Pacific NW Fertility

Dr. Lamb has been very compassionate and really clearly explained every step of the procedure, as well as the studies behind certain options that make her recommend or not recommend them. She seems incredibly up to date on the latest science.

Her schedule books quickly, and I did not see her on the majority of my visits or my egg retrieval, so you might want to plan that out ahead of time. However, all of the doctors or NPs I saw were great.

I'm 37 and had one prior egg retrieval that only resulted in 5 eggs, so we did BCP agonist, a higher dose of Gonal-F with the addition of mini HCG, and a HCG trigger. I generally have a high amount of follicles but my eggs need more to mature, and this seemed to do the trick.

We went through insurance, so we were only out of pocket about $3000 for genetic testing. I believe the total billed to insurance was something like $18k.

This clinic has a rule that for PGS embryos, they will only transfer one single. I'm not sure of the policy on non-tested embryos, since we did not go that route.

Dr. Shahine is a very active person in the field of fertility medicine. She is very active on her social media Instagram to help raise awareness for infertility including available grants and support groups. She is also a specialist for recurrent pregnancy loss and an author. The reason why I seeked her out for a second opinion on my recurrent pregnancy loss was to gain some new insights on why I've miscarried two babies already in the last two and a half years. So far, I'm not sure I've learned anything new, that I haven't heard from my previous RE. To be honest, I did not expect her to have the magic pill that would fix RPL, but maybe we'll learn more as our treatment at this new clinic moves forward.

Dr. Shahine is good about making sure you have your questions answered. She is also reassuring and encouraging. I say this about any Dr or situation, to be your own advocate and bring those hard questions to them.

After reviewing and discussing our last IUI treatments with our first RE, she noticed the dosage of the fertility meds and some complications I had. She suggested we change the dosage on some meds due to those complications. This clinic also times the IUIs differently than my last clinic to be anytime on the day after trigger shot instead of a set 36hrs after trigger like my previous clinic's IUIs.

Medications for a hybrid oral/injection cycle ran about $440 and the IUI and sperm prep were covered at 80% by our insurance.

Dr. Lamb has always been a candid and proactive part of my treatment. My partner and I came to the clinic with some complicated issues, so we are still undergoing treatment and discussing potential future treatments. I appreciated Dr. Lamb's personalized approach to my care, and I know that she truly wants us to leave the clinic with a baby. It's just a matter of finding the right path to get there. Dr. Lamb has been patient with my severe anxiety, and I appreciate her direct and scientific answers to my questions. I am very happy with my experience as a patient.

Don't be afraid to ask questions and ask for more explanations. I shared my ideas for potential protocol changes, and Dr. Lamb always explained to me why those changes would be good or bad with evidence to back up her answers. Don't be afraid to play an active role in your care and approach IVF as a team process.

We used a higher dose of Follistim during cycling and triggered with HCG. All of my eggs produced were mature, but we didn't get as many healthy embryos as expected. We used IVF + ICSI. We are in the process of troubleshooting our approach for our next cycle since we are dealing with severe male factor infertility and less eggs making it to blast.

The cost for a full cycle was approximately $18,000. This doesn't include medications and optional PGS testing.

Dr. Lamb prefers eSET/pursuing one healthy singleton pregnancy at a time.

Doctor Shahine is really good at giving you all the options and staying neutral to allow you to make the best decision for you. However if you ask her “what would you do if you were in my situation?” She will give you an honest answer and list the reasons why. Which I appreciate. Doctor Shahine is really good at explaining treatment procedures and keeping you informed of what needs to happen.

You can never ask too many questions. Do some research on each treatment beforehand and come in with some questions written down.

In my case I have a “balanced translocation” a condition with my chromosomes that can be passed down to my eggs that lead to miscarriages. Since a large number of my eggs would not result in a viable pregnancy, Doctor Shahine told me we would be more aggressive with the egg retrieval medication. That way we’d have better odds of getting a “good egg.” The results were effective as we ended up with one embryo to transfer.

A large portion of our treatment was covered by insurance. Treatment costs included egg retrieval, kearotype testing, fertility medication, PGD and PGS testing.

Dr. Shahine has a sweet demeanor, has great bedside manor and is very to the point. She is great at listening and answering every question I present. I began seeing her after my previous RE retired within the practice. The transition was seemless and I am so pleased with the attention to detail and protocol she has put in place for me.

Initially starting with a fertility consult can be very scary and intimidating and although she wasn’t my initial Dr on this journey I had to start over with a new protocol with her and I was immediately heard and cared for. She is relatable and incredibly knowledgeable. She is every active in the community, an author and advocate. Overall a great physician!

Dr. Shahine has set up a FET protocol for my which included birth control pills, a saline sonogram, Lupron, Estrogen patches and Progesterone in Oil injections. Lupron was part of my protocol due to the suspicion of endometriosis.

I did get a sheet with the 2018 FET cost estimate. I don’t have the specifics on hand but with meds it was around $6,000 per transfer.

All of the physicians with in the clinic agree that 1 healthy pregnancy at a time is best. Best for Mom and baby as a pregnancy with multiples run a higher chance of encountering risks. However, they will consider transferring 2 on a case by case basis.

She does her homework about you prior so you don’t have to explain your story over and over. She is competent in her job, kind, compassionate, and direct. She really was amazing. She is willing to do what you want to do, or get you to the right people that you need. She works with outside facilities if you live outside the Seattle area.

You will love her. She is so kind, so caring. She is educated, direct and compassionate. She is prepared for your visit and treats you with respect and explains everything fully.

She gave us the option of trying to do IVF with our own eggs but our chances of having a quality egg would be very low. If our end game was a healthy child she suggested we use donor eggs. But she wanted to make sure whatever choice we made she would go 100% toward that choice and do everything she could to make our dream come true

We got quotes for both and outside monitor IVF with and with PGS and quotes for outside monitoring donor cycles. Costs ranged from 22,000ish to 40,000 ish with and without medications

I understand the single versus multiple egg transfer. Dr Shahine’s clinic promoted single egg high quality transfer. The thought of multiples scared us so that eased our minds.

We initially chose to see Dr Lamb (as opposed to the another clinic provider) because her bio on the clinic website seemed like the best initial fit. As a lesbian couple who (initially) was “only needing IUI,” we were worried about feeling like “less of a priority” because we weren’t seeking IVF or something else complicated. But from our very first visit with Dr Lamb, it felt very clear that she was going to dedicate whatever time and attention our treatment plan required. We really felt like to only patients in the clinic when she was sitting in front of us—she was never rushing off to another clinic appointment, never seemed annoyed by our questions—even when we had a half dozen of them! She has always been very compassionate in her demeanor and is easy to talk to about very intimate details of our lives.

Don’t be afraid to ask the “hard questions” that you really want answers to or are wondering about — it might be scary to hear the answer, but hearing it from Dr Lamb really does make it a little easier!

We started with a very basic protocol because all labs, u/s, and hysterosalpingogram were normal. For our first 5 cycles, I took letrozole days 3-7, had a day 12 u/s, then timed ovulation trigger based on u/s results. For the 6th cycle, we tried a ten-day course of letrozole, but because of thin ing of the uterine lining, we didn’t continue that in cycle 7. Cycle 7 we did letrozole days 3-7 + injectables, with day 12 u/s. We used letrozole instead of clinic per Dr Lamb’s recommendation to lower the risk of multiples.

We were provided with a price sheet at the very first appointment, and while we did not expect our insurance to cover any of our fertility-related care, the clinic agreed to bill insurance prior to collecting payment from us. Our insurance ended up covering some components of the care, and it was super convenient to us that hey had been willing to bill.

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Lorna Marshall thoroughly reviewed our chart and was happy to help us with IUI because she knew we were not ready for IVF. When we wanted to be more aggressive she adjusted our protocol and added inhectables. She was always understanding of our situation and showed compassion while at the same time being straight forward with our situation.

I can’t think of any advice to give specifically related to Lorna Marshall.

I was prescribed Letrozole 5mg daily days 2-6. This was a little earlier than typically prescribed because my cycles are a little shorter than average. My ultrasound on day 8 showed 3 mature follicles. I triggered that day and did the IUI next day. The second IUI with PNW Fertility we added follistim (75iu) on day 7 in attempts to be more aggressive. My ultrasound was day 8 and showed 3 mature follicles. I triggered day 8 and IUI was day 9.

Consultation $295-375 Ultrasound $185 Venipuncture $25 Hormone testing $79-85 each Injection $40 Insemination $275 Sperm wash & prep $270

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Dr. Marshall was very calm and considerate whenever we met with her. She is very knowledgable and was patient with us even when we were frustrated that multiple IUI attempts had not worked. I have also heard great things about her from other patients that we have met during our journey. My two critiques are as follows: - Dr. Marshall (and PNW Fertility) was less than willing to stray from the normal playbook. Our case is atypical in that we were using donor sperm and we had no explanation why the IUIs hadn't worked to date. We asked about a laparoscopy to look for possible endometriosis, which she dismissed as too invasive and stated that she thought there was no reason to think my wife had that condition. We decided to move forward with the procedure anyway using my wife's OB-GYN, and they did indeed find endometriosis, which may have been an issue with the prior IUI attempts - At our last insemination, the RN asked if we had been taking in additional medication recommended by Dr. Marshall. These recommendations were in our file, but she had not actually told us anything about it.

Dr. Marshall is knowledgable and considerate, but as with everything in the infertility process, it is important to be your own advocate and make sure you communicate with her if you feel you need more testing or are seeking a different approach.

Multiple IUIs attempted with Dr. Marshall and RNs at PNWF. None were successful. After 5 attempts Dr. Marshall recommended proceeding directly to IVF.

IUI costs included the insemintation, as well as defrosting and testing of donor sperm. We were repeatedly charged for sperm analysis that as not done (since it was a donor). We have begun exploring IVF costs, and while they seem comparable to other clinics in the area, it is... excessive.

Dr. Lora Shahine came highly recommended to me from several friends. I was initially impressed by her, but as my husband and I started coming more often to PNW Fertility, we realized that we only saw her the one time we initially met her. All my IUIs and scans were done by other practitioners. When I voiced concern and wanted to meet with her, we were scheduled for an hour appointment with her to discuss starting IVF. My husband and I took the day off work, and Dr. Shahine was about 50 minutes late and we felt very rushed in our meeting with her. It was very hard to get a hold of her even once we had started IVF, and we basically felt connected to our IVF coordinator but not Dr. Shahine so much. As time has gone on, I feel like Dr. Shahine has been more involved with our care, and we've formed a decent relationship. All in all, it just seems to us as though she is very busy, and we are not important enough.

One piece of advice I'd give a prospective patient is to meet with multiple providers, and then go to the one with whom you feel the best connection. I went with recommendations of friends but I feel like maybe it just wasn't the right fit for us, as we prefer very involved practitioners.

We underwent 3 IUI treatments, with a trigger HCG shot. They were extremely painful and bloody, apparently I have a "tricky cervix". Then we underwent IVF, using birth control pills, Lupron subcutaneous injections, estrogen patches, progesterone intramuscular injections. I think it was the pretty standard set of drugs with usual doses.

The costs for the IUI treatments was around $3000 or $4000, the whole process for IVF was about $58,000.

I think Dr. Shahine is not a fan of multiple embryo transfers for anyone, but especially for people with kidney or heart problems.

Dr Shahine has always been absolutely amazing and cares about me as a person, is always asking how I am doing and how I am feeling. The only thing I haven’t liked in recent visits is the nurse that calls me in, she always seems in a bad mood, always pronounces my name wrong and just seems like she doesn’t like her job, even my husband noticed and said something. I look past this because Dr Shahine is so wonderful but definitely doesn’t match how the rest of the staff is.

Just be prepared that it’s a journey, and it will not happen overnight but Dr. Shahine will always keep you updated and give every option available and then let you make the decision that’s right for you. She will give you the good and the bad but always remains positive that there is always another option to start a family and to never loose hope!

We used a normal IVF protocol for egg retrieval and have had two rounds of frozen embryo transfer that involved lupron, birth control pills and then estrogen patches and progesterone in oil shots

I believe it was 18,000 for the egg retrieval and then 5,000 for each transfer, plus the cost of medication

She explained both and gave her opinion on what she thought was best for us but then left the final decision up to us.

Dr. Swelstad is a pleasure to work with. He is caring and compassionate but also tells you how it is, not just what you want to hear. He will give you all the facts, good or bad, and allow you to make your own decisions. He is easy to understand and always has charts and visual aids to help explain things in an easy to understand way. Even though we have not yet had success, I believe he will get us to our goal and trust that he knows how to get there.

Listen to what he says, even if it is not what you want to hear. He will give you options but also give his opinion. I wish I had listened to his opinion earlier even though it would mean moving to IVF sooner.

We started with Dr. Swedlstad after 3 rounds of medicated cycles (clomid) with two of them including IUIs. Dr. Swelstad instantly switched us to Femera and did 3 cycles of that with IUIs. After this, we took a break and moved to combo cycles with 5 days of Femera and 3 days of Follistim injections followed by a trigger and IUI. The last 2 cycles, we also used suppository progesterone. All cycles failed.

It has been a long road for my husband and I. I met Dr. Marshall during my ART consultation. During this consultation, she was very informative and concise, which is what I look for in a doctor. She took the time to explain the entire process of IVF and answered questions along the way. She has told me how it is through this journey that I am still on. She has told me her concerns and what she feels would be best but always giving me options to choose from.

She is a great doctor and would recommend to all. Although this journey I am on is not something that has been planned, she has made it easier to get through.

I am currently on my first round of IVF. I am on Follistim and Mini HCG. She has titrated the amount according to my labs. She used Ganirelix. She is using a dual trigger with Lupron and HCG. SHe recommends freezing your embryos for at least 2 months to reset your body.

My first and, at this point, my only IVF cycle cost around $25,000.

I do know the office I go to has a protocol for this. For the age I am, she recommends not transferring more then 2 embryos at a time.

Lora Shahine is a caring individual. She always has a smile on her face and cares for her patients deeply. She has been a light in our darkest hours and I am grateful for her. Even in the hard times she shows hope for us.

Know that you aren't just working with a doctor. You will be working with a friend.

We used estrogen patches and Lupron first cycle but it affected my lining negatively so we went with estrogen and estrace and no Lupron and it helped! Once we transferred I was on estrogen, progesterone, estrace and aspirin. This ended in a Chemical pregnancy

Monitoring appointments were great for us. We live over an hour and a half a way and we had back to back appointments during the winter and they always would either see us earlier or get us in right on time because they understood our travel.

So far for our whole experience we have spent a grand total of 30,000.00 including retrieval and transfer. Meds we have spent around 15,000.00 through our pharmacy.

I trust our doctor and what she says will be best for my body.

Lorna Marshall was technical and rather emotionally cold. She was pleasant enough to work with, superficially compassionate, and not very warm. She had a strange story about her parents taking 9 years to conceive her which was unhelpful given my age and situation. She provided information on the procedures and answered the questions we had as best she could. She was less than helpful in giving advice on next steps and directed us away from further examination of my partner's varicocele and potential varicocelectomy. She was helpful in not recommending IUIs with injectables to avoid possible multiples.

Be prepared that Lorna Marshall likely won't be very warm and emotionally supportive through the process.

Lorna Marshall recommended IUIs with letrozole. She had us come in for ultrasounds in advance of the IUI in order to check follicle count in advance of each IUI. She had us use an HCG trigger shot prior to the IUI. Each time, I developed 1-2 follicles on letrozole, but only ever got negative pregnancy tests.

We paid for 2-3 consultations with Dr. Marshall, the cost of letrozole and HCG trigger shot medications, the cost of ultrasounds/IUI/sperm washing procedures, and parking.

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Dr. Lamb was very kind and honest as she reviewed our history. She pointed out that ivf was the next best step for us (given many months of failed Clomid, Femara, and injectable Follistim cycles) but was willing to help us with more injectable cycles and iui if we preferred. She was very thorough, most importantly! She found things my last RE missed: low sperm morphology, uterine septum, and Ashermans syndrome when she went in to remove the septum via hysteroscopy. We had a second procedure to make sure it worked and it had. We valued her attention to detail immensely. She has also been very kind and a good cheerleader when I've felt low. We did do ivf and had a great retrieval -- many eggs and good fertilization with icsi. Many embryos were made and 4 were normal on PGS. I have now had 3 FET: 1 with negative beta, one with positive beta that resulted in my son, and recently a third FET that resulted in a chemical pregnancy.

I think treatment at her clinic is more expensive than some other clinics, but the quality and attention to detail are worth it! Definitely have a consult with her and come prepared with your records and questions.

I have PCOS and a high afc. History of ohss on an injectable cycle with ti with another provider. She watched me very closely because of this due to risk for ohss again and was able to avoid it! I believe it was an antagonist protocol -- Follistim 225 and low dose hcg daily to start with. Follistim decreased to 150 after first ultrasound. Ganirelex to suppress premature ovulation. Dual trigger with hcg and Lupron. Yield was 26 eggs, 21 fertilized with icsi,14 embryos frozen by day 5-6. 4 of these were pgs normal. I was 38 at the time.

I can't remember because we had so many medical costs lately. I think ivf was around 15k with outside monitoring. Icsi was extra. Biopsy of embryos was extra. Medications were extra. Fet with outside monitoring is now just under 4k, not including meds.

Dr. Lamb prefers ESET with pgs tested embryos. Her rationale was sound!

Pursuing IVF is one of the most out-of-control experiences I’ve had. But there is a comfort in knowing you are doing everything you can. Dr. Marshall has given me that comfort. At every step of my partnership with Dr. Marshall, I have had deep confidence in our approach. And the results are there to prove it. I went from two canceled cycles before working with Dr. Marshall to 15 total eggs retrieved in two back-to-back cycles of embryo banking after working with Dr. Marshall. While my transfer cycle is not until next month, I have rock-solid confidence in our path forward. For you to understand how special Dr. Marshall is, it’s helpful to contextualize my situation and the struggles I had before meeting her. If you are short on time, please scroll to the end where I sing her praises. My story – Before Dr. Marshall I am a healthy woman who has been active my entire life. My body has always cooperated with me, and I thought having a child would be no exception. So I spent my 30s focusing on my career and exploring the world, actively avoiding pregnancy, confident my husband of 17 years and I could have a child when and if we chose to. When we were ready to pursue pregnancy, I was 40. To avoid risking delays and miscarriage, we opted for IVF straightaway. This made our case unusual because we hadn’t spent time trying on our own without success, so we weren’t prepared for the rude awakening that followed. The initial diagnosis was beyond disheartening. I learned my FSH (at 13 IU/L) meant I was closer to menopause than I had counted on. Statistical models estimated I had the potential for three eggs each cycle. My new label: 40-year-old with Diminished Ovarian Reserve. Defiant, we proceeded anyway. But we got knocked down HARD. My first cycle was canceled quickly out of the gate because the birth control pills led to over-suppression. Only one follicle responded. Determined to get more information and move forward quickly, I sought another opinion per the suggestion of a friend of mine with extremely high standards. I flew out of town straightway to do so. The second round was canceled too. Once again, I had a dominant follicle emerge and my other follicles wouldn’t grow as a result. I started pouring over medical journals and learned there was a group of criteria used to describe my poor response: the Bologna criteria. Trust me, this is not a group you want to be in. I hated all these labels, and my sense of self started to morph with the loss of hope. It felt like my only option was to throw a hail Mary, without any real confidence that one would work. Not liking this conclusion (and not being able digest mentally why it shouldn’t be possible to preempt the early development of a dominant follicle), I scheduled a meeting with Dr. Marshall, at the recommendation of several friends. MY MEETING WITH DR. MARSHALL TURNED AROUND THE TRAJECTORY OF MY FERTILITY JOURNEY. 180 DEGREES. My story – After Dr. Marshall After my husband and I talked to Dr. Marshall, I knew I wanted to work with her. I knew she would be my final fertility doctor. Several things really jumped out at me during our initial conversation. Dr. Marshall: • Individualized her protocol recommendation, synthesizing her knowledge of IVF research and her experience and innovation with cancer patients. Her ability to individualize effective protocols was absolutely top notch. Most doctors like standard protocols because they are what generally works. But if you are older or not an easy case, you NEED someone like Dr. Marshall—who has the knowledge, the courage, and agility to go beyond textbook solutions. She discussed options with me, and her rationale was targeted and precise. Dr. Marshall was able to design a protocol that was much more compelling and effective than what I was able to find on other sites and in medical journals. During our discussion my prior cycles became critical inputs for deciding how to move forward. My prior doctors had made very solid decisions, but the key to better results was precisely pinpointing what needed to be changed based on what did not work in the past. • Offered us an entire path forward, not just a protocol for the next cycle – Given my first two cycles had been canceled, it seemed naïve to assume that the next cycle would miraculously be “the one.” We talked through a few scenarios that alleviated the pressure on the next cycle even while giving us renewed hope. It felt like a fresh start. • Focused on doing the right thing – Dr. Marshall happily agreed to work with us, even though there was a chance I could hurt the success rates of her clinic. She is clearly motivated to help people achieve their fertility goals, and is willing to put her patients’ needs ahead of her clinic’s numbers. • Has a sense of urgency – Dr. Marshall helped us get started as soon as possible, and worked with us to schedule other diagnostic procedures while we waited for the cycle to begin. Once we got started with the cycle, it felt like I was like I was in a different body. Hope blossomed when the cycle wasn’t canceled, and then turned into giddiness when I saw above-average results for my age. In the end, we made 9 follicles! From two canceled cycles to 9 follicles! Eight of these follicles made it to day 3, but we were down to one healthy embryo after genetic testing. So we opted to bank the first one and try IVF again. The second cycle proceeded as the first. While there were fewer follicles recruited out of the gate (I pursued this cycle as soon as possible after the prior one), we made 6 follicles, 15 total after two tries! And we now have another healthy embryo. These two cycles also highlighted how and why Dr. Marshall is so unique: • Drive for results – Throughout our journey so far, Dr. Marshall has been in the process with us. She does her work with skin in the game. We went from two canceled cycles to 15 follicles over two cycles. • Mental flexibility to do the right thing – Dr. Marshall always has a plan, but dynamically optimizes when there is new information (from bloodwork, from ultrasound, etc.) There are a lot of smart doctors but in my experience her ability to perceive leading indicators quickly and comprehensively and adapt plans accordingly is extremely, extremely rare. I am not used to others staying ahead of me, and it has been a true joy to relax and just do what I’m told! • Blends the best of IVF science with warmth and compassion – From her ability to handle my IVF-emoting to her kind bedside manner, Dr. Marshall brings warmth as well as expertise. My gratitude to Dr. Marshall runs deep. If, like me, you are able to work with her, you will be a very, very, very lucky person indeed!

Work with Dr. Marshall and you can relax.

Estradiol for suppression. Clomid + High dosage follistim for stimulation. Human growth hormone for finishing. The timing Dr. Marshall used for each step was critical for changing my results.

~$10K for physician services (monitoring, aspiration, transfer); ~$9K for embryology (insemination, blastocyst culture, cryopreservation)

Overall we were very happy with Dr. Swelstad. The only negative thing we encountered was the way in which he approached his recommendation that we use ICSI in our first IVF cycle. According to my husband's sperm analysis all his numbers were above average, except for morphology, which was at the low end of average, but still in a normal range. To me, this indicated that there was no male factor, or at least not one that had been proven. Dr. Swelstad's rationale was that because we had unexplained infertility and had never conceived, it was possible that the sperm were having trouble fertilizing the egg despite the numbers being normal. He recommended that we use ICSI and gave us a ballpark figure of the price (not included in our IVF cycle plan) that turned out to be significantly lower than the actual price. Though he apologized for this later with the usual "I'm a doctor, I'm not in billing," we felt that if a doctor is going to strongly recommend an optional and expensive add-on treatment, that he should be informed about current pricing. After discussing it on our own and discovering the real price of ICSI, which seemed to be exorbitant compared to some other clinics we looked into and the national average, we decided we did not want to do ICSI. Dr. Swelstad then proceeded to call us to make the case again. In some ways we appreciated the personal attention, especially as he made the call at 5 pm, but we also felt quite pressured to proceed with ICSI. In the end, since we only had 7 eggs that were mature enough to be fertilized at all, we were glad we did ICSI, which resulted in 6/7 being fertilized. However, if we had had more eggs I don't think this procedure would have been necessary at all, and the clinic would not give us the option of making the decision after the egg retrieval. It is a fine line since the clinic does, of course, have a vested interest in achieving success, but we did feel pressured, despite Dr. Swelstad's generally kind demeanor and obvious commitment to getting us our positive outcome.

We did a fresh IVF cycle using my husband's frozen sperm and my own eggs. I was on fairly standard doses of follistim (increased from 300 daily to 375 when I wasn't responding enough), mini HCG, and later Ganirelix. My follicles weren't getting big enough, thus the increased dosage. If I did it again I would want to be on the higher dosage from the beginning, as I believe this was the cause of our relatively mediocre-average egg retrieval count. But at the time there was no way of knowing how I would respond, and we definitely didn't want to over-stimulate. I needed a few extra days, and therefore extra doses of ganirelix, but it all worked out well in the end, and I experienced almost no side effects at all from the treatment. 11 eggs retrieved, 7 were mature, 6 were fertilized using ICSI, and 5 survived to day 5. We transferred two and are now pregnant with twins.

We opted for the refund plan, which, once you added the extra fees for ICSI, anesthesia, etc came to over $20,000. The terms were that if you used all your embryos in 12 months and still hadn't sustained a pregnancy to 12 weeks, you would be refunded 80% (not including those extra fees and add-ons).

There was no option because we chose a refund plan that required us to transfer two at a time, and we were fine with that.

I absolutely loved doctor shahine! She was patient and through with her information and very current with her knowledge. She was also Very compassionate. The only criticism I would have is that her schedule is very busy and doesn't always coincide with dates for procedures - but for me she was available 90% of the time.

I would go into the whole process with a open mind and a positive attitude - and I felt doctor shahine was good at fostering these.

We did an embryo donation. From the start there were many hoops to jump through - a very through psych evaluation for myself and my family and a very through physical evaluation to confirm that we were st the best possible starting place to Give the most ultimum results. I had to have a Procedure to remove scar tissue which pushed back the transfer procedure but in the long run this was a great preventive step to avoid miscarriage.

The ebryo transfer with medications was about 5k and then the procedure to remove scar tissue was about 1500$ after insurance.

I liked the fact that they promote single transfer - doctor Shahine's rational for it was that the risk didn't out weight the small chance of benefit. I being an older mom the risk of caring multiples to a full healthy term didn't justify the small percent bump of likely hood of implantation that you might get from transferring two.

It's great so far. Honestly, I'm just getting started after seeing my regular OB-GYN for about a year before seeking additional expertise. My first visit was great, I felt like we had a gameplan and well taken care of. UPDATE: The gameplan played out exactly as she predicted, after one failed cycle (I ovulated, but did not get a positive pregnancy test), I got pregnant on the second cycle and am currently 16 weeks along and everything looks good so far (hoping I didn't jinx it by counting it as "1 live birth" on a previous question).

Come prepared with lots of information.

Started taking metformin (500 mg/day for first week, then bumped up to 1000 mg) Taking 5mg of Letrazole on days 3-7 (I was already doing this with previous OB) Ultrasound on day 13 with injection of 10,000 USP units/vial to induce ovulation

$295 for office visit/comprehensive exam $185 for pelvic ultrasound $135 for pregnyl shot through MRD pharmacy

not applicable as of now

When meeting with Dr. Marshall I felt very confident in her knowledge. She has a gentle disposition and is able to clearly explain the process and procedures she recommended. I went to her after having a bad experience at another clinic and upon meeting her she put my mind at ease.

Expect to not see her at every visit.

Dr. Marshall's first treatment plan was to have me try Metformin as she explained that it sometimes helps patients with PCOS get pregnant naturally. My body didn't react well to the Metformin so she then had me start on Clomid with IUI. Her reason was that there is a better chance in conceiving with IUI versus naturally as the timing is exactly right. After 7 cycles of Clomid (and 6 IUIs) she recommended that we move forward with IVF.

Each IUI cycle (including meds, ultrasounds, IUI procedure, and lab work) cost about $1,100 out of pocket - my insurance does not cover infertility medications or treatments. I was told that I can expect IVF to cost between $20,000 - $25,000.

I was told that my clinic likes to transfer single embryos; however, if we would like to transfer two we have that option. They would not transfer more than two.

Dr. Marshall is competent and speaks clearly, though not necessarily an overly warm or gushing personality. My husband and I make a lot of jokes and she would often simply smile at us, and sometimes laugh a little, but not give a huge guffaw. (I call the vaginal ultrasound wand, "My old friend.") I thought we had a good, collaborative working relationship. I can't work with a doctor with zero sense of humor, especially about something so crazy as fertility treatment and IVF. I appreciated her openness to answering my questions and telling me what she was doing step by step. She'd take time to explain everything she was seeing on the ultrasound, which I appreciated. I learned a lot going through this process and she is open to taking a teacher approach, which is what I desire in a doctor. She also held my hand at one point before the egg retrieval and said, sincerely, "We want this to work for you." That meant a lot to me and made me cry (in a good way).

You really have to trust your doctor a whole lot during what may be the most vulnerable and stressful period of your life. This person is going to see you at your worst. Don't be afraid to switch doctors. We switched to Dr. Marshall from another doctor at another clinic. As with any doctor, speak up and advocate for your own care. Things do slip through the cracks and open communication is key. ...I still never fully got the hang of fertility treatment -- I was never fully comfortable with having to be a part of that system, though much of the struggle was in my own head. It's important to recognize in yourself when the doctor is really the problem, or the problem is within yourself. Conceiving a child is such a personal, magical thing -- and here you have to welcome strangers into the process. Eventually, with IVF, they will no longer be strangers but some of the people you see most often during the week. Fit is so important.

We had male factor infertility caused by cancer treatment. We used husband's frozen sperm. Treatment plan with this clinic was two IUIs, one of which resulted in miscarriage and another that didn't take. We'd had three IUI failures at a previous clinic, as well. Dr. Marshall encouraged us to continue with IUIs, but I was tired of failures and the imprecision with my irregular menstrual cycle -- so I made the case for IVF and Dr. Marshall agreed. This is important to note because the clinic makes a LOT more money off of an IVF patient than an IUI patient. And yet, Dr. Marshall did not push us to do IVF before we were ready, in fact, I was ready to take the next step and asked for IVF. It's important to have a doctor who sees you as a human being with hopes for a family, rather than a source of cash and profit.

From memory: $5,000 - $10,000 out of pocket over the years $15,000 - $25,000 insurance over the years

We did genetic screening of our embryos, put one embryo in, and I am now seven months pregnant with an apparently healthy baby. The genetic screening cost about $2,500 out of pocket. This seems like a reasonable risk/reward for our family to minimize the chances of a failed transfer and to minimize the odds of multiples.

Pursuing IVF is one of the most out-of-control experiences I’ve had. But there is a comfort in knowing you are doing everything you can. Dr. Marshall has given me that comfort. At every step of my partnership with Dr. Marshall, I have had deep confidence in our approach. And the results are there to prove it. I went from two canceled cycles before working with Dr. Marshall to 15 total eggs retrieved in two back-to-back cycles of embryo banking after working with Dr. Marshall. While my transfer cycle is not until next month, I have rock-solid confidence in our path forward. For you to understand how special Dr. Marshall is, it’s helpful to contextualize my situation and the struggles I had before meeting her. If you are short on time, please scroll to the end where I sing her praises. My story – Before Dr. Marshall I am a healthy woman who has been active my entire life. My body has always cooperated with me, and I thought having a child would be no exception. So I spent my 30s focusing on my career and exploring the world, actively avoiding pregnancy, confident my husband of 17 years and I could have a child when and if we chose to. When we were ready to pursue pregnancy, I was 40. To avoid risking delays and miscarriage, we opted for IVF straightaway. This made our case unusual because we hadn’t spent time trying on our own without success, so we weren’t prepared for the rude awakening that followed. The initial diagnosis was beyond disheartening. I learned my FSH (at 13 IU/L) meant I was closer to menopause than I had counted on. Statistical models estimated I had the potential for three eggs each cycle. My new label: 40-year-old with Diminished Ovarian Reserve. Defiant, we proceeded anyway. But we got knocked down HARD. My first cycle was canceled quickly out of the gate because the birth control pills led to over-suppression. Only one follicle responded. Determined to get more information and move forward quickly, I sought another opinion per the suggestion of a doctor friend of mine. I flew out of town straightway to do so. The second round was canceled too. Once again, I had a dominant follicle emerge and my other follicles wouldn’t grow as a result. I started pouring over medical journals and learned there was a group of criteria used to describe my poor response: the Bologna criteria. Trust me, this is not a group you want to be in. I hated all these labels, and my sense of self started to morph with the loss of hope. It felt like my only option was to throw a hail Mary, without any real confidence that one would work. Not liking this conclusion (and not being able digest mentally why it shouldn’t be possible to preempt the early development of a dominant follicle), I scheduled a meeting with Dr. Marshall, at the recommendation of several friends. MY MEETING WITH DR. MARSHALL TURNED AROUND THE TRAJECTORY OF MY FERTILITY JOURNEY. 180 DEGREES. My story – After Dr. Marshall After my husband and I talked to Dr. Marshall, I knew I wanted to work with her. I knew she would be my final fertility doctor. Several things really jumped out at me during our initial conversation. Dr. Marshall: • Individualized her protocol recommendation, synthesizing her knowledge of IVF research and her experience and innovation with cancer patients. Her ability to individualize effective protocols was absolutely top notch. Most doctors like standard protocols because they are what generally works. But if you are older or not an easy case, you NEED someone like Dr. Marshall—who has the knowledge, the courage, and agility to go beyond textbook solutions. She discussed options with me, and her rationale was targeted and precise. Dr. Marshall was able to design a protocol that was much more compelling and effective than what I was able to find on other sites and in medical journals. • Offered us an entire path forward, not just a protocol for the next cycle – Given my first two cycles had been canceled, it seemed naïve to assume that the next cycle would miraculously be “the one.” We talked through a few scenarios that alleviated the pressure on the next cycle even while giving us renewed hope. It felt like a fresh start. • Focused on doing the right thing – Dr. Marshall happily agreed to work with us, even though there was a chance I could hurt the success rates of her clinic. She is clearly motivated to help people achieve their fertility goals, and is willing to put her patients’ needs ahead of her clinic’s numbers. • Has a sense of urgency – Dr. Marshall helped us get started as soon as possible, and worked with us to schedule other diagnostic procedures while we waited for the cycle to begin. Once we got started with the cycle, it felt like I was like I was in a different body. Hope blossomed when the cycle wasn’t canceled, and then turned into giddiness when I saw above-average results for my age. In the end, we made 9 follicles! From two canceled cycles to 9 follicles! Eight of these follicles made it to day 3, but we were down to one healthy embryo after genetic testing. So we opted to bank the first one and try IVF again. The second cycle proceeded as the first. While there were fewer follicles recruited out of the gate (I pursued this cycle as soon as possible after the prior one), we made 6 follicles, 15 total after two tries! And we now have another healthy embryo. These two cycles also highlighted how and why Dr. Marshall is so unique: • Drive for results – Throughout our journey so far, Dr. Marshall has been in the process with us. She does her work with skin in the game. We went from two canceled cycles to 15 follicles over two cycles. • Mental flexibility to do the right thing – Dr. Marshall always has a plan, but dynamically optimizes when there is new information (from bloodwork, from ultrasound, etc.) There are a lot of smart doctors but in my experience her ability to perceive leading indicators quickly and comprehensively and adapt plans accordingly is extremely, extremely rare. I am not used to others staying ahead of me, and it has been a true joy to relax and just do what I’m told! • Blends the best of IVF science with warmth and compassion – From her ability to handle my IVF-emoting to her kind bedside manner, Dr. Marshall brings warmth as well as expertise. My gratitude to Dr. Marshall runs deep. If, like me, you are able to work with her, you will be a very, very, very lucky person indeed!

You're smart to work with her. You can relax now.

We used a protocol that Dr. Marshall developed in her work with cancer patients. Suppression with estradiol. Then a combination of Clomid, Follistim, and Omnitrope. I will need to confirm exact timing and doses.

We froze embryos after both cycles.

Dr. Lamb seems to "know her stuff" very well and I felt like our treatment plan was tailored to our medical situation and results. I felt like she was genuinely rooting for us and in tune with the emotional side of going through these treatments and procedures. I am a numbers person and at times would have liked more precise percentages from her (e.g. likelihood of x happening) but I also know that data isn't always available.

Take your time and come prepared with questions!

I have DOR and we used an estrace lead in with no birth control suppression, followed by Follistim and miniHCG with Ganirelix added in just prior to expected retrieval. We had one canceled IVF cycle due to a dominant follicle (converted to IUI, which was unsuccessful) and our second cycle resulted in three eggs retrieved and fertilized. By day 5, only one remained and we did a fresh transfer that was successful.

We did a multicycle IVF plan that was $21,000 plus the cost of medications for two retrievals and as many transfers as we needed. I think IUIs were $750-1000 altogether.

My doctor did not have a strong opinion on one versus two embryo transfer, and was comfortable holding off on the decision until 1-2 days before transfer. She did talk with me about the pros and cons and provided information on the risks of multiples. We only had three embryos and just one made it to transfer on day 5, so the decision was made for us.

She is very knowledgeable, and extremely caring. She explained the different steps, and walked me through what the options were. Once I was pregnant, I did feel a little rushed out of the clinic, but I figured that was because she was sure that everything was going well.

Write everything down.

Since I had a previous successful pregnancy, and mostly unexplained fertility, we did a standard course of treatment for my egg retrieval. She used birth control and Lupron, followed by Gonal-F and Menopur. She used an HCG trigger for retrieval. Following transferal, we did progesterone in oil shots, combined with estrogen patches. I had a fresh cycle transfer, but I understand that the clinic now combines PGD with a frozen cycle transfer to improve results. The second transfer was a chemical pregnancy, likely due to attachment on previous scar tissue. For the third transfer, she positioned the embryo in a different place. This led to my second successful IVF pregnancy,r, with birth control for regulation, then progesterone in oil and estrogen patches.

They were covered by insurance, so the total bill for the first pregnancy was about $12,000, but we only paid $1500. The embryo storage was $250/6 months. The second and third transfers were about $2500 each, again, partially covered by insurance.

She said she would let the embryologist decide one versus two based on the quality of the day, for the first transfer, and the embryologist said one. For the second and third transfers, I asked for a single embryo.