Why do I need genetic counseling?
Genetic counseling enables you to understand your genetic risk and testing options, and usually helps you come to decisions about treatment options. My experience in helping patients with the same questions and decision points that you're facing has given me expertise in collecting the most relevant medical information, reviewing the pertinent medical literature and deciphering statistical risk estimates to obtain accurate risk calculations and testing options for you. Working with other patients who have walked this road has helped me develop the skill to hone in on your perspective, your concerns and your fears, as well as practical matters related to your treatment timeline. This makes genetic counseling not only informative, but useful to the decisions you face today.
What can I expect?
The genetic counseling relationship is unique in that it is a space to gather information and understanding about medical and genetic risk, but it does not constitute "medical advice." Genetic information is different than other medical information because it carries unique personal, family and social risks and burdens. The use of genetic information is extremely personal. Genetic counseling is the context for helping individuals understand and address such issues. The communication of this information and the process of counseling are only relevant as they apply to each particular client's concerns and needs. Your session will be tailored to address your specific questions and your understanding of the genetic issue(s) of concern.
What are the limitations of genetic risk assessment?
Risk assessment constitutes an essential component of genetic counseling, and the genetic risk is estimated as accurately as possible for your help in decision making. Our team is committed to providing the highest quality of genetic risk assessment, and we use relevant information from population studies, pedigree analysis, practice guidelines and genetic test results in order to provide you with relevant information. To that end, we spend the majority of our time when not working with clients in researching individual cases and following the medical literature in genetics and reproductive medicine. Our goal is to be as transparent about genetic risk as possible, your options for testing, and the limitations of predictive risk assessment. We make this information understandable to individual clients. However, it is important to understand that there is always a risk for a birth defect or genetic condition, even with the most advanced genetic testing and genetic risk assessment. There is no guarantee that a child conceived, after genetic risk assessment is performed, will be free of birth defects or other disease.
What is my responsibility at this appointment?
If you are not sure of your family’s health history, now is the time to ask. The genetic risk assessment is limited by the information we are provided, and if there is something in your family history that you would like to explore, please get as much information as possible in advance. Further, we are highly aware that each person brings their own values and personal health beliefs, as well as their questions, to the genetic counseling experience. We encourage you to take the time to reflect on your goals in assessing genetic risk, so that we can best manage our time in providing the best information and support to you in our session. After your session, you should have enough information to formulate your thoughts and make relevant decisions. We are here to support you through this process, and are available for additional questions you may have after our session is complete. However, it should be clear that decisions are yours to make. We support autonomous, informed decision-making as you pursue treatment in reproductive medicine.
Do I need a referral to make an appointment?
No, you do not need a referral to make an appointment. However, it will be ideal to provide all relevant medical records prior to your consultation, and it is often easier if I have a relationship with your reproductive medicine provider. Please let me know if I can reach out to your healthcare team.
What do I need for my consultation?
Please download, fill out and submit a Medical Record Release Form to your referring provider's office (or, if you are self-referred, you may attempt to get relevant records from your reproductive medicine provider). Please also fill out the New Patient Information Form within 2 days of your scheduled appointment. If you are able to consult with family members to clarify the family health history, that is ideal.
How will I pay for my care?
All consultation fees are the responsibility of the patient/couple at the time of appointment scheduling. All major credit cards are accepted. Phone consultations for genetic counseling services are not typically billable to insurance companies at this time (and most genetic counselors working at major medical centers for which insurance-paid consultations are available are not specialists in reproductive medicine). If you are interested in seeking reimbursement yourself from your insurance company, I am happy to provide any information the insurance company might need.
Rates for genetic counseling services are as follows:
Genetic consult-complex: $400
Intended for the patient/couple with a specific concern, this service includes assessment of at least three generations of family health history, appropriate genetic counseling and recommendations for genetic testing/follow-up. This level of genetic consult is intended for the following concerns:
Infertility or recurrent miscarriages
Specific family history concern
Consideration of PGD/PGS
Concern about risk of birth defects with assisted reproductive technologies
General preconception counseling
Donor evaluation: $275
This service includes an assessment of at least three generations of the donor's family health history by direct interview and review of relevant medical records. Review of genetic testing results and/or recommendations for appropriate genetic testing will be provided as part of this service.
Match consultation (for intended parents working with a donor): $200
This is a consultation for intended parents to explain any genetic risks identified with the donor consultation, which must be completed prior to this appointment, as well as review of other risks and testing options in pregnancy. Review of the family history of the other reproductive partner (i.e. intended father, intended mother) is assessed at this consult, if available.
What is your cancellation policy?
I request a 24 hour notice to cancel all appointments. Please be sure to contact me if you will not be able to make your scheduled appointment, and we can reschedule at your convenience. If you would prefer not to reschedule, your consultation fee will be refunded.
How can I get hold of the genetic counselor?
Please send an email to [email protected] or call me at 415-967-3375. All email and phone messages will be returned within 24 hours. Messages left after 2 pm on Friday will be answered on Monday, unless urgent in nature.
What are your office hours of operation?
I am available Monday through Friday from 9 am through 2 pm, by appointment. Extended service hours are sometimes available (please see Appointments). Weekend appointments are reserved for in-cycle PGD/PGS results, which are time-critical.