He [Dr Stein] puts up rather well with my many questions that arise from looking at so many sources. I also appreciated that he wasn't pushy about any sort of particular treatment. He very plainly explained the options to us based on our situation. He told us the laid back approach, all the way through the very aggressive approach, the pros and cons of each option, and then let us decide.
All of the nurses I've talked to [at RMA of New York] are good, but Jean-Ann is the best. She offered to help me with injections two mornings when I was there for monitoring, since my husband was out of town. One time she even called me on her day off to respond to an email I had written.
How was your experience with Daniel Stein at RMA of New York?
Dr. Stein is very accessible and usually very warm. We have his email address and he always writes back promptly with detailed answers. I am someone who asks a lot of questions and who wants to know every little detail. I also have a lot of anxiety around this process which means I do a lot of research and ask a lot of questions to many different people on the subject (RE, OB, PCP, nutritionist, acupuncturist, friends/coworkers who have gone through this, 2nd opinions...anyone). He puts up rather well with my many questions that arise from looking at so many sources. I also appreciated that he wasn't pushy about any sort of particular treatment. He very plainly explained the options to us based on our situation. He told us the laid back approach, all the way through the very aggressive approach, the pros and cons of each option, and then let us decide. It doesn't seem to be about money with him - he truly seems to want us to get pregnant with a viable baby, and not just for money or to "up" his numbers. I really believe he cares. So far in our treatment he has been right in all of his opinions of what our fertility issues are. We aren't out of the woods yet, but I've been seeing him for just over a year now and we are definitely very close to a viable pregnancy with our own sperm and eggs. I have more hope now than I had before. Also, he always recognizes me when he sees me in the waiting room. He has so many patients, and yet he knows who we are. (Maybe he only remembers me because I'm crazy, but I don't think so - he seems to remember lots of people). It feels more personal, instead of me just being another number. UPDATE: We seem to be out of the woods now! After my 2nd embryo transfer (both with genetically tested single embryo) I am now almost 16 weeks pregnant! (1st embryo transfer with genetically tested embryo did result in a pregnancy, but he thought it was a chemical pregnancy as it miscarried very shortly after the positive pregnancy test). This current pregnancy - my 5th one - is the first one to make it this far by a mile. It's the first one I ever even heard a heartbeat. I'm still only cautiously optimistic because of all of the miscarriages prior to this, but we have hope!
What's one piece of advice would you give a prospective patient of Daniel Stein at RMA of New York?
Don't be shy to ask questions. He's fairly patient with this, but sometimes won't think to have us try a certain thing until we bring it up. For example we did two egg retrievals and only the second one brought us normal embryos (genetically tested). He assumed we were going to do a frozen transfer the next cycle. We thought about it, and then asked if it would make sense to do another egg retrieval and try to bank a few more genetically normal embryos before the transfer. (We had several reasons for this). He said that was a great idea, and he recommended highly that we do it, if we were up for it - but he didn't suggest it himself - we brought the subject up to him.
During treatment, were you treated like a number or a human with Daniel Stein at RMA of New York?
See my previous statement. I definitely feel like a person there, and not a number.
Describe the protocols Daniel Stein used in your cycles at RMA of New York and their degree of success.
IUI: 5 days of Letrozole, then monitoring. IUI done when I had 2 or 3 eggs maturing. (Ended up in pregnancy - my third, but miscarriage at 6w1d). Rationale was not to use injectables for an IUI cycle, as those tend to result in multiples which is risky. So we just gave my ovaries a little push and it worked! But the embryo was abnormal (tested fetus after miscarriage and was missing part of the 8th chromosome) so IUI didn't seem to be for us. We needed to move on to IVF with genetic testing.
Egg retrieval #1: 150 gonal F and 2 vials of menopur. Then a few days later added in a 3rd vial of menopur and also gonarelix. Egg retrieval on day 13. 10 eggs/8 mature/5 fertilized/1 made it to day 6/0 tested genetically normal. :(
Egg retrieval #2: 225 gonal F and 2 vials of menopur. Then a few days later added in a 3rd vial of menopur and also gonarelix. Egg retrieval on day 14. 24 eggs/20 mature/17 fertilized/6 made it to day 6/2 tested genetically normal (grades CB and DA). Rationale was to try and get more eggs than the first retrieval - which worked, and gave us at least a few "normal" ones.
Decision as to whether we should transfer one of the "normal" embryos, or if we should try to bank a few more "normal" embryos before a transfer. Opted to bank.
Egg retrieval #3: 200 gonal F and 2 vials of menopur. Then a few days later added in a 3rd vial of menopur and also gonarelix. Egg retrieval on day 14. 10 eggs/10 mature/8 fertilized/5 made it to day 6/3 tested genetically normal (grades AB, BB, BC). Rationale was to get better quality eggs, rather than quantity. It worked! This was by far my best cycle in terms of embryology results. At this point we had 5 "normal" embryos frozen (although he said the DA looked really bad - and in all his years of doing this he's only seen a viable pregnancy with a D embryo twice.
Transfer #1: 2 mg estrace taken twice a day. A few days later upped it to 2 mg of estrace three times a day. 5 days before transfer started 50 mg progesterone intramuscular shot once a day/16 mg Medrol for 7 days/1000 mg Azithromycen once. Transfer of BB embryo that thawed to an AA embryo. Lining was at 10mm. Resulted in positive pregnancy test (my 4th) but it didn't stick. Doctor said this was a fluke or bad luck that it didn't work - that with a genetically "normal" AA embryo with 10mm lining (and nothing else structurally wrong with me) this should have worked.
Transfer #2: Same protocol as above, however upped to 75 mg progesterone when mine tested slightly low. Transfer of AB embryo that thawed the same. Lining was at 9mm. This one worked! (My fifth pregnancy). As of this writing I'm almost 16 weeks pregnant.
Describe your experience with your nurse at RMA of New York. (Assigned nurse: Jean-Ann Mckiernan and Ferstendig)
All of the nurses I've talked to are good, but Jean-Ann is the best. She offered to help me with injections two mornings when I was there for monitoring, since my husband was out of town. One time she even called me on her day off to respond to an email I had written. I really feel like she's in our cheering section and is hoping for us to succeed.
Eliza was also awesome. When I got discharged from the RE's office (to my OB), I hadn't said goodbye to her before I left, so she ran out into the hall while I was waiting for the elevator just to say goodbye and good luck. So sweet!
Describe your experience with RMA of New York.
Very pleasant and clean and comfortable.
Describe the costs associated with your care under Daniel Stein at RMA of New York.
Our insurance was pretty good. They were in network the year where I had the bulk of my treatments (Anthem Blue Cross). They are not in network anymore, so it would have been much more expensive.
What specific things went wrong at RMA of New York?
- Failed to convey critical information
Describe the specific things that went wrong at RMA of New York.
Nothing major. Our IVF coordinator isn't the best. I didn't feel that she had answers to some of our questions, or that she was a one stop shop for us. She is a very, very nice person, but we don't have a lot of confidence in her. We recently got assigned a new coordinator and it's too early to tell how good she is. UPDATE: Second coordinator wasn't much better than the first. I'm still not quite sure what an IVF coordinator is supposed to do.