Arbor Fertility

We have been with Dr. Zarek through it all - our testing/diagnosis, IUIs, the round of IVF that finally brought us our little girl in 2020, and now as we are back in treatments to try to make her a big sister. I think like most couples that find themselves facing infertility, we were really anxious and overwhelmed at the outset. Infertility is something that happens to "other people", right? And there are so many unknowns - the biggest being whether or not our story would resolve with a take home baby. But from our very first appointment, we have always been confident that we were exactly where we needed to be. Dr. Zarek is knowledgable and accomplished, of course; but it is her compassion, sincerity, calm confident, and wit that have always gotten us through the peaks and valleys that inevitably come in this journey.

If you haven’t set up an appointment...just do it! Dr. Zarek is the best!

IUIs: We had previously used Clomid with TI at my OBGYN, but my ovaries were unresponsive to it, so Dr. Zarek prescribed Letrozole with an Ovidrel trigger. I produced follicles and ovulated, but the IUIs were ultimately unsuccessful. IVF: We started with birth control + Lupron suppression; stimmed fairly easily with Menopur + Gonal-F. She had me increase the dose once, but dropped it back down when my estrogen levels started trending up. We got 18 eggs (14 mature), 12 of which fertilized. We ended up with 9 embryos. Normally, she recommends a freeze-all to give the body time to recover before a transfer. But because our insurance doesn't cover much of anything in a transfer cycle, she agreed to plan for a fresh transfer as long as I didn't develop OHSS. When my estrogen levels jumped, putting me at risk for OHSS, she took preventative measures, prescribing Cabergoline prior to retrieval (this far removed I cannot remember what exactly it does) and Lovenox starting the night of retrieval. She monitored me for OHSS following the retrieval, and I didn't develop it, so we went ahead with our fresh transfer 5 days later, giving us our little miracle girl. Frozen Transfers: We have since returned in hopes of conceiving again, and have had 2 transfers this year. We suppressed with birth control, followed by applying estrogen patches, PIO and E2P4 suppositories for 5 days before transfer. The second transfer she added estrogen injections. Ultimately both failed, and we just did the Receptiva test to see if there are more underlying issues before we continue with transfers. We switched the protocol a bit, using Estradiol pills and Estrogel instead of patches and injections, which was actually kind of a nice change. Who is going to complain about less needles, am I right? I do want to add that the original plan for this mock cycle was to do an ERA; but with the recent studies that have come out questioning its validity being a big topic at ASRM, she came back to me after and suggested a pivot. I really appreciated not only the attention placed on the most recent data, but also the flexibility to amend the plan midstream when the available data suggested that the current plan isn't the best choice anymore. Because I'm like a lot of people - I'm not a doctor or statistician, so I don't always understand the science or data behind these things unless it's really broken down for me. So I have always relied very heavily on Dr. Zarek when we're making these decisions on next steps, and have always been appreciative of the attention and rationale behind our care.

Current costs for most things are listed on Arbor's website (arbor-fertility.com). Her goal is to keep things as low-cost as she can for us! Tanesha, the financial counselor, is very responsive as well if you have any questions about prices or insurance coverage. She isn't currently in network with insurance, but bloodwork and meds can be submitted to insurance if you have coverage.

Dr. Zarek's general recommendation is to transfer only one embryo at a time because multiples pose a greater risk for the health of mom and babies—but I know that she does do two in certain cases. I have a uterine anomaly and don't want to risk having a multiples pregnancy, so we transfer one at a time.

We had a wonderful experience with Dr. Zarek and Arbor Fertility! From day 1, we felt like we were valued as people, not just a number or customer. Our experience was individualized and excellent across the board. Dr. Zarek made herself available to us 24/7 which helped give so much peace of mind going through a lot of new treatments and procedures. Every question was met with grace and a knowledgeable answer. After multiple steps of treatment and nothing working, she was flexible and open to trying new things, all while letting us become advocates for our care in the process. After a lot of of up's and down's in the fertility journey, we finally are pregnant thanks to Dr. Zarek at Arbor Fertility! We don't have enough great things to say about this clinic and the ease of working with the team in all aspects. The satellite campus in Columbia has saved us countless hours of driving back and forth to St. Louis which has helped so much! We can't thank the team enough for all of their support and care over the last year and a half!

Never be afraid to ask questions -- big or small. Dr. Zarek always wants your input and thoughts to be expressed.

1. IUI I was on letrozole 2. Egg retrieval I was on Menopur 75iu, Follistim 225 IU for 13 days prior & Ganirelix 0.25mg 9 days prior to retrieval; using Pregnyl for trigger 3. Letrozole 7.5mg x 7 days prior to FET, estrogen patches + sildenafil suppositories, Pregnyl trigger, then PIO 100mg IM + E2P4 suppository 5 days prior to FET and after until pregnancy test 4. Prep for FET #2: sildenafil 25mg four times daily vaginally, estrogen patch every other day, cetrotide 0.25 just prior to trigger x 3 days, pregnyl trigger, then PIO 50mg IM daily, E2P4 suppository, sildenafil 25mg 4 times daily, estrogen patch, Lovenox 40mg SQ daily -- transfer was cancelled due to poor lining thickness, and we got pregnant anyways

IVF retrieval was $13,000 which included anesthesia, the procedure, ICSI, sperm prep, ultrasounds, embryo freezing, virtual follow up, 1 year embryo storage, and lab fees; additional fees were medication costs of around $5,000, transfer fee of $3,000, and optional genetic testing $3,500

Recommended 1, agreed with recommendation based on evidence provided

Dr. Zarek is extremely compassionate and professional. She eased all of our fears, explained everything thoroughly, and checked in with us frequently. She made a stressful uneasy process easier. We actually ended up getting pregnant prior to our planned IUI cycle and she continued to follow us and monitor with bloodwork and early ultrasounds. We had a history of a prior loss and she was clearly invested in our care and in ensuring we did everything to prevent another loss.

Hands down the best experience I could have wanted. Don’t be afraid to share your fears and ask questions.

At the initial appointment my husband had a sperm analysis and I had a baseline an ultrasound to evaluate my ovaries and uterus. Tested by AMH, TSH, and Vitamin D levels. I had a borderline vitamin D level so she started me on a weekly dose of vitamin D. She also recommended I start taking COQ10 400mg BID. All treatment plans were discussed at the initial consultation with a soft plan but after my AMH level came back lower than desired we planned to move straight to IUI with a medicate cycle. I ended up getting pregnant before the IUI. I was started on progesterone 400 mg intravaginally BID, asprin 81mg, and lovenox 40mg due to history of prior 1st trimester missed miscarriage. I had an ultrasound at 6 weeks 4 days and then another at 8 weeks 5 days.

All costs outlined on website

Very kind and welcoming. I don’t feel rushed or like I’m an inconvenience. I feel like I could ask her anything at any time. I did have a few communication issues regarding scheduling in the beginning, but she was transitioning clinics, so I think that was why.

Remember to ask questions. Even if you think it’s silly. We didn’t get the results I had hoped for, and I regret not asking some questions that were on my mind before the procedure.

We used Follistim and menopur, and added Ganirelix. We ended up doubling the doses for Follistim and menopur both.

$7500 for egg retrieval $5000 for transfer

She said that she recommends one embryo to prevent risk of pregnancy complications and we haven’t pushed so I’m not sure what she would say if we did.

Dr. Zarek is everything you're looking for and more in a fertility doctor. She's caring, loves what she does, and takes care of her patients and their partners. I trusted her and the plan she had for me and because of that, we had a successful egg retrieval and frozen transfer. I'm sad that at this point, I've "graduated" from Arbor Fertility, but so happy with the care we received.

I would tell people that Dr. Zarek is going to be the best communicator in any doctor I've ever met with. In terms of availability, you have her cell phone number and she's very responsive. I've never felt so comfortable messaging a doctor but she is very down to earth and geniune.

Dr. Zarek started me on medications to prepare my body for the egg retrieval. The procedure was very quick and Dr. Zarek was able to get 3 healthy blastocysts to do a frozen embryo transfer. My body needed more time on medications including progesterone 2ml, estradial valerate .4ml, estrodial patch and nightly suppository. I was also on a birth control pill. Baseline labs and ultrasounds were preformed and a transfer date was set for 2/1/24. Medications continued. Bloodwork was done 2/12 and 2/14 to test Hcg numbers. I was able to do these at another clinic and send results to Dr. Zarek. The results were very promising and she said the pregnancy was developing like it should! An ultrasound was scheduled at the Columbia site 3/1 with positive results!

Luckily, since I lived 2 hours from the St. Peter's clinic, I was able to do monitoring appointments at home and have the results sent to Dr. Zarek that day.

Dr. Zarek and I agreed that a single embryo transfer is the safest route to go and I trusted her approach.