Further Thoughts on Choosing a Fertility Clinic

03:00 13th February 2014 | Accredited IVF Centre

Quality Mangement IVF Treatment Ovarian Stimulation Protocol Maintainance Laboratory Media Incubators Room Temperature VOC Egg Collection Follicular Fluid HFEA Reproductive Medicine IVF Specialists Biological Science Obstetrician Gyneacologist Professional Body

What does quality management mean to you?
Quality management ensures that the IVF treatment that you receive is good enough to provide you with your best chance of getting pregnant. It means;

  • Your egg yield for IVF is optimal. Ovarian stimulation protocols are tailored to the selected patient’s parameters to assure adequate egg yield, adequacy being a function of the quality and quantity of the eggs, at egg collection.
  • The handling of your gametes is assured and controlled to deliver the best embryos by maintenance of optimal condition of temperature for the laboratory media; the work stations, incubators and the overall room temperature. Other complex systems include the eradication of volatile organic compounds (VOCs) which are toxic to the embryos, maintaining the pH of the laboratory by assuring the quality of the CO2 used to name a few.
  • There is no risk of gamete mix-up
  • Quality management of the processes in theatre mandate that the environment within theatre simulate the conditions within the body. To achieve this, the egg collection procedure must be brisk and the follicular fluid stored in a hot block; the temperature of the hot block must be between 36.5 to 37.5 degrees centigrade, and the transit time of the collected eggs to the laboratory must be short so that the temperature is maintained optimally.

Experience and expertise
In choosing your IVF clinic it is particularly important to investigate the experience of the clinic as evidenced by their track record as well as the expertise of personnel as evidenced by their competencies. In developed countries couples investigating IVF clinics have access to their track record of success rates via league tables.

Most regulatory bodies, for example the Human Fertilisation and Embryology Authority (HFEA) in the United Kingdom, publish these data on their websites with emphasis on the fact that the under listed information should be considered in line with other parameters;

  • Whether the clinic’s success rate is above, below or consistent with the national average across all clinics in the country
  • The actual number of treatment cycles a clinic carried out and how many of those resulted in a live birth
  • The predicted chance of a woman having a live birth if she is treated at this clinic

The track record of a clinic becomes particularly relevant as one can holistically review the service offerings of the clinic being considered with respect to the patients diagnoses; the average age of patients treated and the average duration of infertility and make associations with their success rates as a centre. Unfortunately these systems do not exist in developing countries like Nigeria and there are no clear systems for regulation of IVF practices or practitioners. The responsibility is then on each clinic to present itself credibly to prospective patients. Options include the ratification of the clinic’s results by a credible auditing firm, with expertise in auditing healthcare institutions or as part of inspection reports by an international accreditation body.

The expertise of the personnel in the fertility clinic should be of utmost importance to a couple when choosing a clinic. IVF, with its high dependence on technology and cutting edge research, requires that the personnel delivering service are highly trained and retrained.  There are no programmes in our tertiary systems in Nigeria that train people, on a technical level, in Reproductive Medicine and IVF specialists in Nigeria largely learn on the job. That said, the centre is mandated to invest in training and retraining of its personnel by affiliations with organisations which can provide this expertise. The person responsible for the fertility clinic should possess the relevant academic qualifications in the field of medical or biological sciences from a recognised tertiary institution as well as a minimum of two (2) years of practical experience in reproductive medicine. He or she would be responsible for ensuring that proper equipment is used in the unit; that arrangements exist for the storage of human gametes and human embryos as well their disposal should the need arise, that the clinic operates according to laid down protocols in a suitable premises, that patient records are protected, that the clinic operates within the moral and ethical frameworks of the society and ultimately be responsible for the establishment and implementation of an accredited quality management system. To achieve these, the person responsible must have demonstrated integrity and possess the managerial authority and capabilities for the execution of his duties.
Furthermore there must be established relationships between the responsible person and external specialists to assure professionalism in the management of the clinic. The clinic should have a sufficient number if medical, nursing, embryology and counselling personnel in its operational team who should have relevant academic qualifications from recognised institutions of learning, registration with the relevant professional bodies and be proficient in their areas of responsibility. They should be trained as well as regularly updated as dictated by procedural changes and advancements in their field and must be able to demonstrate up-to-date awareness of new and emerging trends in their field.

The clinic should have a designate with overall clinical responsibility who should be a registered Obstetrician and Gynaecologist with an award upon completion of his training from a recognised professional body.

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