Kate Devine

Dr. Divine, from the beginning, has been honest and candid about my fertility options. Given that I am over 40, she shared the scary statistics without making them feel daunting. Instead, she highlighted all possible options including ones I had never considered (e.g., using donor eggs if mine are not viable). Although she has a direct communication style (think: straight, no chaser), I found her candor to be refreshing. You definitely know where you stand, both with her, and your fertility options. After every appointment, I was clear on what to do next. She has been thorough, rigorous and quick minded I implicitly trust that she will do everything possible to ensure that I have the best possible options during this journey. Given that I struggle financially and, like many, juggle other life stresses, it is a relief to have a doctor and medical team who don’t add unnecessary stress due to lack of bedside manner, incompetence, etc. Overall, I am pleased with Dr. Divine and I look forward to having her continue to guide me through this process!

Ask as many questions as you would like. She is patient and thorough! She’s extremely knowledgeable! She will also guide you to nurses for questions they can address.

I am on round one of IVF with donor sperm. My protocol includes birth control pills and IVF “shots” to include the trigger shot. I have had to increase my Vitamin D. I also elected for PGA testing. Going straight to IVF instead of IUI made the most sense for my age (42)

23,500 for the two round bundle deal. 5,000 for PGS testing, 5,076 for medication. Also approx 2,000 for donor sperm. This is all out of pocket for me unfortunately. No insurance coverage outside of the initial visits

No comments on this actually. She mentioned preferring single and it makes sense to me.

Dr. Devine is very knowledgeable in her field of practice. It is clear that she wants results and hold herself to high standards. She is direct and no-nonsense while still offering hope and I really appreciate this quality in a doctor. Because of these strengths I found it really disappointing that I had almost no contact with her. I had much more contact with the nurse assigned to me-Sheila Ormond who is a phenomenal nurse and support to me during my cycles. When I walked in for my first IUI cycle I was dismayed to see a woman I had never met. I asked her where my doctor was and she said that Dr. Devine would not be performing my IUI. I really wanted to see Dr. Devine and get her real time insights on my cycle. Same thing during my 2nd IUI cycle. Doctor Devine was nowhere in sight. I was assigned a Physicians Assistant who did the IUI. During my 2nd cycle I ran into some complications --my trigger shot did not work! I was sure of it and I needed to speak to Dr. Devine desperately. The nurses did not seem concerned by my pleas to speak with her. They told me that they would handle it and that I should speak to her through them. At that point I reminded them that I am a self-pay patient and I deserved to speak with my doctor. After several hours, she called and we talked at length and she was able to devise a new plan of action. Again, I respect Dr. Devine and her expertise and it is this respect that I have for her that leaves me wanting more contact with her, especially during a complicated cycle.

Have all of your questions written down in advance. She does a great job answering them but you must offer them. If not, she keeps it short and sweet. Also feel free to contribute your thoughts and ideas, after all you are an expert on your own body. She is willing to work with patients when devising treatment plans.

1st cancelled IUI cycle protocol: Clomid 100 mg CD 2-7, Gonal -F 75 CD7-9, trigger, vaginal prometrium 200 mg twice a day. Result: cancelled due to overstim 2nd IUI Cycle: Femera CD 2-7, Menopur CD 7-8, HCG trigger,Estrace due to thin lining, prometrium 200 mg twice a day. Result BFN 3rd Cycle: Femera CD 2-7, Menopur CD 7-8, HCG trigger (trigger failed), 2nd trigger novarel administered intramuscular, Estrace due to thin lining on femera, prometrium 200 mg twice a day. Result TBD I was started out on a high dose protocol due to an elevated day 3FSH, I overstimmed and I also had strange visual side effects with the clomid so I was switched to femera. Not sure why I was switched to menopur but my nurse said something about it being helpful to my lining? (not sure whether that is coming from any real wisdom or if it was a way to get me to stop asking questions) I was switched to novarel trigger during my 3rd cycle because I did not respond to the Ovidrel.

base IUI fee $1800 Meds: $500

Dr. Devine is not warm and fuzzy, as noted above. But she is really really good at setting expectations and I appreciate that. I went to her to preserve my fertility because I had a difficult time getting and being pregnant with my first child. That evolved into me actually trying to get pregnant with a second child - this has not happened yet and we've moved onto getting a gestational carrier and will be working with Shady Grove to do this. We decided it would be a good idea to create embryos right away after having our first child (in part because my insurance actually covered it and I had the time). I got amazing results from the one IVF cycle that I did at Shady Grove: 28 eggs retrieved, 24 were mature, 21 fertilized, 16 made it to day 5 embryos and were frozen, and 8 were genetically normal (2 of the 16 were re-biopsed because they didn't get conclusive results and one was normal and the other was not). That was awesome. However, during the IVF cycle, we discovered that I had "Asherman's Syndrome" still or again - I had it before my first child was born but thought it was treated. It either wasn't totally treated or it recurred from a c-section. We then discovered that even when the scars sticking the sides of the uterus were cleared I still seem to have an abnormally thin lining that tends to collect fluid during treatments that raise my estrogen level - there seems to be a trade-off between thickening the lining and increasing the fluid. Neither of these things is good for implantation. Ugh. I've now had 3 more hysteroscopies since doing IVF (I had 3 prior to having my first child)and done 2 questionable transfers of genetically normal embryos to suboptimal lining conditions at Shady Grove (under the theory that I got pregnant before with a very thin lining - 4mm). My lining does not make it out of the 4mm range. We've now called it quits on the transfers and we are officially moving onto a gestational carrier, as noted above. Dr. Devine actually thought I should go straight to a GC the first time I met with her based on the trauma of my first pregnancy (di-tri triplets, multi-fetal pregnancy reduction, debilitating nausea, intrauterine growth restriction, c-section at 36 weeks and 3 pound 11 ounce baby). But I insisted on trying again to get pregnant. I am calling it quits because it's been 4 years of infertility taking over my life, more than 5 different fertility doctors (not to mention the other ob/gyns and MFMs involved), 2 miscarriages, 2 partial ovarian torsions, 1 botched D&C, 1 multi-fetal pregnancy reduction, 1 c-section, 1 amazing baby with scary terrible pregnancy, 6 hysteroscopies, 2 unsuccessful frozen embryo transfers, and countless random doctors and nurses telling me that my uterus doesn't look good on ultrasound. I can honestly say that the least stressful part of this whole experience was actually my IVF cycle at Shady Grove. That was a total nothing. Worked out great. Can't ask for better results.

If you want someone warm and fuzzy, I would not go to Dr. Devine. If you want someone who will be straight with you, Dr. Devine is amazing. I must tell you that because of how Shady Grove works, you end up seeing whoever is there that day so I didn't always see Dr. Devine. She will call you to follow up but sometimes it's not at a convenient time for you so you end up relying on what other doctors and nurses are saying. This is not a problem with Dr. Devine; this is more just about how the Shady Grove practice works. Everything is high quality, but you don't get your hand held by one person. You have A LOT of access to your nurse, but not as much access to your doctor.

I actually don't remember the specifics of the drugs I took for my one IVF cycle with Dr. Devine. She was concerned about over-stimulating me (I have PCOS and am very responsive to fertility drugs and have had partial ovarian torsion twice). She managed to maximize the number of mature eggs while not over-stimulating me which was great. The rationale for doing IVF was to preserve my fertility since I was 36, my insurance covered it, and I had a hard time conceiving my first child due to Asherman's Syndrome. It's now totally awesome that we have the embryos because we are pursuing a gestational carrier. Okay, here's the complicated thing that happened while I saw Dr. Devine: I wanted to get a hysteroscopy from my old doctor in San Francisco because he had already performed 2 hysteroscopies. I went to him in December of 2016. On hysteroscopy, he thought my uterus looked pretty good and put me on an estrogen therapy protocol. Every single time I went in to have my lining checked at Shady Grove during the estrogen therapy protocol, the lining was still really thin and my California doctor thought I should keep taking the estrogen. Dr. Devine didn't think the estrogen therapy was working. I went with the California doctor's advice because he had helped me in the past and I had had a successful pregnancy. Dr. Devine might be right that it wasn't working. I don't really know. Anyway, I did the estrogen therapy for 3 months. Then I did two unsuccessful frozen embryo transfers. Both cycles were really confusing because my lining didn't look great (still thin and fluid-filled), I was in the process of moving to New York City and was doing outside monitoring and seeing random clinicians for the measurements/assessments of my uterine lining. I would take a picture on my phone of the image of my uterus and send it to Dr. Devine's nurse because outside monitoring does not actually send the images (just a written report). I don't even know what to say about that experience. Outside monitoring is just a really really terrible experience if you have a uterine lining problem. It was terrible but not because of anything Dr. Devine did. She was very clear about the likelihood of success with these transfers not being great (as mentioned above, she is very good about setting expectations - and in my case, setting them low). This all prompted me to actually get another doctor in New York City. This New York doctor partnered really well with Dr. Devine and that was great. They knew, liked, and respected each other and I felt like I was in much better hands once that occurred. I really wish someone at Shady Grove had encouraged me to actually see a doctor in New York sooner (and not just do outside monitoring). I only got another doctor because I took the initiative. The nurse at Shady Grove made it seem like it was no big deal to do outside monitoring and let me tell you it really really was for me. It was expensive, time-consuming, and frustrating.

They weren't too bad. My insurance actually covered a round of IVF so that was minimal cost. We also had a physician discount of 20% (my husband is a physician) on other procedures. The thing that was really expensive was actually the outside monitoring that I did in New York City. So be prepared for that. Shady Grove is really good about preparing you for the costs of things in general. But I was not prepared for the cost of outside monitoring.

Dr. Devine is a huge advocate of eSET. I'm sure there are specific situations where she would be okay with a multiple embryo transfer. But not for me!

I was under Dr. Devine's care for over a year. At every step she would lay out the plan then we would talk it through. After a surprisingly unsuccessful first IVF, we regrouped and she presented a new plan. When that plan didn't work, I asked if she would ask other SGF doctors what they thought. I thought I was being a little pushy and that she might have felt that I was losing confidence in her. I wasn't, I just wanted a little additional reassurance. She did exactly as I asked and called me to discuss their thoughts as well as her own. When she presented her own opinion, I felt even more confident because she had the input of her colleagues. She was very responsive and supportive, but struck the right balance as my doctor. Even after two failed cycles, she said, "we will keep going and we will get this to work." When I had a successful third cycle that produced 2 genetically normal embryos, I asked for her guidance in whether or not to do another cycle. She gave me really helpful advice and I decided to do another cycle to produce more embryos. I was glad that I did. One of the things I liked most about Dr. Devine is that when I was frustrated, she was frustrated and when I was successful, she felt successful. We worked as a team and I have a high degree of trust in Dr. Devine and the entire practice.

Dr. Devine is direct but nice. She isn't a hand holder, so when she gives you information, think carefully about what questions you need to ask to feel comfortable. She has all the information for you, but you need to be proactive in sharing it and also expressing how you are feeling about the process. Don't be afraid to speak up. I felt that Dr. Devine was most effective in the times that I was struggling, nervous, or unhappy. If you ask for help and guidance, she will absolutely provide it, but she is cautious to not assume what you need from her.

Cycle 1- standard protocol, Menopur and Gonal F, Lupron trigger (suggested because my test results were very good). This cycle produced 1 embryo that did not implant. Cycle 2- Lupron microdose flare- suggested for poor responders. Still not a great response, only 1 embryo that did not transfer. Cycle 3- high dose Menopur, Gonal F, and HCG trigger. Worked much better and produced 2 PGS normal embryos, unfortunately, I developed OHSS. Cycle 4- same protocol as #3, slightly lower HCG. Great results. 4 PGS normal embryos.

In all of the monitoring appointments for four cycle, I only had one time where I had to wait for a while and it was on a weekend at 9am, when patient load is heavy. This part is well run.

I was able to squeeze insurance coverage for 3 cycles and paid for one out of pocket ($15,500 for IVF with ICSI and a FET).

Yes, Dr. Devine was very clear that only 1 embryo was appropriate for me given my age. I agreed.

I do feel that Dr. Devine is a good person. I just felt like there were maybe so many patients that I couldn't get the individualized care that I was hoping for. I had to be my own advocate. The first round of IUI was a fire drill. I came in for day 12 monitoring as scheduled and we realized we needed to quick give myself the trigger shot and come back for IUI the next morning. For the second cycle, I was asked to come in on day 12 again. I requested to come in on day 9 since it seemed I ovulate sooner than most people. They said okay and on day 9 I was ready for my trigger shot and were able to follow the typical schedule better by having a day between the trigger and the IUI. In addition, I also felt I had to be the one to ask questions about "is this the right medication for me?" The first round I took Clomid which produced multiple follicles, but thinned my lining. The second round the nurse did not mention anything would be different and I had to say that I did not want to do the exact same thing as it did not work well the first time. Dr. Devine may have already been thinking she would change the medicine too but this was not communicated to me and I had to make that request. The third round of IUI, I had to request again to come in even earlier. The plan was to give additional shots to help follicle growth if needed. I was asked to come in on day 8. Since previously I was ready to ovulate on day 9, I had to request to come in on day 6 so that we had time to give the shots if needed. It seemed like common sense to me (and all the monitoring was included in our price), but it felt like I was not be treated individually based on my previous responses to the medications and IUI. I felt frustrated a lot of times that I needed to be the one to raise questions and change the course rather than the experts helping guide me through the best course for me.

Ask questions and request frequent communication with Dr. Devine. She eventually responded well to this and had better communication with us towards the end of our 3 months.

As previously mentioned, my first round of IUI was using Clomid. It produced multiple follicles but it thinned my lining and resulted in a negative pregnancy test. There was a standard protocol for all rounds of IUI, which was ultrasound on day 3, medication day 3-8, and monitoring day 12, with usually IUI day 14. Because I seemed to ovulate early, I had to request to come in earlier than the protocol recommended. I also eventually (3rd IUI cycle) had to begin medication on day 2. For my second cycle I was switched to Letrozole. For my third cycle, I continued with the same dose of Letrozole, but gave myself FSH injections multiple times while being monitored each day. Both the second and third cycles of IUI resulted in only one follicle for ovulation and both resulted in a negative pregnancy test.

$1800 for each IUI cycle + $50-150 for medications

I know that Dr. Devine preferred single embryo transfer to reduce the risk of multiples and the complications that can occur with multiple births (prematurity, CLD, etc.)