RES disagree on diagnoses

[Anonymous]

Anonymous wrote:OP - which immunity tests did you do? Which treatments did they recommend?

Have you done a RPL panel too? Clotting factors, etc?

How is your thyroid? What is your TSH?

FWIW, after dabbling with a few IVF cycles down here and the immunity path, we finally found success at Cornell. If you want your absolute best shot with OE, just go there IMO.

OP here. I've had my thyroid tested about 5 times in the last two years. Always normal results and TSH is 2.1. I have asked each Dr. whether this is too high and they all said it is perfectly fine for TTC.

I have not had RPL panel done because I have not had any RPLs. I just cannot get pregnant and Dr. Abassi believes I have repeat implantation failure. I have not done the clotting panel yet. I did the Beers blood test--it tested for about 10 different things.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Given that only one doctor suspects immune issues and others (including Cornell, which is a leader in the field of IVF) don't think immune issues are at play, why not listen to the majority of doctors? You haven't mentioned finances, but if I were you I would either do the two cycle package at SG or go to Cornell. It seems like your eggs aren't great based on your stats and your response to the stims for the IUIs so I don't see a reason to suspect immune issues at this point. At 38, it is much more likely to be your age/egg quality (sorry).

Others, including Cornell, don't believe in immune issues, and therefore never suspect them. Many places also don't believe in blood clotting issues, despite studies pointing to the opposite. OP said that she was tested for immune issues and multiple thing came up as red flags.

This is the PP - Cornell docs are very up on the latest research and do a lot of peer reviewed studies. If they don't believe in immune issues, don't you think there is a chance that they don't exist? Of course, even if they didn't exist, "treating" women for them would still lead to pregnancies since IVF is essentially a roll of the dice. Given that OP is older, why not start with the obvious diagnosis (age/egg quality)? It would be one thing if she failed after transferring multiple perfect looking blasts, but that is not the case here.

OP here. I think what you're saying is very valid. I guess though the reason I investigated immune issues before trying a round of IVF us that my goal is to have a baby with the fewest number of IVF cycles and fewest amounts of meds possible. So ideally that would be only doing one round of IVF total, which is why I am open to donor eggs given my low AMH and poor response to IUIs. Of course I would prefer to use own eggs but I also don't want to do IVF round after IVF round and taking tons of IVF drugs in order to find my one golden egg given my ovarian reserve issues.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP - which immunity tests did you do? Which treatments did they recommend?

Have you done a RPL panel too? Clotting factors, etc?

How is your thyroid? What is your TSH?

FWIW, after dabbling with a few IVF cycles down here and the immunity path, we finally found success at Cornell. If you want your absolute best shot with OE, just go there IMO.

OP here. I've had my thyroid tested about 5 times in the last two years. Always normal results and TSH is 2.1. I have asked each Dr. whether this is too high and they all said it is perfectly fine for TTC.

I have not had RPL panel done because I have not had any RPLs. I just cannot get pregnant and Dr. Abassi believes I have repeat implantation failure. I have not done the clotting panel yet. I did the Beers blood test--it tested for about 10 different things.

Did you have your thyroid antibodies tested also or just TSH? My TSH has always been normal to ideal -- around 1.3 or 1.5 -- and T4 is fine too, yet I have antibodies and therefore a Hashimoto's diagnosis. I do have a history of recurrent losses though which is what led me to get tested.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Given that only one doctor suspects immune issues and others (including Cornell, which is a leader in the field of IVF) don't think immune issues are at play, why not listen to the majority of doctors? You haven't mentioned finances, but if I were you I would either do the two cycle package at SG or go to Cornell. It seems like your eggs aren't great based on your stats and your response to the stims for the IUIs so I don't see a reason to suspect immune issues at this point. At 38, it is much more likely to be your age/egg quality (sorry).

Others, including Cornell, don't believe in immune issues, and therefore never suspect them. Many places also don't believe in blood clotting issues, despite studies pointing to the opposite. OP said that she was tested for immune issues and multiple thing came up as red flags.

This is the PP - Cornell docs are very up on the latest research and do a lot of peer reviewed studies. If they don't believe in immune issues, don't you think there is a chance that they don't exist? Of course, even if they didn't exist, "treating" women for them would still lead to pregnancies since IVF is essentially a roll of the dice. Given that OP is older, why not start with the obvious diagnosis (age/egg quality)? It would be one thing if she failed after transferring multiple perfect looking blasts, but that is not the case here.

OP here. I think what you're saying is very valid. I guess though the reason I investigated immune issues before trying a round of IVF us that my goal is to have a baby with the fewest number of IVF cycles and fewest amounts of meds possible. So ideally that would be only doing one round of IVF total, which is why I am open to donor eggs given my low AMH and poor response to IUIs. Of course I would prefer to use own eggs but I also don't want to do IVF round after IVF round and taking tons of IVF drugs in order to find my one golden egg given my ovarian reserve issues.

you seem to be overly afraid of drugs. short-term treatments (like fertility drugs) are unlikely to cause much damage. it's the cumulative effects on taking something regularly for many years that is more troublesome.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP - which immunity tests did you do? Which treatments did they recommend?

Have you done a RPL panel too? Clotting factors, etc?

How is your thyroid? What is your TSH?

FWIW, after dabbling with a few IVF cycles down here and the immunity path, we finally found success at Cornell. If you want your absolute best shot with OE, just go there IMO.

OP here. I've had my thyroid tested about 5 times in the last two years. Always normal results and TSH is 2.1. I have asked each Dr. whether this is too high and they all said it is perfectly fine for TTC.

I have not had RPL panel done because I have not had any RPLs. I just cannot get pregnant and Dr. Abassi believes I have repeat implantation failure. I have not done the clotting panel yet. I did the Beers blood test--it tested for about 10 different things.

Seems strange to me that Abassi would think implantation failures when your numbers, age and response to stims suggest bad eggs. It makes me think she is just telling you what she thinks you want to hear. Given your reluctance to do multiple cycles, maybe you should go directly to donor egg.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP - which immunity tests did you do? Which treatments did they recommend?

Have you done a RPL panel too? Clotting factors, etc?

How is your thyroid? What is your TSH?

FWIW, after dabbling with a few IVF cycles down here and the immunity path, we finally found success at Cornell. If you want your absolute best shot with OE, just go there IMO.

OP here. I've had my thyroid tested about 5 times in the last two years. Always normal results and TSH is 2.1. I have asked each Dr. whether this is too high and they all said it is perfectly fine for TTC.

I have not had RPL panel done because I have not had any RPLs. I just cannot get pregnant and Dr. Abassi believes I have repeat implantation failure. I have not done the clotting panel yet. I did the Beers blood test--it tested for about 10 different things.

Seems strange to me that Abassi would think implantation failures when your numbers, age and response to stims suggest bad eggs. It makes me think she is just telling you what she thinks you want to hear. Given your reluctance to do multiple cycles, maybe you should go directly to donor egg.

I don't think you understand how this works. Abassi ran actual tests, the results of which indicate that OP's uterine environment is incompatible with pregnancy and normal implantation. She isn't guessing.

[Anonymous]

Bad eggs and immune problems aren't mutually exclusive diagnoses. It's quite possible to have both.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP - which immunity tests did you do? Which treatments did they recommend?

Have you done a RPL panel too? Clotting factors, etc?

How is your thyroid? What is your TSH?

FWIW, after dabbling with a few IVF cycles down here and the immunity path, we finally found success at Cornell. If you want your absolute best shot with OE, just go there IMO.

OP here. I've had my thyroid tested about 5 times in the last two years. Always normal results and TSH is 2.1. I have asked each Dr. whether this is too high and they all said it is perfectly fine for TTC.

I have not had RPL panel done because I have not had any RPLs. I just cannot get pregnant and Dr. Abassi believes I have repeat implantation failure. I have not done the clotting panel yet. I did the Beers blood test--it tested for about 10 different things.

Seems strange to me that Abassi would think implantation failures when your numbers, age and response to stims suggest bad eggs. It makes me think she is just telling you what she thinks you want to hear. Given your reluctance to do multiple cycles, maybe you should go directly to donor egg.

I don't think you understand how this works. Abassi ran actual tests, the results of which indicate that OP's uterine environment is incompatible with pregnancy and normal implantation. She isn't guessing.

No one wants to hear that they have immune issues! I agree with PP that actual tests show a problem. However, that doesn't mean it's the only problem. Like previous PP said, all the responses suggest bad eggs. The thing is, if there are immune issues, donor egg is unlikely to solve them. Sounds like OP needs to attack the issue on both fronts. Try own eggs once or twice with immune meds, and if that doesn't work, move on to donor egg with immune meds.

[Anonymous]

OP, if you have reservations about the science behind immune treatment, I'd suggest checking out Dr. Beer's book ("Is Your Body Baby-Friendly?"). It's exhaustively documented (the bibliography is huge) and directly addresses many of the questions you and others have raised. Last I checked it was still available on Amazon.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP - which immunity tests did you do? Which treatments did they recommend?

Have you done a RPL panel too? Clotting factors, etc?

How is your thyroid? What is your TSH?

FWIW, after dabbling with a few IVF cycles down here and the immunity path, we finally found success at Cornell. If you want your absolute best shot with OE, just go there IMO.

OP here. I've had my thyroid tested about 5 times in the last two years. Always normal results and TSH is 2.1. I have asked each Dr. whether this is too high and they all said it is perfectly fine for TTC.

I have not had RPL panel done because I have not had any RPLs. I just cannot get pregnant and Dr. Abassi believes I have repeat implantation failure. I have not done the clotting panel yet. I did the Beers blood test--it tested for about 10 different things.

Personally I would (and did) run the RPL panel anyway (I also was unexplained and no m/cs - just tons of BFNs). It's just a blood test. Also have they tested for karotype (?) - I'm blanking on that test name but it's one they do pretty early on.

Any symptoms of endometriosis? That can cause implantation failure.

Has your DH's sperm been tested for % of sperm DNA frag? I'd say skip the test and just put him on antioxidants (Proceptin) 90 days prior to cycling.

I am very surprised that SG is suggesting long lupron at 38 - they aren't concerned about over-suppressing, even with your IUI response?. Why did they say no EPP? EPP is pretty standard for older women. FWIW - Cornell excels at customizing protocols - they fine tune carefully during the cycle each day. They know protocols and if they are recommending EPP I'd go that route.

Why did Dominion not recommend natural cycle IVF? That seems like a good lower-cost, lower-med option to start.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP - which immunity tests did you do? Which treatments did they recommend?

Have you done a RPL panel too? Clotting factors, etc?

How is your thyroid? What is your TSH?

FWIW, after dabbling with a few IVF cycles down here and the immunity path, we finally found success at Cornell. If you want your absolute best shot with OE, just go there IMO.

OP here. I've had my thyroid tested about 5 times in the last two years. Always normal results and TSH is 2.1. I have asked each Dr. whether this is too high and they all said it is perfectly fine for TTC.

I have not had RPL panel done because I have not had any RPLs. I just cannot get pregnant and Dr. Abassi believes I have repeat implantation failure. I have not done the clotting panel yet. I did the Beers blood test--it tested for about 10 different things.

I think Dr. Abassi felt that overall my eggs are probably good, given that my FSH and estrogen are all good/normal, as well as my AFC, even if my AMH is bad. (FSH, 7; estrogen, 50, AFC, 12). This is what Cornell and GW also said (they basically said we're going to disregard your AMH because other nu,bers are good). But the fact remains that I have not had a single BFP in 2 years of trying. Dr. Abassi suspected repeat implantation failure issues, ran tests, and my immune numbers are pretty much uniformly abnormal.

So you can see why I'm confused and not sure what to think or how to proceed. But this discussion is very helpful!


Seems strange to me that Abassi would think implantation failures when your numbers, age and response to stims suggest bad eggs. It makes me think she is just telling you what she thinks you want to hear. Given your reluctance to do multiple cycles, maybe you should go directly to donor egg.

[Anonymous]

Also, for more information on RI issues, check out this yahoo group:
https://beta.groups.yahoo.com/neo/groups/immunologysupport/info

[Anonymous]

I think Dr. Abassi felt that overall my eggs are probably good, given that my FSH and estrogen are all good/normal, as well as my AFC, even if my AMH is bad. (FSH, 7; estrogen, 50, AFC, 12). This is what Cornell and GW also said (they basically said we're going to disregard your AMH because other nu,bers are good). But the fact remains that I have not had a single BFP in 2 years of trying. Dr. Abassi suspected repeat implantation failure issues, ran tests, and my immune numbers are pretty much uniformly abnormal.

So you can see why I'm confused and not sure what to think or how to proceed. But this discussion is very helpful!

[Anonymous]

You did Beers testing? Looks like it may have covered some RPL-related tests too?

http://www.repro-med.net/an-introduction-to-our-program

http://www.repro-med.net/thrombophilia-recurrent-miscarriage-and-infertility

Did you have any clotting issues (sorry if I missed a post about this earlier)? All REs would recognize those as "real" medical issues so you could treat those while cycling at any clinic.

[Anonymous]

Anonymous wrote:I think Dr. Abassi felt that overall my eggs are probably good, given that my FSH and estrogen are all good/normal, as well as my AFC, even if my AMH is bad. (FSH, 7; estrogen, 50, AFC, 12). This is what Cornell and GW also said (they basically said we're going to disregard your AMH because other nu,bers are good). But the fact remains that I have not had a single BFP in 2 years of trying. Dr. Abassi suspected repeat implantation failure issues, ran tests, and my immune numbers are pretty much uniformly abnormal.

So you can see why I'm confused and not sure what to think or how to proceed. But this discussion is very helpful!

It is confusing, particularly with so many REs weighing in. I would recommend that you read the Beers book another poster suggested (Is Your Body Baby Friendly), and see what you think. Obviously you can only do what you are comfortable with. I got mine off Amazon about 8 months ago for maybe $20.

Do you have any history of autoimmune or clotting issues in your family?