How was your experience with Eric Levens at Shady Grove Fertility?
From the first time I met Dr. Levens, it was very clear that he makes a personal investment in the care and well-being of his patients. I tend to have a lot of intricate questions and he regularly engages in answering these in sufficient detail. While Dr. Levens has a game plan with treatments, he is open to patients' input and, if so desired, will discuss the pros/cons of what one might have found in researching the latest protocols or merits of various options. I have recommended Dr. Levens to numerous friends and acquaintances as he has a terrific bedside manner. Infertility treatments can make male partners feel marginalized yet Dr. Levens' attitude and soft-spoken nature are very approachable to men as well and he puts them at ease. Although this stage of the relationship deepened with IVF (and was less so during the TI/IUI phase of my treatment), Dr. Levens frequently calls ahead of procedures if he isn't the one on-call that day and even after to offer support/encouragement. As the complexity of my clinical situation expanded, Dr. Levens' personal attention to my case increased and he communicated updates to me much more often rather than relying on the nursing staff. When one egg retrieval went particularly awry, he updated me regularly on what was going on. It was clear that Dr. Levens was as interested in the outcome of my medical care as my husband and I--further, he even commented on how personally took this clinical setback so Dr. Levens is definitely in the trenches with his patients. Through my several years as his patient, I particularly appreciated how Dr. Levens sought to keep as many options open for his patients as possible (e.g., endometrial prep for a fresh transfer just in case we decide to go for this option on day 5 vs do a freeze-all, go/no go options on PGS testing, etc.). The language a person chooses to use can say a lot about one's true take on a situation and Dr. Levens speaks of 'we' vs 'you' as in 'we are in this together' and that shows up in every aspect of the care I received to date--infertility really is a team sport.
What's one piece of advice would you give a prospective patient of Eric Levens at Shady Grove Fertility?
Although he has a very caring nature, Dr. Levens tends to have a more pessimistic/realistic view of the situation so be mindful of this. For instance, Dr. Levens regularly subtracts 10% from assorted success statistics I've seen (e.g., chance of implantation, odds of pregnancy from procedure, etc.) so consider this when hearing both good news (it's likely better) or bad news (it might not be as bleak). Dr. Levens is also really approachable so do take him up on the offer of reaching out with questions in between consults and/or during monitoring as he will make time to speak with you. As with any infertility treatment, be your own advocate.
During treatment, were you treated like a number or a human with Eric Levens at Shady Grove Fertility?
Despite having a very busy practice and being its medical director, Dr. Levens frequently goes the extra mile to answer detailed and numerous questions, calling ahead of and after treatments, and being available to do procedures himself whenever possible. He listens carefully and attentively so I have never felt rushed during consults or even with middle-of-the-hallway questions during monitoring. Dr. Levens encourages patients to be engaged in their care and always invites follow-up inquiries as needed.
Describe the protocols Eric Levens used in your cycles at Shady Grove Fertility and their degree of success.
I did 2 medicated timed intercourse cycles with Clomid, an IUI with Clomid and supplemented with Gonal-F, 2 non-consecutive IUIs with Gonal-F, an antagonist IVF (Gonal-F and Menopur with Cetrotide followed by HCG trigger), an agonist IVF (Lupron, Gonal-F, and Menopur with HCG trigger), an antagonist IVF with a dual trigger (Gonal-F and Menopur with Cetrotide followed by HCG and Lupron triggers), and 2 estrogen priming antagonist cycles (i.e., estrogen is used to prime follicles mid-luteal phase ahead of a stim cycle the following month). After 5 IVF stim cycles, I finally got pregnant from my 2nd estrogen priming cycle. During this time and ahead of the FET, I also used CoQ10/ubiquinol (~6 months), acai berry (~2 months), and acupuncture (~5 weeks ahead of transfer). For the FET, I was on PIO, vaginal Estrace, low-dose aspirin, and Lovenox. In terms of rationale for stim protocols, we were working on reaching greater levels of egg maturation by various mechanisms in hopes of making more embryos. My last cycle yielded 2 AA blasts (a personal record) of which 1 became my daughter.
Describe your experience with your nurse at Shady Grove Fertility. (Assigned nurse: Layluma and Chelsea)
I've been in treatment for so long that managed to have 2 nurses. Layluma was fantastic--very sweet and caring--both as my primary nurse (for TIs and IUIs) then we kept in touch upon her promotion to leading the surgical team. Chelsea took over as my primary nurse thereafter and has been great about answering my many questions promptly and patiently. During a particularly stressful time during my doctor's rare day off, she even went the extra mile of getting timely guidance on protocol modifications from an RE late on a Friday afternoon. As a testament to her approach to patient care, I decided to stay with Chelsea even after she switched to another office. Since most of your clinical relationship is with the nurses, I was fortunate to have had a positive experience with a responsive team.
Describe your experience with Shady Grove Fertility.
Shady Grove's (SG) strength is in its reputation and size as apparently the biggest fertility clinic in the nation. With experienced REs across multiple centers, the within network expertise is available to guide treatment plans in difficult cases. I liked the flexibility of being able to go to any of its numerous locations (even in several states) as medical records are linked. Overall, getting an appointment is easy especially for monitoring, which can be done in different centers across town rather than needing to be at one's primary clinic every time. Having said this, I found it necessary to book a post-treatment follow-up appointments with my RE weeks out (typically at the start of a cycle) if my goal was to not miss any time due to scheduling availability. While getting a phone consult to regroup was an option, in-person consults had to be scheduled further out. Even though one has to medically qualify, SG's programs such as Shared Risk allow for a certain sense of security to the stress of many unknowns associated with IVF cycles. While I haven't used SG's Shared Risk program, either party (clinic or patient) can choose to withdraw at any time in which case the patient receives a full refund. Although I learned of this too late to fully benefit when first seeking care, SG provides a free consultation for would-be patients who attend a free seminar. This is a terrific idea since some insurance companies make women jump through multiple hoops before being allowed to see a specialist yet timing of early diagnosis is so critical to improved outcomes. SG's major weakness is that patients do not see an RE at every appointment (far from it) and unless one really tries, it's possible--likely even--to have very little interaction with the clinician overseeing your medical care. I had to specifically work on getting attention from my RE between consults since SG is nurse-centric-in patient care, which is admittedly to a detriment relative to competing clinics. For instance, I had to actually ask to receive attention from my RE between consults via call-backs by request through my nurse or run-by Q&A during monitoring if we happened to intersect (his idea & willingness, by the way, for mid-hallway dialogue). Admittedly, my RE was quite open to grant the extra time and even came in purposefully early on numerous occasions to do my egg retrievals himself. Were it not for my RE taking an interest in seeing me succeed in having a baby, I would have left SG for one of the several competing clinics offering more ready access to its REs. I further think that much can be missed by having REs only analyze images rather than being there to see results firsthand and would urge SG to restructure its practice towards a greater fraction of direct patient care.
Describe the costs associated with your care under Eric Levens at Shady Grove Fertility.
I am fortunate enough to have had insurance coverage for infertility treatments. With BCBS for IVF, my costs were usually $5k-$7k for medications, and $2.5k+ for procedures. Via this insurance, patients could bank embryos up to a $25k ART procedure max and $15k medications max (medications coverage was charged at a much higher rate by the pharmacy such that this sum only lasted for 0.5 of an IVF cycle). With my new insurance through Aetna, coverage of procedures and medications varied by whether met the high deductible ($2.8k for family) but then medications and procedures were a reasonable copay. After hitting the OOP max ($4.3k for family including deductible), then everything became free for the remainder of the year. However, this insurance plan has a 4 IVF cycle lifetime max and the insurer directed whether patients were covered for each procedure (e.g., no embryo banking possible). Overall, we spent $25k+ in fertility treatments and medications to have our daughter.
Describe Eric Levens's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at Shady Grove Fertility.
As most REs, Dr. Levens would recommend transfer of a single blastocyst especially following PGS testing although is willing to consider multiple embryo transfers when clinically indicated (e.g., untested embryos, following past implantation failures, advanced maternal age, diminished ovarian reserve, etc.).
What specific things went wrong at Shady Grove Fertility?
- Failed to order appropriate test
- Provided conflicting information
- Failed to convey critical information
Describe the specific things that went wrong at Shady Grove Fertility.
While overall treatment plans ran smoothly, there were a few instances with room for improvement. The front desk staff didn't always have accurate information on which RE was scheduled to do a particular procedure even a day or two out. As a planner, this kind of information was important to me especially since infertility is a process where patients have so little control over anything. When my RE ordered the use of a dual trigger protocol, I received conflicting instructions from the weekend nursing staff of when the two triggers needed to be done relative to each other and the dosing. Although this got resolved because the day of trigger ultimately fell on a school night, if I were not the type of patient to self-advocate and seek out answers then that cycle may have been jeopardized. For one of my embryo transfers, I did not get notification ahead of the procedure how many embryos survived or their status (e.g., morula, blastocyst, etc.) until we were already in the procedure room. The RE on-call even already prepared paperwork with her plan before indicating to my husband and me what were our options. The RE did end up giving us some time to figure out what to do without pressure but I would have appreciated being informed the morning of about the status and grades of my embryos so that could be in a better place to make a clear-headed decision. Further, calls to inform of bad news were on a few instances saved until the end of the day or even after hours. While one has to admire the fact that my RE wanted to give difficult news himself so as to be available to provide better guidance than the nursing team, the wait was excruciating and unnecessary. A better approach would have been for a nurse or even the front desk can do an initial call or even send an email to say that the RE will call to discuss the results. Lastly, the financial department is very much hit or miss so incorrect information was provided on a few instances. For instance, I was told that PGS testing was covered for at least the biopsy; however, this ended up being denied about 9 months later by insurance. In another instance, I was given the green light to start an IVF cycle despite the fact that the financial department could not confirm whether my insurance had enough to the max coverage sum to fund another IVF cycle. Instead, I had to piece together this mystery myself and then pull out of stimming upon having started the cycle because--to the best of my understanding after many, many calls to all responsible entities--insufficient insurance coverage funds remained. Although it has been over a year, this situation still unsettles me greatly as this could have cost me the opportunity to have another child. In speaking with others, discrepancies of various kinds with SG's financial department are not a rare occurrence.