Estrogen Priming Protocol for DOR with Duostim I have diminished ovarian reserve from multiple surgeries for endometriosis. Dr. Masaba wanted to try IUI first to see how I would respond to meds before proceeding with IVF. IUI is covered by my insurance whereas IVF is not, so I thought this was a good idea before deciding to invest a large amount of money. My antral follicle count had been very low during monitoring - around 2 or 3 during two different baseline ultrasounds. Once it was confirmed that I was responding to meds during my IUI cycle (albeit poorly), Dr. Masaba recommended estrogen priming in conjunction with IVF to increase my follicle production.
Strong was closed for a full week in January (for "winter break") which delayed the start of my treatment by several weeks. - Strong was closed again for a full week less than two months later for "spring break". Luckily for me it did not impact my treatment. I'm sure others weren't so lucky. I own a retail business in a time sensitive industry and the thought of closing for an entire week is laughable. - Egg retrievals are not done on Saturday or Sunday. This severely limits flexibility as a day or two can be the difference between more or less eggs being retrieved.
How was your experience with Erin Masaba at Strong Fertility Center (U of Rochester)?
Dr. Masaba is smart and straightforward, but also kind and warm. She has a positive attitude and a lot of energy. She cares about her patients and is willing to explain things in detail. She's returned my calls during off hours and has never hesitated to help. She gets excited about your treatment and each small success. She's also down to earth and very real, not pretentious in any way.
What's one piece of advice would you give a prospective patient of Erin Masaba at Strong Fertility Center (U of Rochester)?
Dr. Masaba talks quickly and is very energetic. I absolutely love that type of personality as it matches my own pace, but some people may prefer a doctor with slower and steadier style. While Dr. Masaba is extremely smart, to the point, and very enthusiastic, she sometimes struggles with details and organization. As long as you self-advocate and stay up on your treatment details (which I'm finding to be an absolute necessity as an IVF patient), you should be fine.
During treatment, were you treated like a number or a human with Erin Masaba at Strong Fertility Center (U of Rochester)?
Dr. Masaba remembered all the details of my treatment, the specifics of what was going on with me each time I saw her, and recommended a new protocol she had just learned about during a conference because she felt I fit the required profile.
Describe the protocols Erin Masaba used in your cycles at Strong Fertility Center (U of Rochester) and their degree of success.
Estrogen Priming Protocol for DOR with Duostim
I have diminished ovarian reserve from multiple surgeries for endometriosis.
Dr. Masaba wanted to try IUI first to see how I would respond to meds before proceeding with IVF. IUI is covered by my insurance whereas IVF is not, so I thought this was a good idea before deciding to invest a large amount of money.
My antral follicle count had been very low during monitoring - around 2 or 3 during two different baseline ultrasounds. Once it was confirmed that I was responding to meds during my IUI cycle (albeit poorly), Dr. Masaba recommended estrogen priming in conjunction with IVF to increase my follicle production. My antral follicle count went up to 13 and 15 respectively during the two cycles I've done with estrogen priming, so it did help.
The first cycle produced 3 follicles. It was less than hoped for, but the cycle was ultimately canceled because the trigger shot failed and converted to an IUI. No pregnancy.
The second cycle was a freeze all duostim. The plan was to stim, retrieve, and then stim again 5 days later in the same cycle month to capitalize on all the antral follicles from the priming. The first retrieval in the duostim resulted in 3 follices, with 2 mature eggs. Both fertilized. The second retrieval in the duostim resulted in 7 follicles, 5 mature eggs retrieved, and 5 fertilized.
After the duostim, I had a frozen embryo transfer of two high quality 8 cell embryos on day 3. We had one embryo make it to blastocyst on day 6 so that is currently frozen. I did not get pregnant from the transfer.
I proceeded with another duostim using estrogen priming rather using my remaining frozen embryo since I'm 36 and want multiple children. The second duostim had similar results as the first in terms of numbers but I ended up with two 5 days blasts for my frozen embryo transfer and two 6 day embryos to freeze! I was thrilled! I am currently 5 weeks pregnant from the embryo transfer this cycle.
Describe your experience with your nurse at Strong Fertility Center (U of Rochester). (Assigned nurse: Kaitlin)
Kaitlin is extremely sweet and a super caring person. She was meant to be an IVF nurse. She's completely genuine, friendly, and took a personal interest in me as a patient. I always felt comfortable talking to her about anything regarding my treatment. She is a bright point at Strong Fertility.
Describe your experience with Strong Fertility Center (U of Rochester).
Although I'm happy with my doctor and nurse, I am a bit underwhelmed with Strong Fertility as a whole. There were major missteps during many points of my treatment, costing me both money and fertility time. The front desk staff is very uninformed and there are a few staff members that are downright angry and rude. That said, they are conservative and practice evidence based medicine (even though it may mean they are not on the cutting edge). If you prefer science over the kitchen sink approach, then this clinic is likely a fit for you based on the choices in the area.
I've left detailed comments on all of the missteps and errors that occurred so far during my treatment in another section of this review.
Describe the costs associated with your care under Erin Masaba at Strong Fertility Center (U of Rochester).
At the time of my treatment, this was the pricing scheme:
Package 1. $6500 - Includes one fresh IVF cycle and up to 2 transfers (one fresh transfer and one frozen transfer, or 2 frozen transfers)
Package 2. $10,800 - Includes 2 fresh IVF cycles and up to 3 transfers (either fresh or frozen)
Package 3. $14,700 - Includes 3 fresh IVF cycles and up to 4 transfers (either fresh or frozen)
I started with package 1, moved to package 2, and will be continuing with package 3. My medication costs per cycle were around $4000-5000 (would have be $9-10,000 if I hadn't ordered overseas).
If you needed to do any retrievals beyond package 3, previously you needed to start over at package 1 and pay $6500 again which didn't make any sense! After complaining to every doctor I encountered at Strong and making multiple calls to the IVF secretary over my fourth retrieval, I'm thrilled to say that this has been changed! Now additional cycles are $4900 (Package 3 divided by three).
Describe Erin Masaba's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at Strong Fertility Center (U of Rochester).
Dr. Masaba strongly recommended eSET and warned against the complications of multiples. Ultimately I signed my transfer instructions document with another doctor who happened to be in the office that day. She had no issue transferring two embryos considering my age and infertility history, so that's what I ultimately did.
What specific things went wrong at Strong Fertility Center (U of Rochester)?
- Failed to call in prescriptions to pharmacy
- Lost paperwork
- Failed to call with results
- Failed to order appropriate test
- Provided conflicting information
- Failed to convey critical information
- Canceled a cycle due to clinic error
Describe the specific things that went wrong at Strong Fertility Center (U of Rochester).
- Strong was closed for a full week in January (for "winter break") which delayed the start of my treatment by several weeks.
- Strong was closed again for a full week less than two months later for "spring break". Luckily for me it did not impact my treatment. I'm sure others weren't so lucky. I own a retail business in a time sensitive industry and the thought of closing for an entire week is laughable.
- Egg retrievals are not done on Saturday or Sunday. This severely limits flexibility as a day or two can be the difference between more or less eggs being retrieved. Also, if you have any issues with your trigger shot (as I did), and your retrieval is scheduled for a Friday, you cannot simply reschedule your procedure since the office is closed. I had to cancel my cycle.
- When my trigger shot failed, I was told by the nurse to "hope for the best" and continue with the retrieval. No doctor called to discuss my options and the office was closed at that point. After doing research online, I realized that the chance of retrieving any eggs with a trigger failure was basically zero. I had to contact the on-call doctor, who wouldn't really give me any advice either way. When my husband and I decided to cancel and convert to IUI so we could get our money back, he said "You definitely made the right choice". I would have appreciated the straight talk up front so we didn't have to do our own research.
- My medication script was written incorrectly twice. In the first case, I came up short on one medication and had too much of another. As a result, I had to overnight meds last minute and had a stockpile of the other leftover. Luckily I needed them in a later stimulation, otherwise I would have been out thousands of dollars. Had I not seen the mistake the second time around, that number would have doubled.
- The clinic gave me a difficult time about ordering meds overseas as they felt it was unsafe. I understand the concern, but after doing probably 20-30 hours of research on my own, I found that it was both legal and safe. Many clinics actually recommend ordering overseas to their patients. I understand their concern for safety and liability, but I would have expected them to be more knowledgable on this subject. They kept citing a single patient who had a bad round. It was very hard to get scripts printed and I got pushback. Ultimately I ordered overseas and saved over $8000 on medications for my multiple retrievals. The cycle where 100% of the meds I used were ordered overseas resulted in the most eggs collected and fertilized out of the 3 cycles I've done. I am now pregnant using overseas meds.
- The embryologists at Strong do not grade your embryos. I received no number and letter grading. During my call to followup on my frozen embryos, I was told one was "healthy" and had been frozen, but the other was "unhealthy" and discarded. When I called my doctor to discuss, she said they don't give grades. I don't know anyone who has gone through IVF and not received embryo grades. UPDATE: As of September 2018 this seems to have changed.
- Calls are typically made once the office is closed. If you miss any information or have any questions, it's too late to call back in 90% of cases.
- The nurses line is unreliable at best. I'm not sure I've ever received a call back when I've left a message. For example, I contracted an infection during my first IUI, I left a message at 9am saying I had a fever and was in immense pain. Nobody called me back. I called again at 10:30 and left another message. Nothing. Finally I decided to call the "if this is an emergency" extension at lunch. Only then was able to speak to someone. I was seen at 2:30pm, which was great, but it was still quite a while after my initial call. They did treat me in the office with IV antibiotics, which saved me a trip to the ER, but it was concerning that they don't have enough staff to monitor and return calls on the nurses line.
- There are a lot of treatment inconsistencies. For example, for my first two stims I was not told to take any supplements. Then on my 3rd stim, there was a handwritten note to take Co-Q10 everyday. Why was I never told this before?
- Billing is totally screwed up. The clinic has a different billing system than the hospital and they never match up. I never know what to pay and my balance changes month to month.
- Overall I feel that this clinic is understaffed and inconsistent. Their hours are not friendly to the IVF process and certain staff members should likely be replaced. I understand that IVF is a very involved process and managing numerous patients has to be a lot to handle. My recommendation would be to hire more staff to keep things running smoothly, especially considering how much patients are being charged for treatment. UPDATE: More/new staff has been hired as of summer 2018 and things have been running more smoothly in my opinion.