How was your experience with Spencer Richlin at RMA of Connecticut?
Dr. Richlin is fantastic. He knows his stuff as well as he cares about his patients. I worked with him for 2 years prior to our first RMA baby and we have been at it again for the last 14 months. When my husband and I first met with him, we were eager and optimistic. Dr. Richlin connected with my husband (as well as me) and made us both feel comfortable being in the unfamiliar office, with unfamiliar technology (the vaginal ultrasound wand is no joke!). As we progressed through diagnostic procedures without unveiling answers, I got more frustrated, but Dr. Richlin stayed with me, motivating me and explaining what "unexplained" means. He also gave insight into what we were finding and helped us understand our options.
After the required (by insurance) 3 IUI's, we headed into IVF. When we had no embryos on day 5 after our first retrieval, Dr. Richlin called me in shock. Hearing the surprise in his voice made me feel better. I was not a number, I was a future success story, but he was as frustrated as me by our roadblock. After another failed retrieval, he took our chart to "case review" to get his colleague's opinions. I love that he was humble enough to do this and that the others cared enough to help. What is better than 1 amazing brain? 5 of them! We kept tweaking the protocol and ended up with something that worked. When it was time for us to come back for baby #2, he welcomed us with open arms as though we'd never left. When I more recently had a miscarriage, he followed up via phone and email to see how I was doing. Knowing I have his support and that he is walking with me on my journey makes it so much easier to walk back through those doors.
What's one piece of advice would you give a prospective patient of Spencer Richlin at RMA of Connecticut?
Don't be afraid to ask questions! He will gladly take the time to explain something to you, or work through a scenario with you. He is a great listener and wants to know your concerns.
During treatment, were you treated like a number or a human with Spencer Richlin at RMA of Connecticut?
Dr. Richlin knows me and emails and calls me directly after good and bad news. When I first worked with him, I was feeling particularly hopeless and over the phone he switched gears from medical doctor to checking on my mental health. He then adjusted our protocol in response.
When I recently had a miscarriage, he squeezed me in on a Saturday in between other scheduled appointments to check on my unexplained bleeding. He saw me again the next day (Sunday) and had a very in depth conversation with a partner who saw me on Monday. On Monday, it was decided I needed to go to the hospital for emergency surgery (I was having an heterotopic miscarriage which resulted in a ruptured tube and several days later a D&C.). Dr. Richlin called the hospital and worked closely with the head of surgery to make sure the director would be doing the (tubal) procedure. He also shared my file (with my permission) so that I was able to bypass many pokes and prods in the ED. Later in the week, it was decided that I needed a D&C. The office facility was booked, so Dr Richlin scheduled the OR at the hospital and again worked with the Director of Surgery so that they both did the procedure (after hours).
Dr. Richlin also celebrates our successes (they are his as well!) and always welcomes our 2 year old when she comes with me for an appointment (our first RMA baby). When I brought her in as a baby, he stepped away from his desk and chatted with us for 30 or so minutes in the middle of the day. He truly cares and his passion for what he does is evident in how he treats his patients.
Describe the protocols Spencer Richlin used in your cycles at RMA of Connecticut and their degree of success.
3 IUI's - standard protocol
1st retrieval - standard protocol, nothing made it to day 5. PROTOCOL: 1/15/15 - baseline ultrasound and bloodwork; 1/17/15 - Dexamethasone 1/2 tablet in AM, Gonal F 300 + Menopur 75 at night; 1/20/15 - ultrasound and bloodwork; 1/21/15 - dexamethasone continues, start Doxycycline 2x daily, Gonal F 300 + Menopur 75 x2 + Ganirelix; 1/22/15 - Ultrasound and bloodwork; 1/24 - ultrasound and bloodwork, 1/25 - ultrasound and bloodwork, last dexamethasone, HCG trigger, Gonal F 300 last time; 1/26/15 - bloodwork; 1/27/15 - retrieval
2nd retrieval - Luteal Estrace/Antagonist. 2 blasts on day 5 (very very low quality) (untested); PROTOCOL: 3/2/15 - bloodwork; 3/2/15 - start estrace 2mg twice daily, start baby aspirin; 3/12/15 0 ultrasound and bloodwork; 3/14/15 - Gonal F 300 + Menopur 75 at night; 3/14/15 - start dexamethasone 0.5mg 1/2 dab orally every am until taking HCG; 3/15/15 - last dose of estrace; 3/17/15 - ultrasound and bloodwork; 3/19 (or around then) start ganirelix (.25 prefilled syringe) and possibly started menopur; take HCG 10,000 units or Ovidrel 250 (mcg) 36 hrs before retrieval; The night of the retrieval take Medrol 16mg for 5 days, also start Doxycycline 100mg 2x/daily for 5 days. Start Estrace 2mg 2x/daily after retrieval and begin Crinone 90mg the morning after retrieval (prep for fresh transfer)
1st transfer (FRESH) resulted in a negative pregnancy test (PROTOCOL - see above)
3rd retrieval - IVF with Luteal Estrace/Antagonist - resulted in 1 embryo on day 6 (untested); PROTOCOL: 4/27/15 bloodwork; 4/27/15 start estrace 2mg 2x daily, start baby Aspirin; 5/11/15 - ultrasound and bloodwork; 5/12/15 - Gonal F 300 + Menopur 150 every evening also Dexamethasone 0.5mg, 1/2 tablet orally every morning until HCG; 5/13/15 - last dose of Estrace; 5/15/15 - ultrasound and bloodwork; 5/17/15 (or around then) - begin Ganirelix and likely Menopur; HCG 10,000 units 36 hrs before retrieval
4th retrieval - Luteal Estrace/Antagonist - resulted in 1 embryo on day 6 (untested)
2nd transfer (frozen, used 2 blasts) resulted in a positive pregnancy test. One fetus was lost at week 7, other is a precious 2 year old :) Used estrace valerate to support my estrogen numbers.
--break due to pregnancy and nursing--
5th retrieval - did luteal phase priming - resulted in 4 high quality embryos on day 5. None were tested. (at this point, I've been on NeoQ10 for almost 5 years, otherwise the result was a surprise) PROTOCOL: 2/19/18 - bloodwork to confirm ovulation; 2/19/18 - start estrace 2mg orally twice daily, start taking baby aspirin; 3/5/18 - return for ultrasound and bloodwork; 3/6/18 - Gonal F 300iu + Menopur 150iu every evening; 3/7/18 - last dose of estrace; 3/9 - ultrasound and bloodwork; 3/11/18 (or around then) started ganirelix and may have increased menopur
3rd transfer (frozen, using 2 blasts)- used estradiol valerate and copied the protocol from transfer #2 - negative pregnancy test. PROTOCOL: 4/10/18 Start Estradiol Valerate (0.2ml (4 mg) injections. One injection every 3 to 4 days so that you are doing them 2x a week. Start baby aspirin daily. 4/20/18 - REturn to office for bloodwork and ultrasound. 4/21/18 - Start Progesterone 50mg (one cc) IM @ 12pm alternating every other day with Crinone one vaginal insert 2x daily. Continue Estradiol Valerate at the same dose and schedule. 4/26/18 - Transfer day. Use Crinone, one insert vaginally in the morning. 5/4/18 - Pregnancy blood test
4th transfer (frozen, using 2 blasts) - used estradiol valerate and copied protocol from transfer #2 - positive pregnancy test, week 6 demise of both pregnancies. I had a heterotopic pregnancy/miscarriage, resulting in a ruptured right tube and a D&C. PROTOCOL: 8/9/18 Start Estradiol Valerate (0.2ml (4 mg) injections. One injection every 3 to 4 days so that you are doing them 2x a week. Start baby aspirin daily. 8/22/18 - REturn to office for bloodwork and ultrasound. 8/25/18 - Start Progesterone 50mg (one cc) IM @ 12pm alternating every other day with Crinone one vaginal insert 2x daily. Continue Estradiol Valerate at the same dose and schedule. 8/30/18 - Transfer day. Use Crinone, one insert vaginally in the morning. 9/7/18 - Pregnancy blood test
6th retrieval - this was rushed due to squeezing it in before the end of our insurance cycle, we didn't want to "leave money on the table" - resulted in no embryos on Day 3 - quite a shock to have none
* I also do acupuncture 2x a week when in cycle, whether it be a retrieval cycle or a transfer cycle. I do laser acupuncture before and after the transfer.
** I take a prenatal, DHA supplement, NeoQ10 and folic acid regularly
Describe your experience with your nurse at RMA of Connecticut. (Assigned nurse: Kirsten, and now Kaylen)
The nurses are all amazing. I feel very fortunate to have had two of the best. They respond promptly to both email and phone calls and answer my endless questions without a hint of frustration. They explain things as many times as I need it explained and in as many ways. They are great at sending reminders and following up. I give Kirsten lots of credit for our successful transfer. She noticed that my saline sonogram was about to expire and got me to squeeze in one before starting meds for a transfer. During the SS it was determined that I needed a hysteroscopy at which time they cleaned out a bunch of "webbing" in my uterus. The nurses absolutely go the extra mile. They greet me with a smile in the morning and followed up with genuine emails and calls following our miscarriage.
Describe your experience with RMA of Connecticut.
The strength of RMA-CT is 100% its people. They are professional and they care. I'll say it 100 times - they truly care - everyone from the person at the front desk to the fantastic blood draw ladies to the doctors and nurses. A close second strength is the holistic approach to healthcare. I have taken advantage of the nutritionist, social worker, acupuncturists and especially Fertile Yoga and Ladies Night In support sessions. Fertile Yoga and Ladies Night In are unique peer-led support groups which have given me an outlet and also a place to grow in this and with this diagnosis. Lisa Rosenthal (the leader) is a tireless advocate for all of us, and for fertility, and inspires me to get back up and try again. Through these support groups, I have developed strong friendships with others going through this process and also with new moms as we mutually emerge from the diagnosis. The clinic treats the whole person - the whole FAMILY - and I am so glad my OB recommended I "go straight there."
Describe your experience with your monitoring appointments at RMA of Connecticut.
Morning monitoring is not awesome, but the waiting room is well-stocked with coffee, tea, TV and on the weekends, bagels. It is first come, first served, but we sit waiting for our name to be called in a very comfortable place. Once your name is called, you go do bloodwork and from there they take you to an exam room. About 15% of the time, the exam rooms are all full and you go back to the waiting room and have your name called again for the exam room. The exam rooms are pleasantly decorated in peaceful tones, but are otherwise exam rooms. The primary facility (where I go) was opened in 2015, so it still feels fresh, clean and new.
Describe the costs associated with your care under Spencer Richlin at RMA of Connecticut.
We are very fortunate to have had many of our procedures covered by insurance. I believe we paid a total of about $30,000 out of pocket for our first child ($20,000 was covered by insurance). We've now paid approximately $10,000 (in deductibles) for our second go-round.
Describe Spencer Richlin's approach to eSET (elective single embryo transfer) vs. multiple embryo transfer at RMA of Connecticut.
Yes. I did not know what to do and felt very comfortable asking him to make that decision.
Transfer #1 - fresh transfer, 2 embryos very low quality - it wasn't discussed too much. I think the doctors knew there was a slim chance either would work.
Transfer #2 - I was mentally exhausted and questioning whether I should even do the transfer. I wanted to only transfer 1 and possibly have the second for a second baby, but I also barely had it in me to go through one transfer cycle. Dr. Richlin talked to me about the consequences of transferring 2, and then said he thought I should do 2 based on my mental state. I needed to get on with things (we were talking egg donor if it didn't work). My husband and I discussed the possibility of having twins and we were excited about it. I was 35 at the time.
Transfer #3 - I was 37 and we discussed it, but transferring 2 seemed like the right thing to do.
Transfer #4 - There was a brief discussion, but we were comfortable transferring 2.
**After the miscarriages from transfer #4, we will now get any embryos tested and only transfer 1.