Closing In on a Clinic Choice

I feel like the choice of a clinic is being made for me, in that out of the four clinics I’m considering, only one can really accommodate my preferred timeline. It looks like I will be going with Stanford again for my next cycle. Here’s what happened with the other clinics:

• Nova IVF: as I mentioned in a previous post, they don’t have any appointments available for the rest of 2014. I went on a waiting list with them and sent in my registration materials. I emailed them some questions about the egg freezing program to try to figure out if it would be worth waiting, but have not received a response.
• FPNC (Fertility Physicians of Northern California): I have a consult set up for March. They have recently become part of the Palo Alto Medical Foundation (PAMF) and things seem to be changing a lot after the merger; the doctor I will be seeing in March is from PAMF and not from FPNC. I am a bit concerned about that because a big part of the reason I was interested in this clinic was their good SART statistics. I will now be seeing a doctor who didn’t contribute to those statistics, which I’m not so happy about.
• Zouves Fertility Center (ZFC): My consult was postponed AGAIN because my medical records STILL have not arrived from Stanford.

I have mixed feelings about going with Stanford again--it is easy, familiar, I like my doctor there, and I can start really soon. However Stanford’s success with regular IVF is well below the national average, and they don’t have much experience with turning frozen eggs into babies. I guess I am hoping that they will improve and gain experience with frozen eggs before I need to actually use the eggs! I can’t help but feel a little discouraged about it being so hard to complete research on all the clinics.

I am keeping my scheduled consults with other clinics because I may well do a third egg freezing cycle and so I will consider the other clinics for that future cycle.

SART Statistics and Egg Freezing

Every year, the CDC collects data from IVF clinics on the success rate of various ART (Assisted Reproductive Technology) procedures and reports that data on its website. The data is also reported on the SART (Society for Assisted Reproductive Technology) website in a format that may be easier to read. By comparing the reports for different clinics, you can see which have the highest success rates. SART warns that “Patient characteristics vary among programs; therefore, these data should not be used for comparing clinics,” but many people believe that in fact comparing success rates amongst clinics is a valid idea. You can also compare a clinic’s success rate against the national average to see if your clinic is above average or not. Carole Wegner points out in her “Finding a Good IVF Clinic” post, “I wouldn’t go to a worse than average clinic. Would you?”

The only problem for us egg freezers is that the CDC and SART don’t publish data on egg freezing. However we can still benefit from the reports. Common sense says that if you have a clinic that is great at other IVF procedures, they are more likely to be good at egg freezing than a clinic that is only mediocre at other IVF procedures.

In her “Finding a good egg freezing clinic” post, Wegner mentions finding a clinic that has a good success rate for regular IVF for the <35 age group. That would be “fresh embryos from non-donor oocytes” in SART language. But the reports also contain information on a couple of procedures that involve freezing and thawing: “thawed embryos from non-donor oocytes” and “thawed embryos from donor oocytes.” I wonder if looking at those numbers might be more meaningful for the case of egg freezing, because at least they have to do with freezing and thawing things--even if those things are embryos rather than eggs.

So here’s where things get confusing: of the four clinics I’m considering, the one that has the lowest success rate for transfers of fresh embryos has the highest success rate for transfers of frozen embryos. The one that has the second-highest success rate for transfers of fresh embryos has the lowest success rate for transfers of frozen embryos. How am I supposed to interpret this? If anyone has suggestions, please let me know in the comments!

Waiting for Clinics

Right now I am doing a lot of waiting for clinics. This is frustrating because I am in a hurry to get this egg freezing show on the road. Right now my job situation makes it pretty easy for me to take the time to freeze eggs, but that won’t necessarily be the case a few months down the road. So I want to get this done sooner rather than later.

• Nova IVF: They don’t have any appointments available for the next year (!). I went on the waiting list. So obviously Nova is not an option for anytime soon, but it could be attractive for another egg freezing cycle in the future because it is supposed to be a very good clinic. Nova has the highest rate of live births from regular IVF of the clinics I’m considering, which indicates that it is a good clinic in general, although I don’t yet know anything about their egg freezing statistics. (There are no nationally reported statistics on egg freezing but you can use the IVF statistics reported through SART to get an idea of if it is a good clinic overall. From Carole Wegner’s “Finding a good egg freezing clinic”: “Even though egg freezing is not tracked directly by the CDC, once you identify ART clinics that also provide egg freezing, you can check out their pregnancy and live birth rates using fresh eggs to get an idea about how good they are at routine IVF and by extension, suggest they might be good at egg freezing. Or put another way, having good IVF rates does not guarantee good egg freezing rates but being a below-average clinic for IVF does not lead one to expect exceptional egg freezing rates.”)
• Fertility Physicians of Northern California: I called to make an appointment but their new patient coordinator is out of the office, so I will have to wait until she returns to find out more information.
• Zouves Fertility Center: I was supposed to have the consultation today, but it has been postponed because my medical records from Stanford didn’t arrive in time.

So I am waiting for clinics. In the meantime, I am continuing with my supplement routine. I haven’t been as good about diet and exercise unfortunately.

I also just finished reading Sarah Elizabeth Richards’ Motherhood, Rescheduled: The New Frontier of Egg Freezing and the Women Who Tried It. It follows the stories of four women (including the author herself) who have frozen their eggs. It is a great read, I couldn’t put it down because I was so excited to see what would happen with each of the women in the end. I would definitely recommend this book if you are interested in egg freezing.

Choosing a Clinic

When I did my first egg freezing cycle, I did virtually no research before choosing a clinic. I went with the Stanford Fertility and Reproductive Medicine Center because it is close to where I live, and because it is affiliated with Stanford, I assumed it had to be excellent. I have no real complaints about the Stanford clinic, but I certainly didn’t do my due diligence when selecting it.

I recently found a great post on “Finding a good egg freezing clinic” on the Fertility Lab Insider blog and it contains a lot of good things to think about when selecting a clinic. I am currently in the process of deciding where to do my second egg freezing cycle, and that post is really helping me understand what kind of research I should be doing and how I can use SART statistics to inform my decision. It also has a great list of questions to ask the clinic.

I decided I should find out the answers to these questions for Stanford, even though I have already completed a cycle there. I contacted the clinic with the questions and received some answers in a voicemail (unfortunately I missed the call). Around 200 women have frozen their eggs at Stanford, but “very few” have come back to use the eggs. It was not clear in the message if any of those women who came back to use their eggs actually had babies. It sounds like there are no real clinic-specific statistics on the thaw survival rate, the fertilization rate, etc. The doctor said in the message that she “expects” the survival rate to be x, the fertilization rate to be y. But it sounded like she was quoting numbers from studies done elsewhere, not actual results from the Stanford clinic. This makes me a little nervous, because it sounds like Stanford doesn’t have much experience turning frozen eggs into actual babies.

However I did learn that Stanford now uses vitrification for freezing eggs. This was my #1 reason for not returning to Stanford for my second cycle; I had thought that Stanford used slow freezing. Now that I have learned that Stanford uses vitrification, I am considering returning there for my second cycle. The clinics I am considering:

• Fertility Physicians of Northern California
• Nova IVF
• Stanford Fertility and Reproductive Medicine Center
• Zouves Fertility Center