How was your experience with Dana Ambler at Conceptions Reproductive Associates?
Dr. Ambler is not overly compassionate and can present information in a blunt manner, but she delivers bad news gently. I prefer physicians who present information factually and avoid sugar-coating bad news, so I liked Dr. Ambler's approach. Infertility diagnoses and treatments can be confusing, so it is challenging as a patient to know what questions to ask during office visits when you hear your diagnosis for the first time. Dr. Ambler and her nurse were available to answer questions after appointments if I had any. Dr. Ambler changed her treatment plan for me as needed based on my results & response to medications. She kept me informed regarding why she was making the changes and what to expect with the new medications. In addition to the initial consultation visit, Dr. Ambler also met with my husband and me after completing 3 rounds of treatments to reassess our plan.
What's one piece of advice would you give a prospective patient of Dana Ambler at Conceptions Reproductive Associates?
Research infertility treatment options before your consultation visit and come with prepared questions. I recommend reading Toni Weschler, MPH's book, "Taking Charge of Your Fertility" to better understand reproductive health, in general. Schedule time for acupuncture, massage, or relaxation to help you maintain sanity while addressing infertility.
During treatment, were you treated like a number or a human with Dana Ambler at Conceptions Reproductive Associates?
Dr. Ambler was receptive to allowing me to attempt pregnancy using my eggs instead of going straight to donor eggs for IVF. With low ovarian reserve, using my own eggs was unlikely to result in pregnancy even with IVF, but Dr. Ambler did not pressure me to use donor eggs simply to improve her statistics. Dr. Ambler, nurses, and ultrasound technicians patiently answered our questions, and we never felt rushed during appointments.
Describe the protocols Dana Ambler used in your cycles at Conceptions Reproductive Associates and their degree of success.
First Cycle: Took Clomid 50 mg for 7 days. Dr. Ambler also prescribed DHEA 75 mg daily (lab work performed to find optimal dose) and 300 mg of CoQ10 daily. I developed an ovarian cyst with Clomid and did not release an egg. Clomid was given to encourage my body to produce more FSH and LH to stimulate egg production. CoQ10 and DHEA help make mature ovaries (maternal age above 35) more responsive and "youthful."
Second Cycle: Took Clomid 50 mg for 5 days. Ultrasound showed an 8 mm immature follicle only on day 12 & LH surge detected in bloodwork on same day. No trigger medications given due to follicle immaturity. Natural intercourse with husband recommended but did not result in pregnancy.
Third Cycle: Letrozole 2.5 mg pills taken once daily on cycle day 3 to 7. Daily Menopur 75 IU subcutaneous injections started on day 6 until day 9. One mature follicle and one immature follicle were noted with ultrasound on day 10. Lab work indicated I was going to ovulate early, and the egg was released before triggering and retrieval could be performed. Again, natural intercourse was recommended, but no pregnancy resulted. Letrozole (Femara) was given to stimulate follicle development and ovulation. Femara is often given if a woman does not respond to Clomid. Menopur is a gonadotropin that mimics FSH and stimulates the ovaries to produce follicles.
Fourth Cycle: Letrozole 5 mg was taken from cycle day 3 until cycle day 7. Menopur 75 IU subcutaneous injection was given cycle day 6 until cycle day 10. Menopur 150 IU subcutaneous injections started on cycle day 10. Lab work and ultrasound performed on cycle day 12, and I again showed signs of early ovulation. Two mature follicles noted. No triggering medications given, and no egg retrieval possible.
Fifth Cycle: Letrozole 5 mg taken cycle day 3 to 7, menopur 75 IU injections given days 6 to 9, menopur 150 IU given days 10-11. Ganirelix started on day 12 to prevent ovulation until follicle could mature. Intra-uterine insemination performed, but did not result in pregnancy because of poor sperm quality (low motility, low count, abnormal morphology). Continued intra-uterine insemination, despite low quality sperm, because my ovary had prepared a healthy mature follicle. Prometrium 200 mg (Progesterone) was taken after IUI. No pregnancy resulted. Ganirelix is a gonadotropin releasing hormone antagonist and was given to delay ovulation since I had a pattern of early ovulation.
Describe your experience with your nurse at Conceptions Reproductive Associates. (Assigned nurse: Tricia)
Tricia was an angel. She was compassionate and patiently answered any questions I had about the treatment plan or medications. She was exceptionally kind and gentle when she had to report negative lab results. She eased my concerns and delivered care in a calm manner.
Describe your experience with Conceptions Reproductive Associates.
Strengths: Multiple locations throughout the Denver area. You may have to drive to all of the locations at some point in your treatment depending on what treatments or tests are required during your cycle. Scheduling appointments was easy. Nurses, ultrasound technicians, and administrative staff were kind. Beautiful offices.
Weakness: Depending on the time of day, the office can be busy with multiple patients having lab work and ultrasounds performed. Administrative staff did not understand how my fertility benefits worked and were going to charge me cash amount for diagnostic tests after a failed IUI. My insurance only covered diagnostic treatments, but since I had IUI performed, staff thought all further office visits and treatments would not be covered. I had to explain that the IUI failed, so we were back to diagnosing the problem, and the office visit and testing should be billed to insurance. Weekend office hours are limited, so it can be challenging to have ultrasound or lab work performed if needed. Lesson learned: Don't make plans if you are receiving infertility treatments. You are a slave to your cycle.
Describe the costs associated with your care under Dana Ambler at Conceptions Reproductive Associates.
I don't remember the exact costs of the medications, but I paid between $200 to $500 for the medications each cycle. The IUI cost approximately $4000. My insurance covered lab work and ultrasounds at 80%, so I paid $50 to $150 for diagnostic testing.
Describe Dana Ambler's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at Conceptions Reproductive Associates.
Dr. Ambler did not express a strong preference for single vs multiple embryo transfer, but we did not reach a point in my treatment where we were discussing embryo transfer for IVF. At the consultation, she recommended single embryo transfer due to risks associated with twins, triplets, etcetera.