I cannot believe how quickly time has flown since we have arrived in Valencia! We arrived on Tuesday, April 17th, and on Friday, April 20th we had our first consultation with Dr. C* at the IVI clinic.
Our initial consultation
Our hotel was a short walk to the clinic, and when we arrived at the modern and bright facility we were directed to go to the international patients’ check-in desk. Here we were greeted by an English speaking coordinator, who took our photographs, documented our passport information, and then explained that we would be assigned a “tutor.” Tutors at the clinic are medical professionals who guide international patients through the initial consultation and the IVF process.
We waited in the waiting room for only several minutes before our tutor introduced herself, and then she ushered us from one room to another to complete the intake process. During this process we submitted all of our recent bloodwork, semen analysis results, and other diagnostic test and health history information. We reviewed and signed the treatment paperwork, and then were directed back to the waiting room to wait for our appointment with Dr. C.
Meeting Dr. C
Just before our scheduled time to meet with Dr. C, our friend Phillip (who is a friend of Dr. C and arranged for us to be seen at the clinic) met us to say hello and to make sure we were having a pleasant experience so far. He then walked us into Dr. C’s office to personally introduce us.
During our meeting with the doctor MH and I reviewed our health histories, the doctor performed a transvaginal ultrasound and a trial transfer (note, this was quick and painless, and I did not take Advil prior to my appointment), and then we discussed next steps. I had several more tests to take, which I would need to do the following Monday since I needed to fast beforehand. MH would need to have another semen analysis and we would also do a freeze. Thankfully, all tests are performed at and processed by the clinic, so waiting time for the results were just a matter of hours (as opposed to days or a week when compared with my experience in the USA).
There were a couple of surprises during this consultation. One, we learned that I would need to complete an ERA test. This is a test that evaluates the ideal time for implantation, and based on these results, will determine the optimal day for the FET. Unfortunately, this test means we have to do a “mock cycle” in between the retrieval cycle and the transfer cycle. Therefore, it will extend the amount of time before we could actually become pregnant. We were planning on taking a month off in between regardless, but since we have to a mock cycle with a biopsy for the test, I will need to be on medication and have to stay close to Valencia for several doctor’s visits during this time. We considered traveling back to the USA to perform the test there, but the cost of the test would be at least double than what we would pay here in Valencia.
The second surprise was according to testing I had completed in the USA, my AMH levels had dropped significantly from June 2017 to April 2018. Dr. C was not happy with the latest number, but his concerns dissipated when he conducted the ultrasound and counted about 17 follicles. He said that AMH was just one of the parameters he looked at when evaluating ovarian reserve, and the drop in levels could have been due to a faulty test. To be sure, he wanted me to get my levels retested prior to my next appointment.
We also learned that Dr. C was going to put me on a “short protocol“. At first I was disappointed to learn that we couldn’t start treatment in my current cycle. I had assumed that I would be on a protocol that was similar to what my previous doctor had recommended, which was referred to as a “long protocol.” A long protocol requires about two extra weeks of medication and it starts during the menstrual cycle preceding the ovarian stimulation phase. However, Dr. C explained that the clinic’s approach is to use the most gentle protocol as possible, so there was no need for me to be on medication prior to my next period. With a short protocol, I would start my stimulation medications on day 2 or 3 of my next cycle, and if all goes well, have the retrieval 10-12 days later. Since I was dreading the shots and how the medication would make me feel, that sounded good to me!
Follow up visit
The following Monday we went back to the clinic for blood work and our follow up visit to discuss next steps. Dr. C confirmed that my AMH levels looked great, and we would start treatment on either Day 2 or Day 3 of my next cycle.
Dr. C did have concerns about MH’s semen test results from Friday. Due to the low count, low motility, poor direction, and poor morphology, Dr. C recommended that we PGS test the embryos. He explained that there is a correlation between poor parameters and genetic issues (which we were aware of because we were recommended to have the DNA fragmentation test performed in the States). Since we are at a higher risk of having genetically abnormal embryos, he wanted to mitigate the risk of transferring an abnormal embryo as much as possible by screening them out.
A different kind of TWW
After our last appointment we excitedly awaited my period… for over two weeks! We visited the clinic several times to pay for services, pick up my prescriptions, receive my first tutorial for administering the medication, and have my questions answered about timing of the ERA test and the FET. On the first day of my cycle I walked to the clinic to inform them I was ready to start; luckily, I already had an appointment on the books for the following day, so I returned to meet with Dr. C and officially started my protocol.
We have been beyond pleased with the clinic and the service so far, with the exception of being able to easily contact an English speaking operator during peak hours. Luckily we are only a 25 minute walk or bike ride away, so we have been able to simply “show up” and speak with someone who can answer our questions.
Everyone at the clinic- including Dr. C- is so friendly, helpful, and efficient. Despite coming from thousands of miles away, we feel completely at ease. I learned that approximately 50% of the patients are international patients, many of whom come to Valencia specifically to be seen by Dr. C. Based on the “concierge” level of service we have received, the clinic is clearly set up to treat a global patient population .
*We have changed the names to protect the privacy of these individuals.