How was your experience with Jeffrey Keenan at Southeastern Fertility Center?
I picked Dr. Keenan primarily for ethical reasons as unused embryos are never destroyed. My first egg retrieval with Dr. Keenan was safe and I successfully got 6 eggs, 3 of which were mature and 3 which were intermediate to freeze. My second egg freezing cycle I got 4 mature eggs and 4 intermediate eggs to freeze. Despite Dr. Keenan really working to get me more eggs and improve the protocol each time, I got 5 mature eggs my third cycle and 6 mature eggs my last cycle. His patient packet said that you could get 8-10 eggs and 80%-90% were mature, and he told me I could get average 10 so my number of mature eggs was lower. Intermediate eggs make babies at half the rate of mature eggs. Dr. Keenan did all the ultrasound monitoring himself except on weekends when Autumn, the nurse practitioner did it or during a specially scheduled baseline ultrasound during my third cycle. I did not see Dr. Keenan during blood test only appointments. Dr. Keenan and I get along fine now, but my first cycle was tough. Dr. Keenan was good about answering questions about dosing and medications, but there was not a lot of time for asking all about what is happening with the protocol and the whys of dosing adjustments during my first cycle, although you can fit in a few. Prior to my cycle, I had an initial consultation with Dr. Keenan where he told me I would need two cycles to have a 50% chance of conceiving. I had more questions than time for the 1.5 hour appointment allowed. I also found that if I asked questions that had yes or no answers to, then I would literally get yes or no for an answer so over time I realized that if I wanted more explanation or whys, I had to ask explicitly. He is generally knowledgable about clinical practice, but doesn't quote lots of studies and stats although he did tell me that each egg has a 3% chance for survival given my age. After my first appointment, I asked a lot of questions about not wanting to have quadruplets if he implanted 4 embryos and he just simply said, "I have never seen that happen before." Or do people ever regret egg freezing and the answer was, "No." Afterwards, I found it hard to get ahold of him for answers. I had emailed the practice manager and the IVF nurse more questions about the long term risks of the procedure and didn't get very satisfactory answers. He said that the staff and him had already answered all the relevant questions, but then later he realized that I was evaluating other options, I did get concise answers. Also there was one time when I told Lynda there were changes in my family history and she said Dr. Keenan wanted me to get tested for Lynch syndrome. But it failed to come with the caveat that I could be denied life insurance and long term disability if I tested positive or recommendation for genetic counseling about the implications. After googling, I asked him. He said that it was up to me, but he wouldn't do it if he were me. Maybe he is legally liable to tell me to get tested. I finally got answers on long term side effects when the consent form came out and he was able to spend 30 minutes with me on the phone, but that was months later. Also he was concerned about my anxiety and suggested counseling, SSRIs, and other anti anxiety treatments, but when I talked to a therapist, they said that the issue was I needed more information. I refused to take SSRIs as they are habit forming and have side effects and as soon as you stop taking them the anxiety comes back so it doesn't treat the disease, but Dr. Keenan said he was not aware that you could treat anxiety with acupuncture. Later though after my second cycle, he thought that it worked as I was only stimming on one side during my first cycle, but was more balanced on the second cycle and got eggs from both ovaries. In his handout he says that if you are especially anxious to speak to him so that he can get you started on medications. He also says on his sheet about weight management to drink dairy so he has a more Western focus. While I trust Dr. Keenan for fertility and appreciate his concern, I questioned whether he should be telling me, I need to be on SSRIs when he is not a qualified mental health professional. Sometimes when I ask would why he does or doesn't do things, I felt like he thought I do not trust him. I asked him if I would experience any of the side effects on lupronvictimshub and he initially told me that I would drive myself crazy if I didn't stay off the internet and trust him. Later in the call, he did explain that he hadn't seen any of the long term side effects and as soon as Lupron left my body so would the side effects and addressed my concerns about the issue fully. After my first cycle he said that I had to limit my emails to five sentences per day and two questions and things have been better since. I think I was just writing too much and they were overwhelmed. He did ask me questions to indicate that he had read some of my concerns in email. I also did art therapy and acupuncture all of which helped.
What's one piece of advice would you give a prospective patient of Jeffrey Keenan at Southeastern Fertility Center?
Plan early as this practice gets super booked up and it might take longer than expected to complete your cycles. Schedule a fertility check up in your late 20s to make sure you can wait. The ideal age for egg freezing on average is 34, so call the practice to schedule between 8 AM - 4:30 PM but not lunch from noon to 1 when you are 33 or as soon as you are deemed infertile. Do your research beforehand so you can think and be prepared to ask questions that you can't find on google and if you want more than just a yes or no answer, ask specifically. Limit questions to 2 per day and keep emails short (5 sentences or less)
During treatment, were you treated like a number or a human with Jeffrey Keenan at Southeastern Fertility Center?
I felt treated like a human when Dr. Keenan accommodated me and rebooked my appointments so that I could take my family vacation and still join his September cycle. He also does his best accommodate my schedule as he scheduled my baseline ultrasound to not conflict with when I needed to be on site at work and fit me into a March cycle. He also worked with me until I was able to complete 4 egg freezing cycles to get my equivalent of 20 mature eggs. He also did answer my concerns before my first cycle and prayed for me when I asked and told me he would do everything he could to help me, so I think that he genuinely cares. But I felt treated like a number after my first cycle, because Dr. Keenan is super busy and has a lot of patients. He has a lot of responsibilities being on the faculty of University of Tennessee in Knoxville, directing the National Embryo Donation Center, taking on traveling and speaking engagements, member of the Christian Medical and Dental Associates, in addition to all his fertility and embryo adoption patients. While Lynda, the IVF nurse, worked 10 hour days and had to come in for weekends during cycles, the clinic is not open 365 days a year and outside of business hours except during active treatment cycles when they do monitoring and surgeries on weekends like some of the larger clinics. I understand that Dr. Keenan and staff need time to sleep and rest so they don't mess up their surgeries, but from a patient perspective, I still felt like it took longer than I wanted to get all my questions answered during my first cycle, get booked for cycles, get prescriptions faxed, and the appointment time is limited. They did hire another nurse recently two days a week and mentioned in the CMDA Christian Doctor's Digest podcast that they would like to hire another RE and have more affiliate clinics.
Describe the protocols Jeffrey Keenan used in your cycles at Southeastern Fertility Center and their degree of success.
I was on the Long Lupron protocol with birth control, but during my first cycle I was down regulated for longer because I was on vacation. My protocol started with birth control along with 10 mg Lupron from 7 PM to 9 PM for about a week, and then just Lupron for 4 days before a baseline ultrasound and lab. Then another 10 days of just Lupron before starting 125 FSH (Gonal F and Follistim) in the AM and 1 vial of Menopur in the PM with Lupron between 7 PM and 9 PM for two days before lab. Menopur increased to two vials for the rest of the time. Lab Thursday and lab and ultrasound on Sunday, Tuesday, Wednesday, Thursday. Lab only Friday. (Total stim time 12.5 days). No medication Friday night and Ovadrel. 2 Doxycycline Saturday night before retrieval. The long Lupron protocol was used because I was a woman of typical ovarian reserve for my age so that is a very typical protocol. My estradiol was not going up high enough so that is why I was given two vials of Menopur and not switched to Ganirelix. However my leading follicle was big 23 mm on Thursday and my ultrasound showed 9 total follicles. 8 were retrieved and 3 mature and 3 intermediate. My second cycle was the same except I did not take Lupron for as long and I started with 2 vials of Menopur to hopefully get more eggs. I stimmed from January 4th and had my retrieval the 17th (total stim time 10.5 days). My second cycle I had 4 mature eggs and 4 intermediate eggs to freeze, but there were 11 follicles total in my ovaries. My third cycle was the same as my second cycle except that Dr. Keenan waited one more day than would otherwise in hopes of getting more mature eggs (total stim time 12.5 days) and used HCG instead of Ovidrel. Also because I had on site work scheduled, I had extra time between my baseline ultrasound and next lab. On my fourth cycle, I went back to Ovidrel and I may have had an extra day of downreg due to other commitments.
Describe your experience with your nurse at Southeastern Fertility Center. (Assigned nurse: Lynda McCollum)
Lynda McCollum is my IVF nurse coordinator. She gave me a hug after my third cycle as she thought it would be my last. There is another nurse Mari on staff who takes care of general infertility and they hired another woman, Sandy, two days per week. Dr. Keenan's wife, also named Sandy, is also a nurse and she teaches the injection class to local candidates which I missed since I am from out of town. I thought Lynda was good about answering the questions that she knew via email or getting Dr. Keenan, but I felt that some questions fell by the wayside during my first cycle until I was asked to sign a consent form saying I had all my questions answered. For example when I went to the acupuncturist, he recommended an herbal medicine for anxiety and I asked her if I could take it since Dr. Keenan says not to take herbal medicine without approval. She told me she would ask Dr. Keenan and I never heard back until a phone conversation months later when I asked him and told me no, I need to be on SSRIs. To be fair, I had a lot of questions and didn't remind them. She told me I could swim in a pool, but not a hot tub and when, when to start taking baby aspirin, why I was given a prescription for vitamin D when I was already on high dose vegan vitamin D, referred me to the acupuncturist the clinic used, etc. But when they are in cycle, you don't get questions answered right away if it is about the new patient packet even if you are trying to decide whether to sign up as they think it is not time sensitive. But sometimes it is if you are deciding whether or not you need to start taking birth control or go to another clinic on your natural period or you are feeling anxious about the risks or birth defects. I do not think she is lazy, but more swamped. There was one time when she told me that I would get my prescriptions faxed Friday, but then after two Fridays they never got faxed. Turns out I didn't need it until the end of the month, but that was not communicated to me. She ordered Lupron for me from Village Fertility Pharmacy and the rest of my medication at ivfmeds and needles from Walgreens. But I did not order them before I left for vacation as I was going to have them shipped to my hotel. She gave me medication and told me to just have the meds sent to the clinic and put them in the fridge when they came. She also showed me how to use Gonal F and Menopur, but I don't remember her telling me to take them within a two hour time window and my treatment calendar only said AM and PM. But it was clarified two days after I started stimming. She also showed me how to break the glass ampuoles from the international pharmacy. Later in the cycle she was busy and I had to come into the clinic to get refill medication and to ask them to call in my Ovidrel and she did not have much time to price compare. On my second cycle, ivfmeds sent my medications between Christmas and new years when the clinic was closed and luckily Lynda was there to receive the medications. I also ordered too many meds and had leftovers due to getting donated Menopur. By the third cycle though, I felt like a pro and Lynda was nice enough to let me borrow Menopur from the clinic and I could pay the clinic back with medications from ivfmeds. Also, they loaned me HCG when Dr. Keenan switched my medication at the last minute from Ovidrel and I was able to order a replacement from Metro Pharmacy. I ended up having to do the price comparison. ivfmeds is the cheapest for Follistim and Menopur if you don't have insurance as is Lupron, but Lupron is covered by insurance after you meet your deductible and only costs $10. Otherwise, if you are paying cash, the compounded Lupron from Metro Pharmacy is cheaper than the Avella specialty pharmacy that this clinic calls all the prescriptions into. Metro Pharmacy is a Merck pharmacy so they have cheaper HCG with $10 for 3 day shipping. Freedom Fertility Pharmacy was best for EMD Serano's Ovidrel and has free overnight shipping. On my fourth cycle, I had to be out of town and I did not realize that my Menopur injection needle was not packed until I was in Boston. Luckily the doctor on call was able to advise me to use a larger needle to stim. The practice manager, LJ, is newer so it is not useful for me to review the previous practice manager who quit before my first cycle. LJ was still coming up to speed during my first cycle so she was not that helpful in certain areas at first. But she made a mistake and gave me discount on my second cycle which Dr. Keenan honored. LJ is also a registered RN and helped me prep for surgery during my second egg retrieval by taking my vitals, putting my stuff away and helping me get to the bathroom with my IV, etc. Sandy (not Dr. Keenan's wife) helped me prep and get ready for the surgery during my first cycle. She was good about walking me through the process and keeping me calm, playing music for me and discharging me, but she picked a vein for my IV that caused a lot of blood and left a huge bruise. My hand is normal now though. Sandy also did my IV for the second cycle and she had to stick me twice because the first vein did not work and she said that it was because I wasn't relaxed. She was going to ask Sherry to stick me, but then the second vein that she picked worked. The anesthesiologist , who was very skilled, put in my IV on the third cycle and she did it in my arm which was much less painful than the first two times. On my third cycle, I needed an intramuscular injection for my HCG. Since it is hard to self administer and I was concerned about hitting my sciatic nerve, Sandy (Dr. Keenan's wife) met me at 9:00 PM at the clinic and gave me the injection.
Describe your experience with Southeastern Fertility Center.
The clinic's strengths are that they do not destroy embryos as all patients undergoing the cycle sign a consent form saying they will use all their embryos or donate them. I feel very fortunate to have found this clinic as one woman in my fertility support group shared that her sister refused to do IVF due to concerns about embryo destruction and never had children. The state of Louisiana supposedly does not allow embryo destruction, but clinics may not care about creating extra embryos or may destroy embryos if the laws change.
Many clinics only know how to fertilize all the embryos and donate the leftovers or say something oversimplified like, "You can just implant two and have twins." This clinic can fertilize only a small number of embryos that you need based on statistics, have a child, and freeze leftover eggs and has more experience with how many to fertilize that will make it to stage 3 or blastocyst. In a time when many clinics that offer egg freezing have never even thawed any eggs, this clinic has also thawed over 1000 embryos in their embryo adoption program and are very experienced with fresh IVF cycles as well. Also because they don't always create all the embryos at once and freeze eggs, they know how to handle the thawing of eggs, which are supposedly harder thaw than embryos. The freezers are in the same place as the National Embryo Donation Center which receives millions of dollars in grants from the federal government. They are also a holistic practice although not in an alternative medicine and herbs way. I also had to explain to them that I preferred to take my high dose vegan vitamin D over what they prescribed which they approved of after I explained. They have general advice on their website like how to lose weight that included going on an Atkins diet, but they told me I did not have to follow it as my BMI was fine and I am not a morning exerciser, don't eat a lot of meat based proteins, etc. Also they told me I didn't have to take prenatals. I really liked Sherry, the Phlebotomist, who gave me advice about how to inject myself so it didn't hurt and was really good at giving shots, and Taylor at the front office, who always answers the phone. Dr. Keenan is generally responsive to concerns, for example, agreeing to let me cycle with him even though he thought I should go to a local clinic, changing my protocol to use Ovidrel which is subcutaneous instead of intermuscular Pregnyl, when I told him it was painful, redoing my protocol to accommodate my vacation, asking me questions that indicated that he had read my emails after I was upset that they ask to sign the consent form, etc. I have never felt coerced into signing something. The patients in this practice are friendly and supportive. I became Facebook friends with a woman who was cycling with me and we had a retrieval the same day. A husband gave me a bracelet that said, "He >I John 3:30" and encouraged me that, "My wife and I wanted to remind you that God performs miracles every day" when I shared that there weren't as many eggs in ovaries as I had hoped. The weaknesses of the clinic are they work somewhat on their schedule, not yours as all patients are synced and they didn't operate super quickly as they were understaffed, but they are much better now than before. They only have egg retrievals on specific days in September, January, and May although they did a March one for me. If you have a commitment during that time and you let Lynda know, they can schedule your baseline ultrasound earlier. Plus to be on those cycles you have to be taking birth control one month before. When I made my initial appointment in May, I asked if I could join their May cycle and they were like, "Oh no, these people have already been taking birth control for a month, etc." This may limit options such as going on your natural period and possibly certain protocols. Their reason for syncing has to do with cost savings supposedly. Even in September, their November cycle for embryo transfers is already booked. The clinic recognizes that they are swamped and has been actively looking for another RE and affiliate clinics that subscribe to the NEDC's charter of beliefs, but this has been tricky. Their office hours are 8 AM-4:30 PM with lunch from noon to 1, which means that they are open when you are working, although Autumn does take evening appointments and they do work weekends during their September, January, and May cycles and as needed for their March cycle. It really only matters for making the initial appointment though as when I filled out the web form I never heard back for two weeks and then after I didn't hear back about the second form called to find out it was broken. Once you visit the clinic for your initial consultation, you get access to emails, etc. But five days after my initial consultation, when I was waiting to hear back about whether or not I could get into their July cycle and should start taking birth control, I did not hear back the day before I was supposed to start taking it. Turns out, they were discussing my care and how they could fit me in, but I was not privy to the information. I still had all these unanswered questions which Lynda told me to email to her. Ultimately I needed more time to gather information, but by the time I decided it was too late even though it was still June. To be fair, I had lost the patient packet, which answers a lot of questions. I had asked about the September cycle dates and mentioned the dates that I had booked my hotel in e-mail and no one ever told me those were not the dates until my protocol came out. Also Dr. Keenan thought I had anxiety and I told him about how I went for acupuncture and the therapist told me I needed more information, but by the time he responded to me months later, it was way too late for me to seek counseling before my first cycle. I felt like I had to scramble for medication multiple times during my first cycle, but I did not run out of medication during my second cycle and got fast response during my third cycle. The first time, they moved my protocol 10 days early to accommodate my vacation with Lupron starting Sunday and I hadn't ordered my medications yet as I was still shopping around and did not realize that I would need it so soon. They emailed me Friday at 4:45 PM, but I did not check my email until after office hours and the doctor was on vacation. The doctor on call told me it was not an emergency even though the pharmacists at Freedom Fertility Pharmacy told me it was, but later Lynda called and ordered for Monday delivery as there was no Sunday delivery so I started my Lupron one day late. Another time, I had emailed Thursday night saying I only had 5 vials of Menopur since I was double dosing which means I would run out Sunday and asked about how many to reorder. I didn't hear back by Friday afternoon after calling and leaving message multiple times and waiting all day for a response, so I drove to the clinic to borrow more of their Menopur. Lynda had told me not to reorder Lupron as someone in the clinic had donated it, but then later when I realized it was the 28th day since piercing my Lupron and that is the shelf life and wanted more, there was none on hand in the clinic as the Lupron donated was a different kind of Lupron. Even though Dr. Keenan thought it was fine, Lynda ordered more for next day shipping but I still had one day expired Lupron. (But I should have given Lynda a few days notice as I did not realize my Lupron was expired.) Dr. Keenan said my trigger would be Thursday or Friday and Lynda told me on Wednesday that she wanted to know what pharmacy to fax to. I told Benita that I wanted it called into MRX pharmacy and it needed to be done before 7 PM for overnight shipping as I needed it Thursday and to let Lynda know. Benita assured me that she would tell Lynda that day and it never got called in as Benita left a note on Lynda's desk which she didn't see or had already left. I am hoping that Lynda knew that my trigger was on Friday so she didn't need to order it on Wednesday, but nothing was ever communicated to me about my care. Since half my eggs were still immature when retrieved, I am thinking that my trigger was not Thursday. I found that as a mostly cash paying patient, I had to navigate my own price comparison for medications, except for the referral to ivfmeds. Dr. Keenan uses Avella specialty pharmacy, but other places are cheaper. You also get your estradiol results days after the lab; it would be nice to know in real time. For my March cycle, I never got any lab results. The one advantage of being a cash paying patient is that even though ivfmeds is a pain to deal with, using an international pharmacy saves money as some clinics do not allow you to use an international pharmacy.
Describe the costs associated with your care under Jeffrey Keenan at Southeastern Fertility Center.
$6350 per cycle for monitoring, egg retrieval and full anesthesia per cycle, medications cost me about $3000 on my first cycle, less on subsequent cycles because I did not have to order Menopur at the last minute from the US pharmacy, labs were covered by insurance which I am in network and the estimated payment is $50 for each weekday lab and the weekend labs were around $30-$63 each. The price for the procedure may have been slightly higher by the end of the fourth cycle due to increasing costs. I ordered medications from Metro Pharmacy for compounded Lupron and HCG, ivfmeds for Follistim and Menopur and possibly Lupron, and Freedom Fertility Pharmacy for Ovidrel. Needles and syringes for Menopur, birth control, and anti nausea patch I got at Walgreens and CVS. Insurance covered non compounded Lupron after reaching my deductible and birth control always and discounted needles. But not the rest of the medications. In the end though I had over $1000 of unused medications and it got dropped off and donated to the clinic on my retrieval day. I did not get the chance to go back and get it to try to sell to someone else due to my travel schedule. I pay more for my health plan which offers Dr. Keenan in network. Otherwise the weekday labs may be $90 each and weekend labs may be $300 if you pay cash. The weekday labs bill around $245 each before the insurance discount and maybe around $350 for weekend labs. The mental health professional that met my needs was out of network and cost $200 for initial intake and $102 for subsequent weekly visits which is the discount price for paying cash. The acupuncturist that Dr. Keenan's nurse recommended, Kathleen Klimaitis, cost $140 for initial session and $90 for each additional session. On my third cycle, I ended up going to Sam at The People's Acupuncture of Asheville, NC and that was sliding scale $25-$45. When I am not cycling, I go to the Virginia University of Oriental Medicine intern clinic which costs $20 per session. I also bought melatonin, asprin, and vegan vitamin D. For after my retrieval, I needed tylenol, crackers and coconut water to avoid nausea. After my first retrieval, I felt so terrible that I had to go to the ER for chest pain which turned out to be esophageal spasms from throwing up and I have a high deductible plan. I did not have nausea with my second cycle as Dr. Keenan and staff were aware of my nausea and prescribed a patch for me and took precautions. The initial consultation costs around $450 but I got a slight insurance discount plus the costs of a vitamin D test and AMH test. You also need an STD test which insurance is supposed to cover, but my gynecologist charged me although I don't remember the amount. Since I cycled from out of town, I also needed travel and lodging costs at hotels and airbnb for consultations, monitoring and appointments, uber/lyft to and from clinic on retrieval day, gas, bus ticket and airfare to Knoxville, etc.
Describe Jeffrey Keenan's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at Southeastern Fertility Center.
Since unused embryos are never destroyed and it is really hard to only create one euploid embryo (my guess), this clinic has a higher rate of multiples compared to other clinics. But there was one woman who Dr. Keenan suggested implanting one and she told him she wanted to implant two so she could get it over with. He offers freezing embryos for a sibling though and I am not sure why people do not do that more. During one of my cycles, one couple had two embryos did not seem to want twins, but had to decide because if they refroze the embryo and thawed it later, it might have a lower rate of survival. The embryologist told her that one embryo meant a 40% chance of pregancy while two meant 70%. I asked Dr. Keenan if embryos are not good quality would you still implant them and he said yes because they might take with 10% probability. Usually Dr. Keenan implants two in his fresh IVF cycles and two to four in the embryo adoption because they might be lower quality. You are not counseled much on this topic in egg freezing only cycles, but one patient who was doing a fresh IVF cycle said that Dr. Keenan has statistics about how many embryos to create, implant, etc.
What specific things went wrong at Southeastern Fertility Center?
- Failed to convey critical information
Describe the specific things that went wrong at Southeastern Fertility Center.
The previous practice manager, who no longer works at the clinic, gave me the wrong range of dates for the September cycle. My family planned their vacation on dates in September and then I saw that my first protocol would be in the middle of my vacation. At first Dr. Keenan said those dates were scheduled long ago and I could consider coming in January or skipping the baseline ultrasound. They were able to work out an alternative plan though where I did my baseline ultrasound before my vacation, and stayed on Lupron longer. I had to travel with medications for all my cycles though which always stressed me out despite the foil bags being great for keeping things cool.
10
Clinic
Southeastern Fertility Center
Knoxville
