Prelim Report from Cornell and opinion/advice requested

[Anonymous]

I had my initial consultation with Dr. Davis at Cornell yesterday. We talked for a long time (30-45 minutes or so) and I had an initial exam, cultures, PAP(I was due) and u/s. Dr. Davis did an antral follicle count, which I've never had before. Mine was pretty good. I had 12 and I am 41. He says that he thinks that AFC is a better indicator of ovarian reserve than FSH. My FSH is around 8. I've had 2 failied IVFs at CFA and he talked about why he believed the IVF's failed and the different stim protocol he is going to put me on. Here is where I am in need of some opinions.

We discussed the fact that I am seeing an acupuncturist and taking the Chinese herbs. He had no problem with either of these things. We also discussed exercise. I was a hardcore exercise junkie and I gave it up to start doing IVF, even before stimming. He says that I could go back to my exercise routine until I start the next cycle, which will be in July. (I need a break, good idea to let ovaries rest a bit and clinic is closed in June) The acupuncturist says that from the Eastern medicine perspective, exercise should be at a level where my heartrate is kept below 140. I can still exercise, I just can't do what I used to do. She says that heavy exercise affects hormones and ovaries. For the record, I am still exercising, just not like I used to and I miss it.

Would you go back to your routine or not, if you were me?

I'm also wondering if anyone has taken DHEA. Dr. Davis gave me the ok for taking that too. He also gave me the dosage information, etc. If any of you have taken DHEA, did it work or help with IVF? Did you have the negative side effects? What type or brand did you use?

TIA

[Anonymous]

I would take it easy with exercise. Going up to Cornell is a huge emotional and financial committment. I took 2 months off cardio (other than walking 2 miles/day) before going up to Cornell. I really missed the exercise - but that cycles did work so maybe taking it easy helped. Good luck - you are in great hands!!!!

[Anonymous]

Your numbers sound great. I think it is totally fine to go back to your normal exercise routine until you start your stims at Cornell. There is no evidence that exercising prior to IVF impacts success rates. This assumes that you don't go too crazy that you stop getting your period - but a normal routine is fine. (And BTW, the 140 heart rate max that your acupuncturist cites is from the mid-1980s American College of Gyno. guidelines, which have been revised several times since).

I took DHEA. I think it is one of those things that may help some women but you won't know if you are one of those until you try. (Because, of course, if it helped everyone then every RE would be prescribing it.) I didn't have any side effects. You are supposed to take it for 3 months before starting stims for maximum effect. There's lot of info on IVFconnections if you want to learn more - a small number of women have hair loss, and REs recommend you get your DHEA levels tested before taking it, although at 41 it is more likely that yours are low.

[Anonymous]

While I have not taken DHEA, I have seen information from folks who have that the pharmacy/prescription grade DHEA (not OTC at a healthfood store) is what you want to take. I do know there are some side effects, as PP mentioned, so I would definitely ensure your level is checked and the dosing set according to that level.

[Anonymous]

OP here. I went up to Cornell and I was under the impression that MD IPA (fed) is accepted up at Cornell and now I'm not sure. Did anyone do a cycle up there with fed insurance from down here? Thanks.

[Anonymous]

I don't think CRMI takes MDIPA, but you can call and check. Also even if CRMi doesn't take MDIPA, maybe MDIPA would still pay your hospital charges (about $1500 if I remember correctly).

[Anonymous]

Very curioous - what protocol are they recommending for you?

[Anonymous]

OP here. Dr. Davis is recommending the estrogen priming protocol. If they don't take MD IPA I'm going to have to insist on doing EPP down here at my current clinic. I can't afford the 20 grand it would cost up there. The cycle plus the coculture, plus the drugs would be close to 16-17 plus travel and hotel up there for a week. Dr. Davis didn't actually recommend co-culture because he said it was for women whose embryo quality is poor. I don't have poor embryo quality so he said at worst it would be neutral. (I figured if I was going to cycle up there, I would do the coculture to give myself the best odds.) I just needed to get my number of eggs up so that they could transfer more than two. He said that the reason I wasn't getting pregnant was more of a numbers game, number of embryos transferred that is, rather than my hormone or AFC numbers. Yes, I am 41, but I'm in pretty good shape.

[Anonymous]

I can't imagine Cornell with take MDIPA because MDIPA is a regional HMO. We have it as well and love it but it only pays for ER care outside of the VA/DC/MD area.

I know that a few doctors at SG will do the estrogen priming protocol. I have had friends find success with it after several other failed cycles at SG.

[Anonymous]

I have MDIPA as well and just called to see if they would accept CCRM, which takes United Healthcare, which is the parent company of MDIPA. They said no doctors outside the MD/VA/DC area and that because IVF needs an authorization, they would not pay for the medicine if you used an out of network doctor as well. Now I am really not sure what to do either. I was going to try to go to CCRM or Cornell, but the difference with MDIPA is 30, 000 versus about 4000 with MDIPA at a local clinic. FYI, I tried the EPP at Shady Grove but it did not work for me.

[Anonymous]

FWIW - I just turned 42 a month ago and have been ttc#1 for several years. I have been doing IVF for the past 2 years and have tried several protocols. I am at SG and have gotten pregnant twice now with EPP after having varied results on other protocols. The first time ended up as a m/c in Dec. I started my second cycle on my 42nd birthday and, as of my first u/s last week, we had 2 sacs in my uterus I am waiting for my second u/s tomorrow to hopefully see a h/b or two (fingers, toes, eyes, etc crossed). I can truly say that EPP has given me better results in terms of quantity and quality.

Dr. Sacks at CFA does a slightly different version of the EPP protocol and I have had two friends get pregnant with that protocol after failing cycles elsewhere. One of these friends was 42 when she got pregnant with his protocol on IVF #8, which was her first cycle with him. Good luck!

[Anonymous]

i am pretty sure that cornell does not accept mdipa.

[Anonymous]

PP 6:41. Thanks for your encouraging story. I wish you only the best and I hope you see two happy little heartbeats. I wasn't able to talk to the insurance person at Cornell today, but the more I thought about it, the more I think all of you are correct that MD IPA wouldn't cover me up there. I made an appointment with Sacks to discuss EPP and I am going to talk to Dr. Davis about possibly writing down the exact protocol he suggested and discussing it with Sacks.

I am currently a Rifka patient. I love him but Sacks is the one who seems to be best with EPP and seems to have more success with us ladies in our early 40s.

I still think that I can get pregnant and I think that the EPP would give me the best chances. Thanks for your support and answers.

I haven't made any decisions on the DHEA. I'm doing the Chinese herbs and acupuncture and I'm also taking wheatgrass pills. Herbs are supposed to help as is wheatgrass. At worst these are benign

[Anonymous]

Dr Davis and the CRMI doctors have published the results of clinical trials using the EPP protocol. You can find the article by doing a pubmed search for articles by Owen Davis. I doubt he'd write down the exact protocol so that you could use it with another RE, but it's worth a shot I guess. The published article might have as many (or more) details than you'd get from Davis himself. Unfortunately, what makes Dr Davis so special is the way he adjusts your protocol during the cycle depending on how you react so as to maximize the number of perfectly mature eggs on retrieval day - and that is something (sadly) that you can only get from him. But I have heard great things about Sacks and know people who have had success with him after previous failures.

If you are considering other RE's, I got the impression from Davis that he and Dr Stillman at SG are friendly.

[Anonymous]

SG uses the same EPP protocol as Cornell, although PP is right that they don't monitor folks as closely as Davis does.