Madigan Army Medical Center

Dr. Chow has been a good doctor. He explains things well and let me ask all my questions. I would also say that he has good bedside manner and speaks in an tone that I appreciate. He is not available for questions outside of your appointment time and can only be reached my email that one of the nurses would pass on. I would prefer a better phone communication with him.

Make sure you have all your questions ready to go at your appointment time and make sure you understand the treatment plan.

When I 1st went to the clinic Dr. Chow started me on Clomid. Same time every day or a specific number of days and then blood draws and ultrasounds were performed to calculate my most fertile days and recommend days for intercourse. The logic behind this was that because I have PCOS and my body was not ovulating on it's own then I have Clomid make me ovulate and try a more natural way to conceive. This was successful once, resulting in an ectopic pregnancy. Then we did the treatment for IUIs. Which were pills on certain days, blood work and ultrasounds, then an injectable to make my body release the egg and suggest days for intercourse along with the date for the IUI procedure. The night before the IUI I took the injectable to release the egg and they then placed a concentrated amount of my husband's sperm in my uterus. Wait 2 weeks to check for a positive pregnancy test or not. The logic behind this treatment was to place the sperm close to the egg in hopes for a better chance at pregnancy. We tried that 3 times, once it resulted in a chemical pregnancy. Then we moved on to and egg retrieval cycle. All of these eggs were to be frozen and we would thaw out 2 to 3 at a time to fertilize and then dona frozen transfer. We were successful in retrieving 19 eggs and 17 were successfully frozen. Then 2 months later, I prepared my body for the transfer and transferred 2 embryos and that did not result in a pregnancy. Dr. Chow suggested this because he thinks at this point this is our best chance at achieving pregnancy.

We never had to pay anything to the Madigan clinic but we did have to pay for the IUI and IVF services that Madigan did in partner with Seattle Reproductive Medicine. We paid a discounted rate of $200 for IUIs to the SRM clinic and $10,000 for IVF procedure to the SRM clinic.

He suggested we transfer no more than 2 in. He said more thann2 would be a risk to be and any potential children I might bear.

We started seeing Dr. Pier shortly after the laparoscopy that I underwent in March of 2019. Dr. Pier has always been upfront and has answered all questions that my husband and I had for him. Dr. Pier always made sure that we were comfortable and had all the resources and materials needed to proceed with the IVF process. If not for the fact that Dr. Pier can only see patients with Tricare or military couples, I would recommend Dr. Pier to any and everyone suffering from infertility.

The advice that I would give to any perspective patient of Dr. Pier would be to finally breathe. You are in good hands with Dr. Pier and his staff at the REI Clinic at Madigan Army Medical Center. My husband and I understand that infertility is very stressful, having someone as caring and as knowledgeable as Dr. Pier on your side finally levels the playing field when it comes to infertility and the challenging effects it has on a couple.

Treatment strategies that Dr. Pier recommended to myself and my husband were to first utilize IUI to try to conceive. We did this for about 6 months, the medications used were Letrozole and Ovidrel. After seeing no results for that 6 month period Dr. Pier then looked at my results from the laparoscopy and discovered that my remaining fallopian tube also had significant scarring. Dr. Pier then recommended that we try IVF, Dr. Pier and his staff were very transparent when it came to explaining the cost, procedure, and risks involved with IVF. The IVF cycle that we completed with Dr. Pier yielded significant results, 24 eggs retrieved, 20 matured, 15 fertilized, and 9 embryos. The medications that Dr. Pier prescribed for the IVF cycle were Gonal F, Menopur, Ganirelix, and Ovidrel.

Doctor visits, prescriptions, labs, and the laparoscopy were all covered by insurance. IUI costs were $200 per session. IVF was $8,584 for the cycle.

At this time we currently have not undergone embryo transfer, we are scheduled for transfer in June of 2020.

Dr Chow is kind and compassionate and has an excellent bedside manner. He is attentive and listens to all of your concerns and does his best to ease those concerns without giving you false hope. He has a lot of experience and cares about each of his patients. We did 4 IUIs with Dr. Chow and all 4 of them failed. We never changed my protocol and In hindsight I wish I had advocated to try something new. We would’ve moved onto IVF with Dr. Chow but we received military order to move.

Dr Chow is. Great doctor, but since Madigan is understaffed you really have to be your own advocate. Ask a lot of questions. If something doesn’t make sense to you or your don’t understand ask for clarification.

We did timed intercourse for several month with femara and a trigger shot. Then we moved onto IUIs and we also used Femara and a trigger shot for all 4 IUIs.

Each IUI was $200 out of pocket

Generally speaking Madigans policy was to only allow you to transfer one embryo at a time unless there were other extenuating circumstances.

Strengths: Dr. Chow has a realistic, candid approach, which I appreciate immensely. He is knowledgeable and works within the parameters of what the Madigan RE clinic is equipped to do. Weaknesses: Since we work with Dr. Chow (work-up for IVF) from a different state, there are times when it is difficult for the doctors we work with in our state of residence to quickly get in touch directly with Dr. Chow. As his schedule is very full, I don't always come away from appointments/teleconferences feeling that I've had time to ask all of my questions.

Expectation management. I am incredibly grateful that military families have some RE treatment available through facilities such as Madigan that helps reduce the exorbitant cost of fertility treatment- especially IVF. With that said, realize that, because of overwhelming need/demand, your experience may not be as relaxing/intensely personalized as you'd like.

Treatment prior to PCS out of WA: Initial consult and testing, including intravaginal ultrasound; suspected uterine fibroid. Exploratory Hysteroscopy (done by doctor OTHER THAN Dr. Chow) to investigate possible fibroid was performed without any medication/sedation and was extremely traumatic mentally/emotionally/physically. Results did not reveal any uterine abnormalities. Treatment done from distance: Work-up to IVF, (following HSG, several unsuccessful medicated cycles (letrazole, follistim, and ovidrel), two failed IUIs, SIS, and operative hysteroscopy to remove uterine scar tissue in current state of residence): Dr. Chow has been working with my doctor in current state of residence, providing consultation and advice for operative hysteroscopy and talking with us about plans for future IVF cycle when we travel back to WA. We will be doing a frozen sperm sample (husband deploying), medicated stim and egg retrieval, ICSY, and frozen cycle (Dr. Chow is working with us on timing, in order for husband to be present at potential birth).

General consultations/testing/exploratory procedures (with Tricare Prime: $0 IUI (done at Seattle Reproductive Medine): ~$500 IVF: -medications: IF filled at Madigan pharmacy: $0 (unsure as to cost at other pharmacies, but there will be a cost) -sperm freeze: $200+ -egg retrieval/ICSY/fresh transfer: $8,000+ -egg retrieval/ICSY/frozen transfer: $9,000+

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I had an ultrasound at my first appointment in which it was pointed out that i had "a lot of follicles" which was pointed out as a good thing. My amh came back elevated, yet he did not mention it. I did the research myself and at the next appointment I brought up how I had read the elevated amh and the ultrasound to me seemed like PCOS even though he had said we had unexplained infertility. I don't feel that I was really heard or paid attention to.

Advocate for yourself if you are coming to this clinic in general. As a military spouse, I have seen first hand how sometimes the level of care in a military facility is not always great. I felt that when I was seen by Dr. Chow as well as other staff at this clinic that I had to really do research myself and ask questions, versus being guided and encouraged the way someone going through infertility should be.

I was given letrozole at the lowest dose days 3-7, followed by an ovidrel shot and IuI. Before moving away, this is the only treatment we were able to try at this clinic. I only produced one decent follicle and was told my lining looked good, yet it did not work.

One blessing was that we did not have to pay for service here. Even the IUI was free which with it not working, I am glad we did not have to pay.

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We love all the doctors at this clinic. All doctors are very good at explaining what things are and plans of action. Very caring doctors, always with a smile on their face. Very good at showing results and why things are certain ways. I once felt very insecure about going in for my first abdominal ultrasound, but the dr and resident were very welcoming and went slow and it made it less stressful.

You can trust this clinic!

Right now my medicated cycle has been delayed/cancelled due to my prolactin levels being almost double. Dr felt it was smarter to fix that as sometimes that actually can help to fix my ovulation issues on their own. We will try that this cycle, if no change or pregnancy occurs then iui or medicated cycle next month

I have had no costs so far as all have been covered by tricare

We have not approached this yet, so no issues

I love Dr.Chow. He creates a plan tailored to you as a patient. He carefully looks over past history and goes from there. When talking to him I don’t feel as though he is “sugar-coating” things. But he does make sure you understand.

Ask as many questions as you need too.

We have done countless ultrasounds..Going forward we are going to be starting IVF treatments. I know that Dr.Chow will be there every step of the way.

None

Wonderful at his job. My IUIs with him were painless and one resulted in a positive pregnancy test, which is the desired result. I had less cramping or side effects when Dr. Chow did the procedure. He isn’t a man of many words, but that was perfect for me. He was very clear and blunt about everything we were doing.

Do your research beforehand and be prepared. He doesn’t mince words and will speak to you as an equal. Going in prepared will ease the process for everyone.

Letrozole 5mg, since my previous lower dose didn’t work. Produced a chemical pregnancy, which is still a positive!

None, Tricare

IUI onlu

My experience with Dr.Pier has been positive. I started with a long and lengthy consultation in January and was scheduled to start my IVF cycle in May, but due to Covid, plans are on hold. Dr. Pier was in touch with my out of state OBGYN and has been very great at communicating in the portal about medications, my questions, etc.

Be prepared and be an advocate for yourself.

I have not yet started my protocols yet.

$8500 for IVF and Fresh Transfer, with embryo storage at SRM rates.