Reproductive Medicine Institute

I'm still undergoing treatment with RMI, so I am unable to write a full review of the entire process. That said, there are some things I like and some things I don't. I don't always feel a great connection with the people on my care team. The most caring and compassionate nurses and staff I've encountered are actually people I've worked with when they were covering for someone else. I often felt like I wanted more information than was provided for me, and felt very alone in the process. I tried my best to stay away from the internet and only go off instructions from my actual doctor/nurse, but sometimes that was extremely hard because I didn't feel well informed. There are great staff members, though. I love the phlebotomist -- she's always cheerful and will pick the colored gauze to match your outfit that day. I also have almost always been able to get an early enough appointment to get my bloodwork done before work, which is appreciated. The communication can feel lacking, and I do sometimes feel like I would like a more personal touch. The medical parts of this process have gone very well so far; it's just the emotional support that feels lacking. Finally, I have heard from friends at smaller clinics that while they know their team very well, the doctor will only perform transfers every three months -- I could not handle that, and I am grateful that RMI works with the schedule that's best for me.

I felt that I had little information about this process. I skipped over IUI and straight to IVF, so perhaps my team felt I understood more than I did. I got a phone call at 4:45pm on a Friday the first time I was told to do injections, and felt I had zero support. Throughout the process I learned I needed to ask far more questions, because I felt the information they provided me was not sufficient. I did have a consultation with Dr. Rana after our first failed transfer, and I appreciated the time he took to meet with me. However, I didn't always feel like my concerns were being fully heard.

My coordinator, Krystyna, is okay. She responds to calls quickly, but I do wish I had a direct extension to be able to reach her. I also haven't had much facetime with her, other than when we were first getting started and when we have to sign paperwork. But, it's actually the nursing staff during the retrieval and transfers are the ones I like best. They're much more approachable and informative, and have a friendlier demeanor.

Dr. Rana was helpful during our initial consult in explaining why my husband's sperm count and motility pretty much necessitated IVF. That was the most informative conversation i got through this process. However, when I had concerns about my mental wellbeing and questions about exercising during the process for my mental health, Dr. Rana didn't seem to understand why I would want to exercise for reasons other than weight loss. I was feeling down and frustrated and like I needed more information and support. However he simply referred me to an acupuncturist, and I didn't feel entirely supported or heard.

Advocate for yourself. Ask lots of questions.

I had to do a round of birth control before each cycle. For my Stim cycle, I was on Follistim, Menopur, and Ganirelix. I also had to do Doxycycline before each transfer. For my frozen transfer I was on two pills of Estrace twice a day and PIO. For my fresh transfer it was only one Estrace pill 2x day.

My insurance covered nearly all of the procedure, other than embryo storage, once my deductible was met.

My doctor recommended "1 or 2" embryos, and I selected 1 both times, for my fresh and frozen transfer. If this cycle doesn't work, I will do 2 next time. I think Dr. Rana prefers two, but when I told him I'd prefer 1, he didn't push one way or another.

It is very clean and professional. There is parking behind the building and is easily accessible. The hours are not ideal due to abnormal work week, however I’ve been able to go on my lunches since it’s so close to where I work.

Everyone in the office showed courtesy and was extremely helpful and understanding.

The nurses were exceptional. I have never had to wait for an appointment. I had my period the perfect time for an ultrasound and they performed it that day. They explained everything in detail, spoke about insurance, provided a timeline and wrote every date out, answered every question we had and one provided her story of infertility and how she was successful with IVF. They’re all amazing.

Dr. Rhinehart listened to both me and my husband. He was able to get my husband and I to compromise on a plan that made us both comfortable. He provided three options, explained them in detail, made a suggestion and was very open to what we wanted. Dr. Rhinehart was very detailed about the risks and percentages of each option. I’ve heard nothing but positive reviews and I highly recommend this doctor.

I have endometriosis and have done a lot of research. Some of the explanations Dr. Rhinehart provided went over my husband’s head, but I was well informed and was able to keep up because I did my homework. The team is very good at explaining all of the processes and procedures, but it’s still a lot to take in.

I am currently doing my first IUI cycle with Clomid and HCG shots before and after the procedure. My gyno did an extensive work up and diagnosis of endometriosis, but did not want to attribute that to my infertility. She did not want to prescribe clomid and said she could not definitively say that my infertility was due to my endometriosis. I had MRIs done, multiple ultrasounds, the dye testing to see if my tubes were open and a lot more prior to going to Dr. Rhinehart. He examined the findings and immediately said it was due to the endometriosis and wanted to be more aggressive than if I didn’t have it. It was nice to finally have a solution and a plan of attack.

Clinic's Strengths: Well organized and accommodating to your work schedule Clinic's Weakness: Phone system that only allows for calling one main line and being transferred. This is especially unhelpful if you receive a call from someone when the office is technically closed and the main phone lines go to their answering service. I have never experienced longer than necessary wait times or felt that it was a hassle to schedule my appointments. Everyone is incredibly friendly and remembers you as a patient, which is probably due to how frequently they see you in a week!

Working with Dr. Rana, I definitely felt more like a human than a number. I am unable to say, unequivocally, that I felt completely human under his care because the consultation felt a bit "paint by numbers" while discussing our needs. I believe if we had more questions to ask, he would have answered them with no issue. However, there have been moments where I feel he has been doing this work for so long that we all just sort of bleed into each other and don't stand out as unique patients.

Huma, Dr. Rana's primary nurse, has been amazing. She is available to answer questions and direct us to the appropriate member of our care team. Honestly, we communicate with her much more than Dr. Rana. Krystyna, our IVF coordinator, has also been great. She is direct with all of her communication and clearly explained what we need to do in each step of the process.

Dr. Rana's biggest strength is his experience and ability to clearly communicate each step of the process. He is direct which helped us a great deal but could be offputting to patients who would prefer a more delicate approach. At no point did I feel I was under the care of an uninformed doctor. His greatest weakness, in my opinion, is how he communicates. As we were told and observed during the first cycle, our case had little to no complications and did not require a lot of explaining. I believe that if we needed to ask more or had more details to discuss, it would have been more difficult.

Research the entire process so that you can ask him direct questions during the consultation. Also, if you know that you will require a doctor who is more sensitive, he may not be the ideal fit.

We used an Antagonist Protocol for our first cycle. The medications included 7 days of Follistim and Menopur for the first 7 days, and Ganirelix was added from days 8-13 as well as several days following the egg retrieval. We used Novarel for the HCG injection shot. The rationale was not explained to us at all but we were provided with details on what injections to take and when via our portal following each blood draw and exam.

$2700 out-of-pocket costs for IVF with PGS/PGD $250 out-of-pocket costs for prescriptions Insurance covered a great deal of our first cycle

We have discussed multiple embryo transfer as an option with Dr. Rana but are waiting to discuss further after our second (and hopefully last!) IVF cycle.

They have good hours. I had to get in early and they were always able to get me in so I wasn’t late for work. Dr. T is always running late, but she will give you the care and attention needed. The billing department was fine. A lot of turnover when we were there but they explained everything in detail which was helpful.

Annie and the nurses are wonderful and so supportive.

Annie and Robin are the best. We also had other nursing staff during our journey who were great. Stacy and Annie were both there during our first daughter. Annie and Robin were the primary nurses during our second child. They are caring, knowledgeable and helpful during a very rough and emotional process.

Dr T is a no nonsense doctor. She is very clinical and often late, but she provides very good care. Every time something didn’t work like we were hoping she would give us a hug and work to adjust. We got two wonderful babies from her and her clinic. I would recommend her.

Trust her. She gives every patient care and attention even if she’s not all warm and fuzzy all the time or running on time.

We did 3 IUIs with our first daughter. 2 at a different clinic. The last one with Dr. T. That resulted in our first child. We did 4 IUIs, three retrievals and I think 6 transfers. The last transfer resulted in our second child. The first 3 were single and then we did two more transfers of 2 embryos (we had to thaw 3 to get 2 at one point.) All were PGS tested. I forget all the meds. There were so many over the time we were patients. Clomid, injectables, patches, you name it, we had it.

Our insurance covered much of the treatments except for certain medications and the PGS testing.

Being under 40 we started by transferring 1 at a time. Then we began transferring two to hopefully get a better chance of conceiving. That worked and we had one child from a double transfer.

We visited the Oak Lawn location for consults and monitoring, and never had to wait more than 5 minutes. At times there were some miscommunications between Oak Lawn and the main Oak Brook clinic in regards to billing, so my recommendation is to just error on the side of over communicating with both.

We visited the Oak Lawn location for consults and monitoring, and never had to wait more than 5 minutes. The staff and nurses were very friendly and compassionate and always took time to answer our questions.

We had a few different nurses care of us over the two years we received treatment. They were all very friendly and compassionate, and took time to answer all our questions and hypothetical scenarios. One of the nurses shared that her children are a result of IVF and she is extra passionate about helping couples conceive.

Dr. Rinehart was respectful about our hesitations in pursuing IUI/IVF and allowed us to make some modifications to the process. He seems to be a scientist at heart. He presented the facts and probabilities of our case as he saw them, and was very matter of fact. My husband has a science background and related well to him. After a successful IVF cycle, Dr. Rinehart was very warm and excited for us at our 6-week ultrasound, and you could tell those type of moments are the reason he does what he does.

Don't be afraid to ask questions and advocate for yourself. I was a little intimated by him at first, but quickly realized he has been doing this a long time and has heard every question under the sun.

For a long time my husband and I did not want to use assisted reproductive technology due to religious reasons. For three years we tried to conceive, trying multiple charting methods, holistic remedies and a few rounds each of clomid and letrozole. We sought care from two different OB/GYNs during that time, both labeled us with “unexplained infertility” and each referred us to a different fertility clinic. We finally sought care from Dr. John Rinehart at Reproductive Medicine Institute. He and his staff were respectful about our hesitations and allowed us to make some modifications to the process. We did two rounds of IUIs, neither of which succeeded, and the following year returned to try IVF. For all treatment cycles we were allowed to collect my husbands sample using a collection condom at a nearby hotel (we lived over an hour away from clinic). For IVF, we were also allowed to designate a limit of how many eggs to fertilize, to reduce the likelihood of unused embryos, with a plan to freeze remaining eggs. We were so fortunate to conceive on our first fresh embryo transfer! We now have a three-week-old son.

Here is the breakdown of what we spent on our IVF cycle: IVF case rate: $11,550 Medications: $5,129 (included discounts and refills of two medications) Cyropreservation of extra embryos: $1,200 1 year of offsite embryo storage: $250

At our IVF consult Dr. Rinehart said he recommended transferring only one embryo, and cited the increased risk factors involved with multiple pregnancies if two embryos were to be transferred. However, he also said he would allow two embryos to be transferred if that is what we really wanted. We agreed with him that we felt it was best to only transfer one embryo on our first attempt. However, he must not have noted this in the chart, because when we showed up on transfer day, the embryologist said “we are doing two embryos, right?” Since Dr. Rinehart had approved us for 1-2 embryos, the transfer team just assumed we wanted to do two. They gave us 5 minutes alone to discuss, and we decided to stick to our plan of transferring only one. My advice to future patients would be to clarify your desire with the doctor and transfer team before the day of transfer, so that you do not have to make (or reconsider) your decision moments before the procedure).

RMI is an alright clinic. It was kind of hard for me to get to with public transportation and the doctor was only available on certain days. The clinic in Evanston is small. The receptionist doesn't seem very happy to be there. Their phone system between the locations is kind of weird because sometimes I would call Evanston and then be transferred to a different location I had never been to. Sometimes it was hard to get a hold of the care coordinator but she would return my calls. They do have early hours so you can get your blood drawn before going to work.

Dr. Nayak is friendly and thorough. When she was meeting with us she was present and optimistic. I never spoke with her on the phone though and she only performed my saline test. The rest of the ultrasounds and things were done by the nurses. Our time with her also felt a little rushed as she had other patients to see.

The nursing staff were fine. They were helpful when I was nervous or not feeling well after a blood draw. The care coordinator returned my calls and went over all dates and steps in protocol.

She was knowledgeable and thorough going over all the test results. She tried to push us to get genetic testing but we didn't want to do that because of costs. She only performed the saline procedure. The rest were done by nurses. It would have been nice to see her more. I didn't particularly feel a strong connection with her but overall she did her job and said everything she needed to.

Be sure to ask a lot of questions and advocate for yourself.

We just saw her for a consultation and going over our test results. We didn't pursue any other treatments with her.

It would have cost us a lot to continue going there. We used our health savings account to cover most of the ultrasounds, blood tests and procedures. Our insurance only covers diagnostic tests but not procedures.

I feel they monitor patients very well. The phlebotomist in the office is friendly, kind and a pro at taking blood. The ofice is very clean. The nurse needed to improve with communication both written and spoken.

The doctor gave me information and wanted to answer any questions I had. Doctor also respected and found value in the knowledge O had already. It was important to him that I understood my situation and treatment.

My nurse was not a great communicator. I had to clarify things quite a bit. She implied I made things very confusing. The lack of clarity and mistakes is what caused me to have to reach out to get info corrected or clarified. Instructions should be correct and clear.

I enjoyed Dr. Dmowski as my doctor. He has an incredible amount of experience in his field. He is more than happy to share his knowledge and make it understandable. He is very sincere, but also has a sense of humor. He is a caring and compassionate physician.

If you are looking for a lot of sugarcoating and hand holding, he probably isn't the doctor for you. If you want a doctor that gives it to you straight and uses his experience to get you pregnant without any mishaps, he is your man.

Protocol was birth control, Lupron, Follistim and menopur. HCG trigger. Doxycycline. Intramuscular delestrogen and progesterone. Used ICSI for severe MFI. We ended up with 4 good quality blasts. One fresh transfer ended in negative beta. One frozen transfer resulted in positive beta.

My insurance covered most of my stimulation, egg retrieval and fresh transfer. When my insurance benefits ran out I paid $5,000 for a complete FET cycle with monitoring and transfer.

Doctor advised he would not transfer more than 2. He educated me on the pros and cons of both and respected my decision to transfer 2.

Weaknesses - wish they had earlier hours. Not always warm and fuzzy. Had some "don't ask don't tell" types of behaviors where I felt in the dark unless I asked questions. Strengths - organized, quick, and answered your questions that you asked.

Dr Rinehart was direct and to the point. He took the time to talk to me and my fiance after each unsuccessful transfer and listen to my concerns. He does come off a bit pretentious (with his Harvard and John's Hopkins degrees and very data driven language).

Very compassionate and organized. Well run office in my opinion. Got you in and out of appointments fast.

Dr Rinehart is very knowledgeable, and kind. he took the time to explain things to me, although I had to ask a lot of clarifying questions. However, I do not feel that he really thinks outside of the box, as each new step we took after a failed transfer (PGS testing ERA) were always my idea. I feel that he believes so much in his protocol that he does little to stray from it and believes it is just a numbers game - AKA try more and it should eventually work. He did do all of my procedures and didn't pass it off to an associate, which I liked.

Ask lots of questions and be ready for "batching" meaning you will be on Birth control for awhile in order to get in "sync" with out women in the practice so egg retrievals/transfers can be timed up.

My protocol included BC for awhile, then starting stims (Pregnyl, Follistin, Menopur and an HCG trigger) and then prep for transfer was typically Estrace and PIO.

$800 ERA - Their Genetic PGS testing was more pricey than other clinics (Total for 2 retrievals and testing 8 embryos and freezing/storage fees etc was $8055 out of pocket and my insurance covered the actual procedures)

Was willing to transfer 2 embryos, even though they were PGS tested, due to my age (41 at that tome)

I think this clinic has the benefit of not being one of the HUGE players in the Chicagoland area, so its not as crowded and is a little more personal. They also share offices with specialists in Endometriosis, so if you have that as a complication, it's probably an excellent place to go.

While actually speaking with Doctor Rana and some of the nurses at the clinic, I felt very much like a human - but at times with scheduling or regular lab visits, I felt like I was being cycled in/out amongst hundreds.

I had a care coordinator who dealt with paperwork/ordering medications (Krystyna), who was very helpful and on top of everything. Other than that, I had the same nurses for ultrasounds/bloodwork 90% of the time. They were both friendly, though the ultrasound tech was always a little reticent.

For the times I saw Dr. Rana (only for the initial consultation, on the day of the egg retrieval, and for the WTF appointment), he was patient with our questions and seemed interested in finding something that should work for us. The ins-and-outs of recommendations for drug dosages, etc., also seemed very tailored to what was happening with me. However, there were times when he was pretty insensitive (at WTF appointment told me we'd all be happier if I didn't cry).

Don't expect tons of communication directly from Dr. Rana - instead you'll deal mostly with his assistant/the nurses.

Dr. Rana uses an antagonist protocol - the drugs I used first cycle were 3 weeks of birth control suppression, followed by stimming with Folistim, Menopur, and Ganirelix, with an HcG trigger. This resulted in 1 egg that was mature, but did not fertilize (out of ~7 good sized follicles). He said the other follicles were either empty, or the eggs were of such poor quality they broke up upon retrieval. In my current (second) cycle, he increased the dosages of Folistim/Menopur, and added some HcG microdosing throughout the cycle. We did no suppression beforehand. Haven't done retrieval yet, but my follicle and E2 numbers are higher so far this time.

My costs for my first cycle were greatly covered by insurance, so I don't have a good answer for others.

Dr. Rana highly suggested single embryo transfer in most cases, citing the reduced success in live births with multiples. However, he did say that he might encourage multiple transfer in certain situations (advanced age, low embryo quality, others)

The clinic was nice, it was clean and organized. But I didn't like that we had to drive almost an hour away, to Oakbrook, for procedures. They are good about getting you in quickly for appointments and you can be in and out within 15 min for monitoring appts, if you go 1st thing in the morning which was very nice.

The doctor and nurses were all very friendly and helpful. They really took the time to explain things and were great about getting back to us right away when we had an questions or concerns.

Annie was excellent about conveying information and helping us to understand all the procedures. She was very compassionate and you could tell she really cared about us and our results. She was always trying to help us out wherever possible by getting us donated meds or helping us find med discounts. She was always very prompt at getting back to me whenever I had questions or concerns.

Dr. Trukhacheva was very compassionate and good at explaining procedures, however she is known for being consistently late. She was late for all of our procedures, the last cycle she was over an hour late for the retrival. With time sensitive procedures it is not ok to always be late, especially an hour or more late! As a result of being so late, she rushed through the procedure and wound up causing me a lot of extra pain and bleeding after the procedure, it was almost to the point I was going to have my husband take me to the E.R.

Ask to be the 1st procedure of the day, so she's not as late for your procedure. Because she gets consistently further behind and later as the day goes on.

Dr. Trukhacheva had me on menopur (225iu), Follistim 450 units, and microdose hcg 2ml(200 units). It was the same doses for all 3 cycles with her, but she did add microdose lupron and a steroid pill with my last cycle(I can't remember dosages offhand for these). She also had me do estradiol and testosterone patches for about 9 days leading up to the injections.

I can't remember specific costs, our insurance covered about 85%, and we paid for meds out of pocket (minus the meds our nurse coordinator, Annie, was able to provide us with).

Dr. Trukhacheva strongly suggested transferring both embryos for our best chance due to my age.

Quiet and clean, soothing and inviting. There will be front faces who are mostly “doing their job” and therefore may have never walked a day in our shoes fighting infertility, I like to keep my conversations with them to a minimum as you can definitely tell the vibe when people are compassionate towards your Situation. The back nurses who will draw your blood and meet with you are great- caring, helpful and compassionate.

Dr Rinehart makes you feel important and worthy of his time- he explains procedures and diagnoses with honesty and although blunt with percentages and likelihood of attaining what we hoped for - he is always open to discuss questions or concerns we had and wished us luck.

The nursing staff was so friendly and felt like cheerleaders. They were glad when things were going well and shared in our sadness when we didn’t get a positive test or just had a hard day or week.

I went with my husband for our first consult after a year and a half of trying to get pregnant- we had already received the not so great news that our lack of a positive pregnancy test likely was due to MFI. We went to our appointment nervous, heartbroken, confused but hopeful. He laid it all out for us and talked openly about what this meant for trying to become a family- there was no sugar coating anything or allowing us to put our heads in the sky - there were tears but there was also a fire that got lit under us that we can do this- he knows his stuff and he will do all he can to guide us towards a positive pregnancy test. He was always cheerful at appointments where i saw him and made sure to explain what he was going to do, what he saw on the screen and what that would mean for the next step.

Be ready for him to tell you his very honest medical opinions and don’t let it get you down- you will know what you’re up against and gather the strength to fight forward. Also ask questions- nothing is dumb or silly he will explain to you anything you want to know or have concerns about.

He started drugs in a lower dose to see how I’d respond and adjusted from there- I never had a problem with OHSS or anything like that. I guess you could say my stim cycle was a pretty good one considering he got right around the number of oocytes he hoped for and no problems arose. I will begin my second stim cycle at the end of this month as we used all of our frozen embryos and my protocol will be very similar to last time.

I know in total we ended up spending almost 15k out of pocket. Medicines were just under 5k for the stim and between 1-2k for the frozen cycle. We had 80% coverage for procedures and a $50 copay every visit. This time around we will only have 60% coverage and our additional insurance to cover IVF is $400/month.

I was allowed to choose one or two embryos for both transfers - one was a fresh which resulted in a BFN and the second was frozen which resulted in a singleton pregnancy. This time around it sounds like he’d advise to transfer one 5 day embryo whereas last time for the fresh cycle it was two 3 day ones. He definitely knows the risks multiples can bring and doesn’t want to put myself or a baby in an unfavorable position.

Nice office, calm setting. People are friendly and helpful. The only suggestions would be the front lady can sometimes be a bit rushy with you and make you feel “cut off” and Like your question isn’t important. I can’t stress enough how much compassion and care needs to be in this area of work- people are at their lowest and hardest times navigating a very hopeless time.

He sat down with us and let us show our emotion and reacted to it as he understood our concerns, fears, lack of hope and confusion. He responded with encouragement but also honest percentages and was very upfront about outcomes. He took the time to let us ask questions and made sure we understood what he was telling us.

This time around I have new nurses- last time I felt very secure with my nurses and they seemed to be very organized and on top of the appointments, necessary things to do and making sure I was on track. I am very organized and this time I have new nurses that are new to the practice and they’re figuring things out. They are very caring and helpful but I am staying on top of everything to make sure there are no issues while they get into their groove🙂

I can’t thank him enough for our beautiful son we have and now as we work to expand our family there was no where else we wanted to go. We trust his experience and appreciate his honesty and the way he offers hope to us is a calming force for us when going through such a trying time.

Be ready to hear things honestly as he does not sugar coat anything and trust his knowledge but ask anything as he will explain in detail what you want to hear more about or need to know.

So I am starting IVF right now again and in the beginning stage of using birth control - he is doing primarily the same protocol as I did in 2015 with a successful oocyte stim cycle which then resulted in a positive FET. I know my drug lists include Lupron, Menopur, follistim, hcg trigger shot. I grew 15 eggs last time and 8 were mature. 7 fertilized. 2 were transferred fresh and neither took. Of the remaining 5 two were able to be frozen and of those two transferred on June 9, 2015 one took! During the early stages of pregnancy I was doing progesterone oil shots and orally taking estrace.

Out of pocket we spent around 14k. I have to take out additional insurance at $300/ month last time in 2015 and $400/month this time as our insurance does not cover Ivf. The clinic was helpful in providing around 4,000$ worth of medicines in 2015 and hoping to help a little this time if possible as we have no insurance for the meds.

I trust my Drs guidance, this time around I will probably do what he suggests as we did last time (transferring two both times).

This is a disorganized disaster. I know you don't want to go to the other place in town fellow infertile friend and I'm so sorry you're going through this. But don't go to RMI. It is not a good alternative. Catelyn is a trainwreck and you'll barely interact with the doctor. RMI feels like a horrid money grab and you'll be so irritated that they are getting paid to treat you this way. Also, you have to go to Oakbrook for egg retrieval.

1. Forgot to place our order. I called concerned a week out and it took that long to chase it down b/c she kept calling it in to the wrong pharmacy. It arrived via courier an hour before it was needed. Seriously. 2. Ordered twice as much as needed despite us being clear we were only doing one round. In fact she blew through the entire $15K lifetime insurance benefit we are lucky to have in one round. 3. Ordered PIO with the original order...PIO is for embryo transfer. We ultimately didn't get anything to transfer. ALSO...I had a conversation with her less than an hour before she placed the order about doing suppositories and not injectables. So no PIO was needed at all. 4. Kept bringing up what to do if we had over 8 embryos for PGS. She wanted to know this b/c then they get to charge our credit card for more. The answer is actually no big deal - just deal with it when it happens. But she couldn't stop asking. 5. On that note, didn't tell us about a bunch of the costs associated with PGS. She was supposed to cover that with us but we were surprised when billing line itemed them on the bills. 6. Did not call with results or follow up about results after they were absolutely awful. 7. When we complained to Dr. T about the non-order of the drugs she told us...and I quote "we do this a lot and some just slip through the cracks." So this must be common with Catelyn. Dr. T doesn't care.

As a doctor, she was candid with us the 2 times we met with her. She had an appropriate level of compassion and explained her approach. However, in addition to being well over an hour late to the 2nd appointment, she clearly could not care less. It appeared going into our 2nd appointment she'd had to review for the first time the results of the lab. She certainly hadn't called us with results or reached out after the results were zero viable embryos. Nobody reached out at all actually.

You're reading this because you're trying to avoid the cattle call of another option in town right? Dr. T is fine, nothing to be enthusiastic about. Her nurses are an actual train wreck. Keep reading. Go to the other place...the cattle call is organized.

PGS was $5400 for 8 embryos and the could come from different retrievals. BUT each new batch was an extra almost $700 in lab fees. Catelyn will forget to tell you this by the way. They send them to Good Start Genetics who is pretty vocal about super reduced prices to make PGS affordable. The margin RMI gets on PGS is insane.

She does not support natural cycle implantation...of course not. It would be very inconvenient for her.

I definitely prefer the small office vibe. The one thing to know about RMI is that if you are located in the city and do all of your monitoring appointments downtown you still have to travel to Oak Brook for the big appointments (retrieval, transfer, etc.).

Dr T. always takes the time to talk to you during appointments and procedures. She is often running late and it's because she answers every single question from every patient. The front desk and nurses are also very friendly. Not at all like previous experiences.

I could not say enough nice things about Annie. She answers all of my questions and is so thoughtful in her responses.

We ended up seeing Dr. T, per the recommendation of a friend who was successful. She was actually our 3rd RE. We were about to start IVF with another doctor, but their accepted insurance changed and so we began the process with Dr. T. Since I've had 2 prior miscarriage she wanted to start with a Hysteroscopy before beginning IVF (something the prior doctor did not think was necessary). She did find scar tissue which she removed and we began IVF. We've never gotten any answers for our infertility and recurrent pregnancy loss so we were very optimistic that IVF would be the answer, but we were also cautious because of my AMH. From the beginning they knew they would be very conservative and that we would likely do a freeze-all because of concerns of OHSS. I had a mild case of OHSS that was resolved with a culdocentesis. Dr. T was always hyper aware and I feel like I received the best care during all of this time. At this point, we've tried 2 FET and both have been unsuccessful. We've been transferring one at a time because of their grades, but will move on to 2 embryos starting this month. Each month leading up to the transfer we've tried different tactics to ensure my lining is thickening. I'm still hopeful Dr. T will get us pregnant, but can't report it at this time.

She will always be late, but it's because she gives each patient such good care and attention and she never says no. She apologies and she's warm and she is ready to dedicate herself to you so I've just learned to live with this part (although it's not fun when you have a full bladder awaiting a transfer, as one would imagine).

Goodness, it was all so complicated I don't really remember. I know we used Menopur and Gonal-F, dosages were cut in half after a week, then Ganilrelix was added to suppress ovulation. HCG was used to trigger. I am lucky enough to ovulate on my own each month and I have a slightly higher than normal AMH so 40+ eggs were fertilized and I feel fortunate to have 10+ embryos to transfer. The issue will my unexplained infertility has been getting and staying pregnant so once we figure out how to make that work I'll happily update this protocol description.

Luckily, insurance covered IVF for me once I hit my deductible. You do have to pay out of pocket to freeze the embryos (1200) and you have to pay a lab fee with each transfer (195).

Dr. T seems to always recommend 1 embryo for transfer, but after 2 failed transfers we are going to start trying 2. She is very conservative and mindful of the patient and the pregnancy.

The clinic needs to do a better job of educating patients on their shots. People are very skittish about giving themselves injections but a 5 minute, in person lesson (i.e. not ONLY a video) would truly have helped me with this process. I wanted the chance to ask questions and receive tips and tricks. For the intramuscular shot, I had to ask a nurse to do this for me (not my usual nurse, the weekend nurse). She was happy to do it but this is something my primary nurse should have offered. I even explained to her that I needed help with this one because I have a back issue wherein I cannot twist around to do it in the rear and also I am doing it alone. Some advice would have been helpful.

Dr Nayak took the time to explain processes and results over the phone or in the office whenever I needed.

Tracy was very organized and a good communicator over email. Her weaknesses, however, caused me to research other clinics knowing I would receive a similar protocol from other doctors who came highly recommended. In other words, since she was the primary face I dealt with, the doctor almost wasn't enough to keep me around. She was very insensitive to the fact that I'd never given myself a shot. I received ZERO instruction and she never let me know there are videos out there I was supposed to be watching. I let her know I needed help but she never responded and it was the weekend and I was supposed to do my first shots the next day. First of all, I should NOT have taught myself how to do a shot from youtube bloggers who are taking hcg for weight loss. Secondly, the dosage instructions didn't make sense with the needle I was given. I had to go to the pharmacist the next day and ask them to explain for me. They agreed that they weren't sure what the dosage should have been when I posed my question to them. So they called the office and spent an hour on the phone with the on-call nurse, who also wasn't entirely sure. We ended up going with what the on-call nurse assumed was the best protocol with the instruction that I needed to follow up with my nurse, Tracy, on Monday. When I followed up with Tracy, she stated in her email that whatever happened is between me and the pharmacy and she was uncertain what I wanted her to do. What I asked her to do was call the pharmacy so they could straighten out my dosage, if necessary. I asked her this two times and also ask that she call me. If a patient's pharmacy has a question on the dosage and even the on-call nurse isn't 100% sure how to proceed, I would expect a diligent, caring nurse to get on the phone with the pharmacy to be sure the patient is taking the right medicines. Other nurses I worked with at this clinic while Tracy was on maternity leave were wonderful - Tiffany Abrams (who has since left) and Rachel Easton (unfortunately Rachel is in the Evanston office and I'm in Chicago). The ultrasound and lab technicians were also warm, compassionate, and caring.

Very good communicator. Laid out all the medical science along with statistics and suggested courses of treatment. She also did a really nice job of presenting all options which often left me not knowing what to do but I'm glad I had all the information I could have wanted/needed so I could then consult with family, friends and other medical providers. Very thorough. Also, it was discovered I had cysts post-treatment and she's personally followed their progress since.

Two weeks on a birth control pill. Then started 2 mg Estradiol and 2 mg patch of Androderm. Continued this for about 10 days. Went for baseline ultrasound and labs and ~3 days later started 225 units follistim and 50 units microdose HCG every morning and every evening. After ~4-10 days, added Ganirelix to this. After several more days, triggered with 10,000 units HCG.

Follicle puncture for oocyte retrieval $2,700 Ultrasound Guidance for Aspiration of Ovum $1,000 Embryo culture 4-7 days $1,300 Progesterone blood work $105 Ultrasound Transvaginal $425

Parking at the Chicago office can be a bit hard to find and expensive. I would recommend really early appointments for ease of parking and stress. Appointments are painless to make and I have rarely had to wait in the waiting room for more than 3 minutes.

Every time I step into RMI I am greeted by my first name and the staff always makes an effort to engage in conversation. They make the process short and sweet, but always take the time to answer any questions you may have.

The nursing staff, IVF coordinator and administrative support at RMI, specifically speaking to the Chicago office is amazing. They all work tirelessly to support women going through some of the toughest life challenges they have ever had to face. They do so with grace and support.

Dr. T is very thorough and caring. Do not expect to see her overtime you walk into the clinic, but if you need to schedule an appointment specifically with her, there is always availability within a few days and she always treats you like your questions and concerns are her top priority. Be prepared, she typically runs late, so your appointments will not start on time, however, she goes back and forth between the suburbs and Chicago all the while, not rushing any patient out the door. She makes as much time as needed for each couple and individual. Dr. T clearly discussed our treatment plan and met with us for an IVF consultation to explain some questions we needed answers to before making our final decisions. Dr. T always performed initial testing and procedures and will perform our IVF egg retrieval and transfer. She did not perform our IUI's as it was not necessary. Among many things, one thing I especially appreciate about Dr. T is that your health and well-being is of utmost important. She informs you of risks and makes decisions for your treatment based off of what is in your best interest. Although our goal is to get pregnant, she makes it clear that my safety as a patient is top priority and she doesn't let numbers and statistics overshadow that importance.

Dr. T has a thick accent, and it takes a little bit of time to get used to understanding her. Don't let that barrier discourage you, she is well worth it.

My husband and I had been trying for 3 years and had many tests done in that time frame, we hesitated with ART until we comfortably made the decision it was best for us. I was diagnosed with Unexplained Infertility along with PCOS. Because of the amount of time we had been trying, Dr. T immediately started us off on medicated IUI cycles with trigger. Our plan was 3 and then on to IVF. At the time, we still didn't know if IVF was right for us, so we went ahead with a 4th IUI, all of our IUI's failed, never resulting in a pregnancy. We met with Dr. T regarding IVF and she explained our treatment plan to us and why it was best. We will do ovarian stimulation, egg retrieval, fertilization of eggs with ICSI and once eggs are fertilized and make it to Day 5 embryos they will be frozen. We will undergo a frozen embryo transfer 3-6 weeks after egg retrieval. I am at great risk for OHSS due to PCOS and my age (29) and she feels it is best and safest to not proceed with a fresh 5 day transfer post egg retrieval.

Dr. T is an in-network provider under my plan and I have not had any surprise charges that I did not expect.

I know that this is a big decision for everyone and one that should be made personally with the guidance from your doctor, but in our treatment plan, Dr. T is a firm believer of one healthy baby at a time, and that is what my husband and I are most comfortable with too. Her approach to single embryo transfers in our specific case is something we 100% agree with.

My husband was not allowed in the room when we did our Frozen Embryo Transfer. After the transfer I was left to "relax" (as if anyone can) for 5 minutes in the quiet, and it would have been incredibly comforting to have him in the room at that point if he couldn't be there earlier. It is their office policy to not allow any unnecessary people in the room to preserve the "embryo friendly environment" (my husband was absolutely necessary in that moment), and I HATED that he wasn't allowed to be with me at this important moment in our lives. Also- after we did our blood work and came in the next week for an ultrasound I was discharged from the practice and told I needed to schedule with my OBGYN for follow up appointments so we called and scheduled an appointment with my OBGYN for another 3 weeks from then. This was on a Thursday early evening. Less than 72 hours later I started hemorrhaging and when we called to see if we could get in to see the fertility doctor, we were told he could not see us because we were discharged. I was actively bleeding and 6.5 weeks pregnant and told to call my OBGYN they couldn't do anything about it. Even though my apt wasn't until another 3 weeks. Even though I literally work down the street from the fertility clinic and it hadn't even been 72 hours since I had seen the doctor, they refused to see me and instead could only refer me out. I almost miscarried, and during that scary time instead of letting me talk to the nurse, the front desk staff clearly had me move on. Although our overall experience was a good one and we luckily got pregnant on our first cycle- it left a pretty bad feeling ending that way.

Dr spoke candidly about our options, always gave me step by steps regarding what would happen/what to expect before doing anything, knew my name, and took the time to answer our questions to our satisfaction.

Overall I felt very much understood and cared for. There were a few things I didn't like including being given timelines that were not always accurate , but in general I had confidence in my nurse.

Our situation was a bit different as we had to do IVF due to not wanting to pass on a genetic issue to our kids, so IVF with PGD was always our only option, with no prior attempts at pregnancy. We had done a lot of research before meeting with him, I knew his training/read some of his publications, and had an idea of what he would be like before we met. When we met he was exactly what I was thinking, and he remained professional the entire time. I am a psychologist, I'm not sure if he did this purposefully to demonstrate he had read our intake information or if it was a chance fluke, but during our initial meeting he had a journal article about the toll on patient's mental health and improving it throughout IVF on his desk that was current and he was clearly reading. That stuck with me. He always explained procedures and options clearly, compassionately, but he did not bullsh*t around. He was able to joke with us and overall I had a good first fertility doc/treatment experience.

Have a list of questions available and don't be afraid to ask them- he will answer all of your questions, and he's willing to have phone consults as you go as needed.

After speaking with genetic counselors, our only options were either IVF with PGD or adoption. Pretty straight forward. We met in December '16, did all of the testing to make sure no other problems were present for either of us, Was on & off birth control for a while, Started Lupron 10ml injections Dec 31 '16, then added Menopur and Gonal-F, did the Egg Retrieval by the end of January (we had 15 eggs, 12 were useable, 10 continued to mature, then 7 were able to be biopsied, and then only 2 were useable without having the genetic disorder), had my body on "shut down/recovery mode", was back on & off birth control, then back on Lupron, then on Estradiol, then added Progesterone in Sesame Oil, then Frozen Embryo Transfer April 10th, found out through bloodwork 10 days later we were pregnant, I was discharged from the clinic after we did a transvaginal ultrasound the week after and told to contact my OBGYN and continue my meds, I continued 2x/day PIO shots until ending May 17th, then on Progesterone suppositories for 2 weeks, and then done with medication.

In total we paid out of pocket rates- our insurance covered nothing. We spent about $15-18k

I was given the choice between transferring 1 or 2 embryos. I was told the chance of getting pregnant with only transferring one (both were graded the highest grade quality) we had only a 30-40% chance of getting pregnant. If we transferred 2 we had a 60-70% chance, and if we did 2 there was only a 20% chance of multiples.

Strengths- they were ok. I think they were understaffed and disorganized.

He knew who I was and our situation.

Worked with Rachel primarily. She was very compassionate. Sometimes awkward but this was not a problem for me. The clinic seemed understaffed. She was doing everything. She did most of my iui's as well. She also forgot to do certain things- request pharmacy perscriptions. Also the injection instructions were minimal. Worked mostly with youtube videos.

He did not explore my situation to the fullest he could have. Went to subsequent doctors and they were surprised by a few things: One that we had such a poor stimulation but he continued with the egg retrieval. That he didn't explain why this happened. That he didn't explore the blockage of hormone and my clotting issue. This lack of digging is frustrating. Also that we spent the time/money on an ivf cycle that should have been cancelled. He stated diet and other lifestyle factors weren't important and they were.

Ask questions. Get second opinions. Do your own research.

First we tried IUI. we got pregnant- yay! Then we lost it :( We then tried two more IUI. Both failed. We then went right into two back to back cycles of IVF. I should have not done this. I should have taken time to increase my protein (make more follicles). First cycle I had only 3 follicles. It should have been cancelled. He put me on Birth control as part of the start of this cycle. It slowed my system way down and made me not produce enough follicles. So in my opinion this cycle should have been cancelled. Second time he did not put me on BC. He retrieved 6 eggs- none of them worked.

It was expensive

There typically wasn't a long wait for appointments, which I appreciated. I didn't initially understand that you didn't see the doctor for monitoring appointments and would have liked to know that, but in a large clinic it seems to be the norm. The office was always clean and efficient.

Dr Rana always listened. He would always validate my questions and suggestions for changes, but also take parts of what I said and try to incorporate them into the next parts of treatment. I always did my research and knew what we were discussing since it was my body that we were manipulating to get the results we needed. He always made me feel empowered by information which I appreciated!

Amazing! They were always compassionate, caring, and great listeners. I never felt rushed, although I know they were extremely busy. They would remember to ask the doctor questions that I had, and always posted my results in a timely manner. They were happy with good news and grieved with us for the not so good news. They felt like family and it was difficult to leave them to transfer to the OB

I wouldn't be where I am today, with a toddler running around and 32 weeks pregnant without him. His compassion for patients and willingness to listen to all of my ideas was always appreciated. He remembered details about our personal life and always had amazing bed side manner.

Be open to suggestions but also be prepared with knowledge. Dr Rana always listened to all of my suggestions and questions and answered each and everyone!

Our first cycle we did the tropical lupron down regulation. That resulted in only 3 eggs, all mature and fertilized, but only 2 transferred on day 3 (chemical). Second ivf we used an antagonist protocol and got 6 eggs, 6 mature, 6 fertilized, 4 blastocysts, transferred 2, froze 2, started as twins, lost one at 8 weeks (resulted in singleton birth. Third ivf antagonist protocol, got 14 eggs, 10 mature, 6 fertilized, 4 blasts, transferred 2, froze 2, resulted in singleton pregnancy (32 weeks).

We were extremely fortunate that out insurance covered a lot of the procedures and treatment. Otherwise it was billed through them and you could pay by phone or portal (Internet access)

Keep record of any appointments you make, because there were multiple times when I made an appointment and showed up and they said I didn't have one. In fact, my main issue with this clinic was the scheduling. This is just something that cannot happen with fertility clinics since in my case the delay caused me to have to wait another month to get an appointment and start treatment.

Dr. Rinehart's clinic was smaller, so I did feel cared for by him, however his demeanor is a bit more reserved and straight-forward, which I've met women that appreciated, but for me it felt a bit harsh. I was seeking a doctor who demonstrated a bit more empathy, and whether Dr. Rinehart felt this or not (I believe he did) he didn't show this very well.

In the end, Dr. Rinehart did do the retrieval (since I've only done one retrieval) that resulted in my daughter. So I do trust that he did what was necessary and knew what he was doing. After I miscarried after my first transfer, I thought his conclusion that my eggs were poor quality was a bit rash, but perhaps that is what the evidence suggested. I had issues with his clinic mostly, not Dr. Rinehart.

Like with any clinic, be your own advocate and ask questions. Don't feel like you are an inconvenience, this is your appointment and consultation and you deserve to get all you can out of it. Ask questions and force doctors and nurses to be thorough in their explanations. Ignore any signs of them rushing you or of annoyance.

Dr. Rinehart followed a baseline protocol for my egg retrieval, I believe it was a standard medication protocol and it seemed to work fine with me. I don't remember what I was was on specifically but I know nothing was altered.

I transferred two embryos with Dr. Rinehart. They advised us to do one, but we wanted to increase our chances. For this transfer our embryos were not pgs tested.

I also can not appropriately convey how amazing the staff at RMI’s downtown location are. The receptionist was always friendly and helpful. The billing department was very quick to get back to me and made sure I understood everything before my procedures. All of the nurses I worked with were wonderful but Stacy Roland and Annie Kane went above and beyond what I expected. I know they see so many patients each day but they always took the time to chat with me and ask how I was feeling. They were incredibly responsive by email and phone and thoroughly answered every question I had. Unfortunately, I moved away from Chicago before my daughter was born. I wish I could move back just so I could work with the RMI again. One of the only negative things I can say about the Reproductive Medicine Institute is the inconvenience of one of their clinics in Oak Lawn, Illinois. I initially met with Dr. Trukhacheva in the downtown Chicago location, which has great public transportation access. During my IVF cycle, I was able to use that location for labs and ultrasounds. However, on the weekends I had to go to Oak Lawn, which was okay because I had a car but would have been very difficult for anyone without their own vehicle. The egg retrieval and transfer both took place in the Oak Lawn location as well.

The doctor and her staff care so deeply for their patients. I never felt rushed and she carefully answered any question on had. On my retrieval day when I had only 3 eggs, she cried right along with me. They checked in during and after my pregnancy. She truly is one of the kindest and smartest people I've ever known.

My primary nurses were Stacy Roland and Annie Kane. Both worked around my schedule for labs and ultrasounds. They both called during treatment and my pregnancy to check on me.

Dr. Trukacheva put my needs first. She scheduled a next day surgery the day before thanksgiving so my IVF plan didn't fall behind schedule. She worked with my insurance to help get me a fair price. She held my hand as I cried and called to check on me. She was both very honest and blunt about my prognosis while being gentle and understanding. I trusted and loved her nurses so much that I named my daughter after one of the nurses. I know I will never trust another doctor as much as I did her. For a few of my appointments, Dr. Trukhacheva ran very late, often upwards of an hour. Initially I was aggravated but after meeting with her I understood that she runs late because she cares deeply about her patients. She took the time to thoroughly go over my history and past treatment plans. I never felt rushed when I met with her. Before I worked with Dr. Trukhacheva I had an HSG with Dr. Pavone but not a hysteroscopy. I learned after meeting with Dr. Trukhacheva that having a hysteroscopy should have been something Dr. Pavone did based on my symptoms. Dr. Truckhacheva fit in my hysteroscopy and subsequent polyp and scar tissue removal the very next day, which was the day before Thanksgiving. She was initially supposed to be traveling but changed her plans so my IVF cycle didn’t have to wait until the following month. She was aggressive in the dosage of my medication which helped make my first IVF with her successful. I was worried about doing a 5 day transfer rather than a 3, but she assured me that she believed it was the most likely to produce a viable pregnancy and she was correct. Every time I met with Dr. Trukhacheva, she remembered my name, my husband’s name and knew my history. That has not been my experience with other doctors. On the day of my retrieval when I had far fewer eggs than expected, Dr. Trukhacheva was incredibly empathetic and took the time to comfort me even though I knew she had a long day ahead of her.

Trust in her completely.

I have a diminished egg reserve. She used a higher dose of medicine than a previous doctor used which allowed me to create 3 eggs. She did a 5 day transfer rather than a 3 which worked out well.

Her clinic helped squeeze my IVF in before the end of the year so I didn't owe as much for my deductible. Including medicine I paid roughly $4k for IVF.

I feel the care and treatment protocol at RMI is a bit more individualized than other local clinics, which is great! The nurses gave me their email addresses and would answer my questions quickly at any time - weekends and holidays included. Annie and Stacey at the Chicago office are amazing! Dr. T only works in the downtown location three days a week so there were only certain days I could see her or come in for procedures. They batch their IVF and FET cycles since doctors only have certain weeks they are in the lab. She is often running quite late - 1-1.5 hours late. However, I know she tailored my IVF stim protocol specifically to me, and when I did see her, she took as much time as I needed to answer all my questions. I think the reason she runs late is because she spends so much time with her patients. She is also extremely empathetic, which I valued during such an emotional trying period of my life.

Annie (and Stacey) were both terrific. They answered all my questions, ran the monitoring appointments quickly and smoothly, and gave me email address for any additional questions that came up outside of business hours. If/when we go back to try to conceive a second child, we will likely go back to RMI just given the quality of the nursing staff. I will say that I didn't feel that either nurse had extremely robust technical knowledge, but they understood the procedures and how Dr. T worked, and would always ask the doctor if I had questions they couldn't answer.

Dr. T was a caring individualized doctor that always gave me her full attention and plenty of time to ask questions. She tends to be conservative. She prefers single embryo transfers and was quite concerned about OHSS during my IVF stimulation. She does run quite late on a regular basis, and once missed a major IVF cycle related procedure. She had another doctor in the practice cover for her, and I know things happen, but we were not pleased to hear our doctor wasn't even going to show up for a big procedure.

Be patient! You will have to wait to see her, but when you do you will not be rushed.

I was on birth control to start my IVF cycle, and then started stimming with menopur and gonal-f. Eventually I added ganirelix to supress ovulation. I triggered with HCG and lupron since I was at risk of OHSS. Dr. T did not do a fresh embryo transfer with me given my risk of OHSS. She did have me take a couple doses of ganirelix after my egg retrieval. We retrieved 16 eggs, six were mature, and four were frozen at blastocysts. I had one failed single embryo transfer and am currently 17 weeks pregnant with one child from a second FET, in which we transferred two embryos. We have one frozen embryo remaining. I was disappointed we only had six mature eggs from 16 retrieved. I do feel Dr. T was a bit conservative given my risk of OHSS. She admitted the day after my retrieval she was hoping for more mature eggs. However, unfortunately a lot of IVF is trial and error. Dr. T did recommend switching from ICSI to traditional fertization the day of my egg retrieval. My husband's sperm counts had been consistently strong, and Dr. T felt that if we had the option, embryos fertilized traditionally hold up better. We were very pleased to get four frozen blasts from six mature eggs. This exceeded Dr. T's projections.

My insurance covered a good amount of treatment. We were responsible for paying 10% of estimate costs, and any embryo freezing costs (not covered by insurance).

RMI, in my opinion, was a great choice for me. A lot of other women I knew who were going through IVF were getting a lot of different numbers from their doctors throughout various stages of the cycle. I didn't get that. They tell you the basics, but nothing that is out of your control. It saved me a lot of endless googling and stress. I probably could have asked for more info, but I trusted that they were doing everything they could for me. They also offer counseling services, which I didn't take advantage of, but I would highly recommend others do.

Dr. Coulam was great - her bedside manner was incredible. She was always on time for appointments and I really enjoyed my experience with her. She was caring and honest. One general note, when choosing any doctor, remember that this is just like any other healthcare experience. You need to be your own advocate - ask questions when you have them. I trust that she was looking out for my best interests, but there were times when I questioned meds I was on, or how many eggs they want to transfer, etc. Don't assume that since these people create life that they are better doctors. They still usher patients in and out and are under a lot of pressure. This is nothing against Dr. C, I'm just sending a general warning to ensure you're looking out for yourself.

They don't give you a lot of the scientific/background information from your bloodwork, etc. I actually really liked that. Knowing certain hormonal levels or other numbers just leads to bad google searches...