My Appt (2nd opinion) with Dr. Abassi

[Anonymous]

This morning I had my second opinion with Dr. Abassi. I've been with Shady Grove for nearly 2 years and after several failures (including a m/c and 3 PGS normal FET negatives) I've decided to look into Dr. Abassi and her immune theories. I have endometriosis and a previous ectopic so it seems like the natural next step, especially since SGF doesn't ascribe to endo being an issue for implantation AT ALL!

So, the thing that resonates most with me is that she kept asking me "Why are you doing all of this research on your own? Why hasn't SGF been supporting you?" Yeah, good question! After my last FET failure of 2 PGS normal embryos, my Dr. recommended doing an ERA and that's about it. I feel like they're left me hanging. It just doesn't feel right. Don't I want a Dr. that's gonna try everything?

I ended up emailing my nurse to let her know I went to get a second opinion and this is what I wrote:

I went to get a second opinion to explore some issues I've read through my research that could be hindering my ability to get pregnant.
While I don't subscribe to everything I was told, I do feel that these are very real possibilities and want to see if Shady Grove would be  willing to explore them so that I can feel better and confident that these are indeed not issues that are effecting me. I don't necessarily want to leave Shady Grove but I do want to explore the issues below for my own personal sense of whether I am doing everything in my power to give these last two embryos all the chance they deserve. 


These are the issues I've identified to explore:


1) Doing a thrombophilia panel (Due to the SCH I experienced during my son's pregnancy this seems warranted) <SGF never suggested this>


2) Thyroid antibodies testing <SGF just does basic thyroid testing. Could this extra test be useful?>


3) Immune Panel with the Alan Beer Resource Center (I know SG doesn't necessarily believe in this, but I would like to know if SG would consent to looking into this--or even be able to interpret them)

4) Doing the ERA twice if it comes back unreceptive to confirm the results <because my Dr. said just do it once if it's unreceptive, not knowing if I need more than 1 extra day of progesterone-- we haven't been on the side of what works for the majority thus far so why not be extra sure?>

5) I've also been told that it wouldn't be the best thing to transfer two embryos that are potentially different days (i.e. a day 5 and a day 6) because they could cause problems with hurting each other's implantation chances. <Is this a real issue? We would like to just transfer both because I just don't think I can emotionally do two more transfers>


Dr. Abassi also gave me their blood tests for the things that she normally tests for. The first is The Thrombophilia Panel with various test names and the second was the Immune Panel of tests with Alan Beer Resource Center. If anyone is interested I can list the CPT codes/names of tests.


So now my husband are at a crossroads. Dr. Abassi said she would only treat me if I become her patient. Do we make the move? Nothing has worked with SGF thus far so I would be stupid not to change, right? What to do! I suspect whenever I hear back from my nurse she's going to be ok with everything except the Immune panel. Even if SGF did it, I doubt they would even know how to interpret the results. If you've had repeated implantation failure and 2 embryos left (1 PGS normal, 1 untested) what would you do??? We definitely know we don't want to do another round of IVF, so this would be our last shot ART wise. Opinions please!!!

[Anonymous]

So what exactly is stopping you from going to new doctor?

[Anonymous]

This is a tough decision for other people to make for you. I think you have a better shot at going with the doctor who will listen to you, and is already very willing to do the testing you are interested in. If you have to force SG's hand, what's the point? It adds more stress and pressure to an already stressful and pressure filled experience.

I'd switch.

[Anonymous]

OP here. Is it the right decision or is immune stuff snake oil? Then there's the hassle of transferring embryos, extra costs... It's not easy but then again I've done easy with SGF and I see where that got me. CFA is also not as warm and fuzzy, and I worry about their professionalism... I mean SGF is organized... But again no luck with them. I think I just have a mental block from starting all over again in a sense... And will it be worth it or are we just opening up Pandora's box? I know there are no guarantees in this world but is this a necessary move? I've been through the ringer and can't take much more.

[Anonymous]

The immune stuff is anecdotal and not proven so shady grove doesn't ascribe to it. They're not the only ones. If you think that's your issue change doctors. I will say though, I'd be a little turned off by a doctor who was so quick to criticize another practice. I sought many opinions and appreciated that this never happened. Also, I'm sure abassi knows shady grove doesn't support immune stuff, so why would she even ask why they're not supporting you?

[Anonymous]

OP here. Well, to be fair, abassi was questioning why they never looked into thrombophilia panel. She never outright dismissed SGF... And I told her I actually do like sgf and my Dr... But without success and then really working for me and my success this isn't enough. I definitely didn't get the warm and fuzzies from abassi... And she told me from the start she's a straight shooter... So I guess that's gotta count for something

[Anonymous]

OP, I'm in a similar situation to you. I'm meeting with Dr. Abbasi next week and then Dr. Humm at GW the week after. I think I am going to be done with SG soon (I am doing the ERA now and then have one more frozen embryo to transfer), so I will probably switch my care to CFA or GW if I like them better based on these consults.

One point on the ERA. You said:

4) Doing the ERA twice if it comes back unreceptive to confirm the results <because my Dr. said just do it once if it's unreceptive, not knowing if I need more than 1 extra day of progesterone-- we haven't been on the side of what works for the majority thus far so why not be extra sure?>

Here's how it was explained to me: If the first biopsy comes back unreceptive, they will do a second biopsy. For example, right now I am doing the first biopsy with five days of progesterone. If it comes back "pre-receptive" we will do another round and try seven days of progesterone. It doesn't make sense to have the first round come back unreceptive and then just take a guess at what the right number of days is. I'm surprised your doctor would suggest that.

[Anonymous]

SGF seriously doesn't believe endo causes implantation issues?!? I didn't even know that was a debatable proposition. And you're concerned that Abassi is the one selling you snake oil?

[Anonymous]

OP, just to clarify -- will Dr. Abbasi run the thrombophilia and immune panel before you make your decision? I am in a similar situation as you (though not as far along as I have never had actual treatment by SG, just 2 miscarriages under their care from spontaneous pregnancies). I told Dr. Abbasi I wanted a second opinion and she wanted extra PCOS tests, thrombophilia panel, and immune panel. I did not tell her I was committing to treatment by her, although frankly if the thrombophilia or immune panels come back positive, I probably will change to her. If they come back negative I will have to see what her treatment recommendation is and weigh it against what SG recommended (which was basically just Clomid).

I would get the thrombophilia and immune testing done with her now. Then you will have more information about which may be a better choice. I agree with everything you said about SG's logistics and operations being far superior. I have seen Dr. Abbasi twice now and there is no nurse assigned, front desk gave me wrong info, and they never told me my labs came back -- I got the notice from LabCorp, waited a week, then made an appointment with Dr. Abbasi to discuss them on my own initiative. But however great SG's logistics are, if they are not getting the job done, you may need to try somewhere else. Of course since you have embryos frozen it's a tougher choice, and I sympathize.

[Anonymous]

OP again. SGF's response to endo causing implantation failure was the ERA. DR said that endo and ectopic suggest issues with progesterone... So nothing to do with immune response but progesterone. I me research I tend to believe they're connected... And yeah, my Dr said that because 70% of people who do ERA and get unreceptive need one more day of progesterone then we should do that if 1st comes back unreceptive... But then I'm like, really? Auth have things worked out for me that have worked out for others? Definitely seems wrong. My Dr said she's trying to save time and money but I feel like they're done with me and want me to just move on without extra work and effort on me .i feel neglected and like they don't even care. This fuels me to look elsewhere.

[Anonymous]

Anonymous wrote:OP again. SGF's response to endo causing implantation failure was the ERA. DR said that endo and ectopic suggest issues with progesterone... So nothing to do with immune response but progesterone. I me research I tend to believe they're connected... And yeah, my Dr said that because 70% of people who do ERA and get unreceptive need one more day of progesterone then we should do that if 1st comes back unreceptive... But then I'm like, really? Auth have things worked out for me that have worked out for others? Definitely seems wrong. My Dr said she's trying to save time and money but I feel like they're done with me and want me to just move on without extra work and effort on me .i feel neglected and like they don't even care. This fuels me to look elsewhere.

Have you done a lap to address the endo? Honestly, I don't see how endo and the ERA are connected, but maybe I'm missing something.

[Anonymous]

OP here. 12:43, Dr abassi told me straight up she wouldn't help unless I was her patient. She said she didn't work with other Drs and that's that. This does make it a tough decision because they want me to switch before I know what the tests outcome would be. Although I wonder what switching entails. Do I have to sign something to say I will xfer my embryos before they agree to do testing? Seems sketch. Also If they find nothing I wouldn't want to switch... A part of me believes they're gonna find something (because don't they always) but it won't have any bearing on success. So then I'll have switched for nothing to an office I'm not all that comfortable with for nothing...

I just heard back from my nurse at sgf that she's forwarded my questions to my Dr and will get back to me when she had responded... E shall see and I'll share what she says

[Anonymous]

OP again. 12:46, i did a lap in 2014 for a cystectomy sick was my first confirmation of endo. I have a son from a spontaneous pregnancy in 2012 BTW. No known issues before this.
As I understand it, Endo suggests an issue in the expression of progesterone, because it's all about extra estrogen, and how it overtakes progesterone... So an ERA would *probably* come back being more progesterone... That's how I understand how endo and ERA are connected. If anyone knows otherwise please correct me.

[Anonymous]

I've been a patient with both SGF and currently Dr. Abassi. We to have had multiple early chemicals and an ruptured ectopic. I had the same experience with SGF. I can get PG very easy but can't stay PG. IVF was pushed as the only option. Nothing was explored. I'm a huge believer in the Immune issues from my research. I also was tested by Abassi for MTHFR (I'm compound Hetero), 4g/4g PAI blood clotting genetic issues (homo-2 copies for this one) and have very low Vitamin D (19). These were things that were never tested before with several other doctors and specialists including SGF.

I didn't have the hassle of transferring embryos etc so I can't help there. But I Think SGF is very good at traditional cases - MFI, no ovulation etc. But with my history and repeat losses and ectopic they didn't have anything to offer beyond the standard treatment. I didn't need IVF to get pregnant, I did that on my own.

[Anonymous]

Anonymous wrote:I've been a patient with both SGF and currently Dr. Abassi. We to have had multiple early chemicals and an ruptured ectopic. I had the same experience with SGF. I can get PG very easy but can't stay PG. IVF was pushed as the only option. Nothing was explored. I'm a huge believer in the Immune issues from my research. I also was tested by Abassi for MTHFR (I'm compound Hetero), 4g/4g PAI blood clotting genetic issues (homo-2 copies for this one) and have very low Vitamin D (19). These were things that were never tested before with several other doctors and specialists including SGF.

I didn't have the hassle of transferring embryos etc so I can't help there. But I Think SGF is very good at traditional cases - MFI, no ovulation etc. But with my history and repeat losses and ectopic they didn't have anything to offer beyond the standard treatment. I didn't need IVF to get pregnant, I did that on my own.

12:43 here (the PP) -- this sounds like me. Easily get pregnant on my own but have had 3 miscarriages in 10 months, most recent being a suspected ectopic. (First pregnancy in 2013 was successful but the next 3 have all ended at earlier and earlier stages.) Shady Grove said just keep trying, you'll get a good egg eventually. Also said I do not have PCOS despite irregular cycles, high AMH, and high antral follicle count -- but no hormone issues. Dr. Abbasi suspects PCOS and possible immune/clotting issues.

Did you ultimately have success with Dr. Abbasi?