I wouldn't say that Dr. Rinaudo made me feel like a number, but the UCSF clinic environment that he operated in did make me feel anonymous and I didn't necessarily feel like my doctor was strongly invested in the success of my outcome. He is a very kind and genteel person, but he wasn't ever able to offer me insights into why my transfers weren't succeeding or what we might be able to do differently.... My first cycle was cancelled due to poor response to the treatment protocol.
I know that UCSF is a center of excellence, and I took great comfort in knowing that I was at one of the country's best centers for reproductive health. However, I think the patient experience comes down to the doctors and nurses you interact with most frequently, and my experiences there during these cycles left me feeling unsure how important my case was and whether everything that could be done for me (as an older patient with poor egg quality) was being done.
How was your experience with Paolo Rinaudo at UCSF?
I felt like Dr. Rinaudo didn't necessarily have a strong investment in my outcome. My first cycle was cancelled due to poor response to the treatment protocol. From then on (subsequent 2 retrievals) he stayed with a protocol that he said was the only / best one for me given my poor response to the first one. The protocol didn't yield very many eggs, and when embryos were cultured out to Day 5 there were even less to work with. He explained it to me as an egg quality issue / limit of my age, which I understand but I always had a nagging feeling that there should be some adjustment tried or even contemplated to get a better result. From my first retrieval, only three Day 5 embryos survived. We transferred them one at a time with no success. I became interested in PGS for my second retrieval as a way to get past my egg quality issues. Dr. Rinaudo tried to explain the risks of the process to me, but I insisted on it because I was trying to "solve the problem" and I suppose I didn't have enough of a sense that he was trying to solve it with as much purpose or passion. So we went for the PGS, and unfortunately ended up with only one embryo to test which came back as anuploid. It was a traumatic experience for me to go through a retrieval process and end up with no embryos to transfer. I ended up taking a four month break so my husband and I could regroup, and then we switched clinics.
What's one piece of advice would you give a prospective patient of Paolo Rinaudo at UCSF?
I think Dr. Rinaudo could provide more guidance to a couple, to create a more informed process, while still leaving the ultimate decision up to the patient. I think he's a lovely person, and perhaps he and I just didn't have a personality fit, but I felt like I needed more expert guidance from a RE.
During treatment, were you treated like a number or a human with Paolo Rinaudo at UCSF?
I wouldn't say that Dr. Rinaudo made me feel like a number, but the UCSF clinic environment that he operated in did make me feel anonymous and I didn't necessarily feel like my doctor was strongly invested in the success of my outcome. He is a very kind and genteel person, but he wasn't ever able to offer me insights into why my transfers weren't succeeding or what we might be able to do differently. I didn't feel like he was really trying to solve the problem of my case, just repeating the same protocol with no adjustments because he said it was the best / only protocol for me. However, I subsequently switched clinics and have gotten somewhat better results with my retrieval there in terms of the numbers of eggs retrieved (although no positive pregnancy test yet).
Describe the protocols Paolo Rinaudo used in your cycles at UCSF and their degree of success.
Dr. Rinaudo did my first cycle as an antagonist protocol I believe (Gonal F, Ganirelix, Menopur as the primary medications). My body didn't respond well and that cycle was cancelled. For two subsequent retrievals we used a Clomid Flare protocol. I understand this is for poor responders, and that was his rationale for using it. However it resulted in small numbers of eggs (7 one time, 6 the other). I inquired about changing it for my last retrieval with him and he said it was the only / best one for me. However, in a subsequent cycle at a different clinic, my RE has used a different protocol and gotten better results (14 eggs retrieved). So I believe that my nagging feeling that Dr. Rinaudo should have looked at ways to adjust that protocol for me was the correct feeling.
Describe your experience with your nurse at UCSF. (Assigned nurse: Paula Chavez)
The main nurse I interacted with was honestly a bit brusque and lacking in the compassion that I expected from such a role. One time she actually sort of questioned / almost accused me about having an extra dose of one of my medications when I provided her with a medication inventory for an upcoming cycle (it turns out that she had over-ordered it). And one time she forgot to order needles for one of my injectables and my husband and I had to scramble to get them. We had a communication issue related to my Day 2 embryo report on my second cycle, which left me not knowing whether I would be doing a Day 3 transfer the next day, or whether my embryos would be cultured out to Day 5. It was incredibly stressful. I actually felt mildly uncomfortable with this nurse and did feel like I was a number to her.
Describe your experience with UCSF.
I know that UCSF is a center of excellence, and I took great comfort in knowing that I was at one of the country's best centers for reproductive health. However, I think the patient experience comes down to the doctors and nurses you interact with most frequently, and my experiences there during these cycles left me feeling unsure how important my case was and whether everything that could be done for me (as an older patient with poor egg quality) was being done. This is why I switched - I felt like I needed more personalized attention, and I had had a good experience with an RE who had moved on from UCSF so I could compare the approaches. So I went to his clinic after two unsuccessful cycles with UCSF.
Describe the costs associated with your care under Paolo Rinaudo at UCSF.
My first retrieval and three transfers were covered by my insurance. My final cycle was a self-pay cycle with a retrieval and PGS but no transfers unfortunately, and I believe it was around $15,000.
Describe Paolo Rinaudo's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
Dr. Rinaudo understood that my husband and I were trying to avoid twins, and he was supportive of our decision to only transfer one Day 5 embryo at a time. However, I wish he had educated us more on the statistical probability of that approach actually working out for someone of my age. My current RE let us make the ultimate decision of course, but he did a statistical analysis that showed that we could safely transfer 3 Day 3 embryos at a time to cover the number of embryos that probably wouldn't survive. I know it's difficult to compare Day 5 to Day 3, but I felt like we were making a more informed, rational decision with our current RE than with Dr. Rinaudo.
What specific things went wrong at UCSF?
- Failed to call in prescriptions to pharmacy
- Failed to call with results
- Failed to convey critical information
Describe the specific things that went wrong at UCSF.
I think I've elaborated on what went wrong during my previous responses. But in particular there was an issue with my Day 2 embryo report results not getting communicated to me in a timely manner that caused me enormous stress during my final cycle there. This left me not knowing whether i'd be doing a Day 3 transfer the very next day, or whether my embryos would be cultured to Day 5 and sent for PGS testing. The nurse apparently couldn't get through to my cell phone and left multiple messages there all day long without trying any other avenues, such as my email or my husband's cell phone. When the nurse finally connected with me it felt like she was blaming me for the messages being delayed on my cell phone. I have no idea why my cell wasn't working properly but a nurse has to be a better problem solver than that.