I recommend a consult with Dr Davis at Cornell. He is the best doctor I've ever worked with.

Do not underestimate the value of a good lab and different monitoring. Local clinics are not in the same class as cornell and CCRM. Even if doing the same protocol it doesnt mean that the doctors won't adjust meds differently during the cycle. For difficult cases having an excellent lab is imperative. I failed 5 times locally and was told to do DE. 6th cycle at a top clinic worked.

This is 18:44 again. I am sorry that I am writing such long posts. I am not going to do a good job answering the question about why they didn't recommend using an agency because I don't remember that part of the conversation as well. (We were not going to use an agency anyway and there was so much information coming at me that I didn't attend as carefully to this part.) However, we are going back to meet with the social worker in a few weeks and I will ask this question to her specifically and post what she says since there seems to be some interest in the answer.

Let me just say that I am not trying to pass judgement on anyone's decision about whether or not to use an agency. I am just passing along an opinion that was given to me by someone who has worked in the field for many years and seen a lot of DE cycles. Everybody's decision is specific to her circumstances. To the OP - the social worker at Columbia did say that they have outreach programs in a number of minority communities in NYC to recruit specific ethnicities among their donors (she mentioned certain Asian communities, for example.) She also said that if they don't have a match already, they will put out feelers in those populations to see of they can find a better match. I got a really good vibe about their matching process. For practical reasons, I think you would only find something like this at one of the bigger clinics.

Basically, the doctor was stressing how comprehensive the screening process is for donors in their pool and how they have so many applicants (this is NYC) that they don't have to take anyone who has any potential problem in her physical or psychological work up. He also pointed out that at a place like Columbia that is not-for-profit there is no incentive to take someone on as a donor, while agencies have a financial incentive to keep people in the pool. He said that they do have people who decide to work with agencies and things work out fine, but often those donors don't have as many screenings or have things in their profiles that would have disqualified them from the Columbia pool (and often don't have comprehensive drug testing since not every agency requires it) --- and the recipient has to pay more money for the cycle. He wasn't saying that you can't get a great result using a donor agency, just that you are paying more (with the agency fee) and not getting a better outcome for the money. Also, at Columbia the in-house donors come in to take their meds and agency donors are often not local so they take the meds on their own and (sometimes) the recipient has to pay travel costs for them to come in for the retrieval. This is not usually a problem, but Columbia went to giving the donor meds at the clinic because they found that donors (especially second time donors) would sometimes alter their dosages if they wanted to change the retrieval day a little bit to make it more convenient (wanted/didn't want a weekend, for example.) I am sure this is rare, but common enough that a big clinic altered their policies to prevent it.

Anonymous wrote:18:44 - This is the OP here. Thanks for your post -- that was really helpful. I totally get where you are, and feel like we've had such similar experiences. Like you, I feel like I've gotten really good care from both of the local clinics I went to, and I am unfortunately just at the end of the bell curve. I have some background in statistics, so I understand that concept all too well. With all the different protocols I went through, I felt that my doctors had very good reason to recommend them. My body just didn't respond, and that's just my biology. My consultation with CCRM confirmed that they would have done the same protocols as well.

Out of curiosity, why did your doctor advise against donor agencies? I would prefer to choose from a clinic's donor pool, but I none of the DC clinics have someone of my ethnicity in the donor pool -- they are mostly caucasian women. That is essentially the only reason I am looking at a donor agency. Although, I suppose a clinic in the NY area may have a more diverse donor pool.

Have you checked out GIVF? Their donor pool is quite extensive.

18:44 - This is the OP here. Thanks for your post -- that was really helpful. I totally get where you are, and feel like we've had such similar experiences. Like you, I feel like I've gotten really good care from both of the local clinics I went to, and I am unfortunately just at the end of the bell curve. I have some background in statistics, so I understand that concept all too well. With all the different protocols I went through, I felt that my doctors had very good reason to recommend them. My body just didn't respond, and that's just my biology. My consultation with CCRM confirmed that they would have done the same protocols as well.

Out of curiosity, why did your doctor advise against donor agencies? I would prefer to choose from a clinic's donor pool, but I none of the DC clinics have someone of my ethnicity in the donor pool -- they are mostly caucasian women. That is essentially the only reason I am looking at a donor agency. Although, I suppose a clinic in the NY area may have a more diverse donor pool.

Sorry, that last post was for 18:44.

18:33 what are the arguments you heard against using an agency for DE?

new poster to this thread.

Agree 100% with going to SIRM. Also would consider GW for natural cycle IVF because Dominion has had their issues. GW is more organized and less "salesy" when it comes to pushing certain protocols. Sounds like your current clinic was just tossing jello to the wall to see what would stick with your protocols. Time to change for sure.

If we do another cycle it will likely be SIRM because Dr. Peters is an amazing doctor who gave us a 20 minute consult with about 10 years worth of info. it was unbelievable. He's that good.

This is 18:44 again.

I also wanted to mention something that Dr. Sauer told me about DOR that made me feel better. Baring a few rare and specific causes, DOR is essentially a symptom of early menopause. (POF, or Premature Ovarian Failure, is just DOR diagnosed after the fact instead of during the process. They are, in fact, the same except for semantics.) The age of truly diminished fertility where likelihood of conception is nil sits on a bell curve, with most women falling between 45 and 50. Correspondingly, the center of the bell curve for menopause is between 50 and 55. But, as with all bell curves, someone has to be at the extreme edges. Since fertility declines about three to five years before the onset of menopause, he said that if you took a random group of 500 women, there would always be one that aged out of fertility by thirty. It is just statistics.

This somehow made me feel better because it made me realize that I didn't do anything to cause this. I just naturally ended up on the extreme of one side of the fertility bell curve.

OP, our histories are uncannily similar. I am 36, started trying at 33, have DOR, did multiple rounds of IUI (with clomid and then stims) and four IVF cycles (all of them in the last year starting when I was 35.) Your response is a bit better than mine. I had three of the four rounds cancelled and one produced one egg, which fertilized but didn't implant. One of the canceled cycles was coverted to an IUI and I got pregnant but had a blighted ovum miscarriage at six weeks. We have no MF problems or implantation problems.

We also had full coverage for IVF with OE (very lucky) and have enough money to try DE (also very lucky, but it will be - and always is - out of pocket so not an inconsiderable expense.) We decided after our fourth round not to try again with my eggs. The success rate is 5-10% for people in my age range with DOR. With DE, the success rate is around 50% (and with likely FETs available and given our age is actually north of 75%.)

To answer your question, we just came to the conclusion that the toll of our unsuccessful journey through infertility was too high and successfully getting pregnant and getting out of this emotionally punishing cycle was much more important than genetics.

We were able to get a consultation with Dr. Sauer at Columbia-Presbyterian in NY and decided to do donor egg with him (likely to happen in April since it takes a few months for the process to be completed.) What I liked about him was that when we went to NY for our initial meeting, he spend about 45 minutes going over our chart (and we had done a consult with him about six months earlier so he was already familiar with the case) and he told me that he thought our clinic (GW) had done a really good job trying all possible protocol combinations. Ours is not a case of poor care. It's just not possible given the biology. He did find a few of my lab numbers that were within the normal range but they were trending unusually so we did a bunch of lab work to track down any undiagnosed problems. This was another thing that made me feel like he had really taken his time with my chart. Columbia has an amazing program, does a high number of DE cycles a year, has a great donor pool (he made a very compelling argument against using an agency), and they have all of their donors come in to the clinic everyday to get their meds so there are no mistakes.

Good luck with your decision and I hope we both have some long awaited luck in the new year.

Anonymous wrote:

Call SIRM. I seriously think they are the best. They will give you a free consult that will look at ALL your records and then give you an honest answer. You are still young and I bet you have some good eggs left. Hang in there. I was successful on my fifth at SIRM (well , first with SIRM, the other four were local. )



Which doctor/location did you go to? What did they do differently for you than local clinics?

I saw both Dr Corley and Dr Peters. They are both excellent. Dr Corley did my initial phone consult and immediately figured out that I was being given TOO MUCH LH when I was cycling. Too much LH can hurt egg quality. So they set me up on an individualized cycle where I was given the LH only every other day. So I went from having only 25% of my eggs fertilize too 100% fertilize. I was quite impressed with them. I think its worth calling them.

PP, what was your diagnosis and how old are you? Thanks!

Call SIRM. I seriously think they are the best. They will give you a free consult that will look at ALL your records and then give you an honest answer. You are still young and I bet you have some good eggs left. Hang in there. I was successful on my fifth at SIRM (well , first with SIRM, the other four were local. )



Which doctor/location did you go to? What did they do differently for you than local clinics?

I saw both Dr Corley and Dr Peters. They are both excellent. Dr Corley did my initial phone consult and immediately figured out that I was being given TOO MUCH LH when I was cycling. Too much LH can hurt egg quality. So they set me up on an individualized cycle where I was given the LH only every other day. So I went from having only 25% of my eggs fertilize too 100% fertilize. I was quite impressed with them. I think its worth calling them.

I was similar to you PP but I was 34 and had success at Cornell after 3 failed cycles at SG (last cycle only one embryo made it to day 3 and it was just 4 cells). Cornell used a different protocol (EPP) and co-culture. it was a night and day difference. transferred two and now have twins. But I hear you on not being able to afford both Cornell and DE. If you decide to do DE, yo won't regret it and you'll be so happy once you are a mom and you can put all this stuff behind you!!!!!!!!!

Thirty-six seems very young for an egg quality problem. OP, in your history of trying have you ever had a miscarriage or chemical pregnancy? Or has it pretty much been just BFNs?

15:44 - where did you do NCIVF? Is there any clinic besides Dominion that offers it as an option? What is the process like (how many visits, is the retrieval and transfer same as stimulated, etc)? I have to admit that part of the attraction of NCIVF is that it seems much less taxing on my body, whereas I am not sure I have the emotional energy to do another stimulated cycle.