“Over the years Sher-IVF has 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 one 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.”
Couples from throughout the United States of America and from more than 40 different other countries, have sought advice and care regarding IVF treatment through consultation with me (or s designee) at Sher-IVF. In fact, currently about 60% of my patient consultations emanate from out-of-state or from abroad. Most such patients tend to be are older, have had repeated pregnancy losses or have complex reproductive issues, having experienced numerous “unexplained” IVF failures. Such patients have been able to access seamless care in a caring and non-stressful environment, under my guidance and supervision. In one case, after experiencing 22 consecutive IVF failures, a couple who journeyed from Melbourne, Australia, had a baby following a single IVF attempt. My approach is to orchestrate and oversee individualize care, targeting those factors that often adversely affect IVF outcome.
IVF cycles are prescheduled to occur during about eight to ten pre-scheduled, 1-2 week cycle batches per year (dependent on whether fresh embryo transfers or frozen embryo transfers (FET) are required. This means that patients will almost always know well in advance of treatment, when they need to be present in Las Vegas for IVF. It also allows for optimal convenience, quality assurance, 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 (or a designee). Patients Residing outside of the Las Vegas geographic catchment area, generally schedule a consultation via Skype. This tends to be much more intimate and personal than a telephone consultation and is the closest thing to meeting with the doctor in person. The consultation is made by calling 1-800-780-7437 (for patients who reside in the U.S.A or Canada) or 702-533-2691 (for those residing elsewhere). Patients can also enroll online by going to the home page of the Sher-IVF website, www.SherIVF.com where, upon completing an enrollment form), they are directed to an online questionnaire (or one will be forwarded to them) for completion and are contacted to schedule an initial Skype or an in-person consultation with me (or a designated fertility doctor).They will also be asked to forward copies of whatever medical records (from prior treatment and procedures) they might have available. Anyone having difficulty in completing the questionnaire can contact us by phone and we will gladly hand-hold them through the process.
Upon having enrolled, an online copy of my new book, “Recurrent Pregnancy Loss (RPL) and unexplained IVF Failure: The Immunologic Link”, can be downloaded free of charge.
- The Initial Physician Consultation.
At the initial (approximately) one hour Skype or in-person consultation, all aspects of the patients’ history will be discussed in detail, all available medical records will be reviewed, a preliminary opinion will be given and treatment options will be presented. Patients are provided with contact information that will promptly reach me (or designee), in order to address any future questions or concerns. Within 24-96 hours of the initial consultation, all patients will receive a written communication from Sher-IVF by email, in which their case is summarized, further testing is recommended (as needed) and an opinion is given. The email communication will also provide a list of suggested, supportive articles that can be found on Dr Sher’s blog at www.SherIVF,com , along with directions on how to access these. The initial consultation is followed by several, free follow-up consultations with: a) an administrator (who will provide logistic and financial information), b) with me or another designated physician (to fine-tune, endorse or revise the preliminary advice given) and, c) with a clinical nurse coordinator who will develop and email to them (in advance of another skype or telephonic consultation), a color-coded electronic calendar which details all treatment and investigative actions needed to take the patient to and through a full cycle of treatment with us.
- The Consultation with an Office Administrator and a Clinical Nurse Coordinator
Within days of the initial meeting, patients are contacted to set up a consultation with the Office Administrator to cover the logistical and financial considerations associated with doing IVF. This consultation is free of charge and in no way commits the patient to treatment. It is simply intended to provide pertinent information, in case the patient should choose to do IVF under my oversight/supervision, in Las Vegas. At the same time, patients will be familiarized with the logistics, time constraints, structure, and processes involved in an IVF cycle. This approach enables patients to plan their treatment with precision, even months in advance. Almost all testing and preparation can be done in the patients’ own home settings. Individualized protocols I use to perform IVF during the 1-2 week cycle-batches throughout the year will be discussed so that patients will rarely need to spend more than two (2) weeks away from home to complete a full cycle of treatment.
A specific Clinical-Nurse Coordinator will be assigned to each patient/couple for their entire experience. She will interact with them and their primary care OB/GYN (as required) on a regular and ongoing basis. The Clinical Nurse Coordinator and her team will in effect, hand-hold and triage the patient/couple through all required steps and thereupon will schedule follow-up consultations. Patients will also be provided with contact information by which to reach the Clinical Coordinator, at will.
- Reaching the Crossroad: The Decision on Whether to Proceed
After completion of the above consultations, patients will be asked to make a firm decision as to whether/when they wish to undergo IVF treatment. Only after making such a commitment will they be expected to make a financial commitment to secure a place on the IVF calendar at a designated and mutually agreed upon time.
- Follow-up Physician consultation:
Once all records are available, test results are in, and the IVF cycle is scheduled, patients will again consult with me (or designated physician) for a free, follow-up consultation at which time everything will be re viewed in detail and, if needed, make adjustments. Thereupon further free, follow-up consultations may be scheduled.
- Ongoing Interaction and Follow-up
Our staff will, at all times, endeavor to be affable and available upon request. They will at all times endeavor to maintain regular contact with all patients, throughout. However, we are all human, and thus are capable of erring at times. So, if anything is not in keeping with expectations, we ask that patients immediately bring the matter(s) to our/my attention immediately so that we can address any/all issues in a timely manner.
- How to Reach Sher-IVF and Where to Stay while in Las Vegas
We will gladly advise and assist patients 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 in obtaining very affordable quality accommodations in close proximity to our facility.
- Getting Patients Ready, Conveniently, and On-Schedule
We work with patients to get all of required tests done through their own doctor’s office. The 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 the patient’s hometown environment.
Once we have reviewed all test results, a customized protocol of treatment is developed emailed to the patient/couple. Using the detailed, patient-specific color-coded treatment calendar as a guide (see above) the patient-specific, assigned Clinical Nurse Coordinator will again review it with them in person or by telephone, prior to their initiating an IVF cycle of treatment.
- The IVF Cycle:
The cycle begins with the patient taking the Birth Control Pill (BCP), starting no later than day 7 of menstruation. Depending upon the scheduled date for IVF, the patient will continue taking the BCP Pill for 11-30 days. This will be outlined in detail on the calendar we provide. It will also direct patients as to when to begin their injections. Once they have taken an agonist (e.g. the Lupron, Superfact, and Buserelin) for 3-5 days, the BCP will be stopped. Menses will usually ensue 3-8 days after stopping the BCP. The patient’s 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 they have not formed an ovarian cyst and are ready to begin Gonadotropin (fertility hormone medication) injections. At the same time an ultrasound examination is performed to ensure that there are no obvious cysts.
Depending on the stimulation protocol selected, patients will at this point either continue with daily agonist injections (The conventional down-regulation protocol) or switch to an antagonist (Ganirelix, Cetrotide, and Orgalutron) daily injections (the Agonist/Antagonist Conversion Protocol-A/ACP). Once again, the patient’s calendar will direct them as to when to should start the injections at home and plan on arriving at the center in Las Vegas for monitoring 7-8 days later. Other medications during the treatment cycle of treatment. 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 the patient has a thin uterine lining, she 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 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.
Upon arrival in Las Vegas, IVF patients will come under my personal care or that of another designated fertility specialist who will implement treatment following the designated outlined regime, under my oversight. This will include regular (usually daily) monitoring of blood E2 levels will begin along with ultrasound monitoring of ovarian response and development of the uterine lining. Typically, egg retrieval will take place 2-8 days after your arrival at the clinic for monitoring. Fresh embryo transfer (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, “Staggered IVF (St-IVF)” might be required. Here, the ET is deferred and embryos will be ultra-rapidly frozen (vitrified) for subsequent dispensation in a later frozen embryo transfer (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 for a later FET, most patients will 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.
Here at Sher-IVF, IVF cycles are routinely performed in 1-2-week batches scheduled long I advance. Use of the BCP to shorten or lengthen the time period leading into a treatment cycle, allows this to be effected. This, in my opinion has no down side, makes the process very convenient for all, and facilitates optimal quality control at the clinical and laboratory levels.