IVF Lab Questions to Ask Every Clinic: A Fair Comparison Guide

You can compare two IVF clinics' success rates side by side. You can't compare their embryology labs the same way, because the lab is the one part of your treatment you never see, and "our lab is state-of-the-art" is the only answer most clinics are ever asked to give.

There is a better way. Embryology labs measure their own performance with defined indicators, and an international expert group has published the levels a competent lab should reach. If you ask every clinic the same specific questions, worded the same way, you get answers that can actually be placed next to each other.

Start With the Lab's Own Numbers

In 2017, ESHRE and the Alpha Scientists in Reproductive Medicine published the Vienna Consensus, which set out performance indicators for ART laboratories. For each indicator, it gave two reference points: a competency value (the minimum a well-run lab should reach) and a benchmark value (what the best-performing labs achieve). Key indicators include:

• ICSI normal fertilisation rate: Competency: 65% or higher | Benchmark: 80% or higher
• IVF normal fertilisation rate: Competency: 60% or higher | Benchmark: 75% or higher
• Blastocyst development rate: Competency: 40% or higher | Benchmark: 60% or higher
• Blastocyst survival after vitrification and warming: Competency: 90% or higher | Benchmark: 99% or higher

Ask each clinic: "What were your lab's ICSI fertilisation rate, blastocyst development rate, and blastocyst warming survival rate over the last 12 months?" A lab that tracks these will answer promptly. A lab that cannot produce them either does not measure its performance or prefers not to share it.

Read the answers with care. These figures depend on patient demographics: a lab treating many older patients or poor-prognosis cases will have lower blastocyst rates than one treating mostly young patients, with no difference in skill. Ask two follow-ups: how many cycles the figure is based on, and whether it covers all patients or a selected group. Be wary of a clinic quoting a number far above the benchmark without a denominator. The purpose of the question is to assess operational transparency; the number alone will not settle that.

Ask About the Person Handling Your Case

Under the ART Rules, 2022, an embryologist in a registered clinic needs one of three qualification routes:

1. A postgraduate degree in Clinical Embryology plus three years of ART lab experience.

2. A PhD in a related field plus one year.

3. An MBBS degree with a postgraduate qualification in Clinical Embryology plus two years.

Practitioners working prior to the 2022 rules were permitted to continue.

Key questions to ask:

• What degree does the embryologist who would handle my case hold?
• How many years of hands-on ART lab experience do they have?
• Will the same person be involved throughout my cycle?
• How many cycles does each embryologist handle daily at peak volume?

Embryology is manual, time-critical work, and an overloaded lab increases the risk of error. A clinic that transparently discloses its staffing and workload demonstrates sound operational oversight.

Ask What Happens When Something Goes Wrong

A lab's quality shows most clearly in how it prepares for failure.

- Storage: Frozen embryos sit in liquid nitrogen tanks for years. ESHRE's good practice recommendations specify that cryostorage tanks should be continuously monitored with automated alarm systems, at least one backup tank should be available, and critical equipment (incubators, storage tanks) must have external alarms and backup power. Ask: Are storage tanks continuously monitored with after-hours alarms, is a spare tank available, and what is the backup power arrangement?

- Identification: Ask whether the lab uses an electronic witnessing system (typically RFID-based) that scans and logs each handling step for eggs, sperm, and embryos, or whether checks are strictly manual.

- Incidents: Ask: If a handling error or equipment failure ever affected my embryos, how and when would I be informed? Look for a clear, documented policy.

Ask Who Checks the Lab

India's ART Act requires clinics and ART banks to register, which confirms legal authority to operate. However, registration is not a measure of lab quality, and there is no public registry in India that audits or publishes lab performance.

Additionally, ask whether the lab participates in external quality assessment scheme (EQAS) checks.

Ask About the Culture Environment (Without the Marketing Hype)

Incubator culture conditions directly affect embryo development. Low-oxygen culture (~5%, matching physiological conditions) is considered good practice. Inquire whether the lab uses low-oxygen incubators, whether culture media batches are quality-tested prior to use, and how frequently embryos are removed for checking.

Be cautious of marketing centered purely on proprietary equipment. Studies comparing time-lapse incubators with quality conventional benchtop incubators in well-run labs show no significant difference in live birth rates. Similarly, evidence supporting AI-assisted embryo grading is still developing. Ask whether these tools are used as support for embryologist judgment or as primary decision-makers.

How to Keep the Comparison Fair

• Ask every clinic the exact same questions in writing.
• Record each answer as a number, document, yes/no, or "no direct answer."
• Request formal documentation (accreditation scope, KPI summaries) rather than relying on verbal statements.
• Note response times and specificity if a clinic promises to follow up later.
• Look for operational patterns across all responses.

Frequently Asked Questions

• Is it normal for a clinic not to share its lab KPIs? Many clinics have not been asked before, so an initial delay is reasonable. However, failure to provide a summary after multiple requests is a red flag.
• What if a clinic's numbers exceed the benchmark? Verify the sample size (denominator) and patient mix before drawing conclusions.
• Does NABL accreditation guarantee better results? No. It certifies that processes comply with recognized quality standards, not specific clinical outcomes.
• Can I visit the lab? Physical access is generally restricted to maintain sterile conditions. Requesting a process walkthrough and documentation is a more practical assessment.
• How many clinics should I compare? Comparing two to three clinics offers sufficient context without causing decision fatigue.