Pacific Reproductive Center

Good communicator and friendly. (A nurse practitioner actually did the iui procedure the second time and she was great, too.) Honest about success rates, but still hopeful and encouraging. Felt somewhat patient led in our treatments though, according to research I had done. Wondering how a less informed patient would get treated. Or perhaps because our tests came back with good results, it was more up in the air with what would work and what we could try, rather than tackling specific problems. Things like nutrition and supplements were only brought up if I mentioned them. She agreed with everything I was doing, but again, wondering about a different patient who didn’t do as much research. Not sure if she just didn’t think I’d need to be doing all the healthy things I am or what. She did say that not all of her patients want her opinion about nutrition, so maybe she has learned to gage how willing patients are to change their lifestyle. Our only hindrance in conceiving is that, while my husband’s sperm count is great and mobility is great, his overall volume was a little low. We tried 4 iui’s, which kind of have us equal chances to get pregnant at that point with people who have a normal volume, because they “wash“ the sperm and only insert the “best.” The count for the iui was higher each time than if we had needed to use donor sperm. With the last 2, we really seemed to find the right dosage of letrozole to produce two follicles, while having a great, thick uterine lining. However, none of the iui’s worked, so we have an appt to discuss ivf as the next step.

Do all the research you can and read It Starts with the Egg. Dr. Shala will answer any questions and won’t rush you, but it’s best to be self-informed as much as possible.

The first iui, we tried clomid because my husband’s coworker had success on clomid, though Dr. Shala had wanted to try letrozole first. Though I do not have any apparent issues ovulating or producing eggs, the idea is to hopefully produce at least 2 or more follicles to give us more chances to conceive. Each person responds differently to medication though, so it was a matter of trial and error to see what would work. She was perfectly fine to try clomid instead. In addition, I had read about women taking progesterone to also increase their chances to conceive, so this is something I brought up myself and Dr. Shala has no problem prescribing suppositories, which I would start using at night, the day after the iui, for two weeks until we tested. Though I do not have a luteal phase defect or some kind of progesterone deficiency, it was nice to know I was using these to help increase my chances and get my body prepared for pregnancy. There was always an appt once my cycle has started to ultrasound my uterus and check it’s “readiness.” Then I’d start taking the prescription. The first time being with clomid. A second appt was required shortly before ovulation to check my uterine lining and follicles. The first iui, my lining was at its thinnest, barely thick enough for the green light to do the iui. Then we’d do a trigger shot on the instructed morning. The trigger shot was used to time the iui, but also had some hcg in it to help the body prepare for pregnancy. The morning following the trigger shot, we did the iui procedure, with my husband producing the sperm at the location, an hour before the procedure. It was the same process all four times. The second iui, we switched to letrozole and my lining was thicker, but still only one follicle. The third iui, I took a doubled dose of letrozole and had two follicles ready, with a thick lining of 10mm. The 4th iui, we did the same doubled dosage and I had two follicles again; my lining was at 9mm. We were instructed that we could also have intercourse later on that day, to further increase our chances, which we did for all. Unfortunately, none of the iui’s worked, and we had not consulted about ivf yet, so we are basically missing out on this month with getting started with ivf. Part of me wishes we had consulted sooner, so that I could already be taking shots and starting the process, but we really wanted the iui to work (less money!) so perhaps it’s good to take a break?

It’s all dependent on what a person’s insurance covers. My insurance only covers diagnostic testing, not treatment. Each iui, with all the medications, appointments and procedures probably ended up being $1500 each time. They claim to have a special, thorough semen analysis test that they do on site, which is $125 each time, regardless of insurance. It’s the same for doing the “wash” prior to an iui. Some people come to this clinic just to get the semen analysis done and then the results are sent to whatever fertility place or regular doctor they’re actually going to.

We have not discussed this with our doctor yet. I personally am not sure yet if I’d like to do more than one at a time anyway.

She is very easy to talk to and treats you individually , She explains in detail so you can understand procedures and treatment plans .Every procedure done so far has been comfortable (considering) trans vag ultra sound to be exact is very uneasy procedure to go through - but while doctor talks your way through what is currently happening she helps to put at ease the uncertain. Since our first round of treatment has been unsuccessful she’s always positive to educate us on what we can try next and not Give up. We are so glad to have such an awesome doctor to have treating us as not just a patient but a family who wants to grow by the help of science and what my body needs a little assistance with .

Go in to your apt with an open mind and let your body and your doctor work together . Not every person is the same and one treatment is best for another. Don’t feel embarrassed to ask the million questions that go through your mind - she will listen and guide you through.

After undergoing fibroid surgery (myomectomy) through my OB my husband and I visited Dr S and had lots of questions and concerns about our journey to become parents. Dr S wanted to know surgery details , what we’ve tried in past and was very aggressive but compassionate on our future treatment plans right away. Because of my age (36) the concern of being older all the testing began , blood work, Transvag ultrasound, and analysis began . Once all the test were done our treatment plan begun, so far it’s been one round of clomid which I did not respond too and now our next round of letrozole is currently our new plan .

We have a co pay that occurs every visit and our insurance coverage which happens to be really good , we went through our primary doctor so she is in our network up to certain procedures so as of right now the only out of pocket expense has been my husband analysis and our co pay

She was very detailed in explaining the process in the beginning, along with images showing the process. She took the time to listen to our situation & gave her advice as how to move forward. During the process, she has been fantastic at explaining each step and making sure we understood the process & what was happening. Even when we got results we didn't want, she showed compassion & took the time to help explain what was going on, what the next steps would be, and did extra steps to make sure the results were what they were - which was not good (but no fault of hers).

Give it to God & pray daily. Try to be optimistic & hopeful. Be prepared to go through one of the most emotional times of your life! But she is awesome & will be there for every step.

Don't recall...sorry!

I honestly don't remember the exact cost due to my health insurance covering a certain amount of the cost.

She did give her opinion based off our history & advised us they wouldn't recommend transferring multiple embryos (4 or more) due to our background. I strongly feel that it is a case by case situation.

Outside of my obgyn this was the first Experience with a RE. Dr. Salem was always in a rush she never had time to explain treatment and get to know me and my goals for a family. Dr. Salem was unorganized and late to several appointments. She never gave me any alternative options such as donor eggs or fully explained why my fertility was compromised. Or wasn’t until I started to research independently that I discovered what DOR was and that donor eggs may be the best choice. After I asked for Donor egg information, I was told that someone would contact me. No one ever bothered to follow up. After locating another clinic to help me with DEIVF, Dr Salem’s office refused to mail over my medical records in a timely matter. This caused me to redo some tests that could have been avoided. Horrible experience

Research your situation, ask lots of questions and get several opinions from other doctors. Compare potential protocols

She put me on low medication the first round that yielded better results. This included clomid and limited injectables. The 2nd round she pumped me with more medication that ended in failure

Normal prices about $15k for 2 package cycle and $250 per ultrasound $500 anesthesia

I obvulated early while waiting for egg retrieval procedure. Due to medication mix up

When we first met Dr Salem to discuss our struggles trying to conceive over the last year, she discussed with us what testing we could do and that from there we could discuss options. At that time I had no clue I would need IVF so I told her we did not want to do that, she was fine with our choices. When she called to give me the diagnosis of hydrosalpinx of both tubes, I was devasted and sobbing. She talked with me and never brought up IVF because at our consult we said we didn't want to do it. We chose to go forward with IVF because we knew it was our chance at children together which we so wanted. We met with her and she was kind, I had a notebook full of questions she talked to us about all the options for our IVF cycle. We decided what procedures we wanted to include (ICSI, AH & PGS). I went through each question in my notebook and she answered them all. I have done a fresh cycle/transfer, FET and two more fresh cycle/transfers with PRC. Dr. Salem was involved in all but one (she was on maternity leave). I always felt she cared about us, she wanted me to understand the process, she wanted to figure out how to help us. She is kind, knowledgable, always available for questions and very compassionate. As a result of my cycles I have a 21 month old son and am currently expecting twin girls.

Don't be afraid to ask her questions and trust that she has your best interest at heart. She really cares about her patients.

All of my fresh cycles have been the Long Lupron Protocol with Follistim & Menopur and then trigger with Pregnyl (HCG). All of my fresh cycle we have done AH, ICSI and PGS testing with a fresh day 5 transfer of 2 embryos. My first IVF cycle worked and I got pregnant with my son in 2013, he was born 2014. In 2015 we did an FET with embryos from the 2013 cycle and had a CP. Prior to start of FET we did a hysteroscopy which showed uterus was clear from scarring and polyps. We then did a fresh cycle after which also resulted in a CP. We added Cabergoline this cycle to reduce risk of OHSS because I'm a high reposnder and e2 tends to get a bit high. For the next fresh cycle we did an RPL panel and checked NK cells, the results came back pretty normal except Vitamin D slightly low so I started a D3 supplement. We also repeated hysteroscopy and did endo scratch. Hysteroscopy revealed a polyp and scar tissue which was removed. During the stim cycle we added Heparin until 12 weeks gestation and intralipid infusions during stims, at embryo transfer and after positive pregnancy confirmed with 2 beta HCG blood tests. This cycle and these changes resulted in twin girls which are due October 2016.

Our FET cost about $7000 including all medication. The fresh cycles ranged from $20,000-$25,000 which included all procedures, office visits, monitoring, medication, ICSI, AH & PGS testing.

I feel like she wanted to go to IVF right away and I didn’t understand why. I’m a nurse and I felt like it was a money game. I wanted to start with clomid first and then go from there. She said she didn’t recommend it with no real explanation.

Get a second opinion

I feel like we got no where. The last tho g I did was do the hsg which showed a filling defect. Then I did have polyps removed. And never went back sense.

I don’t remember but I paid 1300 to have my polyps removed. And 150 to test my husband.

She was nice but I did feel like IVF was the way she wanted to go even when I wanted to try IUI and clomid first. She was a good doctor though and understanding. I did value her opinion and what she was telling me.. it just felt like she always wanted me to do more.

Definitely go.. but also get a second opinion.

Clomid/IUI - but it got cancelled because I ovulated too soon Clomid/IUI - but it also got cancelled and i was told to just TTC on the clomid Saline Ultrasound

IVF was going to be upwards of $20-30k (with PGS testing)

n/a

He spent a good amount of time looking at our chart to try to figure the best next thing. I felt like he cared and wanted to succeed. He wasn’t always available because his main office was at the Torrance location.

If you start at the Corona office keep in mind to do almost all the procedures you have to travel to Torrence. This was not told to us at first so it was a bit of a surprise.

This was a FET. Lupron was used.

$5000

He was comfortable doing 3.

She spent about half an hour on our first meeting going over my last IVF and results. She would come in to do my ultra sounds but only spent about 5 minutes doing that. No real conversation ever happen with her. The nurses did all the communicating with me. She would come in so the ultra sounds and then walk out.

Be strong and demand her attention.

I don’t remember.

$12500

N/A

He was a great doctor and explained things really well. He was compassionate and very confident. He was willing to talk when I had questions and he was very positive. He gave us another consultation after we had our first daughter and wanted to try again and really explained our chances with the remaining embryos we had.

Come prepared with questions

For my fresh cycle with Dr. Salem I took metformin all throughout and I was on birth control for 19 days, 14 days in I started Lupron 10 U shots. I did the Lupron shots for 18 days. CD2 I started taking prenatal vitamins, started Follistim 150 shots, Menopur shots, medrol 16 mg/day, and a baby aspirin. I had about 30 eggs growing on each ovary so we scaled down the medications from about CD7...I can't remember exactly what they had me do, but I think I skipped a dose of Follistim. I took all of that for 7 days. On CD12 I had an HCG trigger shot. I had my egg retrieval CD 13. That day I started progesterone injections 1 mL/day, doxycycline (just for 5 days), and delestrogen (0.3 mL twice a week). I continued the prenatal, baby aspirin, and medrol. On CD18 I had my embryo transfer. As far as blood work and ultrasounds: I had blood work and ultrasounds done CD1, CD7, CD9, and CD11. We transferred 2 embryos to increase our chances of at least one implanting. Then I was on bed rest for 3 days. Ten days after the transfer I had a blood test to see if I was pregnant, then two days later I had another test. And i was! Then when I was 7 weeks along I had an ultrasound to make sure there was a heartbeat and then had an ultrasound again at 9 weeks and then I was released to my regular OB. For the Frozen embryo transfer we did about 2 years later I was on metformin all throughout and BC for 16 days. 10 days in I started Lupron 15U shots. I took 15U for 11 days and then we took it down to 10U. On CD2 I started prenatal vitamins daily, baby aspirin daily, and delestrogen .5 mL injections twice a week until CD13. On CD14 I started medrol 16 mg/day and progesterone .50mg shot. Throughout that time I had blood work and ultrasounds on CD1 and CD11. And just blood work on CD8. The embryo transfer was CD19. We transferred 2 embryos again. After the transfer I stopped the Lupron, but started the progesterone vaginal capsules daily, and continued the rest of my medication (progesterone injections, prenatals, baby aspirin, medrol, and delestrogen). Seven days later I had my first blood draw to check to see if I was pregnant and to 2 days later had another. That one ended up being a chemical pregnancy.

It was about $10000 plus medications which were about $3000

He was very charming the first time I met him. From then on, he had no contact with me via phone or email. I had questions about all sorts if things and he didn’t care enough to ever respond because I had already written a check.

Stay far far away. Find another doctor like Dr. Lin in Irvine.

Hysteroscopy for egg retrieval Medications such as cetride, clomid, gonal-f to grow as many eggs as possible 2 fertilized eggs were checked with pgd, both had aneuploidy

It ruined my schedule. It was never according to my convenience but according to theirs. It was come tomorrow at 2. There was no choice. If I didn’t go at 2, the cycle was canceled and there’d be no refund or rolling leftover funds over to the next. cycle.

$30k

He strongly advised implanting more than one embryo if he was able to retrieve multiple eggs

I first net doctor Rifaat Salem for my first egg retrieval, he cane to see while I was getting prepped and introduced himself and explained the procedure. He went on to to many more egg retrievals and transfers as well as other procedures during the multiple cycles we did. He knew us personally and always made me feel at home at that office. I always trusted his expertise as well as his staff, he has a lot of experience and keeps the best staff on hand to treat his patients with him.

He may seem matter of fact but I personally appreciated his cander with us on what we needed to do and how things were going. You can ask himanything and he will take the time to make sure you understand.

All of my fresh cycles have been the Long Lupron Protocol with Follistim & Menopur and then trigger with Pregnyl (HCG). All of my fresh cycle we have done AH, ICSI and PGS testing with a fresh day 5 transfer of 2 embryos. My first IVF cycle worked and I got pregnant with my son in 2013, he was born 2014. In 2015 we did an FET with embryos from the 2013 cycle and had a CP. Prior to start of FET we did a hysteroscopy which showed uterus was clear from scarring and polyps. We then did a fresh cycle after which also resulted in a CP. We added Cabergoline this cycle to reduce risk of OHSS because I'm a high reposnder and e2 tends to get a bit high. For the next fresh cycle we did an RPL panel and checked NK cells, the results came back pretty normal except Vitamin D slightly low so I started a D3 supplement. We also repeated hysteroscopy and did endo scratch. Hysteroscopy revealed a polyp and scar tissue which was removed. During the stim cycle we added Heparin until 12 weeks gestation and intralipid infusions during stims, at embryo transfer and after positive pregnancy confirmed with 2 beta HCG blood tests. This cycle and these changes resulted in twin girls which are due October 2016.

Our FET cost about $7000 including all medication. The fresh cycles ranged from $20,000-$25,000 which included all procedures, office visits, monitoring, medication, ICSI, AH & PGS testing.

Dr Salem never had a good bedside manner but that didn't matter to me. He got the job done for my cycle in 2013 but when I returned in 2016 for a failed FET and later a miserable fresh cycle, he was completely uninterested. He was working on opening a clinic in Dubai and not paying any attention to his work. I didn't lose confidence in him after my failed FET because things happen and no fertility treatment guarantees success so I agreed to do another fresh cycle. That cycle was a nightmare, he barley glance at my ovaries during ultrasounds while I was on stims, only measured ONE follicle so he never increased my dosage when I wasn't responding well. Then because I had so few follicles growing and they were small, he had he continue to stim for too long, likely compromising egg and embryo quality. I was devastated at the results of that egg retrieval and fresh transfer and immediately sought a new doctor.

Choose another doctor. Dr Salem doesn't care about his patients.

Dr Salem prescribed menopur and follistim. He did not properly monitor my follicle growth for my fresh cycle in 2015 like he did in 2013. I needed severa dosage adjustments the first time around. The second time he never bothered to measure my follicle sizes and never increased my dosage throughout the cycle.

My first cycle was a two cycle package (only used one to get pregnant) was $15,000 without medication. I qualified for a reduced rate for a second single cycle later and it was $8500 without medications.