How was your experience with Dan Gehlbach at Midwest Reproductive Center?
I don’t feel like he has a solid understanding of female factors and infertility. If he did, he would know that you can’t treat endometriosis patients with lots of estrogen and get good results. He’d also monitor progesterone levels in a medicated cycle to help increas chances of pregnancy if patients tested low previously. I’m very disappointed in the level of attention given to my care. I had two embryos result and he constantly treated the first step as a “standard” treatment instead of a retrieval for a patient with advanced endometriosis and diminished ovarian reserve. He may have had success with other endo and DOR patients, but I am not one of them that has been able to hold my baby in my arms.
What's one piece of advice would you give a prospective patient of Dan Gehlbach at Midwest Reproductive Center?
Stop treating each patient with the standard approach for the first round, you need to treat each patient with heir diagnosis in mind and the whole patient for their optimal results. The conservative approach does not work when you only have 1-2 tries for each treatment. And do not negate injectable IUIs bc they cost more than medicated IUIs. Do those extra tests and get a whole picture before going forward. You’re the expert and yet I feel like I have a better understanding of my endometriosis and diminished ovarian reserve than you do. Don’t be skeptical of stepping outside the box when the first approach does not work.
During treatment, were you treated like a number or a human with Dan Gehlbach at Midwest Reproductive Center?
They never mentioned my low AMH before doing any treatment. We knew before seeing them I had endometriosis, but nothing else. They constantly negated the causes and symptoms of endometriosis during treatments while only doing “standard” options. I also asked what more we could do and they didn’t give any outside resources to improve egg quality or health, just a more aggressive stim medication protocol in the hopes of getting more eggs to and therefore more embryos. They don’t fully understand female infertility and when addressing my concerns, I felt like they were talking me down from them instead of honestly understanding why I had concerns.
Describe the protocols Dan Gehlbach used in your cycles at Midwest Reproductive Center and their degree of success.
We used letrozole for all of our 7 IUIs. I had 3 mature follicles each time and my husband had very good numbers. Because we always had a good response, they did not want to change to dosage or protocol. I took it beginning on day 3 for 5 days and then went in around day 11/12 for an ultrasound to check follicle response and do a trigger 24-36 hours before the IUI.
For the first retrieval we did 10 days of 225 menopur, 225 follistim, added in ganirelix injections after day 5/6, and a lupron trigger. I only had 7 mature follicles, but all 6 eggs they retrieved were mature, all fertilized with ICSI, and then none of them made it to blastocyst by day 6.
For our second retrieval we did a “poor responders protocol” for 300 menopur, 300 follistim, microdose lupron twice daily, and a growth hormone. We did a double trigger after 11 days of stims after they added an additional day. We had 9 eggs retrieved, 7 were mature, and while 5 fertilized with ICSI, just 2 made it to blastocyst by day 6. We decided to not do genetic testing. For the first FET, I took estradiol 3 times daily and then after 2.5 weeks, they did an ultrasound to check my lining and added in 10ml PIO injections once a day and 100 mg endometrin twice daily the following day. After 5 days of PIO, we did our transfer of a 5AA embryo. We had a negative beta blood test. The next cycle we did a mock one for an ERA test and endometrial biopsy for inflammation. The ERA showed I needed another day of PIO, but no inflammation was present. We attempted another FET, but because I was in estradiol for over 4 weeks, my body decided I needed to have a period and we had to cancel our transfer. I had big concerns about the long time on estradiol, but was talked through the steps they would take to make sure my lining was healthy for transfer. After a 16 day, very heavy period and 7 days of oral progesterone, we prepped for another transfer. I did the same doses of meds as the first, but added the extra day of progesterone after my second lining check. We had a positive beta at 85, but after 72 hours my hcg level was only at 135 and by the next beta 48 hours later my level had dropped to 100. The following beta confirmed a loss at 26 and I went back one more time to follow my levels down to under 5. We have our follow up on Friday and I consider myself still under his care.
Describe your experience with the nursing staff.
They have always been kind, but I feel like one is constantly trying to sell me on the decided treatment plan or talk me out of my concerns with my endometriosis and dimished ovarian reserve. But they are always nice and cordial to talk with over the phone or in person.
Describe your experience with Midwest Reproductive Center.
The standard approach is not ideal. Does it work? Somewhat and sometimes. Do they need to investigate more about each patient before deciding on a course of treatment, yes. We ended up no doing our genetic testing and asked after a few weeks that our credit go to repay part of our loan we had taken out for IVF ( we pay 14% interest on this). The last time I was there they said it was still on my account, not following through makes me feel as though they didn’t fully understand my request.
Describe the costs associated with your care under Dan Gehlbach at Midwest Reproductive Center.
Each IUI we had to pay $380 for the IUI treatment and then $100 for the trigger shot. The oral letrozole was $10-$15 each cycle and our labs and ultrasound were covered by our insurance with a co pay after deductible.
Our IVF cycles we took our a cycle package for 2 retrievals and up to 4 transfers for $20,000 and financed it through another company, ARC and NBT Bank. We paid $5,600 for our first cycle stim meds, $8,200 for our stims meds and medications for the second retrieval. Our estradiol and birth control were all covered by my insurance and only cost us $5 each cycle. Our PIO cost $90 for a 20 day supply, the endometrin cost $95 for a 28 day supply. None of our diagnostic testing was covered and we paid $96-$900 for each over the course of 3 years.
Describe Dan Gehlbach's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at Midwest Reproductive Center.
I appreciate the single transfer because the ultimate goal is one healthy baby and if you transfer a healthy embryo, it may split into twins already. Double that and it’s quads.
What specific things went wrong at Midwest Reproductive Center?
- Failed to call with results
- Failed to order appropriate test
- Provided conflicting information
- Failed to convey critical information
- Failed to consider drug intolerance