Two years into treatment, I was writing an email to the CEO of our clinic’s parent company, laying out everything that had gone wrong, ready to walk away entirely. That’s not where you want to end up. Here’s what I wish we’d known to check before we ever picked a clinic in the first place.
It got that bad because of problems that piled up over time: the clinic didn’t let us reach the Dr. directly, forcing us through staff or an app, and the finance team kept messing up billing codes, which added financial stress on top of everything else. I truly believe that most of the stress I had with my wife back then about schedule, medical decisions, logistics etc. would be prevented if we picked a clinic that takes their patients seriously.
This experience was so bad that after two years with this clinic, we finally decided to move to another one. That decision was brutal on its own — it meant starting tests over and building trust with a whole new team from scratch, right on top of everything else we were already carrying, both medically and in our relationship: getting to know a new Dr. and team, how they worked, their schedules, all of it, from zero. As a last moment act, thinking about future patients of this clinic, I reached out to the CEO and COO of the clinic chain and shared our experience, hoping that they would improve it for the next patients. They were shocked to hear this and investigated with their team what happened. We learned from the executive that there were some problems before with this specific location and that our message was the last straw. They ended up asking us to stay and promised to improve the experience, plus a credit of $7,000 for the next IVF. We did it, and they improved every area that we had mentioned. It ended up being a good experience. I felt like the Kardashians every time we entered the clinic, not to mention the bouquet of flowers they sent multiple times during the IVF.
That’s the extreme version of what can go wrong, and also of what can turn around. But it’s exactly why I’m writing this: before any of it happened, we had no idea how crucial it is to make the right decision and what we should have been checking for in the first place.
When we started this process, we felt clueless about what we need to check when we pick the right fertility clinic for us. We had no idea what criteria should be important to us and how much variance there is between clinics. To make it even more complicated, the clinic you pick will dictate the Dr. options you can choose from and the teams around it — clinic team, finance, scheduling team, assistants etc. Those groups sound unimportant, but each of them might change your experience completely and add more stress and bureaucracy than they should. It’s worth mentioning that doctors who work for a clinic with bad staff and management will likely have a higher chance to move to another clinic — which will be annoying for you if you’re in the middle of a process with them. If you see a clinic with a high doctor turnover rate, there’s a high chance something isn’t going as expected there.
Many people pick the Dr. based on recommendations and, based on that, pick the clinic that works with this Dr. While it might be a good strategy if you know for sure the clinic is solid, this strategy might backfire on you over such a long journey with so many interactions with the team.
Now, you probably think to yourself, what’s the problem? If I decide to change my clinic I can do it anytime — and yes, you’re partially right. You can change it anytime, but it requires a lot of hassle, might delay your timeline, has some inherent risks if you need to transfer your embryos and something happens in the process, or you’re in the middle of a fertility process and have to stop it because the new fertility center has its own procedures and needs to run its own tests before continuing with your planned treatment. Not to mention it requires you to adapt to new ways of working, new websites, new teams. So it’s possible — but why not make the right decision in the first place?
There are a couple of important criteria to evaluate the clinic by:
Doctors
Picking the right Dr. who will be part of this journey is critical to your success. If they make the wrong decision, miss an observation, or lack experience with your case, they can mess up your health, the success of the fertility treatments, and in the worst case, have an irreversible impact on your ability to bring kids into the world.
There are many websites where you can find online reviews on US doctors — FertilityIQ is a dedicated fertility website with verified reviews on specific clinics and doctors. Yelp is another place where people review clinics, and often mention the specific doctor they worked with. It’s important to look for reviews with constructive feedback, not just the best ones. If the same specific piece of constructive feedback keeps coming up from different people, that’s a sign it might be a problem for you too. There’s a tendency for people who had a successful process to share only positive things, and those who didn’t succeed to share only bad ones. Try to find the balanced reviews, and the ones that mention specifics.
Another thing to note — the Dr.’s approach to your situation will make a difference. They need to be willing to try different protocols. If they don’t match your expectations and energy, don’t stay. Some of them come in with their own philosophy, and that’s fine as long as it doesn’t compromise your treatment. In our case, our Dr. recommended genetic testing on the embryos, called PGT-A, which we did in our first IVF. After consulting with other doctors, we decided to do our second IVF without PGT-A, and our Dr. was fine with that.
When we started the process, I didn’t imagine we’d get to IVF, let alone think about anything embryo-related. I learned later that was a mistake — with fertility treatment, you never know what will actually work or how far you’ll need to go, which is exactly why it’s worth asking about things like mosaic embryo transfer before you think you’ll need the answer. If IVF is already on the table for you, here’s what actually happens at each stage of a cycle.
Some clinics won’t transfer mosaic embryos — worth checking, because PGT-A testing sorts embryos into euploid (normal), aneuploid (abnormal, historically discarded), and mosaic (a mix of normal and abnormal cells). Mosaic embryos used to be discarded along with the aneuploid ones, but more recent data suggests some can still result in healthy births, so many clinics now offer them as a real, lower-priority option. Some labs don’t even report mosaicism as its own category, so you might never learn the option existed. And separately, some clinics won’t transfer mosaic embryos tested at a different clinic — possibly because a lower-odds transfer could drag down their own reported SART stats.
Questions to check:
- How many years of experience does your Dr. have? Do you feel like their energy and approach match what you’ll need during the process?
- Do they force PGT-A testing? Do they allow mosaic or aneuploid embryo transfers, including ones tested at a different clinic? (Many clinics won’t accept those from outside, probably because they fear impacting their SART stats.)
- Does the Dr. explain the reasoning behind protocol choices, or just run you through a standard cycle?
- Does the clinic do procedures every day, including weekends, or do they batch patients onto a shared schedule?
Nurses, Staff, and Communication (including finance)
It probably sounds like a joke. We never thought it would be a factor when we picked our clinic. But we learned the hard way that they have a crucial contribution to the success of the treatment. If one of the team members gives you the wrong guidance, schedules an appointment on the wrong date, or doesn’t share your questions with your Dr., you won’t make the right decisions. In our case, it was almost impossible to reach them when we had a question — we were told to only communicate through a third-party app that no one seemed to be improving. You couldn’t find old chats, every question opened a new thread, and there was no way for both my wife and me to be part of the same conversation with the Dr. When we directed a question to the Dr., her nurse answered instead, and the Dr. didn’t even know about our questions.
We also never got any written summaries or after-visit guidance from the team — isn’t that a must, when you barely remember to breathe during an appointment?
The finance team was also horrible. We had to beg to get receipts from the finance team so we could submit them to insurance, and when we got them, they were full of mistakes. Nightmare. I assume it’s not like this everywhere, but it’s something to pay attention to when you read online reviews.
One thing worth doing before you’re even a patient: pay attention to how they handle your very first appointment request. People are on their best behavior early on — if scheduling a first visit is already slow or disorganized, that’s a preview, not an exception.
Questions to check:
- How can you communicate with them, and does the channel actually work for both partners, not just whoever’s the patient?
- Do they send a written summary after appointments, so you’re not relying on memory?
- Do they answer the phone over the weekend?
- Are they organized and communicative?
Fertility clinic location
No one talks about this one enough. It’s one thing to drive once or twice when you meet with the Dr., but if you have to go there almost every week for a couple of months, long drives get very annoying, especially during a tense time when you just want to get to the clinic and get it over with. Also, for last-minute appointments, it’s nicer to be able to get there quickly.
If you have a medical condition that increases the odds of last-minute visits, I’d prioritize location.
Questions to check:
- How does the drive hold up weekly, not just occasionally, especially during the most stressful stretches?
- If you have a condition that raises the odds of last-minute visits, does the distance still work?
- If the clinic has multiple locations, is the closer one the same quality, or a lesser satellite office?
Costs
Each clinic has different costs for different treatments, and it’s hard to compare. In many cases, people don’t compare costs at all, since they don’t know going in that they’ll need multiple IVFs or anything like that. The problem is you can find yourself very quickly spending tens of thousands of dollars on different tests and treatments.
Unless you are the Kardashians, I’d suggest asking questions up front about the pricing of major tests and treatments (IUI, IVF, etc.) — the worst thing that can happen is being surprised by costs you didn’t prepare for while already financially stressed.
Even if your employer has fertility benefits or a certain budget covered, make sure the clinic and Dr. are actually in network so you don’t end up paying out of pocket. Some people assume that employer coverage like Carrot means everything’s covered — that’s not always true. Coverage isn’t always total, and some treatments can even fall into a taxable reimbursement bucket. Side note: even with fertility coverage, you’ll be surprised how quickly it gets exhausted and you start paying out of pocket. One IVF in the Bay Area can easily cost ~$20K (not including tests, medicine, and other costs) — for the full dollar-by-dollar breakdown and how the tax and coverage side actually works, see What Fertility Treatment Actually Costs, and Where the Money Actually Goes.
Additionally, if the finance team makes mistakes with billing codes and you don’t catch it, you can end up paying thousands of dollars for treatments that never happened, or a price you never agreed to. Some clinics have a financial advisor, and some people recommend speaking to them. We never used it, since we didn’t trust the clinic enough to bother.
If fertility costs are out of reach where you are, it’s worth considering care in a different state or a different country — some states legally mandate fertility insurance coverage where others don’t, which can matter more than going abroad. I read about Greece, Turkey, and Mexico as international options, but can’t speak to them from experience. When we looked into going abroad ourselves, the financial savings weren’t enough to justify the long time off work and the logistics of managing frozen embryos afterward.
Questions to check:
- Does the clinic require payment upfront?
- How can you communicate with the finance team?
- How quickly do they send receipts?
- Are they in network?
- Do they have a financial advisor?
Lab
Since they’re not patient-facing, I had no idea the lab had such a big contribution to IVF success when we started. I didn’t know that in most cases they’re a different entity from the clinic itself. The quality of their work directly impacts the success of the treatment. Some clinics have much better success rates than others, largely due to an experienced embryology team and better technology.
Questions to check:
- Is the lab CAP-accredited (College of American Pathologists)? You can check the public directory yourself rather than take their word for it.
- What kind of incubators do they use — continuous monitoring/time-lapse, or older models where embryos have to be removed to check on them?
- How long has the lead embryologist been at this lab specifically?
Talk to people
No one tells you this, but I heard so many things about different clinics only once I told our best friends we were doing IVF and had a bad experience with this one. It turned out they’d already heard stories about that clinic. You don’t need to tell people who don’t already know. But if they already know, it’s worth asking if they’ve heard anything about the clinics you’re considering.
Statistics
Many people will tell you to look at the clinic’s statistics. I don’t trust most of the statistics clinics show me. As a numbers guy, I know how easy it is to manipulate numbers. On top of that, the numbers that should matter to you are the ones for your specific characteristics — age, medical condition, etc. — and those are hard to find.
In the US, there are two main sources of data: the CDC and the Society for Assisted Reproductive Technology (SART). I’ve read in forums that people find SART more useful, but we’ve never used it ourselves.
Questions to check:
- Ask for stats specific to your age and diagnosis, not the clinic’s blended average.
- Ask whether a quoted rate is live births or just pregnancies — those get conflated constantly and mean very different things.
If you’ve never had to navigate the US healthcare system for something like a chronic illness before, budget time — to read up here and in other forums, or even hire a dedicated IVF coach — to learn how to advocate for yourself. This is one of the most bureaucratic, highest-stakes systems you’ll deal with, and the clinic you pick is the single biggest lever you have over how hard that fight is.
This is one piece of a bigger picture — for the fuller retrospective, see What I Wish I Understood Before I Stepped Into a Fertility Clinic.