Guide to clinics - Page 2 - Ask the Embryologist - IVF.ca Forums

Jump to content



Photo
* * * * * 1 votes

Guide to clinics


  • Please log in to reply
54 replies to this topic

#26 shenaniganzz

shenaniganzz
  • Member
  • 176 posts
  • Dx:N/A

Posted 16 February 2007 - 11:38 AM

Hi Peter! :)

I will try not to write a novel, but after five years of treatment (and having talked to many patients about their treatment) I have alot to say!

I think one of the major complaints I hear (and have) is some clinics are making patients feel like a number. There is a serious lack of personalized care. Some clinics are litteraly herding people through their doors. When we receive info from our clinics (whether it is a fertilization report or a diagnosis), we want an opportunity to discuss and question and too often we are rushed through appointments and telephone conversations - leaving us feeling frustrated, upset and confused... none of which is where you want to be when you are trying to get pregnant!

Clinics NEED to offer a standard level of care. I have talked to patients who were not even properly advised how to administer their injections! It is very important for these clinics to spend the time necessary to properly educate us. I think clinics should be encouraged to offer sessions that patients have to attend prior to commencing treatment - either as group or individuals. They can be taught how to administer their meds, as well as be given resources that are available to them such as counselling and support groups, for example. Some patients have been very frustrated as they had NO concept of what an emotional impact treatment could have on them and their relationships. While their clinics had counselling available, they were never advised of this and the emotional stress/impact of treatment was never addressed.

Another poster mentioned organization. Ditto. I think this relates to herding people through clinic doors. Let's assume this is because these clinics all really just want to help as many as they can and not about the money ( ;) !) but the busier the clinic, the less the personalized approach and the less organized they seem.

Many patients (myself included) feel they really have to be on top of their own treatment and that they have to be their own advocate. I think all patients should know what is going on with their treatment, but I don't think it should be because they have to make sure the staff is doing what they should be doing. For example - (my own personal one) on a cycle of IVF I had to catch that I wasn't prescribed enough progesterone (1000 instead of 500 units) and another time I had to ARGUE with my ET doctor to transfer the number of embryos that were written in my chart as she had no compelling reason not to other than her own conservative views AND to insist we try a blastocyst transfer as I had enough embryos to warrant the risk. Not a good situation to be in on transfer day! This shouldn't have even been an issue and all decided/resolved prior to my legs being in stirrups! I also had to advise a doctor that a flare protocol was NOT an option for me due to high, early spikes of E2. How about taking just a few minutes to review a chart before making these very important decisions?

Now, for positives...

I do believe we had a skilled, excellent embryologist. Also, the PGD specialist we dealt with was fantastic. She had a lengthy, meeting with my husband and I. She explained everything thoroughly and really took her time to answer all our questions.

I really loved a few of the doctors (especially my own personal doctor and one of the other RE's) and felt that they really wanted us to succeed.

When I was in a cycle, I thought most of the staff was responsive if I had an "emergencies" (and I had a few)... especially when I made sure my doctor knew about the problem.

The nursing staff, for the most part, were really friendly and accomodating.


Good luck with the report, Peter. I hope some positive changes are made as a result!

Warmly,

Trudy

#27 scoop

scoop
  • Member
  • 18 posts
  • Gender:Female
  • Location:Victoria, B.C.
  • Dx:Unexplained
  • My Clinic:Foothills

Posted 12 March 2007 - 07:30 PM

Hi Peter,

I think clinics could be more effective if they looked at the whole person. We have all heard stories of people smoking, drinking and otherwise abusing their bodies and then going for IVF. Of course, they are the exception. Most patients strive to be healthy because they are serious about success, but I find there is little guidance from the clinics.

For instance, at my clinic I have seen extremely obese patients and those who are very skinny. I have read in countless books and articles that body weight index (BMI) does affect fertility, but how many people are actually advised by their clinic to shed some pounds or try to gain weight? There are also studies about the effects of nutrition, vitamins, stress and so on. Clinics, at least mine, don't talk about any of these (with the exception of talking about vitamins for sperm count).

Clinics should also examine alternative medicines (eg. acupuncture, chiropractic care, etc) and see if any of these could be incorporated into the treatment for willing patients. In Canada, health practitioners are becoming more linked to each other. For instance, family doctors are working more with psychologists, midwives, physiotherapists and others to provide more complete treatment for patients. I think a fertility clinic would be a prime candidate for such partnering. It's called progression.

I also think fertility clinics need to differentiate between people who can't conceive and those who can conceive fairly easily but have repeat miscarraiges. I fit into the latter category, and although my clinic carried out blood clotting, chromosome and other tests after my second miscarraige, I felt my treatment regiment was much the same as patients who fail to conceive. My doctor said her solution was to increase my rate of becoming pregnant, so that I would have a greater chance that at least one pregnancy would hold. But this didn't work. I received 3 IUIs and an IVF which all failed. As I waited to start my second IVF, I became pregnant naturally for the third time in two years. I am now 5 weeks pregnant and wondering if I will miscarry again. Perhaps Canadian clinics need to be more open to NK screening, which you often mention, and other possible causes of miscarraige. On the positive side, my clinic monitoring my beta levels weekly to monitor the pregnancy. This is great because I don't want another silent miscarraige, it's horrifying.

Lastly, I believe doctors need to be more approachable and open to questions, some of them maybe stupid questions. I think the bedside manner of my doctor is severely lacking. There is no doubt she is a knowledgeable doctor, but she can be downright rude and condesceding. Yet, the nurses are extremely friendly as are many of the other doctors.

At my clinic, Foothills in Calgary, I do appreciate how organized they are in terms of setting up procedures and tests. The nurses are very knowledgeable about the procedures which can sometimes seem complicated to me. I do wish, however, I could e-mail questions and concerns, rather than always leave a phone message and wait for a response and sometimes miss their call.

I hope I wasn't too negative. Good luck with your project.

#28 Ivfaz

Ivfaz
  • Member
  • 53 posts
  • Dx:N/A
  • My Clinic:Fertility Treatment Center, Tempe AZ USA

Posted 29 March 2007 - 10:28 AM

Hi Dr. Holland,

Here is my feedback on the clinic I am going to in Arizona, USA.

The things I like about the place:
1. The doctor is very skilled surgeon and she practically saved my overies from being removed due to Endometriosis
2. She is Asian Indian same as me and that gives a chance for her to understand my family situation better
3. As she operated on my body, she knows better about my system than any one else

Frustrating things:
1. They have absolutely no time sense. I wait for an average of 2hours each visit
2. During IVF cycle, doctor sees me only once and rest is all nurse practitiners
3. Only one NP there is trust worthy and rest of them frequently make mistakes which I pointed out to them based on the reading i did online. Like missing a medication, forgetting to chart the dosage I used before, forgetting to draw my blood. This scares me. Things I knew are Ok. But what if they made mistakes I do not know of?
4. Doctor often thinks I try to know too much about my condition. I am a well educated adult and I am better off knowing what is wrong with me than to keep hoping things will be just fine. She often keeps information away from me and cuts me short when I inquire more.
5. During IVF cycle, each NP keeps giving her own interpretation on whether or not the meds should be taken at the same time every day or it does not matter.
6. Sometimes I end up waiting for my visit for 3 hours and end up taking my medicines 3 hours later than the day before.
7. With each IVF failure my doctor gives inconsistent explanation about what is wrong with my body.

I am planning to change doctors. I got my appointment with new doctor on June 4th.

Regards,
Madhu

Me-36, DH-40
TTC since Feb 2005
IVF #1 Oct 06 - BFN
IVF #2 March 07 - BFN
IVF #3 Nov 07 No ET Due to high P4 (3 embies frozen)
FET #1 Jan 08 - BFN
IVF #4 Feb 08
4 not good embies
4 ok embies
again high P4
02/26 Transferred not good embies instead of throwing away
03/10 +ve BETA 47.5
03/12 +ve BETA 128
Beautiful DD born Oct 27th 2008

Trying for second

FET #1 ET Dec 13th 2014 BFN Dec 23rd (2 embryos from frozen batch in 2008)

FET #2 March 5th 2015, Blood test March 16th 2015
 


#29

  • Validating
  • PipPipPipPip
  • 151 posts

Posted 25 May 2007 - 05:07 PM

I am now in the 2 week wait from my first IVF procedure so I can't review the last piece of the process. However I will tell you what I have liked/not liked and how important that is to me.

Positives
A detailed consultation in the beginning that included all of our options, the likelihood of success given what is know about us , some detailed information about how different procedures were handled at our clinic, and a study we could participate in that would reduce the cost as well as any potential negatives to participating - ALL VERY IMPORTANT
Detailed financial review of our options - VERY IMPORTANT
Willingness to answer all of our questions as best as possible- no matter how silly VERY IMPORTANT
Friendly staff - SOMEWHAT IMPORTANT
Open 7 days a week - I'm not sure but I hear some clinics are closed on the weekend I don't even know how this would possibly work
Of course a knowledgeable talented doctor and embryologist are the most important

Negatives
Long waits with appointments / Seem to not value patients time - BIG NEGATIVE
The days that I picked the appointment I always had the first one and therefore didn't usually wait to long. When the time was picked for me, I ended up waiting for hours.
One of these ended up just being a discussion that could have been done by phone - so a waste of 3 hours.

Doctor seemed to somewhat underestimate painful nature of some procedures, I would rather be overprepared for pain than not expect it and be surprised - SOMEWHAT NEGATIVE

One other very important thing - (not sure how our clinic will react to this for future treatment)
Letting the patient decide what treatment is best for them even if it may not be best for the clinic's statistics. For example using natural cycle rather than chemically induced for male factor issues.

#30

  • Validating
  • Pip
  • 25 posts

Posted 18 June 2007 - 01:11 PM

We are starting our third cycle so I'm fairly familiar with the IVF process and have a lot of opinions on this subject - Hope this helps.....

The clinic needs to understand that while the IVF process is routine and a daily occurance for the employees, it is THE MOST IMPORTANT LIFE CHANGING EVENT that is occurring for the patient. What might seem mundane and ordinary to a clinician is of vital importance to a patient. The clinic must understand that the patients has invested all of their emotional, psychological, and in most cases financial well being in the abilities of the Doctor. Every waking moment for the past few years, the couple has been focused on this infertilituy issue, and this is by far the most dominating focus of their lives. In return, each staff member must constantly remind themselves of how delicate and fragile each patient is, and must provide customer service unlike any other industry / area. When push comes to shove, there is really very little difference in the success rates from one clinic to the next. As long as you are working with a well respected doctor, they all pretty much use similar protocals and perform the same proceedures / tests. What separates one clinic from another, aside from a few % points in success rate, is ultimately customer service. What this means for each staff member at each stage of the cycle is as follows:

Office Staff / Billing - Perhaps the most stressful / least addressed aspect of the infertility cycle is dealing with Insurance companies & billing. These proceedures are EXPENSIVE. The more informed the back office can keep you in regards to costs, what is covered and what is not, how, where and when you will get your meds, etc., the better. As an example, We went into our first cycle having no clue whether our injectables would be covered. When we spoke to our insurance carrier, we often got different answers depending upon who we spoke to - We didn't need to be worried / focused on this in such a difficult emotional time. I spent countless hours on the phone with our insurance carriers trying to get answers as to what was covered and what was not. The clinic should take the responsibility out of the patients hands - Do the Financial Due Diligence for them - Deal with the insurance companies from the office level & keep the patient informed. The more responsibility you can take out of the patients hand in this regard, the better. This is a time where it is essential that the patient remains calm and focused. The more stress the clinic can take away from the patient, the better prepared the patient will be for success.

Nurses: The nurse is really the conduit of information in this process, as the doctor does not have time to answer the tons of questions each patient undoubtedly will have. Each nurse in the staf must be familiar with each patient's case. It's so frusterating when you talk to one nurse one day and get one answer, and talk to another the next day and hear something completely different.

Each nurse must understand that even the stupidest of questions are important to the patient who is asking them. The nurse must be patient, and address all of the needs of their clients. When records / blood work are faxed to them, we want to know that the records have been received, that the Doctor has indeed looked at them, and that he has taken the time to evaluate the information. Results of tests / bloodwork shouldn't just feel like a checklist - "OK, you've had test X, Y, and Z - Now you can proceed". Patients want to know and understand the results of the tests...in lamens terms what the results mean, and what the next steps are.....

It is also important that the nurses respond to patients in a timely manner. I don't want to ask a question on Monday and be waiting by the phone for an answer on Wednesday. Even if the answer is not immediately available, a call to let the patient know that they received the message and are working on the answer is important. Patients understand that Doctors are busy and that they may not have the time to respond immediately - but communication is still very important

Doctors: I think that more information is better. When you go in for an ultrasound, it is frusterating to hear the Dr call out some numbers, stare at a screen, and then tell your wife "It looks good" and that's it. I think the Dr should be communicating with the patient throughout - For example - "You have X number of folicles, here are there sizes - based upon the progression, you're y days away from triggering approximately", etc..... Also, the Dr should take time to explain what it is they are doing. "We're using X protocol because your body seems to respond well to X, Y, & Z,.....Here are some things we might be able to do improve your odds", etc.... Again, information, communication, and honesty are key.

The patient also wants to know that the Dr has taken the time to review your records - Your past history - Your Blood Work, etc.....Our face to face time with the Dr is limited. When we do get this time, we want to feel comfortable that he / she is prepared, has reviewed our case - and is willing to discuss everything and anything that might be of concern to us.

Counceling / Post Transfer / Results: The Dr. and staff must understand that you and your wife feel as though you are on an island for the two weeks that you wait until you find out the news. This will either be the best day of your life and complete elation - Or it will be devistating - There is no in-between. Waiting for that phone call to learn of the results of the pregnancy test are among the most painful hours you can imagine.

The Office must be prepared to share this news with you as quickly, and in as effective a manner as possible. I think that this news should be communicated in person and that councelors should be available immediately after the news is shared for assistance. I don't think this is the type of news that should be communicated via a phone conversation. It is important that the Dr. provide support - Either to share in the joy of success or to help comfort in case of failure - This can not be done over the phone.

This is a brief re-cap of my thoughts after two failed cycles and while getting ready to start our 3rd today. Hope this helps....

Doug

#31 Peter

Peter

    Embryologist

  • 1000+
  • 3061 posts
  • Gender:Male
  • Location:London, UK
  • Interests:Stem cells, cord blood and infertility
  • Dx:N/A
  • My Clinic:The Bridge Clinic, Lagos, Nigeria

Posted 18 June 2007 - 02:23 PM

We are starting our third cycle so I'm fairly familiar with the IVF process and have a lot of opinions on this subject - Hope this helps.....

The clinic needs to understand that while the IVF process is routine and a daily occurance for the employees, it is THE MOST IMPORTANT LIFE CHANGING EVENT that is occurring for the patient. What might seem mundane and ordinary to a clinician is of vital importance to a patient. The clinic must understand that the patients has invested all of their emotional, psychological, and in most cases financial well being in the abilities of the Doctor. Every waking moment for the past few years, the couple has been focused on this infertilituy issue, and this is by far the most dominating focus of their lives. In return, each staff member must constantly remind themselves of how delicate and fragile each patient is, and must provide customer service unlike any other industry / area. When push comes to shove, there is really very little difference in the success rates from one clinic to the next. As long as you are working with a well respected doctor, they all pretty much use similar protocals and perform the same proceedures / tests. What separates one clinic from another, aside from a few % points in success rate, is ultimately customer service. What this means for each staff member at each stage of the cycle is as follows:

Office Staff / Billing - Perhaps the most stressful / least addressed aspect of the infertility cycle is dealing with Insurance companies & billing. These proceedures are EXPENSIVE. The more informed the back office can keep you in regards to costs, what is covered and what is not, how, where and when you will get your meds, etc., the better. As an example, We went into our first cycle having no clue whether our injectables would be covered. When we spoke to our insurance carrier, we often got different answers depending upon who we spoke to - We didn't need to be worried / focused on this in such a difficult emotional time. I spent countless hours on the phone with our insurance carriers trying to get answers as to what was covered and what was not. The clinic should take the responsibility out of the patients hands - Do the Financial Due Diligence for them - Deal with the insurance companies from the office level & keep the patient informed. The more responsibility you can take out of the patients hand in this regard, the better. This is a time where it is essential that the patient remains calm and focused. The more stress the clinic can take away from the patient, the better prepared the patient will be for success.

Nurses: The nurse is really the conduit of information in this process, as the doctor does not have time to answer the tons of questions each patient undoubtedly will have. Each nurse in the staf must be familiar with each patient's case. It's so frusterating when you talk to one nurse one day and get one answer, and talk to another the next day and hear something completely different.

Each nurse must understand that even the stupidest of questions are important to the patient who is asking them. The nurse must be patient, and address all of the needs of their clients. When records / blood work are faxed to them, we want to know that the records have been received, that the Doctor has indeed looked at them, and that he has taken the time to evaluate the information. Results of tests / bloodwork shouldn't just feel like a checklist - "OK, you've had test X, Y, and Z - Now you can proceed". Patients want to know and understand the results of the tests...in lamens terms what the results mean, and what the next steps are.....

It is also important that the nurses respond to patients in a timely manner. I don't want to ask a question on Monday and be waiting by the phone for an answer on Wednesday. Even if the answer is not immediately available, a call to let the patient know that they received the message and are working on the answer is important. Patients understand that Doctors are busy and that they may not have the time to respond immediately - but communication is still very important

Doctors: I think that more information is better. When you go in for an ultrasound, it is frusterating to hear the Dr call out some numbers, stare at a screen, and then tell your wife "It looks good" and that's it. I think the Dr should be communicating with the patient throughout - For example - "You have X number of folicles, here are there sizes - based upon the progression, you're y days away from triggering approximately", etc..... Also, the Dr should take time to explain what it is they are doing. "We're using X protocol because your body seems to respond well to X, Y, & Z,.....Here are some things we might be able to do improve your odds", etc.... Again, information, communication, and honesty are key.

The patient also wants to know that the Dr has taken the time to review your records - Your past history - Your Blood Work, etc.....Our face to face time with the Dr is limited. When we do get this time, we want to feel comfortable that he / she is prepared, has reviewed our case - and is willing to discuss everything and anything that might be of concern to us.

Counceling / Post Transfer / Results: The Dr. and staff must understand that you and your wife feel as though you are on an island for the two weeks that you wait until you find out the news. This will either be the best day of your life and complete elation - Or it will be devistating - There is no in-between. Waiting for that phone call to learn of the results of the pregnancy test are among the most painful hours you can imagine.

The Office must be prepared to share this news with you as quickly, and in as effective a manner as possible. I think that this news should be communicated in person and that councelors should be available immediately after the news is shared for assistance. I don't think this is the type of news that should be communicated via a phone conversation. It is important that the Dr. provide support - Either to share in the joy of success or to help comfort in case of failure - This can not be done over the phone.

This is a brief re-cap of my thoughts after two failed cycles and while getting ready to start our 3rd today. Hope this helps....

Doug


This is very useful, many thanks

Peter
www.thebridgeclinic.com
www.wmin.ac.uk
www.smartcells.com

#32

  • Validating
  • PipPipPipPipPip
  • 664 posts

Posted 17 July 2007 - 08:43 AM

I am in a cutting-edge clinic in Atlanta, GA. There are many positive for my clinics, including an amazing and supportive support staff, and a doctor who was willing to talk to me for over an hour during a post-mortem of a failed ivf attempt. I feel as though the doctor is invested in my care as an individual, which is important on such an emotional journey.

I also appreciate the fact that research is continually being conducted at the clinic and patients are invited (but not pressured) to participate. It makes me feel as though I have a better chance at success if my doctor is using the latest technology.

On the negative side: At times the clinic fails miserably at basic communication. As we all know, ivf is incredibly time-sensitive and patients often need information quickly. But when I tried to call the clinic on a quasi-holiday (I think it was the Friday after Thanksgiving in the US), I kept being routed to the after hours number. The operator kept telling me the clinic was open and refused to take a message. And of course patients are never given numbers other than the main numbers. It was incredibly frustrating. Ultimately, I had to drive the 10 or so miles to the clinic just to ask a question. Given the huge sums of money I and many of my fellow patients are paying out of pocket, is it too much to ask for someone simply to answer the phone even on "off" days?

Also a negative ... (and this is a little embarrassing, but important nonetheless) is the apparently appalling quality of the porn! It was sufficiently off-putting for my partner to have to go to a sterile clinic to "perform." Several dog-eared copies of "Jugs" magazine and a few questionable video-tapes of non-traditional sex did not help. I mentioned this to the doctor, who said than any "good" porn simply gets stolen. But in a state-of-the-art practice, why not simply down-load a decent selection to a computer and have patients select from a menu? I doubt anyone will be able to steal an entire computer. (Especially if it is a network with a server stored elsewhere.)

All-in-all, though, it was a positive experience.

Kathryn.

#33 Peter

Peter

    Embryologist

  • 1000+
  • 3061 posts
  • Gender:Male
  • Location:London, UK
  • Interests:Stem cells, cord blood and infertility
  • Dx:N/A
  • My Clinic:The Bridge Clinic, Lagos, Nigeria

Posted 17 July 2007 - 09:49 AM

I am in a cutting-edge clinic in Atlanta, GA. There are many positive for my clinics, including an amazing and supportive support staff, and a doctor who was willing to talk to me for over an hour during a post-mortem of a failed ivf attempt. I feel as though the doctor is invested in my care as an individual, which is important on such an emotional journey.

I also appreciate the fact that research is continually being conducted at the clinic and patients are invited (but not pressured) to participate. It makes me feel as though I have a better chance at success if my doctor is using the latest technology.

On the negative side: At times the clinic fails miserably at basic communication. As we all know, ivf is incredibly time-sensitive and patients often need information quickly. But when I tried to call the clinic on a quasi-holiday (I think it was the Friday after Thanksgiving in the US), I kept being routed to the after hours number. The operator kept telling me the clinic was open and refused to take a message. And of course patients are never given numbers other than the main numbers. It was incredibly frustrating. Ultimately, I had to drive the 10 or so miles to the clinic just to ask a question. Given the huge sums of money I and many of my fellow patients are paying out of pocket, is it too much to ask for someone simply to answer the phone even on "off" days?

Also a negative ... (and this is a little embarrassing, but important nonetheless) is the apparently appalling quality of the porn! It was sufficiently off-putting for my partner to have to go to a sterile clinic to "perform." Several dog-eared copies of "Jugs" magazine and a few questionable video-tapes of non-traditional sex did not help. I mentioned this to the doctor, who said than any "good" porn simply gets stolen. But in a state-of-the-art practice, why not simply down-load a decent selection to a computer and have patients select from a menu? I doubt anyone will be able to steal an entire computer. (Especially if it is a network with a server stored elsewhere.)

All-in-all, though, it was a positive experience.

Kathryn.



Many thanks! The 'porn problem' is longstanding and it is true that the 'good' stuff gets stolen........putting the whole lot onto a computer is a good idea!!

Best wishes,

Peter
www.thebridgeclinic.com
www.wmin.ac.uk
www.smartcells.com

#34

  • Validating
  • Pip
  • 5 posts

Posted 17 July 2007 - 10:57 AM

Hi,

Thank you for conducting this survey. I was going to give feedback to my clinic, but then felt they probably wouldn't even read it.

I have no idea of what is standard in clinics, so I'll just comment freely.

Pros of my clinic:
-nurse gave cell phone number, so I could call whenever I had a question about injections or the process. i used it twice, and she was happy to answer my questions
-nurse called me on her vacation twice to find out how the end of my IVF cycle was going
-nurse shared her experiences with IVF and OHSS - made me feel like she really understood what I was going thru
-short waits for blood tests during cycle monitoring
-one of the ultrasound technicians was extremely gentle and considerate - I have a retroverted uterus and have bled after some technicians have _cranked_ on the wand during a transvaginal scan.
-nurse who withdrew blood was very experienced...very little pain
-other patients were quite open and would share their experiences with the process freely
-booklet of info given on IVF process, including steps for key days, hormone side effects
-waits to see doc weren't too long (30 min max) (background info -In Canada, you can wait hours to see a specialist. My husband had an appointment with his urologist at 1pm, finally saw him at 4pm)
-nurse gave injection information to us one-on-one

Cons of my clinic:
-doc didn't explain sonohysterogram procedure before beginning or what to expect afterwards (spotting)- the cramping was a shock to me
-washroom located next to waiting room - _awkward!_
-washroom was poorly maintained - out of toilet paper, light burned out for 4 days
-nurse who did daily blood withdrawals was extremely impatient if you did not follow her procedure to a T (which is difficult to know on your first day of cycle monitoring!).
-doc seemed to make up stats on the spot, which didn't jive with online information (e.g. she claimed FET success rates were 60% in her clinic, whereas she quoted me a 40% success rate for fresh several months earlier)
-although injection info was 1-on-1, as an educator, I know giving large amounts of new information without any hands-on experience is not effective; from what I have read, other clinics let you inject into oranges during the instruction. Nerve racking when the first thing you ever inject is your own leg!
-no support group offered
-little extras - a hook to hang your freshly-pressed blouse on in the ultrasound room (during cycle monitoring, many of us are leaving to go directly to work), a water dispenser to fill up your water bottle when it doesn't hold enough for a full bladder, set up ultrasound rooms so you can clean yourself and change with some privacy (not have to walk right by the sonographer's desk), or a privacy screen
-booklet of info on IVF process out of date for the clinic (e.g. Gonal-F pen was given, but instructions were not for the pen), pictures would have been helpful (e.g. how to change mixing needle to injection needle, what Gonal F pen should look like if properly loaded).
-I ended up with mild OHSS (7800 e2, 8x7cm right ovary) and felt very alone in dealing with the problem as the great nurse was on vacation. doc said to keep up the gatorade and ensure and call the office two cycles from now, right after telling me I had fluid collecting in my upper and lower abdomen (minimal around the uterus the day before). To convince me not to do the embryo transfer, she told me about possible complications of OHSS and pregnancy - hospitalization, stroke, death... but then tells me to call the clinic in two months...I felt very unsettled. As well, the nurse suggested that the doc (my doc's partner covering during vacation) had been too aggressive with the gonal-f b/c I was responding slowly. She claims she warned him that I "was very tiny...be careful." No info booklet on OHSS was provided - I had to troll the internet and sift my way through journal abstracts, out-of-date info, and fertility clinic advertisements
-it would be nice if the doc/clinic could provide info on what was generally "normal" - e.g. if you have x number of follicles stimulated, how many eggs might you expect, how many might fertilize, how many will survive the freezing process
-would have been great to have the entire injection/medication protocol written out on a calendar - hasn't anyone developed the software for that yet?

I work with students with learning disabilities, and there is no way an adult with these difficulties would be able to make it through this process. So much information is given verbally, with no offer of a pen or paper. Information given would not be accessible to someone with a reading disability or poor working memory.

Hope something in this was useful to you. Thanks again for asking.

#35

  • Validating
  • Pip
  • 5 posts

Posted 17 July 2007 - 11:01 AM

Just an FYI - I have a low body mass index, but am menstruating and fully fertile. We have male factor fertility problems, and that is why you might see me, the skinny girl, sitting in the waiting room.

Hi Peter,

I think clinics could be more effective if they looked at the whole person. We have all heard stories of people smoking, drinking and otherwise abusing their bodies and then going for IVF. Of course, they are the exception. Most patients strive to be healthy because they are serious about success, but I find there is little guidance from the clinics.

For instance, at my clinic I have seen extremely obese patients and those who are very skinny. I have read in countless books and articles that body weight index (BMI) does affect fertility, but how many people are actually advised by their clinic to shed some pounds or try to gain weight? There are also studies about the effects of nutrition, vitamins, stress and so on. Clinics, at least mine, don't talk about any of these (with the exception of talking about vitamins for sperm count).

Clinics should also examine alternative medicines (eg. acupuncture, chiropractic care, etc) and see if any of these could be incorporated into the treatment for willing patients. In Canada, health practitioners are becoming more linked to each other. For instance, family doctors are working more with psychologists, midwives, physiotherapists and others to provide more complete treatment for patients. I think a fertility clinic would be a prime candidate for such partnering. It's called progression.

I also think fertility clinics need to differentiate between people who can't conceive and those who can conceive fairly easily but have repeat miscarraiges. I fit into the latter category, and although my clinic carried out blood clotting, chromosome and other tests after my second miscarraige, I felt my treatment regiment was much the same as patients who fail to conceive. My doctor said her solution was to increase my rate of becoming pregnant, so that I would have a greater chance that at least one pregnancy would hold. But this didn't work. I received 3 IUIs and an IVF which all failed. As I waited to start my second IVF, I became pregnant naturally for the third time in two years. I am now 5 weeks pregnant and wondering if I will miscarry again. Perhaps Canadian clinics need to be more open to NK screening, which you often mention, and other possible causes of miscarraige. On the positive side, my clinic monitoring my beta levels weekly to monitor the pregnancy. This is great because I don't want another silent miscarraige, it's horrifying.

Lastly, I believe doctors need to be more approachable and open to questions, some of them maybe stupid questions. I think the bedside manner of my doctor is severely lacking. There is no doubt she is a knowledgeable doctor, but she can be downright rude and condesceding. Yet, the nurses are extremely friendly as are many of the other doctors.

At my clinic, Foothills in Calgary, I do appreciate how organized they are in terms of setting up procedures and tests. The nurses are very knowledgeable about the procedures which can sometimes seem complicated to me. I do wish, however, I could e-mail questions and concerns, rather than always leave a phone message and wait for a response and sometimes miss their call.

I hope I wasn't too negative. Good luck with your project.



#36

  • Validating
  • Pip
  • 12 posts

Posted 30 July 2007 - 02:02 PM

I also agree that there needs to be more standardization from clinic to clinic. We have used two clinics in the 3 yrs we have been TTC. The reason we changed to the new clinic was that the lab was much closer for me, meaning I didn't have to take a half day off school each time I had to have b/w and u/s. We found our new doc was more agressive in treatment (if something doesn't work once, don't do the exact same thing again), and really explained things clearly. Most important in my opinion though, is that the clinic has clear "rules" about how many times they will suggest a treatment and how many embryoes they will transfer. I hear stories of people who have gone through multiple cycles of IUI and IVF with no success, and I wonder if they are getting the best advice possible. I know that every situation is different, but I still feel there needs to be more correlation in the standard practices of individual clinics.

#37

  • Validating
  • Pip
  • 3 posts

Posted 07 August 2007 - 10:55 AM

My DH and I are both 40 in great health. No male factor. We have not gone through any assisted reproduction such as IUI, IVF etc.
We went straight for Donor Egg due to my age. Over past 4 years I have had two surgeries, removal of Fallopian tubes due to endometriosis and removal of fibroids and myomectomy. Cleared by my surgeon to have essentially normal uterus Have been through a wonderful clinic for testing etc. but they did not have donor program. We had great clinics to choose from in our state but chose an out of town clinic due to the donor and claims by the clinic for experienced lab, embryologists, testing etc. HUGE MISTAKE!!!!!

First phone contact with "financial counselor" felt like speaking to a used car saleswoman going down a list of options, talking about a "premium" being charged because I had a myomectomy...spoke about embryos and freezing like she was talking about options on your car....Atlhough had a pleasant voice...just was robotic and mechanical...."and the grand total for our money back guarantee offer is $ 60 thousand......"
This should have set warning bells for us but our local RE had recommended their program and we were enamoured by the chosen donor.

Donor egg coordinator who is their Director of their donor egg program was hard to reach, would be out of office, would not let me know, during critical parts of the cycle...starting mock cycle, shots, did not offer much information, got our written calendar, no counselling, had to deal with 2-3 different coordinators, they were sending information with our private information to a wrong address, which was only discovered after I resent my address to confirm. I got someone else's email forwarded to me by mistake with private information about that person. Got the wrong prescription for BCP's during the beginning of the cycle to synchronize with donor....started to have some spotting ... " oh, don't worry, there's nothing we can do about it now.."

When we finally came for first ultrasound at their facility (we took two weeks off for egg retrieval up to embryo transfer day for a mini vacation) did not meet Dr even after we requested (he left for the day), nurse could not get my blood for estrogen level after two punctures and said...oh, your ultrasound shows a good lining, we don't need to know your E2 level. After day1 after ER got different reports on how many were fertilized, etc. DID NOT GET a call from embryologist at ALL...had to call on Day 2, Day3 and spoke to a nurse who says that they are doing good, then after asking to speak to embryologist am transferred to another nurse who says they are "average' When asked a grade...she says "oh you can't expect to have perfect embryos!!!!" I call coordinator on Day 4 and no additional infomation on how to prepare for ET....

ET day, I arrive 1 hour before actual transfer ...no donor coordinator to meet us ( I went for acupuncture on my own, to relax me) ushered to ultrasound room because the other resting rooms were full, met a doctor we never spoke or met before, she shows me a paper from embryologist (who had checked embryos 2 hours before) that we had a morula and 2 compacted and says we are transferring three....no discussion, no explanation and she is doing this from across the room. Comes close only after seeing shock in our faces and then proceeds to say...Well we have seen pregnancies with the morulas but we really can't give you stats because we really don't do much of these....no other attempt to reassure us...leaves room for us to "talk" ...donor coordinator enters room doesn't come close and says 'We really don't expect these things to happen...." Everything was a blur...just remembered that we requested to have 2 put in as I did not really understand the chances with these morulas...no guidance... Then doctor comes in with "good news" that one of the compacted became a morula in the two hours since they checked.
During procedure she "SHOVES" speculum in me without warning...SEVERE PAIN and almost passed out...she adjusted two more times and said "you shouldn't be in pain!! i was still uncomfortable after third adjustment but was really feeling so helpless and violated by this time...wanting to pee so bad...
I had brought report from my local RE who did a mock transfer and that showed how to navigate my uterus as it was retroverted etc. and asked coordinator to make sure doctor saw this....DOCTOR was pushing catheter in and kept saying " I am feeling resistance!!! NOT TALKING to me but to US tech....SEveral time tried to push it in and I was near panic!!!! Still no attempt by doctor to speak to me....( I WAS quiet whole time as was trying to relax....)
Finally gets embryos in and leaves room...only ultrasound tech comes over and holds my hand and says good luck...we'll check you in 30 minutes. ....

Left there in a daze...no coordinator to be seen anywhere....Called her in the pm to relay terrible experience and she says, " Well you were probably not relaxed since you had just gotten the bad news about the embryos....maybe next time we will give you Valium....Then covers her tracks to say, Oh but I don't think this will affect the outcome....

Well, we had no embryos make it to blast, so no eggs to freeze (donor was 27 and my husband has no male factor) and was given news on Aug 3 that beta was negative... We paid basic fee for two cycles but have to pay $10,000 for donor for another cycle...no way in [email protected]@#l!!!!
We are of Asian descent and we try to be as low key and cooperative with process...but this was really traumatic and ridiculous!!! We work in the medical field and have some experience with dealing with patients. Will be telling our story to their CEO to assist us in getting some money back as it is supposed to be nonrefundable...
Even if I had achieved pregnancy with this clinic would still want to warn as many couples as we can about this place that is Robotic, mechanical and has lost the human touch!!!

#38 Peter

Peter

    Embryologist

  • 1000+
  • 3061 posts
  • Gender:Male
  • Location:London, UK
  • Interests:Stem cells, cord blood and infertility
  • Dx:N/A
  • My Clinic:The Bridge Clinic, Lagos, Nigeria

Posted 08 August 2007 - 03:29 AM

My DH and I are both 40 in great health. No male factor. We have not gone through any assisted reproduction such as IUI, IVF etc.
We went straight for Donor Egg due to my age. Over past 4 years I have had two surgeries, removal of Fallopian tubes due to endometriosis and removal of fibroids and myomectomy. Cleared by my surgeon to have essentially normal uterus Have been through a wonderful clinic for testing etc. but they did not have donor program. We had great clinics to choose from in our state but chose an out of town clinic due to the donor and claims by the clinic for experienced lab, embryologists, testing etc. HUGE MISTAKE!!!!!

First phone contact with "financial counselor" felt like speaking to a used car saleswoman going down a list of options, talking about a "premium" being charged because I had a myomectomy...spoke about embryos and freezing like she was talking about options on your car....Atlhough had a pleasant voice...just was robotic and mechanical...."and the grand total for our money back guarantee offer is $ 60 thousand......"
This should have set warning bells for us but our local RE had recommended their program and we were enamoured by the chosen donor.

Donor egg coordinator who is their Director of their donor egg program was hard to reach, would be out of office, would not let me know, during critical parts of the cycle...starting mock cycle, shots, did not offer much information, got our written calendar, no counselling, had to deal with 2-3 different coordinators, they were sending information with our private information to a wrong address, which was only discovered after I resent my address to confirm. I got someone else's email forwarded to me by mistake with private information about that person. Got the wrong prescription for BCP's during the beginning of the cycle to synchronize with donor....started to have some spotting ... " oh, don't worry, there's nothing we can do about it now.."

When we finally came for first ultrasound at their facility (we took two weeks off for egg retrieval up to embryo transfer day for a mini vacation) did not meet Dr even after we requested (he left for the day), nurse could not get my blood for estrogen level after two punctures and said...oh, your ultrasound shows a good lining, we don't need to know your E2 level. After day1 after ER got different reports on how many were fertilized, etc. DID NOT GET a call from embryologist at ALL...had to call on Day 2, Day3 and spoke to a nurse who says that they are doing good, then after asking to speak to embryologist am transferred to another nurse who says they are "average' When asked a grade...she says "oh you can't expect to have perfect embryos!!!!" I call coordinator on Day 4 and no additional infomation on how to prepare for ET....

ET day, I arrive 1 hour before actual transfer ...no donor coordinator to meet us ( I went for acupuncture on my own, to relax me) ushered to ultrasound room because the other resting rooms were full, met a doctor we never spoke or met before, she shows me a paper from embryologist (who had checked embryos 2 hours before) that we had a morula and 2 compacted and says we are transferring three....no discussion, no explanation and she is doing this from across the room. Comes close only after seeing shock in our faces and then proceeds to say...Well we have seen pregnancies with the morulas but we really can't give you stats because we really don't do much of these....no other attempt to reassure us...leaves room for us to "talk" ...donor coordinator enters room doesn't come close and says 'We really don't expect these things to happen...." Everything was a blur...just remembered that we requested to have 2 put in as I did not really understand the chances with these morulas...no guidance... Then doctor comes in with "good news" that one of the compacted became a morula in the two hours since they checked.
During procedure she "SHOVES" speculum in me without warning...SEVERE PAIN and almost passed out...she adjusted two more times and said "you shouldn't be in pain!! i was still uncomfortable after third adjustment but was really feeling so helpless and violated by this time...wanting to pee so bad...
I had brought report from my local RE who did a mock transfer and that showed how to navigate my uterus as it was retroverted etc. and asked coordinator to make sure doctor saw this....DOCTOR was pushing catheter in and kept saying " I am feeling resistance!!! NOT TALKING to me but to US tech....SEveral time tried to push it in and I was near panic!!!! Still no attempt by doctor to speak to me....( I WAS quiet whole time as was trying to relax....)
Finally gets embryos in and leaves room...only ultrasound tech comes over and holds my hand and says good luck...we'll check you in 30 minutes. ....

Left there in a daze...no coordinator to be seen anywhere....Called her in the pm to relay terrible experience and she says, " Well you were probably not relaxed since you had just gotten the bad news about the embryos....maybe next time we will give you Valium....Then covers her tracks to say, Oh but I don't think this will affect the outcome....

Well, we had no embryos make it to blast, so no eggs to freeze (donor was 27 and my husband has no male factor) and was given news on Aug 3 that beta was negative... We paid basic fee for two cycles but have to pay $10,000 for donor for another cycle...no way in [email protected]@#l!!!!
We are of Asian descent and we try to be as low key and cooperative with process...but this was really traumatic and ridiculous!!! We work in the medical field and have some experience with dealing with patients. Will be telling our story to their CEO to assist us in getting some money back as it is supposed to be nonrefundable...
Even if I had achieved pregnancy with this clinic would still want to warn as many couples as we can about this place that is Robotic, mechanical and has lost the human touch!!!


Thank you for telling me your experiences

Peter
www.thebridgeclinic.com
www.wmin.ac.uk
www.smartcells.com

#39

  • Validating
  • PipPip
  • 74 posts

Posted 10 August 2007 - 06:28 PM

Great idea

Pros
1. How friendly the staff is
2. You meet with a nurse after every ultra sound. Awesome. They are extremely caring and you can tell that they really want you to have a baby.
3. The doctors are thorough. They explain everything they're doing. And they too are extremely friendly and are there for you. They want success just as much as you do.
4. How the retrieval was done- the embryologist technician opens up the window and you can see her, and she counts off the eggs as she receives them. It's kinda' fun. Same with the transfer. It's like she was babysitting our embies for a while, and she did a great job.
5. Most of the bloodwork technicians were very friendly early in the morning- great stuff for 7:00 am.
6. They give you warmed blankets for the retrieval and transfer. Felt nice.
7. During the retrieval, the nurse held my hand. My husband held the other.



Cons
1. I know they have alot of patients; some of them do remember your name. It would be nice if most did.
2. Optional counseling- we haven't gone yet. I think counseling is a must. I wish we have, but b/c it's optional, we forget about it. Plus the drive is an hour away and that makes it difficult.
3. Wait time- IVF did not work this time. Our follow-up is in a month. I think when you're a patient at the clinic (not on the wait list for getting in) these appointments must be quicker! I realize, especially at my clinic, that staff is loaded with work- they went from 4 doctors to 2 in the last 2 months!
4. Being assigned to a doctor but that doctor never did one procedure- 3 IUIS, Retrieval and transfer were done by different doctors.
5. Maybe the clinics could have some financial advising?
6. Never getting a voice on the other end of the phone.
7. I wish ultrasound technicians could tell you more, but that is the nurse's job. But you feel like just a body as they probe it.
8. I wish they supported other methods or advised about it- acupuncture, naturopathy, etc.
9. Parking costs! Usually around $7.50 a visit. Maybe give us a 'package deal'. $50 for all parking- something like that.

#40 yanie

yanie
  • 1000+
  • 2237 posts
  • Gender:Female
  • Location:montreal, canada
  • Dx:PCOS
  • My Clinic:The McGill Reproductive Centre

Posted 10 August 2007 - 07:21 PM

important/essential/desirable/undesirable/unacceptable

i think a clinic should be open 7 days a week.
i dont get my periods monday - friday during the hours of 9 to 5.

i love the clinic where i go my very fisrt oppmt was dec 26 2006
i was very impressed to see they were starting my file the day after x-mas and not just waiting till the new year.

i feel at home there and everyone knows my name. i cant believe it, they all knew about my 33 egg collection with out me telling them. they the ladies at the front desk!!!
i feel that my doctors want me to have a baby just as bad as i want to have a baby.

i love the McGILL Reproductive center
age: i'm 30 husband is 33
married: for 6 years togther for 13
ttc:5 years
clinic :mcgill reproductive center in montreal
told i have severe PCOS
husband is great
JUNE 07 clomid 50mg did not respond to meds
JULY 07 clomid 100mg did not respond to meds
AUG 07 doing IVM for a study
SEPT 1, 07. 33 eggs collected, 27 matured and frozen
SEPT 12, 07. 3 were put in. a 4cell and two 3cell
SEPT 14, 07 BFN from IVM
DEC 7, 2007 D&C went well
MARCH 10, 08 IVM, E/R 12 mature eggs 30 inmature eggs total 42 eggs
MARCH 13, 08 E/T tranfered 3, Two 8 cell, and One 7 cell embryo's.
MARCH 26, 08 beta .08 BFN
SEPT 9 FET PUT IN 4, a 8cell,a 7cell, two 6cell
SEPT 23 beta 8.3 BFN
have 3 frozen
total of 75 eggs collected in 2 E/R
total of 10 embryos put in in 3 E/T.

moving to IVF
giving to science
3 embryo's
and 23 oocytes

starting fresh with IVF!

April 9, 2011 took a HPT and got a BFP!!!
April 13, 2011 found out that i'm 8 weeks and 2 days pg!
natural pregnancy
It's a Boy!!!!!



I am too postive
to be doubtful
too optimistic
to be fearful
and to determined
to be
defeated




Posted Image

 BabyFruit Ticker

#41 hopeful123

hopeful123
  • Global Moderators
  • 4938 posts
  • Gender:Female
  • Location:burlington ,on
  • Interests:golf,ski,scrap booking ,gardning ,rollerblading
  • Dx:Immunological
  • My Clinic:sirm

Posted 25 August 2007 - 12:45 PM

hi peter thanks for doing this

well i've noticed that clinic try to discourage procedures that they are not actively involved in and tryto push things that they are interested in

eg ,pgd versus cgh ,the clinic i am at now is really ahead in cgh so they highly recommend that ,saying it tests for all 23 pairs of chromosomes rather than just 9 in pgd
my previous clinic really discouraged me from doing pgd saying its 50 % chance to get an answer and then 50 % chance that they will thaw successfully

there are clinics that really push for pgd saying its a life saver

while you can not compare pgd to cgh they are entirely focused on different problems from each other
and discourage one test as they are not well experienced in that particular test

at least they should refer the pt's to a different clinic that does feel confident about the concerned test

also there shopuld a real person to answer the phone calls ,not an answering machine ,or e-mail that is replied immediately

sam
me:33 ,dh:30
ttc:8y
3 natural m/c dec 99, mar 01,oct 07
clomid x1 -ohss
lap x 1 apr/05-endomet left tube blocked,half of left ovary resected
1st ivf cycle nov/05 developed mild ohss again
DEC 2ND/05 BFP u/s small sac slow heart beat small fetus misscariage at 9 weeks 1 day
fet may 06 -cancelled due to very rare -sub acute viral thyroiditis
fet oct 20-bfp ,beta 700 on nov 1 ,1700 on nov 3,3900 on nov 5 u/s 2 small sacs ,slow heart beat small fetuses m/c nov 23/06 ,day of our 9th wedding annivrsay
1 blast still frozen
IVF#2 july 07 7 BLASTS FROZEN 2 normal 2 have trisomies 3 not tested less than 6 cell on day 3 fet oct 25/07,transferred 2 instead of one ...oops
1st beta nov 2 bfp (again) 23,2nd beta 83 ,3rd beta 371 u/s nov 21 hb 118 bpm
beautiful baby boy Nayal born via planned c-section on july 3rd 2008 @ 12:35 pm

#42 Duck

Duck
  • Cyclebase
  • 1851 posts
  • Gender:Female
  • Location:Toronto
  • Dx:Endometriosis
  • My Clinic:Repromed

Posted 04 November 2007 - 11:18 AM

Peter,
What i like about my clinic is that after about the 3rd visit, the receptionist does not ask my or dh's name - she already knows. I rarely see other people in the waiting area - the waiting area is small only accomodates maybe 10 people, which is nice, as i really don't want to see other people, i know that sounds strange. The receptionist is really a key component to the clinic, she is the person you see in the begining, and the person who, in my case, witnesses me leaving in a wreck, she never looks horrified, and always makes sure that i have everything that i nead.

A wide variety of reading matterial is nice, not just fluff magazines, but more serious magazines like the economist is always nice to read.

It may seem odd, but there really should be some sort of suggested rules of how many people you can take with you to an apointment, i was waiting, and in horrible pain, for a scan, and in the waiting room with me was a couple and the dh's mother, and they were discussing there cycle, and it made me and dh very uncomfortable, i don't want to hear about it - ye know?I've never seen childeren in the clinic, which i think is very nice (no offense to people that are lucky enough to have children - but sometimes when i go there i get yet MORE bad news and the last thing i want to see is a child). Although the wall of baby pics are nice, they give me hope.

I go to a small clinic so i see my re for all my scans, all my apointments are with him, and i feel that is very important, as they are on top of everything that is happening.
Thats about all i can think of.

Diagnosed with endometrosis at age 19

5 pelvic surgeries

2 IVF, numerous FETs

2 different gestational carriers

Now mother of 2 year old twins.


#43 Zuzu

Zuzu
  • Member
  • 32 posts
  • Gender:Female
  • Dx:N/A

Posted 14 November 2007 - 03:54 PM

Peter,

Are you still looking for responses?

#44

  • Validating
  • PipPipPipPip
  • 154 posts

Posted 11 December 2007 - 01:03 AM

My biggest concern is trusting the team. I have had concerns about my RE being a little evasive, and not committing to a plan for me. Rather, he is giving me options but not explaining them all and their rationale adequately. So my dh and I are left feeling very confused.
I want someone to say, let's get you pregnant, starting with the least invasive process and then gradually getting more agressive if the options run out.
I also want nurses who are more competent, and I can say that because I am a nurse. When I ask about a side effect, and the nurse tells me to call a separate pharmacist about it, I am not only very pissed off, but concerned about whether the team is competent.

#45 blueslippers

blueslippers
  • Global 100+
  • 409 posts
  • Gender:Female
  • Location:Edmonton
  • Dx:Endometriosis
  • My Clinic:PCRM (Burnaby), now back to Edmonton

Posted 06 January 2008 - 12:08 PM

It's interesting how many opposite opinions you will get Peter. I am just the opposite of "Vancouver". When I went to see my RE for the first time, he wanted to start conservative and I didn't. I asked him point blank what he would do if I were his own wife and told him that that is how I wanted him to treat me. Do the treatment that will work in the least amount of time with the least number of "life interuptions". Costs were not a concern as I decided it was well worth it and every day I took off work was very expensive for me so whatever works the fastest was best for me. He decided to skip Clomid and went straight for IUI with injectables (our clnic doesn't do IVF yet). I did manage to get pregnant after the fourth one, but m/c'd. I am now moving on to IVF at a different clinic that works with ours. I had to be VERY proactive in getting the treatment I wanted as our clinic seems almost scared of offering these more expensive options. So far with the 2 years of infertility treatments my suggestions would be;

1. Definately treat the pregnant women on a different time or day than those still struggling with IF. My clinic sees the pregnant women on one afternoon a week separate from all the IF patients. that was nice.
2. kindly request patients to not bring their babies or children with them. Some days when I'm feeling positive and optimistic I like it, because I see it as a sign that these treatments work. But on other days when things are going so well, you want to yell at the women and say "how can you be so insensitive?". I know they aren't meaning to and it is difficult to get childcare so frequently but with all the hormonal ups and downs it is easy for those of us without children to get upset.
3. request patients to avoid heavy perfumes and scented products. Some days when I was getting my IUI done and at the peak of hormonal sensitivity, the heavy colognes of some other patients (mostly the DH's) would make me want to throw up. I've also read that it can be bad for embryo's when doing IVF.
4. Take a photo of every patient and have that photo on the computer chart or inside their chart. When the clinic reviews charts for the next day, the receptionists should have an idea of who is coming in and what they look like, so there is a sign of recognition on their face and maybe even greeting by name. Even after TWO YEARS of coming to the clinic on a weekly basis the receptionists STILL have to ask my name. I know they see lots of patients, but my file is almost 2 inches thick, you'd think they'd at least remember my first name.
5. Clean the "men's room" better. My DH was afraid to touch anything in that room which made "aiming in the cup" even more difficult. I second the vote for a computer with porn on it so that the "job" can get done quickly and with a "little gusto" to get a big sample.
6. Ability to email clinic
7. I don't expect clinic to handle my insurance issues - that will only increase the costs since they are doing more work for you. But, maybe some information in the clinic manual that deals with FAQ about insurance and a step by step guide on how to get preapprovals', reimbursements, etc. And maybe some ideas and suggestions for financing. There are companies out there like CareCredit and GM medical etc, but the clinic needs to subscribe to them in order for you to get financing and not use your regular credit cards and lines of credit that you might need for regular expenses or are saving for use on maternity leave.

Well, that's it for now. I will do another review of my new clinic after my IVF this month.
Me 38 DH 38 TTC x 9 years IUI with injectables x 4 BFN endometriosis surgery BFP March 2007 with IUI, m/c at 8w2d:( 2 more IUI, BFN IVF 1 and 2 BFN FET 1 BFN discovered I was a Type I diabetic (WTF?) started insulin failed adoption of Baby Boy May 2009 (mom changed her mind via Text Message) back to the clinic IUI #7 BFP, Baby boy E born at 37w via induction (placental abruption)July 18, 2010 8lbs4oz doing great! took a break to breastfeed until 2012 (only part of this that ever came easy for me) TTC #2 January 2013 IUI 1B, 2B, 3B BFN IVF #1B BFP but slow and low betas, m/c one twin 6w, lost the other one at 9w FET #1B Feb 19, 2014 transferred last two embies. BFP - praying this one works out because I think we are done with ART otherwise.

#46

  • Validating
  • Pip
  • 23 posts

Posted 18 January 2008 - 08:32 PM

Peter:

Thank you so much for asking this question. You're the first person I've "met" who's asked.

I have had several different doctors over the years, starting with a ob/gyn (most memorable appointment: he got up in the middle to deliver a baby, which I thought was so exciting. He was gone for less than 10 minutes and yet still managed to buy a coffee). Next, a doctor who was very open to - and actual pushed for - alternative therapies. It gave me a sense of involvement and control. The problem was that when things started to go wrong, these things worked the opposite way. The treatment wasn't working because of what *I* wasn't doing. His attitude was patronizing, and when I opted to go another route he declined to give me a referral to a fertility clinic.

Next up, a fertility clinic. The thing that impressed me most about my clinic was the doctor we worked with. She was what I need: someone who was going to give me the truth, tell me what my chances were, tell me what she could do for me. It was very much a collaborative effort - if she gave me directions, I followed them, and in turn, I really felt that she recognized that I was doing everything I could and was right there with me. When it failed, I really had the sense that she care about the fact that there was a live human being on the other side of that organ, not just someone who was going to throw off her stats.

Now, because of several factors, primarily the treatment route we are taking, we are looking for another clinic here and in the US. Here are a few of the things I've thought during my experiences with doctors, nurses, lab technicians, business managers, untrasound technicians, receptionists, hospital administrators, and all of the other women who have been standing by my side in a hospital gown and socs:

- What is your front-line staff like: After phoning countless clinics, I am always struck by the differences in the way my initial call is handled. Do clinics realize how their front line staff sound and treat prospective patients? This is the person who is going to be helping someone to decide to get referred to you, and is also the person who is going to speak to your patient under the best and worst of circumstances.

- what is your website like: If the clinic is a book, this is it's cover. Some have the barest facts, no prices, and only the request to "contact us". On the other hand, there are sites which publish things like articles the doctors have written, complete fee structures, an overview of how they work, cycle-walk throughs, ideas of wait times, and things that really give you a sense of who you are dealing with.

- what level of information do you provide before I become a patient: one clinic answered all questions by directing me to fill out their application form and submitting it with a non-refundable $200 fee. Another one walked me on a tour around the entire clinic - I had only walked in to their offices see if I could pick up a brochure since I was in the area.

-how much do you include my husband in the process. I had one really lovely lab technician who knew that it hurt when they drew the blood from my hand, so she always had my husband come into the lab with me to distract me (finger puppets). Also, when my husband is in the room with me during the ultrasound and the consult with the doctor, talking to him as well is great. There are two of this in the process.

-the big switch over. If I am going to show up at the clinic on Sunday morning, and be inseminated by someone I've never met before, please let me know ahead of time.

- do you recognize that we aren't old pros at this: Yes, many of us have joined "The Century Club" after logging our hundredth untrasound, but we aren't as blase about things as you are. We don't know things off the top of our heads and we do need to be reminded of things. Again. Also understand that there are going to be times when I am upset and frustrated.

- someone else had posted earlier about babies in the waiting rooms. Yes. As well, the 3 foot by 3 foot black and white stills of babies hanging on the walls - I don't need to be sold on the idea of having one, thanks. Save the money and update the mags in the waiting room instead.

But the real question is for the industry: how do I, as a patient, figure out which is the best clinic for me? Even if I do manage to find out that a clinic is good and has a good record, a clinic may be great for one type of treatment, but not great with another. Or how do I evaluate a very negative comment another patient might make - esp. when this might be someone who had a bad _outcome_ or had unrealistic expectations about the process? Even looking at the success rates doesn't really help. Are the numbers low because they take the hardest cases or high because they have such tight guidelines on who gets in?

This isn't a matter where, if your first experience didn't work, you can try someplace else and do it all over again as many times as you need to. There is a very finite amount of time, money and endurance. It's frustrating that people are difficult to deal with or seem to be working at cross purposes to yours. It's awful to have to spend these amounts of money. It's painful to have to undergo the treatment and where you may or may not get the support you need. It's heartbreaking to find it didn't work. But it's just overwhelming to go through all of that, and then sit back and think, "What if we had done it differently?" or "I wish we had the chance to do it all again." Even now that I *am* doing it all again, and know now what I didn't know then, it's still a hard road. I just ask better questions this time.

Oh, and if I could change one thing? It would be this: I would ask every fertility doctor to do a "walkthrough" treatment at another clinic, just like a regular patient.

I hope there is something in all this which answers the questions you've posed. I really am grateful that you are writing a review like this. This is an amazing industry whose technology, doctors, nurses, technicians and staff do life-altering work that holds out such promise for people like us. While the process is inherently hard, there are are things that can be changed to mitigate those things, if people just understood what gives rise to the difficulty in the first place. It's initiatives like yours that can bring about those changes. Eleanor Roosevelt was described as a woman who would rather light a candle than curse the darkness; thank you for lighting a candle on a bit of the darkness.

(sorry I wrote a novel)

#47

  • Validating
  • Pip
  • 1 posts

Posted 27 January 2008 - 04:20 PM

Peter,
I am currently off work to recover from my egg retrieval (6 days ago), so I seem to have copious amounts of time on my hands. Hopefully this time can be well spent aiding you in your research.
It took several months after my family physician referred us to get an appointment in the REI program. January 2007 we were finally able to meet with Dr. Rebel.
The first thing that I noticed about my clinic was that the receptionist has a unique ability to speak in a way that only the person to whom she is speaking is able to hear anything she is saying. As a result, I felt like I could trust her more than my own mother! Immediately I felt like this clinic would be a safe place.
I found Dr. Rebel to be very matter-of-fact and impersonal. She seemed to think that I was to young to be worrying about infertility. I was 26. My husband and I had been married 2 years, and ttc since our honeymoon. After a series of tests she reported that there didn't appear to be much wrong, but that I did show some signs of endometriosis. One of my tubes was occluded, but the other had some dye spill out the end. Hormone levels and sperm counts were normal. She recommended we keep tying another 6 months or so using an opk. I had already been charting my cycle for 1 year, using a thermometer and an opk. July 2007 she performed a laparoscopy, and after the surgery informed me that I had stage IV endometriosis. All of a sudden she was patient and compassionate. She repeated the details to me and answered all my questions. I felt like I had been hit with a truck. She told me that both of my ovaries and tubes were bound in extensive scar tissue, as was a large amount of my bowel. My chances of conceiving a child naturally were next to none. She recommended that we pursue IVF as our best option. I was 27.
Dr. Rebel gave us the paperwork we needed to get the screening tests that would allow us to freeze our embryos.
Our first meeting for IVF took an entire 8 hour day. Before we arrived the clinic had sent us a stack of literature to read, and upon our arrival we were handed a binder that neatly organized all the details into colourful tabs - Costs, Medications, Procedures, Embryo Freezing, Counselling, etc. I love the binder. It has served as a valuable resource when I'm up late at night wondering!
Our caseworker, a RN, took the time to build a rapport with us before she introduced us to each member of the team, and escorted us between offices. She was supposed to be intimately familiar with our case and be the communication link for us at the program. I have heard other women comment that they grew very close to their caseworker. I haven't seen ours since that 8 h day when we were orientated to IVF. Perhaps she isn't working their anymore. I think having one caseworker could be a great experience... It has been all right having whichever RN was available though... Karen has called me most often to tell me my blood tests, etc. Various nurses took me under their wing to teach me one-on-one how to inject (and even let me practice on fake skin with a gonal-f pen/syringe), talk me through ultrasounds, help me through the retrieval, and prepare me for the embryo transfer.
The doctors were all fantastic in their own way to. There is a team of 5 doctors at the clinic. 2 Female; 3 male. My favourite doctor is Jackie. The first time I met her she introduced herself, and then joked that it is always nice to know someone's name before they go down there. She immediately put me at ease. I later found out that Jackie went IVF herself as a patient, and that is where her son came from. Jackie did my oocyte retrieval and had the same light-hearted demeanour then too. Another doctor, who will remain nameless, I found to be very unfriendly and rough. Even during my ultrasounds he seemed to shove the probe stiffly wherever he felt, and never notice the amount of pain that he put me through. I might have thought this was normal with my endo, etc, except that none of the other doctors hurt me as much as he did. This was the doctor who did the embryo transfer. I begged doctor Power to do the transfer instead, but Dr. Power assured me that this doctor has an 80% success rate and was the man for the job. Great, I thought, and bit my tongue. A friend of mine is doing IUI at the same clinic. She shares my opinion regarding this doctor.
My favourite person in the IVF program is the counsellor. Although I have not seen him since the day we met and spent 2h chatting in his office, I still really like knowing that he is there and has the ability to quickly put my husband and I at ease.
Leaving the ET my husband turned to me and said, "I've finally knocked you up... and it only took a roomful of men to help me." If there is one thing I would change about the program, it is that... I would prefer to have the option for an all female staff - from lab tech, to RN, to doctor - to be nonchalantly digging around in my vagina. Otherwise, the experiece has been interesting and I am hopefull that my little embroy are snuggling in for the next 9 months. Good luck in your research!

#48 shola

shola
  • Member
  • 128 posts
  • Gender:Female
  • Dx:N/A

Posted 31 January 2008 - 10:25 PM

Hi Peter,

Thanks for taking the time to do this research. I'm new to the board, but I just finished my first round of IVF (will find out the results soon), so I do have some comments. The positives and negatives are mixed together, i just wrote them as i thought of them.

- My clinic all around was very good. They were well organized, and took time to answer my questions (and I ask a lot of them), even my dr who spent 1 hr with us doing consents. They were professional, and I really appreciated that.
-The nurses were all really nice, and they really took time to make sure we understood what we had to do, in terms of self injections and other meds.
- most of the drs were really nice too, though i would have prefered to have my own dr do the proceedures, and not the person on schedule for the day.
- One doctor gave me a scare about my follicle count, when there was no need, by predicting my ER outcome very early in my stimulation stage. Turns out he was totally wrong and I was scared and crying for a day for nothing.
- at the beginning of my cycle, i got an actual calendar with my meds written on it, along with prospective ER and ET days, which was very helpful
- pharmacist was really nice too, and took time with us. would have been nice to get infomation sheets on the meds, though, like at other pharmacies.
- The clinic gave us a booklet on what to expect, which was mostly helpful, though there were a few errors in it.
- There was an error in one of the consent forms that I didn't find out about until transfer day.
- The ER was really really painful, and I was not prepared for this. They gave me a sedative beforehand, when what i really needed was better pain relief. Actually ER was the most painful experience of my life, and I was basically crying and moaning thoughout the whole thing, and my dh practically passed out from seeing me in so much pain. this was really the worst part. at least the dr recognized that i was in so much pain and said that he hopes i never have to go through that again, but if i do they will be sure to give me something stronger.
- they have a great website with all their fees and consent forms / information kits online to look at. however, their stats have not been updated recently.
- a few times i had to wait for a long time for my u/s, even though i had an appointment at a set time
- the clinic was not located at a hospital, so there were only IF patients there, and no obviously pregnant women.
- i really liked that the nurses called me once after er, and a week after et to check up on me. in the latter, she even asked me for feedback on how i found the process, particularly if the instructions etc were clear. so i mentioned some of the errors i wrote above, and she was quite eager to hear that, which was really nice.

that's all i can think of at the moment. hope this helps...

#49 shola

shola
  • Member
  • 128 posts
  • Gender:Female
  • Dx:N/A

Posted 01 February 2008 - 05:01 PM

One other thing I wanted to add, is that the clinic was well set up. "men's room" in a fairly secluded spot, with a window to the lab just across the hall. u/s rooms have private entries for patients, where you change. i always got to see the u/s as they were being done, even during et and er. i really appreciated this. and as far as i could tell, all ivf patients were booked at the same time, so there was no overlap with other clients. this was good for maintaining a bit more privacy.

#50

  • Validating
  • Pip
  • 15 posts

Posted 08 February 2008 - 08:02 AM

Dear All,

I want to write a review on what is important/essential/desirable/undesirable/unacceptable in an IVF clinic from the point of view of the patients.

I don't think that many clinics actually hear praise, complaints, ideas and feedback from patients. If they do they might not listen........

Some things will be very clinic specific, others might be more generic.

The review will not mention or criticise/praise specific clinics but is intended to be read by clinic staff in general so that it might ring some bells about their policies and procedures and ensure the highest quality of care for patients.

I need comments about every aspect of clinic activity from the receptionist to the lab to the operating theatre and back again.......even such things as clinic literature, communication, accesibility, empathy, counselling, friendliness, atmosphere.....anything you feel is important......

I can't do this without your input so I look forward to hearing from everyone.....

Best wishes,


Peter

On the bad side I find that my clinic is so busy, that sometimes I feel that I am just on a conveyer belt in a supermarket. They are a bit handy with the needles too and have precautions about being too optomistic about success just incase it does not work. Yes a conveyer belt in the supermarket "next please" I think it is because their audit said (yes I have read it) they are short staffed and do not have the room for the amount of patients.

One embryologist said to me when I wanted to take our embies to blasto "they are better off inside you, you are making the wrong decision" and gave me hell for the whole 5 days.
When I had my first failed with the clinic I asked for a scan and the nurse on the telephone said to me " we dont do that if we did we would be here all day doing it"
One other nurse said to both of us on a consultation about our next transfer "we dont do blasto we dont do this and we dont do that"
I think they are short staffed and overworked! They are nice people and professional but that is what I think.

On the good side once known in the clinic, they generally listen to what I say (as if I dont give them any option).
The staff start to get to know you and are more emphatic and so on. There are two fantastic embyrologist there who I trust very well and are very professional and the nurses are very nice and give me time. My consultant is also better, he was always good in the first place anyhow.

Reception is good, however have to phone them for at least 30 minutes before I can get through. Administration is good always phone me back and get things done.
Is a nhs hospital treatment so I think the bad things come from too many clients at one time and very very short staffed! Different to our private as they are not as busy.
Hope this helps.