Venting about SGF

[Anonymous]

I am the poster who posted about being fed up with SGF and wanting to switch to GW. Please hear me and please tell me if I am being reasonable with my vent.
I absolutely hate their monitoring system whereby you get monitored by a different person each time who give you totally different observations, based mostly on their own skill at ultrasound monitoring.

1st monitoring appt - 7 follicles

2nd monitoring appt - 9 follicles

3rd monitoring appt - 7 follicles (where did the other 2 go??)

4th monitoring appt - 11 follicles (have the missing 2 reappeared and 2 new appeared (of a good size)??)

I feel this is bad work because they apparently base retrievals on what ultrasound technicians previously observed. Since I do not have a big cohort of follicles I believe they should be more accurate and precise with measuring. It's not like I have millions to throw at them for sloppy work.

Am I mistaken? Do I expect a "lot" Is it like this at other places too? I realize that hormones make a bit nervous, but in my book being sloppy is where I draw a line and different results at each appointment infuriate me.

[Anonymous]

Anonymous wrote:I am the poster who posted about being fed up with SGF and wanting to switch to GW. Please hear me and please tell me if I am being reasonable with my vent.
I absolutely hate their monitoring system whereby you get monitored by a different person each time who give you totally different observations, based mostly on their own skill at ultrasound monitoring.

1st monitoring appt - 7 follicles

2nd monitoring appt - 9 follicles

3rd monitoring appt - 7 follicles (where did the other 2 go??)

4th monitoring appt - 11 follicles (have the missing 2 reappeared and 2 new appeared (of a good size)??)

I feel this is bad work because they apparently base retrievals on what ultrasound technicians previously observed. Since I do not have a big cohort of follicles I believe they should be more accurate and precise with measuring. It's not like I have millions to throw at them for sloppy work.

Am I mistaken? Do I expect a "lot" Is it like this at other places too? I realize that hormones make a bit nervous, but in my book being sloppy is where I draw a line and different results at each appointment infuriate me.

At GW, only doctors do the monitoring. But you potentially have different doctors on different days. For example, the "on-call" doctor rotates on a Thursday-Thursday schedule. There are four doctors, so you will see one of them. All of the doctors discuss every IVF case once a week, so you're getting the brains of four doctors instead of one.

FWIW (and I love GW) the above would not be enough in and of itself to drive me away from a clinic. I think follicle measuring is not 100% exact science. But I did really appreciate that at GW it was always doctors who did the monitoring and that it seemed to be pretty precise and involved.

[Anonymous]

I understand and share you concern regarding the follicle count when you have lower numbers like that bc ive been in the same boat. I just learned this cycle (my 3rd) that your body produces new follicles throughout your cycle so that could be the reason for the larger number at the last appt (but not for the random dip in the middle). The key thing is that they have to trigger when the leading follicles are ready to go so sometimes those late developing ones wont be ready in time. I have also struggled with getting precise information (exact follicle counts and measurements or embryo cell counts or grading) and clear explanations about what is happening. It drives me nuts when I hear medical professionals spout back those truisms that lay people use "it only takes one," etc.

[Anonymous]

Anonymous wrote:I understand and share you concern regarding the follicle count when you have lower numbers like that bc ive been in the same boat. I just learned this cycle (my 3rd) that your body produces new follicles throughout your cycle so that could be the reason for the larger number at the last appt (but not for the random dip in the middle). The key thing is that they have to trigger when the leading follicles are ready to go so sometimes those late developing ones wont be ready in time. I have also struggled with getting precise information (exact follicle counts and measurements or embryo cell counts or grading) and clear explanations about what is happening. It drives me nuts when I hear medical professionals spout back those truisms that lay people use "it only takes one," etc.

OP here - thank you. It is comforting to know I am not the only one who feels this way. Were you with SGF or elsewhere? I am trying to gauge if this the case across the clinics or just at SGF. I think that proper medications dosing, precise monitoring, and good lab are keys to success. From what I understand from PP before you monitoring at GW might be of better quality. I am wondering if they are as good with medications dosing and lab protocols. Before switching over I want to make sure I am not going to another place that does not place emphasis on what matters to me.

[Anonymous]

You may already know this but sometimes they simply do not have a clear view of the ovary because your bowels are full or you have gas.... One time I went and no matter what she could only find 5 follicles on my left ovary when there were 9 the time before and the time after....this was at SGFC.

[Anonymous]

Anonymous wrote:You may already know this but sometimes they simply do not have a clear view of the ovary because your bowels are full or you have gas.... One time I went and no matter what she could only find 5 follicles on my left ovary when there were 9 the time before and the time after....this was at SGFC.

Op here - Yes, I understand that. What worries me is that they base retrievals on the monitoring. So, if your physician is under the impression you have 5 follicles he may not look for 9 that are truly there. Unless I am mistaken? They start with a clean slate at retrieval and trust their own judgment?

[Anonymous]

Anonymous wrote:

Anonymous wrote:You may already know this but sometimes they simply do not have a clear view of the ovary because your bowels are full or you have gas.... One time I went and no matter what she could only find 5 follicles on my left ovary when there were 9 the time before and the time after....this was at SGFC.

Op here - Yes, I understand that. What worries me is that they base retrievals on the monitoring. So, if your physician is under the impression you have 5 follicles he may not look for 9 that are truly there. Unless I am mistaken? They start with a clean slate at retrieval and trust their own judgment?

You should ask your doctor. My experience, after 4 banking retrievals is that they always (at SG) take whatever follicles/ eggs they can find at retrieval. I end up with a bunch of immature ones that were never measured in addition to the ones we expect. The big issue with not measuring the follicle count, I imagine, would be the timing of the trigger, as they generally want a certain amount of estrogen per mature follicle....however i am guessing that the lead follicle would determine the trigger more than estrogen/ follicle. Anyway, i'll end how I started this post. Ask your doctor.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I understand and share you concern regarding the follicle count when you have lower numbers like that bc ive been in the same boat. I just learned this cycle (my 3rd) that your body produces new follicles throughout your cycle so that could be the reason for the larger number at the last appt (but not for the random dip in the middle). The key thing is that they have to trigger when the leading follicles are ready to go so sometimes those late developing ones wont be ready in time. I have also struggled with getting precise information (exact follicle counts and measurements or embryo cell counts or grading) and clear explanations about what is happening. It drives me nuts when I hear medical professionals spout back those truisms that lay people use "it only takes one," etc.

OP here - thank you. It is comforting to know I am not the only one who feels this way. Were you with SGF or elsewhere? I am trying to gauge if this the case across the clinics or just at SGF. I think that proper medications dosing, precise monitoring, and good lab are keys to success. From what I understand from PP before you monitoring at GW might be of better quality. I am wondering if they are as good with medications dosing and lab protocols. Before switching over I want to make sure I am not going to another place that does not place emphasis on what matters to me.

I used Columbia fert for IVF but SGF for IUIs. At Columbia your Dr (not rotating Drs) does all monitoring but I found Dr. Sacks glossed over precise numbers. I found that at most practices — even when news was not terrific I wanted to know bc information helped me manage expectations.

[Anonymous]

What makes you think they aren't being accurate and precise?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I understand and share you concern regarding the follicle count when you have lower numbers like that bc ive been in the same boat. I just learned this cycle (my 3rd) that your body produces new follicles throughout your cycle so that could be the reason for the larger number at the last appt (but not for the random dip in the middle). The key thing is that they have to trigger when the leading follicles are ready to go so sometimes those late developing ones wont be ready in time. I have also struggled with getting precise information (exact follicle counts and measurements or embryo cell counts or grading) and clear explanations about what is happening. It drives me nuts when I hear medical professionals spout back those truisms that lay people use "it only takes one," etc.

OP here - thank you. It is comforting to know I am not the only one who feels this way. Were you with SGF or elsewhere? I am trying to gauge if this the case across the clinics or just at SGF. I think that proper medications dosing, precise monitoring, and good lab are keys to success. From what I understand from PP before you monitoring at GW might be of better quality. I am wondering if they are as good with medications dosing and lab protocols. Before switching over I want to make sure I am not going to another place that does not place emphasis on what matters to me.

It takes more than that for success.

I'm not sure how many cycles you have gone through with SGF. You seem fixated with the monitoring at SGF and think that having doctors monitor makes a difference. I truly don't think they hire technicians who are unable to measure correctly since that is literally all they do, everyday with hundreds of patients. I did one cycle with SGF and I didn't go into the nitty gritty details of the exact size of each follicle and I just let them do their work. The measurements are reviewed by your physician. If these sort of details are important to you, perhaps communicate with your physician and express your concern.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I understand and share you concern regarding the follicle count when you have lower numbers like that bc ive been in the same boat. I just learned this cycle (my 3rd) that your body produces new follicles throughout your cycle so that could be the reason for the larger number at the last appt (but not for the random dip in the middle). The key thing is that they have to trigger when the leading follicles are ready to go so sometimes those late developing ones wont be ready in time. I have also struggled with getting precise information (exact follicle counts and measurements or embryo cell counts or grading) and clear explanations about what is happening. It drives me nuts when I hear medical professionals spout back those truisms that lay people use "it only takes one," etc.

OP here - thank you. It is comforting to know I am not the only one who feels this way. Were you with SGF or elsewhere? I am trying to gauge if this the case across the clinics or just at SGF. I think that proper medications dosing, precise monitoring, and good lab are keys to success. From what I understand from PP before you monitoring at GW might be of better quality. I am wondering if they are as good with medications dosing and lab protocols. Before switching over I want to make sure I am not going to another place that does not place emphasis on what matters to me.

It takes more than that for success.

I'm not sure how many cycles you have gone through with SGF. You seem fixated with the monitoring at SGF and think that having doctors monitor makes a difference. I truly don't think they hire technicians who are unable to measure correctly since that is literally all they do, everyday with hundreds of patients. I did one cycle with SGF and I didn't go into the nitty gritty details of the exact size of each follicle and I just let them do their work. The measurements are reviewed by your physician. If these sort of details are important to you, perhaps communicate with your physician and express your concern.

Op here - I am glad you had good experience. Having said that if you did not have a small follicle cohort like me than things that I am "fixated on" don't matter to you. But they matter a great deal to me, since every follicle is extremely valuable and it has to meet SGF's requirement of being 18mm on retrieval day. So, yes, this is huge for me. If you have a ton of follicles than I agree that measuring doesn't matter as much. Not all of us have that. It's easy to be judgmental when you are not in another person's shoes.

[Anonymous]

Anonymous wrote:What makes you think they aren't being accurate and precise?

I've been told that there is a margin of error up to 2mm. Also, some technicians don't see follicles that were there yesterday or day before. As someone mentioned, it could be full bowels or gas obstructing the view. I feel they should use more than 5 minutes in effort to "find" follicles. They should also look at previous results to be able to compare their own finding.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I understand and share you concern regarding the follicle count when you have lower numbers like that bc ive been in the same boat. I just learned this cycle (my 3rd) that your body produces new follicles throughout your cycle so that could be the reason for the larger number at the last appt (but not for the random dip in the middle). The key thing is that they have to trigger when the leading follicles are ready to go so sometimes those late developing ones wont be ready in time. I have also struggled with getting precise information (exact follicle counts and measurements or embryo cell counts or grading) and clear explanations about what is happening. It drives me nuts when I hear medical professionals spout back those truisms that lay people use "it only takes one," etc.

OP here - thank you. It is comforting to know I am not the only one who feels this way. Were you with SGF or elsewhere? I am trying to gauge if this the case across the clinics or just at SGF. I think that proper medications dosing, precise monitoring, and good lab are keys to success. From what I understand from PP before you monitoring at GW might be of better quality. I am wondering if they are as good with medications dosing and lab protocols. Before switching over I want to make sure I am not going to another place that does not place emphasis on what matters to me.

I used Columbia fert for IVF but SGF for IUIs. At Columbia your Dr (not rotating Drs) does all monitoring but I found Dr. Sacks glossed over precise numbers. I found that at most practices — even when news was not terrific I wanted to know bc information helped me manage expectations.

Op here - I agree with you. I also want precise information from cycle to cycle so I can gauge my response to medications and manage my expectations. We are after all paying a ton of money to these clinics, we are customers and for that we should get the most accurate information. I am not getting anything for free, so no one should be glossing over any information.

[Anonymous]

Intra- and inter-observer reliability in follicle measurements is quite good -- upwards of 0.8. Further, the most important parameter is lead follicle size, and I suspect inter-observer reliability is even better for that single (pair) of measurements. Retrieval is under ultrasound guidance. The doctor will aspirate every follicle seen that day, of whatever size. I would not worry too much about this.

[Anonymous]

don't they still give you the little printouts wit your follicle measurements at sg?