Posting back about my 4 second opinions!

[Anonymous]

Yes, 4. A bit of background so you can see if this post is relevant to you: I've had 3 IUIs, a cancelled IVF, and 1 IVF to retrieval in June with 4 eggs. 2 normal, 2 abnormal. Of the 2 normal, 1 was mature, 1 immature. the mature one did not fertilize with ICSI. So I've never had an embryo. After the IVF I got the "we can do 1 more IVF but then it's time to move on to DE" speech from RE at SG. In the meantime, he put me on Coq10 and DHEA for 6 weeks- 3 months. Hence, the second opinions. And since I'm totally Type A and have a medical background, I got 4. Yes, that's a lot of cooks in the kitchen. I'm 39, a poor responder, and not sure whether I have DOR. AMH is normal but apparently the eggs I have are crappy and I don't respond well to meds. The last IVF I was on super high, max doses. My RE at SG recommended a low-dose protocol with estrogen priming as a last resort. I have liked my RE and SG, but it's not working and after 1 IVF I don't expect to get the DE speech. I'm also out of pocket now so this next one needs to count. On to second opinion #1- Cornell (Dr. Davis), phone consult. Really liked him. He was prepared and thorough, which at $650 not covered by insurance, he should have been. He suggested basically the same protocol as SG, with a few minor adjustments. He wanted me to repeat certain tests, such as thyroid (which has been borderline, prolactin, etc), which I thought was a good idea. He even sent me scripts for them. #2. SIRM phone consult- they had my records but bc I switched drs after I made my appointment, there was a mixup and the dr I had my consult with didn't have my records, so she was flying blind a bit, which made the consult a bit useless. It was either $250 or $350. She suggested a mid-level approach- not max doses but not low either. She said I only have a 15% chance of a baby, which is about what SG said. Not really a useful consult bc of the lack of records and history. #3- CCRM, Dr. Schoolcraft, no fee. Really liked him as well, he was prepared and had read my records. He, unlike the others, didn't suggest a specific protocol (probably bc it's free). He did say if they could get more eggs, my chances would go up to 40%, but if not 15-20% was about right. I did ask him if they cherry-picked who they took to get such high SART numbers, and he said "if we did, we wouldn't take you, to be honest." I appreciated his honesty. He said 50% of their patients are AMA and DOR and 70% out of state. He did say something I found interesting- that bc my AMA was normal, that actually corresponds to how many follicles you should have. Like if your AMH is X, then you should have between X-X follicles, something doesn't add up, which to him meant the protocol or person doing the counting on ultrasounds. I had never heard this correlation before! #4- GW. I wanted one local second opinion at least. I almost cancelled it because I was deciding between CCRM and Cornell at this point. Well, I didn't, and had the consult with Dr. Frankfurter. I really liked him. He was thorough and had read my file. He disagreed with a lot of the things SG had done. He said he thought I was an "early recruiter"- that my follicles got too big too early in the cycle. First I'd heard of that. He also said he thought the abnormal eggs I had from my previous IVF could have been caused from stimming too long. First I heard of that! My dr. at SG said he thought I had "really, concerning" abnormal eggs due to a possible chromosomal issue. I did karyotype testing which came back normal, he then said it was because I'm AMA. Dr. F said staying on IVF drugs too long can cause abnormal eggs!? He ordered the same testing Cornell did, which I thought was astute. Long story short, I've decided to go with GW because I liked Dr. F, and frankly it would be easier. If the next IVF doesn't work out, I'll probably move on to Cornell or CCRM, but I wanted to give another local RE a try. But mostly they all had something interesting to say and I'm glad I have some other options than SG now. Right now I'm waiting on my irregular, light period to finally start so I can do their day 3 testing and all that and hopefully start IVF again in Sept. Best of luck to you all!

[Anonymous]

Hope you don't mind but your formatting made it very hard to read.

Anonymous wrote:Yes, 4. A bit of background so you can see if this post is relevant to you: I've had 3 IUIs, a cancelled IVF, and 1 IVF to retrieval in June with 4 eggs. 2 normal, 2 abnormal. Of the 2 normal, 1 was mature, 1 immature. the mature one did not fertilize with ICSI. So I've never had an embryo. After the IVF I got the "we can do 1 more IVF but then it's time to move on to DE" speech from RE at SG. In the meantime, he put me on Coq10 and DHEA for 6 weeks- 3 months. Hence, the second opinions. And since I'm totally Type A and have a medical background, I got 4. Yes, that's a lot of cooks in the kitchen. I'm 39, a poor responder, and not sure whether I have DOR. AMH is normal but apparently the eggs I have are crappy and I don't respond well to meds. The last IVF I was on super high, max doses. My RE at SG recommended a low-dose protocol with estrogen priming as a last resort. I have liked my RE and SG, but it's not working and after 1 IVF I don't expect to get the DE speech. I'm also out of pocket now so this next one needs to count. On to second opinion

#1- Cornell (Dr. Davis), phone consult. Really liked him. He was prepared and thorough, which at $650 not covered by insurance, he should have been. He suggested basically the same protocol as SG, with a few minor adjustments. He wanted me to repeat certain tests, such as thyroid (which has been borderline, prolactin, etc), which I thought was a good idea. He even sent me scripts for them.

#2. SIRM phone consult- they had my records but bc I switched drs after I made my appointment, there was a mixup and the dr I had my consult with didn't have my records, so she was flying blind a bit, which made the consult a bit useless. It was either $250 or $350. She suggested a mid-level approach- not max doses but not low either. She said I only have a 15% chance of a baby, which is about what SG said. Not really a useful consult bc of the lack of records and history.

#3- CCRM, Dr. Schoolcraft, no fee. Really liked him as well, he was prepared and had read my records. He, unlike the others, didn't suggest a specific protocol (probably bc it's free). He did say if they could get more eggs, my chances would go up to 40%, but if not 15-20% was about right. I did ask him if they cherry-picked who they took to get such high SART numbers, and he said "if we did, we wouldn't take you, to be honest." I appreciated his honesty. He said 50% of their patients are AMA and DOR and 70% out of state. He did say something I found interesting- that bc my AMA was normal, that actually corresponds to how many follicles you should have. Like if your AMH is X, then you should have between X-X follicles, something doesn't add up, which to him meant the protocol or person doing the counting on ultrasounds. I had never heard this correlation before!

#4- GW. I wanted one local second opinion at least. I almost cancelled it because I was deciding between CCRM and Cornell at this point. Well, I didn't, and had the consult with Dr. Frankfurter. I really liked him. He was thorough and had read my file. He disagreed with a lot of the things SG had done. He said he thought I was an "early recruiter"- that my follicles got too big too early in the cycle. First I'd heard of that. He also said he thought the abnormal eggs I had from my previous IVF could have been caused from stimming too long. First I heard of that! My dr. at SG said he thought I had "really, concerning" abnormal eggs due to a possible chromosomal issue. I did karyotype testing which came back normal, he then said it was because I'm AMA. Dr. F said staying on IVF drugs too long can cause abnormal eggs!? He ordered the same testing Cornell did, which I thought was astute.

Long story short, I've decided to go with GW because I liked Dr. F, and frankly it would be easier. If the next IVF doesn't work out, I'll probably move on to Cornell or CCRM, but I wanted to give another local RE a try. But mostly they all had something interesting to say and I'm glad I have some other options than SG now. Right now I'm waiting on my irregular, light period to finally start so I can do their day 3 testing and all that and hopefully start IVF again in Sept. Best of luck to you all!

[Anonymous]

OP, thanks for this useful feedback.
I have also read that high doses of stims can worsen egg quality, but it was mostly from internet postings.
If you are out of pocket and don't mind, would you share the cost of your cycle at GWU? We might be looking to move from SG, and our IVF insurance coverage is exhausted.

[Anonymous]

Glad you like GW. Sounds like the best of your choices. Since you are all OOP and a poor responder, I'm curious why you wouldn't look into NCIVF at Dominion? It's about $5000 a shot and no meds so you can do it every month. It's fairly non invasive.

[Anonymous]

OP, thank you for writing this all up, you're a rockstar!
We have so many similarities - at 40 my AMH is normal but first cycle at SG was a bust. I stimmed on antagonist for 14 days with 300/150 dosage, and 8 days for Cetrotide. My SG RE was very quick to say that this is an age issue. He also suggested to increase the doses next time and stim for 1 day longer. I had a 2nd opinion consult with at GWU and also got the same info as you - high doses affect quality and stimming for 2 long hurts your chances. I have 2 more consults overseas next week but to be honest, I am leaning towards GWU. Maybe we will be cycle twins Anyway, best of luck to you and lots of baby dust!

[Anonymous]

Sounds like you are with Dr. Widra at SG. And it seems like SG tells everyone the same thing--poor eggs and that you should move on to donor. They couldn't tell me that it was because of my age, AMH, or FSH, but they still said the same--poor eggs, try a donor. I'm also shopping around and am on my 4th or 5th consult. For all of the good that SG does, I think there are certain cases that they don't think very carefully about and just punt to donor.

[Anonymous]

Anonymous wrote:Sounds like you are with Dr. Widra at SG. And it seems like SG tells everyone the same thing--poor eggs and that you should move on to donor. They couldn't tell me that it was because of my age, AMH, or FSH, but they still said the same--poor eggs, try a donor. I'm also shopping around and am on my 4th or 5th consult. For all of the good that SG does, I think there are certain cases that they don't think very carefully about and just punt to donor.

I'm not going to pound the table for Widra since obviously he isn't great for everyone. But he was my doc, I was a poor responder, and he worked with me with various protocols and I have two kids to show for it. I actually wanted to go the DE route when a couple of cycles went badly and one IVF cycle cancelled because I had no decent follicles, but he encouraged me to stay the course and try a new protocol. I got pregnant with twins on the next cycle.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Sounds like you are with Dr. Widra at SG. And it seems like SG tells everyone the same thing--poor eggs and that you should move on to donor. They couldn't tell me that it was because of my age, AMH, or FSH, but they still said the same--poor eggs, try a donor. I'm also shopping around and am on my 4th or 5th consult. For all of the good that SG does, I think there are certain cases that they don't think very carefully about and just punt to donor.

I'm not going to pound the table for Widra since obviously he isn't great for everyone. But he was my doc, I was a poor responder, and he worked with me with various protocols and I have two kids to show for it. I actually wanted to go the DE route when a couple of cycles went badly and one IVF cycle cancelled because I had no decent follicles, but he encouraged me to stay the course and try a new protocol. I got pregnant with twins on the next cycle.

Would you mind sharing what protocols you tried and which ones were successful for you? My problem is that I don't know what to ask for to try out...

[Anonymous]

NP. OP I would recommend EPP for you.

[Anonymous]

OP, would you mind sharing the cost of IVF at GW? We are completely OOP as well.

[Anonymous]

Did Dr. F tell you what protocol he would put you on?

[Anonymous]

Anonymous wrote:Glad you like GW. Sounds like the best of your choices. Since you are all OOP and a poor responder, I'm curious why you wouldn't look into NCIVF at Dominion? It's about $5000 a shot and no meds so you can do it every month. It's fairly non invasive.

NP. I know this is a strategy that some women with DOR who are paying out of pocket use. They plan for half a dozen mini-IVFs or natural cycle IVFs.

[Anonymous]

OP here. I don't know the cost of the cycle yet at GW. I will say that Dr. F did mention that he was going to try to prescribe some of the more inexpensive drugs (Bravelle vs Follistim for example), so he seems to be cognizant of price and that it's all out of pocket. I was with Dr. Levens at SG, not Widra. Also, I haven't looked into NCIVF because half the drs I consulted with said low dose but the other half did not, so I'm not ready to give up on all meds yet. I don't know what protocol would be best for me, it's a shot in the dark right now as I've only had 1 IVF. Dr. F's protocol- he didn't get into specifics too much but said I would monitor for ovulation, then 8 days after my surge, I would start Cetrotide. Then after my next period, I would start Bravelle at 225 and not be using Menopur at all. He said he did not like Clomid or Menopur. He also said EPP wouldn't do anything for me, but there was so much information I didn't ask why. Hope this helps clarify my post-

[Anonymous]

To all posters: IVF #1 is always a gamble. They look at your hormone levels, compare how you responded to meds if you started with IUIs and then go from there. If you need subsequent cycles, information from previous cycles is analyzed and adjusted for the next protocol.

[Anonymous]

Anonymous wrote:To all posters: IVF #1 is always a gamble. They look at your hormone levels, compare how you responded to meds if you started with IUIs and then go from there. If you need subsequent cycles, information from previous cycles is analyzed and adjusted for the next protocol.

It is true, but for example in my case they said stim longer and up the doses. When I went for a 2nd opinion I was told the opposite - that stimming too long on high does actually might be the reason for my poor ass quality eggs...