Abbasi or Braverman for immunes?

[Anonymous]

Ok. I am pretty sure I just miscarried a CGH tested donor egg embryo from SG - this after two BFNs of a CGH tested donor embryo with a different donor at a different clinic. This is secondary infertility - as I had an easy natural pregnancy four years ago.

So I need immune testing and probably treatment. Pros and cons of Abbasi and Braverman please? How hard is it to get to his office? I have a pretty good PPO. Does he take any is insurance?

[Anonymous]

I have been to both. Went to Braverman first 2 years ago and he tested and diagnosed my immune issues. I cycled twice with him and was not successfull. He does take insurance, the plans are listed on his website. I liked him but did not like the way the office was run and also could not afford to continue to see him.

I found Dr Abbasi about a year ago. She is the only one in the area who would give you immune meds. I think she sends her tests to Bears while Braverman uses Reprosources and a lab in Chicago.

Baverman is a reproductive immunologist, one of the few in the country. So if you want a comprehensive testing go with him. You can then pursue treatement with Abbasi locally. Thats what i did. Cycled with her twice locally and she prescribed itralipids and steroids. I did not do Neupogen with her but did it with Braverman.

Have you been checked for endometriosis?

[Anonymous]

Thanks. Maybe I will test with Braverman but the travel is such a hassle. I don't really have any indications of endometriosis.

[Anonymous]

OP, I was about to post the same question "Abassi or Braverman" a week or so ago. And I found an answer after making phone calls and reading through forums.
Abbasi works with you for immunology if you are cycling with her for IVFs also.
Braverman works with you for immunology even if you are not cycling with him. He can work with your RE.
I had a 10 min free consultation with Braverman. He told me that I can do bloodwork locally and get it tested at Reprosource (a lab that he wants to use for immunology). That way we don't need to travel to Long Island until the results come back. Results take 6 weeks and then we need to have a consult with him in Long Island.

[Anonymous]

Thanks: I am also wondering about overall experience. I have heard on these forums also that SG won't work with Braverman and but that maybe one can just not tell SG.

[Anonymous]

Anonymous wrote:I have been to both. Went to Braverman first 2 years ago and he tested and diagnosed my immune issues. I cycled twice with him and was not successfull. He does take insurance, the plans are listed on his website. I liked him but did not like the way the office was run and also could not afford to continue to see him.

I found Dr Abbasi about a year ago. She is the only one in the area who would give you immune meds. I think she sends her tests to Bears while Braverman uses Reprosources and a lab in Chicago.

Baverman is a reproductive immunologist, one of the few in the country. So if you want a comprehensive testing go with him. You can then pursue treatement with Abbasi locally. Thats what i did. Cycled with her twice locally and she prescribed itralipids and steroids. I did not do Neupogen with her but did it with Braverman.

Have you been checked for endometriosis?

I am another posted interested in seeing Dr. Braverman. How are his fees? I have lost lot of money in failed IVFs and wondering if I'll be even able to afford to see him!

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have been to both. Went to Braverman first 2 years ago and he tested and diagnosed my immune issues. I cycled twice with him and was not successfull. He does take insurance, the plans are listed on his website. I liked him but did not like the way the office was run and also could not afford to continue to see him.

I found Dr Abbasi about a year ago. She is the only one in the area who would give you immune meds. I think she sends her tests to Bears while Braverman uses Reprosources and a lab in Chicago.

Baverman is a reproductive immunologist, one of the few in the country. So if you want a comprehensive testing go with him. You can then pursue treatement with Abbasi locally. Thats what i did. Cycled with her twice locally and she prescribed itralipids and steroids. I did not do Neupogen with her but did it with Braverman.

Have you been checked for endometriosis?

I am another posted interested in seeing Dr. Braverman. How are his fees? I have lost lot of money in failed IVFs and wondering if I'll be even able to afford to see him!

Hi, I am the PP quoted. I had insurance when I saw him, he was out of network so 70% of the fee was covered. to be honest, the women I know that have had success with him are the ones that have had previous failed pregnancies. In my case, I went to him after 4 failed IVFs at 3 diffident clinics (CCRM and SG included) and wanted him to look into my immune issues( I have severe endometriosis ) . I willl be forever grateful to him for referring me to Dr Seckin who operated on my endometriosis. I am also glad I met with Braverman because he did diagnose a ton of immune issues and prescribed treatments. But I could not continue to travel to see him and cycle with him, the cost adds up especially with my track record of failed cycles.

Also, when I saw him I did not know about Dr Abbasi, I wish I had met her sooner. I don't know if she would have worked with him. In any case , she did my monitoring while I cycled with him, so maybe yes, she would have. What I am trying to say is that you can do the bloodwork with him so he can diagnose your immune issues and then cycle localy with Abbasi. She is even open to Neupogen which is pretty radical so to say compared to other REs.

[Anonymous]

I am 22:34. Thanks for the information. I am in a similar situation. Have 4 prior failed cycles, all out of pocket. Braverman's front desk told me his fees is $3000 for interpreting immunology results and working with my doctor. If I get pregnant, then additional $3000 for monitoring through first and second trimesters. Blood work and testing fees are separate (about $1600-2000). This is what I understood and am not sure if there are any other unforeseen costs! This is extremely expensive given that i have spent a lot of money already. I liked your idea of doing only blood work with him.

[Anonymous]

I saw Dr Abbasi first a few years ago, went through all the labs through her with AEB and Dr Stricker. The prescribed Humira plus IVIG and I still miscarried twice. With her blessing I saw Dr Braverman (mostly since IVIG did not work) and he tried this new drug Neupogen on me. (That baby is now 2 so this was a few years ago). I did not have to go see him that time since he was able to treat me remotely.

By last March when I was starting to think about baby #2 his policy had changed and I had to go see him for my preconception appointment. We drove up there for my first appointment which sucked, but subsequent times we took amtrak, which ended up being so much better.

Sounds like his fees are higher now because I paid $2000 for my first trimester monitoring, not $3000. I recommend seeing him even if it is just for testing. He does HLA and KIR testing, which AEB and Dr Abbasi won't do. The HLA ended up telling us a lot and it's important for me to know there is a genetic component because I have 2 daughters now and want to do whatever I can to keep them from going through what I have been through. If you had a first uneventful pregnancy (male baby?) I especially recommend this. Two people I know had first born males and subsequent issues due to things uncovered by testing their HLA.

For baby #2, my preconception appointment and ultrasounds at 6w and 12w were covered by my insurance, but I had to pay more than I otherwise would for some labs because he doesn't use labcorp/quest for regular bloodwork. This is separate from the immunology labs. At least when you go to see him you don't have to pay additional for someone to take your blood and ship it, which is what I had to do during the course of both pregnancies.

I wouldn't say using Neupogen is "radical" (unconventional, yes) it's been studied in other countries and has been used by Neutropenic women safely for decades. The NT100 study SG is participating in is a G-CSF derivative so even though they "don't believe" in immune therapies they are doing the study for their patients with failed cycles. For those with RIF and failed cycles it is something worth looking into, especially because they pay for the meds.

[Anonymous]

Very new to immunology but heading that path shortly... What is Neupogen?

[Anonymous]

PP here, Neupogen is a medication used in cancer patients to increase WBC counts and for the same reason to treat people with neutropenia not due to cancer( genetic or otherwise). It works through various avenues (detailed in a US patent you can search for) to create a uterine environment that will more easily tolerate implantation of an "altered self" ie an embryo. Varioius mechanisms are still being uncovered but they appear to be multifaceted.

[Anonymous]

PP: Thanks for all the info. Can you elaborate on the HLA - especially if you had a previously uneventful pregnancy with a male baby? That is my situation.

[Anonymous]

HLA can tell you if you have something called an Hy restricting allele. The particular haplotype that I have includes an Hy restricting allele DRB15 (plus DRB3 and DQB5 generally). You need to have a full HLA panel to get an idea of this information. There are several haploypes that increase your risk of autoimmune issues. The idea is that after the male baby your body is then sensitized during pregnancy and is more able to produce antibodies that can attack the cells that make up the placenta.

I know two other ladies who had secondary infertility after a first born male who was conceived easily. They both have babies now with Dr. Braverman's care, one of them has had 2 more babies. Both had HLA that pointed in this direction and an Hy restricting allele.

[Anonymous]

Thank you!

[Anonymous]

I'm newly diagnosed with stage 2 endo and am currently at Dominion. I'm uninspired by their 0/10 SART record with endometriosis patients last year and am thinking of switching to someone more... up to date.

How long does all the testing/retesting take with Abbasi? Would I have enough time to complete it all if I wanted to do a cycle around Feb or March? Does she automatically order the immune testing as part of like a "endo patient" protocol or would I have to push for it?