Institute for Reproductive Health

The battle to conceive was long and hard but Dr A kept fighting. He never gave up hope which gave us continued hope for success. He performed two D&C’svand a tubal pregnancy removal and always showed compassion. He was very candid that he thought my egg quality was the issue but gave me time and space to work through those thoughts. Ultimately he was 100% correctvand got us to the donor coordinator for further information. We gave two beautiful little girls now and are family is complete. Rainbows do come after storms.

He is an amazing doctor. Sometimes he can be a bit blunt but that’s just because he is trying to get you the results you are trying to achieve. Trust him he’s brilliant.

PGD was prescribed with IVF after multiple IUI miscarriages with chromosome abnormalities. With PGD we discovered that 80-90% of our embryo is had issues. When healthy embryos were unsuccessful. He recommended egg donor cycle. Once we went that route we only had one cycle and now gave one fresh baby and one frozen

IVF with ICSI and PGD was around 12-15k and donor cycle was 20-25k. Donor cycle charges in Clyde freezing of embroyos and frozen transfer. Cycle resulted in two Singleton pregnancies.

I have seen every doctor at IRH over the last two years and over that time, I have become the most comfortable with Dr. B and as a result, switched over to him as my primary physician in early 2019. I am someone who needs my doctor to explain the details of my diagnosis and treatment in order to feel confident in our plan of action. If the details are not explained to me, I get very anxious. Dr. B learned this about me very quickly and takes the time to explain everything to us as well as answer all of my questions. When we ask for additional consult appointments just to talk about next steps, he is always accommodating and takes the time to ensure all of our questions are answered. I am also a very direct person who wants an honest assessment of the situation, even if it's tough to hear. When I'm told overly positive things repeatedly and then experience disappointment, that makes me distrustful. I realize that this helps some patients, but it is not something that works for me. This is why Dr. B is a perfect fit for me. We have had to have quite a few tough discussions over the course of my treatment (he diagnosed 2 of my 3 miscarriages, had a discussion about donor eggs, as well as discussed use of a gestational carrier) and he has been fantastic. He has a way of being direct about the tough things, but is compassionate and helps you understand the full picture. Dr. B opened my mind to the possibility of egg donation after a couple of egg retrievals with less than desirable results but let me know that they would continue to try with my eggs as long as I was willing. He also was honest with us when we asked about a Gestational Carrier, stating that it was our best shot for the one genetically normal embryo we have frozen. Because of Dr. B, we hope to transfer to a gestational carrier in November with our own embryo and hope to transfer to me in December with a donor embryo. I cannot say enough good things about Dr. B. I truly believe we are on our current course because of him and I have 100% faith that he is leading us in the right direction.

If you are somebody who wants all the details of your diagnosis and treatment plan, likes to ask questions, and wants someone who will give you honesty, ask for Dr. B to be your primary doctor (or Dr. S). If you get overwhelmed by the details and want a doctor that will give you more general encouragement, ask for Dr. A to be your primary doctor.

Egg Retrieval 1 with Dr. B (3 Overall): 225 Gonal F, 150 Menopur, Cetrotide = 7 Eggs Retrieved, 2 Blastocysts, 1 PGS Normal Embryo. With this cycle, he added an extra vial of Menopur to attempt to get a 4:1 Ratio of FSH to LH in hopes of retrieving more eggs. The strategy worked as I had only ever had 3 eggs retrieved previously. Egg Retrieval 2 with Dr B (4th Retrieval Overall): Femara 5MG Per Day Cycle Days 3-7, 225 Gonal F & 150 Menopur Starting Day 3, Cetrotide (NOTE: Dr. S recommended this cycle) = 9 Eggs Retrieved, 3 Blastocysts, 0 PGS Normal Embryos. With this cycle, Femara was added in hopes of getting more quality eggs. Egg Retrieval 3 with Dr B (5th Retrieval Overall): F 225 Gonal F & 150 Menopur Starting Day 3, Cetrotide: 4 Eggs Retrieved, 1 Blastocyst, 0 PGS Normal Embryos. With this cycle, we started out with less than an ideal follicle pattern, so our expectations weren't as high out of the gate. The thought was to go back to the retrieval where we got a good embryo and I 100% agreed with this strategy. If I had to go back and do it again, I would do the same protocol. Dr. B also ordered all of my recurrent loss testing after my 3rd miscarriage (which was with a PGS Normal Embryo). He tested for Thyroid Levels, Blood Clotting Disorders, and Auto Immune Disorders. He also recommended a uterine biopsy for an ERA Test for Embryo Transfer Timing & Receptiva Test for Endometriosis. Blood Tests came back with slightly elevated Prolactin & TSH. While he did not believe this is my primary issue, he started me on Levothyroxine. The ERA test came back normal. The Receptiva Test came back positive for inflammation associated with endometriosis. The strategy here was to test me for everything under the sun since I had been pregnant 3 times and all 3 resulted in miscarriage, with the last one being a PGS Normal embryo. Even if we hadn't diagnosed anything, at least we could have eliminated them as possibilities. This was a strategy that I was 100% on board with and would do over again. Treatment for endometriosis consisted of 2 months of Lupron Depot Injections, which put your ovaries into a temporary state of menopause in an effort to get rid of the inflammation associated with endometriosis. We have decided to repeat the biopsy after treatment is completed before attempting an embryo transfer with donor eggs. This repeat test was particularly important to me because I don't want to do an embryo transfer without knowing that the Receptiva Test is negative and I was thrilled that Dr. B was supportive of repeating the test. Our Egg Donor Cycle is currently in process. Our Egg Donor (a known donor) is doing Gonal F and Cetrotide with doses to be determined. Dr. B recommended considering an egg donor after our 1st egg retrieval (2nd cycle as 1st was cancelled) yielded only 3 eggs and no PGS Normal Embryos. We did 4 more egg retrievals after that resulting in only 2 PGS Normal Embryos. So, after 5 egg retrievals and only 1 Frozen PGS Normal Embryo left, we decided it was time to move onto the egg donor waiting in the wings. His suggestion earlier on in the process allowed us to get our egg donor lined up but to continue with our own retrievals until we were ready to move onto the egg donor. We elected to do PGS Testing on our Donor Embryos, which is unusual, but given my history with loss, we were only interested in proceeding with embryos confirmed to be genetically normal. Again, Dr. B was supportive of our wishes and helped us formulate the plan. Finally, we are doing a frozen embryo transfer cycle with our 1 remaining PGS Normal Embryo and a Gestational Carrier (known carrier/friend). Our Carrier took several weeks of Lupron Injections to down regulate her ovaries and will take normal estrace/progersterone protocol for a frozen embryo transfer. When we brought up our concerns about how few of our own embryos we had, Dr. B was in agreement that a Gestational Carrier was our best chance of success. He recognized our priorities and we appreciated his candor and honesty in his recommendation.

This really depends on whether you are out of pocket or insured. IVF with PGS Testing Out of Pocket (all in for meds etc): $24,000 Embryo Transfer: $4500 Screening for Gestational Carrier and Husband: $2700 Screening for Me (to use Gestational Carrier): $1700 Multi Cycle Package for PGS Testing: $2150 With insurance it is significantly cheaper. Once we hit our deductible, IVF without an embryo transfer was about $600. The PGS Testing is $2150 in addition to the $600 but we should potentially get reimbursed for that from insurance. These costs are really going to vary depending on your insurance coverage.

All of the doctors at our clinic typically prefer single embryo transfers. We have always used PGS tested embryos, and in those cases, they will only transfer 1 embryo.

Michael Scheiber was an extremely upbeat and friendly guy. His knowledge made me feel extremely comfortable through the process from multiple check ups, egg retrieval all the way to the transfer. I always left the office knowing I was in good hands.

There is a lot of paperwork! Always check in to see if you have everything signed. Medicine is expensive and on-going. Be prepared if pregnant to order endometrin and estradiol multiple times. Best through an online pharmacy!

Period Day 1: Tuesday, June 11th Start Birth Control: Thursday, June 13th -Spotting on Sunday, June 16th Preliminary Doctor’s Appointment to see how B.C. Is working: Wednesday, June 26th. He said everything looked great and that I would produce multiple eggs due to PCOS -Stop Birth Control July 3 -July 4, July 5 and July 6 no birth control. Very crampy and spotty especially on the last day -Start Follistim and Menopur July 7th. 125 of the follistim and 1 vial of Manipur -Mid Medication Follow Up July 10th at 3:45pm. Follicles progressing good. Start to take Ganirelix on Thursday. Lower Follistim dosage on Friday. -Follow Up July 13th at 10:00am: left side follicles are growing slower. Right side is on track. Next appointment scheduled for Monday. Predicted egg retrieval for Friday, July 19th. -Follow Up Follow Up July 15th at 8:45am. Had to purchase another gani. -Egg Retrieval day. Took vicodin at 7:15am. I arrived at IRH at 7:45am and they took me back on the bed. Pumped fluids through my hand since they couldn’t find a vein. Antibiotics and a relaxant medicine. A window behind the light with a person behind it. Dr. Scheiber recited my name to the nurses in the room and what they were here for. I felt everything that the doctor did but it was quick. Wheeled me back. Was in so much pain. Nurse Melissa told me they retrieved 17 eggs. -Saturday, 8:20am, nurse called and told me all 17 of my eggs were mature and out of that 12 fertilized -Thursday the 25th at 12:06pm nurse called me to tell me I had 6 Day 5/ Day 6 embryos -Started my period Saturday evening 27th/ 28th Sunday morning. Left nurse voicemail Saturday evening. Nurse called Sunday morning. Scheduled lining check on August 8th. Tentative transfer on 16th. Take estradiol 3 times a day -Wednesday 31st institute in Nashville called to say they received the samples and it will take 5 to 7 days for biopsy results -Appointment on August 8th- all embryos normal and healthy. 5 boys, 1 girl -August 16th transfer date

$16,235 for IVF with PGD. Medications and Biopsy costs were separate

No comment. We chose a 5 day embryo through PGS for transfer

Dr. Burwinkel is very kind and caring. His bedside manner was great and he always ensured I understood the treatment process. When I had questions, he took time to listen. He took the time to answer each of my questions and never acted rushed. For my egg retrieval, he came to see me before and after the procedure. He always made sure I was comfortable throughout the process.

I would definitely recommend him and never be afraid to ask questions.

Dr. Burwinkel used femera and ovidrel with my IUIs. I always responded positively but never got pregnant. He used menopur, gonal f, cetrotide and ovidrel for my IVF. I also responded well and had 25 mature eggs. I was given dostinex after my retrieval to help against hyperstimulation. I did not end up with hyperstimulation and was able to have a fresh transfer.

$15000 for 3 IUIs and 1 IVF

I was not happy with the thought of an eset at first but Dr. Burwinkel explained the risk of embryos splitting and multiples with more than one embryo being transferred. I am now grateful because I got pregnant with a healthy single baby from my first IVF.

I was at another clinic and the dr never came in to speak with me or complete my ultrasounds or testings. I decided to change to this clinic and saw one other dr in the practice but voices that is rather keep all appointments with Dr B and he’s been great at making sure he keeps up with our treatment. He takes his time and I’ve never one time felt rushed. He chit chats with my husband which makes my husband feel more comfortable coming to my appointments with me. He always acknowledges my feelings and sets me up for how things can or may go. I love that he’s very blunt and to the point. I don’t want a dr to sugar coat anything with how much we are investing into our journey. I don’t want false hope! I always look forward to seeing Dr B and hearing what plans he has for our treatment. After every IUI he days he prays this is our time and I really feel he means it!

Don’t expect him to beat around the bush. Very forthcoming

Before we started IUI, he ordered a test to look at my uterus and ovaries to make sure they were clear and looked good. During this he found polyps in my uterus and he removed them successfully during surgery. He then scheduled my first IUI using letrozole and then did an ultrasound to check my follicles and gave me the date for my trigger shot. This was the same approach on each IUI. Ultimately my IUIs weren’t successful but endometriosis has a role in that outcome. He also did a progesterone check 1 week after my last IUI per my request to help ease my mind.

So far my insurance has covered everything for my IUIs and most of my meds. I’m not sure what the out of pocket costs are.

We have only had an IVF consult so far, but he likes to do a single transfer starting out. He is open to multiple transfers if at least two IVF transfers were unsuccessful.

Dr. Awadalla seems like a true expert and was very professional. I couldn't always see him because he doesn't work everyday and my cycles didn't work out that way, but he was there for the two biggest days (egg retrieval and embryo transfer).

Do your research ahead of time and make sure that you come in with questions because otherwise you will get hustled out of there. He'll answer questions but he doesn't chat through everything in detail otherwise.

After doing a round of clomid+intercourse with my OB-GYN, Dr. Awadalla did a round of IUI (femara+IUI). Because I have PCOS, we moved to IVF for the next step. We did birth control for 3 weeks so that I could go on a vacation, then 10 days of injections at a very low dose (150). We triggered with lupron and a normal trigger at a lower dose. They retrieved 33 eggs, 31 of which were mature, and 29 fertilized (no ISCI). We ended up with 23 embryos (19 day 5 blasts, 4 day 6 blasts). We did not do PGS. Just yesterday, we did a single embryo transfer after freezing for a month because I developed OHSS.

I was fortunate enough to have most of my costs covered by Fertility insurance. I did pay about $500 for medications/injections and about $250/appointment.

The doctor strongly recommended eSET based on the quality of our embryos and my age. We agreed with this recommendation based on the risks to mother and child(ren) associated with multiples.

I felt that he was thorough when discussing my protocol and I understood everything. I feel like the retrieval caught me off guard because it was a light twilight sedation so I was awake during the surgery. I was never awake with my 3 previous retrievals at another RE so I was not expecting this. I was not informed beforehand that I would be awake. It was not pleasant. Transfer went smoothly. When I got the negative BETA I feel like the news was said to me in a gentle manner.

Same with all doctors and that is to ask a LOT of questions!

We prepped with birth control and lupron beforehand to suppress everything before I started. I am a high responder so he chose to use a menopur only cycle 225iu per night. We continued lupron though stims to prevent ovulation. For transfer only crinone vaginal cream twice daily.

8200 self pay for IVF cycle which included a fresh transfer PGS, ICSI, FET was additional

I only had two embryos from this fresh cycle and I had two failed transfers previously so he recommended that we transfer both to increase our chances.

I feel as if IRH does not care to educate their patients or provide individualized information. They repeat the same responses over and over and don't seem to want to deviate from their "recommendation." If I don't come up with the question myself, there's no way the doctors, nurses, or billing will voluntarily give me any extra information I need or let me know what's going on with my body. I would hear one thing from Dr. Scheiber and something different from the nurses - Which happened on multiple occasions. I feel like since day one the lack of organization, incompetency, inconsistency in knowledge of anything in general (mostly from particular nurses) has been a negative experience. My biggest issue at the moment is my husband and I were thinking about if we should have genetic testing done. We don't want to keep transferring embryos if they're not good embryos. (I personally think this should be part of the IVF process in general, at least to transfer the best one's first, but that's just me.) Anyways, no one discussed the option of testing and the pros/cons of doing so during the IVF process and fresh transfer (yet we found out they advise testing on fresh rather than frozen). We were told by Dr.Scheiber "There's no reason to test unless you have multiple failed transfers." Well we've had one fail and just started researching the idea of screening the other frozen embryos. At my ultrasound on Monday, we asked what Dr.Scheiber thought about testing. He said, the same as before, "let's wait." Well, we called the day after my ultrasound and left a voicemail. A nurse called us back and said, "We don't do genetic testing on frozen embryos." I cannot believe they're just now telling me this. I've asked about testing my embryos multiple times and no mention of this. After a frustrating conversation, she got off the phone, talked to Dr.Scheiber and called me back saying, "Well, we can test them, but it's not advised." Moral of this particular story and situation is the inconsistent information from doctor to patient, to nurse to patient, and so on. This is a huge deal. Testing embryos is a newer procedure, so if that decision should've been made earlier on, they need to make sure that's a heavy conversation and discuss the options with their patients. Last week I spoke to the nurse manager and her answer to a question about my period was, "Well, that's like looking into a crystal ball." Are you kidding me? That's how an infertility clinic is talking to patients? It's already an emotional time, they are supposed to be the experts and professionals. Compassionate and knowledgeable. I'm having a very hard time processing my present situation. This grant could help me start my journey at a new facility and I would be over the moon to receive such a gift.

I would advise a new patient to ask him as many questions as possible and do not leave the appointment until he's answered everything as clear as possible and in as much detail as you need. Also, write everything down!

I was on birth control for a couple weeks to stop my ovulation, then moved on to my injections to stimulate my ovaries, follicles and eggs. I was on Gonal-F 175 and Menopur 1 vial for 10 days. I added Cetrotide halfway through that, and my trigger shot Oviderel 26 hours or so before my egg retrieval. I didn't have to increase or decrease my dosages and my hormone levels adjusted as they were supposed to. We retrieved 17 eggs, 13 fertilized, 8 developed into embryos. I started vaginal progesterone supplements 3 times/day on the day of my egg retrieval. My fresh transfer was on day 5 blastocysts. I transferred 1 blast but received a negative pregnancy test two weeks later. Fast forward a couple months and I'm now scheduled for a frozen embryo transfer in two weeks! I'm on estrogen 3 times a day and I start Progesterone again 6 days before my FET.

Ultrasounds ran smoothly. I was always able to get in and out.

We've gone through IVF with ICSI and have a FET scheduled and we've spent around $15,000.

Dr.Scheiber and every other doctor at IRH recommends and highly suggests 1 single embryo transfer for patients first and second transfer. I thought about transferring 2 on my first fresh transfer, but then decided to go with 1. I believe they allow it, but you must sign consent forms. I'm 75% sure I'm going to transfer 2 on my next transfer.

During my initial consult he was very thorough and detailed about our medical history and our plan. He can sometimes talk quickly leaving me with questions and not quite understanding everything. However, anytime this has happened I have had my questions answered promptly. I do feel that he is extremely knowledgeable and caring, especially in these situations.

Come prepared. Think of questions you may have and have any tests results or medical history available. This helps you get the most from your consult and future appointments.

So far I have done three rounds of Femara, to help with follicle formulation and growth. From there I had follicle scans to determine when they were adequate size and mature enough to release the egg. After follicles were appropriate size I was given a trigger shit called Ovidrel to release the egg and cause me to ovulate. Approximately 36 hours later I would go in to have my IUI. We started with IUI due to months of trying with timed intercourse and husbands low sperm account.

Each IUI cycle has been approximately $1200 for me and then the cost of my husbands sperm washing which was $250

No comment at this time

I feel that Dr Scheiber has a great deal of experience and is very knowledgeable. He tends to be more on the business side with the right amount of compassion. He is very detailed and I felt as if he gave me all my options at each step and made sure I knew what would be happening.

I would suggest to have a list of questions ready and now be afraid to ask all of them. Doctors are busy but don’t feel rushed. It’s your appointment.

The reason my husband and I needed IVF was because of a failed vasectomy reversal and there was no signs that I had an fertility issues so our protocol was pretty simple. Low dosages and we were able to have a great egg retrieval. After the first fresh transfer I miscarried and knew of was semi normal for that to happen since we didn’t do any embryo testing. Now that I have miscarriage twice, Dr Scheiber plans on doing more in depth testing to see if there is potentially something wrong with me.

Ivf cycle with fresh transfer and medication roughly $14,000 (cash only) Frozen transfer with medication $5000 (cash only)

Dr. Scheiber has been a great doctor for us! Before coming to Dr. Scheiber we had honestly almost given up on being able to have another child. We will be starting IVF with Dr. Scheiber next week, and though we know there isn't a guarantee that everything will work out, he has taught us that we have so many options and different ways for us to be able to have another child.

I will be starting IVF next week so I haven't started injections yet. Dr. Scheiber has had me taking birth control until my baseline appointment because I have PCOS, the birth control is being used to shrink any follicles before starting the injections.

I immediately felt like Dr. Awadalla was incredibly knowledgeable. I was put at ease because in my opinion he was trustworthy. My husband and I could always ask him any question. This was also how the other doctors in the office were.

I would say to trust Dr. Awadalla’s knowledge and process and know that he will do what is best for you.

The first time he had me on birth control before starting injection medication. I didn’t have as many eggs as he would like to have so he adjusted and took away the birth control. Then the third time he decided to add Femara. We did ICSI each time because we had male factor infertility and each time we put back 2 embryos.

We did a money back guarantee. After we found out we qualified we did the guarantee that said if after 3 IVF fresh cycles and 3 frozen cycles we still didn’t have a baby we would get a percentage of our money back.

Dr. Awadalla made it clear it was our choice about how many embryos we transferred.

Dr Burwinkel is more dry and matter of fact, but seems to be very caring. He is very open to answering all of your questions and talking through steps. We are just now starting the IVF process, but I have heard nothing but good things about him as a doctor from others who have successfully gone through IVF.

Know that he is very dry and matter of fact, but does seem to care for his patients and their success!

I have lean PCOS and am very healthy and active. I had previously taken five rounds of unmonitored clomid with my gynecologist, and they did not show ovulation when looking at my basal body temperature. Dr. Burwinkel suggested trying Letrozole and then Ovidrel to trigger ovulation along with timed intercourse for three months before moving on to IUI or IVF. During this first cycle with these drugs, he performed an emergency laparoscopy on me due to an ovarian torsion. He believes it was caused from the combination of infertility meds. He managed to save the ovary (it was twisted three times). He has me waiting two full cycles and then we are looking at IVF to hopefully be able to retrieve eggs from the ovary that was twisted and then remove it if it causes another torsion.

Each ultrasound cost me $50 due to being coded as PCOS. Lab work for one cycle was $255 (not covered). My genetic test was covered due to meeting my deductible, but it would have cost me several hundred dollars. My emergency surgery is costing me around 2000.

Although it might not seem that always is the case he really does want to do everything for you to have an outcome of a child. Remember to always ask questions he can be in and out and short but if you ask he’s definitely going to be straight with you. I feel that the more questions you ask the better you’ll feel about everything and it helps keep your nerves calm during a very anxious roller coaster time in your life!

Ask lots of questions all avenues that you could possibly explore

Gosh it’s hard to remember we’ve been at this for so long but we started off with pills then shots in each are you why it got more aggressive with stronger doses more shots and we are now in the process of our first IVF treatment staying positive keeping fingers crossed

Expensive! Unfortunately we did six rounds rounds of our UI is equaling three to $4000 each adds up very quickly sometimes I wish that we would’ve stopped with so many rounds and put that money toward her an IVF cycle

I think that Dr. Scheiber is really a great doctor. There isn't much negative to say at all. He seems to share in our frustration that the process isn't working and we don't know why. He's also been very upfront with his recommendations. I really appreciate that he also gives levels of treatment. Everything from "the gold standard" to something a little less expensive but he still fully backs. Also - he understands my need to try to do every little thing to try to help the process along - so he was ready with recommendations for acupuncturists and supplements. I always feel like he's one step ahead.

Ask a LOT of questions and don't be worried if you think your question is stupid. He's had almost every question asked before and there isn't anything stupid you can ask. He is VERY patient and will say the same thing a few times if you need that.

This cycle is fairly similar to all my other cycles. He started me off with 14ish days of birth control ( to get control of the cycle), then a baseline scan, Then a few days of just gonal-f ( 200 units) and Menopur (one vial). After my second scan, cetrotide was added. I've had a couple scans since the addition of my cetrotide, and my gonal-f was bumped to 250 to try to encourage a bit more growth. I'm taking ovidrel for my trigger shot

I know the cost of medicine for my full ivf cycle is around $4,000. I don't remember the exact cost of the procedure as they are now covered by insurance. But I believe around $15,000

Usually Dr. Scheiber only does single embryo at a time. Mostly this is because a singleton pregnancy has fewer complications then multiples. If you are older or - like me- have had several unsuccessful cycles and/or chemical pregnancies etc...there is a case to be made for doing multiple. It seems like he's trying to make sure that as far as can be controlled - everything is smooth as can be

Dr. Burwinkel is one of the best doctors that I have ever had. He actually listens to what you have to say, and he doesn’t belittle or make you feel you’re questions or feelings are silly, stupid, or unimportant. He’s optimistic and has a great bedside manner and attitude. I was diagnosed with PCOS (before Dr. Burwinkel) and my weight is a problem resulting from my diagnosis. I know a lot of clinics want you at a specific BMI or weight before they even consider tresteing you, and I was worried about that the most before meeting Dr. Burwinkel but that definitely wasn’t the case! He had a game plan and we started treatment right away! I have nothing bad to say about Dr. Burwinkel! Every meeting I’ve had with him has been as perfect as I could imagine.

Don’t be afraid to ask your questions, no matter how silly or stupid you may think it is! He knows this is hard, he gets it and he understands. He will hear you out and give you the answers you need!

With Dr. Burwinkle I was prescribed 1400mg of metformin daily. He then prescribed me to take 5mg (two pills) of letrozole on days 3-7 of my cycle. We then would schedule a scan to check follicle progress on day 11-13 of my cycle. Depending on the progress and maturation of the follicles, I was told when to take my ovidrel trigger shot to induce ovulation. 36 hours after the trigger shot we had our IUI. The first cycle I had one mature follicle and I took my trigger shot approx day 16-18 of my cycle. The second cycle I had to be prescribed more letrozole in the middle of my cycle due to my follicles not being as mature when the doctor wanted. I had to come back for a second scan and was given my trigger shot around day 18-19. The third cycle I had one good mature follicle, and a second one that may or may not have been mature by ovulation day. None of my cycles resulted in any type of pregnancy or success.

Copay for appointments: $35 Sperm wash: $225 IUI procedure: $250 Ovidrel trigger shot: $95 Letrozole: $15

Dr. Awadalla has taken extremely good care of me during my treatment at IRH. He has always maintained a positive outlook for our eventual outcomes and is proactive in adjusting treatments based on the results of our previous cycles. His strengths lie in his knowledge and expertise in the fertility practice as well as his bedside manner. At times I did feel like he was trying to protect my feelings a little too much, which I appreciate, but being a person who requires lots of details and direct communication, it did sometimes leave me uncertain or with questions. However, once I was able to gather all of my questions, I was always able to get the answers and clarity I needed. I would most certainly recommend Dr. Awadalla to any patient as I feel like we are getting the best care possible with him and IRH.

Make sure to educate yourself and do not be afraid to ask questions, even if you call back after your appointment. They process a lot of patients at IRH but they are really great about taking the necessary time with you if you ask for it.

Cycle 1 - Femara, Ovidrel, Timed Intercourse - Negative Pregnancy Test Cycle 2 - Femara, Ovidrel,Timed Intercourse - Negative Pregnancy Test Cycle 3 - Femara, Ovidrel,Timed Intercourse - Negative Pregnancy Test Cycle 4 - Femara, Ovidrel, IUI - Negative Pregnancy Test Cycle 5 - Femara, Gonal F (Doses of 75iu to 150 iu), Ovidrel,IUI - Miscarriage, D&C, Genetic Testing showed Trisomy 22 Cycle 6 - Femara, Gonal F (Doses of 75iu to 150 iu), Ovidrel,IUI - Negative Prenancy Test Cycle 7 - Femara, Gonal F (Doses of 75iu to 150 iu), Ovidrel,IUI - Miscarriage, Cytotec Cycle 8 - Birth Control, Gonal F (Doses of 175iu), Cetrotide 25iu - Terminated Cycle due to poor follicle response Cycle 9 - CoQ10 & DHEA Supplements, Gonal F (Doses of 225 iu), Menopur 75iu, Cetrotide 25iu, Ovidrel - 6 Follicles, 3 Eggs Retrieved, 3 Eggs Mature, 3 Eggs Fertilized, 2 Embryos made it to Day 5 Blast and tested with PGS, 2 Abnormal Embryos (Trisomy 6, Trisomy 9) Cycle 10 - CoQ10, DHEA & Vitamin D Supplements, Gonal F (Doses of 250 iu), Menopur 75iu, Cetrotide 25iu, Ovidrel - TBD. Will do PGS Testing again if we have embryos to test.

Femara - Covered by insurance Ultrasound Scans about $300 per scan, covered by insurance IUI $250 plus cost of sperm washing (covered by husband's insurance) IUI Medications - Ordered through SMP Pharmacy $500 to $1.5K for Gonal F & Ovidrel IVF with PGS - $15,900.00 is their discounted rate and does not include medications or the PGS Testing Lab Fees (Ovation) PGS Testing Lab Fees - about $1,200 for a single cycle with 2 embryos tested, about $2200 for multi-cycle plan for up to 8 embryos tested IVF Medications - $2-5K for Gonal F, Cetrotide & Menopur per cycle

Dr. Awadalla is very pro-single embryo transfer and anti-multi embryo transfer except in special circumstances.

Dr. Burwinkel is definitely a straight shooter. He's not one for false promises of success or sugar coating a point. However, this doesn't mean he's without empathy. He's provided wonderful care through my unsuccessful pregnancies and has always given me clear next steps for things we'll try next time. In 2018, we had success with his treatment and welcomed our daughter into the world.

Be completely honest about your history and situation in your consultation. He can't help to the best of his abilities without full and complete information.

Metformin for PCOS, folic acid/COQ-10 supplements for healthy eggs, Letrozole to boost egg health at time of ovulation, Ovidrel to stimulate ovulation. (RPL, basic therapy only)

Do not remember all costs.

Dr Awadalla determined why I could not conceive (missed by my GYN) and recommended surgery, which he performed. I conceived naturally in 3 cycles after that. For TTC#2, I was older and he shared his concerns with the likelihood of success. Early IUIs were successful, but did not result in live births. After 10 total IUIs, my course of treatment was only adjusted because I asked if it made sense to continue or to look at other options. We have moved on to IVF, but it is still early in the first cycle. I find Dr A to be very accurate in his assessments and knowledgeable. I trust that I am in good hands, for as much as medical science can help me at my age.

Ask a lot of questions. Dr Awadalla is happy to explain the details to patients who are interested. Also ask at what point you should have a consult to evaluate the plans, so you know what to expect.

TTC #1 (age 38): Dx: uterine fibroids, blocked Fallopian tube. Tx: Myomectomy, salpingectomy (tube could not be saved and was removed). Resulted in live birth, conceived naturally in 3 cycles. TTC #2 (age 41): DX: unexplained infertility (age). Tx: IUI with 5mg Femara CD 3-7. IUIs 1 and 4 resulted in pregnancy, but not live birth. Likely due to poor egg quality. Repeated for IUI 5-8 because successful getting pregnant, but waiting for a better quality egg. For IUI 9 and 10, added Follistim (IUI 9: CD 7-10, 50IU; IUI 10: CD 7-11, 100IU). BFN. Given option to select surgery to recheck remaining Fallopian tube or IVF. Started IVF. Currently on CD 9: 5mg Femara CD 3-7, Gonal-F 300IU CD5-10, Cetritide CD10, rest of days/dosage TBD.

With insurance (assuming deductible was paid and yearly maximum for benefits not met), an IUI cycle was roughly $75 out of pocket, not including medications.

Dr. Burwinkel is friendly, but not as attentive as I would like. Dr. Burwinkel did my first DE transfer and explained what he was doing as he did it, but then I had some questions (as I was laying on the table) and he seemed in a hurry to get out of there. Just not as warm bedside manner as I experienced in the past at my previous clinic.

Make sure you ask lots of questions, because you may not see him every visit. Make sure you have a clear understanding of where you are in your cycle and what comes next.

My first DE cycle (negative, currently on FET cycle). E2 3x a day and Prometrium 3x a day plus a low dose aspirin 1x a day. Dr. Burwinkel never explained to me the rationale. It was the nurses who gave me my treatment plan.

My insurance covers some of the cost, and all of my claims are still currently pending, so I am not sure what I will need to pay out of pocket. One donor egg cycle is 16K, but I will be billed a reduced amount.

We only had two blasts from our first cohort of eggs, so we implanted one and froze the other. I recall telling the nurse that I only wanted one implanted, and she said that she will note that on my chart. So, I'm not sure how they feel about implanting two.

Appointments always felt very rushed. If I had questions during the appointment, he didn’t answer, but referred me to the nursing staff. When asking for further testing after an early loss, I felt treated as a child asking for a second piece of cake. Treatment plans never changed, nor were any further tests recommended after several failed transfers. The only solution seemed to be to throw another complete round of donor egg ivf at us.

Be very knowledgeable about treatment options and advocate for yourself! Be very blunt in asking for answers to any questions you may have!

For frozen embryo transfers 1-3, estrace was started at day 1, 3X per day. Progesterone was started 5 days before transfer. 1 early loss and 2 negatives. FET 4 was a “natural cycle” with with follicle monitoring. Once follicle was big enough, we did the trigger shot to release the egg. FET was then a week later. Progesterone was started 5 days before the transfer. Transfer resulted in a negative beta.

Dr. Burwinkel's strengths are he is very kind, his bedside manner is great. His cons are not taking time to explain why decisions would change so quickly. He did well in explaining the course of treatment, but when the course of treatment didn't work, we felt as if the course of treatment was never changed. MFI wasn't deeply explored or even suggested we should see a reproductive urologist, we took that initiative on our own. After the chemical pregnancy, we went back to our obgyn and she found that I had FVL and MTHFR as reasons why we could be miscarrying.

Ask lots of questions. Be educated on what options are available to you with all scenarios.

IUIs- Femara with Ovidrel trigger shot Retrieval #1- BCPs, Gonal F, cetrotide, ovidrel trigger Retrieval #1- Gonal F, Cetrotide, Menopur, Ovidrel trigger FET- Estradiol orally, prometrium vaginally

Our first two cycles we were blessed with insurance coverage, however our copay on each cycle was 1,000. Medications for the two cycles ran us 7,000. FET cost us 4,500, medications were covered under insurance.

IVF #1- single embryo transfer at age 29 IVF #2- double embryo transfer at age 30 FET- single embryo transfer, only had one embryo left

I believe Dr Awadalla is a very intelligent and caring Dr, who’s very experienced. That being said, I think he thought my case was an open and shut case- he didn’t find the need to have my husband tested. We went through 2 rounds of timed intercourse, until I asked about getting my husband tested— which resulted in low count, so we were only eligible for IUI, I felt like we wasted time and expenses. Most appointment are short and he rushes in and out, I always have to ask the nurses what’s going on after. Our next round is IVF, and he has yet to explain the procedure and process.

Ask lots of questions. Research procedures, medications, ahead of time so you can get the information he might not tell you.

Diagnosed with PCOS: Peometrium to jump start my cycle. Day 3-7 femora to stimulate maturation Day 10 ultrasound (On all five of my cycles, I had to redose femora due to follicles not responding). Ovidrel shot to induce ovulation Timed intercourse/IUI once follicles we’re 12-20mm.

Currently, we’re are around $10k.