Dr. Shah was honest with me through the process. She didn't sugar coat things and she let me know her thoughts freely...She took time to determine what my expectations were and whether I wanted to pursue IVF treatments before recommending them to me...For each of my four IVF cycles with Dr. Shah, I was treated with an antagonist protocol. I used the highest dosages of stim treatments due to my diminished ovarian reserve
The physicians [of Penn Fertility Care] function as a team, though your primary physician of course has final say in your treatment. But it's nice to know that multiple physicians are looking at your treatment cycle and providing input. The clinic is well organized overall, though sometimes I had to do some legwork dealing with my insurance coverage and getting certain specialty medications delivered to the clinic
How was your experience with Divya Shah at Penn Fertility Care?
Dr. Shah was honest and open with me about the risks and the chances of these treatments working. She took time to determine what my expectations were and whether I wanted to pursue IVF treatments before recommending them to me. I always felt like she listened to my concerns and took time to go over studies I found and give me her honest opinion about them. But she was quick to let me know if she did not agree with something, and to give me her reasoning. I felt this was fair, especially since I am also a physician and I deferred to her expertise with the understanding that it was much greater than mine in this field. When we disagreed about next steps, I switched to a different physician in the clinic. But there was no animosity involved with the switch. It was simply a difference of opinion after I experienced two miscarriages with PGS normal embryos. I wanted to pursue further workup for endometriosis and also to try prednisone and Lovenox for my next transfer. Dr. Shah disagreed with this course of action because she felt that there wasn't enough data to justify trying this. I understood her point of view, but I ended up switching to a physician who was willing to try these interventions even without the absence of strong data to support them. Every doctor is different, and I respect their right to practice in the way they see fit, as long as they provide evidence based and compassionate care. Dr. Shah did provide that, so I have no misgivings. For what it's worth, the additional workup and interventions did not end up yielding a pregnancy, so we are now pursuing surrogacy as our next option with the embryos we have remaining.
What's one piece of advice would you give a prospective patient of Divya Shah at Penn Fertility Care?
Don't take Dr. Shah's sometimes blunt or brisk manner as a lack of compassion. She does very much care about the outcome and wants it to be successful. But she is data driven and will not pursue treatments that she feels may do more harm than good, especially if the evidence for these treatments is weak at best.
During treatment, were you treated like a number or a human with Divya Shah at Penn Fertility Care?
Dr. Shah was honest with me through the process. She didn't sugar coat things and she let me know her thoughts freely. I could tell that she cared about the outcome, but she did not give me any false hope.
Describe the protocols Divya Shah used in your cycles at Penn Fertility Care and their degree of success.
For each of my four IVF cycles with Dr. Shah, I was treated with an antagonist protocol. I used the highest dosages of stim treatments due to my diminished ovarian reserve (AMH of 0.08 ng/mL). I used 450 IU of Gonal-F alone initially. I then added in 150 IU of Menopur and decreased the Gonal-F to 300 IU after a few days. I used 250 mcg of Ganirelix to prevent ovulation for the last week or so of each stim cycle. Due to my low AMH, my stim cycles were significantly longer than average, between 13-17 days. I triggered with 10,000 IU of HCG 36 hours prior to my egg retrievals. Below are the details of each cycle with Dr. Shah:
IVF Cycle 1 (February 2020): Gonal-F 450 IU x 6 days, then 300 IU x 8 days; Menopur 150 IU starting on stim day 7 x 2 days, then decreased to 75 IU x 6 days; Ganirelix 250 mcg starting on stim day 9 x 7 days; HCG trigger 10,000 IU on stim day 15. Started progesterone 50 mg on night of retrieval in preparation for fresh transfer. Retrieved: 6 eggs, Mature: 3 eggs, Fertilized (ICSI): 3 eggs, Fresh transferred 2 day-3 embryos which ended in chemical pregnancy, froze 1 embryo on day 5 (mosaic trisomy 18).
IVF Cycle 2 (May 2020): Gonal-F 450 IU x 3 days, then 300 IU x 13 days; Menopur 150 IU starting on stim day 4 x 13 days; Ganirelix 250 mcg starting on stim day 10 x 8 days; HCG trigger 10,000 IU on stim day 17. Retrieved: 8 eggs, Mature: 4 eggs, Fertilized (ICSI): 4 eggs, Froze 1 embryo on day 5 (PGS aneuploid), Froze 1 embryo on day 6 (PGS euploid).
IVF Cycle 3 (August 2020): Gonal-F 450 IU x 4 days, then 300 IU x 11 days; Menopur 150 IU starting on stim day 5 x 11 days; Ganirelix 250 mcg starting on stim day 8 x 9 days; HCG trigger 10,000 IU on stim day 16. Retrieved: 12 eggs, Mature: 6 eggs, Fertilized (ICSI): 6 eggs, Froze 4 embryos on day 5 (PGS mosaic and aneuploid), Froze 2 embryos on day 6 (PGS euploid).
IVF Cycle 4 (February 2021): Gonal-F 450 IU x 4 days, then 300 IU x 9 days; Menopur 150 IU starting on stim day 5 x 8 days; Ganirelix 250 mcg starting on stim day 7 x 7 days; HCG trigger 10,000 IU on stim day 13. Retrieved: 15 eggs, Mature: 5 eggs, Fertilized (ICSI): 5 eggs, Froze 4 embryos on day 5 (PGS euploid), Froze 2 embryos on day 6 (PGS euploid), Froze 1 embryo on day 7 (PGS mosaic).
I also had an ERA done in October 2020 before my first FET since I had a small amount of PGS euploid embryos to work with (I requested this and Dr. Shah agreed). It showed I was pre-receptive so we added in 24 additional hours of progesterone for my FETs.
Frozen embryo transfer protocol involves taking OCPs alone for 10 days, then adding on microdose Lupron injections (10 units) for another 7 days, then continuing microdose Lupron alone for 3 days, then decreasing microdose Lupron to 5 units and adding in Estrace 2 mg daily x 4 days, then 2 mg twice daily x 4 days, then 2 mg three times daily x 7 days, followed by a lining check and labs. Goal estrogen level above 200, goal lining above 7 mm.
FET #1 (December 2020): Transferred PGS euploid day 6 4AA embryo. Miscarriage at 6 weeks (heartbeat detected in ER where I went after I started bleeding, due to SCH, but miscarriage completed).
FET# 2 (May 2021): Transferred PGS euploid day 6 3BA embryo. Miscarriage at 6 weeks after heartbeat detected in clinic (no heartbeat on subsequent US, did have SCH but no bleeding this time).
I proceeded to try another FET with a different physician. It ended up with a negative pregnancy test.
Describe your experience with your nurse at Penn Fertility Care. (Assigned nurse: Christina Ward)
Christina was an excellent nurse during this process. She showed compassion, encouragement, and concern. She went above and beyond to coordinate my care, and even stayed on with me as my nurse after I switched providers at the clinic for my last embryo transfer. I truly appreciate her hard work and optimism during my difficult course of fertility treatments.
Describe your experience with Penn Fertility Care.
Penn Fertility has been overall wonderful. When the pandemic shut down the clinic in early 2020, we panicked a little and switched our care to Shady Grove because they were still open. We did one cycle there, and ended up with zero embryos from that cycle. Our other four cycles were at Penn, and each cycle yielded multiple embryos. So we immediately returned to Penn once they reopened. The physicians function as a team, though your primary physician of course has final say in your treatment. But it's nice to know that multiple physicians are looking at your treatment cycle and providing input. The clinic is well organized overall, though sometimes I had to do some legwork dealing with my insurance coverage and getting certain specialty medications delivered to the clinic (my specialty pharmacy would not deliver Lupron depot to my home, and it was pretty difficult to coordinate delivery of this medication with Penn. But eventually we got it done). The nursing staff is compassionate. I'm happy with the care I received to date.
Describe the costs associated with your care under Divya Shah at Penn Fertility Care.
I had insurance that covered most of the costs of IVF. My final IVF cycle involved some more out-of-pocket costs after my insurance was maxed out. I believe that an IVF cycle out-of-pocket costs around $11,000. And I did have to pay for a couple of my transfers after my insurance was maxed. Each frozen transfer is $3,500 out of pocket. This includes all the ultrasounds and bloodwork through the first pregnancy test. My medications were also all covered by insurance, but they have an on-site pharmacy that offers discounted rates if you are paying out-of-pocket. My ERA was not covered by insurance. This cost $795.00 with Igenomix. And PGS testing with Cooper Genomics was $1,950 for up to 8 embryos, $250 for each additional embryo.
Describe Divya Shah's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at Penn Fertility Care.
Dr. Shah encouraged eSET with PGS tested embryos, and I don't believe she would be willing to transfer multiple embryos if they were PGS tested. We did do a fresh 3 day transfer of two embryos after our first IVF cycle. This was recommended by the embryologist and not at our request.