How was your experience with Paul Brezina at Kutteh Ke Fertility Associates?
In my prior response, I have already shared details with regards to our high estimation of Dr. Brezina as an outstanding communicator. We have faced a number of sad situations, including the loss of one of our babies, and Dr. Brezina has always responded with deep and genuine empathy and presence. I think it is also important to share how much we respect and admire Dr. Brezina's fund of knowledge and his clinical acumen. Since I and my husband are both physicians, we have high expectations for the physicians in whom we entrust our medical care. Dr. Brezina trained at Johns Hopkins, and his knowledge and clinical judgment are outstanding. He never appears to be following an algorithm by rote; rather, he takes the time to familiarize himself with the details of each case, thinks outside of the box, and is willing to share his honest reflections and recommendations with you. He has mastered the art of active listening, and he remains self-confident while also humble and open about what he knows and what he does not know. I could not admire Dr. Brezina more; he is the best physician with whom I have ever entrusted my own medical care, and one of the best physicians whom I have ever known.
What's one piece of advice would you give a prospective patient of Paul Brezina at Kutteh Ke Fertility Associates?
During treatment, were you treated like a number or a human with Paul Brezina at Kutteh Ke Fertility Associates?
Dr. Brezina is an extraordinary physician, and an even better person. He has treated my husband and myself as if we were his family. He makes us feel like he cares genuinely about us, and he spends as much time as we need to help us understand and process difficult information and make difficult decisions. He personally calls us to explain complicated test results, and he has corresponded with us over email to ensure optimal transfer of information. We had a very complicated situation with our last cycle, in which we transferred our last remaining embryo, and it actually split on its own and we had identical twins implant. We were ecstatic, but then I had an intrauterine hemorrhage and one of the twins died, and we were devastated. Dr. Brezina suffered along with us, and his compassion and bedside manner were outstanding. In the spirit of full disclosure, my husband and I are both physicians, and I do research in the field of physician-patient communication - so for us, communication is a very important aspect of medical care. Dr. Brezina has exceeded our expectations in this area, and for this we are very grateful to him.
Describe the protocols Paul Brezina used in your cycles at Kutteh Ke Fertility Associates and their degree of success.
I am embarrassed that I know few details; I made an intentional choice to remove myself from these details, because I worried that I would try to micromanage my own medical care in the context of my medical degree, while having zero actual expertise in RI. But this is what I remember. We had a failed IVF with a prior doctor, which was a truly horrific experience. When we switched to Dr. Brezina, we decided to start with an IUI. However, when my husband gave the sperm sample right before the procedure, we learned that his sperm had no motility, which was attributed to cross-linking of the tails secondary to an anti-sperm antibody (based on gross microscopy assessment). We went ahead and did the IUI procedure anyway, since we had already paid for it and I had already done the whole hormonal prep - but it was a failure, unsurprisingly. We then did an IVF (ICSI), and we opted to do a frozen cycle, because this would allow for higher doses of hormones in an effort to get more embryos to freeze (this decision was based off the fact that we had fewer eggs than expected retrieved during the first IVF cycle). They had expected to retrieve 15-20 eggs, but we ended up only with 9. We had 5 that fertilized, and only 2 that matured to 5-day embryos and were frozen. Dr. Brezina strongly advises using 5-day embryos, and we agree with his rationale for a variety of reasons. The first frozen transfer resulted in a chemical miscarriage. The second frozen transfer ended up splitting into 2 embryos (seriously, what are the odds?! Actually, I know that the odds are <<1%...it was an extremely rare event). I had an intrauterine hemorrhage at around 6 weeks, and we lost 1 of the twins, which was heartbreaking. But we were so blessed with the birth of our daughter in 2016, after years of trying to conceive. We are now hoping to do another IVF cycle next month. Unfortunately, my repeat labs show decreasing ovarian reserve, so there is urgency to proceed with this cycle, as well as poorer odds of success projected...but we are still trying to be hopeful. We are planning to do another frozen cycle, followed by transfer.
Describe your experience with the nursing staff.
We have had mixed experiences with Dr. Brezina's nursing staff. Some have been organized, kind, and competent, and others have been quite the opposite. We caught a number of errors in several of the nurses' instructions to us (e.g., doses, protocols for administration of medications, when to schedule visits, etc), which resulted in fracturing of our trust in the overall nursing staff. However, I will say that, when we shared these experiences with Dr. Brezina, he was incredibly receptive to constructive feedback and he took it very seriously. Our comments were discussed with all of the physicians and nurses in the clinic, with policies implemented in an effort to improve the system. So I give Dr. Brezina a lot of credit for his proactive efforts to identify issues and improve the overall care provided by the practice.
Describe your experience with Kutteh Ke Fertility Associates.
I think the clinic itself is lovely, in terms of its aesthetics. It runs relatively smoothly, and we rarely wait for long periods of time. The layout is convenient, so that you can easily go from clinic room to US room to labs, which are all close together in the same space. The front desk staff are hit or miss - some are terrific, and some come across as disorganized and disengaged.
Describe the costs associated with your care under Paul Brezina at Kutteh Ke Fertility Associates.
This is a painful topic...I have tried to block it out. When we did our first IVF cycle, although it was a horrible experience, it was largely paid for by insurance because we lived in a state in which IVF was mandated for coverage. In our current state, however, IVF is not covered at all by insurance. So we have done IUI, a frozen IVF cycle (retrieval), ICSI x5 embryos, storing 2 embryos, and 2 frozen transfers, all out of pocket. I honestly don't know exactly how much that all cost...probably $25,000. Possibly more. And are about to do it all again, which is a huge financial burden that we cannot afford, since we have a total of ~$500,000 in student loans between my and my husband's medical training. Thankfully, my parents are so kind and are helping us, otherwise it wouldn't be possible.
Describe Paul Brezina's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at Kutteh Ke Fertility Associates.
Dr. Brezina is supportive of single or double embryo transfer, but he recommends eSET. I am a pediatrician, and I have years of experience caring for preterm infants in the NICU, which has significantly informed my preference for eSET. As much as I would so so love to have twins, I do not think I could live with a decision that increases the risk of premature delivery and its associated morbidity and mortality risks.
What specific things went wrong at Kutteh Ke Fertility Associates?
- Failed to call in prescriptions to pharmacy
- Lost appointments
- Failed to order appropriate test
Describe the specific things that went wrong at Kutteh Ke Fertility Associates.
Anything that has gone wrong in this clinic has been directly related to a nursing issue. For example, we have had nurses tell us the wrong dose of medication to administer. We have had nurses fail to show us how to properly administer an injection, leading to incorrect injection placement (and, in one case, IM as opposed to SQ, which was highly problematic and almost led to cancellation of a cycle). We have had nurses refuse to contact the on-call MD to ask a question, instead attempting to answer it themselves (and getting it wrong). All that said, those events happened a few years ago, and we discussed them in detail with Dr. Brezina and he took our feedback very seriously. We were told that the clinic had a meeting to discuss all of the issues that we identified, and that steps were taken to improve nursing training and the overall system. Since then, we have had better experiences, although we still do not think that the nurses are consistently excellent - some are terrific, and others less so. However, we also acknowledge that our standards are probably higher than average - we expect consistency in error-free care, and we are quick to identify mistakes because of our medical backgrounds. I think it says a lot about a practice when people are willing to receive constructive feedback and try to improve the system.