When to go to the big name out-of-town clinics?

[Anonymous]

I am doing my third IVF round and so far it doesn't look promising. I am 35, FSH levels in the normal/average range, antral follicle count of 6-7. My response to stims hasn't been great. First cycle was canceled, second cycle 4 retrieved and only 1 made it to transfer, this time round I may have 2-3 that makes it to retrieval. Each time my doc has changed my protocol and put my on more aggressive protocols.

I really like my doctor, but I wonder at what point should I start looking into going to one of the top clinics like Cornell and CCRM? Obviously, it's a lot more hassle because of the travel, etc. I am also not sure whether my insurance would cover because they are out-of-network for me. For women who have gone to those clinics, what were the considerations?

[Anonymous]

Honestly, none of the fertility clinics here in DC are known for being particularly impressive. With your age and track record, I'd suggest it may be time to move on now.

I made the decision to go out of town because I believed (based on my own experience and internet research) that I had a very specific kind of implantation problem and I knew it was an issue no local doctor was qualified to treat. As it turns out, I was right. It still makes me angry that I wasted more than 2 years with doctors who were treating me incorrectly. I'll never understand how is it that I was able to diagnose my own problem with a few hours on Google when 3 different highly-trained and high-paid local doctors couldn't.

The bottom line is that doctors in this area just aren't up on the latest research and many of them are extremely conservative. If you want aggressive and cutting edge, you need to go elsewhere. For your issues, I'd recommend CCRM. In my opinion, Cornell is overrated.

[Anonymous]

ccrm and cornell seem to have better success rates for older patients and for those who seem to be fine, but just nothing is working. although there is nothing that any doctor anywhere can do with someone whose eggs are extremely poor quality, the success rates at the out of town places even for patients in their 40s are significantly higher. the problem many times is that insurance doesnt cover using an out of town doctor. i think these places do more thorough testing for outside-the-box problems.

[Anonymous]

Hi, OP, your post could have been mine. I am 32, have normal FSH (5.4), normal estrogen, but low antral follicle count (6-10), and low response to drugs. Our official diagnosis is diminished ovarian reserve and low morphology (husband). I did two cycles locally with Dominion Fertility and got flat out negatives both times. They were starting to give me the "donor" speech, but suggested that maybe I have a genetic issue and go up to RMA-NJ to Dr. Scott to see if they could do the genetic testing (PGD) on my embryos and let us know whether we "just don't make good embryos anymore." Dr. Scott is one of the leading dr's in the country in his research on PGD. Plus, the head of embryology studied with Schoolcraft at CCRM and uses all of their protocols for culturing the embryos (she's WONDERFUL btw). So, I went up to NJ for my third cycle (am in the midst of a two week wait). The difference is NIGHT AND DAY. In my 2 prior cycles, I had pretty awful looking blast or morulas. This cycle, I had two beautiful hatching blastocysts that they gave their highest grade and told me not to do PGD because these blasts looked perfect. So, I don't know whether it worked yet, but I did produce much better embryos. I have nothing but GREAT things to say about RMA-NJ, from the care and knowledge of the nurses, the billing department, and the procedures themselves. The big difference is that I only met with Dr. Scott once and saw a different doctor every day, but was really impressed with the doctors and the responsiveness of the clinic. Plus, RMA-NJ is only 4 hours away. I had to spend 1 week there during monitoring prior to retrieval, and then just drove up and back for the transfer.

You can check out my blog: www.moreroominmyheart.com. which details my journey.

[Anonymous]

I was in a similar situation to the OP (3 failed cycles at ages 32-33, dx was unexplained infertilty but SG eventually decided I had an egg quality issue). I decided to go to Cornell (Dr Davis), and my cycle there went sooo much better. During my 3rd cycle at SG I only had one 4 celled embryo available to transfer on day 3. At Cornell there were 3 perfect 8 celled embryos available for transfer. We transferred 2 and now have twins.

I would research Cornell and CCRM (and possibly others) before doing any more cycles locally. The trick, I think, is to wait long enough before going out of town that you don't spend extra $$$$ needlessly (not to mention the hassle) but not to wait so long that you are burned out. For my specific problem, I felt that Cornell would be the best bet, but CCRM has strengths as well [I had not produced very many embryoes during my local cycles so I didn't think all their high-tech testing of embryos would help much in my case). I'd recommend a phone consult with CCRM and possibly an office visit with Dr Davis. Setting up an office visit with Dr Davis is a bit of a pain, but well worth it (if you call his office his secretary will explain what to do). Good luck!!!!!!

Also, what protocols did you use? Cornell just published a study about using the estrogen priming protocol in younger poor responders. http://www.fertstert.org/article/S0015-0282(10)02678-6/abstract

[Anonymous]

20:31--- may I ask what was the implantation problem? Was another clinic able to treat it, or do something different to "get around" it?

We decided to go to Cornell/Dr. Davis and are very impressed. Their lab is fantastic, and that is at least as important as the doctor and the protocol.

[Anonymous]

OP here. We weren't able to have any eggs retrieved this cycle so I'm pretty discouraged. My doc mentioned the possibility of egg donor. Thinking that it is time to start looking at CCRM, Cornell and other places. What does it cost to do a consult at Cornell? And do they have any shared risk type of program? Their website doesn't have much information. I'm think that my insurance could cover my drugs and at least some of the monitoring if I do it locally, but we would have to pay for the retrieval and transfer out-of-pocket. It's a shame because I actually have very generous IVF coverage, but only if I go to local, in-network doctors, so that is definitely weighing on me.

[Anonymous]

For those who are relatively responsive to IVF, is there an extra advantage to going to these clinics? Not that I'm eager to be in another locale, etc... but as I don't have to say here IVF is NOT FUN and a great response would always of course be better than an okay response (i.e, would the percentage of success go from "not bad" here locally to "great" at one of the big clinics)?

[Anonymous]

05:41 Poster here: Cornell costs $450 for a phone consult. I found it to be VERY helpful.

OP, sorry to hear you didn't produce any eggs. Definitely look into accupuncture, micronized DHEA as well. Don't know if they helped my most recent cycle or whether that was the clinic, but my embryos were better quality.

As for going out of town to increase your chances, I would only do that if you have 2 IVFs that have failed. It is an extra cost to be living out of town for 1-2 weeks and kind of stressful to coordinate retrieval/transfer.

[Anonymous]

PP 10:00 here. When I went to Cornell, Dr Davis did not do phone consults (although I think other doctors do). It was about $450 for an office visit, plus before you can get an appt with Dr Davis you have to have Cornell's lab test you FSH which costs about $250. Honestly, if I were you I would go to Dr Davis if you are going to the trouble to go up to Cornell. He is amazing with poor responders and also has a great bedside manner and is really dedicated to his patients (he always called us back within an hour during my cycle, remembered details about past conversations we'd had and told me that he never goes on vacation while patients are cycling).

I think a phone consult with CCRM is $250. In both cases, you need to get the clinics copies of your records ahead of time.

Both clinics will let you start your cycle locally.

have you talked to your local clinic about what to do? Dr Widra at SG recommended Cornell/Davis for me given my specific issues (he said if anyone in the country could get me pregnant, it would be Dr Davis).

[Anonymous]

Anonymous wrote:20:31--- may I ask what was the implantation problem? Was another clinic able to treat it, or do something different to "get around" it?

I'm missing a protein in my uterus that's necessary for implantation. It's a problem that commonly occurs in women with endometriosis (which I have). The problem can be diagnosed with a simple endometrial biopsy. CCRM does it routinely. Apparently no one in DC does. I asked my RE at CFA about the test and got a blank look. The treatment is complete suppression (2-3 months of Lupron) which will generally bring the protein back for a few cycles. I just finished my third month and have an FET scheduled for 2 weeks from today. KJeeping fingers crossed that this finally does the trick!

[Anonymous]

Cornell is known for their protocols and their lab, but they don't offer CGH and they don't use vitrification. CCRM probably has the best lab in the country (good protocols too) but they're equally well-respected for their diagnostic work. The drawback with CCRM is that they don't do immune testing (of course, neither does Cornell--you'll have to go to SIRM for that).

[Anonymous]

Anonymous wrote:PP 10:00 here. When I went to Cornell, Dr Davis did not do phone consults (although I think other doctors do). It was about $450 for an office visit, plus before you can get an appt with Dr Davis you have to have Cornell's lab test you FSH which costs about $250. Honestly, if I were you I would go to Dr Davis if you are going to the trouble to go up to Cornell. He is amazing with poor responders and also has a great bedside manner and is really dedicated to his patients (he always called us back within an hour during my cycle, remembered details about past conversations we'd had and told me that he never goes on vacation while patients are cycling).

I think a phone consult with CCRM is $250. In both cases, you need to get the clinics copies of your records ahead of time.

Both clinics will let you start your cycle locally.

have you talked to your local clinic about what to do? Dr Widra at SG recommended Cornell/Davis for me given my specific issues (he said if anyone in the country could get me pregnant, it would be Dr Davis).

With Davis, you can either get all of your records to him or do cd2 testing in their lab before scheduling an appt. I opted to get all of my medical records to him and skipped cd2 testing in their lab. I paid $500 for my consult with him.

[Anonymous]

Why can't there be a lab that does CRM, immune testing, and vitrification, and also has a top lab and progressive protocols?

[Anonymous]

To OP: I am so sorry about your cycle. That is so so painful, and I think it may be a good idea to get second or even third opinions. Hang it there!

To 21:38... I have never heard of that issue or that test. I, too, am dealing with implantation problems and am so frustrated at the lack of response from my doctor. Can I ask, what is the name of that protein and test?

to 13:57--- totally agree!!!!

I wish we could start a thread where we all contribute lesser-known issues and tests that we've experienced. You sure don't hear about them readily from the doctors!!