Anonymous wrote:So I guess I will try to loose as much weight as possible and stick with CFA. I want to try NC in January/Feb.

OP Here, so the nurse that was responding to me, forwarded my emails to Dr. Gordon at Dominion. Below is the email string:


On November 2, 2012, dr.gordon@dominionfertility.com wrote:

Hi Lxxx,

Robin sent me your email chain and there are really 2 separate issues here to discuss.

The first issue is whether NC IVF has an advantage over IUI in your case given your past success with the CC/Ovidrel/IUI. There has not been a randomized controlled trial looking at NC IVF vs. CC/IUI or FSH/IUI in a patient with patent tubes and no sperm issue plus previous success. I would guess that NC IVF would yield similar success rates. However, we certainly have seen patients get pregnant with NC IVF after failing to conceive with IUI. So in your case I guess it comes down to how you want to spend your resources....financial, emotional and physical.

The second issue is regarding the issue of your increased BMI. Would we prefer you to be 100 pounds lighter? Absolutely. Is that possible? Probably not without gastric bypass surgery. Clearly there are increased rates of miscarriage, stillbirth, C/S and pregnancy induced hypertension in patients who have a high BMI. What I have decided to do in such cases is to discuss the issue frankly with the patient and I have now started suggesting a preconception counseling session with a MFM specialist so the patient has got the facts straight. In some cases, the patient really cannot safely undergo an egg collection in our office because of the risk of delivering anesthetic....so those patients must seek care elsewhere.

Hope this is helpful.

Good luck

DrG

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On Nov 2, 2012, at 11:33 AM, lxxx hxxxxt wrote:

Hi DrG,

Thank you so much for your quick response. Although disappointing , I appreciate the honesty. One last question...From my research I have found that Domion is the most experienced doing NCIVF and have done the most cycles in this area. But based on your response to my situation, I would not be an acceptable patient for you to treat---so that being said, if go to another clinic that offers NCIVF and they say "Hey your weight's no big deal, we can do NCIVF on you no problem!" Should I not trust them/take them with a grain of salt and know that I'm probably setting myself up for failure?

I know you probably don't want to make judgement regarding another clinic's ethics but I know Dominion's reputation on in this area, I value any information you can offer.

Again, I really appreciate your response.


Best Regards,
Lxxx Hxxxxt

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Hi Lxxx,

Well again the question first of all remains why do NC IVF given recent near miss with IUI? Also your weight needs to be considered in concert with your height...are you 5'2" or 5'11'' ..that makes a big difference as well.

You are correct in stating that we have the biggest experience with NC IVF....It is not that difficult a procedure but really the issue is that the clinic needs to really believe in that approach and not just do hand waving...

Weight is such a tough issue to discuss with patients. Just want everyone to be on the same page in understanding the risks involved....

Good luck

DrG

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So I just wanted to let everyone one know that the folks at Dominion did respond with a more helpful information which I greatly appreciate. It was really great that DrG took the time to be so responsive.....But it looks like they are still out.

GW also does NCIVF and they will take tough cases that other clinics would not consider. I don't know their policies on BMI though. It's worth a call.

My bigger concern is your age. Do you know at what age your mom went through menopause? It's likely that your fertility will start declining around 5 or so years before that. The irregular periods can be a sign of perimenopause too, even if your blood work seems fine. For most women fertility declines sharply after 40. 42 seems to be the point where things really start to fall apart for most women too. If money is really tight, you might just keep TTC on your own.

OP, thats so odd that Dominion just gave you a form response like that. I am a patient of theirs..do not have weight issues, but I have dealt with them for a while and have NEVER heard of a Robin. The IVF nurse is Natalie and then there are the doctors. For sure, maybe she is new, or just someone I haven't come in contact with, but as another poster mentioned, there are people of all shapes and ages there. I am no spring chicken myself.

I don't blame you at all if you are put off with them, I probably would be. If you have it in you, call them and just ask for a consult. I see Gordon and he is great. Honest, but nice and very open to the patients ideas and gut feelings about what is best for them. I push him quite a bit and he (to my face at least!) is always pleasant. I am just surprised at the blanket statements you received.

Best of luck, this is not an easy journey.

I'm surprised that they take such a firm stance on the BMI. I'm sorry, I'm sure it's frustrating. You might be able to lose quite a bit of weight quickly with significant dietary changes though. I cut out gluten, dairy, sugar, red meat, caffeine, and processed foods. I'm eating plenty but the weight is falling off and I don't crave any of the food I've cut out. It's a bit of a pain but might be worth a try- I feel so much better from it.

That's a shame. I too really appreciated that Columbia Fertility was willing to work with me when Shady Grove wouldn't (because of age and high fsh).

OP I am in a similar situation and have tried everything to lose weight, but my BMI is around 38. My RE at SGF refused to let me do IVF and every time I saw my ob she lectured me on the risks of pregnancy for me. It's so frustrating

So I guess I will try to loose as much weight as possible and stick with CFA. I want to try NC in January/Feb.

OP back, well Dominion is out for me. I sent another email and this is what I got back:


"Hi XXX,
Our physicians feel strongly that patients should be as healthy as possible for pregnancy, and being overweight does increase your risk for pregnancy related complications. Therefore, they would not treat you until your BMI was close to 30, and they would probably agree with your current RE that you should continue the Metformin to regulate your cycle.


Robin R.N.
Dominion Fertility
46 S. Glebe Road
Arlington, VA 22204
703 920-3890


On November 2, 2012 13:47:58 WET, <lh@!!!.com> wrote:


Hi Robin,

Thank you for responding to my question.

Your answer seems very firm, based on that would Dominion not consider me at all for NCIVF? I mean should I not even explore a consultation with the physicians at Dominion?

Again, I appreciate your answer, I just want to know if it is a hard and fast rule or just a "guideline". I have heard that Dominion has the most experience with this procedure and I would much rather attempt it with Domion than with other clinics that offer it.

Any assistance would be greatly appreciated.

LH

Go in and have the consult. You can always go back to CFA.

OP Here,

I sent a question (basically exactly what I postedhere except for the already at CFA part to dominion Fertility via their Naturalcycleivf.com website. I got this basic response back:

"Dear XXX,
Thank you for contacting Dominion Fertility, our physicians follow ASRM (American Society for Reproductive Medicine) guidelines which recommend patients have a BMI less than 30 for IVF treatment.


Robin XXXX R.N.
Dominion Fertility
46 S. Glebe Road
Arlington, VA 22204
703 920-3890"

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So should I go further and actually get an consult with one of the DOCTORS? I find it odd that the nurse responder did not even recommend anything like "Hey these are the guidelines, but come in anyway for a consult to talk to the doctor..."

Of should I just stick with CFA, who I know doesn't haven't an issue with my weight?

Definitely try NC IVF, and don't wait another few months please. Just get in there and go. Take a month off from the clomid. Good luck!

My insurance covered the consult and testing for NCIVF, but not the actual procedure, which is $4400 + $500 if you need assisted hatching.

If you have to choose between NCIVF or IUI and you are paying out of pocket go with the NCIVF. My case is similar to you and I did 6 IUI and no BFP and no explanation why. All numbers are good. Insurance pays for IUI but not IVF any form.

Dominion does not take my insurance at all and I want to do NCIVF but everything will cost including first Consult $350 and testing $2800 then NCIVG $5000. Columbia is with insurance but they say that NCIVF takes about three rounds which equals one regular IVF.

Weight - they would like to see down but don't seem to be as focused on that or mention it as a deterent.

I really want Dominion because of experience as it seems CFA and SG seem to offer NCIVF recently.

I don't think weight is an issue for NCIVf but I don't know for sure since I do not have that exact issue. What I can tell you is that some of the women I have seen in the waiting room during monitoring hours are larger/ obese and older- some look over 300 lbs and some look almost 50 to me but what do I know...

Why not get a consult- it is free, you could also email them or post on the fertile thoughts website. Often the doctors answer questions of people who are obviously not current patients. Also, look at Dominion's website the have a lot of information on NC IVF. Certainly trying to lose weight and cleaning up your diet won't hurt your chances. You do get a portion of the 5K refunded if you don't make it through the entire process. If you have a premature LH surge you get approximatly $3,500 refunded or a credit going forward. NC IVF is very easy. There is am monitoring but if a cyle is cancelled you can start right over again the next month. Good luck to you!

I am so waiting for you to get responses as this is very similar to my situation too. Good luck!!

I just want some opinions here.

I am 42.5, have one DD concieved 9 years ago. Been trying to concieve for a little over 2 years. This past February, I did get pregnant via IUI but MC after 8 weeks. My cycles are exactly 28 days, but I am on Metformin 1500mg qid, which I think is why this occurs. Prior to Metformin I did not have regular cycles. AMH .225, but FSH is usually between 4-7 every month.


I have been on clomid/timed intercourse last 2 cycles with monitoring and I always produce follicles in the 18-21mm range. This month I switched to letrezole because clomid was destroying my cervical mucus. So I am in the 2ww right now. But I don't think I had enoughtg sex this month, so I don't have my hopes up.



So I am considering NCIVF in January. Here are my issues. I am obese. Weight 289lbs. I am activiely trying to lose weight. Hoepfully loose about 15lbs by January.

Based on my issues, should I even try NCIVF based on my weight and age? Is weight a concern in the NCIVF process?

I'm currently at CFA, but based on the reputation of Dominion, I am going to switch to Domninion for the NCIVF cycle. But that also make me nervous. I have been with CFA all this time and they do NCIVF--should I switch or should I stick with the place I've been with and know my history?

I can not afford full IVF and actually NCIVF is a real stretch of my families finances. I am just wondering that with my weight issues in combination with my age should I spend this $5000 on NCIVF or should I try a few cycles of inj IUI cycles? What would be better?