Lorna Marshall

Before meeting with Dr. Marshall, we had two very disappointing IVF cycles at a previous clinic. I'm 36 years-old with diminished ovarian reserves and in the previous two cycles I had retrieved 4 eggs (1 fertilized) and 2 eggs (0 fertilized). I felt like a total failure after the 2nd IVF cycle so I decided to reach out for a second opinion and selected Dr. Marshall based on some of the FertilityIQ reviews about diminished ovarian reserve. We met with Dr. Marshall and it was night and day from our previous clinic. In our one-hour consultation she arrived with detailed notes on our medical history and jumped right in with new protocol recommendations. I mentioned to her that my previous clinic never technically categorized me as diminished ovarian reserve. Her response, "Really? Of course, you have diminished ovarian reserves and there are very successful treatment protocols that we've developed. We just need to adjust your treatment plan." This interaction made me feel so good just to know that there was a path forward. Dr. Marshall answered all our questions thoughtfully and backed up her suggestions with clinical research findings. My husband and I knew after that first meeting that we had to switch to Dr. Marshall and we were grateful that she would consider taking our case given the challenge and likelihood that it might lower the clinic's success statistics. Fast forward to our first IVF cycle with Dr. Marshall, she had me on an estrogen lead in protocol to suppress the lead follicles. I took Clomid for five days, immediately began stimulation with 450IU Gonal F and mini-HCG after my day 3 suppression check. We went from retrieving 3 eggs in my last cycle to getting 10 eggs! Of the 10 eggs, 4 fertilized and 2 grew to a blastocyst which is the farthest we had gotten. Unfortunately, both blastocysts were abnormal but upon reflection I'm so grateful to have used PGT-A to avoid wasting time and money on blastocyst that would not result in a viable pregnancy. Overall, we're still a challenging case and I can't say we have a happy ending yet. However, Dr. Marshall has and continues to do everything she can to support patients like me who are really challenging. She hasn't forced donors eggs on us and she's supportive of going forward with additional IVF cycles.

If you have questions always ask Dr. Marshall, she really wants to make sure patients have all the information they need to understand their options.

Lead in with 2mg estrogen 2x daily. Day 3 stimulation with Clomid 100mg, Gonal F 450IU, mini-HCG 20 units. Stimulated for 12 days (which is 5 days longer than my previous cycle). Added in Cetrotide at some point, but I forget when.

IVF including meds, ICSI and PGS $22,000

Before meeting with Dr. Marshall, we had two very disappointing IVF cycles at a previous clinic. I'm 36 years-old with diminished ovarian reserves and in the previous two cycles I had retrieve 4 eggs (1 fertilized) and 2 eggs (0 fertilized). I felt like a total failure after the 2nd IVF cycle so I decided to reach out for a second opinion and selected Dr. Marshall based on some of the Fertility IQ reviews about diminished ovarian reserve. We met with Dr. Marshall and it was night and day from our previous clinic. In our one-hour consultation she arrived with detailed notes on our medical history and jumped right in with new protocol recommendation. I mentioned to her that my previous clinic never technically categorized me as diminished ovarian reserve. Her response, "Really? Of course, you have diminished ovarian reserves and there are very successful treatment protocols that we've developed. We just need to adjust your treatment plan." This interaction made me feel so good just to know that there was a path forward. Dr. Marshall answered all our questions thoughtfully and backed up her suggestions with clinical research findings. My husband and I knew after that first meeting that we had to switch to Dr. Marshall and we were grateful that she would consider taking our case given the challenge and likelihood that it might lower the clinic's success statistics. Fast forward to our first IVF cycle with Dr. Marshall, she had me on an estrogen lead in protocol to suppress the lead follicles. I also Clomid for five days, immediately began to stimulate with 450IU Gonal F and mini-HCG after my day 3 suppression check. We went from retrieving 3 eggs in my last cycle, to getting 10 eggs! Of the 10 eggs, 4 fertilized and 2 grew to a blastocyst which is the farthest we had gotten. Unfortunately, both blastocysts were abnormal but upon reflection I'm so grateful to have used PGT-A to avoid wasting time and money on blastocyst that would not result in a viable egg. Overall, we're still a challenging case and I can't say we have a happy ending yet. However, Dr. Marshall has and continues to do everything she can to support patients like me who are really challenging. She hasn't forced donors eggs on us and she's supportive of going forward with additional IVF cycles.

If you have questions always ask Dr. Marshall, she really wants to make sure patients have all the information they need to understand the options.

2mg estrogen lead in. Day 3 stimulation with Clomid 100mg, Gonal F 450IU, mini-HCG 20 units. Stimulated for 12 days (which is 5 days longer than my previous cycle). Added in Cetrotide at some point, but I forget when.

Not sure because insurance hasn't billed us yet.

Dr. Marshall seems to be very well practiced in her field. I have 100% trust in her knowledge of fertility treatment. She was present for most of my procedures and often entertained my questions. After my hysteroscopy she told my husband about the results, because I was still coming out of anesthesia, but she would have never followed up with me if I hadn't asked. After our failed embryo transfer, when we were finally able to meet up to discuss what happened - she couldn't remember a lot of the details of my cycle (how many embryos did we get? did I have a positive HCG?, etc) and clearly hadn't refreshed herself prior to the meeting. Which was disappointing. After such a loss (chemical pregnancy of your one and only embryo), I was hoping for answers but since she didn't appear to know me from the next infertile woman so it felt like a waste of time.

She's very knowledge but not that personable - she lays out the facts but she doesn't pressure you to go one way or the other. She is one of the harder doctors to get appointments with - prepare yourself for a lot of 'hurry up and wait'.

I was diagnosed with low ovarian reserve (AMH ) and probable poor egg quality, other than that I don't know why the meds and doses were chosen. my IVF regimen was as follows: 3 weeks of BCP suppression check/blood work Follistim 450 IU and miniHCG 20u for 12 days. Meanwhile reporting to the clinic day 5 (ultra sound - 9 follicles), day 7 (US - 12 follicles), day 9 (US - 14 follicles), day 11 (13 follicles), and day 12 (12 follicles). Started Ganerelix on day 9. On day 12 max follicle size was 18.6 so HCG Trigger shot was scheduled for that night with retrieval the next morning. Egg retrieval in the morning, 10 eggs retrieved, 7 of those were mature. Day one report - 5 fertilized. Day 5 - 1 blastocyst and two more still growing. Day 6 - 2 blastocysts, both biopsied and frozen PGS report a four days later (we were told it would take 2 weeks) - 1 chromosomal normal blastocyst About a week after the retrieval I had a hysteroscopy and removal of some polyps found during the Saline Sonogram. Then I took a month and a half break (continuing birth control pills) to allow healing. For the FET, I did 2 weeks of lupron at 10u (some overlap with the BCP). A suppression check and blood work prior to starting Estrogen patches. The patches started at two every other day for a week then increased to 3 patches every other day for a few days then up to 4 patches every other day. Lupron had been reduced to 5 units every day. My first lining check was not thick enough so I continued with 4 patches. Still continuing with Lupron. Finally my lining was thick enough (it took 5 weeks instead of the 4 that was initially outlined). Progesterone was to start 6 days prior to transfer, but I forgot to start the progesterone so the cycle got cancelled. For the next cycle to prepare for the frozen embryo transfer, we repeated the BCP and lupron portion of the meds but I reacted negatively to the estrogen patches (rashes) so we switched to delestrogen injections. The delestrogen injection worked much better and my lining was ready pretty quickly. 6 days prior to the transfer I started progestrone injections and stopped the lupron. 10 days later I had my first beta HCG which was 150ish and my follow hcg test had declining levels so I had to repeat it again and the number was even lower so I was told to stop the delestrogen and progesterone.

IVF with ICSI and PGS $22,000. Meds for IVF were about $4,000. FET about $800. Meds for FET about $1200.

We met with 3 different fertility clinics and doctors for initial consults with Dr. Marshall being our last. We immediately could tell how knowledgeable she is and felt like she could answer all our questions well. She also put an emphasis on having a positive attitude throughout the process, which none of the other doctors spoke about. We really aligned with that and ultimately decided to work with her.

Ask every single one of your questions because she'll not only answer them but help you understand her answers. Also, don't expect to see her at every visit. However, you can expect to see an amazing Dr. from her team and almost every visit which is not something you experience at other clinics.

I led in with birth control pills then proceeded with an antagonist protocol with 10 days of injections. We did not need to adjust any dosages throughout the cycle as my body responded well.

There's a cost for the IVF cycle itself then additional cost for PGT that varies depending on the number of embryos sent for testing. The rest of the pre-diagnostic testing was covered by my insurance.

Dr. Marshall is kind, funny, calm, and reassuring. She clearly has a lot of experience and I trust that she knows what she's doing. Sometimes this can be a double edged sword, as she assumes I also know the details of a procedure/protocol, but she is always happy to answer questions. I appreciate her work towards trying to get insurance coverage for fertility treatment in the state of Washington!

Don't be afraid to advocate for yourself. Dr. Marshall said the same - we should feel comfortable calling and asking questions whenever we want.

For IUI with PCOS - first 3 rounds were with Letrozole and trigger. Round 4 and 5 included additional Gonal-F.

IUI with ultrasounds, approximately 1,000-1,200 per cycle IVF - 23,500 + 3-6,000 meds, 1,000 testing, 4,000 PGT-A testing

The clinic strongly feels that one embryo per transfer is the way to go. At my age, I have no issue with that but would likely feel differently if trying to conceive later in life.

I spoke of this before. However, she is a great physician and advocate. I appreciate all of her compassion and direction. She is compassionate and gracious. Every time, we start with where we are in life. Checking in on how we are doing. While is sounds simple, she has a knack for disarming your nerves to feel comfortable with the most difficult decision of your life.

As our second doctor, I was so scared to try to build a relationship again. The doctor and staff become part of your family. You share your hopes and dreams with them. She instantly make you feel like you had a team that you could count on.

The cost were very straighforward. She is not the most economical nor the most expensive. We appreciate the breakdown of finances.

We absolutely love Dr. Marshall. We came to her from SRM to get a second opinion because it felt like we were trying the same protocol over and over again with no results. When we walked out of that meeting, my husband looked at me and said 'I don't care if the results are different, she makes me feel calm and actually cared for." We switched immediately after. Dr. Marshall suggested a completely different protocol and the results were dramatically different compared to our previous 2 cycles (round 1: 4 embryos - all abnormal, round 2: 2 embryos - all abnormal, moved to Dr. Marshall, round 3: 11 embryos, 2 normal). (I have a genetic condition that results in a small % of normal embryos) Beyond the outcome, the experience felt different - from her proactive communication, to her kind and thorough bedside manner, to the fact that even though she didn't do the retrieval surgery, she popped in right after to check on us - it felt like she was on our side and we were on the same team throughout the entire process. We are doing a 4th round to get a few more embryos and I feel completely confident in Dr. Marshall. Finding her has been a game changer in reducing the anxiety and stress of this entire experience, while also giving us a better outcome.

Ask her for a second opinion if you are thinking of moving to her from another clinic. She had more thoroughly reviewed our file and had a more in depth conversation with us about our situation than our medical team at our previous clinic.

The stimulation portion of our IVF treatment plan included 450 IU of Gonal-F, 20 IU mini HCG, and 250 mcg Ganirelix. For the trigger, we used a dual trigger (Lupron and HCG). We have yet to do an embryo transfer since we'd like to bank a few more first.

We're fortunate to have insurance cover a large portion of the bill. Our coverage is capped, so we still have reason to keep costs down. The medical staff has been helpful in tailoring our plan to use leftover medications from previous cycles. The finance department is quick to answer with any questions (e.g. how much will this count towards our insurance cap?). They have proactively gotten pre-authorizations from our insurance company without us asking or being involved. At SRM, we had to call daily to ask them to submit the pre-auth and then follow up daily to make sure progress was being made, so this was a very welcome change.

We indicated our preference to transfer one embryo at a time and Dr. Marshall agreed.

We met for a consult and updated testing. When we arrived for the results, she had thought the office had provided us the results and what the results met prior to meeting. When she quickly realized the proper information was not yet conveyed to us, she took the time to explain what the number meant, drew visuals so the results made more sense. She presented the options and her recommendations. Dr. Marshall answered all of our questions. It definitely is not the news you want to get as a patient trying to conceive. She was honest and allowed us the space to show emotions. I appreciated her candid honesty. She gave us the opportunity to ask more follow-up questions and responded in a timely manner. She offered follow-up resources to assist us in processing.

Dr. Marshall is very experienced and has knowledge to share that is truly valuable. Be candid with you concerns . I was very impressed with her!

Consult and testing only

Initial Appointment-$386.00 Testing - AMH-$88.00 E2-$85.00 FSH-$80.00 Follicular Monitoring-$190.00 Venipuncture-$26.00 Follow-up Appointment-$196.00

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She is very straight forward but not too blunt. When talking about my chances being lower than others because of low egg count she talked us through specific number examples and let us throw in hypothetical questions. She set the expectations really well in our very first appointment so we have felt like we've been "on track" because it's working out to match what she set us up for - it's not ideal (of course I wish it was way easier) but she's been really good about knowing what we can expect.

Don't be afraid to ask your questions. She is so smart and it could be intimidating to ask what might feel like a dumb question but she's actually very patient with the crazy things I've asked her. It's ok to keep asking why - she'll answer when she can and be honest when there is no explanation for a specific result.

My first IVF cycle was with hcg (20 units) and folistim (450 units). The folistim is at the highest dose because I have very few eggs for someone my age. We started a day earlier than planned and retrieved a day earlier than predicted. I stayed at those dosages the whole cycle and the trigger was planned when the largest follicle was at about 19 mm. Early on she let me know it would be best to do retrievals now if I want to plan for more than one child because my egg count is so low so we are starting a second cycle now.

Lorna Marshall thoroughly reviewed our chart and was happy to help us with IUI because she knew we were not ready for IVF. When we wanted to be more aggressive she adjusted our protocol and added inhectables. She was always understanding of our situation and showed compassion while at the same time being straight forward with our situation.

I can’t think of any advice to give specifically related to Lorna Marshall.

I was prescribed Letrozole 5mg daily days 2-6. This was a little earlier than typically prescribed because my cycles are a little shorter than average. My ultrasound on day 8 showed 3 mature follicles. I triggered that day and did the IUI next day. The second IUI with PNW Fertility we added follistim (75iu) on day 7 in attempts to be more aggressive. My ultrasound was day 8 and showed 3 mature follicles. I triggered day 8 and IUI was day 9.

Consultation $295-375 Ultrasound $185 Venipuncture $25 Hormone testing $79-85 each Injection $40 Insemination $275 Sperm wash & prep $270

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Dr. Marshall was very calm and considerate whenever we met with her. She is very knowledgable and was patient with us even when we were frustrated that multiple IUI attempts had not worked. I have also heard great things about her from other patients that we have met during our journey. My two critiques are as follows: - Dr. Marshall (and PNW Fertility) was less than willing to stray from the normal playbook. Our case is atypical in that we were using donor sperm and we had no explanation why the IUIs hadn't worked to date. We asked about a laparoscopy to look for possible endometriosis, which she dismissed as too invasive and stated that she thought there was no reason to think my wife had that condition. We decided to move forward with the procedure anyway using my wife's OB-GYN, and they did indeed find endometriosis, which may have been an issue with the prior IUI attempts - At our last insemination, the RN asked if we had been taking in additional medication recommended by Dr. Marshall. These recommendations were in our file, but she had not actually told us anything about it.

Dr. Marshall is knowledgable and considerate, but as with everything in the infertility process, it is important to be your own advocate and make sure you communicate with her if you feel you need more testing or are seeking a different approach.

Multiple IUIs attempted with Dr. Marshall and RNs at PNWF. None were successful. After 5 attempts Dr. Marshall recommended proceeding directly to IVF.

IUI costs included the insemintation, as well as defrosting and testing of donor sperm. We were repeatedly charged for sperm analysis that as not done (since it was a donor). We have begun exploring IVF costs, and while they seem comparable to other clinics in the area, it is... excessive.

It has been a long road for my husband and I. I met Dr. Marshall during my ART consultation. During this consultation, she was very informative and concise, which is what I look for in a doctor. She took the time to explain the entire process of IVF and answered questions along the way. She has told me how it is through this journey that I am still on. She has told me her concerns and what she feels would be best but always giving me options to choose from.

She is a great doctor and would recommend to all. Although this journey I am on is not something that has been planned, she has made it easier to get through.

I am currently on my first round of IVF. I am on Follistim and Mini HCG. She has titrated the amount according to my labs. She used Ganirelix. She is using a dual trigger with Lupron and HCG. SHe recommends freezing your embryos for at least 2 months to reset your body.

My first and, at this point, my only IVF cycle cost around $25,000.

I do know the office I go to has a protocol for this. For the age I am, she recommends not transferring more then 2 embryos at a time.

Lorna Marshall was technical and rather emotionally cold. She was pleasant enough to work with, superficially compassionate, and not very warm. She had a strange story about her parents taking 9 years to conceive her which was unhelpful given my age and situation. She provided information on the procedures and answered the questions we had as best she could. She was less than helpful in giving advice on next steps and directed us away from further examination of my partner's varicocele and potential varicocelectomy. She was helpful in not recommending IUIs with injectables to avoid possible multiples.

Be prepared that Lorna Marshall likely won't be very warm and emotionally supportive through the process.

Lorna Marshall recommended IUIs with letrozole. She had us come in for ultrasounds in advance of the IUI in order to check follicle count in advance of each IUI. She had us use an HCG trigger shot prior to the IUI. Each time, I developed 1-2 follicles on letrozole, but only ever got negative pregnancy tests.

We paid for 2-3 consultations with Dr. Marshall, the cost of letrozole and HCG trigger shot medications, the cost of ultrasounds/IUI/sperm washing procedures, and parking.

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Pursuing IVF is one of the most out-of-control experiences I’ve had. But there is a comfort in knowing you are doing everything you can. Dr. Marshall has given me that comfort. At every step of my partnership with Dr. Marshall, I have had deep confidence in our approach. And the results are there to prove it. I went from two canceled cycles before working with Dr. Marshall to 15 total eggs retrieved in two back-to-back cycles of embryo banking after working with Dr. Marshall. While my transfer cycle is not until next month, I have rock-solid confidence in our path forward. For you to understand how special Dr. Marshall is, it’s helpful to contextualize my situation and the struggles I had before meeting her. If you are short on time, please scroll to the end where I sing her praises. My story – Before Dr. Marshall I am a healthy woman who has been active my entire life. My body has always cooperated with me, and I thought having a child would be no exception. So I spent my 30s focusing on my career and exploring the world, actively avoiding pregnancy, confident my husband of 17 years and I could have a child when and if we chose to. When we were ready to pursue pregnancy, I was 40. To avoid risking delays and miscarriage, we opted for IVF straightaway. This made our case unusual because we hadn’t spent time trying on our own without success, so we weren’t prepared for the rude awakening that followed. The initial diagnosis was beyond disheartening. I learned my FSH (at 13 IU/L) meant I was closer to menopause than I had counted on. Statistical models estimated I had the potential for three eggs each cycle. My new label: 40-year-old with Diminished Ovarian Reserve. Defiant, we proceeded anyway. But we got knocked down HARD. My first cycle was canceled quickly out of the gate because the birth control pills led to over-suppression. Only one follicle responded. Determined to get more information and move forward quickly, I sought another opinion per the suggestion of a friend of mine with extremely high standards. I flew out of town straightway to do so. The second round was canceled too. Once again, I had a dominant follicle emerge and my other follicles wouldn’t grow as a result. I started pouring over medical journals and learned there was a group of criteria used to describe my poor response: the Bologna criteria. Trust me, this is not a group you want to be in. I hated all these labels, and my sense of self started to morph with the loss of hope. It felt like my only option was to throw a hail Mary, without any real confidence that one would work. Not liking this conclusion (and not being able digest mentally why it shouldn’t be possible to preempt the early development of a dominant follicle), I scheduled a meeting with Dr. Marshall, at the recommendation of several friends. MY MEETING WITH DR. MARSHALL TURNED AROUND THE TRAJECTORY OF MY FERTILITY JOURNEY. 180 DEGREES. My story – After Dr. Marshall After my husband and I talked to Dr. Marshall, I knew I wanted to work with her. I knew she would be my final fertility doctor. Several things really jumped out at me during our initial conversation. Dr. Marshall: • Individualized her protocol recommendation, synthesizing her knowledge of IVF research and her experience and innovation with cancer patients. Her ability to individualize effective protocols was absolutely top notch. Most doctors like standard protocols because they are what generally works. But if you are older or not an easy case, you NEED someone like Dr. Marshall—who has the knowledge, the courage, and agility to go beyond textbook solutions. She discussed options with me, and her rationale was targeted and precise. Dr. Marshall was able to design a protocol that was much more compelling and effective than what I was able to find on other sites and in medical journals. During our discussion my prior cycles became critical inputs for deciding how to move forward. My prior doctors had made very solid decisions, but the key to better results was precisely pinpointing what needed to be changed based on what did not work in the past. • Offered us an entire path forward, not just a protocol for the next cycle – Given my first two cycles had been canceled, it seemed naïve to assume that the next cycle would miraculously be “the one.” We talked through a few scenarios that alleviated the pressure on the next cycle even while giving us renewed hope. It felt like a fresh start. • Focused on doing the right thing – Dr. Marshall happily agreed to work with us, even though there was a chance I could hurt the success rates of her clinic. She is clearly motivated to help people achieve their fertility goals, and is willing to put her patients’ needs ahead of her clinic’s numbers. • Has a sense of urgency – Dr. Marshall helped us get started as soon as possible, and worked with us to schedule other diagnostic procedures while we waited for the cycle to begin. Once we got started with the cycle, it felt like I was like I was in a different body. Hope blossomed when the cycle wasn’t canceled, and then turned into giddiness when I saw above-average results for my age. In the end, we made 9 follicles! From two canceled cycles to 9 follicles! Eight of these follicles made it to day 3, but we were down to one healthy embryo after genetic testing. So we opted to bank the first one and try IVF again. The second cycle proceeded as the first. While there were fewer follicles recruited out of the gate (I pursued this cycle as soon as possible after the prior one), we made 6 follicles, 15 total after two tries! And we now have another healthy embryo. These two cycles also highlighted how and why Dr. Marshall is so unique: • Drive for results – Throughout our journey so far, Dr. Marshall has been in the process with us. She does her work with skin in the game. We went from two canceled cycles to 15 follicles over two cycles. • Mental flexibility to do the right thing – Dr. Marshall always has a plan, but dynamically optimizes when there is new information (from bloodwork, from ultrasound, etc.) There are a lot of smart doctors but in my experience her ability to perceive leading indicators quickly and comprehensively and adapt plans accordingly is extremely, extremely rare. I am not used to others staying ahead of me, and it has been a true joy to relax and just do what I’m told! • Blends the best of IVF science with warmth and compassion – From her ability to handle my IVF-emoting to her kind bedside manner, Dr. Marshall brings warmth as well as expertise. My gratitude to Dr. Marshall runs deep. If, like me, you are able to work with her, you will be a very, very, very lucky person indeed!

Work with Dr. Marshall and you can relax.

Estradiol for suppression. Clomid + High dosage follistim for stimulation. Human growth hormone for finishing. The timing Dr. Marshall used for each step was critical for changing my results.

~$10K for physician services (monitoring, aspiration, transfer); ~$9K for embryology (insemination, blastocyst culture, cryopreservation)

It's great so far. Honestly, I'm just getting started after seeing my regular OB-GYN for about a year before seeking additional expertise. My first visit was great, I felt like we had a gameplan and well taken care of. UPDATE: The gameplan played out exactly as she predicted, after one failed cycle (I ovulated, but did not get a positive pregnancy test), I got pregnant on the second cycle and am currently 16 weeks along and everything looks good so far (hoping I didn't jinx it by counting it as "1 live birth" on a previous question).

Come prepared with lots of information.

Started taking metformin (500 mg/day for first week, then bumped up to 1000 mg) Taking 5mg of Letrazole on days 3-7 (I was already doing this with previous OB) Ultrasound on day 13 with injection of 10,000 USP units/vial to induce ovulation

$295 for office visit/comprehensive exam $185 for pelvic ultrasound $135 for pregnyl shot through MRD pharmacy

not applicable as of now

When meeting with Dr. Marshall I felt very confident in her knowledge. She has a gentle disposition and is able to clearly explain the process and procedures she recommended. I went to her after having a bad experience at another clinic and upon meeting her she put my mind at ease.

Expect to not see her at every visit.

Dr. Marshall's first treatment plan was to have me try Metformin as she explained that it sometimes helps patients with PCOS get pregnant naturally. My body didn't react well to the Metformin so she then had me start on Clomid with IUI. Her reason was that there is a better chance in conceiving with IUI versus naturally as the timing is exactly right. After 7 cycles of Clomid (and 6 IUIs) she recommended that we move forward with IVF.

Each IUI cycle (including meds, ultrasounds, IUI procedure, and lab work) cost about $1,100 out of pocket - my insurance does not cover infertility medications or treatments. I was told that I can expect IVF to cost between $20,000 - $25,000.

I was told that my clinic likes to transfer single embryos; however, if we would like to transfer two we have that option. They would not transfer more than two.

Dr. Marshall is competent and speaks clearly, though not necessarily an overly warm or gushing personality. My husband and I make a lot of jokes and she would often simply smile at us, and sometimes laugh a little, but not give a huge guffaw. (I call the vaginal ultrasound wand, "My old friend.") I thought we had a good, collaborative working relationship. I can't work with a doctor with zero sense of humor, especially about something so crazy as fertility treatment and IVF. I appreciated her openness to answering my questions and telling me what she was doing step by step. She'd take time to explain everything she was seeing on the ultrasound, which I appreciated. I learned a lot going through this process and she is open to taking a teacher approach, which is what I desire in a doctor. She also held my hand at one point before the egg retrieval and said, sincerely, "We want this to work for you." That meant a lot to me and made me cry (in a good way).

You really have to trust your doctor a whole lot during what may be the most vulnerable and stressful period of your life. This person is going to see you at your worst. Don't be afraid to switch doctors. We switched to Dr. Marshall from another doctor at another clinic. As with any doctor, speak up and advocate for your own care. Things do slip through the cracks and open communication is key. ...I still never fully got the hang of fertility treatment -- I was never fully comfortable with having to be a part of that system, though much of the struggle was in my own head. It's important to recognize in yourself when the doctor is really the problem, or the problem is within yourself. Conceiving a child is such a personal, magical thing -- and here you have to welcome strangers into the process. Eventually, with IVF, they will no longer be strangers but some of the people you see most often during the week. Fit is so important.

We had male factor infertility caused by cancer treatment. We used husband's frozen sperm. Treatment plan with this clinic was two IUIs, one of which resulted in miscarriage and another that didn't take. We'd had three IUI failures at a previous clinic, as well. Dr. Marshall encouraged us to continue with IUIs, but I was tired of failures and the imprecision with my irregular menstrual cycle -- so I made the case for IVF and Dr. Marshall agreed. This is important to note because the clinic makes a LOT more money off of an IVF patient than an IUI patient. And yet, Dr. Marshall did not push us to do IVF before we were ready, in fact, I was ready to take the next step and asked for IVF. It's important to have a doctor who sees you as a human being with hopes for a family, rather than a source of cash and profit.

From memory: $5,000 - $10,000 out of pocket over the years $15,000 - $25,000 insurance over the years

We did genetic screening of our embryos, put one embryo in, and I am now seven months pregnant with an apparently healthy baby. The genetic screening cost about $2,500 out of pocket. This seems like a reasonable risk/reward for our family to minimize the chances of a failed transfer and to minimize the odds of multiples.

Pursuing IVF is one of the most out-of-control experiences I’ve had. But there is a comfort in knowing you are doing everything you can. Dr. Marshall has given me that comfort. At every step of my partnership with Dr. Marshall, I have had deep confidence in our approach. And the results are there to prove it. I went from two canceled cycles before working with Dr. Marshall to 15 total eggs retrieved in two back-to-back cycles of embryo banking after working with Dr. Marshall. While my transfer cycle is not until next month, I have rock-solid confidence in our path forward. For you to understand how special Dr. Marshall is, it’s helpful to contextualize my situation and the struggles I had before meeting her. If you are short on time, please scroll to the end where I sing her praises. My story – Before Dr. Marshall I am a healthy woman who has been active my entire life. My body has always cooperated with me, and I thought having a child would be no exception. So I spent my 30s focusing on my career and exploring the world, actively avoiding pregnancy, confident my husband of 17 years and I could have a child when and if we chose to. When we were ready to pursue pregnancy, I was 40. To avoid risking delays and miscarriage, we opted for IVF straightaway. This made our case unusual because we hadn’t spent time trying on our own without success, so we weren’t prepared for the rude awakening that followed. The initial diagnosis was beyond disheartening. I learned my FSH (at 13 IU/L) meant I was closer to menopause than I had counted on. Statistical models estimated I had the potential for three eggs each cycle. My new label: 40-year-old with Diminished Ovarian Reserve. Defiant, we proceeded anyway. But we got knocked down HARD. My first cycle was canceled quickly out of the gate because the birth control pills led to over-suppression. Only one follicle responded. Determined to get more information and move forward quickly, I sought another opinion per the suggestion of a doctor friend of mine. I flew out of town straightway to do so. The second round was canceled too. Once again, I had a dominant follicle emerge and my other follicles wouldn’t grow as a result. I started pouring over medical journals and learned there was a group of criteria used to describe my poor response: the Bologna criteria. Trust me, this is not a group you want to be in. I hated all these labels, and my sense of self started to morph with the loss of hope. It felt like my only option was to throw a hail Mary, without any real confidence that one would work. Not liking this conclusion (and not being able digest mentally why it shouldn’t be possible to preempt the early development of a dominant follicle), I scheduled a meeting with Dr. Marshall, at the recommendation of several friends. MY MEETING WITH DR. MARSHALL TURNED AROUND THE TRAJECTORY OF MY FERTILITY JOURNEY. 180 DEGREES. My story – After Dr. Marshall After my husband and I talked to Dr. Marshall, I knew I wanted to work with her. I knew she would be my final fertility doctor. Several things really jumped out at me during our initial conversation. Dr. Marshall: • Individualized her protocol recommendation, synthesizing her knowledge of IVF research and her experience and innovation with cancer patients. Her ability to individualize effective protocols was absolutely top notch. Most doctors like standard protocols because they are what generally works. But if you are older or not an easy case, you NEED someone like Dr. Marshall—who has the knowledge, the courage, and agility to go beyond textbook solutions. She discussed options with me, and her rationale was targeted and precise. Dr. Marshall was able to design a protocol that was much more compelling and effective than what I was able to find on other sites and in medical journals. • Offered us an entire path forward, not just a protocol for the next cycle – Given my first two cycles had been canceled, it seemed naïve to assume that the next cycle would miraculously be “the one.” We talked through a few scenarios that alleviated the pressure on the next cycle even while giving us renewed hope. It felt like a fresh start. • Focused on doing the right thing – Dr. Marshall happily agreed to work with us, even though there was a chance I could hurt the success rates of her clinic. She is clearly motivated to help people achieve their fertility goals, and is willing to put her patients’ needs ahead of her clinic’s numbers. • Has a sense of urgency – Dr. Marshall helped us get started as soon as possible, and worked with us to schedule other diagnostic procedures while we waited for the cycle to begin. Once we got started with the cycle, it felt like I was like I was in a different body. Hope blossomed when the cycle wasn’t canceled, and then turned into giddiness when I saw above-average results for my age. In the end, we made 9 follicles! From two canceled cycles to 9 follicles! Eight of these follicles made it to day 3, but we were down to one healthy embryo after genetic testing. So we opted to bank the first one and try IVF again. The second cycle proceeded as the first. While there were fewer follicles recruited out of the gate (I pursued this cycle as soon as possible after the prior one), we made 6 follicles, 15 total after two tries! And we now have another healthy embryo. These two cycles also highlighted how and why Dr. Marshall is so unique: • Drive for results – Throughout our journey so far, Dr. Marshall has been in the process with us. She does her work with skin in the game. We went from two canceled cycles to 15 follicles over two cycles. • Mental flexibility to do the right thing – Dr. Marshall always has a plan, but dynamically optimizes when there is new information (from bloodwork, from ultrasound, etc.) There are a lot of smart doctors but in my experience her ability to perceive leading indicators quickly and comprehensively and adapt plans accordingly is extremely, extremely rare. I am not used to others staying ahead of me, and it has been a true joy to relax and just do what I’m told! • Blends the best of IVF science with warmth and compassion – From her ability to handle my IVF-emoting to her kind bedside manner, Dr. Marshall brings warmth as well as expertise. My gratitude to Dr. Marshall runs deep. If, like me, you are able to work with her, you will be a very, very, very lucky person indeed!

You're smart to work with her. You can relax now.

We used a protocol that Dr. Marshall developed in her work with cancer patients. Suppression with estradiol. Then a combination of Clomid, Follistim, and Omnitrope. I will need to confirm exact timing and doses.

We froze embryos after both cycles.

She is very knowledgeable, and extremely caring. She explained the different steps, and walked me through what the options were. Once I was pregnant, I did feel a little rushed out of the clinic, but I figured that was because she was sure that everything was going well.

Write everything down.

Since I had a previous successful pregnancy, and mostly unexplained fertility, we did a standard course of treatment for my egg retrieval. She used birth control and Lupron, followed by Gonal-F and Menopur. She used an HCG trigger for retrieval. Following transferal, we did progesterone in oil shots, combined with estrogen patches. I had a fresh cycle transfer, but I understand that the clinic now combines PGD with a frozen cycle transfer to improve results. The second transfer was a chemical pregnancy, likely due to attachment on previous scar tissue. For the third transfer, she positioned the embryo in a different place. This led to my second successful IVF pregnancy,r, with birth control for regulation, then progesterone in oil and estrogen patches.

They were covered by insurance, so the total bill for the first pregnancy was about $12,000, but we only paid $1500. The embryo storage was $250/6 months. The second and third transfers were about $2500 each, again, partially covered by insurance.

She said she would let the embryologist decide one versus two based on the quality of the day, for the first transfer, and the embryologist said one. For the second and third transfers, I asked for a single embryo.

She takes the time to explain procedures and recommendations and gets into the 'why' of what we are doing. She explains things in a way that I (an RN) and my husband (not in a medical profession) both understand what we are doing and why. She is flexible with us to make changes in what we are doing (decided not to do an IUI), and listens to our concerns.

Ask lots of questions. Write things down so you don't forget the little details.

2013 egg retrieval before chemo: Menopur/Follistim/Ganirelix and HCG trigger. I was 35 years old and we got 11 eggs. 8 made it to freeze as embryos at day 3; 2 made it to day 5 freeze (in 2015), and one of those was found to be chromosomally normal after PGS testing. The remaining embryo has the genetic mutation that caused my cancer, so we are currently doing a second egg retrieval in one more shot to try for a baby without this mutation hanging over their head. Based on my AMH and FSH levels, Dr Marshall actually recommended against doing another egg retrieval when we first asked. But when we decided that we wanted to try even though there was a higher chance of failure, she worked with us full force. We are pulling out all the big guns on this one: 4mg Estrace x12 days, then 100mg Clomid x5 days; 150mg Menopur; 300IU Follistim. Will start Ganirelix once follicles are ready, and will have an HCG trigger

It was about $9500 for our initial egg retrieval in 2013 (with a cancer patient discount and meds paid for through another cancer patient fund); in 2015, it was $4850 for PGD; $1k for PGS; $4500 for embryo biopsying and sending samples to the genetics company; it will be $11800 for this next round of egg retrieval, including ICSI (currently doing injections for this); I paid $5184 for my meds this time around. Another $1800 for biopsies to send for PGS and PGD; $3865 for FET, plus the cost of meds.

Dr. Marshall is straight forward and easy to understand. She clearly has incredible experience in the fertility world. Any frustrations we had with the process were simply because it can be a frustrating process, not anything related to Dr. Marshall.

Be patient. The process can be slow and involves a lot of waiting. But you are in good hands.

My first retrieval resulted in very poor fertilization rates. For my second retrieval we switched to an antagonistic protocol and had amazing results. For my first two transfers we did a typical medicated cycle, both of which failed. For the third transfer we did a "kitchen sink" natural FET. That transfer resulted in my twins.

My first two transfers were eSET. When those failed we asked about transferring two embryos and Dr. Marshall was supportive given our situation and the fact that I was young and healthy.

She was compassionate and optimistic about results. She offered alternatives when they did not meet our expectations. She is very knowledgeable and does share everything she can. I do wish I saw her more frequently, she did not perform my IUIs.

I would recommend more time with patient, although I know this is hard given how many people seek treatments. I often felt when I was meeting with other doctors they did not have the full context (although I am sure they did) and weekend appointments because of timing made it so I was seeing other people.

I cannot remeber.

They were high, $30K.

NA

Dr Marshall is extremely experienced in her field. She is very well spoken and communicated all of the possible Options in a way that was easy to understand. I trusted her expertise and treatment plan. She was honest and direct about expectations. I saw her almost every time I was in the clinic. This doctor, this woman changed my entire life.

Do whatever she tells you to do.

Insurance paid

Very nice and very informative. I wish I could have seen her more often and felt like she was really working to try to make things happen for me. I didn’t feel like she remembered me whenever I saw her.

Ask a lot of questions. She is thorough with her answers.

Started with no meds and IUI, then moved to letrozole for 3 cycles, then moved to letrozole and follistim, all with IUIs. No positive results. Discussed embryo donation, egg donation, and ivf and pros and cons with each.

$330 per IUI. Ultrasounds and doctor visits cheaper.

Dr. Marshall was so understanding about our situation. she always asked if we had questions. if I wanted to do any testing, she would always understand and always would listen to my concerns and questions.

Ask questions. There are no stupid questions. Ask everything. Dr. Marshall will listen and address them!

During our IVF cycles, Dr. Marshall would monitor very closely with labs and ultrasounds. If any numbers were off , low or too high they would adjust my medications very quickly and accurately. If I received a positive test, she always recommended i be seen and monitored early due to my history and I always felt like she cared about me and my situation.

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costs were very much comparable to other facilities. Billing was so easy to speak with and helpful. They were there to answer all questions.

none.