How was your experience with David Barad at Center for Human Reproduction?
I am an older patient in terms of fertility treatment, which is difficult in and of itself. Dr. Barad and CHR do present themselves as specializing in older women, which of course helped me feel somewhat better and, as a long-distance patient, this was the primary reason I chose CHR. Dr. Barad was noticeably kinder and more reassuring in his manner (despite the abysmal statistics we have faced and still face in this process). He was communicative and receptive to questions or concerns. However, CHR as a whole, including all 3 of its physicians to varying degrees, could do a far better job with patient communication. For example, for our first IVF cycle, we were not told that we would be automatically required to do ICSI and assisted zona hatching. We arrived on the day of scheduled egg retrieval and at this point were asked by front desk staff to pay an additional ~$3500, which seemed very unprofessional. Also, my partner and I currently live outside the U.S., and particularly prior to our first IVF cycle, at times it was very difficult to get clear, prompt and complete answers to our questions from nurses ("Clinical Coordinators") and staff. This greatly hindered our efforts to complete the requested immunological testing for CHR prior to the first IVF cycle. It took an inordinate amount of phone calls, clarifications and excess time to clear up what could have been resolved in a couple hours with clearer and timelier answers and better communication.
What's one piece of advice would you give a prospective patient of David Barad at Center for Human Reproduction?
Ask all the questions you have; be very clear about what information you need and have questions prepared ahead of time. You get very little designated face-to-face time with physicians at CHR during a cycle. If you're struggling emotionally and if you're able to, let him know that this process is hard for you.
During treatment, were you treated like a number or a human with David Barad at Center for Human Reproduction?
Dr. Barad is very kind and is receptive to questions / concerns. He has a warm manner and seemed to understand how terrifying and profoundly disturbing this process can be.
Describe the protocols David Barad used in your cycles at Center for Human Reproduction and their degree of success.
Initial ultrasound around cycle day 2, then Follistim (or Bravelle or Gonal-F) 450 IU QAM for about 9 days, along with Menopur 150 IU QPM for about 9 days. Daily ultrasounds starting about day 5 of hormonal stimulation process. HCG trigger shot timed so that follicles were not too mature. Egg retrieval 36 hrs. later, about cycle day 13. Important - NOTE: Embryo transfer for me was always on DAY TWO. So all embryos were only 2-day embryos. This is something CHR does often with older women. Also, we were explicitly advised AGAINST pre-implantion genetic diagnosis. Dr. Gleicher (as "lead" CHR physician) felt that PGD offered more risk than benefit for my embryos as an older patient. (This was of course in direct contrast to what other clinics had told us, but I was ok with it.) I had some evidence of an unidentified immune issue, so in addition to hormonal medications, here were the medications prescribed: DHEA 75mg daily before and throughout all cycles (I took less), CoQ10 1000mg daily (I took ubiquinol instead as I believe it's better absorbed), low-dose aspirin, prednisone ranging from 10mg and 60mg at different times during IVF cycle, doxycycline around time of egg retrieval, Lovenox (enoxaparin) 40 mg following egg retrieval, and daily progesterone in oil injections until pregnancy test (or 12 weeks gestation). Prior to IVF treatment, with my second (natural) miscarriage, I learned my thyroid was underactive, so I now take natural dessicated thyroid (a medication called "WP Thyroid"). Dr. Gleicher told me, as I understood it, that he sees any unexplained hypothyroid issue as an autoimmune issue. My initial immunological testing also found that I had an extremely high interleukin-6 level, which is indicative of inflammation, but not useful information in terms of any specific clinical cause or source. I also was prescribed an IV infusion of Immunoglobulin-G (very expensive) before egg retrieval due to likely autoimmune issue, as well as because Dr. Gleicher believed my partner and I had some HLA type I and II matching. (Apparently, Dr. Braverman of Braverman Reproductive Immunology, who we consulted with briefly, disagreed with this assessment.) Before my second IVF attempt I was directed to start Plaquenil (hydroxychloroquine) 400 mg daily to (hopefully) prevent miscarriage prevention. CHR prescribed Plaquenil as an attempt to address my high IL-6 level/suspected autoimmune issue as well as recurrent miscarriage. (I have since chosen on my own to discontinue Plaquenil.)
Describe your experience with your nurse at Center for Human Reproduction. (Assigned nurse: Maria)
I had a hard time getting clear, timely and complete answers to questions with my initial coordinator at CHR, Ella. We were communicating from outside the U.S. and needed very clear information about what tests CHR was requesting and how to get blood samples shipped to CHR, and trying to get clear and complete answers from our coordinator and the nursing staff was a complete nightmare. Ultimately I asked to speak with a supervisor, and the nursing supervisor took over. It was an unpleasant experience. We later worked with Maria, who was much more reliable, although not easy to reach directly and not particularly warm or communicative.
Describe your experience with Center for Human Reproduction.
I think I've answered this question already in my previous responses.
Describe your experience with your monitoring appointments at Center for Human Reproduction.
It was not too bad - we did not have a problem with the scheduling. It was however difficult at that time to ask any questions of the doctor, who always seemed quite rushed.
Describe the costs associated with your care under David Barad at Center for Human Reproduction.
Because I was not working, and because of the current exchange rate, we qualified for the reduced IVF rate of $8500 per cycle. To this was added the following: $4200 per cycle for anesthesia, ICSI, and assisted zona hatching; $4000 per cycle for IVIg; $3500 on average per cycle for hormonal and other medications; $4500 per cycle for travel (from outside the U.S.) and lodging costs; $3700 (one-time) for all initial immunological testing needed before first cycle.
What specific things went wrong at Center for Human Reproduction?
- Failed to call in prescriptions to pharmacy
- Lost results
- Failed to convey critical information
Describe the specific things that went wrong at Center for Human Reproduction.
After working very hard to get the correct information from CHR on what phlebotomy tubes were needed, I completed a blood draw outside the U.S. for a lupus anticoagulant antibody test (along with 1 or 2 other tests), and shipped the sample overnight to CHR, at high cost to us. We were then told that CHR's lab could not use the sample because either the patient was on anticoagulant medication (I was not), or the wrong tube was used.
We also were not told that we were automatically required to undergo ICSI and assisted zona hatching until the day these procedures needed to be completed - the day we arrived for our first egg retrieval. We were asked on arrival that day to pay an additional ~$3500 for this, which had never been mentioned before. I found this inappropriate and unprofessional.