Another second opinion question

[Anonymous]

I didn't want to hijack the other thread, but was hoping to hear from others who have been in my situation.

I am 34 with severe endometriosis (which was removed through laparoscopy and laparotomy)...I did IVF, and one cancelled cycle (due to poor response) and one microdose lupron protocol later, my DD was born when I was 31.

My FSH is on the higher end of normal for my age. I just had a cancelled cycle in my attempt to conceive #2 (this time the cancellation was the microdose protocol that I used for DD). I have an HMO that will pay for two more attempts, if I stay local.

I am a little unnerved that I had such a poor response to a protocol that worked last time, and I am starting to look ahead. For people with these kind of stats, who in the country would you recommend for a second opinion consult (I am specifically interested in experts outside of DC)? I feel like when I hear Cornell and CCRM, people who rave about them have some different issues than me, and I am starting to realize I know very little about what else is available outside the DC area.

FWIW -my RE has said he doesn't think it's a matter of egg quality (I produced few eggs for DD, but they were very good according to my clinic), just getting my ovaries to respond to produce the eggs.

Also, even though I am not having outright endo symptoms, I still have irregular periods, heavy bleeding and some of my same old problems unless I am on birth control.

Thanks for any input from those who've BTDT.

[Anonymous]

When was your last lap?

Endo can cause egg quality issues (but it sounds like you're OK there?) and also implantation failure. IMO it would be worth finding out if your endo is back.

I know everyone is different but I have endo and had a horrible response to MDL. have you tried any other protocols at all?

For poor responders, I would say do a local consult with Dominion Fertility (Dr Gordon) and ask about a natural cycle IVF. Two women that I know who are poor responders both recently found success there. At least worth a consult.

And I'd do a consult with Dr. Davis at Cornell. It might take longer to get an appt with him (& it's more of a PITA because you'll have to do bloodwork for him), but he is kinda the poor responder expert. There are other great REs (Chung, Spandorfer, Schattman, etc.) there too if you don't want to wait that long or deal with the paperwork/bloodwork. The REs all consult with each other so you are getting a package deal.

Sorry you are having to go through this, OP. Good luck figuring out next steps.

[Anonymous]

oh - and IMO I'd wait to decide next steps until after your consults - you might come away from those with questions for your current RE that might affect your next protocol, etc.

[Anonymous]

OP here, thanks PP for your advice and kind words.

My last lap (actually a laparotomy) was right before the IVFs that produced my DD (about two and half years ago).

I have kind of wondered about the endo coming back (though I am not experiencing the symptoms I had before...just my usual wacked out hormones), but, like I said, the egg quality wasn't an issue for #1.

I have thought of natural IVF ....the only problem is that my cycles are so out of wack, I have no idea how an IVF would work without me being on some hormones to regulate my system better.

This whole process is so frustrating -I don't want to flip out over one cancellation -but I also don't want to waste time repeating something if it won't work. I do think I am going to find out about a Davis consult, just to have a second set of eyes on this.

[Anonymous]

Anonymous wrote:OP here, thanks PP for your advice and kind words.

My last lap (actually a laparotomy) was right before the IVFs that produced my DD (about two and half years ago).

I have kind of wondered about the endo coming back (though I am not experiencing the symptoms I had before...just my usual wacked out hormones), but, like I said, the egg quality wasn't an issue for #1.

I have thought of natural IVF ....the only problem is that my cycles are so out of wack, I have no idea how an IVF would work without me being on some hormones to regulate my system better.

This whole process is so frustrating -I don't want to flip out over one cancellation -but I also don't want to waste time repeating something if it won't work. I do think I am going to find out about a Davis consult, just to have a second set of eyes on this.

do you know if you do ovulate regularly? is it just that the timing varies? I still think it'd be worth a consult to ask how that would work...or Dr. G has a forum somewhere (INCIID?) - or at least he did. Maybe there's a way to research more about it to see how "regular" you need to be.

[Anonymous]

http://www.inciid.org/forum/forumdisplay.php?s=94f1d69b3daa994ce2ac73caa438c041&f=11

[woodyanita]

You may seek the opinion at http://www.testtubebabyclinic.com/new/default.asp The clinic and the team of doctors is very specialized and supportive.

[Anonymous]

I went through many IVFs at Shady Grove (9 fresh total) so I've been though many different drug protocols. It took us 4 attempts to conceive our first child and I had an AMAZING response to that protocol - we were all like "finally - we found the magic protocol" - because previous attempts had resulted in low egg yield, poor quality, one cancellation for poor response. I think I probably had almost 20 eggs that go around - maybe 16 embryos. I think 7 made it to blast by Day 5.

When we went to conceive #2 about 18 months later - we used the exact same protocol figuring - why not - it worked last time. I was horrified to have my worst response. I think I had 7 eggs yielding in 2 embryos which stopped growing by Day 3. I was devastated.

We did several second opinions - all doctors basically told me that each cycle is like the changing tide of the ocean and you never know how you'll respond - they're all different. Not ideal explanation - b/c I wanted a definite rationale for how this could happen. We went on to tweak my drug protocol and finally got one to work and I conceived my twins.

It never hurts to have a second opinion so do what would give you confidence and security going into your next cycle.

[Anonymous]

For an appt with Dr. Davis, you need to either do day 2 b/w in their lab OR get a copy of all of your medical records to him. If it is going to take awhile to get your records and you are at the end of your cycle, then it might make sense to do the day 2 b/w in NY. If you have your records or can get them easily, then I would suggest just sending the files to him. Once they receive your files, it can take about 3-4 weeks to get an appt (or sometimes longer!). They do have a cancellation list and will call you if something is available sooner, though it may be the afternoon before you have to be up in NY for the appt.

Also, the sooner you can get things in place for a Dr. Davis consult, the better if you want to cycle this year. Cornell's lab closes for a solid month and you have to be done with stims by early Dec to do a cycle this year.