Three failed rounds of IVF and time to talk to the doctor

[Anonymous]

Have any of you gone for a second opinion yet? Go see Abassi - she will order the various blood clotting tests for you. I saw her after my first ivf failure and she ordered the tests for me. All came back normal and I decided to do one more cycle with sgfc before ditching them. We did an endo biopsy with that cycle. Transferred two good quality 8-cells on day 3 and one so so. Got my first bfp ever that is now 18 months. I honestly feel the biopsy made a difference for me.

[Anonymous]

Anonymous wrote:Have any of you gone for a second opinion yet? Go see Abassi - she will order the various blood clotting tests for you. I saw her after my first ivf failure and she ordered the tests for me. All came back normal and I decided to do one more cycle with sgfc before ditching them. We did an endo biopsy with that cycle. Transferred two good quality 8-cells on day 3 and one so so. Got my first bfp ever that is now 18 months. I honestly feel the biopsy made a difference for me.

What type of biopsy are you talking about? The "scratch"?

[Anonymous]

For me, Abassi wouldn't do any testing unless I transferred my frozen embryos to her first.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP again: I just looked up my notes from our egg retrieval, in case this tells anyone anything: 13 eggs, 9 usable, 7 embryos produced, all 7 made it to day five, and then three were discarded. The remaining four were transferred over three cycles, quality ratings AA, AB, or BA.

We saw the RE (Sagoskin) yesterday and he wants to do the exact same stim protocol for our next round. I asked if there was anything we could do to the protocol to get better eggs, he said no. He gave us paperwork for karyotyping. I asked if there was any other testing we could do, such as for clotting issues, he said they only test for that if you have recurrent miscarriage, not implantation failure. I forgot to ask about thyroid, but I'm going to check with the nurse for my latest TSH.

The doctor highly suggests we do PGS for the next round. I just need to get my husband on board, but I think it is the right way to go.

I don't know anything about P-ICSI, so I might also ask the nurse about that.

NP here. This kind of thing makes me so mad. Really? You want to wait to see if I have recurrent miscarriage prior to administering a simple test? I don't understand why EVERYTHING isn't tested prior to jumping into something as major as IVF. I hate finding out about tests I could have had after I've already had a bunch of failed cycles. Makes no sense.

Yep. I had same experience with Widra. Exact same protocol, no changes, no extra tests, because it's not ACOG standard of recommended care to test. At which point I left SG. I don't care about ACOG and large randomized studies, I care about me and not having multiple miscarriages.

[Anonymous]

Anonymous wrote:I am in a similar situation to you, but when I met with dr. widra he said that he does not believe that implantation failure is real and did not want to do additional testing on me. He also just pushed trying more cycles and maybe pgs. It's so frustrating because I feel like we are not figuring out the cause of my failures.

This!!! He blindly advised me to continue with double retrievals without even running a basic AMH test. We got a second (fine, fourth) opinion at Yale and I was diagnosed with premature ovarian failure. Thanks so much, Widra (sarcasm)! OP, at this point, I would definitely recommend getting second and even third/fourth opinions with someone who is a leading expert for MFI. I cannot express how relieved we felt after meeting with the doctors who really specialized in our area. Best of luck. Three failures is awful, I've been there.

[Anonymous]

OP here: I'm probably being naive, but I don't see the value in seeing another RE right now. (Possibly I'm also exhausted from dealing with all of this and the thought of starting over with another doctor sucks.) I can't really argue with the protocol because everything did go perfectly...right up until failure to implant. I guess I could demand they give me any kind of testing they would give for recurrent miscarriage, but I'm not sure that would get me anywhere.

The doctor did mildly suggest an endo biopsy, although NOT "the scratch." This one would require an entire medicated stim cycle with no egg retrieval, just an endo biopsy instead. And somehow this would tell the doctor whether I needed more estrogen and progesterone. I frankly didn't understand this at all. Do any of you know what I'm talking about? It seems like an awful lot of time and effort for not much in the way of information. And going through another fresh IVF cycle (and adding PGS to it) already seems like it's going to take forever, so why would I want to tack on an extra two months for this weird endo test?

[Anonymous]

Anonymous wrote:OP here: I'm probably being naive, but I don't see the value in seeing another RE right now. (Possibly I'm also exhausted from dealing with all of this and the thought of starting over with another doctor sucks.) I can't really argue with the protocol because everything did go perfectly...right up until failure to implant. I guess I could demand they give me any kind of testing they would give for recurrent miscarriage, but I'm not sure that would get me anywhere.

The doctor did mildly suggest an endo biopsy, although NOT "the scratch." This one would require an entire medicated stim cycle with no egg retrieval, just an endo biopsy instead. And somehow this would tell the doctor whether I needed more estrogen and progesterone. I frankly didn't understand this at all. Do any of you know what I'm talking about? It seems like an awful lot of time and effort for not much in the way of information. And going through another fresh IVF cycle (and adding PGS to it) already seems like it's going to take forever, so why would I want to tack on an extra two months for this weird endo test?

I have heard of this before, but I agree with you -- it sounds like a lot. I definitely wouldn't do it. The biopsy and month off is one thing. But having to take all the stims? No ma'am.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Have any of you gone for a second opinion yet? Go see Abassi - she will order the various blood clotting tests for you. I saw her after my first ivf failure and she ordered the tests for me. All came back normal and I decided to do one more cycle with sgfc before ditching them. We did an endo biopsy with that cycle. Transferred two good quality 8-cells on day 3 and one so so. Got my first bfp ever that is now 18 months. I honestly feel the biopsy made a difference for me.

What type of biopsy are you talking about? The "scratch"?

Yep the scratch. Sgfc will try it after two failed ivfs of good quality embryos. In my case they were running a study and my RE - Dr. Osborn recommended I enroll after 1 failed ivf cycle with transfer of good quality embryos.

[Anonymous]

Anonymous wrote:OP here: I'm probably being naive, but I don't see the value in seeing another RE right now. (Possibly I'm also exhausted from dealing with all of this and the thought of starting over with another doctor sucks.) I can't really argue with the protocol because everything did go perfectly...right up until failure to implant. I guess I could demand they give me any kind of testing they would give for recurrent miscarriage, but I'm not sure that would get me anywhere.

The doctor did mildly suggest an endo biopsy, although NOT "the scratch." This one would require an entire medicated stim cycle with no egg retrieval, just an endo biopsy instead. And somehow this would tell the doctor whether I needed more estrogen and progesterone. I frankly didn't understand this at all. Do any of you know what I'm talking about? It seems like an awful lot of time and effort for not much in the way of information. And going through another fresh IVF cycle (and adding PGS to it) already seems like it's going to take forever, so why would I want to tack on an extra two months for this weird endo test?

Honestly - a second opinion would do you well. That doesn't mean that you need to pursue ivf with the new doc but a different perspective would do you well. Maybe sgfc is pushing you too hard and a reduced stims approach would yield better quality eggs...

[Anonymous]

PGS will tell you which ones to transfer but even if you'd added it to all of your previous cycles, unfortunately you'd still be empty handed. It doesn't really take your treatment "to the next level." It just sounds like you haven't produced the right embryo yet. I agree with pp and would make sure you feel comfortable with the protocol.

[Anonymous]

OP again: I checked with my nurse and my most recent TSH was 3.17. I asked if that wasn't a little high, and she said no, anything 4 or less is fine.

I'm surprised by this, but apparently some REs are A-OK with a higher TSH, while others insist on less than 2. (Obviously I should have been keeping better track of my own results instead of assuming the RE would flag any problems for me, sigh.)

Time to see an endocrinologist, since Shady Grove seems to have zero interest in helping me out here. I don't necessarily think a better thyroid will be the magic bullet, but since I probably won't have another embryo transfer until at least March, might as well try, right? I am also going to see if I can get someone (GP? endocrinologist? hematologist?) to do a recurrent pregnancy loss panel.

[Anonymous]

Anonymous wrote:OP again: I checked with my nurse and my most recent TSH was 3.17. I asked if that wasn't a little high, and she said no, anything 4 or less is fine.

I'm surprised by this, but apparently some REs are A-OK with a higher TSH, while others insist on less than 2. (Obviously I should have been keeping better track of my own results instead of assuming the RE would flag any problems for me, sigh.)

Time to see an endocrinologist, since Shady Grove seems to have zero interest in helping me out here. I don't necessarily think a better thyroid will be the magic bullet, but since I probably won't have another embryo transfer until at least March, might as well try, right? I am also going to see if I can get someone (GP? endocrinologist? hematologist?) to do a recurrent pregnancy loss panel.

I posted up-thread, but let me divulge more about my experience. We went to Shady Grove initially because of male factor infertility. The doctor we got was Sagoskin. He was good in that we did P-ICSI for our IVF. However, he did not think anything was wrong with my TSH of 3.5. I was suspicious of that so I went to my primary care physician to do a thyroid panel (as a side note, she put fatigue as the reason for the tests because according to her the insurance didn't accept infertility as a reason for coverage). The thyroid panel showed high thyroid antibodies in addition to a TSH of 3.2. That was one reason I decided to get a second opinion from a different RE (the other reason was that I did not like the protocol I was on). We ended up switching clinics. I honestly believe that if I had stayed with Sagoskin it would have taken much longer and more money to get our child.

[Anonymous]

Anonymous wrote:OP again: I checked with my nurse and my most recent TSH was 3.17. I asked if that wasn't a little high, and she said no, anything 4 or less is fine.

I'm surprised by this, but apparently some REs are A-OK with a higher TSH, while others insist on less than 2. (Obviously I should have been keeping better track of my own results instead of assuming the RE would flag any problems for me, sigh.)

Time to see an endocrinologist, since Shady Grove seems to have zero interest in helping me out here. I don't necessarily think a better thyroid will be the magic bullet, but since I probably won't have another embryo transfer until at least March, might as well try, right? I am also going to see if I can get someone (GP? endocrinologist? hematologist?) to do a recurrent pregnancy loss panel.

Honestly your RE should be the one to do this.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP again: I checked with my nurse and my most recent TSH was 3.17. I asked if that wasn't a little high, and she said no, anything 4 or less is fine.

I'm surprised by this, but apparently some REs are A-OK with a higher TSH, while others insist on less than 2. (Obviously I should have been keeping better track of my own results instead of assuming the RE would flag any problems for me, sigh.)

Time to see an endocrinologist, since Shady Grove seems to have zero interest in helping me out here. I don't necessarily think a better thyroid will be the magic bullet, but since I probably won't have another embryo transfer until at least March, might as well try, right? I am also going to see if I can get someone (GP? endocrinologist? hematologist?) to do a recurrent pregnancy loss panel.

Honestly your RE should be the one to do this.

But let me add, if you don't want to do this with your RE, then make an appointment with your gynecologist.

[Anonymous]

Yeah, I know they should. I'm going to email the nurse back and ask for it. (I'm sure they can do it through Quest so why the hell not?) If she says no, I'll figure something else out.