RMA of Philadelphia

Dr. Castelbaum is a very smart man. He is not an alarmist - he only gives you the information you need, and I think that’s to keep you for over analyzing or overthinking. I do, though, prefer to have more knowledge than I may need, so this has bothered me from time to time. When in his care, you need to have the mindset that he’s a professional and you need to trust him. Sometimes this can be hard for me, but I have seen many people have great success with him, so I do trust him.

Ask for more information when you need it.

I was put on the antagonist protocol. He never explained the logic for this protocol. This yielded 14 eggs and resulted in 10 frozen embryos. We transferred 1 embryo each time. First transfer resulted in a negative test and the second resulted in a miscarriage.

The cost of an IUI cycle was approximately $1,000 and for an egg retrieval and transfer, it cost just over $10,000.

I appreciate his conservative approach because the thought of carrying multiples worries me due to the increased health risks for myself and potential babies.

Dr. Gutman is very patient, caring and experienced. While you can tell she is very busy with many patients, the appointments never felt rushed. If questions aren't asked, she won't got into much detail. However when questions are asked, she will tell you what she is was thinking. Overall I would say her methods are on the traditional/conservative side. While I appreciate her not pushing any products or treatments that don't have proven success rates, I do wish we would explore more out of the box options. Overall, I feel a sense of trust working with Dr. Gutman and feel like she truly cares about my outcome.

If you have a question, ask it. Don't assume. She doesn't give much detail if you don't ask for it. If you want to try something new, you need to start that conversation as well.

I have been through 2 IVF cycles with Dr. Gutman. The first cycle we used BC for a week prior to starting stims. We then followed the agonist protocol with an aggressive med list. We did 300 follistim iu and 75iu menopur for twelve nights. About a week into stims, we realized I wasn't responding to the meds as we would expect for someone my age. I was producing fewer eggs than normal. The word "cancel" was tossed around once or twice, however we went through with the retrieval. 8 follicles were retrieved, 6 were mature, 4 fertilized and made it to day 5, however only 1 was able to transferred. That round ended in a negative beta. We took a month off, and then started another round of stims. This time instead of BC, we primed with estrogen ( we thought the BC may have suppressed me too much). We then did the same agonist protocol with the same dosages. We stimmed another twelve nights and all monitoring appointments showed more follicles than the first round. However, retrieval yielded only 7 follicles, and none fertilized. We haven't done another IVF cycle since then. We have done 4 IUI's with follistim and follistim/clomid. The first IUI resulted in a chemical pregnancy. The other three ended in negative betas. Each IUI showed at least 3 mature follicles.

Early morning monitoring appointments were hit or miss. Some days I would be in and out very quickly, other days I would be there for almost an hour. I would say they were usually on the quicker side for the most part, however there were still a handful of times that took way longer than needed. The days that did take long however, once I got into the monitoring room, I did not feel rushed out.

My insurance covered monitoring and bloodwork for IUI cycles. Nothing was covered for IVF. RMA prices are high and they don't offer any bundled packages which is the main reason I am holding back on moving forward with another cycle. If they offered better more affordable options, I would have started another retrieval already because I do feel comfortable and trust them. They did offer a tiny discount however with my next cycle being my third round, I was hoping for a deeper discount than offered.

We never had the option to transfer more than one embryo. However for our IUI with injections, Dr. Gutman was ok with proceeding with 3 or 4 mature follicles.

I wish I would see Dr. Freedman more often as well as hear from him throughout a cycle. I know he is making decisions behind the scenes, but I usually only hear about them through the nursing team. He makes small adjustments as needed, but I'm not always aware of what those changes are expected to accomplish.

Come with lots of questions and don't be afraid to advocate for yourself.

My first retrieval I did 2 weeks of birth control followed by an antagonist protocol. Part way through my Menopur dosage was raised. I stimmed for 11 days and retrieved 8 eggs, all were mature, 6 fertilized, and 2 made it to blast. Both came back mosaic. My second protocol we eliminated the birth control because Dr. Freedman thought it may have over suppressed me and we could get more eggs. Same medicine and we retrieved 13 eggs, 8 were mature, 6 fertilized, and none made it to blast. We were shocked and have no good reason why it happened. I am planning a microdose lupron protocol next month.

Currently covered by insurance

He is very adamant that single is best, especially at my age.

Dr. Gutmann is very candid and thorough. She is very blunt and straightforward, but underneath there is a wicked sense of humor, which both my husband and I appreciate. Her personality fits well with us and we appreciate her ongoing collaboration in our treatment.

She is very thorough and knowledgeable. She is a straightshooter and is very clinical in her assessments. Some people not like or appreciate that, but I do.

We started with clomid and timed intercourse. I did not like clomid and the side effects that occurred with it and we quickly moved on to injectable meds with timed intercourse. She was very candid about her treatment plan and why she recommended moving on to IVF when she did.

It was very smooth, they take patients for sonograms on a first come, first serve basis. Bloodwork can take a bit more time since it is done in the outpatient lab but is not usually too long of a wait. RMA patients are expedited in the outpatient center.

Our treatment leading up to IVF was covered under insurance. I appreciate that she did not recommend IUIs (which would not be covered under my insurance). Stating that they don't produce good outcomes and we would most likely end up needing IVF. Total cost of IVF cycle with medication cost approximately $16k

She prefers to transfer one embryo at a time due to the risks multiples create. I wanted to have a discussion about transferring two, which she happily obliged.

I saw Dr. Gutmann primarily for our diagnostic work up as we then moved out of state. The clinic has you complete a through form outlining your medical history and history trying to conceive. During my initial appointment with her, Dr. Gutmann reviewed my answers with me and asked follow up questions when needed. My husband had to participate by phone and she answered his questions as well as mine. She explained the benefit of getting a HSG completed. I ended up getting my HSG done by her a few weeks later. I was very nervous and found the procedure to be painful She was kind and compassionate throughout.

She will be direct and very scientific about what your chances are of conceiving.

I saw Dr. Gutmann for diagnostic workup.

My diagnostic tests were covered by my insurance.

NA

Dr. Guttman is very knowledgeable and up to date on latest research. I trust her medical advice but her communication is not good. She does not explain things in detail. For example, she just says "looks good". Other REs that I have seen in the same practice actually explain to you the ultrasound, what they see on the screen, not just "looks good". It is important to know for yourself what is going on because how else will you be able to make a decision.

If you need hand holding find another doctor. If you go, you'll need to be a very strong advocate of your options.

Strong preference for eSET not multiple.

I generally had good interactions with Dr. Freedman. I rarely saw or spoke to him during my cycles, but I saw him each time at pregnancy ultrasounds. During ultrasound appointments it often seemed like he was busy, which I am sure he was.

Be willing to do most of your interactions with the nurses at this practice.

I did three IUIs with Letrozole. There wasn't really an explanation for the medication or dosages. When I asked the nurse about next steps after the second unsuccessful IUI, she pretty much conveyed that she wasn't sure, but probably the same thing. I asked for the dose to be increased and it was.

Some IUI cycles weren't covered by insurance and those were $1000, plus cost of medicine.

She is a good advocate, competent with both medical and procedural aspects of infertility medicine. My success was limited in part to the fact that my insurance coverage was limited and affordable injection medicine was not available to me

Start your infertility journey early and don’t mess around with IUI. Go straight to IVF, donor eggs, whatever. I personally believe that if you cannot get pregnant naturally IUI is not enough to get you pregnant. Be more aggressive in pursuing pregnancy

We used Clomid, letrozole and IUI. I have regular cycle, normal uterus and endometrial lining. Tubes were patent. She never used the term unexplained infertility but I suspect that is what I have. We planned on injections but insurance would only cover it if the medicine was given in a medical short procedure unit. When I informed her of that , she didn’t think it was a good idea

I had HRA plan. I had expected costs. My pharmacy plan did not cover injections. I had to pay out of pocket for sperm

No experience

We have been seeing Dr. Gutmann for almost a year. She is extremely knowledgeable and I trust her with my care. We have had a couple different procedures with her and she is always very professional. She is a little blunt and to the point but is compassionate as well, which I have found is a great mix for a doctor to have. She also took the time to call me personally after my failed cycles and to provide feedback on next steps. She came up with a new protocol for us which we were so thankful for. Overall, I would highly recommend her to anyone seeking help in conceiving.

We had insurance coverage during our treatment.

As we PGS tested our embryos and as we are u dear 35, Dr. Gutmann would only let us transfer one embryo. This is the general practice at RMA.

Dr Guzman was great, very candid and to the point, I just felt like a number and our situation was not paid any attention. I had to call to check on the status of our charts, whether plans with our other doctors were communicated and the status of results and file updates.

Ask questions, do your research, come win questions and be prepared to be the facilitator with any other doctors esp urologists

We were on the treatment path for male factor and then changed doctors

Pretty standard

Not applicable

So far it has been an excellent experience. She has been very thoughtful and has been ordering tests for issues that were not previously followed up on by my prior doctor. She has been excellent with communicating with me and her office always follows up within 24 hours

I want a doctor to dig deeper and I feel like he did not. He was helpful in getting us a reason for pregnancy not to be occurring and I feel he took the perfect first steps but as it didn’t work I think we should have been more aggressive in next steps. He was super compassionate as I was scared about all the firsts and he did a good job at explaining everything.

Be your own best advocate.

We chose IUI first and did 6 rounds of clomid with IUI. One of the rounds we did not do IUI. I forget why.

Not sure. Used insurance.

She really listened to our struggles and wanted to make a realistic plan for us, not for her or the clinic. She was encouraging each step of the way and even encouraged us to apply for a grant (which we received!).

Less time with other providers in the office. I wish she did the egg retrieval, I didn't care for that physician's personality and approach.

We went for an aggressive egg retrieval protocol due to my infertility issues. All injectables and worked with my insurance to find the best cost sensitive medications.

Dr Kallen does allow you to email and he will often return messages directly by phone if it is something pressing or important. He is very much a scientist and thinks about things in terms of percentages. Sometimes I think he knows what we should do next, but almost involves us too much in the decisions, but I am not sure if that is because both my fiancé and I are also doctors!

Be very very direct with your questions and most important ask at every step how you are expected to feel. Also, ask what is the "usual" experience for a woman with a similar health profile. I was surprised by how I felt after egg retrieval and also how many embryos actually are mature, fertilize, and then grow! There is a drop off at every step and no one explained that to us! We will know better now if we have to do more rounds!

Dr Freedman was very nice. He explained everything as it was going to happen. He was very thorough. He was also always on time. It was a nice clean facility and always had follow up calls. Great time.