How was your experience with Michael Putman at Fertility Center of Dallas?
Dr. Putman is a kind and gentle care provider. I have always felt that he takes the time, never rushing us through appointments. He is someone who doesn’t mess around with treatment options, yet, we never felt pressured to pursue more invasive interventions, such as IVF. Initially, my husband and I did not think IVF was right for us. Dr. Putman, suggested we start with other interventions first. When those were unsuccessful, he used that information to inform his next recommendations, and eventually, I underwent one round of IVF, producing two embryos. Dr. Putman, along with is Embryologist, Dr. Zhang, both felt like we could do better and changed my protocol accordingly for the second round, which I am getting ready to start. In addition, I felt that he was aware of my labs and results at all stages of the IVF process even changing protocol decisions along the way, including the type of trigger shot to use. Overall, I have had a very positive experience.
However, I would have liked to have seen more alternative approaches incorporated into my treatment plan, including acupuncture, a review of harmful toxins, etc.
What's one piece of advice would you give a prospective patient of Michael Putman at Fertility Center of Dallas?
Don’t expect him to force your hand and tell you what to do. He will make recommendations, but you will also need to have voice and advocate for yourself.
During treatment, were you treated like a number or a human with Michael Putman at Fertility Center of Dallas?
In any practice, it is not just the doctor’s responsibility to make the patients feel like a human rather than a number. Every member of the Fertility Center of Dallas has made sure to treat me as a woman desperate for help. Certainly, Dr. Putman sets the standard, and every appointment I go to, I feel that he has familiarized himself with my file, ensuring he is prepared to answer all questions. He also includes my husband in the dialogue. He reflects on the data and manages to find the balance between simply explaining possible approaches while providing all the details.
Describe the protocols Michael Putman used in your cycles at Fertility Center of Dallas and their degree of success.
After initial consultation with Dr. Putman, he ran all the standard tests plus additional testing he recommended after IUI #2. The HSG revealed I have a possible blocked tube. Other tests indicate good reserves and AMH and FSH levels for my age. Once we started the IUIs and before we moved forward with IVF, we ran additional testing, including genetic testing via Horizon and natural killer cell testing. All were “normal.” My husband has some morphology issues and I have slight issues with hormone levels.
4 IUIs: 3 with natural ovulation (no trigger); 1 with an HCG trigger; all with Letrozole
- IUI #1 (September 2016): Letrozole, no trigger shot, BFN. Ultrasounds starting around CD 10. IUI around CD15, one day after positive OPK.
- IUI #2 (October 2016: Letrozole, no trigger shot, BFP, chemical pregnancy. We used OPKs and started monitoring with ultrasounds around CD 9 or 10 every two days or so. IUI happened on CD 14 or 15. It produced a positive pregnancy test with an HPT and beta on CD 28. Dr. Putman ran blood work every two days. HCG increased (12, 20 +/-), but did not double and by the fifth day after the initial beta test, HCG levels started to drop. I began to bleed 8 days after first beta.
- IUI #3 (November 2016): Letrozole, no trigger shot, BFP, chemical pregnancy. We used OPKs and started monitoring with ultrasounds around CD 9 or 10 every two days or so. IUI happened on CD 14 or 15. It produced a very faint positive HPT for a couple of days (over 4 tests), but I was out of town for Thanksgiving and unable to run a beta. I started bleeding CD 32, four days after anticipated cycle start day.
- IUI #4 (December 2016): Letrozole, HCG trigger shot, BFN.
After the last IUI, we had a follow-up consultation with Dr. Putman. He had advised us that we would try three IUIs before moving on to next steps. There is no need to continue to try something that is not successful. However, we opted for one more IUI since I couldn’t start IVF until after the New Year anyway. He also presented the option of going in surgically to see if he notices anything else going on, specifically related to the blocked tube. Ultimately, we opted for the general work-around and started on the IVF journey.
IVF Cycle 1 (February 2017): OCP/Cetrotide Protocol (Antagonist) with ICSI and PGS
- Doxycycline- 10 days
- Lo-Ovral Cryselle OCPs for 21 days, no sugar pills
- Menses: 4 days (didn’t start until day 4 and started stimulation the next day.
- Stimulation for 11 days
o Day 1-Day 3: 225 IU Gonal-F in AM; 75 IU Gonal-F in PM; 2 vials of Menopur (75 IU each) in PM
• Estrogen spiked significantly so Dr. Putman removed second Gonal-F injection (75 IU)
o Day 4: 225 IU Gonal-F in AM; 2 vials of menopur (75 IU each) in PM
o Day 5-Day 9: 225 IU Gonal-F in AM; 2 vials of menopur (75 IU each) in PM; .25 mg Cetrotide in PM
o Day 10: 225 IU Gonal-F in AM; 1 vials of menopur (75 IU each) in PM; .25 mg Cetrotide in PM; changed to Lupron trigger from Novarel to prevent OHSS
o Day 11: 225 IU Gonal-F in AM; Lupron trigger in evening
o Day 12: Nothing
o Day 13: Egg retrieval
Retrieval, Fertilization, and Embryo Results
• Retrieved 17 eggs;
• 2 that were mature were immediately identified as abnormal;
• 2 were immature;
• 13 looked viable and they attempted fertilization;
• Of the 13 that they attempted to fertilize, 9 fertilized normally when they checked a day later resulting in 9 embryos incubating.
• The embryologist doesn't really do three-day checks or let his patients know figures until the end of the process. They just wait it out with the philosophy that the best place for those little dudes is safe and sound in that incubator. At this point, the embryologist let me know that "normally" about half will make it to the blastocyst stage to be biopsied for pre-implantation genetic screening. Could be less, could be more.
• A week later….
• Of the 9, 3 almost made it to blastocyst, but the third stopped growing on Day 6.
• We have 2 embryos officially frozen. One is good quality. The other is questionable because it grew very late, was frozen on day 7, and is subpar quality.
• Although they didn't sound too hopeful about the second, they were able to biopsy both for genetic testing (PGS).
• They are keeping the PGS culture “on ice” for a while before we they have to send it off for testing with the hopes that we will bank another round and have more embryos to send.
• The embryologist believes this process verified that egg quality is very likely the issue and explains the many early miscarriages. Of course that isn’t definitive, but I can role with hypotheticals.
• I am giving my body a break from March though May and will start another round in June, which will be a different protocol with the hopes to get better results with a slower growing process.
• The next round will be a 4.5-week stimulation (AACEP Protocol) process as compared to a 2-week stimulation process.
Describe your experience with your nurse at Fertility Center of Dallas. (Assigned nurse: Krissie (with IUIs), Andrea Farris and Jan Mazraani (with IVFs))
The nursing team is phenomenal. Krissy actually performed one of my successful IUIs and was so gentle, compassionate, kind, and informative. When she had to communicate the disappointing results of the beta levels and ultimate miscarriage, she did so in a very tender manner. I appreciated Andrea’s and Jan’s organization and help in explaining the IVF process. They returned calls quickly and responded professionally. Dr. Zhang, the Embryologist, was no different. She answered myriad questions, including at the starting point when we had many questions about the consents. She was so thorough in explaining and patient with our questions. When she delivered the news about the embryos, she was so kind yet matter of fact.
Describe your experience with Fertility Center of Dallas.
I think the clinic is great. They were able to process anything that could be coded as a diagnostic through my insurance. The front staff, including Shelly, is helpful and efficient. Tina, the Administrator, put together an IVF estimate very quickly when we were thinking we needed to do it before the end of the year. The lab technician is wonderful as well. All labs and appointments are done on site. However, should an unusual circumstance arise, the clinic is connected to Baylor Hospital-Dallas so has extensive resources. For example, when I had to change my trigger shot to a Lupron shot, they had me go to different lab within Baylor to make sure that the results were expedited in order to confirm my egg retrieval.
Describe the costs associated with your care under Michael Putman at Fertility Center of Dallas.
Dr. Putman processed all that hey could via insurance; however, I do not have fertility treatment coverage. Therefore, we have spent around $25,000 thus far (IUS and one round of IVF with PGS).
Describe Michael Putman's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at Fertility Center of Dallas.
We have discussed this vaguely with Dr. Putman and determined that we would have to wait and see what the final embryo results are from both rounds before making decisions about transfers.