I choo-choo-choose you!

It turns out that choosing a donor egg clinic overseas is a lot like internet dating for your uterus.  You spend a lot of time browsing through profiles online, looking for features you want and filtering out the ones you don't.  Outdoorsy?  Yes.  Gainfully employed?  Yes and yes!  Ugh, is that a shirtless photo?  He's probably a douchebag.  Wait, there's a photo of him posing in front of his sportscar.  DEFINITELY a douchebag.

I rest my case.

In our case, looking at basic criteria online proved to be pretty useless.  For instance, price for DEIVF in the Czech Republic is pretty standard across the board.  You can do it a bit cheaper in smaller cities like Brno or Zlin, but since we'd be flying into Prague (and spending the five days between fertilization and transfer there sightseeing) we'd just end up using what we saved on the procedure for extra travel.  One thing I did find to be key here was looking at exactly what was included in the price of treatment.  Some clinics offered a lower base cost, but stuff like ICSI, assisted hatching or extended cultivation were extra.  I tended to prefer the clinics that didn't mess around and had an all-in price for everything you need.

Success rates also proved to be a bit of a red herring, since pretty much every single clinic advertised a DE clinical pregnancy rate around 60 to 65%.  Ongoing pregnancy rates (based on fetal heartbeat) were generally in the 50% range, which makes sense considering that even young, healthy women have roughly a 20% chance of miscarriage.  Obviously there were small differences of a percent here or there, but not enough to make any one clinic stand out to us as really good or really bad.  The numbers were also on par with US clinics, which was a comfort as well.

Things started to fall into place when we began looking at the guarantee programs.  Unfortunately, Czech clinics don't offer US-style "live birth in X cycles or your money back" guarantees.  They do however guarantee at least 6 eggs retrieved, with 2 high-quality embryos to transfer.  If this doesn't happen for any reason, they will do a new cycle for free.  Some clinics go further and will offer you free or discounted future cycles if you are not pregnant after a few tries.  This was a big attraction for me, since only clinics that have high success rates will risk losing money by giving away a cycle based on this guarantee.  However, this is also where reading the fine print became important, because not everyone's definition of success was the same.  One clinic would have considered "pregnant" to be a positive HCG test!  Sorry kids, but I've had one of those and that's just not gonna cut it.

After a lot of reading I settled on a few contenders and reached out via email.  All of them got back to me very quickly (using excellent English) and asked me to fill out some forms with basic info about ourselves and our infertility history.  There was some back and forth with questions about guarantee programs, drug protocols and waiting times.  Then, we got asked on a date.  A Skype date, that is.

The first clinic to offer us a Skype consult did so very quickly.  It felt kind of rushed, like that guy you meet on Lavalife (I'm totally dating myself here) who asks for your number in his first email.  Being newbies, we accepted, and like most first dates, it was a bit disastrous.

Because the Czech Republic is 6 hours ahead of us and we wanted to avoid arranging a Skype consult during midday at work, we scheduled something in the early morning before we left for the office.  On the appointed day we dragged ourselves out of bed super early, got ready for work and then sat nervously before the computer, waiting for our 6am call.  When it came, we could see the RE....but we couldn't hear him.  He could hear us, apparently, so I told him that there was obviously a technical issue.  After much fiddling around, him mouthing what I assume was "can you hear me now?" and me shrugging, we agreed (through text messaging) to sign off and try again the next day. 

Perhaps it was a result of rousing ourselves at an ungodly hour for a second day in a row, but we both felt that the consult itself was underwhelming.  While the RE seemed very nice, he didn't really do much beyond tell us what we already knew about his clinic and then asked if we had questions.  I asked a little bit about donor selection and timing, but started to get a little concerned when he talked about their usual "morula transfer".  For whatever reason, this clinic does primarily Day 4 transfers which seemed a bit odd to me, and suggestive that their lab was maybe not good enough to get an embryo all the way to Day 5.  Both M and I agreed afterwards to keep looking, but did think it was pretty cute when the RE translated birth control as "anti-baby pills". 

Our second Skype consult with the next clinic went much better.  The RE had clearly read my file and actually started off discussing the fact that with my age and average number of eggs retrieved, he would suggest pursuing a few more cycles of IVF with my own eggs first.  I liked this a lot, since on paper I don't look as dismal a case as I've proven to be in real life.  Also, IVF costs a lot less than DEIVF and this helped me to feel comfortable that he was looking at me as a patient and not a bank account.  We talked about my issues with poor egg quality, and then moved on to discuss their donor program.  Unlike the other clinic we Skyped with, they prefer Day 5 single embryo transfers, which is much more in line with the standards we've come to expect here in Canada.  Both M and I finished the consult feeling really positive about this place, and eventually we decided not to bother Skyping with the other clinics that I was emailing and just go with our gut on clinic #2.

On top of the great impression made by the RE (who spoke flawless English and has almost 20 years experience in the field), this clinic also impressed me with their response to my query about their guarantee program.  They advertise the third cycle free if the first two fail, and I wanted to know how they defined "success": was it a positive HPT, fetal heartbeat or live baby?  The lovely woman that I'd been emailing wrote back with "A live birth, of course, what other measure of success would there be?", which gave me the warm fuzzies and made me feel like this clinic just got it.  The only thing that causes me even the slightest hesitation is the fact that this clinic is quite new (having opened in Fall 2013), so their success rates are based on a much smaller sample size and there are limited reviews from previous patients online.  What I can find is good, and of course one of the benefits of them being new is that there is no real waiting time, so we could potentially cycle there as early as July.  Their facility is also new and pretty state-of-the-art.  The downside is that, if things don't go well, I'll probably be kicking myself for making a bad choice and not going with one of the longer-standing clinics.  Given the pedigree and professionalism of the people I've dealt with so far, though, I'm really hoping that won't be an issue.

As a postscript to my little internet dating metaphor, once we'd made our choice I had to write to the other clinics I'd been speaking with to let them know that we wouldn't be proceeding further.  This should have been easy ("Hi, thanks for all the info, we've decided on another clinic") and yet, I am a total spazz.  I don't know if I thought that their feelings would be hurt, or if I'd get uncomfortable emails asking which other clinic and why, but I LIED.  Just like telling a guy that I didn't want to go on another date because I decided to get back together with an ex-boyfriend (really, it's because you drank an entire litre of cheap wine and then asked to sleep on my couch because you didn't want to take the bus)*, I told the other clinics that I was going to try again with my own eggs and would keep their information for later.  Like they care.  I'm such a dork.

*scenario may or may not have been drawn from actual life