Describe your experience with your nurse.
My experience with my IVF coordinator, Emily Gray, and all the nursing staff has been top notch.
It is difficult to identify all the traits that an ideal IVF coordinator has, but my experience with Emily has helped to crystallize them:
• Deeply knowledgeable – Emily’s ability to smoothly manage communication and coordination among my doctor, the front desk, my pharmacy, geneticists, and others is rooted in her knowledge of both IVF medicine and the PNWF process. Her knowledge is broad (covering my questions on embryo banking, acceptable medications, etc.) and deep (e.g., risks associated with back-to-back IVF cycles).
I’ve worked with many nurses in multiple fields who can go through the motions, but can’t connect each process step or my question to the bigger goal. Emily goes way beyond.
• Commitment to results – As with Dr. Marshall and with the entire team, Emily has always been “in it to win it” with my husband and me. During one visit, I expressed that I appreciated her working with me even after I had proven to be the Cancellation Queen. She responded immediately and confidently: “I’ve never known you as that.” At that moment, I realized how important it is to feel in my bones the support and belief of the team you are partnering with.
• Attunement and sensitivity – Emily is upbeat when delivering good news, and compassionate when delivering bad news. This sensitivity is HUGE when going through the IVF process. There is nothing worse than going through a gut-wrenching process with a tone deaf partner.
• Proactive and clear – Emily stays ahead of me in all aspects of the process: from sending me a tentative calendar before we’ve even finalized target dates to ensuring my prescriptions are ready to go.
• Responsive and patient – I’m not an easy patient. I ask lots of questions. All the time. Emily has been gracious with her attention and timely with her responses, often providing more information and insight than I even know to ask for.
The rest of the nursing staff and front desk staff has been great to work with as well. At a certain point, I started to feel like a regular given the number and frequency of my visits. Everyone has been so kind and understanding. It has meant so much they everyone takes such pride and care in what they do: from handling my frequent blood draws to providing thoughtful care before and after egg retrievals.
The team at PNWF fertility provides a fabulous combination of medical talent and attentive care.
How was your experience with Lorna Marshall?
Pursuing IVF is one of the most out-of-control experiences I’ve had. But there is a comfort in knowing you are doing everything you can. Dr. Marshall has given me that comfort.
At every step of my partnership with Dr. Marshall, I have had deep confidence in our approach. And the results are there to prove it. I went from two canceled cycles before working with Dr. Marshall to 15 total eggs retrieved in two back-to-back cycles of embryo banking after working with Dr. Marshall. While my transfer cycle is not until next month, I have rock-solid confidence in our path forward.
For you to understand how special Dr. Marshall is, it’s helpful to contextualize my situation and the struggles I had before meeting her. If you are short on time, please scroll to the end where I sing her praises.
My story – Before Dr. Marshall
I am a healthy woman who has been active my entire life. My body has always cooperated with me, and I thought having a child would be no exception. So I spent my 30s focusing on my career and exploring the world, actively avoiding pregnancy, confident my husband of 17 years and I could have a child when and if we chose to.
When we were ready to pursue pregnancy, I was 40. To avoid risking delays and miscarriage, we opted for IVF straightaway. This made our case unusual because we hadn’t spent time trying on our own without success, so we weren’t prepared for the rude awakening that followed.
The initial diagnosis was beyond disheartening. I learned my FSH (at 13 IU/L) meant I was closer to menopause than I had counted on. Statistical models estimated I had the potential for three eggs each cycle. My new label: 40-year-old with Diminished Ovarian Reserve.
Defiant, we proceeded anyway. But we got knocked down HARD. My first cycle was canceled quickly out of the gate because the birth control pills led to over-suppression. Only one follicle responded. Determined to get more information and move forward quickly, I sought another opinion per the suggestion of a friend of mine with extremely high standards. I flew out of town straightway to do so.
The second round was canceled too. Once again, I had a dominant follicle emerge and my other follicles wouldn’t grow as a result. I started pouring over medical journals and learned there was a group of criteria used to describe my poor response: the Bologna criteria. Trust me, this is not a group you want to be in. I hated all these labels, and my sense of self started to morph with the loss of hope.
It felt like my only option was to throw a hail Mary, without any real confidence that one would work. Not liking this conclusion (and not being able digest mentally why it shouldn’t be possible to preempt the early development of a dominant follicle), I scheduled a meeting with Dr. Marshall, at the recommendation of several friends.
MY MEETING WITH DR. MARSHALL TURNED AROUND THE TRAJECTORY OF MY FERTILITY JOURNEY. 180 DEGREES.
My story – After Dr. Marshall
After my husband and I talked to Dr. Marshall, I knew I wanted to work with her. I knew she would be my final fertility doctor.
Several things really jumped out at me during our initial conversation. Dr. Marshall:
• Individualized her protocol recommendation, synthesizing her knowledge of IVF research and her experience and innovation with cancer patients. Her ability to individualize effective protocols was absolutely top notch. Most doctors like standard protocols because they are what generally works. But if you are older or not an easy case, you NEED someone like Dr. Marshall—who has the knowledge, the courage, and agility to go beyond textbook solutions. She discussed options with me, and her rationale was targeted and precise.
Dr. Marshall was able to design a protocol that was much more compelling and effective than what I was able to find on other sites and in medical journals.
During our discussion my prior cycles became critical inputs for deciding how to move forward. My prior doctors had made very solid decisions, but the key to better results was precisely pinpointing what needed to be changed based on what did not work in the past.
• Offered us an entire path forward, not just a protocol for the next cycle – Given my first two cycles had been canceled, it seemed naïve to assume that the next cycle would miraculously be “the one.” We talked through a few scenarios that alleviated the pressure on the next cycle even while giving us renewed hope. It felt like a fresh start.
• Focused on doing the right thing – Dr. Marshall happily agreed to work with us, even though there was a chance I could hurt the success rates of her clinic. She is clearly motivated to help people achieve their fertility goals, and is willing to put her patients’ needs ahead of her clinic’s numbers.
• Has a sense of urgency – Dr. Marshall helped us get started as soon as possible, and worked with us to schedule other diagnostic procedures while we waited for the cycle to begin.
Once we got started with the cycle, it felt like I was like I was in a different body. Hope blossomed when the cycle wasn’t canceled, and then turned into giddiness when I saw above-average results for my age. In the end, we made 9 follicles! From two canceled cycles to 9 follicles!
Eight of these follicles made it to day 3, but we were down to one healthy embryo after genetic testing. So we opted to bank the first one and try IVF again.
The second cycle proceeded as the first. While there were fewer follicles recruited out of the gate (I pursued this cycle as soon as possible after the prior one), we made 6 follicles, 15 total after two tries! And we now have another healthy embryo.
These two cycles also highlighted how and why Dr. Marshall is so unique:
• Drive for results – Throughout our journey so far, Dr. Marshall has been in the process with us. She does her work with skin in the game.
We went from two canceled cycles to 15 follicles over two cycles.
• Mental flexibility to do the right thing – Dr. Marshall always has a plan, but dynamically optimizes when there is new information (from bloodwork, from ultrasound, etc.)
There are a lot of smart doctors but in my experience her ability to perceive leading indicators quickly and comprehensively and adapt plans accordingly is extremely, extremely rare. I am not used to others staying ahead of me, and it has been a true joy to relax and just do what I’m told!
• Blends the best of IVF science with warmth and compassion – From her ability to handle my IVF-emoting to her kind bedside manner, Dr. Marshall brings warmth as well as expertise.
My gratitude to Dr. Marshall runs deep. If, like me, you are able to work with her, you will be a very, very, very lucky person indeed!
Describe the costs associated with your care under Lorna Marshall.
~$10K for physician services (monitoring, aspiration, transfer); ~$9K for embryology (insemination, blastocyst culture, cryopreservation)