB referred them, or they were recommended by a friend. Maybe you put a lot of consideration into the matter. Maybe you didn't even realize how much of a choice you had. Sometimes, that turns out just fine; the closest RE might be absolutely incredible. In other cases, people really wish they had chosen someone else.
May the best doc win
All fertility doctors are brilliant. There are only about 1,300 board certified REs in the entire country. They go through four years of medical school, four years of OBGYN residency, and three years of REI fellowship. Then they get to take the hardest exams of their lives. Including undergraduate studies, that's fifteen years of higher education and training! There's not a dumb one in the bunch is what I'm saying here. Still, that doesn't mean they're all the same. REs are people. Like chefs, boyfriends, contractors, break dancers, and internet marketers...some are just plain better than others.
Some are better surgeons, some are more personable, and some have better staff. I believe I've done more research on fertility reviews than anyone. People leave their opinions based on a number of factors. First, it's true that people are far more likely to leave positive reviews if they've become pregnant and far more likely to leave negative ones if they have not. You should be aware of this skew, because you would expect it to influence a doctor's rating. Somehow, however, there are a few dozen REs and practices in the United States and Canada who each have very few complaints and dozens of glowing reviews. How? There is no such thing as a fertility practice with anywhere close to a 100% success rate. It suggests that there are some all-stars who simply provide a better overall experience.
Having read thousands of fertility doctor reviews, spoken to hundreds of people who have struggled with infertility, and met at least a few dozen REs in person, I discern my own very unscientific conclusion. 20% of fertility doctors over-deliver in nearly every aspect of the care experience, 20% are absolutely atrocious with patient relations, and maybe 60% fall somewhere in the middle. I feel as though many in this majority are good, honest physicians whose practice experience may vary from patient to patient because they haven't quite been able to embed that outstanding service into every facet of their operation.
I've told you before that fertility treatment is a business. I don't say this disparagingly, I love meritocracy. Even if you live in a state or province like Massachusetts or Ontario, it's still likely that you will be paying something out of pocket. You still have a choice of who receives your reimbursement. The value that I can provide to you is helping you utilize your leverage in your business relationship. We want the best REs and fertility clinics to be booked solid. The people who go above and beyond to deliver a better care experience deserve to make more money than those who do not. I really believe that. Those that stubbornly ignore patient feedback and don't invest in patient relations aren't entitled to stay in business. Let's cut our losses with the bottom 20% in patient satisfaction, I don't think we can change them. When we see 20 of 28 reviews describe a fertility doctor as someone who "just wants your money," this suggest that this person just doesn't get it. So the question becomes, how do we impact the 60% majority to improve the overall standard of care?
vote with your feet
Let's start with the most highly rated REs, the ones people "can't thank enough." They have very few complaints and a great many compliments. These doctors are early adopters and innovators of a better care experience. They super-serve you because they are fascinated by exceptional care, or because compassion is simply one of their signature personality traits. The Diffusion of Innovation Theory asserts that the majority "needs to see evidence that an innovation works before they are willing to adopt it." In fertility terms, practices will invest more in individual attention, responsiveness, and empowerment when they see how excellent service boosts their competitors' top line.
You may live in a remote area where you really don't have more than once choice. That's a sad truth for many, and one we can only change with broader awareness of infertility and advocacy for better access to care. For everyone else, you don't have to choose someone just because your OBGYN referred them to you. You have several ways of exploring your choices.
1). Look at the clinic's success rates
Every fertility clinic in the country has to report their success rates to the Center for Disease Control (CDC). The Society for Assisted Reproductive Technology (SART) also requires its member clinics to report their IVF success rates. SART says that their data shouldn't be used to compare centers because patient populations may vary from clinic to clinic. That makes sense if the goal is statistical purity. Your goal, however, is to have a baby and some clinics have as much as double the success rate of others. You should be comfortable with a clinic's success rates before you decide on them.
Note: You should also reflect on how important this clinical metric is to your overall experience. In a brief report I conducted on people coping with infertility, slightly more than half said that extraordinary success rates with an awful bedside manor were more preferred than a compassionate, personable team whose success rates are well within the standard of care. There isn't a wrong decision here. It's your money and your emotional energy. You may be able to find the best of both worlds, but you should decide which is the greater priority so you know what you're looking for.
2). Check their online reviews
Vetting a fertility center by their online reviews is an absolute must, even if you were referred by a close friend. Think of it this way. Do you hate your friend's favorite restaurant? Imagine describing that restaurant to a third person. If the new person only heard about the restaurant from your friend, it would seem like the obvious choice. It's only when the newcomer has additional opinions to consider that her judgement is balanced. I've written in detail about how to use reviews to choose your fertility center because the more experiences you have to consider, the more whole your preview of the clinic will be. In addition to the platforms I've recommended before, a new site has caught my eye. Fertility IQ shows how patients rate their doctors on communication, response time, and even if they felt like they were treated like a number or a human. Patients answer qualitative questions about their experience and they rate the clinic on nursing, billing, atmosphere, and more. At this time, the site has too few responses to be able to adequately judge most doctors and practices, but keep it on your radar, because I think it will provide a tremendous amount of value to prospective patients. If you have already seen a fertility specialist, it would really help the community to leave a review there.
3). Press your OBGYN
Maybe your OB knows the RE that she is referring you to very well. Maybe she's never even met him. Ask. Inquire about what opinions she has heard from her returning patients. Once patients finish with fertility treatment, they return to their OB, so your doctor should have plenty of feedback regarding the RE.
- Were the patients delighted with their experience?
- Were they disappointed?
- What other REs would she consider referring you to?
- What have patients said about them?
- Why does she recommend that RE as opposed to others?
People sometimes tell me that they were really disappointed with the RE or clinic that their doctor referred. Make sure your OB knows if you weren't satisfied with your experience. REs aren't entitled to referrals and your doctor should be informed to protect her patients' best interests.
4). Ask people in your support group
There are hundreds of infertility support groups out there; independent groups, faith-based groups, ones led my mental health professionals, and those that are peer-led. If there is a RESOLVE support group in your area (or a Fertility Matters group in Canada), you should visit one of their meetings before you even choose a fertility center. These are people who have faced the same challenges you face. They have felt the same loneliness, the same longing, the crushing disappointment, and the financial hardship. Most of them have already been to a fertility specialist. Tapping in to their collective knowledge will help you learn from their wins and avoid duplicating their regrets. They also have a good idea of how proactive the practice is in empowering patients to find support resources. You don't want to be left to fend for yourself when it comes to finding community and professional support.
5). Talk to people on social media
The #infertility hashtag has been posted more than 143,000 times on Instagram alone. There is a vibrant #ttc (trying to conceive) community on Facebook and Pinterest as well. On Instagram, I often see people from the same city discussing their experience at their fertility center. Take advantage of their knowledge. You can send private messages to people who have left reviews on Facebook and Yelp. Reach out to those who have left negative and positive reviews. Talk to as many people as you feel gives you an accurate picture of what is important to you.
The choice is yours
We don't live in 1981 when the first IVF cycle was performed in the United States. Back then, your only option to find a fertility specialist would have been from a referral from your doctor. Today, you have so many options at your disposal to make the best decision. You are going to let a very important person play a role in a very delicate part of your life and you will most likely spend thousands of dollars of your own money. A fertility practice isn't entitled to your money or your emotional energy just because one doctor referred them. You deserve the best attention, considering what you are putting into it, and frankly, fertility clinics with a better patient experience deserve to do better than those who ignore what their patients want and need. If you have already been to a fertility practice or have undergone treatment, I hope you share your experience in detail with anyone who is considering the same.