wtf

it was kind of nice to not be obsessing for the past couple of weeks.  i didn’t realize just how stressed i was until i came roaring back last night.  i tossed and turned all night, worrying about today’s wtf, and finding a new clinic, and my general un-pregnant-ness.  so please forgive the lack of coherent thoughts from today’s appointment.  according to Dr. Derman:

  • i was over-surpressed & then hyper-stimmed.  the increase in e2 levels causes an increase in testosterone, which lowers egg quality.
  • even though he still won’t say officially that i have PCOS, he’s going to treat me just like i am
  • his notes said that there were some difficulties during transfer: i guess he had to bend the catheter a bit to get it to work, but did say there was no blood and he saw the “flash of light” and those are both good signs
  • he doesn’t suspect a sperm issue (other than those that made us need ICSI to begin with) since we had 10 out of 13 fertilize.  he says a rate of 60-75% is to be expected with ICSI
  • he couldn’t find my embryologist’s report on the computer (which we knew from the phone call with Hina).  but it wasn’t just that a page from my file was missing – someone else’s report was scanned into my file!  seriously?  he left to find the hardcopy, and couldn’t.  if there was any doubt before, i am sure i am dumping his ass.
  • when i asked if then endo can effect implantation, he rambled on that it can cause lower pregnancy rates, but surgery can significantly lower AMH levels and ovairan reserves.  he said again though that it’s at least stage 3 or 4
  • since he’s going to treat me just like it’s PCOS, he called in a prescription for extended release metformin and said to cut back on carbs.  he also said we would just do meopur (um…we only did menopur) and cut the BCPs.  cut back on lupron (after just saying i was on a low dosage) and do just 3 vials of menopur to start and then step down
  • he puts the odds of a frozen cycle at half a fresh one  so about 25%.  but then said in the next breath that if it is an endometrial issue that a frozen cycle is better.  he would thaw all three, and we could decide to transfer 2 or 3.  we could try to grow the 3rd out to blast and refreeze
  • they don’t do PGD, they were finding very low pregnancy rates with embryos tested compared to those that weren’t
  • even if christmas hadn’t gotten in the way, they wouldn’t have done a day five transfer unless i had a bunch of 8 cells on day three (although he made a big deal the morning of ET how great it was to have an 8 cell in just three days)

i guess that’s most of it.  he mentioned i could start lupron tomorrow (CD20) for another fresh cycle (before we had even discussed a frozen one yet), but when i said we needed more than just a day to decide, he backed off.  we left it with we’ll call him when we are ready.

so what do you think, wide world of bloggers?  what did he say that contradicts what your doc (or research) has said?  because, honestly – i felt like he was some sleazy used car salesman, blowing smoke up my ass and telling me whatever he thought i wanted to hear.

oh, and any advice on the practicalities of getting a second opinion?  do i request my files and send the new clinics a copy?  do i contact them first, and they request the files?

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4 thoughts on “wtf

  1. Hi There-stopping by from ICLW. Here’s my advice on second opinions: If you think its time to get one, even slightly, its time to get one. I’m on my 3rd RE (which might sound a little obsessive) but I can honestly say I probably should have transferred one cycle before I did with each. No one is going to care about you getting pregnant more than you do, so do everything in your power to do that, including changing Drs.

    Looking at your WTF above…here’s what I can say (opinion only). 1) Ironically, I was given Testosterone prior to stimming to “increase” egg quality. I think that’s just a function of the practice of reproductive endocrinology; everyone kind of goes by their opinion, doesn’t share info, and no 2 clinics are the same. So Frustrating. 2) statements like “difficulty with transfer” sets off warning bells to me, only because in my experience they downplay everything, so if they are actually saying something is difficult, for me that’s something to pay attention to. Hopefully they did a mock transfer when you first came in so that they knew what they were dealing with in terms of your anatomy, level of difficulty inserting catheter, etc. 3) Can’t find a hard copy of a report? Seriously? I agree with your statement. 4) I’ve heard the same contradictory info about frozen, also the same thing about PGD.

    I get that same vibe in terms of telling you what you want to hear, and downplaying what may have been wrong; most importantly, not learning from mistakes, and then blaming outcomes on old eggs, endo, whatever. Do your research beforehand is my only advice an approach this like you are hiring them to perform a service, ie, you’re in charge here. The first RE I went to was at the recommendation of my Primary Care Physician. In retrospect, that RE was a mess. I didn’t think too much of it, because I didn’t think I was going to have a problem getting pregnant once I took a little clomid (HA). But there were signs-really inefficient office staff, delayed calls with my progesterone level results…I could go on and on. Then I went to the practice with the highest rates in my area. My first IVF was a bomb, the RE mentioned it was really hard to extract my eggs during retrieval (that was a sign); also, my e2s weren’t really doing what they should have, lots of med adjustments, etc. and I honestly felt like I should have been cancelled, but wasn’t. The following cycles, I felt like I was a) being the one to really push and question about protocols, diagnoses, and a case of endometritis, diagnosed at my own request for a biopsy, two cycles in….I felt like a number, like you I felt like I was being BSed, and I didn’t feel like there was anything going on proactively. The nurses were also not consistent in who I dealt with or talked to, and not the friendliest. Now I’m on #3, mostly as a result of insurance change, but who was recommended to me a year ago…the best in the region.

    My advice is to ask around-a lot, and do web searches and read message board postings; there’s a lot of info out there about REs on the message boards, good and bad. Look at SART/CDC rates, especially for your age range. Go to more than one RE that you select to get your opinion. Fill out the release of info forms that those offices provide for records transfer, at least two weeks before your consult appointment; if they transfer between Drs they won’t charge you; yet if you get a copy of your own records, they most likely will. Don’t be afraid to travel if necessary and you can afford it; I’m driving now an hour but that’s a trade-off I’m willing to make and can. Get your question list prepared before hand, and no question is a “stupid” one. If they laugh or scoff, that’s a sign. And honestly/most importantly, I’d say go with your gut: If the office or nurses do anything, or if you feel uncomfortable, or if you just don’t feel right-first impressions really do tell you something. One last thing-if your significant other can go with you, take them; sometimes its hard to catch everything that’s being said..good to have a second pair of ears. Sorry for the rant-but hope this is helpful.

    All my best to you!

  2. Commenting on the endo issue. I have endometriosis, which was diagnosed via surgery (only way to diagnose 100%). During that surgery they removed an endometriomal cyst (or two). I have since had a small one come back, but it wasn’t much of an issue. As for endo affecting implantation, yes, it does! That is my “only” known issue with infertility and the reason we weren’t getting pregnant. Endo makes the uterus a hostile place embryos to attach and thrive.

    I have never had a mock transfer, but that is just how my clinic is. Maybe if ultrasounds showed something different or…I don’t know. But thankfully I never needed it and it wasn’t an issue for me.

    Sorry this doctor just isn’t cutting it. As Kelly said, no two clinics (in the same town, state or country) do things the same. It’s just a matter of finding one that works for you. Good luck on searching for a second opinion.
    Here from ICLW.

  3. Visiting from ICLW…and just finished retrieval for my 3rd IVF. (Both were successful, though my 1st son died the day after he was born.)

    I am very similar to you in a lot of respects. I’ve been diagnosed with PCOS, though my RE thinks that was a premature diagnosis (it was really based on my LH: FSH ratio and ultrasound pictures of polycystic ovaries) because I don’t have ANY other symptomology. He thinks that it’s my endometriosis (stage 3, diagnosed when they were looking to check out some ovarian cysts and SURPRISE! found endo!) and I have to say, considering both cycles were successful (and this one has done great, all things considered!), I guess he might be right.

    That said, I have acted like a PCOSer in every cycle (including this one, where they nearly cancelled because of my ovaries and estrogen) and know all about being over-suppressed (first cycle) to over stimming (second and this cycle)…super fun on all accounts!

    I love our clinic (Shady Grove). I LOVE all the REs I’ve seen and my main one, especially. If you don’t feel secure in what you are being told. There’s NOTHING like trusting those taking care of you. Especially when you feel like it’s all for naught.

    Best wishes! You are not overreacting. This is a BIG deal and there are doctors out there that make it ALL fabulous.

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