Ratings of 1 indicate that a clinic was poorly operated.
Ratings of 10 indicate that a clinic operated very well.
Scheduling
8.8
8.8
Scheduling
Ratings of 1 mean it was difficult to schedule appointments with this clinic.
Ratings of 10 mean it was easy to schedule appointments.
Billing Department
6.5
6.5
Billing Department
Ratings of 1 indicate an unsatisfactory billing department.
Ratings of 10 indicate an excellent billing department.
Nursing Team
8.6
8.6
Nursing Team
Ratings of 1 indicate an unsatisfactory nursing team.
Ratings of 10 indicate an excellent nursing team.
LGBTQ+ Care
10
10
LGBTQ+ Care
Ratings of 1 indicate an unsatisfactory LGBTQ+ care.
Ratings of 10 indicate an excellent LGBTQ+ care.
Attention to Detail
7.7
7.7
Attention to Detail
Attention to detail is on a 1 - 10 scale, and is scored based on the rate, and severity, of errors committed by the clinic according to the patients.
For example, a severe error might be failing to inform a patient of critical information, while a small error might be failing to call a patient with results.
CDC Success Rates
This is the most recent data from the CDC. The CDC cautions that it should not be used to compare doctors and clinics. This data represents the outcomes of IVF cycles when using a person's own eggs.
For more information please see our FAQs.
Where you see a “?” on the chart, a clinic has done fewer than 20 cycles in this category and age range, so the CDC says showing percentages from this small data set would be misleading and unreliable.
It's disheartening when you have invested a ton of emotional energy -- not to mention money -- and the doctor and/or staff get things wrong or forget you have already completed steps. I know it's a busy clinic and that Dr. Cedars is a leader in her field, but when you're investing so many resources, you want to feel like people have taken time to look at your chart or to gather the correct information before meeting with you.
Everyone I encounter [at UCSF]is very nice. I work with Ruth, mainly. She can seem very overwhelmed, but she's always been responsive. It's hard to get her live on the phone, so it's a great deal of listening to each other's voicemails or reading messages in the portal....The actual clinic is in a very newly constructed, modern facility. Everything feels new and clean....It's disheartening when you have invested a ton of emotional energy -- not to mention money -- and the doctor and/or staff get things wrong or forget you have already completed steps.
How was your experience with Marcelle Cedars at UCSF?
She clearly knows what she's doing and her reputation precedes her. She sees so many patients -- like all fertility doctors -- so I don't expect a touchy feely connection with her, but it does feel like this is a transaction. There was another doctor I was interested in--outside of UCSF-- but I couldn't afford him, unfortunately.
What's one piece of advice would you give a prospective patient of Marcelle Cedars at UCSF?
Just know this is a very western, clinical, transactional experience, but you should be in good hands.
During treatment, were you treated like a number or a human with Marcelle Cedars at UCSF?
It's disheartening when you have invested a ton of emotional energy -- not to mention money -- and the doctor and/or staff get things wrong or forget you have already completed steps. I know it's a busy clinic and that Dr. Cedars is a leader in her field, but when you're investing so many resources, you want to feel like people have taken time to look at your chart or to gather the correct information before meeting with you.
Describe the protocols Marcelle Cedars used in your cycles at UCSF and their degree of success.
Right now, I'm just increasing estrogen intake and taking progesterone to force a period. We haven't moved into the actual IVF protocol yet.
Describe your experience with your nurse at UCSF. (Assigned nurse: Ruth)
Everyone I encounter is very nice. I work with Ruth, mainly. She can seem very overwhelmed, but she's always been responsive. It's hard to get her live on the phone, so it's a great deal of listening to each other's voicemails or reading messages in the portal.
Describe your experience with UCSF.
A huge strength is that it's near my house. The previous clinic was in Irvine (I'm in the bay area). The actual clinic is in a very newly constructed, modern facility. Everything feels new and clean. I haven't done very much other than meet with Dr. Cedars and the care team, so I cannot speak to the treatment rooms as much. I will say that I would strongly advise against meeting with Dr. Laurie Pasch, the clinic psychologist, and meet with Dr. Holley instead.
Describe the costs associated with your care under Marcelle Cedars at UCSF.
All in, to have donor eggs, using a known sperm donor (we froze his sperm at UCSF) and one transfer (no testing, no ICSI -- all of those costs are extra), it will be a little over $30,000.
I did appreciate his [Dr. Mitchell Rosen's] vast knowledge about infertility and he put a great plan in motion for me and far as my protocol. I was nervous when I found out he wasn’t able to perform my egg retrieval or transfer...be patient if you want to get on his schedule. He rarely has openings...We opted for a mini cycle and I was very pleased with the outcome. I responded well and after taking clomid for 5 days, a couple shots of ganarelix and I think one or 2 shots of gonal I was ready to trigger. It happened very quickly.
The finance dept [at UCSF] never answers the phone tho so expect a lot of emails going back and forth. Most team members are prompt with their email responses and call backs. They do close rather early though so you have to get your calls and emails in early. Sometimes I had to ask questions to my care coordinator more than once. They were short staffed at the time though so I tried to be patient. But when you’re spending so much money on such a personal journey you’re often anxious to get questions answered and the wait can feel like forever.
How was your experience with Mitch Rosen at UCSF?
Overall I had a good experience. Except for what I mentioned previously in that I allowed myself to be put in the “infertility box” and didn’t trust my gut instincts, and I know my body very well. I should have been more sure of myself and only transferred one embryo as I knew my body couldn’t handle a twin pregnancy. However, I did appreciate his vast knowledge about infertility and he put a great plan in motion for me and far as my protocol. I was nervous when I found out he wasn’t able to perform my egg retrieval or transfer. But the staff was top notch and I was very comfortable with everyone who helped me.
What's one piece of advice would you give a prospective patient of Mitch Rosen at UCSF?
He’s one of the best, If not the best doctors at the clinic so be patient if you want to get on his schedule. He rarely has openings.
During treatment, were you treated like a number or a human with Mitch Rosen at UCSF?
It’s not that I felt like a number but I felt like a statistic. I’ve always been very fertile but my tunes are tied. In This field the dr’s tend to go on statistics and research and I was talked in to transferring 2 embryos against my gut instinct to transfer just one. I was assured I’d likely only have one stick, if any. But both stuck and I was unable to carry 2 (that’s a long complicated story) and ended up having to terminate both.
Describe the protocols Mitch Rosen used in your cycles at UCSF and their degree of success.
We opted for a mini cycle and I was very pleased with the outcome. I responded well and after taking clomid for 5 days, a couple shots of ganarelix and I think one or 2 shots of gonal I was ready to trigger. It happened very quickly.
Describe your experience with your nurse at UCSF. (Assigned nurse: Cathy)
My nurse was extremely smart I just wish she’d taken a little more time to explain things. I always felt rushed.
Describe your experience with UCSF.
Overall they run a well oiled machine. The finance dept never answers the phone tho so expect a lot of emails going back and forth. Most team members are prompt with their email responses and call backs. They do close rather early though so you have to get your calls and emails in early. Sometimes I had to ask questions to my care coordinator more than once. They were short staffed at the time though so I tried to be patient. But when you’re spending so much money on such a personal journey you’re often anxious to get questions answered and the wait can feel like forever.
Describe the costs associated with your care under Mitch Rosen at UCSF.
All in we paid about $8,500. This included meds, anesthesia, appts, ultrasounds, etc.
Describe Mitch Rosen's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
I shouldn’t comment bc I don’t have fertility issues, my tubes are tied and I’m super fertile.
I felt that Dr.Cedars actively listened to our history and clearly had read over our records prior to the consultation. She explained her reasonings for the desired treatment plan in a way that I was able to understand. ... She had a calmness to her presence which was very important to us. ... Our treatment cycle consisted of Letrozole 5mg starting CD2 x 5 days.*We had previously done 3 IUIs with clomid
The office [UCSF] has separatewaiting areas depending on what procedure you're there fkr (u/s, specimen collection, IUI). The "checkout" process was sort of confusing having to back to the front desk staff anticipating they know what your next schedule will be. When paying for services (we decided to pay cash) they staff was somewhat unprepared to handle that process. They do not have a cash register and are unable to give change.
How was your experience with Marcelle Cedars at UCSF?
She had a calmness to her presence which was very important to us. When explaining her treatment plans, she provided credible sources (studies/journals) to further ensure us the information was up to date.
What's one piece of advice would you give a prospective patient of Marcelle Cedars at UCSF?
Be prepared to see other providers for most of the visits, who may not fully understand your specific case as well as Dr. Cedars. All questions which that require detailed responses she be directed to her nurses who can give direct messages to Dr. Cedars.
During treatment, were you treated like a number or a human with Marcelle Cedars at UCSF?
I felt that Dr.Cedars actively listened to our history and clearly had read over our records prior to the consultation. She explained her reasonings for the desired treatment plan in a way that I was able to understand.
Describe the protocols Marcelle Cedars used in your cycles at UCSF and their degree of success.
Our treatment cycle consisted of Letrozole 5mg starting CD2 x 5 days.*We had previously done 3 IUIs with clomid 100mg with our 1st clinic.*
U/S follicle check on CD 12 showed 2 follicles; 21mm and 13mm. With a lining of 11.4mm. *We did not see Dr.Cedars at this visit*
Was told to trigger shot the following night CD 13. And returned to clinic on CD14 for "specimen collection" and IUI. *We did not see Dr.Cedars for this procedure visit*
Describe your experience with your nurse at UCSF. (Assigned nurse: Jill and Ruth)
Ruth was great with communication. She was very sweet each time we spoke, answered my questions quickly and even set up a call with Dr.Cedars when my questions were beyond her knowledge of advice.
Describe your experience with UCSF.
Very clean and upscale/modern feels. The office has separatewaiting areas depending on what procedure you're there fkr (u/s, specimen collection, IUI).
The "checkout" process was sort of confusing having to back to the front desk staff anticipating they know what your next schedule will be.
When paying for services (we decided to pay cash) they staff was somewhat unprepared to handle that process. They do not have a cash register and are unable to give change.
Describe the costs associated with your care under Marcelle Cedars at UCSF.
Consult including u/s $250.
The medication protocol at discount pharmacy was $30.
The follicle scan, sperm wash and IUI - $1566.00
Describe Marcelle Cedars's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
We were not at the IVF stage yet. But when i did ask her approach to single vs multiple embryo transfer she advised that in for personal case that a single would be plenty as multiple can increase health risks for mom and baby(s)
Dr. Anaya is thoughtful and supportive. ... There have been several complications (discovery of Hashimoto's disease and a septate uterus) and poor outcomes to procedures ... Whenever I expressed concern or doubt about the route we were taking, Dr. Anaya explains all the options, the pros and cons of the options, and the studies/or lack of studies supporting it. She is detailed and blunt but done in a compassionate and caring way.
I think they need a more robust financial advisor program. Due to some unclear instructions on both the part of UCSF and our insurance company we blew $12K (out of only $20K) on IVF medication. We were not informed of UCSF's community program with Walgreens until our second round. ... Instead we spent ~$18,000 out of pocket. ... The entire care team including the phlebotomists and rotating fellows are all kind and friendly.
How was your experience with Yanett Anaya at UCSF?
Dr. Anaya is thoughtful and supportive. My IVF journey has been a very twisted path. There have been several complications (discovery of Hashimoto's disease and a septate uterus) and poor outcomes to procedures (first IVF we retrieved 32 eggs but only 1 passed PGS testing). Whenever I expressed concern or doubt about the route we were taking, Dr. Anaya explains all the options, the pros and cons of the options, and the studies/or lack of studies supporting it. She is detailed and blunt but done in a compassionate and caring way.
She understands its a hard road and practices patience with patients. However, she is very busy and splits her time between two clinics. Sometimes she is not available when you wish she was. But if you ask to talk to her, the care team always gets in contact with her and schedules a time for you. When you are talking to Dr. Anaya, you have her full attention and she never rushes a conversation.
What's one piece of advice would you give a prospective patient of Yanett Anaya at UCSF?
The one piece of advice I would give a prospective patient is to speak up, ask questions and advocate for yourself. However, I would probably give this advice to anyone talking to any medical provider.
During treatment, were you treated like a number or a human with Yanett Anaya at UCSF?
UCSF is a HUGE clinic, if you aren't careful you may feel like a number. But the desk staff, nurses, and Dr, Anaya all try very hard to make each interaction as informative, thorough, and reassuring as possible.
You may need to use the messaging portal to ask questions to your nurse. Or ask the nurse if you can set up a call with Dr. Anaya. But as long as you advocate for what you need, Dr. Anaya and her care team will be responsive and compassionate in taking you through the very long IVF journey!
Describe the protocols Yanett Anaya used in your cycles at UCSF and their degree of success.
IUI #1 = Clomid, 2 folicles, no pregnancy
IUI #2 = Clomid, 4 folicles, no pregnancy
IUI #3 = Letrozole, 2 folicles, no pregnancy - switched to see if outcome would change
IVF retrieval #1 = BC primer, 150 menopur, 225 gonal-F, later added ganerelix, used lupron during trigger shot ==> resulted in 32 eggs retrieved, 24 fertilized, 17 Day 3 embryos, 6 blastocyst sent to PGS testing, ONLY ONE NORMAL
My husband, myself, and Dr. Anaya were all disappointed. We talked about doing another IVF round with the same protocol or with a changed protocol. I pushed for a more mild protocol and Dr. Anaya worked with me.
IVF retrieval #2 = Estrace & lupron injection primer, 150 menopur, 150 gonal-F, stimed longer, used an HCG trigger ==> resulted in 33 eggs retrieved, 24 fertilized, 17 Day 3 embryos, 6 blastocyst sent to PGS testing, 4 tested normal
FET #1 = First embryo died in thawing process; Estrace patches (1,1,2,4,4,3,2,1) and progesterone injections, 1 embryo transferred ==> no pregnancy
UCSF and Dr. Anaya prefer playing it conservatively, only transferring 1 embryo at a time. I agree and prefer this approach.
Three embryos remaining and I am currently doing an ERA test.
Story is to be continued
Describe your experience with your nurse at UCSF. (Assigned nurse: first 9 months Gianna, now Cheryl)
The entire care team including the phlebotomists and rotating fellows are all kind and friendly. Some are more knowledgeable than others, but if a person doesn't know the answer to a question they will go look for the answer for you.
Describe your experience with UCSF.
UCSF is a HUGE clinic. They have a lot of patients and a lot of staff. Sometimes it takes minute to find the right person to talk to via phone or email, but someone always answers questions within a 12 to 48 hour window. And when interacting with me everyone is friendly and compassionate.
I think they need a more robust financial advisor program. Due to some unclear instructions on both the part of UCSF and our insurance company we blew $12K (out of only $20K) on IVF medication. We were not informed of UCSF's community program with Walgreens until our second round.
Describe Yanett Anaya's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
UCSF and Dr. Anaya prefer playing it conservatively, only transferring 1 embryo at a time. I agree and prefer this approach. I think this is particularly a good approach for my situation, no previous pregnancies (even in miscarriage) and 35+.
What specific things went wrong at UCSF?
Failed to convey critical information
Describe the specific things that went wrong at UCSF.
I think they need a more robust financial advisor program. Due to some unclear instructions on both the part of UCSF and our insurance company we blew $12K (out of only $20K) on IVF medication. We were not informed of UCSF's community program with Walgreens until our second round. If the program had been communicated appropriately and we were advised to self pay medications, we would have enough money left to have covered both rounds of IVF retrieval. Instead we spent ~$18,000 out of pocket.
Dr. Noel was measured and didn’t try to pressure me into IVF vs other doctors I had consulted. ... Dr. Noel is compassionate and thoughtful about each patient’s case. ... Strengths: Dr. Noel is thoughtful about her recommendations and fertility plan. She also takes the time to explain and answer questions. She’s responsive over email.
Strengths: wide range of time slots, both early morning and weekends. Very professional staff [UCSF], punctual and high quality of care. Weaknesses: hard to get into the system initially but go above and beyond once you’re a patient. ... Weekend staff didn’t update me on status of embryos as planned. ... Care coordinator: Thuy - she is very responsive and helpful with getting all of the paperwork and necessary appointments set up. Very organized. Main nurse: Olga - she is very organized and is the main point of contact for updates.
How was your experience with Martha Noel at UCSF?
Strengths: Dr. Noel is thoughtful about her recommendations and fertility plan. She also takes the time to explain and answer questions. She’s responsive over email.
Weaknesses: Dr. Noel hasn’t been as always to access since the email system got updated. Now you can only email the care team and a nurse usually responds. At least the responses are within the day.
What's one piece of advice would you give a prospective patient of Martha Noel at UCSF?
Dr. Noel is compassionate and thoughtful about each patient’s case. UCSF is structured to rotate doctors and nurses for each visit. Even though you won’t have that much contact with Dr. Noel, she is making the final decisions and recommendations for you.
During treatment, were you treated like a number or a human with Martha Noel at UCSF?
Dr. Noel is thoughtful about my case and take the time to explain everything simply, draw diagrams, provide important details and answer all of my questions. She is also realistic and kind at the same time.
Describe the protocols Martha Noel used in your cycles at UCSF and their degree of success.
We started conservatively with progesterone treatments, then moved to IUI (4 rounds) then IVF when previous methods were unsuccessful. Dr. Noel was measured and didn’t try to pressure me into IVF vs other doctors I had consulted.
So far no pregnancy but Dr. Noel mentioned it could take a few tries due to age and lower egg count.
Describe your experience with your nurse at UCSF. (Assigned nurse: Olga)
Care coordinator: Thuy - she is very responsive and helpful with getting all of the paperwork and necessary appointments set up. Very organized.
Main nurse: Olga - she is very organized and is the main point of contact for updates. Very efficient and explains processes well. Can sometimes be curt but don’t think she means it negatively.
General nursing team: all wonderful, well-informed, professional and kind.
Describe your experience with UCSF.
Strengths: wide range of time slots, both early morning and weekends. Very professional staff, punctual and high quality of care.
Weaknesses: hard to get into the system initially but go above and beyond once you’re a patient.
Describe the costs associated with your care under Martha Noel at UCSF.
IUI costs $3-5k depending on monitoring and insurance coverage.
IVF costs about $20-30k depending on specific procedures performed/elected.
Describe Martha Noel's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
The approach is meant to optimize for saving the embryos that I can produce due to lower egg count. So day of transfer and # transferred depends on how many eggs and embryos in that cycle.
What specific things went wrong at UCSF?
Failed to call with results
Describe the specific things that went wrong at UCSF.
Weekend staff didn’t update me on status of embryos as planned.
At start of consultation I was 38 with low ovarian reserve (3 follicles barely 4mm each, FSH 11.2) My husband was 35 and with history of chemo due pancreatic cancer. He [Dr. Rinaudo] said IUI would be the less aggressive route since we wanted to avoid IVF ... Dr. Rinaudo it's one of the most compassionate and caring doctors ice ever dealt with. He was candid, expressed concern and helped with decision making applying evidence based expected outcomes specific to our case
The rooms could be a little "less medical" feeling but honestly I didn't care about going to a foofy clinic. I cared about the expertise and everyone at RHC has been wonderful! ... Both Kat and Norma [nurses] are so fast in responding and so organized. They're always communicating with each other and made every step of the process seamless! They're absolutely the best supporting team I'm ever worked with!
How was your experience with Paolo Rinaudo at UCSF?
Dr. Rinaudo made this difficult and scary process just the opposite. He explained everything very clearly and set realistic expectations. My husband was just a couple of years post pancreatic cancer treatment when we first saw Dr. Rinaudo and we assumed the issue was just a male factor but when I got tested and discovered that I had a very low ovarian reserve (only 3 follicles and barely 4mm each during pelvic US) we realized our situation just became tenfold more complex. I was 38 at the time so it wasn't statistically surprising but it was definitely emotionally shocking to find out nevertheless, considering I've always been healthy. After 3 cycles of IUI didn't work Dr. Rinaudo recommended IVF. Having lost my childhood best friend to breast cancer at the age of 33 shortly after IVF, the thought of it was terrifying. Though the statistics aren't clear that IVF causes cancer, I've personally witnessed too many cases. We discussed this with Dr. Rinaudo and he explained that it is important to consider that it's not just IVF but the ongoing hormone surges throughout pregnancy that could trigger cancer. This shed more light on the subject but didn't make going through IVF more enticing. We agreed with my husband that if we came to the point where IVF was the only option we'd get further genetic testing for cancer. This is the ONLY weakness that I would say Dr. Rinaudo has. Neither HE nor ANY medical professional was the one to suggest this test, despite my husband's history of cancer and my Ashkenazi background. Once we told him we want to do the genetic testing, Dr. Rinaudo very quickly arranged for us to meet with a wonderful generic counselor who performed the saliva test. After a few weeks we were contacted by the same genetic counselor who gave us the terrific news that my husband was clear of any genetic cancers (which was my biggest fear) and followed the news my revealing that I have the BRCA2 gene (a fear we didn't anticipate). Now I was even more glad we did the test but even more confused by why NOBODY ever suggests to get this test done considering 1 in 40 people of Jewish descent have some form of the BRCA gene. We decided for me do a double mastectomy and reconstruction and put IVF on hold until I recovered. Now I'm recovered and less fearful of going through IVF. Now I'm ready to get back on track to starting a family.
What's one piece of advice would you give a prospective patient of Paolo Rinaudo at UCSF?
Pick his brain. He's brilliant. But do your research and be your own advocate in the process. This would apply to any doctor as well.
During treatment, were you treated like a number or a human with Paolo Rinaudo at UCSF?
Dr. Rinaudo it's one of the most compassionate and caring doctors ice ever dealt with. He was candid, expressed concern and helped with decision making applying evidence based expected outcomes specific to our case.
Describe the protocols Paolo Rinaudo used in your cycles at UCSF and their degree of success.
At start of consultation I was 38 with low ovarian reserve (3 follicles barely 4mm each, FSH 11.2) My husband was 35 and with history of chemo due pancreatic cancer. Double whammy! He said IUI would be the less aggressive route since we wanted to avoid IVF possible so he said we'd give no more than 3 cycles a try then move on to IVF. 3 cycles of IUI resulted in 0 pregnancies.
Describe your experience with your nurse at UCSF. (Assigned nurse: Kat and Norma)
Both Kat and Norma are so fast in responding and so organized. They're always communicating with each other and made every step of the process seamless! They're absolutely the best supporting team I'm ever worked with!
Describe your experience with UCSF.
The clinic is started off the art and overall beautiful. The rooms could be a little "less medical" feeling but honestly I didn't care about going to a foofy clinic. I cared about the expertise and everyone at RHC has been wonderful!
Describe the costs associated with your care under Paolo Rinaudo at UCSF.
We were fortunate to have Cobra insurance coverage under my husband's previous employer in Massachusetts which covered all fertility treatment. We no longer have this coverage and were quoted about $15,000 not including medications per cycle for out of pocket cost.
Describe Paolo Rinaudo's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
Dr. Rinaudo suggested single embryo transfer to avoid potential risks associated with potentialof multiples based on our situation and my age
She was the first doctor in our process to outline our options and give us hope. Her attention and knowledge were outstanding. ... Due to high risk of OHSS -I had 33 follicles during the initial consult-, Dr. Cedars treated me with an antagonist protocol. ... Doctor Cedars took the time to explain our diagnosis and options. She answers many questions during the course of treatment
I worked with Katharine and Ruthie [nurses at UCSF] and they were both outstanding. They would follow up with me within minutes of me sending them messages, they were on top of the schedule and reacted quickly when we had to make changes (i.e. initiating stimulation a week earlier due to my menses being early). ... I never had to wait more than 5 minutes for any of my appointments and I loved finding a book of notes for patients by patients that made me feel understood and less lonely going through the process.
How was your experience with Marcelle Cedars at UCSF?
After a year of trying and getting no answers from Kaiser we transferred our case to UCSF and Dr. Cedars saw us immediately, used the battery of tests we had done through Kaiser to diagnose us and gave us a path forward. She was the first doctor in our process to outline our options and give us hope. Her attention and knowledge were outstanding. To date (we are awaiting to see if the Fresh transfer worked), we joke that we may call any future daughters of ours Marcelle after the doctor.
What's one piece of advice would you give a prospective patient of Marcelle Cedars at UCSF?
Trust the doctor
During treatment, were you treated like a number or a human with Marcelle Cedars at UCSF?
Doctor Cedars took the time to explain our diagnosis and options. She answers many questions during the course of treatment and she worked with Dr. Smith who was treating my husband. She was extremely positive and even conducted some procedures like the saline sonogram herself.
Describe the protocols Marcelle Cedars used in your cycles at UCSF and their degree of success.
Due to high risk of OHSS -I had 33 follicles during the initial consult-, Dr. Cedars treated me with an antagonist protocol. We started with 75 Menopur and 150 Gonal-F. After 10 days, my estradiol levels went down (one big follicle collapsed) and we increased the dose of Menopur to two vials. Two days later we triggered and we got 19 eggs (all 19 mature).
Describe your experience with your nurse at UCSF. (Assigned nurse: Katharine Porras)
I worked with Katharine and Ruthie and they were both outstanding. They would follow up with me within minutes of me sending them messages, they were on top of the schedule and reacted quickly when we had to make changes (i.e. initiating stimulation a week earlier due to my menses being early). I have really enjoyed working with them and I have felt very cared for.
Describe your experience with UCSF.
The facilities have to be the best in the country. The Mission Bay Campus is incredible. I never had to wait more than 5 minutes for any of my appointments and I loved finding a book of notes for patients by patients that made me feel understood and less lonely going through the process.
Describe your experience with your monitoring appointments at UCSF.
Monitoring was done in the mornings and it was very convenient as it was from 7 AM until 9 AM which meant not having to miss work. It was extremely easy to get appointments and I was always able to get them at my preferred time.
Describe Marcelle Cedars's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
The doctor strongly recommended eSET due to my egg, hormonal levels and health history. She also recommended a fresh transfer after monitoring me daily from day 5 of stims.
16 eggs retrieved, 9 mature eggs, 7 fertilized, 6 grew to day 6 for biopsy + PGS, 1 euploid embryo [protocol with Dr. Thalia Segal]...While our diagnosis is unexplained infertility, Dr. Segal seemed to create a plan that made sense and explained anything I had questions about...The only complaints I had was that she wasn't aware of the conversation topic for a couple phone consults that were scheduled. Not sure if this was an issue with her team, but it didn't make for a great experience for those calls.
My understanding is that UCSF has very good technology, research and reputation. Their equipment is state of the art and we were able to be a part of a study that had low risks but saved us about $2500 that we would have spent anyways. That is why we chose UCSF. The issue here seems to be process and perhaps that they have WAY too many patients to manage. For instance, there are multiple forms that you must sign with a witness and no one makes sure that you have all of them at once and gets every single item signed at the same time. They are very disorganized and seemingly quite unaware of the issues. They are supposed to be fixing it and I hope they will so other people don't waste time and money. Make sure to advocate for yourself. Try your best to get an understanding of the bigger process and deadlines if you're on a tight timeline. Self pay medications with them are extremely affordable. I think friends that went to private clinics paid a lot more.
How was your experience with Thalia Segal at UCSF?
While I didn't see Dr. Segal much, every encounter in person or on the phone was pleasant. She answered every question I had, made sure I knew the benefits and the risks and was empathetic and informative. Overall really professional. The only complaints I had was that she wasn't aware of the conversation topic for a couple phone consults that were scheduled. Not sure if this was an issue with her team, but it didn't make for a great experience for those calls.
What's one piece of advice would you give a prospective patient of Thalia Segal at UCSF?
Be clear about your goals, ask a lot of questions.
During treatment, were you treated like a number or a human with Thalia Segal at UCSF?
In person and on the phone, Dr. Segal (and every other person at UCSF CRH that I've been in contact with) is kind, informative and very helpful. While our diagnosis is unexplained infertility, Dr. Segal seemed to create a plan that made sense and explained anything I had questions about.
The process at UCSF, however, is very flawed. It's not clear where you are in the process, who you are supposed to be in touch with, it takes on average 3 calls to get a phone call/email back. Expect for this to take longer than you think it will. I had my first appointment early April and was planning to do my first egg retrieval starting end of May and one day before cycle day 1, they called to tell me that they had to push to the next cycle. Needless to say I was quite unhappy about this as we were trying to get all this done as my insurance plan year is coming to a close. Apparently UCSF is working to fix some serious issues, but be warned - you must be an advocate for yourself and push them along. Maybe other teams are more organized but it really sounds like it's a UCSF thing not a team/Dr. specific issue.
Describe the protocols Thalia Segal used in your cycles at UCSF and their degree of success.
Skipped estrace priming, 4 days Menopur 150 IU/ Gonal F 150 IU, 5 days Ganirelix 250 mcg and Menopur 150 IU / Gonal F 75, cotrigger with 4mg Lupron/2500 units HCG.
I had 2 lead follicles early in the process so skipping the estrace priming was probably a mistake and will be added to the next egg retrieval cycle. My estrogen level was a bit high so changed to cotrigger Lupron with HCG instead of only HCG.
16 eggs retrieved, 9 mature eggs, 7 fertilized, 6 grew to day 6 for biopsy + PGS, 1 euploid embryo
Describe your experience with your nurse at UCSF. (Assigned nurse: Teona)
I spoke to the nurse very rarely. Two issues happened - the nursing team couldn't call in my prescriptions in time for the first scheduled egg retrieval in early June. This was the reason my cycle was pushed out.
Second issue, is that no one called with my 2nd blood draw numbers and so I didn't change my dosage. It's unknown whether a dosage change would have been needed but I was instructed after my 3rd blood draw that if I hadn't heard from anyone that day to call (even to ER line after hours) the day of a blood draw to confirm the dosage amounts.
Describe your experience with UCSF.
My understanding is that UCSF has very good technology, research and reputation. Their equipment is state of the art and we were able to be a part of a study that had low risks but saved us about $2500 that we would have spent anyways. That is why we chose UCSF.
The issue here seems to be process and perhaps that they have WAY too many patients to manage. For instance, there are multiple forms that you must sign with a witness and no one makes sure that you have all of them at once and gets every single item signed at the same time. They are very disorganized and seemingly quite unaware of the issues. They are supposed to be fixing it and I hope they will so other people don't waste time and money.
Make sure to advocate for yourself. Try your best to get an understanding of the bigger process and deadlines if you're on a tight timeline.
Self pay medications with them are extremely affordable. I think friends that went to private clinics paid a lot more.
Describe the costs associated with your care under Thalia Segal at UCSF.
$15k fertility services charged to BCBS insurance, paid $8k out of pocket.
$5k fertility prescriptions charged to BCBS insurance, paid $2500 out of pocket
Describe Thalia Segal's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
UCSF always talks about the goal being a singleton pregnancy so I believe they will only implant 1 at a time. I'm also high risk due to autoimmune conditions so implanting 1 has been my expectation from the beginning.
My husband was concerned about me becoming the new Octomom and our doctor [Dr. Huddleston] reassured us that she would only be transferring one embryo because multiple embryos means more chance for complications...was very kind and understanding . She answered all of my husband and my questions with great care...was very intelligent and broke down the whole process of IVF even drew pictures so we completely understood what was going on she was very empathetic to our situation and also offered to enroll us into a case study if we wanted to because it could possibly be a little less expensive route . She was very patient and gave detailed explanations to us and asked if we had questions along the way.
Parking was a little expensive [at UCSF]...it is a beautiful facility very clean and warming...you are instantly greeted when you walk in . We didn’t have to wait to be seen we were seen exactly on time!!...Our care coordinator was awesome explained everything answered all my what if questions and worked with our schedule ...My husband was concerned about me becoming the new Octomom and our doctor [Dr. Huddleston] reassured us that she would only be transferring one embryo because multiple embryos means more chance for complications
How was your experience with Heather Huddleston at UCSF?
Dr.Huddleston was very intelligent and broke down the whole process of IVF even drew pictures so we completely understood what was going on she was very empathetic to our situation and also offered to enroll us into a case study if we wanted to because it could possibly be a little less expensive route . She was very patient and gave detailed explanations to us and asked if we had questions along the way.
What's one piece of advice would you give a prospective patient of Heather Huddleston at UCSF?
To be open and honest with her and due to her willingness to explain come in with a list of questions prepared.
During treatment, were you treated like a number or a human with Heather Huddleston at UCSF?
Heather was very kind and understanding . She answered all of my husband and my questions with great care.
Describe the protocols Heather Huddleston used in your cycles at UCSF and their degree of success.
I am currently undergoing treatment with Dr.Huddleston. She did explain in our first appointment why we needed to do the sonogram because my husband and I were hesitant due to us not having coverage for it and did not want to pay for something that was unnecessary at the time but she explained the reasoning why we needed it which was Because she needed to get an initial look at the female reproductive System as well as a current egg count to know an approximation of how many eggs could be produced in retrieval and to see if there were any anatomical abnormalities.
Describe your experience with your nurse at UCSF. (Assigned nurse: Janlyn kong)
Our care coordinator was awesome explained everything answered all my what if questions and worked with our schedule .
Describe your experience with UCSF.
Parking was a little expensive and there is construction around the area currently so it was a little difficult getting there but the contractors were very nice and gave directions but other than that it is a beautiful facility very clean and warming the security helped us find what floor to get to and you are instantly greeted when you walk in . We didn’t have to wait to be seen we were seen exactly on time!!
Describe the costs associated with your care under Heather Huddleston at UCSF.
So far nothing yet but looking over the bill it’s going to be +$10,000
Describe Heather Huddleston's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
My husband was concerned about me becoming the new Octomom and our doctor reassured us that she would only be transferring one embryo because multiple embryos means more chance for complications and she wants us to have a healthy pregnancy so she transfers only one embryo at a time. Unless your over 40 and your egg quality is lower she only does o e embryo.
She [Dr. Cedars] is kind, forthright, and thoughtful, and takes the time to explain treatment options....She’s amazing but busy. She takes the time to call and speak with you directly with positive or negative news. I’ve advocated for myself and I think that has paid off in getting the care I deserve. Her ability to lay out all of the options clearly and address all of my concerns is why I continue to pursue treatment with her and UCSF.
This is my fourth fertility clinic (third one for treatment) and I love everything about UCSF. Yes it’s a huge research institution and there can be a lot of patients in the waiting areas and treatment lounges, but I feel like each interaction with me directly is personalized for my protocol....The biggest issue with Dr Cedars is the continued revolving door of the staff. As soon as you build rapport with one, they leave. There are other permanent staff but they are not as diligent on details as previous coordinators were.
How was your experience with Marcelle Cedars at UCSF?
She’s amazing but busy. She takes the time to call and speak with you directly with positive or negative news. I’ve advocated for myself and I think that has paid off in getting the care I deserve. Her ability to lay out all of the options clearly and address all of my concerns is why I continue to pursue treatment with her and UCSF.
What's one piece of advice would you give a prospective patient of Marcelle Cedars at UCSF?
Do your research and advocate for yourself. Ask questions if anything is unclear. She is super busy, so determine the answers you can get from your care team and those you need from Dr Cedars.
During treatment, were you treated like a number or a human with Marcelle Cedars at UCSF?
She is kind, forthright, and thoughtful, and takes the time to explain treatment options.
Describe the protocols Marcelle Cedars used in your cycles at UCSF and their degree of success.
I’ve only done one donor egg IVF cycle with Dr Cedars but two transfers. The first protocol was Lupron, then estrogen patches, then progesterone, medrol five days before the transfer and Valium for the transfer. I was also taking a huge amount of supplements (Vitamins B,C,D,E, iron, baby aspirin, ubiquinol, metafolinic). Unfortunately my lining was insufficient for my transfer so Dr Cedars ordered an ERA and I had a mock transfer to see if my uterus was receptive.
Once the data came back that I am pre-receptive, she removed Lupron from my protocol during my next cycle and kept everything else.
Although the transfer was smooth, that round was unsuccessful.
I’m waiting for the sign off for my next DEIVF round.
Describe your experience with your nurse at UCSF. (Assigned nurse: Teona, Julie, Anne, Ruth)
The biggest issue with Dr Cedars is the continued revolving door of the staff. As soon as you build rapport with one, they leave. There are other permanent staff but they are not as diligent on details as previous coordinators were.
Describe your experience with UCSF.
This is my fourth fertility clinic (third one for treatment) and I love everything about UCSF. Yes it’s a huge research institution and there can be a lot of patients in the waiting areas and treatment lounges, but I feel like each interaction with me directly is personalized for my protocol.
Describe the costs associated with your care under Marcelle Cedars at UCSF.
I’m pretty privileged in that I received a gift from a family member to pay for costs not covered by insurance, and that my insurance at first covered 50 percent (and has increased to 85 percent) for my treatment. So my costs are variable but I think we probably paid out of pocket for procedures less than $5K (donor-related items are not covered by insurance and for a frozen round the cost is over $13K).
Describe Marcelle Cedars's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
Dr Cedars is complete pro-eSET. For the first round I agreed; as I face my second round I am leaning toward a multiple embryo transfer.
What specific things went wrong at UCSF?
Provided conflicting information
Describe the specific things that went wrong at UCSF.
This is in reference to the challenges with Dr Cedars’s care team. One staff called me with completely incorrect information regarding my protocol and I was frustrated to have to correct them when I know they have access to my file. Just seemed lazy.
The one thing about Dr. Cakmak that I think someone should know is that he can be a bit aggressive/stuck on his treatment plan. ... He does argue his points with me, but will give me the information and his opinion and will defer to my choices. ... We are in the middle of our second cycle and I would actually say I probably feel like more of a number now, oddly enough as I feel like we were sort of thrown into our second cycle with much less guidance and hand-holding.
Know that you will see whoever is on call for that day [UCSF], but it is your doctor who is going to be making the treatment plans and making the big decisions for you. ... about 5 days before the first monitoring appointment (when we'd have to pay), we got notice that to use our insurance, they were going to charge $32,000, and given that we had a lifetime max of $15,000 (and not taking into account we had already used some of that for the visits, ultrasounds, and meds), we would have to pay $17,000.
How was your experience with Hakan Cakmak at UCSF?
The one thing about Dr. Cakmak that I think someone should know is that he can be a bit aggressive/stuck on his treatment plan. I am undecided so far if this is a good or bad thing. I typically see whoever is on call when coming in for my monitoring visits. Last year, they found fluid in the ultrasound that appeared to be in my right fallopian tube. This would have canceled the plans to complete a fresh transfer. Dr. Cakmak was not convinced that it was in my tube. At the retrieval, there was fluid in my uterus, on the right side. All indications that there likely was fluid in my right tube. He left it up to me, but we had so few embryos, I didn't want to risk doing a transfer with a potential hydrosalpinx. He ordered another HSG, and the report stated that the left tube was "clearly patent" and the right was "likely patent". To me, this was not a clear answer that the tubes were clear, but to him it was. We are in our second round gearing up for another retrieval, and I noticed the fluid again. We just saw him today, and he is still not convinced that it is in the tube. When we were going through it last year, we were so emotionally invested in it all going "well" and were so hard hit by any deviation from the plan, that it was comforting when he wanted to barge ahead and not deviate from the plan. But looking back, it seemed that all of the other doctors we saw on call were more hesitant and cautious than he is. I trust him as a physician. I know he knows his stuff and I have seen his published research and studies. However, this "gung ho-ness" (can't think of a better word, feel free to edit that if necessary :) ) is the thing that has made me consider switching physicians. Simply because I am not sure this is the best fit for me. However, knowing this, I have made an effort to be more knowledgeable about options and vocal about my choices for my treatment plan. He does argue his points with me, but will give me the information and his opinion and will defer to my choices.
What's one piece of advice would you give a prospective patient of Hakan Cakmak at UCSF?
As discussed in the previous question: Do your research on your options, listen to his points and ask questions, but don't be afraid to advocate for your treatment choices. Be prepared for how rigid he can be in the treatment plan. As we learn when we start treatment, things change CONSTANTLY as there is no way of knowing what your body will do. Know your options, and be flexible, as in my experience, he is not as flexible.
During treatment, were you treated like a number or a human with Hakan Cakmak at UCSF?
Dr. Cakmak sat at our first appointment and stated that he had reviewed all of my medical records, and I had sent over quite a few releases so that they may have all the info needed. He then verbally reviewed all of my info to verify that he had a good understanding of everything. He then gave his recommendations and why he thought each step was the one we needed to take. It wasn't until our failed cycle that I understood that the first IVF is kind of a crap-shoot because they have no way of knowing until then what your issues are or what kind of cycle you really need. We are in the middle of our second cycle and I would actually say I probably feel like more of a number now, oddly enough as I feel like we were sort of thrown into our second cycle with much less guidance and hand-holding. However, it is hard to say if this is because it is my second time around or if it is because my nurse resigned prior to me starting my second round, so the nurse I have now is a nurse for another doctor on staff.
Describe the protocols Hakan Cakmak used in your cycles at UCSF and their degree of success.
1 IVF: Antagonist, planned to be a fresh transfer. Can't remember the dosing, but I was on birth control in the prep month (and estrace? can't recall), then menopur, gonal F during the cycle, cetrotide to suppress, and had planned on using an HCG/Lupron trigger, but my estrogen levels indicated that I should not do the Lupron trigger, so it was just HCG. High number of eggs retrieved and my estrogen levels put me at risk for OHSS, but luckily did not develop this. Due to potential hydrosalpinx and low number of embryos at day 5, I elected to change it to a freeze-all. Then FET with 1 embryo (only one left on day 6 that was also euploid).
2. (current cycle) Long agonist (doctor decision based on poor quality embryos at last cycle--25 retrieved, 18 mature, 16 ferilized, 8 embryos on day 3, 4 on day 5, 2 made it to blastocyst on day 6, one euploid, one anuploid). 10 units Lupron during prep month. 150 Gonal F, 150 Menopur (decreased to 75 on last day of stims), 25 units Omnitrope (human growth hormaone- to address egg quality thought to be the reason fro poor embryo quality). I will be triggering tonight with 5000 HCG. Planned to be a fresh transfer (day 3 if not at blastocyst criteria, day 5 if they do meet blastocyst criteria), but I will request they look for fluid in my uterus at the egg retrieval.
Describe your experience with your nurse at UCSF. (Assigned nurse: Audra during my first cycle, Maria during my second)
I was glad to have an assigned nurse at this clinic. My first nurse was attentive and responsive. She had joked that she was a "stalker nurse" and would be calling me all the time, but really this was helpful and appreciated. She was a bit clinical during my miscarriage (not at all insensitive though). My second nurse is on loan from another doctor in the practice as Audra left. The day I called to say I wanted to get started and report my day one of the cycle, was her last day. My second nurse, Maria, has also been out of the office for parts of my cycle. When I have called her directly and emailed her, she has always called back or emailed and has let me know when she would be out of the office. I appreciate that she works later hours as it was frustrating trying to make sure I called Audra before 3 or 3:30 as she typically left for the day then and inevitably something would come up a 3:45. Maria has been friendly and personable. I generally have had no issue getting in touch with anyone on the care team. However, there was a day during this cycle that I had significant cramping throughout the day on a day I did not have to go to the clinic for monitoring. I was concerned that I was developing an issue, possibly ovarian torsion as it was localized to one side. I called the care team line as I knew Maria was out of the office and never received a call back. This was unusual as this had not happened before and of course happened on the day I was concerned about a serious side effect of the treatments.
Describe your experience with UCSF.
I don't know if people can request certain doctors. I just called and was sent to the first available, I think, but it'd be worth it to ask and to check out all the doctors who have been reviewed to see who is a good fit for you. Know that you will see whoever is on call for that day, but it is your doctor who is going to be making the treatment plans and making the big decisions for you. I did not mind seeing other doctors. I felt like it gave me perspective about my own doctor. I was appreciative that my care was not passed off to a nurse practitioner like at other clinics. However, it may be important to others that you see your doctor at each visit, in which case another clinic may be a better fit. The billing department is a nightmare.
Describe the costs associated with your care under Hakan Cakmak at UCSF.
My visits were covered. Follow-ups are free if you are on the self-pay. We initially went to this clinic due to insurance coveraage. The only clinics that were "in-network" for my insurance were in San Francisco. So we billed insurance for office visits and my water ultrasound. However, once we got ready for the cycle, about 5 days before the first monitoring appointment (when we'd have to pay), we got notice that to use our insurance, they were going to charge $32,000, and given that we had a lifetime max of $15,000 (and not taking into account we had already used some of that for the visits, ultrasounds, and meds), we would have to pay $17,000. Or we could chose the self-pay option, bill none to our insurance and pay $16,000. Insurance was the whole reason we went to this clinic, and in the end, it was cheaper not to use it. Our second cycle, when I informed my nurse we only had $4,500 left and we'd be using it for meds, she said we should utilize the 340B medication program. What Freedom pharmacy had charged my insurance $6000+ only cost me $250 through this program. She stated that we could then use the $4500 left on my cycle. I knew this was likely not the case, but I figured we could save that money for something else since I didn't like that Freedom wasn't transparent in what they were charging my insurance, so ordering through them with a limited amount of funds left meant I didn't have any way of knowing what I would be charged in overage after the $4500 was gone. Our first monitoring appointment was on a Saturday, and the billing department sent me a letter of financial obligation on Friday at 3PM. Turns out, I was right and we can't partial-bill, so there's no way to use that $4500 toward a cycle. They were gracious and understanding and are letting us pay at a later date rather than at the first monitoring appointment. We are still looking at about $16000 for a fresh transfer cycle with monitoring and egg retrieval. $4000 for a FET. Plus medications.
Describe Hakan Cakmak's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
My doctor and the geneticist I met with at UCSF both really wanted me to implant one, but are allowing me to implant two. They educated me on the risks of implanting two and the risks of carrying twins.
Dr. Rosen is not necessarily the "warm and fuzzy" type. But neither are we, so he is the prefect match for us. He also took the time to connect with my husband to make him feel more comfortable about the process....Dr. Rosen was fantastic and kept it real and was straight forward with us, but also understood the human factor and concerns and anxieties we had going through the process. He used the right amount of humor, but also was always very clear about the process, what he expected, and how we were going to get there.
UCSF is top of the line. I love everything about it. I would say that if you want specialized care where you see your doctor every visit and are able to reach out to talk to him directly, this is not the place for you. During my stimming and follow up appts, I have seen tons of other docs and NPs. After each appt, they would review my hormone level and U/S with my doctor and then I would receive a call from the Nurse.
How was your experience with Mitch Rosen at UCSF?
Dr. Rosen is not necessarily the "warm and fuzzy" type. But neither are we, so he is the prefect match for us. He also took the time to connect with my husband to make him feel more comfortable about the process. After coming from a previous RE where I did not feel as comfortable, every single time I see or talk to Dr. Rosen I walk out of the clinic feeling more positive and hopeful than before. Even with setbacks out of any of our control. We really love Dr. Rosen.
What's one piece of advice would you give a prospective patient of Mitch Rosen at UCSF?
Some people need a warmer demeanor. And I think setting up those expectations from the beginning would be helpful. For us, he is perfect. But he may not be a match for everyone. So laying out his personality/"bedside manner" type during introductions before going into treatment plan would be helpful for people to decide if he is the right doctor for the long haul.
During treatment, were you treated like a number or a human with Mitch Rosen at UCSF?
Dr. Rosen was fantastic and kept it real and was straight forward with us, but also understood the human factor and concerns and anxieties we had going through the process. He used the right amount of humor, but also was always very clear about the process, what he expected, and how we were going to get there.
Describe the protocols Mitch Rosen used in your cycles at UCSF and their degree of success.
First cycle: estrogen priming, gonal F, menapur, started ganorelix around day 6, stimmed for 9 days, egg retrieval on day 11. Had done IUIs with that combination and it worked well, so he decided to try that.
Second cycle: about to start. Doing a random start time with no priming (due to there being a cyst that is delaying ovulation). Not sure yet what medications we will use to stim this cycle, but believe it will be around the same.
Describe your experience with your nurse at UCSF. (Assigned nurse: Cathy)
Cathy and the entire staff at UCSF is fantastic. They call every day that they say they will. They call around the same time and are very clear with their instructions on what the next steps are.
Describe your experience with UCSF.
UCSF is top of the line. I love everything about it. I would say that if you want specialized care where you see your doctor every visit and are able to reach out to talk to him directly, this is not the place for you. During my stimming and follow up appts, I have seen tons of other docs and NPs. After each appt, they would review my hormone level and U/S with my doctor and then I would receive a call from the Nurse. They were like clock work, but it was never Dr. Rosen. So if you want to see the same person every time, its not the place. I call this more of a "well oiled machine" (that is very big). I love UCSF though!
Describe the costs associated with your care under Mitch Rosen at UCSF.
One retrieval round for us, with insurance, was around $9100. We anticipating one more retrieval. And then we will also have to pay for transfer (around $4000). Other expenses were sent to my other provider.
Describe Mitch Rosen's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
Dr. Rosen is very clear that if you do PGS testing, he will only transfer one back. He said that at the beginning and even when we (Husband and I) were toying with the idea of 2 after all of the delays. But he did not waiver and said only 1 an option. Which we actually were good with, and he had stayed consistent with that position, which I appreciated.
Dr. Cedars came across as friendly, kind, and thoughtful. She is a very busy person, but when she's with you, she really gives you all her focus and never makes you feel rushed or like a burden. I felt like I could put a lot of trust in her ... I did a "mini stim" protocol due to my young age, my fertility being unexplained, and the fact that this was my first time doing IVF.
They [UCSF] won't be pushing any treatment you don't actually need. They offer mini-stim IVF for a fraction of the price of IVF at most places, which is a big reason I traveled from MT for my treatment. ... The one thing I will say they fall short of is communicating and getting the ball rolling quickly with starting your care. It can take months to get your first appointment, and we had to be persistent and annoying to get things going in our treatment.
How was your experience with Marcelle Cedars at UCSF?
Dr. Cedars came across as friendly, kind, and thoughtful. She is a very busy person, but when she's with you, she really gives you all her focus and never makes you feel rushed or like a burden. I felt like I could put a lot of trust in her, and that she was doing everything she could to ensure the best outcome for me.
What's one piece of advice would you give a prospective patient of Marcelle Cedars at UCSF?
She can be hard to get ahold of, and you likely won't see her much during your treatment
During treatment, were you treated like a number or a human with Marcelle Cedars at UCSF?
In the few interactions with Dr. Cedars I had, she was very nice and friendly, and made me feel comfortable in conversation.
Describe the protocols Marcelle Cedars used in your cycles at UCSF and their degree of success.
I did a "mini stim" protocol due to my young age, my fertility being unexplained, and the fact that this was my first time doing IVF. It aims for quality over quantity, and results in fewer eggs maturing at once, but increases the likely hood that they will fertilize, and also increases the odds of a fresh transfer. This protocol involved taking clomid day 2-6, then starting injections on day 6 (150 iu of gonal-f, ganirelix, and 75 IU Menopur until trigger). We found out around trigger day that my uterine lining was too thin for a fresh transfer most likely a side effect of the clomid. I also had a low follicle count, and it took some finessing to get a few to maturity at the same time, and by trigger day, it looked like we had 3 good ones, and 5 small ones. We were able to retrieve 6, but given the maturity level, it wasn't much of a surprise that only 2 fertilized. Luckily, of those 2, they both made it to day 3, and were frozen for a later transfer. They were rated well, both grade 2, one was an 8 cell, one was a 6. I participated in a study for my treatment, comparing IVF to Invocell, and was chosen for IVF. The study was a mini-stim protocol, and compares day 3 embryos, so my treatment was tailored to my needs within the parameters of the study. However they wouldn't have accepted me for the study if I hadn't been a good candidate, so I trust that it was right for me.
Describe your experience with your nurse at UCSF. (Assigned nurse: Jill Ford)
Jill was great, she responded quickly to my emails and calls, and helped me understand what I needed to do and when.
Describe your experience with UCSF.
UCSF is amazing because its a not for profit fertility center, with a large volume of patients, meaning lots of experience, and motivation to learn more and be at the forefront of research and new treatment, while also not trying to necessarily make money, like many fertility centers do. Knowing this makes you feel very assured that they are looking out for your best interests, and not their own! They won't be pushing any treatment you don't actually need. They offer mini-stim IVF for a fraction of the price of IVF at most places, which is a big reason I traveled from MT for my treatment. Also, everyone I dealt with there was so nice. Even the people who were way overworked made me feel like they really cared about me in our interactions. The one thing I will say they fall short of is communicating and getting the ball rolling quickly with starting your care. It can take months to get your first appointment, and we had to be persistent and annoying to get things going in our treatment. Once things start though, it's a pretty smooth engine.
Describe the costs associated with your care under Marcelle Cedars at UCSF.
We had no insurance coverage, and Mini Stim IVF is normally around $5500, but we were able to participate in a study that made it $4816 (that includes anesthesia, but also is only for a set amount of appointments, so it can go up a little depending on if you need more monitoring) and then an additional $700 for a year of embryo storage. They refund you for whatever is left over, if you have to stop at any point in the process. They also have a pharmacy next door, that is discounted and it easily saved us thousands of dollars. All in we paid around $300 for all my meds combined!
Describe Marcelle Cedars's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
She originally suggested I transfer both, just out of convenience since I have to travel for my care. However I felt strongly that I only wanted to transfer 1, and not take on the risk of multiples. She was completely on board with that and supported my choice!
He [Dr. Fujimoto] was honest about what the research supported, and what aspects of diagnosis and treatment he simply couldn't answer (based on the research). Sometimes I had to be more proactive than I would have liked to raise different options (such as an ERA test). He also put me in the driver's seat more than I would have expected - for example, one time he asked what dose of a medication I thought I should take. ... He did, however, recommend transferring a single embryo.
The initial calendars/case schedules I was sent by the nursing staff did not always reflect my correct protocol. ... The clinic is absolutely top of the line and has the latest research. The staff was warm and caring - even staff members you might see only once. They also are able to help patients get medications at low prices - I saved thousands of dollars. Wait times for an initial appointment can be months. ...
How was your experience with Victor Fujimoto at UCSF?
Dr. Fujimoto is very down to earth and warm and has access to the latest research. He was honest about what the research supported, and what aspects of diagnosis and treatment he simply couldn't answer (based on the research). Sometimes I had to be more proactive than I would have liked to raise different options (such as an ERA test). He also put me in the driver's seat more than I would have expected - for example, one time he asked what dose of a medication I thought I should take.
What's one piece of advice would you give a prospective patient of Victor Fujimoto at UCSF?
Do your own research and be prepared to ask questions -- he may not raise all issues you should consider, and he may not fully talk through issues unless you push him.
During treatment, were you treated like a number or a human with Victor Fujimoto at UCSF?
All doctors and nurses were very warm and compassionate. However, sometimes they had to be reminded multiple times of my unique circumstances.
Describe your experience with your nurse at UCSF. (Assigned nurse: Deidre Koeb)
Nursing staff and coordinator were very warm and compassionate and responsive. However, they sometimes had to be reminded of my specific situation -- for example, the calendars I received were often incorrect or reflected the wrong protocol.
Describe your experience with UCSF.
The clinic is absolutely top of the line and has the latest research. The staff was warm and caring - even staff members you might see only once. They also are able to help patients get medications at low prices - I saved thousands of dollars. Wait times for an initial appointment can be months.
Describe the costs associated with your care under Victor Fujimoto at UCSF.
I purchased a package that cost $15,000 for one retrieval (including ICSI) and two transfers. PGS was $2775 more, and I paid about $2600 for additional tests and services. So, about $20,000 total.
Describe Victor Fujimoto's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
I was surprised that the doctor made it sound like more of an open-ended decision -- I would have expected him to recommend eSET and educate me on the risks of multiples more strongly than he did. He did, however, recommend transferring a single embryo.
What specific things went wrong at UCSF?
Provided conflicting information
Failed to consider drug intolerance
Describe the specific things that went wrong at UCSF.
The initial calendars/case schedules I was sent by the nursing staff did not always reflect my correct protocol. It seemed like they were sending something generic that did not take into account the modifications the doctor and I had discussed. This was promptly fixed once I identified the error.
Generally when I saw Dr. Huddleston I was treated very well. However, I often saw other doctors or residents and sometimes they were not aware of my specific situation until I brought them up to speed. ... Almost all of my interactions with Dr. Huddleston were excellent. She is a good listener, is calm and explained things in great detail when I asked. ... she presented pros and cons of both and I elected to transfer one embryo
UCSF CRH is a big clinic. People won't remember you from visit to visit and you are essentially moved through the process without many personal touches. ... The financial coordinators are very difficult to reach, and I was not told that I could have an in person meeting with them until after I'd already started treatment. ... My first nurse was Anne who I had several negative experiences with. My second nurse (I asked to be switched) was Olga and she was great and a very good communicator.
How was your experience with Heather Huddleston at UCSF?
Almost all of my interactions with Dr. Huddleston were excellent. She is a good listener, is calm and explained things in great detail when I asked. She was also fairly responsive when I asked my nurse or coordinator to ask her questions between visits. She was also willing to work with me to accommodate my disability.
What's one piece of advice would you give a prospective patient of Heather Huddleston at UCSF?
Go with a list of questions prepared ahead of time. Advocate for yourself - you are your own best advocate and you have the most invested in your treatment.
During treatment, were you treated like a number or a human with Heather Huddleston at UCSF?
Generally when I saw Dr. Huddleston I was treated very well. However, I often saw other doctors or residents and sometimes they were not aware of my specific situation until I brought them up to speed. That made me feel more like a number. Also my interactions with the front desk staff and clerical staff and some of the nurses and coordinators made it obvious that I was more of a number to them.
Describe the protocols Heather Huddleston used in your cycles at UCSF and their degree of success.
Dr. Huddleston treated my DOR and recommended ICSI since I was using donor sperm (not related to infertility but because I do not have a partner with sperm). We also did PGS testing on the embryos that were created.
Describe your experience with your nurse at UCSF. (Assigned nurse: Janlyn, Anne, Olga)
My coordinator was Janlyn. She got more responsive as my treatment progressed. My first nurse was Anne who I had several negative experiences with. My second nurse (I asked to be switched) was Olga and she was great and a very good communicator. I should note that Dr. Huddleston's main nurse (I think her name is Brittany) was out while I was in treatment.
Describe your experience with UCSF.
I was paying out of pocket and I looked at UCSF's statistics and prices and compared to other local clinics they are impressive. The clinic is also near my office and I was able to get early morning and lunchtime visits for monitoring. UCSF CRH is a big clinic. People won't remember you from visit to visit and you are essentially moved through the process without many personal touches. I was able to participate in a few interesting research studies (two of which that saved me a bit of money). The financial coordinators are very difficult to reach, and I was not told that I could have an in person meeting with them until after I'd already started treatment.
Describe the costs associated with your care under Heather Huddleston at UCSF.
I paid about $25,000 for one retrieval and one transfer. I had two PGS normal embryos, transferred one, it split, and am pregnant with twins.
Describe Heather Huddleston's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
I did not get the sense that Dr. Huddleston had a strong preference. She presented pros and cons of both and I elected to transfer one embryo (that split into twins). She supported me in transferring one.
What specific things went wrong at UCSF?
Failed to call with results
Provided conflicting information
Failed to convey critical information
Describe the specific things that went wrong at UCSF.
For each of my three betas, the lab results were released in the morning in the online portal (10-11am). I would call the clinic multiple times to try and speak to a nurse or doctor about the results, but wouldn't hear back until 4-6pm in the evening. This was very frustrating for me. There were a couple of times that I was billed extra costs unexpectedly, which I think was more about my not being able to meet with the financial counselors ahead of time than any sort of shady business practices. I also had one nurse who had terrible communication skills. I was switched to progesterone in ethyl oleate after getting pregnant because I became allergic to the sesame oil, and I still haven't been able to get reimbursed because I was "self pay" at UCSF and so they did not submit a prior authorization to my insurance. (I do not have infertility coverage but do have coverage after getting pregnant.)
Dr.Noel is very warm and empathetic yet very straightforward and realistic in her answers. She also remembers details of my case and things I’d mentioned months ago...My case was diagnosed as unexplained infertility, so she made suggestions for changes in protocol that covered both egg and sperm quality, which alleviated quite a bit of emotional burden on my part that I may be the sole source of the problem. She also never pushed for IVF and was gentle and systematic in the progression and escalation of treatment.
Both nurses and coordinator [at UCSF] were excellent and extremely helpful. I could tell that they were very busy and usually rushed in their answers, but they were effective and efficient...Every nurse and doctor I encountered was very capable and empathetic. The appointment times are plentiful and start very early in the day. I could be monitored in the morning and be at work on time in downtown SF, which was an enormous advantage for me.
How was your experience with Martha Noel at UCSF?
Dr. Noel is warm and empathetic yet manages to give all of the information—the good and the bad—in a clear and direct manner. My case was diagnosed as unexplained infertility, so she made suggestions for changes in protocol that covered both egg and sperm quality, which alleviated quite a bit of emotional burden on my part that I may be the sole source of the problem. She also never pushed for IVF and was gentle and systematic in the progression and escalation of treatment.
What's one piece of advice would you give a prospective patient of Martha Noel at UCSF?
As UCSF is a group practice, I didn’t see Dr. Noel very often; however, it was clear that she was following my progress through comments from the nurses. When I did check in with her, she was aware of the details of my cycle. My two retrievals and transfers were with Dr. Rosen and Dr.Siegal, both of whom were wonderful doctors as well. I wouldn’t be put off by the fact that you see quite a few doctors and nurses as they were all very knowledgeable and kind.
During treatment, were you treated like a number or a human with Martha Noel at UCSF?
Dr.Noel is very warm and empathetic yet very straightforward and realistic in her answers. She also remembers details of my case and things I’d mentioned months ago.
Describe the protocols Martha Noel used in your cycles at UCSF and their degree of success.
For my first round of egg retrieval, Dr. Noel recommended using ICSI for fertilization due to my unexplained infertility. She explained that sometimes a round can result in no fertilized eggs which can be emotionally devastating. Her suggestion was spot on as I lost many eggs at fertilization, and the round ended with three day 3 embryos which did not result in a pregnancy. At least going through the motions of an embryo transfer gave me some hope, whereas ending in zero embryos and no transfer might’ve emotionally discouraged me from another round of stimulation and retrieval. For the second round she suggested escalating to PICSI fertilization and adding growth hormones to my stimulation protocol due to low estrogen levels. That second round resulted in my current pregnancy as well as one frozen PGS tested embryo.
Describe your experience with your nurse at UCSF. (Assigned nurse: Olga)
I worked with Thuy, Olga, and Gianna. Both nurses and coordinator were excellent and extremely helpful. I could tell that they were very busy and usually rushed in their answers, but they were effective and efficient. The bills, paperwork, and email security was the most annoying part of the process, which indicates how well UCSF runs the medical aspects.
Describe your experience with UCSF.
The facilities are brand new and beautiful. Every nurse and doctor I encountered was very capable and empathetic. The appointment times are plentiful and start very early in the day. I could be monitored in the morning and be at work on time in downtown SF, which was an enormous advantage for me. They also separate waiting rooms and appointment times such that new patients, mid cycle patients, male partners coming in for sperm collection, patients scanning for a successful embryo transfer don’t wait next to one another. Parking is also easy. They took care to alleviate all of the small stressors that can compound to an already high stress situation.
Describe the costs associated with your care under Martha Noel at UCSF.
Medical procedures came to about $20,000 per round.
Describe Martha Noel's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
Dr. Noel was very clear that her recommended goal is for a singleton pregnancy given the risks associated with multiple pregnancies. Due to my failed multiple IUIs, she recommended the transfer of two embryos and explained that that would likely result in a singleton pregnancy.
Dr. Mok-Lin is a very warm person who speaks directly and candidly but also with a lot of empathy and understanding. As a lesbian couple, we felt heard and understood as well as respected...She keenly understood our desire to pursue reciprocal IVF especially as we contemplated our long-term plans for two children with each of us carrying one of them..When we were ready to begin the process again for our second child, we returned to UCSF (despite having moved to the East Coast) because we felt so confident and comfortable with Dr. Mok-Lin and her team
As a lesbian couple looking to start our family, we sought out a fertility practice that would not only respect us, but also would be knowledgeable about our desired path, specifically reciprocal IVF. Their team [at UCSF] clearly has experience working with same-sex couples and other than discussions about reciprocal IVF, we felt like we were treated as any other patient...evidence-based approach thanks to being a preeminent research and clinical practice
How was your experience with Evelyn Mok-Lin at UCSF?
As a lesbian couple looking to start our family, we sought out a fertility practice that would not only respect us, but also would be knowledgeable about our desired path, specifically reciprocal IVF. Their team clearly has experience working with same-sex couples and other than discussions about reciprocal IVF, we felt like we were treated as any other patient. Dr. Mok-Lin and the entire team at UCSF Center for Reproductive Health (Mission Bay) was extraordinary and we could not speak more highly of our experience.
From the outset, Dr. Mok-Lin took the time to review with us our options, was candid and forthright about the challenges of IVF, and was willing to talk in-depth about genetic testing. She keenly understood our desire to pursue reciprocal IVF especially as we contemplated our long-term plans for two children with each of us carrying one of them.
She explained things in a way that was easy to understand, but never once over-simplified or glossed over anything. We felt free to ask any question and to dive into any of the details. We never felt rushed in any of our conversations and she made time to engage with us both in-person as well as over email and the phone.
And while our conversations with Dr. Mok-Lin included all kinds of information and data, they were also filled with so much warmth and compassion and genuine interest in us.
When we were ready to begin the process again for our second child, we returned to UCSF (despite having moved to the East Coast) because we felt so confident and comfortable with Dr. Mok-Lin and her team. And once again, our experience was outstanding. And this time around, Dr. Mok-Lin and her team corresponded both before our transfer and after our transfer with our East Coast doctors, creating a seamless experience for us. When our second son was born, one of the first pictures went to Dr. Mok-Lin.
What's one piece of advice would you give a prospective patient of Evelyn Mok-Lin at UCSF?
With any first appointment in a fertility setting, bring your questions and concerns and be willing to have an open and transparent conversation. You'll find Dr. Mok-Lin will listen carefully and be willing to answer your questions directly.
During treatment, were you treated like a number or a human with Evelyn Mok-Lin at UCSF?
Dr. Mok-Lin is a very warm person who speaks directly and candidly but also with a lot of empathy and understanding. As a lesbian couple, we felt heard and understood as well as respected.
How competent was Evelyn Mok-Lin at LGBTQ+ care?
Dr. Mok-Lin was extremely welcoming & respectful of us -- and even more importantly really understood our desire to pursue reciprocal IVF so that our (hopeful at the time) two children would share a 100% genetic bond and especially that their genetic bond would not just be from an anonymous sperm donor.
Describe your experience with your nurse at UCSF. (Assigned nurse: Shem Lewis)
Dr. Mok-Lin’s team, especially Shem Lewis, was available to us any time we had questions or concerns. At the beginning, Shem led a hands-on medication and injection clinic was extremely helpful. On one night when we missed our injection time, we phoned the 24 hour line and the attending nurse was able to immediately answer our questions and get us back on track, with Shem following up in the morning to assure us. Shem was warm, supportive and responsive throughout the entire process.
Describe your experience with UCSF.
One of the reasons we chose UCSF over other fertility clinics was their evidence-based approach thanks to being a preeminent research and clinical practice. The level of data and corresponding transparency they provided was exactly what we were looking for – and proved to be a big part of why we felt so confident and cared for throughout our experience.
In addition to all the information that our doctor, Dr. Mok-Lin, shared with us we attended an extensive IVF Orientation session at UCSF that went through all of the details from start to finish. A hands-on medication and injection clinic was also helpful. And we took advantage of UCSF’s genetic counseling services both at the outset and during pregnancy.
How competent was UCSF at LGBTQ+ care?
As a lesbian couple looking to start our family, we sought out a fertility practice that would not only respect us, but also would be knowledgeable about our desired path, specifically reciprocal IVF. Their team clearly has experience working with same-sex couples and other than discussions about reciprocal IVF, we felt like we were treated as any other patient. Dr. Mok-Lin and the entire team at UCSF Center for Reproductive Health (Mission Bay) was extraordinary and we could not speak more highly of our experience.
Describe your experience using 3rd party reproduction (donor eggs, donor sperm, or gestational carrier) at UCSF.
Sperm purchased via California Cryobank, shipped directly to UCSF and the process was seamless.
He l[Doctor Sauer] leaved the clinic [UCSF] in the middle of the process but we continue with doctor Heather Huddleston and she was very professional too, the change was not an issue for us. ... Please bring her all questions and discuss possible scenarios with her. She is very professional, once she did her assessment her team will handle your case, trust them, they are awesome!
Appointments were ON TIME in ALL cases. Nurses, admin and rest of professional were very professional and yet nice. Facilities are top-notch. The only cons is financial services, I know it is the same in all clinics...in my case I am still following up charges more than one year later, it is impossible to contact financial coordinators, etc... There were several nurses during the whole process, one for diagnosis, another for treatment, another at the end...quite confusing but all of them answered or refer to proper contact.
How was your experience with Heather Huddleston at UCSF?
Doctor Sauer was very professional, understood our situation and explained our options dedicating necessary time. There was not much detail of the process, nurses were later very explicative about that.
He leaved the clinic in the middle of the process but we continue with doctor Heather Huddleston and she was very professional too, the change was not an issue for us.
What's one piece of advice would you give a prospective patient of Heather Huddleston at UCSF?
Please bring her all questions and discuss possible scenarios with her. She is very professional, once she did her assessment her team will handle your case, trust them, they are awesome!
During treatment, were you treated like a number or a human with Heather Huddleston at UCSF?
During my whole journey in UCSF we felt very comfortable knowing 1) experts were handling our case 2) procedures and protocols were very clear 3) Drs were taking into account our specific case. Although I never met the same person twice (except for the nurse coordinator) everyone was very polite, understanding and explain in detail every step.
Describe your experience with your nurse at UCSF. (Assigned nurse: Brittney Bates)
The nurse staff was very professional, they explained all details and answered all my questions. It was easy to find them and they responded by email or phone within hours. There were several nurses during the whole process, one for diagnosis, another for treatment, another at the end...quite confusing but all of them answered or refer to proper contact.
Describe your experience with UCSF.
The clinic is amazing! Appointments were ON TIME in ALL cases. Nurses, admin and rest of professional were very professional and yet nice. Facilities are top-notch.
The only cons is financial services, I know it is the same in all clinics...in my case I am still following up charges more than one year later, it is impossible to contact financial coordinators, etc...
Describe the costs associated with your care under Heather Huddleston at UCSF.
Around 30k USD
Describe Heather Huddleston's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
Doctors preferred and suggested elective single embryo transfer.
Dr. Cakmak is very clear and direct. He's not going to be a shoulder to cry on but he feels very focused on results. I felt like he cared when I had a failed cycle but was not overly invested. I liked that he felt competitive with himself--like he was going to figure out this problem....Dr. Cakmak used a very middle of the road treatment my first ivf cycle (I had unexplained). When my fertilization rate appeared low (and the first round didn't work) he came back with a very specific and totally new plan which included HGH.
Everyone [nurses- UCSF] was amazing. I didn't know anyone overly well but they were super on the ball and compassionate....Highly organized and dependable. Not super intimate but very warm. Worked hard to get you in when you needed and always responded quickly. Professional and easy to communicate with. Rotating staff of maybe 30 nurses so you would often work with the same people week to week. Would definitely recommend
How was your experience with Hakan Cakmak at UCSF?
Dr. Cakmak is very clear and direct. He's not going to be a shoulder to cry on but he feels very focused on results. I felt like he cared when I had a failed cycle but was not overly invested. I liked that he felt competitive with himself--like he was going to figure out this problem.
What's one piece of advice would you give a prospective patient of Hakan Cakmak at UCSF?
This doctor is not going to be your best friend but he'll do everything he can to get you the results you want.
During treatment, were you treated like a number or a human with Hakan Cakmak at UCSF?
Dr. Cakmak is very science oriented and has a mind more oriented that way.
Describe the protocols Hakan Cakmak used in your cycles at UCSF and their degree of success.
Dr. Cakmak used a very middle of the road treatment my first ivf cycle (I had unexplained). When my fertilization rate appeared low (and the first round didn't work) he came back with a very specific and totally new plan which included HGH. The second round worked. I think Dr. Cakmak is more comfortable with transferring multiple embryos than other doctors (my first round he suggested three which felt aggressive and I pushed back). I'm very happy to have ended up with (healthy!) twins but it is a much higher risk pregnancy. I think it's important to educate yourself on the risks as this doctor doesn't underscore them.
Describe your experience with your nurse at UCSF. (Assigned nurse: carolyn clarke)
Everyone was amazing. I didn't know anyone overly well but they were super on the ball and compassionate.
Describe your experience with UCSF.
Highly organized and dependable. Not super intimate but very warm. Worked hard to get you in when you needed and always responded quickly. Professional and easy to communicate with. Rotating staff of maybe 30 nurses so you would often work with the same people week to week. Would definitely recommend.
Describe the costs associated with your care under Hakan Cakmak at UCSF.
Ah, I don't really remember exact specifics. About 45k for 2 rounds of IVF
Describe Hakan Cakmak's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
I found Dr. Cakmak very open to transferring multiple embryos and not overly invested on communicating the potential downside of a multiples pregnancy.
Dr Cedars was empathetic and understanding. She patiently answered our questions and walked us through each process. I felt like she had a wealth of knowledge about current fertility medicine practices. ... When it was clear we were undergoing a missed miscarriage, Dr Cedars performed the manual aspiration. When we moved over to IVF, a few things fell through the cracks.
UCSF CRH is a big place, they see a lot of patients. I didn't necessarily want to form personal relationships with the staff, but I also didn't want to be another random warm body. I felt they struck a reasonable balance in this. ... As I mentioned, my varicella immunity was low. This didn't seem to be an issue for IUI treatment as a clinical trial patient, but it was as a cash-paying IVF patient. ...
How was your experience with Marcelle Cedars at UCSF?
Dr Cedars was empathetic and understanding. She patiently answered our questions and walked us through each process. I felt like she had a wealth of knowledge about current fertility medicine practices.
What's one piece of advice would you give a prospective patient of Marcelle Cedars at UCSF?
Ask direct questions and expect direct answers.
During treatment, were you treated like a number or a human with Marcelle Cedars at UCSF?
UCSF CRH is a big place, they see a lot of patients. I didn't necessarily want to form personal relationships with the staff, but I also didn't want to be another random warm body. I felt they struck a reasonable balance in this.
Describe the protocols Marcelle Cedars used in your cycles at UCSF and their degree of success.
Six IUIs with 50mg Clomid and HCG trigger. Lupron demi-halt IVF cycle, two weeks of stimulation/superovulation with Gonal-F and Menopur, HCG trigger. ICSI and potential use of microfluidic chip (FERTILE) as part of a clinical trial -- we were blindly randomized, so I don't know if our sample went through the usual preparation or the chip process.
Describe your experience with your nurse at UCSF. (Assigned nurse: Jill Ford)
During 2016 and 2017, I took part in two clinical trials. For both, the research coordinator, Becca Wong, was my main point of contact. Becca was great throughout, easily accessible, compassionate, funny. Even during her own pregnancy, I never felt anxious or envious. When we moved on to IVF, Jill Ford and Ruthie were our main contacts. I met each of them once only, but we spoke on the phone several times and emailed a lot.
Describe your experience with UCSF.
I am very grateful to CRH. I learnt a lot from the staff. The process of going through six IUIs over two years, as a clinical trial patient, meant I paid $0 for this treatment, and received great care. It was so nice not to even think about insurance or payment during this part of our treatment.
My final round of IUI in 2017 resulted in a positive test. My blood HCG tests were low and rose slowly. For a while we were in limbo, anxious especially about an ectopic pregnancy. All throughout, Becca was available and supportive. I met with Dr Cedars at this time too, who was candid about the chances of the pregnancy going to term. When it was clear we were undergoing a missed miscarriage, Dr Cedars performed the manual aspiration.
When we moved over to IVF, a few things fell through the cracks. Becca had advised I have my OB order some blood tests, including for STDs, and immunity to several diseases. Nobody told me that my varicella (chicken pox) immunity was low and I ought to be re-vaccinated. It wasn't until Jill was running through the pre-IVF checklist that she asked me the result of these tests. (I had allowed my OB's office to share the results with UCSF CRH, so I was under the impression they'd already seen them). The two vaccines and a month "on the bench" pushed back our start date.
Also: at one point Dr Cedars mentioned we'd be eligible for a study which would cover the cost of our stimulation medications. I'd done some research and knew this was potentially a large cost. A few months went by (see above) and I asked the study's coordinator if we were enrolled. He responded that we were ineligible, and that he'd told us that several months ago. This obviously wasn't the case.
Fortunately, we were able to buy our meds from Disco Rex, the Walgreens Speciality Pharmacy in Palo Alto, for under $300 total. This was thanks to the 340B Network Pharmacy Program, as cash-paying outpatients of UCSF. Nobody mentioned this program to me at any point until I was prescribed the drugs, and it would definitely have influenced our clinic selection decision. I wish CRH made a bigger deal of it!
The only other complaint I have is a very minor one: the IVF calendar I received was ugly and a little bit confusing. It looked unprofessional, with no branding, lots of different fonts/text sizes, etc. Random reminders were scattered on various days. Other paperwork we received was also oddly-formatted or a copied copy. I feel sure UCSF has communication staff who would be able to create more professional templates.
Describe the costs associated with your care under Marcelle Cedars at UCSF.
Stimulation monitoring: $4,267
Egg retrieval $2,240
Fertilization and culture $3,365
Embryo transfer $2,810
Embryo cryopreservation (1 year) $1,753
I also paid a few hundred dollars for two ultrasounds after pregnancy was confirmed.
As a clinical trial patient, I underwent six IUIs at zero cost. I was also treated for the missed miscarriage, including the manual aspiration procedure, at no cost. There was some confusion as to the status of these treatments, at one point I made a last-minute appointment to see my OB to take over my care. I'm not sure, but I believe CRH staff pulled some strings in order to have my care covered by the study, which, obviously, I greatly appreciate.
Describe Marcelle Cedars's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
We only ever considered transferring a single embryo.
What specific things went wrong at UCSF?
Lost results
Provided conflicting information
Failed to convey critical information
Describe the specific things that went wrong at UCSF.
As I mentioned, my varicella immunity was low. This didn't seem to be an issue for IUI treatment as a clinical trial patient, but it was as a cash-paying IVF patient.
Dr. Cedars is a really wonderful mixture of realistic and hopeful. She knew I was upset once and called me at 6 one evening to offer encouragement.... Dr. Cedars saw me in 2015 for a consultation and full PCOS work up and was realistic but very hopeful. In 2018 when my husband and I wanted to start trying I made an appointment and she didn't make me jump through any hoops to get treatment she just read my file and knew with my PCOS it would be silly to wait and started me on treatment.
The clinic [UCSF - San Fransisco] has 2 different offices. The one of Illinois St in Mission Bay is FAR superior than the old Mt. Zion clinic. I'm sure they are both perfectly clean and sanitary but the Mission Bay Clinic is just so much more inviting, clean looking... The clinic initially charged me $747 out of pocket for a transvaginal ultrasound. I later thought it odd so called my insurance and turns out whoever does billing never even sent the request to my insurance. It took me weeks but eventually after fighting it out with UCSF
How was your experience with Marcelle Cedars at UCSF?
Dr. Cedars saw me in 2015 for a consultation and full PCOS work up and was realistic but very hopeful. In 2018 when my husband and I wanted to start trying I made an appointment and she didn't make me jump through any hoops to get treatment she just read my file and knew with my PCOS it would be silly to wait and started me on treatment. My insurance was not understanding that despite my age I couldn't "just keep trying" so she scheduled a peer-to-peer and went to bat for me to get my treatments covered. She then called me after and said "they understand much better now, we got you 4 cycles covered and if those don't work we will get more." She is really incredible.
What's one piece of advice would you give a prospective patient of Marcelle Cedars at UCSF?
Make any appointment months before you think you may need it - she books up fast (I waited 3 months for my appointment.)
During treatment, were you treated like a number or a human with Marcelle Cedars at UCSF?
Dr. Cedars is a really wonderful mixture of realistic and hopeful. She knew I was upset once and called me at 6 one evening to offer encouragement.
Describe the protocols Marcelle Cedars used in your cycles at UCSF and their degree of success.
I have PCOS so my eggs and follicles are fine but I do not ovulate and do not have a period unless I am on birth control or other period-inducing medication. Dr. Cedars has used this for 2 cycles and I have ovulated but have not become pregnant yet.
Cycle 1:
(Medroxyprogesterone) Provera 5mg x 12 days
Await period
Letrozole (Femara) 2.5mg x 5 days
Start intercourse every other day starting CD 10 then every other day until you ovulate then sex on that day and the following day. Complete pregnancy test in 15 days.
The second cycle was the exact same but she doubled my Femara dose to 5mg.
Next time around (if I am not pregnant this cycle) we will do the same thing but add in a transvaginal ultrasound to see what my ovaries are doing.
So far, I have no become pregnant at all but Dr. Cedars says "there is still a lot of hope" which as been very helpful.
Describe your experience with your nurse at UCSF. (Assigned nurse: Ruth and Jill)
I am not sure which nurse is my primary but I have worked with both Jill and Ruth. They are very kind, Ruth especially is very energetic and positive. My only complaint is that they have not been very good with phone or e-mail communication. There have been a few times where my emails went unanswered for several days. Other than that they are great.
Describe your experience with UCSF.
The clinic has 2 different offices. The one of Illinois St in Mission Bay is FAR superior than the old Mt. Zion clinic. I'm sure they are both perfectly clean and sanitary but the Mission Bay Clinic is just so much more inviting, clean looking, and also I think they have more advanced technology but I could be wrong about that.
Describe the costs associated with your care under Marcelle Cedars at UCSF.
Ok for the good there was one billing person who was helpful however never even thought of being a peer-to-peer until I asked which seems odd (especially because it worked). Once I did ask for it she happily coordinated and Dr. Cedars did it and it worked! Super thankful for that.
Ok this is where stuff really lagged. The clinic initially charged me $747 out of pocket for a transvaginal ultrasound. I later thought it odd so called my insurance and turns out whoever does billing never even sent the request to my insurance. It took me weeks but eventually after fighting it out with UCSF (nobody from the main billing center ever responded to my 3-5 phone calls and 2 emails) and my insurance rep they charged my insurance appropriately and refunded the bill entirely. Had I not had the skills to fight it though or been struggling with anxiety or depression like so many women in my situation I could have never gotten that money back.
Dr. Cakmak is a great person who truly cares. He's meticulous in his work and thoroughly evaluates all factors related to my situation. While undergoing the saline sonogram (probably the most painful part of the ivf process), Dr. Cakmak tried earnestly to distract me from the pain. It still hurt - but I appreciate that he tried.... Dr. Cakmak spent the time to explain the issues and discussed future solutions after our failed first round yielded no embryos. I was certainly hopeful for an improvement between my own first and second rounds. While the results did improve, we continue to work with Dr. Cakmak to understand why we haven't
UCSF clinic is great. They did a great job with the orientation, the facilities are incredible and the staff is compassionate. The billing department is hard to get a hold of. At some point, there was a billing issue and they assumed responsibility and did not charge me for the additional blood tests. I truly appreciated that.... Without insurance coverage, we opted to use Arc Fertility which would cover 1 retrieval and 2 transfers....
How was your experience with Hakan Cakmak at UCSF?
Dr. Cakmak was a recommendation from a friend who had a successful pregnancy after two rounds of IVF. Dr. Cakmak spent the time to explain the issues and discussed future solutions after our failed first round yielded no embryos. I was certainly hopeful for an improvement between my own first and second rounds. While the results did improve, we continue to work with Dr. Cakmak to understand why we haven't had a successful pregnancy. With an upcoming appointment, I'm looking forward to understanding what else can be evaluated and how best to move forward. I trust Dr. Cakmak and the UCSF team and remain hopeful and optimistic in a positive outcome. I know that he cares and with his diligent and analytical behavior, I trust we can find success together.
What's one piece of advice would you give a prospective patient of Hakan Cakmak at UCSF?
He's slightly socially awkward but he's got a great heart!
During treatment, were you treated like a number or a human with Hakan Cakmak at UCSF?
Dr. Cakmak is a great person who truly cares. He's meticulous in his work and thoroughly evaluates all factors related to my situation. While undergoing the saline sonogram (probably the most painful part of the ivf process), Dr. Cakmak tried earnestly to distract me from the pain. It still hurt - but I appreciate that he tried.
Describe the protocols Hakan Cakmak used in your cycles at UCSF and their degree of success.
The first round started after my period and consisted of 2 shots per day of Gonal-F and Menapur. It ended with a trigger shot. This yielded 6 eggs of which 1 was suitable for ICSI which did not become an embryo. So we had nothing.
The second round started with Lupron (10 units) after confirmed ovulation and then after my period I had 3 shots per day of Gonal-F (225IU), Menapur (2 powders in 1 cc), growth hormone (Omnitrope - 1.45mg). This yielded 6 eggs of which 2 were suitable for ICSI and became embryos. Daily shots of progesterone in oil began the day after retrieval until the pregnancy test. They transferred both embryos on day 2. The pregnancy test was negative after 2 weeks.
Describe your experience with your nurse at UCSF. (Assigned nurse: Audra Katz)
Audra and the support team were great in making sure I got all the appointments I needed. They accommodated me when I was running late and they had an overall supportive and empathetic disposition. They were great.
Describe your experience with UCSF.
UCSF clinic is great. They did a great job with the orientation, the facilities are incredible and the staff is compassionate. The billing department is hard to get a hold of. At some point, there was a billing issue and they assumed responsibility and did not charge me for the additional blood tests. I truly appreciated that.
Describe the costs associated with your care under Hakan Cakmak at UCSF.
Without insurance coverage, we opted to use Arc Fertility which would cover 1 retrieval and 2 transfers. Given we had nothing to transfer during the first cycle, we paid out of pocket and it cost around $10K. We applied the Arc Fertility package to our 2nd round of IVF and it cost $15,212. Medications were separate.
Describe Hakan Cakmak's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
We agreed on a strategy that if we had 6 or more embryos we would freeze all and PGS test all of them. Anything less than 6, then we would do a fresh transfer of up to 3 embryos. Given the risk of failure at each possible juncture we agreed that this made sense.
I think that he appropriately met me where I was--I come from a medical background and wanted to discuss data and details, which is what we did....Dr. Fujimoto was knowledgeable about the process though, and even went the extra mile to print off a recent study from a journal to show me more concrete examples of conception data in my demographic group.... Subsequently, I felt like my access to him was slightly guarded through his gatekeeper/assistant, who would forward my emails to her on to him.
The clinic [UCSF] is pretty great--in a fairly new building that has other things in it like a restaurant. I don't know why, but somehow it made me feel better that I didn't have to walk into some sort of clinic labeled from the outside INFERTILITY in giant red letters. It felt nice to go somewhere that felt more private, but still spacious and nice. The lobby is nice. I also appreciate that there are dedicated financial coordinators who email you.
How was your experience with Victor Fujimoto at UCSF?
We met on my first visit with my wife present so we could start talking about what it would take for us to start a family. I come from a medical background, but a totally different field, so I knew some things, but still needed a good amount of background information and anticipatory guidance. He sat down with both of us, which I appreciated, and laid out what we could expect. He explained the blood work we'd need and the potential ancillary testing. I did feel a bit pressured to get an HSG and the genetic testing, even though neither was something I really wanted. I think it was around that point that I felt like he perhaps saw me more as a woman with infertility than a young lesbian with her wife trying to start a family. At the time, I had no such diagnosis, and had never had any sort of blood work to suggest infertility, so I was a bit taken aback when the ICD9 code associated with the visit was for Anovulatory Infertility. Later down the road, that changed, but it wasn't something that was known at the time of our initial encounter. Dr. Fujimoto was knowledgeable about the process though, and even went the extra mile to print off a recent study from a journal to show me more concrete examples of conception data in my demographic group. I remember him saying "My concern isn't getting your pregnant, it's not getting you TOO pregnant". Subsequently, I felt like my access to him was slightly guarded through his gatekeeper/assistant, who would forward my emails to her on to him.
What's one piece of advice would you give a prospective patient of Victor Fujimoto at UCSF?
Come in with a list of questions in advance--when directly approached, he is direct in response.
During treatment, were you treated like a number or a human with Victor Fujimoto at UCSF?
I think that he appropriately met me where I was--I come from a medical background and wanted to discuss data and details, which is what we did. I may have projected more confidence than I had because I was nervous, but there wasn't much in the way of assessing me/my wife's psychological state of being, other than mentioning there was a therapist on staff.
Describe the protocols Victor Fujimoto used in your cycles at UCSF and their degree of success.
I had an elevated Anti-Muellerian Hormone and a history of irregularity, so we went with Clomid for our IUI. I took 5 days of 50mg Clomid each night (CD2-CD6). Then on CD10 I had a transvaginal ultrasound, but my dominant follicles were still too small. So we are planning for a repeat on CD13 with a tentative plan of doing a trigger HCG injection (Ovidrel) prior to IUI.
Describe your experience with your nurse at UCSF. (Assigned nurse: Danielle)
Danielle was actually super helpful during the process. She was our primary contact point as we figured a lot of things out for ourselves. We had some back and forth on whether or not to use a known donor or a sperm bank, and she explored both of those options with us. She was very responsive via email and gave quick responses. Every time there was a new hoop in my care to jump through, she helped to delineate it and help us through it.
Describe your experience with UCSF.
The clinic is pretty great--in a fairly new building that has other things in it like a restaurant. I don't know why, but somehow it made me feel better that I didn't have to walk into some sort of clinic labeled from the outside INFERTILITY in giant red letters. It felt nice to go somewhere that felt more private, but still spacious and nice. The lobby is nice. I also appreciate that there are dedicated financial coordinators who email you. They are a little bit hard to get an immediate response to, but at least I didn't feel like there were surprises in this (very expensive) process. The rooms were always very clean, and there was a quick turnaround from check-in until the time that I was seen. The Nurse Practitioner led class on IUI and injectables was very helpful as well.
Describe the costs associated with your care under Victor Fujimoto at UCSF.
The bloodwork bill that my insurance generated for the preliminary tests (CBC, HIV, RPR, Rubella, GTT, Prolactin, FSH, Estrogen, Testosterone, Free Testosterone, Estrone, Blood type, Insulin, Glucose, LFTs, Hgb A1C, CRP, Cholesterol pannel, VZV, Androstenedione, SHBG, AMH, Estradiol, TSH) was about $6,100 plus about $300 of doctor/lab worker fees. The IUI Package was $1566 plus an additional $288 thaw fee. Each sperm vial from the sperm bank was $795. The Clomid and Ovidrel were both partially covered by my insurance, so I paid something to the tune of $40 total.
Dr. Cakmak is well read and a respected clinical researcher. He has published extensively and reflected current knowledge of the state of the science as he outlined our treatment plan and as we encountered setbacks. He uses lots of statistics, but was also comfortable talking about how we have not fit those statistics thus far. Of note, his cadence is very typical of a clinical researcher- he does best when you save questions till the end of him running through his algorithms and plans.
Spa like atmosphere- private, calm and quiet- puts me in a good place for procedures. Front desk staff [UCSF] is kind, although doesn't always recognize when people are in line to check in. Clinic staff is thorough in checking ID and ensuring they have the right patient, which felt reassuring. Billing coordinators took weeks to respond to emails.... Carolyn held my hand (via the phone) through complex regimens and lots of bad news (including a miscarriage).
How was your experience with Hakan Cakmak at UCSF?
Dr. Cakmak is well read and a respected clinical researcher. He has published extensively and reflected current knowledge of the state of the science as he outlined our treatment plan and as we encountered setbacks. He uses lots of statistics, but was also comfortable talking about how we have not fit those statistics thus far. Of note, his cadence is very typical of a clinical researcher- he does best when you save questions till the end of him running through his algorithms and plans.
He is an optimist and encouraged me and my partner to maintain hope even when this was hard. He always seems to have the next step planned out incase the one in front of us doesn't work. He is also very clear that if/when he feels that it is unlikely we will get pregnant, he will be honest and clear with us. He doesn't push procedures or treatments that are unlikely to yield results.
What's one piece of advice would you give a prospective patient of Hakan Cakmak at UCSF?
Bring a list of questions to your appointment and ask them after he has reviewed his assessment and plan.
During treatment, were you treated like a number or a human with Hakan Cakmak at UCSF?
Dr. Cakmak feels like a member of our team. He has a dry sense of nerd-humor but I know he cares for us a lot and wants us to succeed at our common goal.
Describe the protocols Hakan Cakmak used in your cycles at UCSF and their degree of success.
Climid with HcG trigger for IUI, with resulting multiple follicle yield each round.
IVF stimulation: Antagonist protocol (used given borderline diminished ovarian reserve) yielded more eggs than expected (a good thing).
Describe your experience with your nurse at UCSF. (Assigned nurse: Carolyn)
Carolyn held my hand (via the phone) through complex regimens and lots of bad news (including a miscarriage). She returns calls the same day (although when I was going through IVF, I called her on 15 minute increments because an hour seemed like an eternity- which is a bit unrealistic now that I look back). She is a saint for dealing with hormonal, grieving women.
Describe your experience with UCSF.
Spa like atmosphere- private, calm and quiet- puts me in a good place for procedures. Front desk staff is kind, although doesn't always recognize when people are in line to check in. Clinic staff is thorough in checking ID and ensuring they have the right patient, which felt reassuring.
Billing coordinators took weeks to respond to emails.
Describe the costs associated with your care under Hakan Cakmak at UCSF.
$15k for IVF stimulation cycle with retrieval and embryo transfer, $400 for medications; $3500 for frozen embryo transfer
IUI cycles were covered by insurance
Describe Hakan Cakmak's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at UCSF.
He didn't have a strong preference (given multiple failed rounds), but educated us on risks of multiple gestation.
Whenever I spoke directly with Dr. Cakmak, he's always willing to explain things in detail with a great deal of patience and honesty. Although he sees so many patients at once, he remembers the details about you and addresses the specifics whenever he sees you. He's very data-oriented which I appreciate. He doesn't sugar coat things and tries to set the most realistic expectations along the way (while also being calming). Although most of my visits and phone conversations were with his team or colleagues
WEAKNESSES: The hardest part of the whole process was getting the first appointment booked with a doctor. When you call [UCSF], you get diverted to a voicemail where you leave your info.... STRENGTHS: Once you get your first appointment booked and get through the initial pre-work, the rest was pretty seamless and easy to follow. The staff (front desk, phlebotomists, nurses, MDs) are all super responsive and kind, and made sure I understood each step of the process.
How was your experience with Hakan Cakmak at UCSF?
Dr Cakmak comes across a little socially awkward but it's well compensated by his calm, patient, and data-driven communication style. He's a very sweet person who cares about achieving the best possible results for you, while also helping to set realistic expectations along the way.
What's one piece of advice would you give a prospective patient of Hakan Cakmak at UCSF?
To look beyond his bit of social awkwardness!
During treatment, were you treated like a number or a human with Hakan Cakmak at UCSF?
Whenever I spoke directly with Dr. Cakmak, he's always willing to explain things in detail with a great deal of patience and honesty. Although he sees so many patients at once, he remembers the details about you and addresses the specifics whenever he sees you. He's very data-oriented which I appreciate. He doesn't sugar coat things and tries to set the most realistic expectations along the way (while also being calming). Although most of my visits and phone conversations were with his team or colleagues, I could tell that he was guiding them along the way. He's also responsive when you need to get a hold of him.
Describe the protocols Hakan Cakmak used in your cycles at UCSF and their degree of success.
* Initial ultrasound showed slow follicle growth (13 follicles; smaller in size)
Days 1-6: Menopur 150; Gonal F 225
* Day 7 ultrasound showed sudden follicle growth (around 25-30) with a couple follicles growing faster than others so I was told to immediately start using Ganirelix as an antagonist.
Days 7-8: Menopur 150; Gonal F 150; Ganirelix 250
* Dr Cakmak reduced the stimulants to help follicles catch up to one another and ordered an extra trigger shot - Lupron (in addition to HGC trigger)
Days 9-10: Menopur 150; Gonal F 100; Ganirelix 250
* Stimulants reduced again
Days 11-? (today is Day 11): Menopur 75; Gonal F 100; Ganirelix 250
Describe your experience with your nurse at UCSF. (Assigned nurse: Audra Katz)
Audra is a thorough communicator and is good about contacting you in a timely manner to provide reminders or new instructions.
Describe your experience with UCSF.
WEAKNESSES:
The hardest part of the whole process was getting the first appointment booked with a doctor. When you call, you get diverted to a voicemail where you leave your info. If you do not pick up when they call you, they tell you to call the same number back (which then results in another voicemail). 4-5 voicemails later, I finally got an appointment booked. Phew! The next hardest part was dealing with their Cisco secure email system which sometimes wouldn't always load the email properly, particularly if large files were attached. The initial email with a long list of instructions and action items for both my husband and I was also hard to read -- it was very MS Word 97! You need to be super detail-oriented to get through that email and also the additional verbal instructions provided over the phone for all the initial lab work, orientations and forms.
The last frustration is their Financial Navigators team. They're understandably very busy but it's challenging getting a response from them if you have questions about billing and insurance.
STRENGTHS:
Once you get your first appointment booked and get through the initial pre-work, the rest was pretty seamless and easy to follow. The staff (front desk, phlebotomists, nurses, MDs) are all super responsive and kind, and made sure I understood each step of the process. It was easy to book follow-up appointments in person and there was rarely a line to talk to the front desk.
The facility is also really nice - making it a pleasant environment to visit multiple times. There's easy parking below that isn't too expensive and there's a Walgreens just down the street for any last minute refills that you may need.
