Couples from all over the world seek access to IVF services at Sher-IVF in Las Vegas, NV. In fact, about 70% of our patients emanate from out-of-state or from abroad. Most are older, have failed IVF numerous times, have had repeated pregnancy losses or have complex reproductive issues. This article explains how we treat such patients at Sher-IVF and how we are able to provide seamless care in a caring and non-stressful environment. In one case, after experiencing 22 consecutive IVF failures, a couple who journeyed to see me from Melbourne, Australia, had a baby following a single IVF attempt. My approach is to individualize care and target those factors that adversely affect IVF outcome.
At Sher-IVF, IVF cycles are batched into about eight to ten, 1-2 week cycles per year (dependent on whether we do fresh embryo transfers or frozen embryo transfers (FET))…which means that patients will almost always know well in advance of treatment when they need to be at our centers for IVF. This makes the process very convenient for both patients and staff. It also allows us to quality assure the embryology laboratory between cycle batches and so optimizes care and outcome.
HOW SHER-IVF PROVIDES OPTIMAL TREATMENT AT A DISTANCE:
- Setting Up a Skype Consultation
The initial step in treatment is to schedule a consultation with me. Patients living outside of the geographic catchment area of our Sher-IVF, (Las Vegas, NV) clinic generally schedule a consultation via Skype. I find that this is much more personal than a telephone consultation and is the closest thing to meeting me in person. You can schedule this consultation by going to my website, www.SherIVF.com where you can enroll online, by calling the Sher-IVF at 1-800-780-7437, or by emailing Julie Dahan (patient Concierge) at JulieD@sherIVF.com. Prior to your consultation with me, you will be sent a questionnaire that asks for information relating to your medical and reproductive history. You will also be asked to provide copies of whatever medical records (from prior treatment and procedures) you might have available. If you have difficulty in completing the Questionnaire, please contact Julie by phone or email her and she will help you do this.
- The Initial Physician Consultation
You will thereupon be scheduled for initial Skype or an in-person consultation with me at which time I will review all available medical records, ask additional relevant questions and offer a preliminary opinion. I will at that time provide you with my personal cell phone # and will request that you contact me immediately with any future questions or concerns so that I can address these immediately and in so doing, avoid any misunderstandings. This will be followed by one or more free, follow-up consultations with me to endorse or revise that opinion contingent upon supportive clinical and laboratory testing that I might recommend being performed in the interim. Within 24 hours of our initial consultation, you will receive a follow-up email from me which summarizes your case, my opinion and recommends tests needed. The email communication will also provide you with a list of suggested, supportive articles that I have written on my blog, www.SherIVF.com, along with directions on how to access these.
- The Consultation w/Clinical Director and Financial Advisor
Within one or two working days of our initial meeting, you will be contacted by my office to set up a consultation with our Office Administrator to cover the logistical and financial considerations associated with doing IVF with me at Sher-IVF in Las Vegas. This consultation is free and in no way binds you to us. It is simply intended to provide you with relevant information, in case you should choose to do IVF here in Las Vegas, with me. At the same time, you will be familiarized with the logistics, time constraints, structure, and processes involved in an IVF cycle at Sher-IVF. Our approach enables patients to plan their treatment with precision, even months in advance. We will also go over our protocols for performing IVF in 1-2 week batches or “cycles” throughout the year so that our patients rarely need to spend more than two (2) weeks away from home to complete a full cycle of treatment. A Clinical Coordinator will be assigned to chaperone you through your IVF cycle and she will interact with you and your primary care OB/GYN (as required) on a regular and ongoing basis.
- Reaching the Crossroad: The Decision on Whether to Proceed
After completion of the above consultations, you will be asked to contact us with a firm decision as to whether/when you wish to undergo IVF treatment at Sher-IVF. Only after making such a commitment will you be expected to make a modest financial commitment to secure your place on our IVF calendar at a designated and mutually agreed upon time.
- The Consultation with a Nurse, Case Manager:
Once you have committed to, and have committed to a specific IVF cycle, you (and your partner…as applicable) will be scheduled to have a detailed consultation with a Nurse Coordinator who will develop a detailed, color-coded electronic calendar outlining all aspects of your management and treatment. This will include all diagnostic steps and therapeutic procedures required to ensure that your planned cycle of IVF can be conducted as scheduled and without a hitch. The Clinical Coordinator and her team of nursing and administrative personnel will in effect, hand-hold and triage you through all required steps and thereupon will schedule follow-up consultations with you. You will also be provided with contact information by which to reach the Clinical Coordinator, at will.
- Follow-up Physician consultation:
Once all records are available, test results are in, and your IVF cycle is scheduled, you will again consult with me for a free, follow-up consultation at which time we will review everything in detail and, if needed, make adjustments. Thereupon I might require further free consultations with you and you would of course be free to visit or call me on my cell phone with any issues. All I ask is that you do not email or text me. I prefer to be contacted by phone so that we can discuss matters of concern rather than have me respond with one-liners via electronic communication.
- Ongoing Interaction and Follow-up
Our staff will, at all times, endeavor to be affable and available to you upon request, and will endeavor to maintain regular contact with you throughout. However, we are all human, and thus are capable of erring at times. So, if anything is not in keeping with your expectations, I ask that you bring the matter(s) to our/my attention immediately so that we can address any/all issues in a timely manner.
- How to Reach Us and Where to Stay
We will gladly advise and assist you in obtaining the most affordable transportation and accommodations. Couples who elect to undergo IVF will find that accommodations in, and airfare (especially if scheduled well in advance) to Las Vegas, likely be relatively reasonable. In fact, we can assist you in obtaining very affordable quality accommodations in close proximity to our facilities.
- Getting You Ready to Go – Conveniently, and On Time
We work with you to get all of your required tests done through your own doctor’s office. Remember, your primary OB/GYN is just as capable as we are in facilitating or performing virtually all of the necessary tests and procedures that you may need, in your hometown environment.
Once we have reviewed all of your test results, a customized protocol of treatment will be developed and then be emailed to you. Your assigned Clinical Coordinator will provide you with a detailed calendar and will review it with you in person or by telephone, prior to initiating your IVF cycle of treatment.
- The IVF Cycle:
Your cycle begins with the Birth Control Pill (BCP), starting no later than day 7 of menstruation. Depending upon your scheduled date for IVF, you will continue taking the BCP Pill for 11-30 days. This will be outlined in detail on the calendar we provide you with. It will also direct you when to begin your injections. Once you have taken an agonist (e.g. the Lupron, Superfact, Buserelin) for 3-5 days, the BCP will be stopped. You can expect to menstruate 3-8 days after stopping the BCP. Your blood estradiol (E2) level will be measured at the onset of menstruation. An E2 level of less than 70 pg/ml (200pmol/L) provides relative assurance that you have not formed an ovarian cyst and that you are ready to begin Gonadotropin (fertility hormone medication) injections. You will also have an ultrasound examination to ensure that you have no obvious cysts.
Depending on the stimulation protocol selected, you will at this point either continue with daily agonist injections (The conventional down-regulation protocol) or switch to an antagonist (Ganirelix, Cetrotide, Orgalutron) daily injections (the Agonist/Antagonist Conversion Protocol-A/ACP). Once again, your calendar will direct you as to when you should start the injections at home and plan on arriving at the center in Las Vegas for monitoring 7-8 days later. Please note that you will also be taking other medications during your cycle of treatment. This may include daily human growth hormone (HGH) until the day of hCG “trigger” and/or, low dosage oral steroid therapy (dexamethasone/prednisone) starting early in the stimulation and continuing to the 10th week of pregnancy,
If you have a thin uterine lining, you might receive vaginal sildenafil (Viagra) suppositories from the early stage of ovarian stimulation to the day of the hCG “trigger”. In the case of embryo recipient cycles (e.g. egg donation, gestational surrogacy, low dosage oral steroid therapy (dexamethasone/prednisone) will start early in the stimulation and continue to the 10th week of pregnancy. Treatment of an underlying immunologic implantation dysfunction (IID) may in addition require that you receive an intravenous infusion of 20% Intralipid (IL) about 10-14 days prior to embryo transfer (ET) and/or low molecular heparinoid (Lovenox or Clexane). This might need to be repeated one or more times after a positive beta-hCG pregnancy test depending on the type of immune issue involved in your case.
Once you arrive at Sher-IVF in Las Vegas for treatment, regular (usually daily) monitoring of blood E2 levels will begin along with ultrasound monitoring of your ovarian response and development of your uterine lining. Typically, egg retrieval will take place 2-8 days after your arrival at the clinic for monitoring. Fresh ET usually involves blastocyst transfers which take place 5-6 days after egg retrieval. Frozen embryo transfers almost invariably involve hormone replacement and take place 6 days after the initiation of progesterone therapy.
In some cases, we recommend “Staggered IVF.” In such cases, the ET is deferred and your embryos will be ultra-rapidly frozen (vitrified) for subsequent dispensation in a later FET cycle. Sometimes (especially in older women and those with diminished ovarian reserve), embryos are frozen and banked over several cycles in an effort to accumulate as many as possible before the “biological clock” runs too low. In such cases, the embryos will have been pre-biopsied for chromosomal testing which is often deferred until several blastocysts (advanced embryos) have been banked. In the process, only one chromosomal test is done at the end of the “stockpiling”, thereby reducing the cost to the patient.
Whether a fresh ET is done or your embryos are banked, you should be ready to return home within 24 hours of the final procedure.
Blood pregnancy tests and subsequent ultrasound confirmation of pregnancy can readily be performed through your primary OB/GYN approximately 8-10 days after embryo transfer.
Our IVF cycles are routinely batched…which means that our patients know well in advance of treatment when they need to be at our centers for IVF. This makes the process very convenient.
“Over the years we have performed IVF on many patients that often journeyed from as far away as, France, South America, China, Europe, Africa, Central/South America, Canada, Japan, the Middle East, Russia, etc. Almost all have been surprised at the convenience that our system afforded them. In fact, most have readily volunteered that it is easier to be treated at a distance in the manner described, than having to drive in and out through bustling traffic to and from the doctor’s office amidst a busy work schedule. And what is more, taking off up to two weeks for treatment in a relaxed setting where you can bond with your partner and with us, can only help promote an optimal outcome.”