Martha Noel

Strengths: Dr. Noel is thoughtful about her recommendations and fertility plan. She also takes the time to explain and answer questions. She’s responsive over email. Weaknesses: Dr. Noel hasn’t been as always to access since the email system got updated. Now you can only email the care team and a nurse usually responds. At least the responses are within the day.

Dr. Noel is compassionate and thoughtful about each patient’s case. UCSF is structured to rotate doctors and nurses for each visit. Even though you won’t have that much contact with Dr. Noel, she is making the final decisions and recommendations for you.

We started conservatively with progesterone treatments, then moved to IUI (4 rounds) then IVF when previous methods were unsuccessful. Dr. Noel was measured and didn’t try to pressure me into IVF vs other doctors I had consulted. So far no pregnancy but Dr. Noel mentioned it could take a few tries due to age and lower egg count.

IUI costs $3-5k depending on monitoring and insurance coverage. IVF costs about $20-30k depending on specific procedures performed/elected.

The approach is meant to optimize for saving the embryos that I can produce due to lower egg count. So day of transfer and # transferred depends on how many eggs and embryos in that cycle.

Dr. Noel is warm and empathetic yet manages to give all of the information—the good and the bad—in a clear and direct manner. My case was diagnosed as unexplained infertility, so she made suggestions for changes in protocol that covered both egg and sperm quality, which alleviated quite a bit of emotional burden on my part that I may be the sole source of the problem. She also never pushed for IVF and was gentle and systematic in the progression and escalation of treatment.

As UCSF is a group practice, I didn’t see Dr. Noel very often; however, it was clear that she was following my progress through comments from the nurses. When I did check in with her, she was aware of the details of my cycle. My two retrievals and transfers were with Dr. Rosen and Dr.Siegal, both of whom were wonderful doctors as well. I wouldn’t be put off by the fact that you see quite a few doctors and nurses as they were all very knowledgeable and kind.

For my first round of egg retrieval, Dr. Noel recommended using ICSI for fertilization due to my unexplained infertility. She explained that sometimes a round can result in no fertilized eggs which can be emotionally devastating. Her suggestion was spot on as I lost many eggs at fertilization, and the round ended with three day 3 embryos which did not result in a pregnancy. At least going through the motions of an embryo transfer gave me some hope, whereas ending in zero embryos and no transfer might’ve emotionally discouraged me from another round of stimulation and retrieval. For the second round she suggested escalating to PICSI fertilization and adding growth hormones to my stimulation protocol due to low estrogen levels. That second round resulted in my current pregnancy as well as one frozen PGS tested embryo.

Medical procedures came to about $20,000 per round.

Dr. Noel was very clear that her recommended goal is for a singleton pregnancy given the risks associated with multiple pregnancies. Due to my failed multiple IUIs, she recommended the transfer of two embryos and explained that that would likely result in a singleton pregnancy.

Overall I feel very positiely towards Dr. Noel. My treatment with her was interrupted because she went out on maternity leave for a few months, and the few other doctors I saw in her absence really did not compare. Her approachability and ability to explain what's going on in a kind, clear way are great. I wish she were more accessible (I was never allowed to email her and had to always go through her assistant, which I felt led to needless delays and games of telephone and misinformation), but that was my biggest complaint.

Beware her scheduling assistant. Nice, but not exactly competent. If receiving panicked emergency calls about forms not being in order right before your first IUI will upset you (as it did me), you might be best off avoiding Dr. Noel because you're stuck with the coordinator she has.

Letrozol + ovidrel -- we increased the letrozol in the 3rd and 4th IUIs resulting in 2 mature eggs instead of one. no success with IUI

The IUI cost changed during my second cycle (described earlier) and during my 3rd/4th I was on new insurance that covered my treatment so I only had $20 copays. Unfortunately I dont remember more except that I believe initially IUIs were about $900 out of pocket, and skyrocketed to $2700 or $3000 (which I never paid because I protested them raising the price when I was literally already in the middle of treatment).

for our age at least (early 30s), UCSF seems pretty adament about eSET only, no multiples transfer

Dr. Noel is amazing and confident in her recommendations. She is warm and understanding of the emotion that goes with infertility. She has wonderful bedside manner and truly listens to all questions and concerns. She is never rushed and is responsive to emails and calls. She directed every aspect of my treatments even if she wasn’t the doctor to perform them based on my cycle. She also adjusted my treatments when I didn’t tolerate the hormones well. She is amazing and the reason I’m expecting my daughter. I can’t recommend her enough! UCSF is the best hospital with the best doctors and Dr. Noel is an example of that. She’s wonderful.

Fertility treatments are not easy but with the right doctor you will get positive results.

I had a natural conception and no issues with my first child. When I had a miscarriage with my second pregnancy and trouble conceiving thereafter, I wasn’t convinced I needed to see a fertility specialist. I met with Dr. Noel unconvinced I had true fertility problems and based on my prior natural conception, she recommended I do Clomid with IUI’s. We tried 3 with no luck. Thereafter we stepped up the fertility to an egg retrieval and PGS testing as egg quality was the suspicion. The PGS was telling and I ended up with 3 normal and good quality embryos. I did a medicated cycle to prepare for my first transfer. I took a drug that is used for treatment of prostate cancer that suppresses the ovaries. I then had to do progesterone injections. The medication was very hard on my body but resulted in a positive pregnancy. The embryo didn’t show proper growth and resulted in a miscarriage with manual uterine aspiration. In discussing my second transfer, I advised Dr. Noel that the medications were very difficult on my body and she suggested we do a natural cycle. We did and it resulted in a positive test and healthy pregnancy. I used estrogen suppositories to boost the pregnancy which were easy to use. Dr. Noel followed my progress through delivery and was so kind. She was as excited that I was pregnant as I was!

For the IUI’s and harvest and 2 transfers, we spent approxsintelt $20,000.

I only wanted one additional child so we planned to only transfer one embryo at a time.

She is extremely approachable, easy to talk to, is not judgmental at all about "stupid" questions (just to say there isn't anything I would be embarrassed or hesitant to ask her), she's thorough and very reasonable, she does the serious talks with kindness and gives straightforward answers, but she also is personable and will laugh with you about all of the ridiculous moments that inevitably happen throughout this process. She will talk short game and long game, and when she (very appropriately) raised the possibility we might need to resort to donor eggs and I was not emotionally prepared to talk about it, she respected that. But I know that if we got closer to that point, she would approach it again kindly (as she should). I trust her to tell me the truth in a way and at the time that I'm ready.

Nothing specific to Dr. Noel, only general advice about entering this process or seeing any doctor, like make a list of questions and be sure to write down the answers they give because you can't remember everything, things like that.

I am 30 with DOR (very very low AMH and AFC 10). We did three IVF retrieval cycles, one of which we cancelled before the retrieval, all to freeze embryos. Cycle 1: Estrace for mild supression, stims of 300 IU Follistim, 150 IU Menopur, adding Ganirelix. Trigger was Pregnyl with Follistim co-trigger. 4 follicles at time of retrieval, 3 eggs retrieved, 1 mature, it fertilized with ICSI, and was frozen on day 3. (Yield: 1 embryo) Cycle 2: half dose Estrace, start with Clomid (100 mg), 300 IU Follistim, 150 IU Menopur- canceled cycle before retrieval. (Yield: 0 embryos) Cycle 3: Lupron strting 6 days after ovulation, stims of 300 IU Follistim, 150 IU Menopur, and omnitrope. Trigger was Novarel with Follistim co-trigger. 5 follicles at time of retrieval, 5 eggs retrieved, 4 mature, 3 fertilized with ICSI, 2 looked great and were frozen on day 3, while 1 was poorer quality and so was grown to dat 5 to see how it went then it didn't make it. (Yield: 2 embryos) We did not do PGS and so are very nervous about the egg quality, and 3 embryos doesn't give much "wiggle room" for failed transfers, miscarriage, aneuploidy, etc., especially since we would love 2 kids. We're hoping for one more IVF cycle to get a total of 5 embryos is possible.

$27,000 for cycles $10,700 for medication

We will only be transferring 1 embryo at a time, for two reasons. 1) we have very very few, we can't mess around with them. 2) I'm fairly young and my uterus looks good, so we should have a higher implantation rate.

Dr Noel was informative and direct while being really sensitive and gentle. She gave us information and success probability of all our options and let us decide what felt best for us. We ultimately decided to go with an egg donor because I was not up for numerous more stims and retrievals.

I think she’s an excellent option, I don’t think there’s anything specific for her. As with any RE- have specific questions written down, to make sure everything gets answered

We haven’t started yet

UCSF has a program to discount costs if your insurance does not have fertility coverage, which is one of the reasons we chose to use them. I think our costs for OVF including meds will end up being around 20k

We’ll be using donor eggs so eSET is required

Dr. Noel was kind and nice to work with. She responded timely to all my emails and addressed my concerns, although we disagreed on the correct course of action frequently. I did feel she was ultra-conservative in my treatment relative to friends and other women I have spoken to undergoing treatment for similar issues.

Be your own advocate. Do your own research and come prepared with questions. I don't think you can necessarily rely on this clinic to personalize treatment to your specific conditions, so it best to ask for you want and need.

Letrozole and timed intercourse

$489 for ultrasound monitoring appointment

N/A

I'm just starting my visits with Dr. Noel and will begin a medicated cycle next month but so far she's been really great explaining everything in a clear, concise, and straightforward manner. All of my appointments except one have been with Dr. Noel and the one time I saw her nurse was for a minor follow-up appointment. The only negative thing I've experienced thus far is having to wait for my appointment when she's behind schedule. When she is running late she's very apologetic.

She appreciates when you're armed with information about your cycle and specific questions you have.

Unfortunately our insurance doesn't cover any fertility costs so we're paying out of pocket. I haven't started a medicated cycle yet so I'm not sure how much that will cost but when paying out of pocket follow-up visits are $119, a transvaginal ultrasound is $243, and I believe an SA is $80.

I could not have asked for a better doctor! She's the perfect combination of being realistic but still having an emotional/personal touch in everything that she does. She has made this process as seamless as it possibly could be.

You are in great hands and trust her expertise.

I started on Lupron and then used Menopur and Gonal F. I was very happy with the results and produced more eggs than expected. We also had more make it to day 5 than expected.

Treatment & Retrieval is about $15k, Genetic testing is about another $4k

We are genetically testing ours so it will be a single embryo transfer.