The Fertility and Gynecology Center

The first time I met Dr. Ramirez, I was very nervous about what he could discover. That initial visit didn't feel as warm as I wanted (more of a down-to-business type of person), but I didn't want to judge him solely by that visit (everyone has their off days!). We put off treatments for a couple of years because of life circumstances, but when I began visiting his office again he was exactly what I expected and needed. He was warm, informative, direct and encouraging. I highly recommend him!

If you don't understand, ask questions! Don't be afraid to email him, even after hours. He will respond quickly!

We decided to jump straight to IVF. I started on birth control, prenatal pills, and medicine to help lower my thyroid (Dr. Rameriz likes a low thyroid for treatments). Once my cycle started, I began giving myself Follistim and Menopher. I also took Asprin. My body wasn't producing as many follicles as Dr. Rameriz wanted to see, so I took the trigger shot and change the cycle to an IUI. I had back-to-back days of IUI, but were unsuccessful (although I did ovulate at the right time). During that time, I took progesterone vagally.

My husband handled the financial side of things with this clinic. We paid a "down payment" for the month we wanted to start IVF. We also had to have the entire cost be paid before we started. When we changed my cycle from IVF to IUI last minute, Dr. Ramirez was so kind enough to credit us for IVF in February if the IUI didn't work. I know this is not a common practice for infertility doctors, but it really spoke wonders of his integrity.

Dr. Ramirez is so knowledgeable and he explained all the options, information and answered all my questions with patience and grace. For such a complicated process, it felt easy and smooth. Dr. Ramirez offered IUI but we wanted to skip right to IVF. Again, the whole office made the experience as smooth and efficient as possible while still remaining warm, compassionate and caring.

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In Vitro Fertilization – Single Cycle – $9,640.00 Clinical monitoring including ultrasound Egg Retrieval Surgery Center Fee Embryology Laboratory Procedures Involving In Vitro Fertilization Embryo Transfer Freezing of non-transferred Embryos and 1st year of storage Anesthesia (Anesthesiologist, IV conscious sedation and monitoring) – $690.00 Intracytoplasmic Sperm Injection -$1,860.00 (ICSI) (Sperm Injection) Used for male factor and age related infertility Laser Assisted Hatching – $805.00 Pre-Implantation Genetic Testing (PGT) ……………………………… $2,000 Biopsy and processing of embryos for genetic abnormalities (includes testing of all available embryos) Does not include the outside PGT Laboratory Testing cost which will be billed by the Lab **A portion of this fee is non-refundable once the services have been initiated. Frozen Embryo Transfer Cycle……………………………………. $4,500 Includes: Determination of Appropriate Hormonal Preparation Protocol (Based on Results from Previous Tests or IVF Cycles) Clinical Monitoring including Ultrasound Examination Embryology Laboratory Procedures: Identification, Thawing, Culturing, Processing and Preparation of Frozen Embryos Embryo Transfer Procedure Clinical Coordination and Medication teaching

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He told me my 2 miscarriages were insignificant in the grand scheme of miscarriages and I needed to get over them. At the end of my 2nd egg retrieval, a previous coordinator said she thought the pressure of the incubator was off because everyone was having slow/bad results with their embryos. When I asked her about it the following week she retracted her statement and left the practice the nest week. The last round I did was just awful. After my egg retrieval and being told the next day how many fertilized I had to call/text to try and find out what was going on without getting any calls/texts returned. It wasn't until day 6 I was contacted to respond to my inquiries. Previously, they updated every other day. Day 7 yielded no confident answers and I never heard from them again until I emailed a question about a huge bill I received. The bill was an error because, as the billing person told me, they don't always communicate. I was left for a long time with no answers, no conclusion, nothing. It was extremely aggravating, disappointing and lonely. During the later part on in my journey, anytime I went to appointment alone they would make comments and facial expressions that were indicating I was on this journey by myself. Making it seem as though my partner was not supportive of the process, I don't see why she would need to take time off work for a blood draw. Looking back, lots of moments where red flags and I should have stopped and found another doctor to work with on this journey. It's also important to note to do research on cost. This dr is way more expensive then a lot of other doctors. I had to have a blood test in LA at one point of a cycle and the test was HALF the price. If I was starting out now, I would do a lot more research. Somethings I would look at include the lab- it is state of the art? Are there more then 1 embryologist? Only 1 leaves them with all the responsibility of looking at every single egg, finding the mature ones, doing IVF or ICSI meaning they are finding the best sperm to use then watching them over the days. 1 set of eyes. If the cycles are done in batches 1 person is looking at hundreds of eggs. Is that something your comfortable with or should there be more than 1 to help and support, be back up if 1 gets tired or isn’t in the right mood for the day. So many factors. Are cycles done in batches with specific dates or are they done following your body and what it needs and that’s all that matters? I also feel I was mislead in supplement information to help with the possible quality of eggs. After finishing my 3rd and last round with him I decided to do my own research and found research suggested taking supplements for 2 months. I had taken them for 3 weeks before my egg retrieval. Extremely disappointed. They have definitely gone from a supportive, let's make a baby/family to money hungry. More of a push them through service. With my experiences, I feel like I was taken advantage of just to bring in $10,000+++ another time. They also don’t give refunds so if you don’t make it to retrieval or transfer you still pay for it.

Don’t go for convenience of location. Go for a dr and clinic that fits your needs best. My new dr was 100% different then this dr.

Each round of IVF I used follistim and menupor with ganerelix. The follistim dosages varied slightly but the menupor and ganerix was always the same. My first round yielded 10 eggs/5 blastocysts. My follistim was upped for round 2 and I had 16 eggs/0 blastocysts. My follistim was taken down for round 3 and I had 18 eggs/0 blastocysts. Nothing else was changed. The only extra tests ran were to make sure my chromosomal karotype was normal and to see if I had an MTHFR mutation. Those 2 were only done after my chemical pregnancy and miscarriage of twins with my first IVF cycle and I had to beg for them to test for something.

They were welcoming and respectful HOWEVER in between my 2nd and 3rd egg retrieval he told me i am very attracted and it would be cheaper if I just slept around, that I would eventually get pregnant. I AM HAPPILY MARRIED TO A WOMAN. He also did nothing to try to figure out my unexplained infertility. No extra tests. Nothing.

There were a lot of hidden costs. We had to pay a flat rate up front of over $10,000 but that did not include any ultrasounds or blood tests. So it was surprising to get the extra bills that were quite high.

I have always transferred 2 embryos. Due to age and them not being tested it was ok to transfer 2 according to the quote lines.

We worked with Dr. Ramirez in 2015, when my wife conceived our son on our first IUI. I started working with Dr. Ramirez the end of 2016 and had 5 IUI's during the course of 2017. We had many heartaches in 2017. 1 ectopic pregnancy, 1 chemical pregnancy and 3 unsuccessful attempts. It was incredibly difficult for us. in 2018, we started the process for IVF and although it is invasive, our experience has been very positive. We are appreciative of everything Dr. Ramirez has done to help our family!

Don't be afraid to ask questions! It's not about statistics and numbers. It's about creating a family. Be your own advocate. Don't be afraid to say what you need. Dr. Ramirez is there to help you thru this process but you need to be honest with yourself about what you need, and also with Dr. Ramirez. It's an emotional journey. Try to take it all in and then come back with questions and the support you need.

For my 5 attempts at IUI, I was on either Clomid or Femara. I had more success with Clomid. I was on the max dose of both the Clomid and Femara and if I remember correctly, I only produced 2, maybe 3, appropriate sized follicles each cycle. He was hoping for 3-4 per cycle. I'm currently in my first IVF cycle. The hyperstim process and egg retrieval went very well. I tolerated my med regimen without difficulty. The actual embryo transfer went very well and now we're in the wait period to find out if I'm pregnant.

None of our fertility costs were covered by insurance so it has been challenging for us, financially. We did apply for a health care loan, which Dr. Ramirez's office assisted us with, and have a very reasonable interest rate. Melissa is fun to work with (financial coordinator in the office) and the loan company has actually been very nice to work with as well.

Dr. Ramirez left it up to us whether we wanted to transfer 1 or 2 embryos. In our case, we only had 1 viable embryo.

Their office is like a small boutique clinic. Dr Ramirez spends time with every patient at each visit. His staff is well trained and each one aids in the process. If we had questions between visits, he was always available through email or phone. Once I had an allergic reaction to a drug and we were communicating with him while he was in a different country. His patients are not numbers to him and you know it. He is always checking the latest research, so you know you're getting the highest quality care and planning

Don't give up, because he won't. I wouldn't recommend anyone else in the Monterey Bay Area...he's the best!!!

Which time? We tried everything from drug assisted, IUI, IVF (my eggs) and finally IVF (donor eggs) - each time the treatment was tailored to our unique circumstances and adjusted based on the previous session. Our last IUI ended in an ectopic pregnancy so we moved to IVF. But I didn't respond like an PCOS patient so we had to increase the medications on the 2nd IVF. Eventually we maxed out on medications, but my eggs were old. Our last IVF was using donor eggs, which finally ended in a live birth of our son. We have severa frozen eggs now, which we will work with in the near future.

We were provided an itemized cost list for each service. The last cycle IVF donor cost approximately $20k plus medications. I don't have a copy of these bills since they were paid.

In our last three IVF cycles we all decided multiple embryo transfer was best due to our history. We were well aware and informed of the risks, but due to our previous failures, believed the risk of a multiple birth would be low. With our donor IVF, we transferred 2 eggs... but only had one live birth. Dr Ramirez is very much against the octa-mom scenario, but is reasonable with his approach. In most cases, he would suggest eSet.

Dr. Ramirez is very straight-forward without being cold. He understands what it's like to go through fertility treatments and is very compassionate. We saw him at every visit and he always took the time to answer our questions. I never felt rushed by him.

Take the time to at least go meet him for a consultation and see if he might be a good fit for you. We highly recommend him to anyone who needs help conceiving.

We had 4 IUIs (2 with Clomid and vaginal progesterone & 2 with Femara / vaginal progesterone, Ovidrel trigger, estrace, ). We then moved on to 3 rounds of IVF with Follistim, Gonal-F, Ganirelix, Menopur, progesterone in oil, and medrol. On rounds 2 and 3 we added baby aspirin and heparin. We did one FET cycle after our 2nd fresh cycle. We used Lupron, progesterone in oil, medrol, estradiol, estrogen patch). We waited several months in between rounds 2 and 3 and I added CoQ10 (to possibly improve egg quality), and my husband added Proxeed (to possibly improve sperm volume and viscosity). Our first round of IVF resulted in a chemical pregnancy. Our 3rd fresh cycle resulted in a live, singleton birth.

He charged around $1,000 for a medicated IUI cycle. We purchased an IVF package that included 2 fresh cycle and any resulting frozen transfers for about $16,000 (not including medications, bloodwork, and monitoring). All together, for 4 IUIs and 3 IVFs, we spent a little over $50,000 (including medication, monitoring, and labwork).

Dr. Ramirez, as I said before, was very thorough in all his explanations. He allowed us to try IUI even though I was close to forty. After each failure he was upbeat and listened to our frustrations...even the ones that we may have had against him! Never once did he make us feel ignorant and when I had my miscarriage, he was so considerate and took care of me through that horrific event. He is the only doctor you will see when you visit his clinic. It is always one on one care with him. My husband had to deploy (in the Army) and Dr. Ramirez made sure that we would be able to do IVF even with him being away. We froze his sperm and were able to do two cycles! Luckily we got lucky with the second cycle and we now have a lovely daughter.

Dr. Ramirez is the best and kindest doctor...don't let your failure to conceive right away discourage you because he will find out what is wrong and make sure you have the right protocol.

Nice, but not great bedside manner. You have to press him to explain things. He seems to stay up to date with new research, but one article could have saved me from having a failed retrieval if he’d read it a few days earlier. His military involvement is problematic for scheduling especially if you want to try IUI

Ask questions

If you have PCOS he will recommend using Lupron as your trigger to avoid OHSS

Egg retrieval was around $20k plus medication and FET was around $4k plus medications

from the first interview he paid all his attention and ask us questions to create a comfort ambiance, then place the probabilities and possibilities as they are ... asked us to think and then come with an answer, never put pressure on us. his team is so kind and knowledgeable... always there in any emergency or consultation .

explanation of everything

12,500