How was your experience with Julierut Tantibhedhyangkul at Cleveland Clinic Fertility Center?
Dr. Tan was informative and caring. She took the time to listen to and address all of our questions and concerns. Even though we saw various other doctors and nurses for procedures and monitoring, I felt good knowing that Dr. Tan was ultimately making the decisions about my care. I will say we did usually have a long wait once we arrived for appointments, but that’s because she takes the time to address all her patients’ concerns during each visit. I never minded sitting in the waiting room because I knew I’d be getting the same personal attention once we were called back. I would recommend her, hands down, to a friend going through infertility. She listened to me when other doctors didn’t, and I am eternally grateful for that.
What's one piece of advice would you give a prospective patient of Julierut Tantibhedhyangkul at Cleveland Clinic Fertility Center?
Prepare a list of questions before your appointment and make notes during your consultation. Be prepared to wait to see her, but know it will absolutely be worth it.
During treatment, were you treated like a number or a human with Julierut Tantibhedhyangkul at Cleveland Clinic Fertility Center?
We only saw Dr. Tan in person a few times for consultations and testing, but each time she knew who we were and was warm and friendly. We went in with a (long) list of questions and she took the time to answer every single one thoroughly. We never once left her office still wondering something or feeling as if we hadn’t been cared for thoroughly.
Describe the protocols Julierut Tantibhedhyangkul used in your cycles at Cleveland Clinic Fertility Center and their degree of success.
We were diagnosed with unexplained infertility. My first medicated cycle, I did Clomid and she ordered bloodwork to gauge my response. I responded well, so we moved onto IUI with Clomid plus Ovidrel trigger. We did two rounds of that, monitored with ultrasound. My lining was on the thin side, and I had bad hot flashes from Clomid so then I switched to Letrozole. We did two more IUIs with Letrozole plus Ovidrel trigger, and monitoring via ultrasound. I had negative pregnancy tests for all of these. At that point, we met with Dr. Tan and my husband and I were ready to move on to IVF. For IVF, I took birth control pills for 3 weeks then had a suppression check (bloodwork and ultrasound). Everything looked good and I was cleared to stop birth control and start stims 4 days after my last BCP. I used Gonal F for stims and added in Ganirelix around day 4 or 5. I got bloodwork and ultrasound monitoring every 2-3 days to adjust meds as needed. My doses were low because I had a higher AMH. I did 8 days of stims then was told to trigger. Based on my bloodwork, I did a combination Lupron plus HCG trigger. I had bloodwork done the morning after trigger to be sure everything looked good. My retrieval was the following day, and I was cleared for a fresh transfer (we did not opt for any PGT). The day after retrieval, I started progesterone suppositories, doxycycline, and Medrol. I took the doxycycline for 5 days and Medrol for 4 days. I had a day 5 transfer of one embryo. We froze two day 5 embryos and one day 6 embryo. (Initially I had 11 eggs. Nine were mature. 8 fertilized. They used ICSI on all mature eggs. I had 7 mature and 1 immature fertilize). Four days after my transfer, I started Vivelle Dot patches. I did those for about 2 weeks, changing patches every 3 days. I got a positive beta HCG on 15 days post 5 day transfer, so continued progesterone suppositories until 10 weeks of pregnancy.
Describe your experience with the nursing staff.
The nursing staff varied. I was never assigned to one specific nurse, and I think that’s just the way the Cleveland Clinic runs things. When I called, I’d just get whoever was available first to return my call. Over time, we learned which nurses were good and which weren’t so great. We had a few that were phenomenal. They were caring, compassionate, informative, and responsive. I loved those ones! I also had a couple with less than stellar bedside manner. With those, I often felt blown off and had to advocate harder for the care I deserved. One in particular never seemed to get my prescriptions ordered (which was time sensitive!) so whenever I had her, I made sure to follow up until everything was taken care of.
Describe your experience with Cleveland Clinic Fertility Center.
Strengths: Being at the Cleveland Clinic, I felt I was getting the most up to date care. I know they do a lot of research and some cutting edge procedures, so I felt good about that. There were also multiple locations. We drove 45 minutes to see Dr. Tan but for procedures and monitoring, the main location was 20 minutes from our home, which was very convenient. I also felt they had a really good embryology lab. I got phone call updates every day about our embryos, and they seem to have very up to date technology. There were multiple doctors, so when we didn’t like our first doctor, we were able to switch to Dr. Tan (who we loved).
Weaknesses: I wish I’d been assigned one or two specific nurses. After the fact, I realized that I think I could have requested a certain nurse when I called and they would have tried to honor the request but I was unaware of that until after my treatment was completed. Communication was sometimes difficult as a result. I feel like that is a problem at a lot of clinics though, based on talking to others in support groups.
Things to know: The biggest thing I learned is to advocate for yourself. You deserve quality treatment. You deserve to be heard and have your concerns addressed thoroughly. You deserve quality care. If you feel you’re not getting it, push until you do. Dr. Tan and most of the nurses were great and this wasn’t a problem with them. With our first doctor and a couple nurses though, we had to push and be on top of things. I felt bad about it at first, but over time I realized we were paying a lot of money and going through something so difficult and we deserved good care. Don’t feel bad about making sure you get it.
Describe the costs associated with your care under Julierut Tantibhedhyangkul at Cleveland Clinic Fertility Center.
We were fortunate to have insurance coverage. But we did have to meet our deductible before it kicked in. I think each IUI cycle (monitoring, IUI, sperm wash and prep) was around $1000 before insurance kicked in.
For IVF, they gave a packet upfront with costs. The package was $11,600. That included the retrieval, one transfer, embryology lab, and one year of embryo storage (basically everything but medications and monitoring). For monitoring, they offer a self pay package. It was around $825 total for 5 ultrasound, bloodwork, and nurse consult appointments. Medications were dependent on where you get them and what you needed. If you wanted to freeze a back-up sperm sample ahead of time, that was $710. Infectious disease lab work was $304. Genetic carrier screening was $500. Both infectious disease and genetic carrier screening were required prior to starting IVF. A hysteroscopy, if needed, was $450. If you’d had an HSG, SIS, or hysteroscopy within the last year, you were not required to get the hysteroscopy before IVF. After the first year, embryo storage is $577 per year.
Describe Julierut Tantibhedhyangkul's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at Cleveland Clinic Fertility Center.
We were comfortable with eSET. Given our ages and situation, we would not have wanted to transfer more than one embryo because the risk of twins was too high. Our clinic’s goal is one healthy baby, and we were on board with that.
What specific things went wrong at Cleveland Clinic Fertility Center?
- Failed to call in prescriptions to pharmacy
- Failed to order appropriate test
Describe the specific things that went wrong at Cleveland Clinic Fertility Center.
Our first doctor did not want to order any hormone bloodwork on me. He said since my cycles were regular “I was fine.” When we switched to Dr. Tan, she ordered a full panel of bloodwork. I’m glad she did because it revealed a thyroid issue that would otherwise have gone untreated. It wasn’t the cause of our infertility, but still needed to be addressed to prepare for pregnancy.
One specific nurse twice failed to get my prescriptions ordered. Once for birth control, which I was told to call on the day I started my period and it would be ordered for me to start the same day. I had to call 3 times and finally speak to a different nurse in order to get it called in. The same nurse failed to call in my post-retrieval medications. I had to call the on-call doctor after hours to get them called in.