Carl Herbert (retired)

As I mentioned before, he treats me like a human being with feelings that are valid. He also has a very calm manner, which puts me at ease.I also never feel rushed or as if he does not have time to speak with me, be it in person or via the phone.

Be upfront with him, and he will treat you the way you want to be treated. He will respect your wishes and will not let you do unnecessary treatments just to make the clinic more money. He told me I could still attempt IVF with my own eggs, but that I would most likely end up right back there 3 months down the road with no embryo's and out $30,000. I appreciate that in. a physician.

I haven't actually done any myself. My sister donated eggs for me and went through one round of IVF. As far as I know they were very good at adjusting and gaging when to up medicines during the stimulation cycle and about guiding her through the process. I am waiting on our SIP to be lifted, so that I can start my FET protocol. They want to do a medicated cycle with medication assistance. Estrogen and Progesterone.

$21,000 for my sisters IVF cycle. $4,300 for one FET, does not include meds $375 initial intake consult $395 meeting with Psychiatrist for working with third party (donor eggs) $275 for meeting with genetic counselor, all additional follow ups associated were included

At PFC they only transfer 1 embryo at a time. Which I agree with

Dr. Herbert offered to explain everything and will answer questions if I ever have them. The office staff are very prompt and responsive. Office is busy, so I didn't get to see Dr. Herbert at every visit, but that was okay. Although there is some setback and delay with my cycle, the clinic is always in touch to keep me updated.

It's just important to ask questions. He will not go into too much detail unless you ask him the questions. Make appointments ahead of time because he is busy.

We decided to have an egg donor , with a frozen embryo transfer cycle after viable embryos are retrieved. Because only 1 viable embryo was retrieved after PGT testing, Dr. Herbert offered ERA cycle as a diagnostic test to increase success of the transfer. He offered advice and information when we were disappointed with only 1 embryo retrieved. We have not gone through the frozen embryo transfer but the coordinators and staff are always ready to help us through it all

It was costly, mainly because it's in San francisco and is a very lovely, professional looking office that takes up the entire floor in a decent sized building. Compared to other couples undergoing same protocol, I believe we paid noticeably more. But it's a good group of doctors, nurses and coordinators.

The clinic strongly endorses eSET transfer, which is a safer approach and I agree after doing my own research.

Strengths: Set realistic expectations on number of eggs expected; explained what he was observing during the ultrasounds and when he was reviewing blood work in a clear way Weaknesses: Not warm and fuzzy, if that is important to you

He is objective and clear, but not a cheerleader if that is what you need

My protocol was the following: Follistim 200 IU for first 4 days Menopur 75 IU for first 4 days -- Ultrasound & estradiol test; medication adjusted Menopur 75 IU for 3 days Ganirelix Acetate 250 mcg for 3 days Follistim 225 IU for 3 days -- Ultrasound & estradiol test; medication continued Follistim 225 IU for 2 days Menopur 75 IU for 2 days Ganirelix Acetate 250 mcg for 2 days Retrieval injection for retrieval 36 hrs later

Medication costs were $2000-2500; doctor's services were $9000

NA

Dr. Herbert has a very straightforward manner but I don't mind it. I still felt I could joke or cry with him. Anytime I had a question and arranged a phone call I felt he took time to answer my questions. Most notably, the month I was set to begin I was extremely sick and at my baseline ultrasound pretty upset because my follicle count was lower than it had been at my consult ultrasound. He explained my options to me (go for it or wait a month to see if the count would be better). As I became increasingly upset, I think he could see how devastated I was and suggested I wait/get better. It was most definitely a human moment. There was one instance that stung just a tad, but in the moment I called him on it and I truly believe there was no ill intention. During my consult when discussing options, he assumed and suggested at some point I would pick a sperm donor. I joked and reminded him that finding a future partner was still an option. I did sort of feel just in that initial consult that some added sensitivity around me being there alone as a single person would have been nice. I only felt that way during the first appointment. In my subsequent calls or ultrasound appointments I don't recall feeling that way.

It's a piece of advice I plan to use myself which is to understand more what my blood test numbers mean/meant. During my consult, my mid-cycle ultrasound provided a surprising number of follicles as compared to my blood tests. However once I began treatment it seems what I'm seeing is more in line with those test results. I now feel I have more questions and want a better understanding of all my options. Additionally, I would say if warm and fuzzy is what you're looking for as a patient this may not be the best fit.

It was suggested I take Vitamin D, a prenatal and Co-Q-10. I had a very bad reaction to Co-Q-10 and after playing with the dosage and timing, we just sort of agreed I was done with it. I was put on 300 Follistim and 150 Menopur. After an injection class, once I realized everyone was on different meds, I did call to inquire how these decisions get made. I would say I was not super clear on the answer and now that I'm in the cycle again wondering if different meds or doses would work better (questions I now plan to ask). It's too soon for me to comment on results.

More than $10,000 when you factor in medication. Between 8-9k not counting medication.

NA

Dr. Herbert is direct and to the pony. This may not be for everyone. I personally really liked it. He was also very compassionate and caring. He also thought outside of the box, learned from my first canceled cycle and was successful the second time. Where other doctors would have stopped he kept going and tried.

To be honest and to know that he will try his absolute best for you.

below were drugs for my first cycle where I had a positive pregnancy, second cycle was the same minus the Letrozole. Both cycles we did extended stim an additional 7 days for a total of 20 days bc of my endometriosis. Medication SIG Quantity Refill Substitution Lupron MD (1:10 dilution) 50 mcg/0.1mL - Vial 1:10 Dilution (1mg/0.2mL), final conc 50 mcg/0.1 mL) Dispense 4 mL vial. Sig: Take 10 units BID as directed. 1 1 DAW Syringe 1/2 cc (U100) Insulin - - - - As directed. 22 1 DAW Follistim AQ Cartridge 300 IU - Injection As directed. 8 1 DAW Menopur w/ Q-cap vial adapters 75 IU - Vial As directed. 13 1 DAW Syringe 3cc 20g 1.5 in - - - - As directed. 14 1 DAW Needle 27g or 29g 0.5 in - - - - As directed. 12 1 DAW Needle 25g 1.5 in - - - - As directed. 2 1 DAW Sharps Container - - - - As directed. 1 0 DAW Letrozole 2.5 mg - Tablets 2 tab po on CD3 - 7 10 1

With drugs a cycle was about $15,000 but that did not include genetic testing.

We did multiple embryo transfer for both. He let me make a decision I was comfortable with.

Again, mentioning his affability, he is very likable and an easy communicator. After a successful round of ivf with ccs, I had three frozen chromosomally normal eggs. We implanted one, I became pregnant, but no heartbeat at 7 weeks - having a dnc at week 8 - a few months later I implanted the next one, similar outcome. At this point, I had had 5 miscarriages, 7 pregnancies in 4 years.....with one naturally conceived easy live birth so I knew that I could carry to term. I had every blood test under the sun, always normal. I kept asking dr. herbert, 'is there anything that you can think of that would be causing these miscarriages?',...'should we check for anything else before we implant my last frozen egg?', His answer was fair for sure, 'could be anything, we never really know..let's do a medicated implantation this time' (more costly and time consuming for me) Before implanting my last egg, I sought a second option with ucsf, within one hour of meeting me they did a sonogram of my uterus and determined that I had a significant amount of scar tissue in my uterus due to all the pregnancies and dnc's over the last few years. Since I always miscarried around week 8, they determined that this was the most likely cause, the embryo simply couldn't grow any bigger. On one hand I was relieved that I finally had a potential answer for all my recurrent miscarriages, but on the other hand I was astonished that I had seen almost every doctor at PFC (pacific fertility center) over the course of two years and not one of them thought to investigate my uterine cavity. During my sonogram at ucsf, she pointed out all the scar tissue on the screen, it's white and very easy to see even with my untrained eye. A hysteroscopy was performed at ucsf a few weeks after the initial diganosis and a post-op sonogram revealed virtually no scar tissue, again very easy to see the difference with my untrained eye. It seems that an easy routine test in the form of a thorough sonogram could have prevented so much heartbreak, let alone time and money.

Be your own advocate

basic IVF, 12 days on meds, I responded well to meds and 17 eggs were retrieved. I should mention I was 41 at the time and exceeds all stats etc.

I think 25K for IVF plus meds plus another 3K to natera for genetics testing, implant 3K each times 2

He has been in the field a long time and seems to know his stuff. I wish he would have been better at talking me through things and showing a bit more compassion throughout the process. Compared to other doctors, I think he did a good job during the ultrasounds. He didn't rush through them like many of the other doctors I saw and he was sure to show me each follicle and tell me how it was doing - this I really appreciated.

Don't go into it expecting him to cushion the blow. He is up front and realistic which can be good, but also hard for someone who may be emotional and having a hard time.

I wasn't given much explanation for the protocol used. I now now (only since I have been to another doctor) that he used the long protocol. I took estrogen pills before my cycle and then went on to menopur, follistim and ganirelix for about 9 days. My menopur was 150/night and follistim was around 350/night. He didn't explain there were different options so I assumed this was the only one. During my cycle he also upped my dosage and it wasn't clear why he did that.

my insurance didn't cover anything besides the initial visit so I paid for all ultrasounds as well as the procedure cost, Anastasia, and meds.

I liked Dr. Herbert in general, he was kind and friendly enough. But I would say the warmest/most compassionate doctor in the practice is Schrioc. He proably has the best bedside manner/warmth. Over the course of the many years I was at PFC, I had appointments with all of the doctors, as they cover for each other for u/s and all the way to retrievals and transfers. Dr. Herbert would get on the phone and answer questions and was responsive. It's looking back that I'm not sure he was as creative with treating my infertility. I had 3 retrievals and many transfers there - and don't think there were very many changes to my protocol. That being said, when I asked for some things, for example, for them to let all of my embryos "have a chance" and grow them out and freeze them, even if they were low quality, he let me. He let me transfer them too. Those "bad" embryos at least got me pregnant, though I did miscarry. My current clinic would not have frozen or transferred those low quality embryos. The fact that Dr. Herbert did and I got pregnant, gave me hope to continue - as that was my first pregnancy ever. Had my 1st round of IVF not produced a pregnancy at all, I think we would have quit. So bottom line, I found him more open to listening to my wishes, in that sense and letting me decide. I think that was a good thing. On the other hand, I did bring up a concern with transferring fresh embryos when I am an endometrios patient (a disease that flares up with hormones). He wasn't very open to exploring this and we continued to transfer my best embryos in fresh transfers. My current clinic said they would not have done this with me, full of stim meds. In fact, the trend overall now, is to mostly do FETs. I always wonder if we wasted by best embryos at PFC doing those fresh transfers. I wish he would have taken more time to consider what I was saying.

I think if you are not successful with a protocal or a doctor, ask them to change things. They should learn from the data they have on your cycles. I would also ask them for their success rates with people similar to you. PFC is a big enough clinic now that nothing should be completely new to them. If it is - I would find another clinic. You don't want to be any clinic's guinea pig.

Too long ago and too many to remember specifically. I know I used Follistim, Menopur, Cetrotide. My FETs were (mostly) unmedicated. I got 15 eggs on two rounds, 17 on another. So not a lot of variance there. We tended to have about an 80% fertilization rate. My embryos didn't do well between day 3 and 5 in the lab, so for my 2nd and 3rd round we froze on day 3. I had a few pregnancies, and all ended in m/c - some early and one 2nd trimester. No living children to date.

In 2010, I think IUIs were roughly $2,000 plus meds. For our second & third ERs we did a plan that allowed you to do two ERs if you didn't get pregnant, at a slight discount. That was in the mid-$20,000 range - drugs, monitoring and additional transfers were all in addition to that.

Open minded, kind and professional are qualities I would ascrbe to Dr Herbert. He was recommended to us by a very happy former patient and her faith in him was borne out. We were very happy with him. It was gratifying that he was willing to use a new procedure that limited or most injections and relies instead on vaginal suppositories and oral meds to prep me as the recipient of the donor egg. This was an approach that has been very successful in the UK and I wanted to try it and avoid all the injections. It worked! Herbert had no ego around holding on to his own approach but did his own research and went forward with me in this novel approach with great success.

If you are using a donor egg ask him about approaching it using suppositories vs injections!!!

See previous comments and implant one embryo only.

I don’t recall in detail. It’s been a while!

Pros: Very experienced doctor cares about his patients, knows all the most modern techniques. Dr. Herbert answers all the questions and concerns, even if you have tons of them. He is physically very respectful and doesn't make you feel physically embarrassed. Cons: Can be arrogant, his jokes don't always come at a good moment and can be insensitive.

He is old school in his style so bare with him. Don't hesitate to ask any questions until you feel you understand it all.

ICSI was suggested due to low sperm count. I had an endo cyst in my ovary so we went for 5 days genetically tested embryos to increase chances of conceiving quickly.

$30000

He recommended SET

I think he has excellent bedside manner. I've felt his compassion for my situation and his desire to help. He is a very clear communicator. However, during some of my appointments I have felt rushed at times, like there isn't enough time for me to ask questions.

Don't be afraid to ask questions even if they seem obvious. It's the doctors job to explain things thoroughly and in a way you can understand.

approximately 20,000

My partner and I love seeing Dr. Herbert. He is very warm and has shown compassion with each negative pregnancy test. From the start of treatment, I was clear about what our path would be. After 1 failed IUI, he adjusted medication dosage. After 3 failed IUI, he prepared us for the possibility of IVF and explained all pros and cons of the treatment process. During visits, Dr. Herbert moves quickly and I am sometimes left with some questions about the course of treatment, however, he's been consistently available for follow up via email, phone and in person. Overall, my partner and I have received clear guidance and realistic expectations throughout our process with Dr. Herbert.

I would review all of the information you receive after each visit. If any questions come up, email the staff and/or schedule a call with Dr. Herbert.

He was always warm and patient with me. He also always told me how it will be and did not sugarcoat anything to make me feel better. He did that in a way that was patient and caring and I always felt in the best hands with him.

Ask all the questions. He's on your team, you might as well be motivating the team together by cheering each other on.

We decided to try IUI before going to any further measures. He and his team explained very well what will happen and answered all the questions. I did cycles with using Letrozole and then the trigger shot before procedure. It was all very straightforward and well explained. I was very lucky to produce a live birth after only one IUI. And conceived again using the same strategy 1.5 years later that resulted in another live birth.

It was around $1,135 for the IUI plus medications.