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.

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.

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.

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.

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.

I wanted to write this review before we transferred so I could share my experience without bias stemming from success or failure. I have had consultations with three REs and been in treatment with two, so I'm writing about Dr. O'Neill in relation to my general experience of the fertility industrial complex. PROS: -willing to listen and try newer diagnostics such as ERA and DNA fragmentation testing, *if you suggest them* -considers research brought by patients when developing a treatment plan -will initiate phone calls (vs. portal messages) outside of official consultations for quick discussions on next steps forward -seems to have a consultative approach and often mentions working with her Fellows and other colleagues to come to a decision on treatment. -while I would not say she is deeply informed on the role of race in infertility treatment, I was able to bring up the subject and she did not shy away from it -Genuinely kind and empathetic when you get bad news CONS (with the note that I think many of these are universal problems in high-patient volume clinics) -Not so good at communicating with her nurse. On multiple occasions I've gotten one set of medication instructions from Dr. O'Neill, a different set from the nurse, and had to ask her to double check with Dr. O'Neill. -Can be overconfident when she's incorrect about something - e.g. you believe you are having a procedure to look at X and Y issues, but she only remembers issue Y, so you have to ask her to go dig through your records to find evidence of issue X NEUTRAL/GENERAL INFO -Seems to err on the side of slightly conservative measures when it comes to making adjustments in treatment protocols. As mentioned above, she's open to ideas, but when left to her own devices, her style seems to favor treatments with a long track record of success -Does not give estimated probability of success (I didn't ask for it either) -Can be blunt and action oriented or warm and sympathetic at turns

Very efficient. Never had to wait more than ten minutes and usually in and out within thirty minutes total. I like that they have soothing images of clouds, etc .on the lights! Each treatment room has its own private bathroom, which is a plus.

I had insurance through Aetna (NJ) so most of my costs were covered. I did pay out of pocket for sperm freezing ($350ish/year), embryo storage ($430/yr), and mock transfers ($240)

Dr. O'Neill bases her transfer protocol for untested embryos on anticipated number of euploid embryos by age. For example, if you have three embryos and research estimates 30% aneuploid, she would transfer one embryo, then two, since we'd assume at least one of those embryos would not be viable.

Dr. Bachman has always been willing to answer my questions, though I did have to often ask for a phone call. I have only seen her in person about 3 times, but it was clear that she was following my progress. Though my egg retrieval was a success, ultimately, we did not get any sperm from my husband's TESE procedure that happened concurrently. That was very disappointing, and even though Dr. Bachman did not have a role in that procedure, she still reached out to check in with us. She then guided me through the sperm donor process, which ultimately led to my current pregnancy. If you're looking for a doctor who will be present and hold your hand every step of the way, Dr. Bachman probably isn't for you. That's not her fault, but rather the way that the clinic runs. I think if I had asked for her to reach out to me more, she would have. She did answer her cell phone on a Sunday to talk to me when I was upset about our canceled cycle. Considering how big and busy they are, she makes a considerable effort to communicate with you.

Advocate for communication if you have questions or concerns.

For my egg retrieval, I stimmed with Gonal-F, Menopur, and Ganirelex. I was also taking baby aspirin and Lovenox due to an unrelated blood clotting disorder. I did a Lupron only trigger due to my risk for OHSS as a PCOS patient.

We chose to do a package that included one egg retrieval, embryo creation with ICSI, one year of storage, and one transfer. That cost roughly $12000. We spent roughly $3,000 on medications. Nothing was covered by our insurance.

We only transferred one embryo. There was never any discussion of transferring multiple embryos.

Dr. Shah was always friendly and available when I had questions and concerns. She listened to what I wanted and felt was best for my body. She never pushed for something I wasn’t comfortable with. While we were unsuccessful, I was pleased with our experience. I felt she did everything she could.

Don’t be afraid to speak up and voice your concerns and ask questions.

Our first cycle with Dr. Shah we kept our doses lower to avoid OHSS. As a result I ended up with a small amount of eggs. This led to an unsuccessful day 3 transfer and no remaining eggs to freeze. The second cycle we doubled my meds, yes doubled. This resulted in 21 mature eggs, which was awesome! But our fresh transfer was canceled due to borderline OHSS. We ended up with 4 embryos to freeze. After 2 frozen embryo transfers (1 embryo and 2 embryos respectively) were unsuccessful we decided to take a break. We have 1 frozen embryo remaining.

A single cycle with fresh transfer was $11,000. A FET $3,500.00.

Dr. Gracia was kind and she clearly knew what she was doing. She explained to my husband and I that she recommended having donor sperm as a backup in case his TESE was unsuccessful or only partially successful. She answered all of my questions during the two times I met with her personally.

Ask about the logistics of how the practice works, how often you will see her and who will perform your procedures.

For egg retrieval: Gonal-F, Menopur, Ganirelix, Lupron/hCG co-trigger. For embryo transfer: estrace and PIO.

Everything was covered by my insurance except storage.

Dr. Kalra is a very kind and knowledgeable woman. We saw her after two natural miscarriages, and the OBGYN pointed us towards Penn to try and get some answers as to why it happened twice. Dr. Kalra sat down with us and mapped out the next steps and what blood work and tests were needed. She explained the process of pregnancy and why miscarriages happen from time to time. While under her care, my husband and I went on two have two more miscarriages and she could not have been more compassionate during that time. She really felt for us and it showed. During the course of treatment, often times you will see the nursing staff and not necessarily your doctor. When I did see Dr. Kalra, she was really great.

I think it is important to ask questions. While she explained everything to us, asking for clarification or more detail can be very important. Often it is very emotional and overwhelming when receiving all of the details, so come prepared with questions!

After receiving the initial testing back, Dr. Kalra told us to try on our own for a few months. We did and it resulted in a pregnancy that then ended in miscarriage (#3). We met with her again and she told us to try on our own. When nothing happened after 4 months, I started Clomid and timed intercourse. The following month we did Clomid and IUI, which failed. I then got my period too soon and thankfully a wonderful NP stepped in and viewed my chart and changed me to Letrozole. We then did three more IUI cycles, all which failed. During this time, I did not have any communication with Dr. Kalra and had it not been for the WONDERFUL NP, I most likely would have left Penn. Following the IUI failures, we met with Dr. Kalra again and were going to move towards IVF. However, I ended up getting a new job, and we put that on hold for the summer. Low and behold, I ended up pregnant again on my own, with yet another miscarriage (#4). Now we are awaiting results and another doctors visit.

The four rounds of failed IUI cost me about $1000 out of pocket.

She is always very kind and took the time to answer all my questions, especially when I had bad results. I have since learned that I didn’t always get all the details I would have needed, and I think she was less inclined to think outside the box regarding m case (i.e. taking supplements, knowing my hormone levels and what those meant), but she was a great person and I think for more cut and dry cases, she is fabulous.

Read up about infertility before you go in and ask her all the questions you have regarding things like antral follicle count, hormone levels, etc., so you can track them and also understand where you fit. Chances are she has the info but she doesn’t always share it unless you ask.

After a few Clomid/IUI cycles where many were canceled because my right ovary was working but my right tube had been removed, we moved onto IVF. The first protocol was the high dose protocol of Gonal F and Menopur with a Lipton primer. It was canceled due to poor response. My second cycle was the Lipton flare protocol. We went to retrieval expecting 2 eggs but the one follicle was empty and the other fell apart overnight. I have never been pregnant. Since then, I had my endometriosis removed and have read about low stimulation protocols working better in patients with DOR. I spoke to her about that and she didn’t agree and said donor eggs would be my best bet. She may be right, but I’m not ready to give up on myself yet, so I am switching clinics.

IUI was covered by insurance, so I’m not sure if that. One complete IVF cycle - $8,000 plus approx $4K in meds

N/A - I never had an embryo to transfer

My impression of Dr. Kalra is that she is incredibly smart and incredibly busy. I only saw her during consultations. All my other procedures and monitoring appointments were done by someone else (Dr, technician or resident). I did not get a "warm and fuzzy" vibe but, in the end, that was not the most important thing to me. I think the protocol she chose was best for me and when it did not work, she adjusted it.

Come prepared with all your questions because she is impossible to reach outside of specific office visits.

Mostly covered by insurance. Trigger shot was $30. Clomid/Femara $10. Bloodwork $50. HSG $180. IVF ???? likely in the neighborhood of $7-10k

I was told that, due to my age, only one embryo is recommended. I was not given an option for multiples.

I felt comfortable with Dr. Shah immediately and felt like I was in great hands. Most of my reluctance of recommending her would only come from how Penn Medicine is run and my experience with the nurses. Dr. Shah had a worksheet made up to help guide her conversations with her patients regarding all of the possible causes of infertility and the tests to identify them. It was incredibly thorough and helpful. I have nothing but great things to say about her.

Be aware that Penn Medicine acts a bit like a team and even if Dr. Shah is your primary RE and guiding your care, you will see any of the doctors at a given procedure and no doctor at all during your monitoring.

Dr. Shah debated between an antagonist protocol (which she selected) and another type of protocol (not sure what that would have been) based on my DOR diagnosis and relatively young (in infertility world) age. The logic for going with the specific protocol was never relayed to me. Did a natural start, 450 gonal f for days 1-5, then ganarelix was added, and I went to gonal f 300 + menopure 150. I had a dominant follicle by day 7 which they warned me might get me cancelled and by day 9 they cancelled the cycle and converted me to IUI that didn't work.

Prices changed July 2016 and I do not know current rates. 6750 covered one retrieval and 2 transfers (1 fresh, 1 frozen or 2 frozen) and ALL embryology, anesthesia, monitoring, bloodwork, mock transfer, etc. Everything. Cancelation before retrieval netted a refund of all but 1500. There were other graduated refunds possible (ie only one transfer, but no embryos to transfer reduced cost to 5000). 1 retrieval and 1 transfer (fresh or frozen) was 5000, but the only refund possible was if your cycle was cancelled before retrieval (cost reduced to $1500). This also included absolutely everything (monitoring, embryology, icsi, bloodwork, education seminar, med training).

I had a good experience overall at Penn Fertility. Dr Kalra was a great doctor. However, if you're looking to build a close relationship with your doctor this may not be the best place for you. I didn't get to do any of our IUI's or IVF transfers with her. I basically saw her at our consult appointments and when we were discussing our plans. If you got to this practice you will end up with whatever doctor is available at the location that day. It can sometimes feel a bit impersonal.

Dr Kalra used all of our day 3 testing results to decide which protocol to use. She said my AMH was within normal range so she used what they called a high responder protocol. It worked and we had a smooth and successful retrieval with embryos to freeze. Our first transfer was unsuccessful but our frozen embryo transfer gave us a BFP.

IUIs were 1000 each not including trigger shot and clomic IVF was 6775 for retrieval and 2 transfers (I ended up doing 1 fresh and 1 frozen) My meds for stims were 1800 Meds for FET 350 Overall they are extremely affordable in comparison to many other clinics

Dr. O'Neill was great she empathize with my pain but was candid in her decision making for our care. She did lab orders that I asked for without question and supported us throughout our journey with her.

Always use your voice. You are your biggest advocate.

Her plan if we got to egg retrieval and transfer was to put 2 back in. I have a proven uterus, we have an 8 year old but are struggling with DOR, secondary infertility with male factor. So she felt putting in 2 gave us a better chance of conception.

Strengths: she showed lots of compassion. She was very thorough and I appreciated that about my initial visit. Weak: I wish I could have spoken to her to share some of my concerns including be given the option to have an ultrasound the day of my IUI. Since I suffer from PCOS my progress has always been a little slow so I believe my IUI may have been done too early. I did not get monitored after my IUI. In fact, the office never called and checked on me after my IUI. I was just instructed to call if I get a positive test. If I don’t then I would just call on the 1st day of my cycle.

You may only see your doctor once and that’s it

Letrozol day 3-7....then trigger shot.

$250 for iui

she was very nice. she came into the clinic near the end of my treatments there. I only moved on to another practice because the donor pool they had was much smaller than I hoped and the wait was longer.

It was awhile ago so numbers are a bit vague but we started with clomid, and IUI's. then when I had a blighted ovum decided to move to donor eggs. Their donor pool was small and we decided to move to a larger base. We did do a few IUI's and I recall it was a pain to go into the city to do that specific procedure whil everything else was done in radnor.

I don't recall. We did have insurance to cover some of the procedures and I remember that they sat down and went over everything with me. It was overwhelming but they knew their stuff and explained it all.

His strengths are his empathy and compassion for a very difficulty journey. He answers questions in a simple manner and during each encounter he takes his time to explain thing thoroughly. I have never felt rushed when speaking with him.

Don't be afraid to ask questions.

So far we have only been through consultations and are in the works of developing a treatment plan.

So far have only done consultation with Dr. Edwards. Based on my insurance each consult or appointment will typically cost $50.

Overall I was very pleased with Dr. Sondheimer's care. He took the time to explain the process to my husband and I and made changes when necessary in order to get the best outcome. He took time to call me to check-in to see how I was doing when we did not get the outcome we were hoping for.

Ask questions.

My first round of IVF was covered with my insurance. I am currently in my second round of IVF and am expecting to have to pay for 1/2 of the cycle out of pocket.

Dr Edwards helped our family achieve our goals. He kept us well informed, took time to explain options, risks and odds. I always felt safe in his care.

Be your own advocate. Don't be afraid to ask questions.

We explored many options before we achieved our goal - including IUI, drugs to enhance egg production, etc. I also had a surgery to have a large fibroid removed (myomectomy). In the end, we used an egg donor and, after a miscarriage, had a successful live birth. It was a long road but Dr Edwards helped us at every step along the way.