How was your experience with Samantha Pfeifer at Weill Cornell Medical College?
Dr. Pfiefer is compassionate and a good communicator and she’s made adjustments to my protocols to improve my cycles. My obgyn recommended that I see Dr. Reichman or Dr. Pfeiffer for IVF. Dr. Reichman had better reviews but his assistant never called me back, so I ended up seeing Dr. Pfeifer. At 40 years old, my AMH was 2.29 and my FSH was 7.18, so we thought it would be ok to start with 3 IUI. My first two IUIs were unsuccessful. Dr. Pfeifer then found a small fibroid which she removed surgically. I thought this might be preventing me from getting pregnant so we tried 2 more IUIs which were unsuccessful before moving on to IVF. I’ve done 3 ivf cycles using the antagonist protocol, with adjustments and significant improvement with each cycle. For IVF#1, I had 5 follicles and 7 eggs retrieved, 7 mature, 5 fertilized, but there was fragmentation with most of the embryos. For IVF#2 (four months after IVF#1), I had 9 follicles and 7 eggs retrieved, 5 mature, 4 fertilized but the quality was much better – no fragmentation. For IVF#3 (seven months after IVF#1), I had 9 follicles and 16 eggs were retrieved, 13 mature, 12 fertilized and 6 made it to blastocyst. Two were transferred on day 5. Four were PGS tested: 2 normal and 1 mosaic. So far I have had a favorable experience with Dr. Pfeifer. At some point, I asked Dr. Pfeifer if DHEA supplementation could help and she was neutral on it, she said the research isn’t conclusive but it if I wanted to it wouldn’t hurt. I ended up doing my own research and taking DHEA as well as other supplements and my cycles have improved the longer I have been taking the supplements, although I'm not sure if it is the DHEA or something else. I am personally doing a lot to try to improve egg quality, as far as diet, exercise, supplements, acupuncture, yoga, meditation and herbs and educating myself about avoiding fertility harming toxins, and having emotional support of close friends (who have gone through IVF) and family. My second and third cycles were also a lot easier for me mentally since I had been through it before and knew what to expect and was much more adept at administering the medication.
What's one piece of advice would you give a prospective patient of Samantha Pfeifer at Weill Cornell Medical College?
Dr. Pfeifer is a great doctor and you are in good hands. My advice is more in general about IVF: Be sure to have a lot of support from friends and family. Take time to nurture yourself, and educate yourself about IVF so you know what questions to ask. Take the time to educate yourself on what diet, exercise, lifestyle and supplement changes you can implement to improve egg quality because there is a lot you can do. "The Infertility Cure" and "It Starts With The Egg" are good resources. The CCRM fertility supplement list is also helpful.
During treatment, were you treated like a number or a human with Samantha Pfeifer at Weill Cornell Medical College?
Dr. Pfeifer is a kind and compassionate doctor.
Describe the protocols Samantha Pfeifer used in your cycles at Weill Cornell Medical College and their degree of success.
IVF#1: For my first round of IVF, my protocol was 325 to 400 iu Gonal-F for the first 5 days, then 250iu Gonal F, 150iu Menopur and 1 vial Cetrotide for the next 5 days, and HCG trigger on day 11. I only developed 5 follicles, mostly on my left side, which was not as good a response as we thought I’d have. However, Dr. Chung did my retrieval and we were able to get 7 eggs. All 7 eggs were mature, 5 fertilized and we transferred 4 embryos on day 3 by Dr. Schattman. Dr. Pfeifer said that most of the embryos had fragmentation, so it would be best to transfer them on day 3 since it didn’t look like they’d survive to day five. The four that were transferred were one 10 cell, and three 8 cell. One of them was grade 1.5 (which is the highest) and the other 3 were grade 3 which are “so-so” quality. The cycle failed and I spoke to Dr. Pfeifer about what we could do to improve the next cycle. She said it was remarkable that all of my eggs were mature, even though I had some follicles under size 10 and 11 and that she’d trigger me earlier next time, with a lead follicle between the size of 16 to 17, since my eggs appear to mature at a smaller follicle size. She said she also would have me start Menopur sooner. She explained that they aim to have 90% of the eggs be mature. She said this could help with the egg quality because if you are triggered too late the quality could decline. Later on in my research, I learned that there are studies proving that older women usually do much better when they are triggered at a smaller follicle size. IVF#2: I started taking micronized DHEA (25mg 3x a day) along with other supplements 2 to 3 months before my 2nd IVF. I also saw a fertility acupuncturist 1 to 2x a week who prescribed me custom herbs to take before and after ovulation, did yoga regularly, and I tried to cut down on exposure to bpa/phthalates/fragrances, the use of household plastics and plastic food containers/water bottles. I had a better response for IVF #2. My protocol was 300iu Gonal-F and 150iu Menopur daily, with Cetrotide added mid-cycle. When I triggered, I had 9 follicles (6 on the right and 3 on the left) – which was 4 more than I had with IVF #1. On the morning of my trigger my follicles on the right were size 17.8, 16.8, 16.6, 15, 14, 11.4, and on the left they were size 15.3, 14 and 14 and my E2 was 1944. However, only 7 eggs were retrieved by Dr. Kang. 5 of the eggs were mature and 4 fertilized but they didn’t have the fragmentation that embryos had during my first cycle. All four were transferred on Day 3 and Dr. Pfeifer did my transfer. We were hopeful, since all 4 embryos were graded 1.5, which is the highest grade, but I didn’t get pregnant. I met with Dr. Pfeifer and I asked her a lot of questions, such as should I be tested for natural killer cells, should we test for dna fragmentation, are there any other tests I should do and should I try an ultrasound guided transfer. She said she didn’t believe in natural killer cells and didn’t think any other tests were needed. She said she didn’t think an ultrasound guided transfer would make a difference, but we could do it next time. Also, she said she was happy with how my second cycle went and would keep my protocol the same, except she would have me use the Estrogen patch before my next cycle. IVF#3: I had my 3rd cycle of IVF two months after my second cycle and it was the best so far. The number of eggs retrieved doubled, and the number of fertilized eggs tripled compared to my previous cycle. My protocol was the same as IVF#2 except I took the estrogen patch 6 days before I started stims, changing it every other day. My AFC on day 1 of my period was 12, with 6 follicles on the left and 6 on the right. After 10 days of stims, the morning of my trigger I had 9 follicles, 4 on the right (size 16.3, 16.2, 14.5, 12.5) and 5 on the left (size 17.6, 16.8, 15.2, 17.5, 14.6). My lining was 11-12 and E2 was 2440. I was triggered with 5,000 HCG. Dr. Kligman did my retrieval and 16 eggs were retrieved, 13 were mature and 12 fertilized. This was amazing considering I never had more than 7 eggs retrieved or 4 eggs fertilize. Dr. Pfeifer was surprised with the results since my response was significantly better with virtually the same protocol. This was the first time I had enough eggs to push to day 5. On day 5, I transferred 2 blastocysts grade 3AB and 2.5AB via a fresh ultrasound guided transfer by Dr. Chung, with a visiting doctor from Taiwan present. On day 6, I was told I had four extra blasts which were PGS tested. Two weeks later I was told that 2 were normal and one was mosaic, and I had the option of knowing the genders. Unfortunately, the fresh transfer was not successful but I am feeling hopeful after my recent follow up appointment with Dr. Pfeifer. She said she expects a 60% success rate for each frozen embryo and would recommend a single embryo transfer, and she is encouraging me to do a number of tests that should improve my chances for success. I did a lot of research on questions to ask and tests to do after a failed IVF cycle. I asked if I should do a saline sonogram (to check for fibroids), hysteroscopy, endometrial biopsy/scratch, endometrial receptivity array, and be tested for an infection or blood clotting disorders. Dr. Pfeifer said I should do an saline sonogram (between day 6 and day 10 of my cycle) and depending on the results, we would or would not do a hysteroscopy. She discussed the endometrial biopsy/scratch and endometrial receptivity array and said that it could possibly aid in implantation. However, since I had irregular cycles in the past, I would need to do a mock cycle with estrogen and progesterone prior to doing this test, so I'd have to wait another month before I could do this test since I need to start taking the estrogen on day 2 of my period. She didn't think I was not getting pregnant because of an infection since my white blood cell counts are normal, but she agreed to have my blood tested for clotting issues. She was so pleased with my improvement in more than doubling the number of eggs retrieved and the significant improvement in egg quality that she took notes as I shared with her what I did differently. I told her that I continued with acupuncture and yoga which I strongly believe contributed to stress reduction, and that my husband also made positive changes in lifestyle and also took supplements which I found supportive. I shared with her a very long list of supplements that I had been taking after the first failed cycle, including 500mg of Ubiquinol, 100mg of Pycnogenol, 75mg of DHEA and several others. I stopped taking certain supplements during stims and in the two week wait. I continued to try to avoid exposure to bpa and other toxins. I started doing more cardio and meditation, changed my diet to include more protein and good fats and less carbs and less gluten when possible. I also incorporated more warm, cooked foods, especially vegetables and bone broths. I tried to keep my carb intake under 40% but it realistically ended up in the range of 35% to 45%. I cut out caffeine except for chocolate. I had dark chocolate frequently and I cut down on alcohol except for a few glasses of wine on a few occasions socially. Dr. Pfeifer believes that diet, exercise and sleep are all very important to one's overall health and she encouraged me to keep doing what I am doing.
Describe your experience with your nurse at Weill Cornell Medical College. (Assigned nurse: Evangeline and Rosalie)
The nursing staff at Cornell is excellent, particularly at the Tribeca office. You are in great hands.
Describe your experience with Weill Cornell Medical College.
Others have said it and I agree. Cornell is a well oiled machine. I don't think I've had to wait more than 15 minutes to be seen for monitoring. I've found every doctor and nurse at Cornell to be genuinely kind and compassionate. Only once did I meet a doctor who seemed to be in a rush and that was Dr. Spandorfer. He wasn't unprofessional, but he seemed rushed during my ultrasound and didn't count or measure as many follicles as the other doctors. I have heard that the labs at Cornell are among the best. I have confidence in the labs, doctors and nurses at Cornell.. Cornell also does day 3 transfers and will transfer untested embryos. A friend that went to RMA said that they only transfer PGS tested embryos for women over 40. The main weakness is that everything is communicated over the phone whereas online or email would be more efficient and if you have a question for the nursing staff, you need to leave a message for them to call you back. Also, not sure other clinics do this, but the day after your trigger shot, you need to go to the York Avenue office for pre-op at 6:30am which is very early since my trigger shots were usually 11pm to 12pm.
Describe your experience with your monitoring appointments at Weill Cornell Medical College.
A well oiled machine. At the Tribeca office, I usually arrived between 7:45am and 8:10am and I never waited more than 15 minutes. Usually it was 5 minutes or less. At the York Ave. office, I usually arrived around 7 to 7:30 and the wait was also minimal. I learned my lesson that if you arrive after 8am at York Ave. you may need to wait a long time.
Describe the costs associated with your care under Samantha Pfeifer at Weill Cornell Medical College.
4 rounds of IUI plus 2 rounds of IVF totaled $48,000. I paid about $13,000 out of pocket after $35,000 in fertility benefits/insurance was used ($25,000 for treatment and $10,000 for medication). Note that fertility medication for the first round of IVF cost approximately $11,500 with insurance covering the first $10,000. When you use insurance, the prices of the drugs are somehow inflated. For the second round of IVF, I purchased the same amount of fertility medication, but since I was paying out of pocket, it only cost around $4,000 instead of $11,500. I do not have the total costs for the third IVF cycle yet.
Describe Samantha Pfeifer's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at Weill Cornell Medical College.
For a 40 year old woman, she would recommend transferring up to 4 embryos for a fresh day 3 transfer (untested), up to 2 on a day 5 fresh transfer (untested), and 1 PGS-tested normal embryo for a frozen transfer.