Anonymous wrote:What is close monitoring? Do they do u/s everyday and will I be required to stay in NY?
My recent testing is from last year before first ivf and during then thyroid was in range. 2.4 or so. But it was not as low as 1-2. Laparoscopy indicated no endometriosis but this was at least 1 year ago.

Anonymous wrote:But frankly at this point I'd just push to see Davis at Cornell.

Anonymous wrote:

Anonymous wrote:OP, in your situation I would do the following in parallel:
- use one of the local clinics to do immune testing - I believe Dr. Frankfurter is the only one locally who will do this?
- have your DH start antioxidants ASAP - they take 3 months to fully help. something like Proceptin. This helps with variety of MF issues.
- schedule apt with Dr. Davis at Cornell - he is guru for AMA

Have you had a recent lap/hysteroscopy? Chance of any remaining scar tissue from your surgeries? Any concerns about endometriosis?

To optimize chances (based on research studies) I'd do acupuncture before/after transfer and also try to have some kind of endometrial biopsy done the cycle before you start - co-culture counts.

To answer your question - Cornell very closely monitors/fine tunes your cycle. Great lab (they say to look at DE cycle stats to get a feel for lab quality). Really brilliant team working on your case. This is group that invented ICSI, co-culture, creative protocols (EPP, etc).

Good luck, OP.

This is good advice, but I think Dr. Abbasi is the local RE known for immune testing.

Anonymous wrote:OP, in your situation I would do the following in parallel:
- use one of the local clinics to do immune testing - I believe Dr. Frankfurter is the only one locally who will do this?
- have your DH start antioxidants ASAP - they take 3 months to fully help. something like Proceptin. This helps with variety of MF issues.
- schedule apt with Dr. Davis at Cornell - he is guru for AMA

Have you had a recent lap/hysteroscopy? Chance of any remaining scar tissue from your surgeries? Any concerns about endometriosis?

To optimize chances (based on research studies) I'd do acupuncture before/after transfer and also try to have some kind of endometrial biopsy done the cycle before you start - co-culture counts.

To answer your question - Cornell very closely monitors/fine tunes your cycle. Great lab (they say to look at DE cycle stats to get a feel for lab quality). Really brilliant team working on your case. This is group that invented ICSI, co-culture, creative protocols (EPP, etc).

Good luck, OP.

Anonymous wrote:

Anonymous wrote:From what I've heard re CCRM, the big difference is actually the lab. I have DOR, so the expected yield from any given cycle is pretty low. They claim that better embryologists = better embryos = higher likelihood of success, even if you don't retrieve many eggs. They also recommend that almost everyone do CCS/PGD, so almost all their transfers are of chromosomally normal blasts, which produces a higher success rate and a lower rate of miscarriage.

From my own experience with a local clinic vs CCRM, I think the superiority of the lab, the transfer protocols, and the criteria the clinic applies to which embryos are suitable for transfer are the big differences.

I am a high responder due to PCOS, with 1 kid naturally conceived, but then experienced secondary infertility. Local RE thought it would be a cakewalk, used a well-established protocol, and we had great results: 21 eggs retrieved, 18 mature, 13 fertilized, 7 grew to blasts and were biopsied on Day 5 for CGH testing, 2 normal. 1 fresh and 1 frozen SET. Both BFN.
The transfer protocols consisted of pretty much natural monitoring to find the optimal transfer day, 15 minutes lying down after the transfer, progesterone suppositories, and that's it. Both times I started spotting a couple of days before the beta test.

Second cycle off to CCRM 8 months later(I didn't feel like rolling the dice with the locals again, was approaching 40, and could afford out of pocket cycle with CCRM so went ahead). Exact same stim protocol, I mean literally, maybe one of the meds differed by a few units. Somewhat worse showing, some of it may have been due to my husband's numbers dramatically plummeting between the local and CCRM . 18 retrieved, 13 mature, 10 fertilized, 4 grew to blasts and biopsied, all of them on Day 6 on top of everything, 1 normal. At this point I felt like I had pissed a bunch of money down. This is where the differences between the two clinics became very obvious. CCRM does medicated transfers with ridiculously close monitoring. Recommended acupuncture (very specific electro-acupuncture treatment based on one specific paper), which I did religiously. Also recommended acupuncture immediately before and after transfer (done on site at their clinic), very specific progesterone supplementation (shots and suppositories), which continues after transfer, low dose steroid, antibiotic, complete bed rest without elevating your head above 45 degrees for 2 days, no lifting of anything heavy, no exercise where your heart rate exceeds 140, etc. etc. it was unbelievably prescriptive and restrictive. Since it was my only normal embryo, and the cycle cost so much, and I really wanted to avoid another cycle, I followed everything to the t, even though I really didn't believe it will work. Lo and behold, BFP, and on top of it embryo split so twins. To this day they call me the lady with the 2-for-1 deal.

It is impossible to tell which part made the difference, and no one person can conduct a controlled experiment to say. But there are a couple of other distinguishing characteristics between my local clinic and CCRM. The first is CCRM has strict criteria on which grade embryo they will transfer and which they won't, and don't allow patients any choice (e.g. for gender). Local clinic has the philosophy of "I know women who have gotten pregnant with a D-grade embryo so who am I to take away that chance." This is a fundamental difference that, as long as there is correlation between embryo grading and implantation rate, will obviously produce higher success rates for CCRM. And the higher success rates are there not only for the frozen transfers (most of which are CGH-normal embryos), but also for the fresh (none of which are CGH-tested embryos). The second difference is that CCRM collects and analyzes every data point, whereas the local clinic operates on anecdotes (even though they are big enough to have enough data for analysis.)

What is odd is that as a doctor, I much preferred my local RE than the CCRM one. But in IVF there is only one variable that counts when evaluating outcomes: pregnant or not.

Anonymous wrote:From what I've heard re CCRM, the big difference is actually the lab. I have DOR, so the expected yield from any given cycle is pretty low. They claim that better embryologists = better embryos = higher likelihood of success, even if you don't retrieve many eggs. They also recommend that almost everyone do CCS/PGD, so almost all their transfers are of chromosomally normal blasts, which produces a higher success rate and a lower rate of miscarriage.