How was your experience with Edward Nejat at Generation Next Fertility?
Dr. Nejat is disturbingly available by email. If you have questions, they will be answered. He is personable but professional. And very positive and likable. During procedures, he is very focused, and I felt like I was getting excellent care. There are several times where he gave advice that he allowed me to overrule. In hindsight, perhaps I should have listened to him on those few occasions. But part of the infertility journey is emotional and wandering, and I think that he also understands that a patient may not be psychologically ready for the most straight forward medical path. In several conversations with him, it's been clear that he is considering the whole human in his medical practice--both what the body and mind need. There were times that I wished he had pushed a little harder with early advice to start treatment and transition to IVF more quickly because of my age. It took me a long time to realize just how tough the road is for women of my age. My first consultation with him was at 43 and I didn't start a cycle until I was 44. I do wish I had started earlier. Dr. Nejat does not readily give macro evaluations of how things are going. Most of the process is detailed and step by step. Perhaps that is by design. But some part of me wanted to be graded overall, so I would know whether to speed up or slow down or generally reframe how I was thinking about my prospects.
What's one piece of advice would you give a prospective patient of Edward Nejat at Generation Next Fertility?
I would be as proactive about asking questions and following up on things. And be prepared to see Dr. Luk on occasion, as Dr. Nejat does have to take vacation and they swap coverage for holidays. Be very diligent about making sure your care plan is communicated between the doctors or with the rest of the staff if you have to see the other doctor. Dr. Luk is awesome, though, so you won't feel slighted.
During treatment, were you treated like a number or a human with Edward Nejat at Generation Next Fertility?
Dr. Nejat is incredibly empathetic. You always have the sense that he cares as much about your success as you do.
Describe the protocols Edward Nejat used in your cycles at Generation Next Fertility and their degree of success.
The clinic has a preference for more mild, treatments, I believe. And I was much more successful with milder treatments. After my first IVF, where I retrieved 10 eggs, but only 2 embryos were sent for testing, I personally asked to be more aggressive, because it seemed like it was basically a game of roulette to try to get quality eggs down the chute. We used more drugs, and the second IVF produced 5 eggs and only one survived to embryo testing. Dr. Nejat had suggested canceling the cycle and I overruled it (in part because I had done so much work with injecting the drugs). After my one embryo came back abnormal, of course, I wish I had saved myself the money. The next two cycles we went back to a protocol that was similar to the first one, but each time improved. We got 22 eggs and 6 embryos out of those cycles. Specific drugs: 1st--> chlomid, gonal 150-200, cetrotide .25; 2nd--> vivelle dot, gonal 225-300, menapur 75-150, microdose lupron 2x40; 3rd and 4th--> chlomid, gonal 150-200, cetrotide .25, vivelle dot.
Describe your experience with the nursing staff.
Everyone who works at the clinic is incredibly nice and professional. It was a little hard to keep track of all the faces in the clinic, and my appointments, I would typically see Dr Nejat, a medical assistant who tailed Dr. Nejat, someone who drew my blood, and the ultrasound technician. I feel like most of my interactions with the nurses came during phone and email communications, and during procedures where they were in charge of my pre- and post-procedure care. I also asked the nurses to draw circles on my butt for injections, and they explained the injections to me. Generally speaking, I felt very comfortable contacting the nurses by email with any questions and problems. It took me a long time to understand who actually handled what and when it was appropriate to reach out, but now that I do, I feel good about the system. No one wears nametags, which is good for sterile environments, but I feel bad that I can't communicate with people more personally because I dont know their names. The nurses on a few occasions said they would send me something and they didn't, and in those cases I usually just let it drop, it was never anything totally crucial. But it may be useful to diligently track all the things you need and want and be proactive about asking for them. On one or two occasions, I had to double check some instructions and they were revised after I spoke up. One person on staff, who I am not sure official had a "nurse" title, and now has moved out of town, spent time chatting with me when I didn't feel well after a procedure. That was nice. And god bless who ever cleaned up the blood that I spilled on the floor on more than one occaision.
Describe your experience with Generation Next Fertility.
One thing that I have discovered is unique about the clinic is that they allow you to do your procedure with only local anesthesia, rather than general anesthesia. I am a single woman, and this was extremely helpful. You can walk yourself out of a retrieval and take the subway home if you have local. With general you have to find someone to escort you home during the middle of the work day. This was stressful for me as a single person, and the local anesthesia, was totally fine. I think if you have tons of eggs, its not a good option, but I did it with 12 eggs. And I hear some woman did it with 20 (not sure if this is true). We as woman have all experienced worse. And its nice to be able to watch the procedure on the monitor. I also appreciate the clinics aptitude in less medicated cycles and the personal attention you get from the doctors. I wish I had gotten more detailed written instructions directly from the clinic about what to expect and what steps I could take to help/hurt at home. I ended up spending a lot of time googling around my appointments as many of us probably do. And trying to interpret results and answer my own questions. I guess I could have just asked, but I am shy about asking. I don't know what other clinics are like, but a number of the rooms are small and not a lot of places to put your stuff. They are doing an expansion into another part of the building, so I guess that will change. I love that they have a Japanese bidet in the bathroom. That is a great touch. And I think the nurses and finance team do a really good job of handling the insurance and prescriptions. They fought for coverage on a few things for me, and knew where I would get the best prices on meds, and I always felt like those two things were being handled in a way that I didn't have to think about them. Ultimately, I felt like this clinic is more affordable than the places I got quoted in my process of choosing. I had to watch the billing department and correct at least one mistake. And when I am done with my treatments I will go line by line through the charges, but overall, the costs were lower than I thought they would be. I felt like I had two issues in the hand-off between doctors. When Dr Nejat was on vacation, and my third IVF cycle was starting, I got instructions to start with a protocol that I had used in my 2nd IVF, even though that protocol was less successful than my 1st IVF. They immediately alter the protocol when I brought it up, but in that moment, I had to be an advocate for my own treatment and remember the conversation I had had with Dr. Nejat after the dip in success. During this same 3rd IVF cycle, I also saw a rapid drop in estrogen on a day when Dr. Nejat was out. After monitoring, Dr. Luk called me back in to do a retrieval that day, rather than the following morning as it had been scheduled for. I came back in, and we retrieved one immature egg after opening three follicles, and paused and decided that I should come back in the next day and have Dr. Nejat retrieve the rest. So I had to do two retrievals back to back, which was not fun, but ultimately this cycle produced the only normal embryo that I've gotten so far. Not sure if we would have had the same result if Dr. Nejat had been doing the monitoring day, but perhaps. The clinic expanded its monitoring hours, which really helped my schedule. If you are starting your fertility journey, I think it's important that you track your own care and advocate for yourself at all times. There are so many people involved in your care and so many details that no clinic can be 110% on everything. I have thought about whether I should try another clinic, but I just had a good feeling the first time I walked in the door, and I do a lot of things on instinct. I think this clinic was able to quickly find a path that was smart for my treatment, and I feel like I'm in the right place.
Describe your experience with your monitoring appointments at Generation Next Fertility.
Monitoring is a well-oiled machine. Only on a few occasions did I have to wait too long. The receptionist can tell you there are times that are busier than others, so I would suggest asking if you need to be in and out.
Describe the costs associated with your care under Edward Nejat at Generation Next Fertility.
$1,600 for IUI, $4,000 FET, about $5000-$6000 for IVF retrieval cycle.
Describe Edward Nejat's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at Generation Next Fertility.
We only had one normal embryo to transfer, so this was not a specific conversation we had at the time of transfer, but I do believe with PGS testing, Dr. Nejat does prefer to transfer one embryo. He is willing to consider transferring mosaic and some abnormal embryos. And in those cases, I believe he is willing to transfer multiple. He did make it clear to me early that my wish for twins was probably something I should get over because of the medical risks. Advice taken.
What specific things went wrong at Generation Next Fertility?
- Failed to call in prescriptions to pharmacy
- Provided conflicting information
Describe the specific things that went wrong at Generation Next Fertility.
Noted in previous comments.