Divya Shah

Dr. Shah was honest and open with me about the risks and the chances of these treatments working. She took time to determine what my expectations were and whether I wanted to pursue IVF treatments before recommending them to me. I always felt like she listened to my concerns and took time to go over studies I found and give me her honest opinion about them. But she was quick to let me know if she did not agree with something, and to give me her reasoning. I felt this was fair, especially since I am also a physician and I deferred to her expertise with the understanding that it was much greater than mine in this field. When we disagreed about next steps, I switched to a different physician in the clinic. But there was no animosity involved with the switch. It was simply a difference of opinion after I experienced two miscarriages with PGS normal embryos. I wanted to pursue further workup for endometriosis and also to try prednisone and Lovenox for my next transfer. Dr. Shah disagreed with this course of action because she felt that there wasn't enough data to justify trying this. I understood her point of view, but I ended up switching to a physician who was willing to try these interventions even without the absence of strong data to support them. Every doctor is different, and I respect their right to practice in the way they see fit, as long as they provide evidence based and compassionate care. Dr. Shah did provide that, so I have no misgivings. For what it's worth, the additional workup and interventions did not end up yielding a pregnancy, so we are now pursuing surrogacy as our next option with the embryos we have remaining.

Don't take Dr. Shah's sometimes blunt or brisk manner as a lack of compassion. She does very much care about the outcome and wants it to be successful. But she is data driven and will not pursue treatments that she feels may do more harm than good, especially if the evidence for these treatments is weak at best.

For each of my four IVF cycles with Dr. Shah, I was treated with an antagonist protocol. I used the highest dosages of stim treatments due to my diminished ovarian reserve (AMH of 0.08 ng/mL). I used 450 IU of Gonal-F alone initially. I then added in 150 IU of Menopur and decreased the Gonal-F to 300 IU after a few days. I used 250 mcg of Ganirelix to prevent ovulation for the last week or so of each stim cycle. Due to my low AMH, my stim cycles were significantly longer than average, between 13-17 days. I triggered with 10,000 IU of HCG 36 hours prior to my egg retrievals. Below are the details of each cycle with Dr. Shah: IVF Cycle 1 (February 2020): Gonal-F 450 IU x 6 days, then 300 IU x 8 days; Menopur 150 IU starting on stim day 7 x 2 days, then decreased to 75 IU x 6 days; Ganirelix 250 mcg starting on stim day 9 x 7 days; HCG trigger 10,000 IU on stim day 15. Started progesterone 50 mg on night of retrieval in preparation for fresh transfer. Retrieved: 6 eggs, Mature: 3 eggs, Fertilized (ICSI): 3 eggs, Fresh transferred 2 day-3 embryos which ended in chemical pregnancy, froze 1 embryo on day 5 (mosaic trisomy 18). IVF Cycle 2 (May 2020): Gonal-F 450 IU x 3 days, then 300 IU x 13 days; Menopur 150 IU starting on stim day 4 x 13 days; Ganirelix 250 mcg starting on stim day 10 x 8 days; HCG trigger 10,000 IU on stim day 17. Retrieved: 8 eggs, Mature: 4 eggs, Fertilized (ICSI): 4 eggs, Froze 1 embryo on day 5 (PGS aneuploid), Froze 1 embryo on day 6 (PGS euploid). IVF Cycle 3 (August 2020): Gonal-F 450 IU x 4 days, then 300 IU x 11 days; Menopur 150 IU starting on stim day 5 x 11 days; Ganirelix 250 mcg starting on stim day 8 x 9 days; HCG trigger 10,000 IU on stim day 16. Retrieved: 12 eggs, Mature: 6 eggs, Fertilized (ICSI): 6 eggs, Froze 4 embryos on day 5 (PGS mosaic and aneuploid), Froze 2 embryos on day 6 (PGS euploid). IVF Cycle 4 (February 2021): Gonal-F 450 IU x 4 days, then 300 IU x 9 days; Menopur 150 IU starting on stim day 5 x 8 days; Ganirelix 250 mcg starting on stim day 7 x 7 days; HCG trigger 10,000 IU on stim day 13. Retrieved: 15 eggs, Mature: 5 eggs, Fertilized (ICSI): 5 eggs, Froze 4 embryos on day 5 (PGS euploid), Froze 2 embryos on day 6 (PGS euploid), Froze 1 embryo on day 7 (PGS mosaic). I also had an ERA done in October 2020 before my first FET since I had a small amount of PGS euploid embryos to work with (I requested this and Dr. Shah agreed). It showed I was pre-receptive so we added in 24 additional hours of progesterone for my FETs. Frozen embryo transfer protocol involves taking OCPs alone for 10 days, then adding on microdose Lupron injections (10 units) for another 7 days, then continuing microdose Lupron alone for 3 days, then decreasing microdose Lupron to 5 units and adding in Estrace 2 mg daily x 4 days, then 2 mg twice daily x 4 days, then 2 mg three times daily x 7 days, followed by a lining check and labs. Goal estrogen level above 200, goal lining above 7 mm. FET #1 (December 2020): Transferred PGS euploid day 6 4AA embryo. Miscarriage at 6 weeks (heartbeat detected in ER where I went after I started bleeding, due to SCH, but miscarriage completed). FET# 2 (May 2021): Transferred PGS euploid day 6 3BA embryo. Miscarriage at 6 weeks after heartbeat detected in clinic (no heartbeat on subsequent US, did have SCH but no bleeding this time). I proceeded to try another FET with a different physician. It ended up with a negative pregnancy test.

I had insurance that covered most of the costs of IVF. My final IVF cycle involved some more out-of-pocket costs after my insurance was maxed out. I believe that an IVF cycle out-of-pocket costs around $11,000. And I did have to pay for a couple of my transfers after my insurance was maxed. Each frozen transfer is $3,500 out of pocket. This includes all the ultrasounds and bloodwork through the first pregnancy test. My medications were also all covered by insurance, but they have an on-site pharmacy that offers discounted rates if you are paying out-of-pocket. My ERA was not covered by insurance. This cost $795.00 with Igenomix. And PGS testing with Cooper Genomics was $1,950 for up to 8 embryos, $250 for each additional embryo.

Dr. Shah encouraged eSET with PGS tested embryos, and I don't believe she would be willing to transfer multiple embryos if they were PGS tested. We did do a fresh 3 day transfer of two embryos after our first IVF cycle. This was recommended by the embryologist and not at our request.

Dr. Shah was always friendly and available when I had questions and concerns. She listened to what I wanted and felt was best for my body. She never pushed for something I wasn’t comfortable with. While we were unsuccessful, I was pleased with our experience. I felt she did everything she could.

Don’t be afraid to speak up and voice your concerns and ask questions.

Our first cycle with Dr. Shah we kept our doses lower to avoid OHSS. As a result I ended up with a small amount of eggs. This led to an unsuccessful day 3 transfer and no remaining eggs to freeze. The second cycle we doubled my meds, yes doubled. This resulted in 21 mature eggs, which was awesome! But our fresh transfer was canceled due to borderline OHSS. We ended up with 4 embryos to freeze. After 2 frozen embryo transfers (1 embryo and 2 embryos respectively) were unsuccessful we decided to take a break. We have 1 frozen embryo remaining.

A single cycle with fresh transfer was $11,000. A FET $3,500.00.

When we saw Dr Shah she would always let us share our questions and provided very detailed (with notes!) explanations of her answers and, at times, what would happen next in our treatment. Unfortunately, we only saw Dr Shah in the office twice (an initial consultation and a meeting before starting IVF). After failed transfers, it would take at least a month to see her and so it felt like she didn't really know us and wasn't closely following our journey. She was conservative in her practice and was adamant at continuing the same protocol even after repeated failures. You need to be an advocate for your own needs and protocol because issues that might come up for you or your health might not be closely monitored or addressed if they're outside the standard protocol.

Choose Dr Shah because you're looking for a safe, researched-based practice that won't be aggressive and make sure you speak up and advocate for your own needs.

FSH / GNRH Antagonistic Protocol - the plan was to do PGS and frozen cycle(s) so the goal was to push my body a little harder than if we were doing fresh. The Dr wanted to be careful since I have a higher AMH about OHSS/over-responsiveness. We had around 12-15 mature follicles in each ovary prior to retrieval but they were only able to get 7 eggs out.

Retrieval & biopsy - $9,000; FETs $2,500 (these prices have now been updated & significantly increased)

Our Dr strongly encouraged single embryo transfers, it didn't feel like there was an option for anything else

Dr. Divya’s strengths include showing compassion, being detail oriented, knowledgeable, and thorough. I haven’t had any negative experiences with Dr. Divya. She explained what would happen every step of the way and also explained the results to all of our testing. She also explained the potential treatments before the results were back and then explained then gave options for treatment. She gave me her opinion, but let my husband and I decide what the best treatment would be for us.

My advice to anyone would be to be prepared with questions. Plan on having some testing done after the consultation as well. We had our consultation, then had blood work, genetic testing, and an ultrasound all in her office minutes after the visit.

We haven’t started any treatment as of yet, but she recommended IVF for us. We’ll be going over the details at our next appointment.

I haven’t completed treatment, but I believe IVF will cost about $15,000. Medications alone will cost a couple thousand and egg freezing will cost about $500 for 3 months (I believe).

She stated that for young couples, I believe under 35 years of age, she would recommend single embryo transfer, but I think it would ultimately be the patient’s decision.

When we started seeing Dr. Shah we had come from another fertility clinic who told us that IVF was the only option we should consider. Instead of just moving us along to that process, Dr. Shah ordered new rounds of bloodwork and some additional tests to round our our history that the other clinic hadn't done. Once we had those results, we were presented with two options - continue trying Clomid or move onto IVF. Given our current financial situation, it was a blessing to hear that Clomid was still a viable option for us. Since that first consultation I've seen Dr. Shah twice more. Each appointment she takes the time to explain to me in very simple ways what is going on in my body and how that impacts my fertility. She's patient and willing to explain things multiple times to make sure I feel comfortable with our plan. She's the best person we could have guiding us through this process at this time.

It took us over a month between when we initially called for an appointment and when we were able to schedule one, so I'd consider calling early. I also don't see her at every appointment, but have been able to (and encouraged by the nurses) schedule other appointments with her if I need to.

I have been taking the highest dosage allowed of Clomid coupled with an Ovidrel shot to trigger ovulation and timed intercourse. That combination works best for me - other options have not worked. Because I have PCOS and annovulation, she has not recommended that we move onto Clomid and IUI. IUI isn't going to increase our chances all that much more and because it isn't covered by my insurance, she doesn't think it's something we necessarily need to consider. This treatment combination has produced one strong follicle in 4 of the 5 cycles we've completed. We had no reaction in the last cycle which caused us to take a break for the summer. We just resumed last week and are in the middle of a sixth Clomid cycle now.

She is a wonderful, honest, thorough physician and she never got frustrated with my thousands of questions. She did everything she could to explain each step of my treatments with me. She also was extremely honest with me in regards to my fertility issues and what my realistic expectations for pregnancy were. I never felt like she would push me toward something she didn’t feel would work for me.

Come prepared with your questions and have an understanding of the process. I feel like having a handle on things and knowing what to ask shows that you are ready to make informed decisions and that you are completely invested in the process. She will explain and re-explain anything you don’t understand. She will give you realistic expectations and she will guide you toward the best options for your specific situation!

I did two iuis with her using an antagonist protocol, then we did and hsg which showed I more than likely have a blocked right tube. We tried a microdose Lupron ivf protocol which never led to a retrieval and was cancelled on cycle day 13 after no growth. I am currently in the tww after a succeful ivf cycle called the estrogen patch protocol and an antagonist protocol.

They were scheduled times with a first come first served policy. Through the years I got to know both the sweet lab technician and the wonderful ultrasound tech! They were always understanding and excited when all was going well or on the harder days too!!

I have insurance coverage to a certain capped amount, so I only paid a copay for dr visits and for donor sperm related costs. Medication coverage limits were reached so I pay all Meds out of pocket.

Because of my low amh and my age, we decided to transfer two eggs to give me the best chance of a positive pregnancy test. I completely agree.

Dr. Shah is excellent at communicating what's going on. She breaks things down for "non-science people" and will re-explain something as much as you want. She is kind, compassionate and has been rooting for us since day 1. She is open to my concerns and suggestions (one example is that I wanted to try a natural FET instead of a medicated cycle). She explained the pros and cons of each and ultimately let me decide. This is just one example of many where she has helped me make a decision.

Be prepared to acknowledge that the office is run much differently than most other clinics because UPenn is a teaching hospital. Once I figured this out, it became much less stressful. You will be on hold a lot. You might have to follow-up with the nursing staff. If you miss a call, it's a huge pain to get the team back on the line. Having said that, Dr. Shah ALWAYS called me back in the same day that I asked to talk directly to her and there is ALWAYS an on-call doctor that you can reach (even at 3am). You just have to know that Dr. Shah is managing your care and that every single doctor at UPenn is fantastic, as well. I never had concerns about my care, it was just annoying the way their communication system is.

Antagonist protocol for egg retrieval (BCP, Follistim, Menopur, Ganirellex). For transfers BCP, Lupron, Estrace, PIO, but ultimately what worked was a natural FET with only Crinone.

The clinic follows the national recommended guidelines for embryo transfer. Due to my age, we transferred 1 embryo each time. Dr. Shah never pushed me to transfer more than 1 and I never asked to.

She was very empathetic and clearly knowledgeable. My only negative is that she was more cautious than I would have liked, after 22 cycles all negative tests- I’ve learned I would’ve like to be more aggressive a year ago.

She will do whatever you choose - so push if you feel like you’re not being aggressive enough with your treatment.

I did the first 8-10 cycles taking letrozole and times intercourse. We moved to letrozole and IUI because that did not work. Due to my PCOS, ovulation was unclear so we introduced ovidrel shots as well. I reacted fine to all of this, the 2.5 mg of letrozole day 3-7 just made me a little more emotional than usual. Then we moved to gonal-f injectables with IUI. This cycle was longer because we started on too low of a dose. At this point we are back to monitoring with oral meds and times intercourse while saving for the inevitable (IVF).

My insurance has covered everything except the gonal-f to date. IVF begins at $8,500. PGS testing is an additional $6,000 and meds between $2k and $5k.

Dr. Shah does not perform multiple embryo transfer to my knowledge.

Dr Shah is genuine and compassionate and although we rarely saw her, we felt like she was monitoring us closely from afar. She didn’t do any of my procedures and I think that played a part in feeling like a number and not a patient at this clinic.

Trust her and don’t be afraid to ask questions!

I was on a high-responder protocol. I was on Follistim 150 daily to start. Eventually added in Ganirelix and menopur. Eventually we attempted HGH because of a cycle that resulted in poor quality embryos, howevery retrieval was cancelled.

We paid separately for the egg retrieval ($12,000), FET ($2,500). PGD was paid directly to the lab and meds were separate. I must also say that the Financial coordinator is extremely unhelpful! We were better off googling. At my first meeting with her, I asked her what options there were for paying (do people ever take out loans, are there assistance programs, any opportunities for discounted meds, etc) and she looked at me like I had 12 heads.

We got the lecture about risks of multiples to the nth degree. I was told I would be the next octomom if we transferred two embryos!

I felt comfortable with Dr. Shah immediately and felt like I was in great hands. Most of my reluctance of recommending her would only come from how Penn Medicine is run and my experience with the nurses. Dr. Shah had a worksheet made up to help guide her conversations with her patients regarding all of the possible causes of infertility and the tests to identify them. It was incredibly thorough and helpful. I have nothing but great things to say about her.

Be aware that Penn Medicine acts a bit like a team and even if Dr. Shah is your primary RE and guiding your care, you will see any of the doctors at a given procedure and no doctor at all during your monitoring.

Dr. Shah debated between an antagonist protocol (which she selected) and another type of protocol (not sure what that would have been) based on my DOR diagnosis and relatively young (in infertility world) age. The logic for going with the specific protocol was never relayed to me. Did a natural start, 450 gonal f for days 1-5, then ganarelix was added, and I went to gonal f 300 + menopure 150. I had a dominant follicle by day 7 which they warned me might get me cancelled and by day 9 they cancelled the cycle and converted me to IUI that didn't work.

Prices changed July 2016 and I do not know current rates. 6750 covered one retrieval and 2 transfers (1 fresh, 1 frozen or 2 frozen) and ALL embryology, anesthesia, monitoring, bloodwork, mock transfer, etc. Everything. Cancelation before retrieval netted a refund of all but 1500. There were other graduated refunds possible (ie only one transfer, but no embryos to transfer reduced cost to 5000). 1 retrieval and 1 transfer (fresh or frozen) was 5000, but the only refund possible was if your cycle was cancelled before retrieval (cost reduced to $1500). This also included absolutely everything (monitoring, embryology, icsi, bloodwork, education seminar, med training).

Explained everything, didn’t make promises she couldn’t keep, was compassionate to our situation, worked with us to try to figure out new plans. LISTENED TO ME and our pushback on the embryologists resulted in my pregnancy.

Advocate for yourself, she’ll listen.

I can’t remember details. I know with unexplained infertility, she wanted to try 4-6 IUI’s to see if that would work. We got disheartened after 4 (well, after all) but we agreed to do the 2 more so the months weren’t wasted.

$400/ IUI, ~$6,000 egg retrievals, $~2,000 transfers.

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She was very honest and compassionate. This wasn't our first cycle so we knew what to expect, but she still went over everything thoroughly. Overall she just came off warm and caring at a point in our lives when we were fragile.

Ask all the questions, even if they sound silly to you, she embraces educating her patients on their treatment.

We used a very strong protocol with ganorelix. I did not produce a lot of mature oocytes. And our fertilization rates were low as well. With PGD and PGS after all.of this we typically ended up with 1 or 2 embryos per cycle.

Our insurance paid 80% after we met our deductible of $2000, but PGD and PGS were not.covered, so we spent $7000 out of pocket on that each cycle.

Strong preference for SET. Very concerned with health and safety of mother.

Strengths: she showed lots of compassion. She was very thorough and I appreciated that about my initial visit. Weak: I wish I could have spoken to her to share some of my concerns including be given the option to have an ultrasound the day of my IUI. Since I suffer from PCOS my progress has always been a little slow so I believe my IUI may have been done too early. I did not get monitored after my IUI. In fact, the office never called and checked on me after my IUI. I was just instructed to call if I get a positive test. If I don’t then I would just call on the 1st day of my cycle.

You may only see your doctor once and that’s it

Letrozol day 3-7....then trigger shot.

$250 for iui