Sunday, February 22, 2009

Choosing an RE

This week I did some research on RE's, and it was wonderful to have something proactive to do.

I found that there is only one IF clinic in my area. It is a satellite office for a very large and (based on internet searches) well respected center in a huge city about two hours away from me. Two of the RE's travel to my city 1-2 times a week for appointments with patients, but most ultrasounds, labs, etc. are done by a physician's assistant, nurse, and ultrasound person who permanently staff my local office. For any actual procedures like IUI or IVF we would travel to another office.

I also researched two other clinics in the big city.

We're not even close to doing IVF at this point, and aren't even sure if we would go down that path. As a disclaimer, I do believe that creation begins at conception. In my humble opinion, I think that IVF *can* be done in a way that still upholds the value of the life God created. I think God can direct some couples do do IVF and others to not. I don't know which side of things we will fall on if we end up facing that road. I know we would not want to create more embryos then we would be willing to have as children. I have also looked into egg freezing as an alternative to embryo freezing...all three clinic below have this as an option.

Because I know IVF could possibly be an option for us and it's really the only measure to see how "successful" different clinics are, I have been looking at SART scores. However, I don't know how much weight to put in them.

Also, how much should the published cost of IVF factor into our decision? Do the published costs typically reflect all of the fees (I know they don't include meds and anesthesia)? The clinic I spoke with gave me a breakdown of three fees: the IVF cycle, the hospital, and the lab.

Ok, here's a breakdown:

Clinic 1:
  • Distance: 10 minutes away/ 1-2 hours away for procedures
  • SART score: pregnancies: 54%, live births: 47%
  • IVF Cost: $10,500 (includes all three fees)
  • 2 recommendations
Clinic 2:
  • Distance: 1.5 hours away
  • SART score: pregnancies: 36%, live births 31%
  • IVF Cost:$6,900 (not sure if it includes all three fees, but the website makes it sound like it includes the everything but the normal things)
  • 2 recommendations
Clinic 3:
  • Distance: 2 hours
  • SART score: pregnancies: 66%, live births 60%
  • IVF Cost: $7,000 (not sure if it includes all 3 fees -- website says it does not include anesthesia/operating room fees, and the OR part sounds like one of the fees included in clinic #1's cost)
  • Haven't heard of anyone using this clinic
I don't want to choose clinic #1 just because it's local, but the flip side is that life would be so much easier without have to spend a ton of time driving through congested freeways. But -- it's more expensive, and while the SART scores seem strong they are not as high as clinic #3.

Since we're not at the IVF stage yet (and maybe never will be), I am wondering if we should just stay local for the testing and early stages of treatment that lie ahead. Then we could reanalyze the situation if we got to IVF? Although DH and I like the idea of sticking with a doctor who has worked with us throughout treatments.

My head is spinning, I don't know!! Any input or suggestions you have would be very much appreciated! Are there other factors I should also consider? How did you choose your RE?


Anonymous said...

I chose my RE based on location location location and that was WRONG.

My second RE I chose because he was NOT RE #1 and because he wasn't affliated with "the baby factory" I did get pregnant, but they bombed during the care of my miscarriage.

RE #3 is much like your option for clinic #1-I see the nurses, and the ultrasound techs more than the doctor BUT to be honest that was true of 1 & 2 as well and most often the case for ALL RE's.

I sincerely suggest that since you aren't at the IVF stage that you interview all 3. Seriously--if you are only charged a co-pay. That way you can view the office--comfort is key there too. You can ask questions of ALL of the staff, not just the doctor. Then you can make an educated decision based on your comfort rather than statistics on the net--for honestly those statistic mean squat if you are uncomfortable!

Amanda said...

I only knew of 1 clinic in my area when I made my first appt... as it turns out there is another clinic, and their SART records are better, but I like you, feel IVF is a ways off so I'll cross that bridge if I get there. One thing that turned out to be good about the clinic I go to is that there really wasn't much of a wait to get in, but I probably would have had to wait several months for the other clinic.

If I were you, I would also consider cost of u/s and IUI at each clinic since those costs add up fast. The u/s at my clinic are $85 and at the other clinic is $120... if you have to get three scans a cycle, that's a lot of money (and I still get a great scan at my clinic with a real tech or sometimes the actual RE and it's on a really snazzy 4D machine).

So, basically, I think I feel like maybe because I go to a smaller clinic I get more attention. But the most important thing is that I like my dr and think he knows what he's doing. I read a lot of other blogs where it sounds like their RE is just calling it in and doesn't care and I don't feel that way.

I agree with Betty, interview all three and get a feel for each clinic before you decide.

Remember, if you don't like your level of care after a few months, get a new clinic.

The Wife said...

My first RE I chose because my OB/GYN referred me to him. He was horrible and his whole office seemed like they didn't care. There were always other women/couples waiting in the waiting room so I thought that meant they were good. But as soon as I had that first initial meeting, I knew something was wrong. When I finally decided to switch, I just went on my health insurance website and went with the first clinic that a live person actually answered. I felt so much better with the 2nd RE since that first phone call. My advice would just be to go with your gut feeling and don't be afraid to switch if things aren't going the way you want.

Leslee said...

Thanks for your comment. I really appreciate it. He was a great guy and is sorely missed.

We have no clinics in our area and so chose the one clinic that would work with our gyn to do the testing locally. I've been very happy with the RE despite the fact that we've been with him for three years and haven't had success (Wait, what?. Maybe we should look into switching clinics. I don't know.) But I really like the RE and feel like he's on top of our situation.

Is it possible for you to meet with each of these REs, and to find out what exactly the costs will be. Based on my experience, the costs will not include medicine AT ALL. It's annoying, but true.

Take your time. You'll make the best decision.


Find joy in every journey said...

I must play the devil's advocate here...
Feel free to ignore my post, just some ideas...
I am a strong advocate that IF is a disease. It should be treated that way.
Please check out The success rates of CrMS is up to 80%.
I know for some couples it can be difficult to get this time of treatment for IF due to location, etc. It is worth looking into.
Just my 2 cents!
My OB/GYN is a NaPro doctor so I have not seen an RE. We did travel to NYC to see Dr. Toth for infections causing our IF and for a urologist for DH. NYC is 3 hours away to us so it was doable.
I just knew in my heart that we would not get pregnant if I didn' feel good. After the antibiotics I feel amazing. It was so worth it.
I would be more than happy to answer any questions.

Sara Scissors said...

My RE is not the closest to my house, but isn't hours away either. About 35 minutes depending on traffic. He was recommended by my OB/GYN that I have seen for years and really, really trust. He is such a kind soul and understands my type-A personality. Both him and my RE are affiliated with one of (if not the) best hospitals in my area.

My RE has over 25 years experience and was confident from the start that he would some day get me pregnant. I think an initial meeting one-on-one (well with DH as well) is key. You will just get a vibe from some one whether it's a good fit or not.

As you know, we're in the IVF stage now and will be doing ours at the seperate clinic that my RE is associated with. It's about a mile down the road from his office and staffs another RE who a friend of mine goes to. It soley does IVF procedures all year round. The other RE does my protocal, u/s, b/w etc while I'm stimming for IVF then my RE will come in for the ER and ET at the end.

My best advice would be to go with your gut. I would start with the office closest and see how that goes. I wish you all the best always! :)

cady said...

i researched various if clinics in atlanta, and ultimately chose mine because it is at a major teaching hospital and had the best success rates of any of the other clinics. plus, it was a tad cheaper. all of those reasons make the long drive worth it.

i'd be skeptical of clinicals that are under $10,000 total cost, personally. i've done some research online and found that many of those are so cheap because they use clomid rather than higher stimulating injectibles. they go for a small number of eggs, which is not what you want when doing ivf.

caitsmom said...

We chose based on the recommendation of my regular doctor. We were fortunate to have insurance that covered the procedures. Though we didn't ever get to the point of using IVF, we did have lots of tests and other procedures. I can't imagine going through another year of IF, and can only send my love and support to those who do. It is so hard and takes lots of energy. Peace. ICLW

Anonymous said...

i picked my RE b/c they are affiliated with the large university in my city. i figured they were held to higher standards because of this (less likely to fudge stats for preg rates, etc). i just went there b/c i didn't even look anywhere else. not a good start, i know. BUT i developed a great relationship with a doc who we've worked closely with over the last three years.

it will probably be much easier to go to appointments etc if things are closer.


Good Egg Hunting said...

I started with an RE who came highly recommended but I never quite felt comfortable with him. Always felt he was out of touch with me as a patient and with my particular story. I only realized after meeting with my new RE that I never trusted the first one. And I've realized how critical that is. You should leave every meeting with an RE feeling a few things: a sense that s/he is doing everything possible to get you pregnant, that s/he is customizing treatment based on YOU as a patient, and, most importantly, a strong sense of hope. I wish you all the best in finding someone you're comfortable with! Don't underestimate the importance of this, beyond all the numbers.

Caroline said...

Hi Hillary,

I'm sorry that I can't offer any good advice about choosing an RE. I chose mine based on some recommendations (and limited options). So far it seems to have been a good choice.
Although I can't offer any advice I just wanted to offer some encouragement. I hope that that you find a great RE.

Anita said...

Over here it seems that most RE's are also OBGYN's. Some of my friends had seen my doctor for pregnancy and IVF so I went based on what they said about him. He sounded professional and nice :) I have no idea what my clinics stats are though, but they have a good reputation. I would suggest meeting with the Doctors, asking questions and trusting your instints as well:)Good luck!

Fallopian 'Tudes said...

Hmmm I have never chosen an RE before, even though I've bene at this for over a year I still go to the good ol' family doc. I think it's high time I start thinking about it though. I understand the feeling about the IVF.

daega99 said...

Hi Again! We don't have any REs here on the Island. An RE from NJ visits the Island quarterly and things like IUIs and HSGs are done by OB/GYNs. I now don't even have an OB/GYN since there is a shortage of OBs on the Island at present - I have to rely on my GP for my annual exams. So as it relates to this journey, I have to go overseas if we have to do IVF and I have no idea where the NJ-based RE might send us to do IUI (if we get the chance to do it).

ICLW #34

Kristin said...

I really can't tell you how to pick an RE. I was lucky and all the testing I needed for my secondary IF was done through my OB's office.

My testing for the luteal phase probs showed my progesterone to be only 8. While this is technically, within the normal range, many REs want to see at least a 10 in order to support a pregnancy. Mine was correctable with progesterone suppositories started at 3 dpo.

Best of luck choosing a clinic and I hope you find a solution and a path that fits with your needs and your faith.


Anonymous said...

Good luck in your decicions. The only one that seemed to have low SART scores was the second one you listed. The other ones seem in line with what I have read.

Best of luck seeking an RE. Finding one you like is so important. Thinking of you.

I Believe in Miracles said...

Boston actual has several clinics to choose from, but I chose mine based on a) location, and b) it was in my hospital system. Or should I say I chose my job because of my clinic location... that might be more accurate.

I've been very happy there AND I 2 friends with success rates there. The success rate thing is key for me.

Good luck!!

Mary said...

What a great response you got with this one, Hillary! I hope you got a lot of good information.
We have 2 clinics and I went to the one my obgyn recommended (out of affiliation). They turned out to be a dud so we start with the second one on Thursday. I've only heard good things about the second clinic and iffy things about the first. Both SART scores are the same. IDK. It's confusing.

Emmy said...

I haven't chosen an RE yet, but will be doing so soon. I really hope to interview or have a consultation appointment before I decide. I will have several choices, so I hope to narrow it down to three or so first.

Good luck. I hope you find someone great for you.

Soralis said...

We just went where we were referred. Lucky for us it was one of the best if not the best clinic in Canada. It was a 4 hour commute to the clinic though.

I wish you the best and hope that you don't need IVF.

Take care

andrea_jennine said...

Since I have now seen 5 different REs and it sounds like we have similar religious convictions, hopefully I can answer somewhat helpfully! I think the SART statistics are very helpful; it can also be good to look at the SART stats on how many patients each clinic treats (too small? too big?). I would not just go based on location, but I also wouldn't rule out the location factor from your decision. Recommendations are good, but I ended up not liking some of the doctors that came most recommended. Here's what I'd say from experience: call each clinic, and see what sort of vibe you get. Be specific about your situation, your beliefs, etc., and see how they respond (even the response of the nurse, receptionist, or office manager will be telling; they'll reflect the type of patients they're used to and the style of the doctor). Do they rush you, or take time to talk? Do they seem familiar with your situation and concerns, or do they seem like they're just saying whatever it takes to get you in their door? Will they look at your case individually, or will they just put you on a standard protocol? Those are just a few thoughts... Feel free to email me if you want more particulars about my experience.
Oh, also - the IVF Connections message boards can be helpful to get a feel for various clinics. You can do a search by city/region.

Dora said...

I agree with the advice to interview REs if you can. Regarding SART stats, they can be skewed by things like whether or not the clinic accepts more difficult patients. In addition to the RE, the quality of the lab is VERY, VERY important. Larger clinics generally have better labs. High volume means more experience. One way to judge the labs at different clinics is to compare their donor egg statistics. Even if you would never, ever go the donor egg route, they give the best idea of the quality of the lab and the ability of the clinic to prepare a woman's body to sustain a pregnancy.

Personally, I would not be comfortable with a clinic that did not have drs doing the ultrasounds.

Mrs. Hammer said...

We were in a unique situation. My RE is actually a collegue of my father. He was recommended by friends and he is very well respected in his field. At the same time I was limited to this being the only clinic in town and the only clinic approved by my insurance. There are other doctors in the practice but I'm very happy with our particular RE. I do think it helps that we have that personal connection but at the same time he is a very genuine and compassionate person. I knew I was in the right place when our RE was as emotional about our failed IUI's as we were. And my friend said that he gave her a big hug when she got her BFP. I liked that he sees us a humans struggling with a disease than just numbers and chart records.

Soña said...

I'm here from LFCA and just wanted to share my experience - I was given a list of three REs from my OB when I left his care. I called all three, asked to speak with their financial person, discussed what the out of pocket costs were for a consult, monitoring u/s, and IUI (which is the treatment we were moving to). I already had a good breakdown of out of pocket pharmacy costs. That way I knew apples to apples what each cost. Then I asked when the first available appointment was. Turns out two of the three had 6 week waits, one could see me that week. I went to the first one later that week, liked his bedside manner and his staff, and went with him. He wasn't the cheapest by a long shot but in the end I got to start my treatment cycle sooner and I'm happy with my decision. Best of luck!

Cassandra said...

When you have to do constant blood draws and ultrasounds (sometimes every other day or daily, if they're monitoring you properly) the long drives really get to be a grind, esp. if they're at the crack of dawn as is the case at my clinic.

I don't trust the SART scores too much, because some clinics manipulate the stats by refusing to see certain types of patients just to keep their numbers high. But I would pay attention to the number of procedures performed every year at the clinic -- if it's too low they may not have enough expertise or something may be fishy, if it's too high it tends to be a factory.

At most clinics the monitoring is done by staff, not the RE. At my first RE I saw an RE every visit (they did all the U/S) because it was a teaching hospital; I was quite shocked when I went to my current RE in a different city and I didn't see the RE at all during the IUI cycle -- even the IUI was done by a nurse. But unless it's a teaching situation with interns and med students, having an RE instead of an ultrasound tech will really drive up costs and seems like a poor use of resources.

Interviewing the docs and getting their perspectives on your situation seems like a good way to go, but it could take several months to get appointments at some places. Personally I'd probably end up going with #1 unless I had a compelling reason not to -- I am not a morning person, and these early mornings are hard enough on me without adding over an hour of driving each way.

Good luck with your decision!

Dora said...

Ah, that's interesting info on the monitoring from Cassandra. In NYC the top clinics are all university/teaching hospital based. (Although, I don't think I ever had a student or fellow in the room for monitoring.)