Hakan Cakmak

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.

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.

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.

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.

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. 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.

This doctor is not going to be your best friend but he'll do everything he can to get you the results you want.

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.

Ah, I don't really remember exact specifics. About 45k for 2 rounds of IVF

I found Dr. Cakmak very open to transferring multiple embryos and not overly invested on communicating the potential downside of a multiples pregnancy.

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.

He's slightly socially awkward but he's got a great heart!

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.

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.

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.

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.

Bring a list of questions to your appointment and ask them after he has reviewed his assessment and plan.

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).

$15k for IVF stimulation cycle with retrieval and embryo transfer, $400 for medications; $3500 for frozen embryo transfer IUI cycles were covered by insurance

He didn't have a strong preference (given multiple failed rounds), but educated us on risks of multiple gestation.

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.

To look beyond his bit of social awkwardness!

* 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

Dr Hakan Cakmak (not Cakmak Hakan) is a very kind and professional individual. He is capable of seeing beyond the regular methods and integrating cutting edge ideas. We were able to continue along a pathway of hope when other Drs had tried pushing us in directions we didn’t want to go. We highly recommend Dr Cakmak and appreciate his help in assisting us with creating our next generation with our own genetic material.

Older ladies remain calm if he repeats how age plays a major role in egg quality.

We did two mini IVF cycles, the first I didn’t respond so well. The egg retrieval collected 4 of 8 eggs but only 2 were mature. We ended up with one embryo of 3 days that resulted in a negative pregnancy test. The second time the protocol was changed to include human growth factor injections (to improve egg quality), and froze all embryos that reached 5 days (so my body could recover and be prepared for the transfer). We had 2 frozen embryos they both made it through the thaw and were implanted. I was having daily Progesterone injections and 3 day estrogen patches to prepare my uterus for the embryos and make it a receptive environment. We were lucky enough for one embryo to implant and become a healthy pregnancy. We couldn’t afford the genetic testing of the embryos but the subsequent blood screening panels were negative to all 175 conditions. I continued the daily Progesterone and estrogen patches until the roughly the end of trimester 1.

$12K roughly for upfront payment of mini IVF freeze all day 5 embryos, frozen transfer with ICSI.

Because of my advanced maternal age we were able to implant more than one which we were happy to do.

Since I rarely see Dr. Cakmak during my visitations, I can't really say much about his strengths. Based on my initial consultation, he explained the whole IVF process to us and it made a lot of sense. He also tries to make me feel comfortable by trying to engage in conversations while performing the sonogram. He had a positive attitude and believed that I would have a successful pregnancy even after multiple failed attempts. I do have to say that one of his weakness is not being able to do a smooth transfer on transfer day even with a mock transfer. He stated that I have a very curvy cervix but other providers were able to do it without working with me.

I would advise a patient to not expect to meet or see Dr. Cakmak other than the initial consultation. Since I was unsuccessful, I had the option of doing a follow-up with him but other than that, you would have to go through the staff. You would only see him if your appointment happens to land on the day he is on duty because UCSF has multiple providers working in the same clinic.

I don't remember protocols for the retrieval process because it was about two years ago. I do remember that in the beginning, he only gave me 1cc or progesterone and then after being unsuccessful, increased it to 2cc and I got pregnant but had a miscarriage. For the last two transfers, we started at .5cc for two days, 1cc for two days, and then 1.5cc up until I found out the pregnancy results.

Well we live out of town so going in for an appointment would be the whole day. All the appointment was never convenient for us as far as the day goes but they did let us choose the time that is convenient for us.

retrieval=$12,000, anesthesia=$800, sonogram=$600, genetic testing=$300, freezing embryos=$500 initially (increases by $100 every year), FET=$3000, medications/supplies=$500-$1000

My doctor strongly suggested that we only transferred one embryo because I was 26 at the time and he said young people have a high success rate. After the first failed attempt, our doctor allowed the following two attempt to have two embryos. He informed us that a single healthy baby was their goal and that multiple births might be risky.

Dr. Hakan was the first infertility doctor I see. I only talked to him once. Because my husband has 0 sperm count, we decided to do IUI with donor sperm. I only saw him once when we first decided on the plan. He never followed up with me after that. I'm not even sure if he ever looked at my test results. I did 5 cycles of IUI all negative. The doctor never once proposed any different approaches, never discussed with me on the result at the end of each cycle. I later switched to Kaiser, and was diagnosed that I had a bloated left ovarian tube, which would produce toxic liquid that cut my pregnancy success rate half. I felt I wasted a lot of time and money for doing the 5 cycles of IUI at UCSF without finding out anything.

go to someone else who actually cares.

Dr. Hakan suggested medical assisted IUI with donor sperm. As I was not aware of any infertility issue on my part, I suggested I'll try the first cycle without medicine assist, which didn't work. The following 4 cycles are all medicine assisted, none of them worked either. Dr. Hakan never reviewed the result with me after each failed cycle. I felt like really left in the dark just trying by myself. Later at a different facility, I was diagnosed with one dialect fallopian tube, and also with poor egg quality.

My insurance covered most of the cost, but the billing process was slow,and I received a bill from them a year after the treatment when I already changed insurance.

didn't discuss that

I like him. He is direct and comes across as honest and caring. He's a little bit awkward when it comes to bedside manner, but I take that as his "scientific" background, not that he doesn't care. Always asked how I was feeling, checked in on my husband, daughter, etc.

Make sure to schedule tie with him. As a research clinic, he typically won't be there at all of your appointments.

As minimal meds as possible. Always open to searching for generics, etc (meds cost savings.) Respectful of what my insurance would cover.

$20,000 for IVF (total, including meds.) Not sure on prices for IUI (my insurance covered.)

Dr. Cakmak is a very patient and dedicated doctor. He makes the time for his patients and is willing to entertain EVERY question. Since I had a diagnosis of unexplained infertility this was difficult to know what course of treatment to take. Through a series of trials (and trials and trials) and errors, we finally ruled out every reason. After transferring a pgs-normal 6aa embryo, it worked. Lots of time, money, tears and care went into having our son, and I feel like our success was Dr. Cakmak's as well. He was with us as a doctor, and also as a counselor.

Be patient. I know it really hurts to hear, but making babies takes time and can be an incredibly frustrating experience. It might not work the first or second or third or fourth time. Be prepared to pay for multiple cycles. You are stronger than you think.

We went to Dr. Cakmak after kaiser couldn't fit us in for a repeat cycle (when the first failed). At our first cycle (kaiser) we had A LOT of immature eggs. 17/22 harvested to be exact. This is not normal. Dr. C reviewed their evidence to harvest when they did and he would have made the same choice, so something was wrong not with protocol but with my response. We did another fresh cycle (with UCSF) and waited longer to harvest. I forget how many eggs they got. 17ish. More were mature. We had average losses by day 3 and 5. Transferred one that failed. Next time FET we transferred two. Failed. Next FET we tried uterine scratch and glue/hcg and it failed. We were out of embryos. We did another fresh cycle. Did a uterine biopsy and sent that away to determine if the timing was off. We had all embryos pgs tested. On our final cycle, we transferred 1 pgs normal 6aa embryo. I thought, there is no reason this shouldn't work...and finally it did. Our son was born healthy at 39 weeks.

$13k per fresh cycle plus meds ($5-6k). FETs were cheaper. I forget how much.

He prefers single embryo transfers. Twins are more risky and a lot more work as a parent!!!

I always had full trust that I was being presented with appropriate, well-supported advice and that my care was in good hands. His bedside manner is perhaps not the best in that communication style is a bit forced-friendly, but honestly that was less important to me than that I was getting top-notch care.

Explain what matters to you. Do you want to hear the numbers/odds, or do you prefer to hear anecdotal stories? Are you willing to do absolutely anything it takes, or do you have limits? He will appreciate your candor.

Dr. Cakmak is caring, would definitely listen to all your concerns, upfront about the risks and expectations. He would always follow up, even on weekends, if there is an issue outstanding. I felt very well cared for and absolutely trusted his advice and recommendations.

He is a great doctor, will be realistic yet willing to take what you are hoping to achieve into account and work with you.