Paolo Rinaudo

Dr. Rinaudo was very thorough, meticulous, and had a deep understanding of Asherman's Syndrome, which is rare to find. There are only a handful of clinics across the U.S. that use best practices to treat Asherman's correctly, and UCSF is on the cutting edge. We only saw him a few times throughout the ten or so months I was in treatment for Asherman's and infertility; for procedures and messaging, we typically worked with other members of the UCSF Center for Reproductive Health staff (which we didn't mind). Dr. Rinaudo is very thorough in his explanations, which I appreciated, and he was always warm and kind with us.

On the spectrum from "info-dump talking" to "listening to feelings," he's more on the "info-dump talking" end. He'd often just dive into the care plan without asking or checking how I've been since the last meeting. I definitely got all of my questions answered with him, felt very well-informed, and trusted his care protocols, but there wasn't a lot of space to talk about my experience or feelings. This was totally fine with me; I didn't need my doctor to be touchy-feely about feelings, but I know that kind of connection matters to some folks, so I thought I'd mention it.

Treatment for Asherman's Syndrome: Saline sonogram to confirm adhesions, then operative hysteroscopy to remove adhesions, followed by balloon catheter placement for five days. I did a month of Estrace supplements, of which the last seven days, I took Provera to induce a withdrawal bleed. We did three cycles after that of unmedicated timed intercourse, which didn't work, followed by two medicated IUI cycles. For each of those, I did Letrozole and Ovidrel trigger shot. The second IUI cycle was successful. Because of Asherman's Syndrome, my lining never got very thick, so we were teed up to add some additional interventions the following cycle (Trental medication; platelet-rich plasma) in case that was the issue. My lining only got to 5.8mm on the day of the second IUI, but it ended up being successful.

I don't remember the final out-of-pocket amounts, but we're lucky that our health insurance covers 90% of fertility care costs. The total amounts we spent were very low and manageable.

Dr. Rinaudo made this difficult and scary process just the opposite. He explained everything very clearly and set realistic expectations. My husband was just a couple of years post pancreatic cancer treatment when we first saw Dr. Rinaudo and we assumed the issue was just a male factor but when I got tested and discovered that I had a very low ovarian reserve (only 3 follicles and barely 4mm each during pelvic US) we realized our situation just became tenfold more complex. I was 38 at the time so it wasn't statistically surprising but it was definitely emotionally shocking to find out nevertheless, considering I've always been healthy. After 3 cycles of IUI didn't work Dr. Rinaudo recommended IVF. Having lost my childhood best friend to breast cancer at the age of 33 shortly after IVF, the thought of it was terrifying. Though the statistics aren't clear that IVF causes cancer, I've personally witnessed too many cases. We discussed this with Dr. Rinaudo and he explained that it is important to consider that it's not just IVF but the ongoing hormone surges throughout pregnancy that could trigger cancer. This shed more light on the subject but didn't make going through IVF more enticing. We agreed with my husband that if we came to the point where IVF was the only option we'd get further genetic testing for cancer. This is the ONLY weakness that I would say Dr. Rinaudo has. Neither HE nor ANY medical professional was the one to suggest this test, despite my husband's history of cancer and my Ashkenazi background. Once we told him we want to do the genetic testing, Dr. Rinaudo very quickly arranged for us to meet with a wonderful generic counselor who performed the saliva test. After a few weeks we were contacted by the same genetic counselor who gave us the terrific news that my husband was clear of any genetic cancers (which was my biggest fear) and followed the news my revealing that I have the BRCA2 gene (a fear we didn't anticipate). Now I was even more glad we did the test but even more confused by why NOBODY ever suggests to get this test done considering 1 in 40 people of Jewish descent have some form of the BRCA gene. We decided for me do a double mastectomy and reconstruction and put IVF on hold until I recovered. Now I'm recovered and less fearful of going through IVF. Now I'm ready to get back on track to starting a family.

Pick his brain. He's brilliant. But do your research and be your own advocate in the process. This would apply to any doctor as well.

At start of consultation I was 38 with low ovarian reserve (3 follicles barely 4mm each, FSH 11.2) My husband was 35 and with history of chemo due pancreatic cancer. Double whammy! He said IUI would be the less aggressive route since we wanted to avoid IVF possible so he said we'd give no more than 3 cycles a try then move on to IVF. 3 cycles of IUI resulted in 0 pregnancies.

We were fortunate to have Cobra insurance coverage under my husband's previous employer in Massachusetts which covered all fertility treatment. We no longer have this coverage and were quoted about $15,000 not including medications per cycle for out of pocket cost.

Dr. Rinaudo suggested single embryo transfer to avoid potential risks associated with potentialof multiples based on our situation and my age

I felt he was very straightforward and kind. He answered all my questions. There is some room for improvement in being proactive in helping me think about decisions involved in doing another round, but I'm not even sure that would have technically been appropriate for him to get involved in my decision making. It would have been great to be able to see him at each ultrasound, too. He didn't do the actual procedure only because he broke his arm.

Be proactive in asking questions - he is a research focused and has a tremendous wealth of knowledge. Don't be afraid to ask for clarification even though he talks quickly and is clearly busy, as all doctors are .

My hormone treatments were very standard. I don't know that there is any rationale other than, there was no reason to deviate from the standard.

$8000

n/a

I felt like Dr. Rinaudo didn't necessarily have a strong investment in my outcome. My first cycle was cancelled due to poor response to the treatment protocol. From then on (subsequent 2 retrievals) he stayed with a protocol that he said was the only / best one for me given my poor response to the first one. The protocol didn't yield very many eggs, and when embryos were cultured out to Day 5 there were even less to work with. He explained it to me as an egg quality issue / limit of my age, which I understand but I always had a nagging feeling that there should be some adjustment tried or even contemplated to get a better result. From my first retrieval, only three Day 5 embryos survived. We transferred them one at a time with no success. I became interested in PGS for my second retrieval as a way to get past my egg quality issues. Dr. Rinaudo tried to explain the risks of the process to me, but I insisted on it because I was trying to "solve the problem" and I suppose I didn't have enough of a sense that he was trying to solve it with as much purpose or passion. So we went for the PGS, and unfortunately ended up with only one embryo to test which came back as anuploid. It was a traumatic experience for me to go through a retrieval process and end up with no embryos to transfer. I ended up taking a four month break so my husband and I could regroup, and then we switched clinics.

I think Dr. Rinaudo could provide more guidance to a couple, to create a more informed process, while still leaving the ultimate decision up to the patient. I think he's a lovely person, and perhaps he and I just didn't have a personality fit, but I felt like I needed more expert guidance from a RE.

Dr. Rinaudo did my first cycle as an antagonist protocol I believe (Gonal F, Ganirelix, Menopur as the primary medications). My body didn't respond well and that cycle was cancelled. For two subsequent retrievals we used a Clomid Flare protocol. I understand this is for poor responders, and that was his rationale for using it. However it resulted in small numbers of eggs (7 one time, 6 the other). I inquired about changing it for my last retrieval with him and he said it was the only / best one for me. However, in a subsequent cycle at a different clinic, my RE has used a different protocol and gotten better results (14 eggs retrieved). So I believe that my nagging feeling that Dr. Rinaudo should have looked at ways to adjust that protocol for me was the correct feeling.

My first retrieval and three transfers were covered by my insurance. My final cycle was a self-pay cycle with a retrieval and PGS but no transfers unfortunately, and I believe it was around $15,000.

Dr. Rinaudo understood that my husband and I were trying to avoid twins, and he was supportive of our decision to only transfer one Day 5 embryo at a time. However, I wish he had educated us more on the statistical probability of that approach actually working out for someone of my age. My current RE let us make the ultimate decision of course, but he did a statistical analysis that showed that we could safely transfer 3 Day 3 embryos at a time to cover the number of embryos that probably wouldn't survive. I know it's difficult to compare Day 5 to Day 3, but I felt like we were making a more informed, rational decision with our current RE than with Dr. Rinaudo.

We had a couple of meetings with Dr. Rinaudo but most of the time, we dealt with his assistant and nurses. At times, I felt like I shouldn't ask too many questions because I sensed that he's busy. It's not that Dr. Rinaudo was unfriendly, it's just that I didn't feel like he genuinely cared. I am just one of the many patients he's treating.

I guess I will say be firm and make sure you get to speak to him when you really need to

I was on the Estrace Priming Antagonist protocol. Since it was my first IVF, Dr Rinaudo said we would go with this and adjust accordingly. We didn't have to adjust anything so I think he selected the right protocol. However, of the 15 eggs retrieved, only 5 fertilized.

Around $15000

I've been reading more about the risks of multiple embryo transfer and I think going forward, I would do PGS and single embryo transfer.

We came in knowing very little and he took the time to explain and made sure we understood the process also gave us options. He was a very nice dr whom showed he cared and wanted us to walk out understanding the process

Write down all your questions because he is very good at explaining

We had a consultation along with an ultrasound and he explained our options and explained the ultrasound results very thoroughly

We have just begun our process. We paid 440$ for the first initial consultation which included the ultrasound. It is very pricey but if that is what it takes for us to start our own family it is worth it.

He suggested single If multiple embryos we can freeze and try one at a time

He spent enough time with me to get a sense of my goals with respect to being able to freeze embryos and eggs, if possible. I knew my age was my biggest obstacle and he set a realistic expectation. I knew not to expect huge numbers of follicles at age 39, so I appreciated his directness/candor to hope for 10 at best.

Come with a list of questions because he is busy and it will take a couple of days to get an email response.

Everyone comes in from 7-9a and it seems as though those hours are the hardest to get specific information.

$14k without meds

Dr. Rinaudo was knowledgeable, kind, realistic and pragmatic. However, he was never the physician that treated me during the actual IUI or IVF process. I went through IUI 3 times and IVF 3 times.

I thought he was fine - not great but fine thus hard to give feedback

I really enjoyed meeting Dr Rinaudo. He was very clear about treatment options and about expectation. Treatment details were clearly explained. I felt I received the appropriate information to make an educated choice

Do not hesitate to ask questions!

he used a standard protocol with ganyrelix

the monitoring visits were efficient and overall on time

10k

we focused on the egg freezing process

Dr Rinaudo was extremely kind and polite. He offered honest care and he was very helpful. The information provided were clear. We knew what to expect at every step. We had a fantastic experience and would definitely recommend him to others.

do not hesitate to call his nurse with questions. Dr Rinaudo will call you right back

we started with IVF because of long history of infertility. His treatment resulted in an excellent response

15k

He's warm and engaging. He's also busy, and our case didn't require a ton of supervision, so, although we had the sense that he was monitoring our treatments, he outsourced the basic stuff to other members of the team. We really only saw him once. . .

Be upfront and candid with him.

No idea.

Still unclear.

Great, helpful, kind

Good option

approx $10k for everything?