Describe your experience with RMA of New Jersey.
RMA is a huge practice (and let's be honest, it's a big business, too) - you'll definitely sit in waiting rooms with dozens of other couples and realize you're one of a few thousand patients they see every year. That said, the size of the practice gave me lots of confidence that each procedure I underwent would follow best practices. I also felt confident that even if my primary doctor did not perform every procedure, I was in the hands of another highly qualified doctor. I was consistently impressed by the quality of care of nursing, reception, counseling, and financial support staff across multiple offices. And last but certainly not least, I'm impressed by everything I've learned about the quality of RMA's lab and the research that comes out of the practice. I felt like everything about my care was state-of-the-art, best-in-class, and holistic. Even though it's a large practice, I think they go through a lot of effort to consider the patient experience, though I think there are small things they could improve in this regard - like providing more info on your full care team (either on the website or as a packet of info when you first start care), streamlining the educational resources they provide, and/or creating a phone system that's a bit easier to navigate.
During treatment, were you treated like a number or a human with Marcus Jurema at RMA of New Jersey?
While I only had a few appointments in which I formally sat down to speak with Dr. Jurema, it was always clear he had carefully reviewed my files and was familiar with the details of my diagnosis and care. Through calls and appointments, he made time to answer any questions I had. Throughout multiple procedures he was always optimistic, yet realistic - giving me as clear a picture as possible of what I could expect without trying to oversell anything. I also appreciated Dr. Jurema's approach to monitoring visits - entering the room slowly (vs. barging in), taking the time to ask how I was feeling, etc.
Describe your experience with your nurse at RMA of New Jersey. (Assigned nurse: Lynette)
Lynette was always on top of things - sending me detailed descriptions of care plans and medication plans and responding to my questions quickly and thoroughly. Overall I've found her to be extremely considerate, caring, and professional. The only downsides of the nursing care at RMA are 1) Lynette was my third nurse in about a 6 month time period, which made my experience feel a bit disjointed; 2) I'm not sure if this is more about RMA or individual nurses, but I don't think there's much of an effort to figure out patient's preferred communication styles, e.g. email, phone, time of day, etc. I found I was always missing phone messages and had to follow up via email and some of that could have been resolved if the info was emailed to me from the start or calls weren't always placed during my morning commute :)
How was your experience with Marcus Jurema at RMA of New Jersey?
Dr. Jurema is friendly and compassionate. During monitoring meetings he always started by asking how I was feeling, which I appreciated. He's very straightforward - I found his descriptions of what we could expect from various procedures to be detailed and realistic, while also optimistic. It never seemed like he was trying to push me toward a particular procedure. I very much felt like I played a role in my care and was able to get all my questions answered.
What's one piece of advice would you give a prospective patient of Marcus Jurema at RMA of New Jersey?
Let him know what questions and concerns you have. He is always happy to respond and provide more info.
Describe the protocols Marcus Jurema used in your cycles at RMA of New Jersey and their degree of success.
We started with two IUI cycles, mostly because that was all my insurance would cover at the time. With a diagnosis of diminished ovarian reserve (my AMH level was 0.82), we thought it was worth trying, but we knew the odds of success were low. Both times I was prescribed 75mL of Gonal F per day. The first time I continued the Gonal F shots for 7 days; the second time for 8 days before taking a 750 mcg/0.5mL syringe of Ovidrel as my trigger shot. I was also taking 600mg per day of CoQ10 (a supplement) during both cycles. Dr. Jurema was willing to try another IUI cycle, but my insurance had changed to provide some coverage for IVF, so we decided to move on. During my egg retrieval cycle I took Alyacen birth control pills for 8 days leading up to the cycle, then I took 300 units of Follistim and 75 unit vials of Menopur for 10 days along with 250 mcg/0.5mL syringes of Ganirelix for the last 6 days. I used two Lupron trigger shots at the end. My egg retrieval took place 2 days later resulting in 22 eggs of which 18 were mature. From there we were able to get 12 embryos, which were fertilized via ICSI, and 8 made it on to Day 5 blastocysts. We froze and genetically tested all 8 of those embyros and found 5 were normal, 1 was abnormal, and 1 was unclear. During my whole retrieval cycle I had about 8 monitoring visits. I'm currently in the middle of my transfer cycle and haven't started medications yet, but we plan to transfer 1 of the normal embryos.
We transferred one embryo. During my transfer cycle I took 2mg of Estrace (2-3 times per day) for three weeks before the transfer and then five weeks after. I also injected 1 - 1.5 mL of progesterone in oil daily for a week before the transfer and five weeks after. And I used Metronidazole the day before transfer and Endometrin 100mg inserts around weeks 5-8 of my pregnancy. In total I had about 8 monitoring visits leading up to the transfer and through week 8 of my pregnancy.
Describe your experience with your monitoring appointments at RMA of New Jersey.
I mostly did my monitoring at the Springfield office of RMA. I found the team there to be incredibly efficient. There were one or two instances in which things seemed to be running behind, but for the most part I was in and out with blood work and ultrasound within 15-20 minutes. The team was always kind and professional. The hours were early enough that I could get in and still make my regular commute to work. Occasionally I had to go to the Basking Ridge office during holidays or on weekends and it was often a different story. My monitoring appointments there sometimes took 1-1.5 hours, but I appreciated that I had a weekend option that wasn't much farther than my regular office, and that the monitoring hours were longer at that office.
Describe the costs associated with your care under Marcus Jurema at RMA of New Jersey.
Initially my insurance fully covered IUI but not IVF, so for my two IUI cycles I paid about $650 for initial diagnostic blood work, an HSG, and co-pays for two visits and medications. All my monitoring visits and the IUI procedure itself were fully covered. For my IVF cycle I had a $10,000 lifetime maximum. Total costs from RMA for the cycle were: $7,977 for the egg retrieval procedure; $1,963 for ICSI; $700 for anesthesia; $1,000 for embryo freezing for up to one year; $1,700 for embryo biopsy; $2,500 for genetic testing; and $4,475 for the embryo transfer. So I paid about $10,315 out of pocket for those expenses. I also paid about $5,500 out of pocket for medications for both the egg retrieval and transfer cycles. And I paid about $400 in co-pays for monitoring visits during both cycles.
I ended up receiving a $4,300 reimbursement from RMA and about $5,000 in reimbursements for medications from my insurance company, so total out of pocket costs were ~$7,000.
Describe Marcus Jurema's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at RMA of New Jersey.
My doctor suggested single embryo transfer, and from what I had read I strongly agreed with this approach. We weighed the risks of multiple pregnancies with the costs of performing procedures (ICSI, embryo freezing, genetic testing) that would help us ensure our single embryo was genetically normal. Ultimately we decided the costs were worth the benefits of an increased likelihood of a normal embryo and healthy pregnancy.