Three failed rounds of IVF and time to talk to the doctor

[Anonymous]

8:26 again. We also talked about going to Sher in NYC. Dr. Wang...who I think has moved to NJ since my time...is supposed to be amazing. I heard great things about him.

[Anonymous]

Anonymous wrote:OP here: I think CFA is a definite for a second opinion. We are in MoCo, so Bethesda office it is.

I can't really see us doing Cornell (honestly it sounds exhausting to travel for treatment, but maybe I'm wrong?). Do you think it would be worth it to set up a phone consult anyway, just to see what they say?

One of the PPs here. I would do a consult with Abassi and if she doesn't click with you then go ahead with the phone consult. For my appointment with Abbasi I brought copies of all our test results. I also had spreadsheets of the failed cycles where I recorded the dosages of meds each day and the size and number of follicles. She looked over everything but still had me repeat the day 3 testing. Dr. Abbasi is a no-nonsense person and very direct. Don't let that intimidate you; ask questions no matter how simple and she will answer them.

[Anonymous]

Dr wang is in westchester now, and he's amazing!!

[Anonymous]

I just did a phone consult with Dr. Davis at Cornell and I can honestly say it was worth the $650 OOP. He has your records memorized, is no bs, and was very candid on what he would have changed in my last protocols. We do plan on using him later this summer, but another plus for him is he seems to recognize that a lot of people use him as a "troubleshooter," and doesn't pressure you to come to Cornell. He actually suggested I try something that would keep me in the DC areas for one more cycle (to save time and money, he said), and then if that fails, come to Cornell.

[Anonymous]

To the Abbassi poster with thyroid issues -- did Dr. Abbassi say anything about thyroid antibodies causing miscarriage? I am a new PP and am curious because my endo says I have Hashimoto's (with a just barely positive thyroid antibody test), but my actual thyroid function is fine, great even. Yet, I have had 3 miscarriages in a row (after a successful pregnancy 2 years ago).

I am with Shady Grove but they don't recommend IVF or indeed any intervention because I am able to get pregnant easily on my own -- just can't seem to sustain a pregnancy. My numbers all came back good with excellent ovarian reserve so they think it's just a "numbers game" and I should eventually hit on a good egg. How many miscarriage that will take is anyone's guess. And my endocrinologist says she would not treat me at all with the normal TSH and T4 tests.

Obviously I would like to trust them both, particularly as they are offering complementary thoughts. And we may try Clomid or Letrozole (with RE's blessing) since I have long and irregular cycles (35 to 45 days) and at least that would increase the number of chances to try. But are we missing some key thyroid connection even though my thyroid function seems ok?

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here: I think CFA is a definite for a second opinion. We are in MoCo, so Bethesda office it is.

I can't really see us doing Cornell (honestly it sounds exhausting to travel for treatment, but maybe I'm wrong?). Do you think it would be worth it to set up a phone consult anyway, just to see what they say?

One of the PPs here. I would do a consult with Abassi and if she doesn't click with you then go ahead with the phone consult. For my appointment with Abbasi I brought copies of all our test results. I also had spreadsheets of the failed cycles where I recorded the dosages of meds each day and the size and number of follicles. She looked over everything but still had me repeat the day 3 testing. Dr. Abbasi is a no-nonsense person and very direct. Don't let that intimidate you; ask questions no matter how simple and she will answer them.

I had the same experience with Abbasi as PP (and success). She really is no nonsense but gets the job done. I think she is pretty amazing since she is one of the only older female REs or maybe the only older female RE in the area.

[Anonymous]

Anonymous wrote:To the Abbassi poster with thyroid issues -- did Dr. Abbassi say anything about thyroid antibodies causing miscarriage? I am a new PP and am curious because my endo says I have Hashimoto's (with a just barely positive thyroid antibody test), but my actual thyroid function is fine, great even. Yet, I have had 3 miscarriages in a row (after a successful pregnancy 2 years ago).

I am with Shady Grove but they don't recommend IVF or indeed any intervention because I am able to get pregnant easily on my own -- just can't seem to sustain a pregnancy. My numbers all came back good with excellent ovarian reserve so they think it's just a "numbers game" and I should eventually hit on a good egg. How many miscarriage that will take is anyone's guess. And my endocrinologist says she would not treat me at all with the normal TSH and T4 tests.

Obviously I would like to trust them both, particularly as they are offering complementary thoughts. And we may try Clomid or Letrozole (with RE's blessing) since I have long and irregular cycles (35 to 45 days) and at least that would increase the number of chances to try. But are we missing some key thyroid connection even though my thyroid function seems ok?

PP here with Hashis and who went from SG to Abbasi: If you have antithyroid antibodies (Hashis), you are a higher risk for a miscarriage than someone who does not have Hashis. My endocrinologist told me there was one study that was well done that showed a correlation. I would caution you that you might have other immunological issues and you might want a full immuno and blood clotting panel done. Most people with Hashis have other immune issues as well.

[Anonymous]

Anonymous wrote:

Anonymous wrote:To the Abbassi poster with thyroid issues -- did Dr. Abbassi say anything about thyroid antibodies causing miscarriage? I am a new PP and am curious because my endo says I have Hashimoto's (with a just barely positive thyroid antibody test), but my actual thyroid function is fine, great even. Yet, I have had 3 miscarriages in a row (after a successful pregnancy 2 years ago).

I am with Shady Grove but they don't recommend IVF or indeed any intervention because I am able to get pregnant easily on my own -- just can't seem to sustain a pregnancy. My numbers all came back good with excellent ovarian reserve so they think it's just a "numbers game" and I should eventually hit on a good egg. How many miscarriage that will take is anyone's guess. And my endocrinologist says she would not treat me at all with the normal TSH and T4 tests.

Obviously I would like to trust them both, particularly as they are offering complementary thoughts. And we may try Clomid or Letrozole (with RE's blessing) since I have long and irregular cycles (35 to 45 days) and at least that would increase the number of chances to try. But are we missing some key thyroid connection even though my thyroid function seems ok?

PP here with Hashis and who went from SG to Abbasi: If you have antithyroid antibodies (Hashis), you are a higher risk for a miscarriage than someone who does not have Hashis. My endocrinologist told me there was one study that was well done that showed a correlation. I would caution you that you might have other immunological issues and you might want a full immuno and blood clotting panel done. Most people with Hashis have other immune issues as well.

Thanks. I had the recurrent loss panel done which included lupus and blood clotting tests, and all were negative. This was of particular interest to me since my mother has lupus and clotting issues. But apparently I do not. I don't think anyone has mentioned immunological issues to me, though. Can you expound on those a bit more?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To the Abbassi poster with thyroid issues -- did Dr. Abbassi say anything about thyroid antibodies causing miscarriage? I am a new PP and am curious because my endo says I have Hashimoto's (with a just barely positive thyroid antibody test), but my actual thyroid function is fine, great even. Yet, I have had 3 miscarriages in a row (after a successful pregnancy 2 years ago).

I am with Shady Grove but they don't recommend IVF or indeed any intervention because I am able to get pregnant easily on my own -- just can't seem to sustain a pregnancy. My numbers all came back good with excellent ovarian reserve so they think it's just a "numbers game" and I should eventually hit on a good egg. How many miscarriage that will take is anyone's guess. And my endocrinologist says she would not treat me at all with the normal TSH and T4 tests.

Obviously I would like to trust them both, particularly as they are offering complementary thoughts. And we may try Clomid or Letrozole (with RE's blessing) since I have long and irregular cycles (35 to 45 days) and at least that would increase the number of chances to try. But are we missing some key thyroid connection even though my thyroid function seems ok?

PP here with Hashis and who went from SG to Abbasi: If you have antithyroid antibodies (Hashis), you are a higher risk for a miscarriage than someone who does not have Hashis. My endocrinologist told me there was one study that was well done that showed a correlation. I would caution you that you might have other immunological issues and you might want a full immuno and blood clotting panel done. Most people with Hashis have other immune issues as well.

Thanks. I had the recurrent loss panel done which included lupus and blood clotting tests, and all were negative. This was of particular interest to me since my mother has lupus and clotting issues. But apparently I do not. I don't think anyone has mentioned immunological issues to me, though. Can you expound on those a bit more?

NP. Thyroid, immune and blood clotting issues can all develop later on in life and get progressively worse over time. So just because you don't have these issues now doesn't mean they won't manifest themselves in the future. How old was your mother when she discovered she had lupus and clotting issues? If she's your birth mother then she obviously was able to sustain a pregnancy at some point in her life. Have you ever asked her whether she had miscarriages?

Is your endo putting you on synthroid.? Even if you have a "barely positive" thyroid antibody test you should be on synthroid or its generic version if you want to get pregnant. The theory is that thyroid antibodies attack the embryo as a foreign infection leading to chemical pregnancies or miscarriage, so you need to get rid of these antibodies.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To the Abbassi poster with thyroid issues -- did Dr. Abbassi say anything about thyroid antibodies causing miscarriage? I am a new PP and am curious because my endo says I have Hashimoto's (with a just barely positive thyroid antibody test), but my actual thyroid function is fine, great even. Yet, I have had 3 miscarriages in a row (after a successful pregnancy 2 years ago).

I am with Shady Grove but they don't recommend IVF or indeed any intervention because I am able to get pregnant easily on my own -- just can't seem to sustain a pregnancy. My numbers all came back good with excellent ovarian reserve so they think it's just a "numbers game" and I should eventually hit on a good egg. How many miscarriage that will take is anyone's guess. And my endocrinologist says she would not treat me at all with the normal TSH and T4 tests.

Obviously I would like to trust them both, particularly as they are offering complementary thoughts. And we may try Clomid or Letrozole (with RE's blessing) since I have long and irregular cycles (35 to 45 days) and at least that would increase the number of chances to try. But are we missing some key thyroid connection even though my thyroid function seems ok?

PP here with Hashis and who went from SG to Abbasi: If you have antithyroid antibodies (Hashis), you are a higher risk for a miscarriage than someone who does not have Hashis. My endocrinologist told me there was one study that was well done that showed a correlation. I would caution you that you might have other immunological issues and you might want a full immuno and blood clotting panel done. Most people with Hashis have other immune issues as well.

Thanks. I had the recurrent loss panel done which included lupus and blood clotting tests, and all were negative. This was of particular interest to me since my mother has lupus and clotting issues. But apparently I do not. I don't think anyone has mentioned immunological issues to me, though. Can you expound on those a bit more?

NP. Thyroid, immune and blood clotting issues can all develop later on in life and get progressively worse over time. So just because you don't have these issues now doesn't mean they won't manifest themselves in the future. How old was your mother when she discovered she had lupus and clotting issues? If she's your birth mother then she obviously was able to sustain a pregnancy at some point in her life. Have you ever asked her whether she had miscarriages?

Is your endo putting you on synthroid.? Even if you have a "barely positive" thyroid antibody test you should be on synthroid or its generic version if you want to get pregnant. The theory is that thyroid antibodies attack the embryo as a foreign infection leading to chemical pregnancies or miscarriage, so you need to get rid of these antibodies.

Endo (Dr. Ahmed in Bethesda, who I believe is well respected on this board) said I don't need synthroid because my TSH and T4 tests are excellent so whatever is causing the miscarriages, it's not my thyroid. RE says I don't need treatment of any kind because I have great ovarian reserve but she's willing to try Clomid if I want.

My mother discovered she had lupus at age 22. She had me at age 34, my sibling at age 36, and a second-trimester miscarriage at age 43. She did have trouble getting pregnant between ages 28 and 34 but eventually got pregnant with me and had uneventful pregnancies (except for the miscarriage which could just as well have been age related). She discovered the clotting issues when she was about 50 -- got a DVT after an international plane flight. She also has rheumatoid arthritis and Sjogrens and those seem to be more recent developments, but it's hard to say because the world of autoimmune diseases keeps getting more refined.

I am 35 and thank G-d have never had any health issues. I had my son at 33, no problems. Got pregnant on the first try at 34, miscarried. Pregnant twice more at 35, miscarried both. The lupus and other tests I had were 2 months ago, after my first 2 miscarriages.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To the Abbassi poster with thyroid issues -- did Dr. Abbassi say anything about thyroid antibodies causing miscarriage? I am a new PP and am curious because my endo says I have Hashimoto's (with a just barely positive thyroid antibody test), but my actual thyroid function is fine, great even. Yet, I have had 3 miscarriages in a row (after a successful pregnancy 2 years ago).

I am with Shady Grove but they don't recommend IVF or indeed any intervention because I am able to get pregnant easily on my own -- just can't seem to sustain a pregnancy. My numbers all came back good with excellent ovarian reserve so they think it's just a "numbers game" and I should eventually hit on a good egg. How many miscarriage that will take is anyone's guess. And my endocrinologist says she would not treat me at all with the normal TSH and T4 tests.

Obviously I would like to trust them both, particularly as they are offering complementary thoughts. And we may try Clomid or Letrozole (with RE's blessing) since I have long and irregular cycles (35 to 45 days) and at least that would increase the number of chances to try. But are we missing some key thyroid connection even though my thyroid function seems ok?

PP here with Hashis and who went from SG to Abbasi: If you have antithyroid antibodies (Hashis), you are a higher risk for a miscarriage than someone who does not have Hashis. My endocrinologist told me there was one study that was well done that showed a correlation. I would caution you that you might have other immunological issues and you might want a full immuno and blood clotting panel done. Most people with Hashis have other immune issues as well.

Thanks. I had the recurrent loss panel done which included lupus and blood clotting tests, and all were negative. This was of particular interest to me since my mother has lupus and clotting issues. But apparently I do not. I don't think anyone has mentioned immunological issues to me, though. Can you expound on those a bit more?

NP. Thyroid, immune and blood clotting issues can all develop later on in life and get progressively worse over time. So just because you don't have these issues now doesn't mean they won't manifest themselves in the future. How old was your mother when she discovered she had lupus and clotting issues? If she's your birth mother then she obviously was able to sustain a pregnancy at some point in her life. Have you ever asked her whether she had miscarriages?

Is your endo putting you on synthroid.? Even if you have a "barely positive" thyroid antibody test you should be on synthroid or its generic version if you want to get pregnant. The theory is that thyroid antibodies attack the embryo as a foreign infection leading to chemical pregnancies or miscarriage, so you need to get rid of these antibodies.

Endo (Dr. Ahmed in Bethesda, who I believe is well respected on this board) said I don't need synthroid because my TSH and T4 tests are excellent so whatever is causing the miscarriages, it's not my thyroid. RE says I don't need treatment of any kind because I have great ovarian reserve but she's willing to try Clomid if I want.

My mother discovered she had lupus at age 22. She had me at age 34, my sibling at age 36, and a second-trimester miscarriage at age 43. She did have trouble getting pregnant between ages 28 and 34 but eventually got pregnant with me and had uneventful pregnancies (except for the miscarriage which could just as well have been age related). She discovered the clotting issues when she was about 50 -- got a DVT after an international plane flight. She also has rheumatoid arthritis and Sjogrens and those seem to be more recent developments, but it's hard to say because the world of autoimmune diseases keeps getting more refined.

I am 35 and thank G-d have never had any health issues. I had my son at 33, no problems. Got pregnant on the first try at 34, miscarried. Pregnant twice more at 35, miscarried both. The lupus and other tests I had were 2 months ago, after my first 2 miscarriages.

Get a second opinion with Dr. Linda Liu in Rockville. She's an endocrinologist who works with fertility patients.

[Anonymous]

Anonymous wrote:
My mother discovered she had lupus at age 22. She had me at age 34, my sibling at age 36, and a second-trimester miscarriage at age 43. She did have trouble getting pregnant between ages 28 and 34 but eventually got pregnant with me and had uneventful pregnancies (except for the miscarriage which could just as well have been age related). She discovered the clotting issues when she was about 50 -- got a DVT after an international plane flight. She also has rheumatoid arthritis and Sjogrens and those seem to be more recent developments, but it's hard to say because the world of autoimmune diseases keeps getting more refined.

I am 35 and thank G-d have never had any health issues. I had my son at 33, no problems. Got pregnant on the first try at 34, miscarried. Pregnant twice more at 35, miscarried both. The lupus and other tests I had were 2 months ago, after my first 2 miscarriages.

Get a second opinion with Dr. Linda Liu in Rockville. She's an endocrinologist who works with fertility patients.

Thanks. (And sorry if I'm hijacking the thread but hopefully the thyroid stuff will be of use to someone else as well.) Dr. Ahmed actually was the second opinion. I originally saw Dr. Liu and she looked at my prior test results, did a physical exam, and said I was fine. Dr. Ahmed wanted to run the tests again since I had been pregnant (with miscarriage #2) at the time they were originally done and she said pregnancy may suppress thyroid antibodies. (She also did a physical exam and pronounced me fine.) When the tests were run again after the second miscarriage, the antibody levels were slightly elevated (126 when normal scale is 0-100). All other results were good.

All the docs are telling me I'm fine and I certainly hope I am. I don't want to take anything if I don't have to. My fear is that they're telling me I'm fine and I'm really not and will just keep having miscarriage after miscarriage. But I don't know how to get around that short of turning into the patient who demands meds -- which I don't want if I don't need them.

[Anonymous]

OP how are your periods? They should be fresh red blood. Have you tried acupuncture? Even though your husband has mf you might need to optimize your uterine environment. My acupuncturist likened it to having healthy soil for the embryo to thrive. Good luck! I know you are young but don't wait too long for a second opinion.

[Anonymous]

Anonymous wrote:OP how are your periods? They should be fresh red blood. Have you tried acupuncture? Even though your husband has mf you might need to optimize your uterine environment. My acupuncturist likened it to having healthy soil for the embryo to thrive. Good luck! I know you are young but don't wait too long for a second opinion.

Periods are fine as far as I can tell; I've never really thought about it. I tried acupuncture twice and wasn't a fan. I'm not young, I'm 35, so officially advanced maternal age. I'm planning to make some phone calls on Monday.

[Anonymous]

PP with Hashis and had success with Abbasi--before I get into immune issues: I got to Dr. Ahmed as well. She didn't want to medicate me but Abbasi said she would touch me unless I was on synthroid. I was given the smallest dose for my cycle.

As for immune issues: your Mother had too many autoimmune diseases and clotting issues for you not to be tested! I realize you probably had clotting done, but go see Abbasi and get the Beers tests. Basically if you have one autoimmune disorder (like Hashis), you are likely to have other (like your mother). The idea is that certain immune responses attack the embie, either preventing implantation or causing a miscarriage. These immune responses are from natural killer cells, APA and ANA antibodies, cytokines, and HLA matches. Basically it can be as simple as you got a virus that triggered these immune responses. The treatment is often baby aspiring, IVIg or interlipids, and/or a steriod along with an antibiotic.
There is more to this...I feel like I am forgetting something. I will post whhen I remember it!