shady grove is driving me nuts

[Anonymous]

I just did an IVF cycle and during the course of the cycle I saw 7 different ultrasound techs/doctors for monitoring and had call-backs from 6 different nurses. I have no idea whatever happened to my "primary" nurse. Of course the retrieval and transfer doctors were ones I had never met before. Fine for retrieval but for transfer I would have much preferred to have someone I knew and trusted to bounce things off of the day of (as we were debating how many embryos to return and the quality of our blasts wasn't perfect and had changed since I talked to "my" doctor the day before).

I had a successful cycle with SG in the past and all this craziness didn't bother me. Now I've had a less than great cycle (final verdict is still out) and I've felt like a boat adrift at sea the entire time. One day I was hearing good news, the next day bad news... Each day the news at the ultrasound and via phone was delivered by an entirely different person with a different take on everything.

My primary doctor is fantastic (I know him incredibly well and have worked with him for 4 years) and I'd trust him with my life but I only talked with him twice during the active 2-3 weeks of the process. It's not like I can call him up personally with every question and I never once saw him for monitoring.

Anyone else feel the frustration of this aspect of SG? I go to them because their lab is great. The reality of having to see 20 physicians and about 15 million other assorted unknowns through the course of a cycle is driving me nuts. It wasn't an issue with a great cycle but it sucks when things aren't going well.

[Anonymous]

I know what you are going thru, been thru it twice with my 2 IVF (sucessful each time) and it can be frustrating not to get a familiar face with your U/S appt.'s. But in all reality, SG knows what they are doing no matter who treats you that day. You are in good hands!

Currently pregnant with twins via IVF

[Anonymous]

Mention your frustrations to your doc. I always called my RE at SG or e-mailed him with questions and he always got back to me promptly -- even on the weekends. I have also learned that some of the Drs there tend to take a more pessimistic view, so I tend to tune them out.

[Anonymous]

Anonymous wrote:I just did an IVF cycle and during the course of the cycle I saw 7 different ultrasound techs/doctors for monitoring and had call-backs from 6 different nurses. I have no idea whatever happened to my "primary" nurse. Of course the retrieval and transfer doctors were ones I had never met before. Fine for retrieval but for transfer I would have much preferred to have someone I knew and trusted to bounce things off of the day of (as we were debating how many embryos to return and the quality of our blasts wasn't perfect and had changed since I talked to "my" doctor the day before).

Which SG office are you using? I'm going to be doing my first IVF at their Fair Oaks office in Fairfax and I am nervous about having the same experience. Does anyone know if the SG Fair Oaks office does all of their monitoring, retrievals and transfers at that office or do I need to go somewhere else?

[Anonymous]

All retrievels and transfers are done at the Rockville office.

[Anonymous]

I went through two IVF cycles with SG and feel your frustration. For myself I had to decide whether I wanted the personal care or the best lab and in the end decided the lab was the most important thing to me.

Despite different doctors at the monitoring, retreival, and transfer it worked. I'm pregnant and in the end that is all that matters to me.

[Anonymous]

OP here.

Yes, I agree that the end result is what counts.
When I got pregnant with a SG cycle I quickly forgot all about the craziness. I could have cared less how I got there---I was pregnant.

Now I just had a really crappy cycle which I can't imagine will end up with a positive and suddenly I'm completely frustrated.
Plus I was put on a protocol that was entirely wrong for me. We're going to change things up next time but I'm beyond frustrated that we didn't use a more appropriate protocol to begin with. My physician has admitted that he made a mistake. I love SG and have for years but this is the first time I think that a major decision regarding my care was not made correctly.

[Anonymous]

I have done 9 IVF cycles with SGF (4 cycles to conceive first child and another 5 cycles to conceive my current pregnancy) so I COMPLETELY know what you are saying. I agree with the poster who said that you need to mention this to your RE (hopefully your cycle will work and this won't be necessary though).

I honestly believe that SGF has grown so tremendously that they tend to treat their patients on the average. My body however is not average as evident by the number of cycles I've gone through. I was so amazingly fed up with how my 8th cycle went that I had a big sit down talk with my RE. I also had different doctors offering different opinions, a change in RNs, etc. I didn't agree with the decisions that were being made and felt I knew my case better than the RE signing off on my chart that day. I ultimately decided to do our final cycle when my RE would be in town the entire time I stimmed/retrieved/transferred. I wanted him to sign off on my results each day, etc. I had to push back my cycle a few times because he had unexpected trips but ultimately I am glad that I made the decision to wait for him to be available and accessible. It's sad we had to resort to that but given how complicated our case is - I didn't feel confident leaving the daily decisions up to a RE who barely looked at my chart.

Best of luck to you and stay positive about your current cycle!

[Anonymous]

Op here..

Previous poster (20:25) I feel like I could have written your post! (minus the fact that I haven't done 9 cycles. You are incredible!).
I've been telling my husband that I feel like SG completely treats their patients "on the average" as you said. Like I am viewed as one of the cohort of 3700 IVF cycles that they'll have that year and not as a unique patient. SG is VERY good at what they do and this approach works very well for a large number of their patients. Stick everyone who comes through the door on the long lupron protocol and throw in a great lab and you'll get 50% of the patients pregnant on the first try. However, if you're not one of this 50% and in fact if you're in whatever percentage it is that has truely complex infertility issues (and you don't respond to the first line of IVF treatment) then it can be a frustrating place to be a patient at.
I've also been talking about asking my RE if he will be 100% involved in my next cycle. I too have been thinking of asking him when he'll be in town for the ENTIRE time. This past cycle I had all sorts of doctors/techs doing ultrasounds and then 3 doctors (mine being one) who actually made decisions about stims. I know because I asked and was told that my doctor was out of the office but doctor X had reviewd my ultrasound/bloodwork and had decided to increase the stims by XX amount. I'm also really hoping to have my doctor present for (or at least accessible by phone the morning of) the transfer.

Congratulations on your pregnancy and I am amazed by your perseverence!

[Anonymous]

I did 3 cycles with SGF. Yes, I was exasperated with them. I had no idea who the hell was handling my embies, retrieving my eggs, who the heck would be monitoring me that day. I went on the web site and found where I could file a complaint and did. I saw my RE once in the beginning of a cycle and then again at transfer time and that's it!

I got pg on the 3rd cycle only to miscarry. So now we are going elsewhere.

[Anonymous]

20:25 Poster Here Again.... OP: If you are still cycling now - I honestly would put a call into your RE and also let your RN know that you need to speak with your RE because you want to speak with him on the morning of transfer. My RE was unable to do my transfer on my last cycle but I did speak with him via. phone because I was very insistent that we needed to speak. As an aside - I'm so glad that we did because we typically did IVF PGD on our cycles however for the first time - he recommended to forgo the PGD b/c we wondered if it was too harsh on my embryos - so we put back our remaining 3 embryos on Day 3 and I'm pregnant with twins. In previous cycles I was unable to speak with him on Day 3 - usually only spoke to the head of the PGD lab who always recommended doing PGD. Anyway - I do believe having my RE involved daily made a difference in my cycle.

I also was initially put on the Long Lupron protocol which was my worst performance followed by the Antagon protocol. I honestly think we tried every protocol - MDL, Low Dose HCG, Estrogen Priming - you name it. Thankfully I had a RE who didn't give up on us b/c I did have other REs during my stimming tell me that I was a hopeless case (nice) among other things. After doing so many cycles we figured out key things that made my cycles successful that I honestly think freaked out other REs during monitoring - ie. my estrogen level needed to get super high to achieve mature eggs - my most successful cycles my estrogen was above 7,000 and I never developed OHSS. These were things that when other REs saw me during monitoring made them nervous and want to cut my stims back which would cause my cycle to flop (happened more than once when my RE traveled or when I did weeekend monitoring).

Anyway - Just be your own advocate - don't worry about rocking the boat there. By the end I was so fed up with how I was treated I just didn't care about creating waves. If I didn't agree with a decision being made - I argued with them about why and usually won because I knew my body and how it responded better to various meds, doses, etc. better than they did. You deserve to be treated as an individual not as one of the 100 patients cycling that day so don't hesitate to do what's best for you. Good luck.

[Anonymous]

PP, which RE do you use? And which protocol worked for you?

I'm feeling the same way in terms of being treated like an average at SG - I don't think that my first IUI protocol and my first two IVF protocols were right for my situation (AMA), but I think my RE wanted to put me on the IVF protocols because they generally bring the highest probability of success. My RE isn't psyched about Estrogen Priming or a different protocol, so I'm trying to decide what to do next. But now that I've been through so much at SG and know how to work the system, part of me would rather stay and try to work with them.

[Anonymous]

PP here - I saw Dr. Sagoskin out of Rockville for all of my cycles over the past 4 years. I was relatively young when we started treatments (just turned 30) but responded very poorly to the meds. (We were supposed to be doing IVF for male factor.) What we figured out after so many cycles was that I need some type of lupron b/c my body responded poorly without it (Antagon) and responded poorly with the Long Lupron (over supressed) so we switched to Micro Dose Lupron protocols.

What we also learned is that I could have my best and worst cycles on the exact same drug protocols. For instance, on the Low Dose HCG protocol - I had one cycle where we had 14 embryos on Day 1 (which ultimately ended up with 7 going to blast and a pregnancy) and we did that same protocol to try and conceive again and I had 2 embryos left on Day 1 which ultimatey resulted in a BFN. We then switched to MDL/Repronex/Follistim which one one cycle yielded 14 embryos on Day 1 (which ultimately resulted with 4 going to blast but I miscarried) and then we did that cycle again and I had 4 embryos on Day 1 (which ultimately we did a 3 day transfer of the remaining 3 fragmented/poor quality embryos and I'm pregnant with twins).

My RE also wasn't thrilled about trying Estrogen Priming but I did pretty well on it - not a lot of embryos but the quality was good but it unfortunately resulted in a chemical pregnancy. While I respect SGF and am thankful for my RE - I do think it's a very, very conservative and cautious practice. That's not necesarily a bad thing but I think if you want them to think outside the box and try something new - you have to really push for it so they don't try to just keep to the same protocol/drug dosage/etc. I also think some RE's are much more conservative than others and some are more pessimistic. I think many questioned why my RE so aggressive in trying different protocols or different doses (I sometimes did up to 600 Follistim/day) - you could tell by the offhand remarks they made to me. While Sagoskin might not have a "touchy/feely/chatty" personality I liked that he was willing to try new things because clearly the SGF standard wasn't working for us.

We did a couple second opinions with clinics in NY and NJ but like you - I didn't want to pick up and start all over again. And we were in the shared risk program which I couldn't have done so many cycles without - we have no drug or IVF coverage at all. But the good thing about those second opinions is they both agreed SGF was trying everything possible - it was just a numbers game and the more times we tried - the more likely we were to eventually become successful.

Sorry this post became so long .... Best of luck to you.

[Anonymous]

I had a bad experience with Shady Grove just from the initial semen analysis my husband had to take. Because of this I went to Columbia Fertility Associates and was very very happy. I saw the same doctor every time. Very caring and professional. The hours were very convenient and I never had to wait for an appt or bloodwork. I spoke to the same two nurses each time with blood results. My doctor was also very responsive to any question I had. Overall it was an incredibly smooth experience. And the pharmacy they use, Freedom Pharmacy, is very professional and prompt in delivering my medications.

[Anonymous]

Thanks, 14:14. Do you remember what your Micro Dose Lupron and Low Dose HCG protocols were? Also, did you doc specifically want you to use Repronex rather than Menopur?