Comparing Clinics

After our last disastrous IVF cycle, I told myself and my husband that we were going to shop around for the right doctor for us if we were going to try any more procedures. I think it's smart to compare clinics and not just jump on the closest one, the cheapest one, the one you've heard good things about, or the one your doctor refers you to. A doctor works for you, you do not work for them, and especially in the infertility world where everything is paid out of pocket and up front-you should expect to have the best possible delivery of services from your doctor.

Over the past month, me, my husband, and my sister have been comparing clinics to figure out where we want to have our egg donor IVF cycle completed at. On May 14th we met with Dr. Awadalla at Institute for Reproductive Health and today we met with Dr. Hofmann at Bethesda Fertility Center. Well, today just me and my husband met with Dr. Hofmann because my niece's daycare is closed this week and we didn't want to torture her by asking her to sit through another long doctor's appointment. After meeting both doctors and their staff, there are pros and cons to both clinics, as there would be anywhere.

ACCESSIBILITY:

Institute for Reproductive Health was much harder to get to and to find when driving down the street it is located on.

Bethesda Fertility Center is all highway directions and was relatively easy to find. If my sister had to go to an appointment by herself, I would be comfortable knowing she wouldn't have to fight with hardly any traffic and would be able to have a stress free drive to the office.

OFFICE SPACE:

Institute for Reproductive Health is a beautiful, modern office with great views. Its also surrounded by many places to eat and shop.

Bethesda Fertility Center is an outdated clinic, probably the most outdated out of the 4 fertility clinics we have been to over the past year. Nothing modern about office decor at all.

FIRST IMPRESSION:

In early April when I scheduled my appointment at Institute for Reproductive Health, it took 2 days for the receptionist to call me back to schedule our appointment and I thought the receptionist was quite rude on the phone. During our check-in the receptionists did not say a word to us.

On the other hand, when I made my appointment with Bethesda Fertility Center, the receptionist was friendly and very prompt with returning phone calls and scheduling our appointment.

DOCTOR PERSONALITY:

Dr. Awadalla was confident in what he does, but arrogantly confident in my opinion. He instantly told me he didn't want to hear anything about Dr. Braverman "and his wild ideas" and didn't seem to care why I wanted the immunological testing completed. I felt like none of my concerns were heard or considered during the appointment and I left feeling like no one was on my side-not even my own husband because Dr. Awadalla had him convinced the Money Back Guarantee Package was our problem solver.

Dr. Hofmann right off the bat was engaging with us, listened to my concerns, understood my concerns, offered actual solutions to my concerns, and even talked to my husband about wines they like and where he should take me to lunch (even though we didn't have time for a sit down lunch today). He sat at a round table with us which to me seemed much more inviting and less like a meeting with a loan officer who was going to rob our bank account dry from fees. He understood why we wanted to get the testing with Dr. Braverman and said "sometimes you have to get you mind and your heart on the same page." He realized it was a peace of mind effort and supportive us with our decision. At the end our our consult he said "I'm going to have to meet that SEESTER of yours the next time you come." SEESTER...SEESTER. He even talks like me and my seester!

DOCTOR THOROUGHNESS:

Dr. Awadalla clearly did not read through my records that I sent him a month in advanced. He was rushed through our consult. He did do an ultrasound on me to make sure there was no fluid in my tubes which was a quick 2 minute scan. He also checked my sisters ovaries to see how her follicles look, but all he would tell us was "she has plenty." He did not appear concerned with how low my Progesterone was during our last IVF cycle, didn't do any blood work, and didn't discuss with us how the egg donor cycle works in making sure my body is ready to receive the embryo before transfer.

Dr. Hofmann, after introducing himself to us, said "you are quite the interesting lady." That told me right there that he had read through my medical records I had faxed to him prior to my appointment-and not to mention he was in Italy the entire month of May until yesterday. He went through my pregnancy history and IVF history with us. He discussed the different types of Progesterone supplements and explained how they work with the uterus and where they get metabolized at-he was agreeable to letting me do the suppositories and could not believe my Progesterone level was so low during my IVF cycle while using the shots after my retrieval. He ordered several blood tests and had my blood drawn right in his office-progesterone and estrogen levels, TSH and Prolactin levels, Vitamin D levels, and the STD & Hepatitis screening that is required every year. He did a complete physical exam, checking my lungs, my thyroid, my abdomen, and did an internal ultrasound to check my uterus and ovaries. He told me "you have a beautiful ovary!" and showed me all the resting follicles inside one of them and pointed out my uterus is retroverted (tilted backwards) which I've known from being pregnant 4 times. He told us he was going to do a Aquasonogram the next time we came back to make sure there was no scar tissue in my uterus from having 2 d&c's within the past 15 months because if there is scar tissue then it could prevent an embryo from implanting itself-no doctor has ever mentioned this to us before. He told us Alex would have to get an updated semen analysis completed and blood work the next time we come back also. And finally, he will be doing a test cycle on me this upcoming month to see how my body responds to the medication I would be on during our egg donor cycle so he knows if the medication is going to work for me or if he will need to make a different medication regimen for me. He wants to make sure my uterine lining is going to get thick enough for an embryo transfer to make sure my uterus will make a good home for the developing baby.

EGG DONOR NURSE COORDINATOR

The nurse at Institute for Reproductive Health was nice but I couldn't tell you her name. She met with us briefly to tell us the next steps for getting my sister medically cleared to become an egg donor.

The nurse at Bethesda Fertility Center, Patty, was so great. She was very thorough with explaining all the next steps we need to take from psychological testing, to the additional sonogram and semen analysis, to my sister's medical screening and physical exam. She even told us we needed to get a legal contract written up and signed in front of a lawyer for us to be able to move forward with the process, and said all clinics are supposed to make sure the there is a legal contract for an egg donor cycle to make sure the egg donor doesn't try to claim the embryos as hers or even the baby as her, and to make sure the recipient couple cannot try to get child support from the egg donor. Now...we would never ever do any of this to each other, but it makes sense and was not explained to us at Institute for Reproductive Health. The nurse explained the test cycle completely to me and said she would be calling tomorrow with my blood test results and instructions on when to start the test cycle. She explained that since my sister was on the depo birth control shot and just switched back to the birth control ring, she has to have three normal menstrual periods before we can do any hormone testing on her. The nurse was very personable and funny. I liked her alot.

FINANCIAL COORDINATOR:

We spent an extensive amount of time with the financial coordinator at Institute for Reproductive Health. She was very thorough in going over the costs associated with a single fresh cycle, a single frozen cycle, and the money back guarantee package. I liked her a lot-she was very friendly and patient.

We did not get to meet with a financial coordinator at Bethesda Fertility Center today. This would be my one disappointment, but it sounded like she would be verifying our insurance benefits and coverage prior to going over any fees with us to make sure she is delivering accurate information.

COST COMPARISONS:

The cost sheets for Institute for Reproductive Health are very clear to read and understand. One fresh donor egg cycle would cost $14,400 with the self-pay discount the clinic offers. This does not include medication. The Money Back Guarantee package is a good option since I'm worried about losing the baby during pregnancy and the package gives 6 changes of having a live birth or you get part of the money back (17,000). It would be a waste of money if we actually did have a live birth on the first or even second try. We would still have to pay an additional $2,300 to have my sister medically cleared and our psychological testing completed. Plus all medications would be additional also.

The cost sheets for Bethesda Fertility Center are very confusing to me. Just the cost for my sister's portion of the IVF cycle with her pre-screening says it would be close to 12 grand...which is double what it is at Institute for Reproductive Health. ICSI is anywhere from $300-$800 more than at IRH also. The embryo transfer costs $5170 and my recipient monitoring would be at least $400 and our psychological testing is $350 which is $100 more than IRH. It is very hard to understand what our exact overall cost would be for one cycle without having met with the financial coordinator yet but so far it seems one cycle would be $4,000-$5,000 more than it would be at IRH unless there is a self-pay discount which is not listed on the forms.

SUCCESS RATES:

In 2012 Institute for Reproductive Health did 60 fresh donor egg cycles with a live birth success rate of 53.5% and 28 frozen donor egg cycles with a success rate of 28.6%

In 2012 Bethesda Fertility Center did 24 fresh donor egg cycles with a live birth success rate of 70.8% and 36 frozen donor egg cycles with a success rate of 36.1%.

So while IRH seems to do more donor egg cycles, their success rate is much lower than Bethesda Fertility Center. Overall, IRH does about 600 more IVF cycles a year than Bethesda Fertility Center which is a considerable difference. I wonder if it is because IRH has several more doctors than Bethesda Fertility does or if word of mouth refers more people to IRH. Its hard telling.

OVERALL SATISFACTION:

Overall, we were more satisfied with Dr. Hofmann's approach and concern during our appointment. I love his thoroughness and feeling as if we aren't just going to get thrown into a cycle of medication that we don't know will work or not like it seems we would at Institute for Reproductive Health. However, the money factor is concerning but we don't exactly know the true cost of what it would be at Bethesda yet either. As of right now...we are leaning towards Dr. Hofmann as we have more confidence in him and his staff than we did in Dr. Awadalla. Both clinics provided a sedated egg retrieval which is a must no matter way. Now we just need to figure out all the little things but it seems as if we are going to be moving forward with Dr. Hoffman for the test cycle at least over the course of the test month.