Reproductive Endocrinologist Recommendations & Laparoscopy Question

[Anonymous]

I searched the archives and the posts all seem to be rather old. Can people recommend (or recommend against) reproductive endocrinologists in the DC area? I live in Arlington VA and work downtown (Conn. & K Street) so practices with offices near those locations are preferable. I also have Unicare/NCPPO as my insurance (which does cover infertility) and so am trying to find a practice that takes my insurance if I can (in-network is covered 100%, out of network only 50%). I know that Shady Grove has really high success rates for IVF but I am hoping we don't have to get to that point, and worry a little bit about feeling like they will push me towards more aggressive options just because that is what they 'do.' I tend to be a person who asks lots of questions and needs a doctor who will hold my hand a little bit, but I obviously also want to get the best medical care that I can.

A bit of background - so far we are unexplained. I've had bloodwork, an endometrial biopsy, and today had an HSG with my OB. DH has had a sperm analysis. And we've had a post-coital test. All were normal. I chart and use the Clear Blue Monitor and OPKs and know that I am ovulating and that our timing has been spot on for at least 6 cycles. I'm 34 and had a normal pregnancy with my first child (actually got pregnant that time without really trying). I've started acupuncture as well and plan to continue, but no luck yet.

My OB has mentioned Clomid and/or or a laparoscopy as my logical 'next steps' and I am in search of a second opinion. I have read (and taken to heart) all of the posts advising against taking Clomid unmonitored under the care of an OB, and so know that if that is indeed my next step then I need to switch to an RE anyway. I'm also interested in knowing, for those of you going through infertility treatments, if laparoscopy is traditionally performed as one of the first steps in treatment/evaluation? My OB made it sound like any RE would tell me that was among my best next options too, but it sounds awfully invasive to me when there is no real reason to suspect I have endometriosis (which is what I thought a lap was usually done to identify and fix).

[Anonymous]

I highly, highly recommend Dr. Frankfurter at GW. I have NCPPO insurance too, and he is in-network. The offices are in the GW-MFA building (a block from the main hospital building). I am also someone who asks a lot of questions and really wants to talk through what the research shows. He has been great about that. My obgyn (who is also at GW) recommended him as being the RE who is the most up the latest research of anyone she knows. I also have unexplained infertility and, while I originally wanted to go right to IVF, he encouraged me to consider starting more slowly, so we are starting with clomid/IUI. He also encourages several office visits and really seems concerned about how we are emotionally and physically dealing with everything. Their hours for monitoring (doing blood tests/ultrasounds during your cycle) are from 7-7:45am, so it's very easy to go before work. He did not recommend laparoscopy for me -- it didn't even come up. We had HSG, blood tests, sperm analysis, and sonogram to check things out. Good luck!!!

[Anonymous]

I also live in the city and started with Columbia Fertility....I saw Dr. Abbasi and Dr. Sacks while I was there. Dr. Sacks works in the downtown office and was GREAT. The office, however was disorganized and I ended up leaving because I felt if I were to ever need IVF I wouldn't be comfortable with their lab.

After having consults with about ever other practice in the area (not Dr. Frankfurther, however) I ended up switching to Dr. Muasher in Fairfax. He is the only doctor in the office, handles all of the lab work himself, and I think is definitely one of the best. He is very dry and to the point, but I was willing to give up warm and fuzzy (Dr. Sacks is very 'warm and fuzzy' which I loved) for an office who knows me by name and always called me with results by 1pm, which never happened at Coumbia. It is in Fairfax (at route 50 & the beltway) but there was never a wait and the ease of the office was worth it for me.

[Anonymous]

OP---I have been TTC for two years. I had laparoscopy over thanksgiving. They found a lot of endometriosis. I always had really severe menstrual cramps, but had lived with it for so long (and with lots of ibuprofen) that it never occurred to me that it might not be normal. So if you have bad cramps---endometriosis could be present.

Still, before the surgery route, I would go see an RE and do a "clomid" challenge, i.e., they put you on clomid and monitor you with ultrasounds and bloodwork to determine what exactly is going on with your ovulatory cycle. I originally went to Shady Grove but found them very "factory-like", and when we got to the stage of trying IUIs---I switched to Dr. Abbasi at Columbia Fertility, whom I really like. I go to the Bethesda/Rockville office mostly but go to the DC office on weekends since it's nearer to home. The DC office does not seem to be as warm as the Bethesda office---but I didn't think Shady Grove's DC office was very friendly either.

[Anonymous]

Hi OP,

I live in DC, work downtown, and also have Unicare/NCPPO. We have been seeing Dr. Widra at Shady Grove's DC Office, and I really like him. We are basically at the same point you are - have done the bloodwork, HSG, semen analysis. Dr. Widra has not mentioned laparoscopy at all. My husband and I are both attorneys and ask a LOT of questions...he is also a very big "researcher." We have found Dr. Widra to be very easy to communicate with, informative, level headed, and calming so far. He is definitely not an alarmist, and has been quite reassuring. Maybe he isn't warm and fuzzy, but he is very nice. The same goes for the office staff - they have been nice enough and very responsive. Personally, I'm not really looking for warm and fuzzy - just someone that I communicate with, answers my questions, and ultimately gets the job done.

I'm very happy with our care so far - fell free to ask specific questions if you like.

Good Luck!!

[Anonymous]

We had a very good experience with Domion Fertility (Drs Dematina and Gordon) in Arlington just off Rt 50.

[Anonymous]

We had a wonderful experience with Dr. Rifka at Columbia Fertility. I had a particularly aggressive case of stage iv endometriosis that required a laparoscopy and then a laparotomy. I was taken by surprise with the diagnosis, and Dr. Rifka spent a lot of time answering my questions during the year I spent with him. Even if I called in a panic about something, he always promptly returned my calls and kept me calm during a very stressful process (I had A LOT of complications that kept cropping up). I don't know if all the docs at Columbia do surgery, (though I am sure Rifka and Butler do), but I would recommend Rifka with no hesitation. I have only dealt with the DC office -the regular staff there is generally pretty good (though, the weekend staff can be hit or miss). BTW, after one round of IVF, we are now expecting our first child. (And I will return to Dr. Rifka for GYN care after the baby arrives this summer).

[cassiea]

I would also say that I like Dr. Sachs (misspelled above w/ Dr. Sacks) at Columbia fertility. They have a downtown and MD office, so I think the former will be best for you. We did have to go through IVF and were successful on the first try, but I was first referred to him from MY doctor who used him herself for IVF. I like him, he is quite personable and laid-back. My only complaint is the suggestion that, on my first try, I put in more than one embryo, which I didn't want to do (and didn't do, thankfully). But I found the office very easy to deal with, generally pretty on time etc. I first started with him as an endocrinologist (where he referred my husband to also get checked out, who ended up being the bigger problem....)

[Anonymous]

If you are up for it, you can always meet with a few REs and get their thoughts before deciding who to use. Since you have insurance coverage this probably won't even cost you much. Just be sure to take a copy of all your test results to each appt. We saw three REs (one at SG, one at Dominion and one at GW) before making a decision.

[Anonymous]

OP here - Thanks so much for the information! I just called Unicare and was told that I don't need a referral, so I think I am going to take the advice to try to meet with a few REs (maybe 3?) before I decide what to do. I always appreciate the wisdom of this board. If anyone reads this and has more suggestions, keep them rolling in, as I'm sure it will provide me with more food for thought and might be helpful for others who - unfortunately - are beginning the infertility process.

(By the way, I am heartened to see so many success stories among you - congratulations to those who have successfully achieved pregnancy with or without treatment!)

[Anonymous]

I wouldn't worry about Shady Grove pushing you to do IVF - I never hear of them doing that, and actually Frankfurter suggested we only consider IVF while SG allowed us to try IUI. But SG is far from warm and fuzzy - I feel like I have to work to get anyone's attention.

[Anonymous]

I highly recommend Shady Grove. We used their VA offices but I was never once pressured to do something more aggressive. And my RE was available via email all the time. This was a huge plus to me since I never think of questions until AFTER I leave the office.

Best of luck!

[Anonymous]

I have had a wonderful experience with Shady Grove in Annandale, specifically with Dr. Greenhouse. He had us do 3 cycles of IUIs and then offered us the option of more IUIs or to begin the IVF process, after they failed. One thing I really appreciate about him (besides quickly answering my emails), is that he is very thorough about testing for everything, so we didn't waste our money on procedures before problems could be fixed. He hasn't suggested lap surgery despite our infertility being diagnosed still as "unknown."He was also incredibly compassionate after we had a chemical pregnancy that occured naturally.

[Anonymous]

I also had a great experience with Dr. Sacks (which is how its spelled...) at Columbia Fertility. Didn't much care for Shady Grove.

[Anonymous]

Dr. Osborne seems really nice. We started with her but just didn't care for the DC office staff itself. After about a year, we switched to Annandale to Dr. Garde who is so nice and sweet and totally hand holds. She's not pushy. We told her from the start that we wanted IUI only, but after 2 failed IUI and the emotional disappointment and toll, we decided to IVF am currently pregnant. IVF is very tough on the body though. So if you want to do clomid, do that under their guidance or IUI. Just realized you have to go in every other day for blood draw and ultrasound so make sure it's convenient as well. GL