Describe your experience with RBA.
Dr. Toledo's assistant - Melissa - is amazing and returns calls quickly. The front office staff, particularly Mary Ellen, is a delight and calls you by name when she sees you come in. They do have a policy that no children are allowed, which I appreciated as a patient before we had our girls and respected as a patient who has had two successful pregnancies. If you are bringing in new babies to meet Dr. Toledo, they ask you to wait across the elevator bank, just so you do not upset couples who have not yet had successful pregnancies.
The only complaint I had about the clinic was their financial/accounting people. They often tried to bill us for things we hadn't had done, and one lady was particularly insensitive when I had to check out after I'd found out we wouldn't be able to go forward with the second planned IUI. The parking is also kind of expensive, so I would recommend carpooling with your significant other for appointments so you don't have to pay two parking fees.
During treatment, were you treated like a number or a human with Andrew Toledo at RBA?
Dr. Toledo is the most kind and caring doctor I've ever had. He has a wonderful bedside manner. Every time we have been back to see him, he remembers us, our kids, and things we like to do. When we did our egg retrieval, we got fewer eggs than we expected, and he let me cry on his shoulder when I found out.
Describe your experience with your nurse at RBA. (Assigned nurse: Megan, Lisa, and Krista)
Megan and Lisa were my primary nurses during my IUIs, egg retrieval, and first transfer. They were both wonderful and responded to all of my emails quickly.
I did not have as much interaction with Krista because I treated there for a relatively short period of time with my second transfer (Megan and Lisa had both left by then), but she was always kind, called promptly with lab results, and answered emails quickly too.
How was your experience with Andrew Toledo at RBA?
Dr. Toledo has a wonderful bedside manner. He is friendly and personable and has been doing this a long time. It takes a long time to get into see him, but there's a reason for it. You won't be sad you waited an extra few weeks.
Some of his explanations are technical, but for the most part, he explains things in terms non-medical people can understand. He will take as much time as he needs with patients for consultations - I think those are booked in one hour blocks, just so he doesn't have to get to another patient. I think we spent one hour with him in our initial consult (not including exams, bloodwork, and meeting with the nurses before and after). He answers questions patiently and is happy to take follow up calls. Once we had decided to go forward with IVF, I had questions about the drugs and injections I was prescribed, and I was able to get on the phone with him personally within a couple of days to get answers from him.
What's one piece of advice would you give a prospective patient of Andrew Toledo at RBA?
Be prepared to wait for your initial appointment, but he is worth the wait. And have a list of questions ready to go and be prepared to take notes.
Describe the protocols Andrew Toledo used in your cycles at RBA and their degree of success.
We started with IUI on Femara. (I had been prescribed Clomid and timed intercourse with my OB/GYN but that had not worked, so we moved onto Femara.) Each IUI cycle also included a trigger shot 12 hours before the first insemination, and then 24 hours, there was a second insemination. The first IUI cycle was negative, so they changed the timing of my progesterone. The second attempted IUI did not make it to insemination because I did not get any follicles, so they reversed on the progesterone timing.
The second and third IUI were identical in terms of medications, and both resulted in chemical pregnancies. My beta with the second IUI stalled at just below 50, and the beta with the third IUI barely made it above 10. Dr. Toledo did give us the option after the second failed IUI to start IVF, but we elected to try one more.
After the third failed IUI, we were told our best option was to proceed with IVF. We had a whole lot of bloodwork done (on both me and my husband) and a meeting with a genetic counselor. Dr. Toledo suspected that we were getting "bad eggs" (resulting in the chemical pregnancies), and he therefore recommended pre-implantation genetic screening to screen for embryos with abnormal numbers of chromosomes. He also suggested ICSI to directly inject the sperm into the egg.
We did our first and only retrieval in November 2013, and came away with 9 eggs, 8 fertilized, and 7 made it to day 5, at which point they froze and biopsied all of them for genetic screening. I was on Bravelle and Menopur at the lowest doses recommended (I believe 2 injections of each, each day) because I have PCOS and they were worried about overstimulating. We then stopped the medication since we would be doing a fresh transfer. We ended up with 4 genetically normal embryos, and planned to transfer one of them in January. For the transfer, I was placed on birth control to level off my hormones and then put on estrogen (patches) and progesterone (suppositories) on the first day of the transfer cycle, which I was on till the pregnancy reached 12 weeks. (They will normally wean you off these starting at 8 weeks when the placenta has taken over, but I was traveling around week 10 and was being extra cautious, so they let me stay on it till 12 weeks, when I started seeing my regular OB/GYN). The transfer took place on day 20 of my cycle, and Dr. Toledo did the transfer himself. We got a positive pregnancy test, and that baby is now almost 4.5 years old. Dr. Toledo also did an "uterine scratch test" at the beginning of the cycle, which has shown increased pregnancy rates.
We did a second frozen transfer in October 2016 with the same protocol and steps as our first frozen transfer, but Dr. Toledo did do an HSG test to make sure my uterus was still in good shape (no fibroids, cysts, etc.) It was all clear, and one of his colleagues did the second transfer. That baby is now 1.5.
Describe the costs associated with your care under Andrew Toledo at RBA.
The IUIs cost around $1500 ($500 per insemination, plus ultrasound monitoring and meds).
For IVF, we used a financing plan that totaled approximately $22,000, but included 3 fresh cycles and 3 frozen cycles (and the benefit stops after a successful pregnancy). We only ended up needing one of each, so we probably overpaid. We were told when we went back for our second transfer that they had changed the program such that we could have used the funds leftover after our first successful transfer to put toward the second transfer.
Medications for the egg retrieval were probably in the neighborhood of $4,000 to $5,000, most of it being out of pocket.
My husband changed insurance plans for our second transfer, which had an allowance for fertility coverage, and it cost us approximately $600 or $700 out of pocket (including meds) . I think the frozen transfer without insurance would have been around $3000.
Describe Andrew Toledo's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at RBA.
Dr. Toledo was strongly in favor of a single embryo transfer - I was 31 and 34 at the time of both my transfers - and he did not see a reason to consider a multiple embryo transfer at my age. Given our circumstances, we also had a very good chance of one working (and those odds only increased with two), and he reminded us that twins is twice the cost at the same time (two daycare payments, two college tuitions, two of all the baby gear, etc.).