Hakan Cakmak

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!

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.

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.

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.

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. 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.

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.

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).

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.

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.

$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!

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.

* 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

Audra is a thorough communicator and is good about contacting you in a timely manner to provide reminders or new instructions.

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.

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.

I felt I was respected and my personal circumstances were taken into consideration. Dr Hakan listened to our ideas and took time to explain what works well for people in our position.

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.

Our nurse was very responsive to all messages, even if she was not working I was able to contact a member of the team. Carolyn is a very positive and encouraging lady, she gave me hope and I looked forward to seeing her. She understands how stressful infertility is and her support really made the infertility journey less scary and manageable.

This clinic caters to everyone possible. They are helpful towards people who can’t afford treatment at private clinics. Important to ask for help and find ways to make treatment and medications feasible. There is a way of paying up front costs to get a reduction of fees. Costs were a major factor for us to get access to fertility treatment, the UCSF have government funding so the costs are less.

$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 honestly don't know how other clinics work but I feel like they don't care for the patient as a whole. They don't check/evaluate the patient's wellness during the visit. I never got evaluated for why I I was unsuccessful 3 times and had 1 miscarriage.

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.

All I have to say is that for the most part, the nursing staff were kind and helpful. Everyone always greet me and my husband with a smile.

The clinic's strengths is that they treat you with respect. The weakness of the this clinic is that they work as a team where you can see anybody within the clinic so there is really no bonding between patient and provider.

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. 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.

Dr. cakmak was with us during every step of our horrible, frustrating journey. We had a "post mortem" conversation after every failed cycle to evaluate what worked and what didn't and where to go from there. We didn't live close to the clinic, but Dr. Cakmak made time for us on the phone. However long it took to understand and talk through it. We also talked via phone during the process. I talked to the nurses too, but Dr. Cakmak's availability to me made me feel like he cared and was in this together with me. We also occasionally communicated via email. The only thing that might have made me feel like a number was when I talked to the nurses (not the ones in the OR, but the ones who scheduled and went over meds with me - they were not nice or helpful). Also would have liked Dr. Cakmak to do all harvests and transfers, but I understand he couldn't be there every time. He did do the last and final successful transfer (and many others along the way when he could be there).

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.

Primary nurse was on leave, so others filled in. Bad communication. Felt like a number here!

UCSF has quality doctors, state of the art facilities, and can handle your care...at a price! Too bad insurance doesn't cover ivf!

$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 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.

always would meet with me or talk on the phone if I asked. Also gave great explanations of what was happening.

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

I've been working with Thuy for a long time. She is quick to call me back, and help me get sone what I need. I only wish that there system allowed for direct communication and leaving messages 24/7, don't just during business hours. If it's outside business hours you get routed through the standard phone tree.

I like that it's a teaching hospital. You get a lot of different caregivers, but this didn't bother me. I like that there is one dedicate care coordinator nurse that is your go-to. It is harder to develop a 1-1 close relationship with your doctor.

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

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.

Office visits included detailed reviews of what had happened, all our options, and the opportunity for me to ask any and all questions.

The front desk staff, coordinators, nurses, and doctors in this practice are all first rate and extremely good. The facilities are pristine too. Only downsides are it is very expensive (more than the average - part of that is it's SF) and the billing department is a complete nightmare.

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.

The nurses were absolutely fantastic. Always on top of everything and super easy to reach and talk to. I always felt super comfortable speaking to them regarding my treatment.

New facilities, quick appointments (rarely much wait), all the staff is super helpful and friendly. The finance department seemed a little out of synch with my case, which had some financial consequences on my insurance coverage.

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

I felt that the doctor gave great care. Although I did not get the results I was hoping for in his care, he was realistic about my chances which I appreciated and helpful where he could be. However, his care team and the other staff did not communicate well with each other and him.

They did not communicate well with the doctor. Also, it was very difficult to get ahold of anyone if I had questions that didn't relate directly to the cycle.