Michael Guarnaccia

I explained at the outset of my first consultation that I'm not the average patient, given my conditions, but Dr. Guarnaccia launched into the general statistics for egg freezing/fertility by age, the relevance of AMH, potential side effects--the standard dog and pony show (Extend was not the first clinic I visited--I also went to NYU, but the doctor there acknowledged me and handed me a packet and told me to schedule an appointment). My experience with Dr. Guarnaccia wasn't negative--he was nice and friendly, but the treatment felt rote, and his medication recommendations were very standard combinations of medications for me that had also been recommended to other women at the follow-up experience where you're taught how to inject yourself. I had specifically asked if he'd be willing to consult my endocrinologist and rheumatologist and my pain management doctor who manages my MCAS diagnosis, and he demurred. It's such an enormous investment of time, money, physical pain, psychological pain (I'm terrified of blood draws) that I wasn't satisfied I'd get the tailored treatment a patient like me probably needs, which was disappointing.

If you're young and healthy, he'd likely be a good choice for you. I think I'd heard he's not known for his bedside manner, but I found him to be likeable enough. I actually cared less about those metrics and much more about my doctor's commitment to tailoring my care/medications to fit my needs, and I didn't have enough confidence that my concerns about that were being heard.

I have them written down somewhere, but I don't have access to them at the moment--basically, Extend has four medication packages they offer in conjunction with the pharmacies they partner with, with varying strengths/dosages of medications. On a scale of 1 (being the least intense) and 5 being the most intense, he recommended dosages of Gonal-F and Menopur (I believe) at the 4 level/amount/dosage. I wish I could be more specific.

At the time, with a promotion, a single egg freezing cycle was $5500, not including medications. My medications (the ones/dosages recommended to me) were in the $4500 range. So, about $10,000. I believe the costs now are about $12,000.

I was not enquiring about IVF at the time so this was not applicable to me.

Dr. G has a good bedside manner--straightforward but warm. He is decisive about the treatments he pursues but makes sure you feel on board with each stage of treatment. He definitely seems like he knows his stuff and answers questions thoroughly and explains the science behind his decisions without being dismissive.

The monitoring sessions can be brief, so if you have questions make sure to have a list ahead of time. Contact him by email if needed.

$6000 per retrieval, $3000 per thaw/fertilization, PGT $300 per embryo.

They prefer eSET and PGT. This was what I planned to do anyway...not sure if they require it.

I never experienced any anxiety or questioning with Dr. Guarnaccia because anytime something would happen, i.e., unexpected spotting I would email him and get a response back immediately.  I never had to sit there wondering if something was wrong or am I doing the right thing.  I am not an easy patient. Every Dr. visit I  would come in with a list of questions I found on forums or the internet. Dr. G patiently listened and provided detailed answers to my questions, never brushing it off or telling me to stay off the internet.  

Estrogen patch before my period Follistim 300 units Menopur 225 IU

Dr. Guarnaccia is a knowledgeable and experienced doctor who is more old fashioned in the way he acts with his patients. He answered every question with patience and understanding, and I think he gets what his patients are going through because he's done this for so many years.

Do the research before you start the process and be as informed as possible. It goes by fast and a lot of information will be thrown your way. If you know the questions to ask you'll always get an informed response.

Microdose Lupron 10 units 2x a day Gonal-F 450 units 1x a day Menopur 2 vials 1x a day Estrdiol patches

It was a well oiled machine even on the busiest of days. When I first started at Extend they had appointments during morning monitoring hours but for my last cycle they had changed that to just showing up anytime between 7-9:30 am which I didn't like. Busy days were harder but everyone was always kind and worked very hard.

Cycles were $5200 for the first and $4000 for any cycles performed after that. I don't recall the costs of all the medications but that differs for everyone.

I only did egg freezing

He seems well-informed and willing to answer my questions and spend time with me going over information. I felt comfortable in his hands and believe he is good at his job. I liked him and appreciate him.

I would go in with an open mind and understand that he is a busy man but he is present with you! He goes over all pertinent information and makes you feel well-informed. He is not going to add fluff but I think that is a good thing. He knows what he is talking about and has a lot of education and experience to back it up.

Dr. Guarnaccia used a chart to determine the correct dosage for my egg retrieval medications based on my blood test and ultra sound results. He assured me that I was in the 95 percentile for my age so I am getting the lowest dose of hormones, which I appreciate.

approx. $6.5 k for the procedure, $4.5K for ten years of storage. $2.5K goes directly to pharmacy (this is the lowest dosage of hormones. They get more expensive as the amounts go up).... Overall, I think this is cheaper than the big NYC hospitals.

Dr. G was very straightforward and detailed, which is an approach I really appreciated. I felt that he was able to express care and concern while also being direct (warmth in a doctor is not a requirement for me in treatment). I would definitely recommend Dr. G to my friends who are interested in egg freezing.

Come with your questions prepared--your anxiety will lessen as he gives you concrete information.

Dr. G explained my bloodwork and ultrasound results, and showed me data comparing my results to others my age. He was specific about his recommendations regarding getting genetic testing done for my family's history of breast cancer.

The window for the monitoring appointments was large enough that I never felt rushed or that it was an inconvenience. As I mentioned, at times the waiting area was very crowded, but the staff is so efficient that it moved fast.

Freezing = 5500 Storage = 2000 Meds = 2169 (I was able to use my friend's leftover hormone meds so saved around $400) Total = $9669

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Dr. G was alway honest and realistic during my treatment. There were many times where my body was not responding to the course of treatment and instead of pressing me to go forward he would always give me the choice of wether I wanted to continue going forward knowing that the chances of an optimal result were low or to stop for this cycle and then try again next cycle. It made me feel good knowing he was more concerned with the result as opposed to just completing the cycle.

My work schedule forced me to come into the clinic very early when they opened at 7am and sometimes I would miss having him scan me. If its important to you to be always seen by the doctor I recommend coming in a little later (8am)

A year prior I had to have my right ovary removed due to a dermoid cyst. Due to my age I had a diminished ovarian reserve and had to take the maximum amount of hormones to see good results. For my first cycle we did a Follistim and Menopur protocol. But my body didn't respond and the cycle had to be cancelled early on. I did an estrogen patch for the days leading up to day 1 of my cycle and then. Then the next two successful cycles I did a micro-flare protocol where I took Follistim (once a day), Menopur (twice a day) and Lupron. (twice a day) and a Pregnyl trigger. For my third and most successful cycle I took Follistim and Menopur once a day and then also Ganarelyx for about 5 days towards the end of my cycle and was triggered with Pregnyl. Please keep in mind that in order to even do the 3 full cycles and retrievals I had about 3 cancelled cycles.

their monitoring hours were perfect because they started at 7am which allowed me to go before work. This was important for me so that I did not have to explain anything to my workplace

The costs to consider were the medications, the procedure fees and the storage fees.

Dr. Guarnaccia came in as a tourist to perform surgery on me. It was the first time I saw him, ever, he was the per diem who came in to cover for my actual doctor that Saturday. Unlucky me. He asked me if I had any medical concerns. This was the first bad sign. When I said heart disease, history of fibroids, cysts and a clotting disorder, he started scrolling through his stack of papers. I was a little nervous at that point. He also asked me who "Jane Doe" was and I said she works here. I got alarmed then. He proceeded to go to the computer to get acquainted with my record as this was not necessarily going to be a walk in the park as he had expected. I took that moment to asked the nurse who that was. They explained my doc who I was confident in and choose to care for me, was away for Sabbath and this was the per diem who was going to perform the surgery. No one informed me of this ahead of time and I almost felt obliged to accept it. All I could think of as a patient was, I don't even know him, I just meet him and he doesn't seem competent; as well as all the money, injections, time off that it took to get to that day to freeze my eggs. I told myself it will all be fine, although I almost wanted to call my boyfriend who was sitting in the waiting room. However, the anesthesiologist came in, he knew exactly what he was doing and I thought it would be ok. A day after my surgery, I had intense pain at work ( i have a high pain tolerance) and my boss sent me home. I called my actual fertility doctor who said everyone reacts differently, if pain persists come for a visit. As far as the results, I am young with no ferlility issues whatsoever, but from the expected 12 eggs to be frozen, we only got 5. My actual doctor admitted it was very unusual. Unfortunately, the pain came back stronger a few weeks later. Basically, I was rushed to the ER from work - they said I had a cyst. Went home, still in pain for a week so I went to my actual doctor and he prescribed me medications. One more week of pain, I am rushed to the ER from my obgyn's office! She tells me this is bad and that I might lose my ovary. I got emergency surgery as the doctors at the hospital feared me losing my ovary due to an hemorraghic cyst. I was crushed. They said consent to have your ovary removed and I just felt numb at that point. When I woke up from surgery, my boyfriend tells me, you still have both your ovaries, instead I had been carrying a 6-week old infection that spread puss to my ovaries, uterus, abdomen, colon/rectum. You can imagine how I felt, emotionally and physically, all this pain. Infections are extremely rare and this was a very bad one. Because of all of this, my fallopian tubes are scared and I will probably need IVF to conceive as is will not happen spontaneously. I was just freezing my eggs as an option because of my heart and fibroid history. Basically, I have reduced my options when I thought I was being smart. And I wonder if this is what killed half of my eggs at retrieval. When I found this site and saw his reviews, I cried, I knew I had been screwed by this doctor. I had to be out recovering for about 3 months, not working. Ended up having to move upstate due to my precarious situation. My living condition is good but very stressful. I got the flu and to top it all, my second heart attack now. I will stop here but you get the point, my entire life has been hanged for the worst. I am thankful to this site and the other reviewers for sharing their story. I am not one to leave a review ever but I felt like a responsibility for anyone debating Dr. G’s care. With such a low review rate, I wonder why he’s even practicing and those hiring him to still be out there are to do their due diligence and be responsible.

Save yourself a bad ending. In my opinion, he should not be practicing and not hired as a per diem. You would think he is qualified and that you should trust him. I fell victim of an unprepared doctor with overwhelmingly bad reviews. Perhaps he has a calling in another field but not fertility.

Dr. Guarnaccia was the per diem performing my retrieval, the most crucial part of the process. He was not part of that process. I was unaware he would perform the surgery on me. 12 eggs were retrieve and only 5 were frozen. All I know is that this was an unexpected result and that I got infected under his care. Also, had extra anti-coagulant shots to take during the hormone treatment because of my blood disorder.

8,500 total

Dr. Guarnaccia is an excellent, thoughtful and sensitive physician. When I started my first cycle for the egg freezing, when I came in on day 6 for my first ultrasound with the doctor on call to see whether the follicles were maturing, the results were negative - and I was instructed by that doctor to stop the fertility shots. I was in tears and Dr. Guarnaccia so happened to be in the office that Saturday, and purposely went out of his way to find me to calm me down and explain that we are not robots--we are human beings and one regimen of shots that works for one patient does not necessarily work for another. He strongly urged me not to give up and encouraged me to do another cycle for the egg freezing and advised that we would do a different regiment of shots. I appreciated his feedback and ultimately agreed, and while that cycle did not get as many eggs as hoped, we did get through the whole cycle and froze six eggs. I was advised to do another cycle to maximize the number of eggs but my finances (and well-being) decided against it for the time being.

Dr. Guarnaccia is a straight-shooter and will not beat around the bush. If you're looking for someone to sugarcoat it, he's not the one. He is diligent and will ask questions of you--and welcomes questions from you as well.

The monitoring timeframe was always set very early in the morning, which was convenient given my work schedule.

Everything involving egg freezing.

Dr. Guarnaccia was more concerned with maintaining the center's statistics then relating to us as human beings. He was cavalier and made light of what was a very serious issue to us. He made us feel as if he were doing us a favor gracing us with his presence. We were matched with him by the Center because we were diagnosed with secondary infertility and the person scheduling appointments at that time said she thought that he would be a good match. He barely looked us in the eye when he spoke with us. We tried to see other doctors in the practice as much as possible because we really did not think Dr. Guarnaccia had our best interests in mind when recommending treatment options - but was rather just concerned with stats of the Center.

He has the type of personality where he thinks he is god's gift to those around him. Don't expect any genuine warmth or caring.

It was routine. Fertility drugs, IUI then IVF. Not personalized but rather their standard protocol.

Dr. Guarnaccia was incredibly knowledgeable and friendly. I would recommend him absolutely as for REI services including egg freezing, which is what I had with him. I appreciated both his candor and his efficiency - working with him as my doctor was all I could ask for during the process.

He is very quick - prepare any questions you might have beforehand

I had egg freezing done with an HCG trigger shot.

It seemed to be a fairly well-run process with my coming in and waiting a max of 15-20 min, mostly less, and getting in and out of the clinic rooms fairly quickly. I think it was also helpful that I went during the summer - less clothing to take on and off!

I can't recall, but all-in each cycle was about $10k

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He comes off as very arrogant and aloof. When asking me questions about past experiences he scoffed at what I had tried to do to get pregnant like he was a miracle worker.

Don't go to Columbia. Period!

IUI with Clomid 50mg and a trigger shot (Ovidrel 250mg). That was done twice and after the 2nd unsuccessful IUI i never heard a word from Columbia. No one told me how bad I would feel during and after taking Clomid. I thought I was losing my mind.

i think my total cost was $1800

He has 20+ years of experience, but for such a sensitive topic, he really had no empathy. I felt like I was being reprimanded during one of my visits.

Ask a lot of questions, probably try to see other doctors in his center.

$17,000

Dr. G set realistic expectations so that I could plan accordingly. He told me I would get 7-14 eggs per cycle, so I knew going in that I would require two cycles. I ended up getting results that were better than expected, but I appreciated that he was straightforward. I also appreciated that he never tried to sell me egg freezing as a guarantee or insurance.

Dr. G is certainly respectful, but I wouldn't describe him as "warm." I personally don't expect or seek emotional support from my doctor, but he might not be the best fit for someone who needs a lot of handholding.

I paid around $10,000 for both cycles minus the cost of medications.

Dr. G was available to answer all of my questions and anytime I needed to see/talk to him. He can be blunt/direct but that's because he is busy (the clinic was always busy every time I went in for my monitoring).

Be prepared to ask all your questions when you see him since all the doctors are busy. I did a zoom call before I started with Extend, saw him 2-3 times during monitoring, and he performed the surgery. I felt that was adequate "facetime" with my doctor and enough time for me to ask any questions I had.

Egg freezing.

5500 egg retrieval after a $1000 discount, $2500-$3000 meds (but I qualified for a 50% discount through a fertility program so it actually came down to $1500), $600 yearly storage

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Dr G is an extremely effective communicator who errs on the side caution when it comes to patient health, comfort and care. You're in good hands with Dr.G! He's extremely informed and patient and seems quite up-to-date in his field, he exceeded my expectations in every way.

Book him!

The doctor listened to my concerns regarding a prior existing health situation and kept good contact with me and my many follow-up questions. When the pandemic hit, altering plans, he called me personally to discuss options.

Dr. Guarnaccia and his staff are committed to making the process transparent.

We are hoping to start my cycle later this month, as my fertility preservation has been deemed medically necessary.

Extend Fertility has set pricing, which appears on their website. There are no hidden fees. Egg freezing is $6,500 plus the cost of meds and storage.

Dr. G is extremely knowledgable and kind. I felt like he really understood and cared how I felt throughout the process and he took the time to answer every question big or small. I would (and have!) recommend Dr. G to friends.

My starting protocol was 225iu of Follistim and 2 vials of Menopur with a Lupron trigger.

Dr. G was professional, kind, knowledgeable, and very action-oriented. I left every appointment feeling confident in our plans and next steps. When he realized that I may need extra monitoring, he made sure that he was doing the ultrasounds so that he could have the most accurate data (since numbers may be different depending on who is doing the ultrasound). I found that to be so comforting.

Use him - you won't regret it!

Dr. G started me on a higher dosage of hormones because my AMH was low. We realized that my body was responding well to the hormones and in fact, my hormone levels were going up quicker than the eggs were maturing. Because of that, I had to go in for more visits than expected and he changed the course of my treatment a bit.

Quick and organized.

I was covered by insurance so I paid about $400 in copays for the medication.

Dr. Guarnaccia met with me for my initial consultation after my AMH testing and explained my potential for egg retrieval, while carefully managing expectations due to the fact that not all factors can be controlled. He told me what drug protocol I would be using and tweaked it towards the end of my cycle (lowering it a bit), which was clearly the right decision because I was very happy with the outcome.

I did a lot of my own research and knew what to expect, so I didn’t have to ask many questions. I’d say that you should take advantage of your initial consultation with him and come prepared with questions.

Dr. Guarnaccia told me that my AMH level showed I had PCOS, and he put me on the lowest drug protocol. Towards the end of my cycle, I was told to skip my menopur injection, which was the right move— if my estrogen was any higher, I’d probably develop Ovarian Hyperstimulation Syndrome.

I was able to request times within their monitoring window that suited my commute from south Brooklyn. I don’t think I ever waited longer than 5-7 minutes to be seen each time, and after my bloodwork was done, my ultrasounds followed quickly. I was generally in and out each time in under a half hour.

I paid $6500 for the egg retrieval and approximately $2500 for the medications.

I always felt I was in safe hands with Dr Guarnaccia. On the occasions where we met, he gave me plenty of time to ask questions and I never felt rushed. He came across as highly professional, competent and trustworthy, as well as warm and personable. I'm pleased with the results I saw with him on my first round of egg freezing and will be going to him again for my second round.

As with any doctor, do some reading in advance and have a list of questions prepared. Make the most of valuable in-person time with the doctor. That being said, on the occasions where I had ad hoc questions (e.g. checking whether a new non-fertility-related medication was safe for me to use in conjunction with my egg freezing treatment), Dr Guarnaccia was highly responsive and came back via the clinical team very promptly and professionally.

On my first egg freezing round, I believe my protocol was 225 Follistim and 1 vial of Menopur per day. We bumped it up to 2 vials of Menopur per day after about day 4 and then included Certrotide towards the end of the cycle. For my second egg freezing round, we are going to be slightly less conservative and do 2 vials of Menopur per day, likely stepping up to 3 vials at some point.

Round 1 - 6500K, Round 2 - 5500K. Medication was an additional 3K on top each time, although I have great insurance that covered 90% of everything

I had a great experience with Dr. G. I appreciated that he always took the time to explain everything thoroughly, but that he was also willing to listen to my concerns and make adjustments when necessary.

Don't be afraid to ask a lot of questions, especially if this is your first time going through the process. Also your first cycle may not yield the results you hoped for, but in my case Dr. G made an adjustment to my meds based on my response and I had much better results in the cycles that followed.

In my first two cycles, I started with an estrogen patch. In my first cycle, I did 375 units of follistim and 150 iu of menopur before switching to 450 units of follistim and 150 iu of menopur after the second monitoring appointment. I injected for 10 days but the cycle got canceled due to poor response. After that, I did a microdose lupron protocol with 10 units of microdose lupron in the morning and evening, 450 units of follistim in the morning, and 150 iu of menopur in the evening. The second cycle, 3 eggs were retrieved and frozen. I did the next two cycles back-to-back without doing the estrogen patch. The third cycle, I retrieved 11 eggs and froze 9. The fourth cycle, I retrieved 13 eggs and froze 8.

I had a great experience with my monitoring appointments. I was in an and out quickly, but I never felt like just another numbers. The staff was very friendly. Ana is especially wonderful!

I believe the cost of four cycles was around $20,000 with the medicine being an additional $20,000.

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