Anonymous wrote:Given that only one doctor suspects immune issues and others (including Cornell, which is a leader in the field of IVF) don't think immune issues are at play, why not listen to the majority of doctors? You haven't mentioned finances, but if I were you I would either do the two cycle package at SG or go to Cornell. It seems like your eggs aren't great based on your stats and your response to the stims for the IUIs so I don't see a reason to suspect immune issues at this point. At 38, it is much more likely to be your age/egg quality (sorry).

OP here. Yes, I agree that what you're saying could be a good approach but the other issue is the IVF protocol type. The Drs. also differ in which protocol they think would be best for me with standard IVF. Shady Grove says long lupron and says they would not recommend estrogen priming. Cornell disagrees and says estrogen priming. GW also agrees with Cornell. Dominion did not recommend natural cycle IVF. That also makes it hard to decide what to do.

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Anonymous wrote:Lovenox is not a drug to be taken just in case it may help - it has pretty serious risks associated with it. That may be true for the other drugs too

OP has test results that would specifically indicate whether or not it's needed.

This. People act like immune and clotting treatments are voodoo. They're not. Doctors may disagree on the science underlying them but the fact is the doctors who prescribe them are measuring actual things. For lovenox there's a blood test you get monthly to make sure you're on the right dose and it's keeping your blood from clotting too much or too little. For prednisone or intralipids or other treatments the doctors will test whatever immune factors they believe are at play and assess the numbers. They don't just hand you these drugs and say have a fun 10 months of pregnancy. I have never been stuck with so many needles in my life. Blood draws every 2 weeks just for the immune stuff, monthly or more for the lovenox, on top of MFM and OB appointments.

Anonymous wrote:Lovenox is not a drug to be taken just in case it may help - it has pretty serious risks associated with it. That may be true for the other drugs too

OP has test results that would specifically indicate whether or not it's needed.

Lovenox is not a drug to be taken just in case it may help - it has pretty serious risks associated with it. That may be true for the other drugs too

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Anonymous wrote:Given that only one doctor suspects immune issues and others (including Cornell, which is a leader in the field of IVF) don't think immune issues are at play, why not listen to the majority of doctors? You haven't mentioned finances, but if I were you I would either do the two cycle package at SG or go to Cornell. It seems like your eggs aren't great based on your stats and your response to the stims for the IUIs so I don't see a reason to suspect immune issues at this point. At 38, it is much more likely to be your age/egg quality (sorry).

Others, including Cornell, don't believe in immune issues, and therefore never suspect them. Many places also don't believe in blood clotting issues, despite studies pointing to the opposite. OP said that she was tested for immune issues and multiple thing came up as red flags.

This is the PP - Cornell docs are very up on the latest research and do a lot of peer reviewed studies. If they don't believe in immune issues, don't you think there is a chance that they don't exist? Of course, even if they didn't exist, "treating" women for them would still lead to pregnancies since IVF is essentially a roll of the dice. Given that OP is older, why not start with the obvious diagnosis (age/egg quality)? It would be one thing if she failed after transferring multiple perfect looking blasts, but that is not the case here.

That would be a very costly gamble, and OP probably doesn't have many good eggs left. Most immune treatments (e.g. steroids, Lovenox, intralipids) are relatively inexpensive. Why not just do both?

There's a reason this board leans pro-immune. It's because so many here have found success that way after countless other failures.

OP - which immunity tests did you do? Which treatments did they recommend?

Have you done a RPL panel too? Clotting factors, etc?

How is your thyroid? What is your TSH?

FWIW, after dabbling with a few IVF cycles down here and the immunity path, we finally found success at Cornell. If you want your absolute best shot with OE, just go there IMO.

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Anonymous wrote:Shady grove tells everybody that it's old eggs, it's their cop out. Your AMH is on the lower side but AFC is OK. What was the issue on the immune tests exactly?

You need the right protocol to get those follicles to grow. Depending on what your immune issue is, I'd go with Abbasi. But it will be pricier most likely.

OP here. I think the question is, what wasn't abnormal on my immune tests? Pretty much every number abnormal. I can give specifics from my report if anyone has specific questions.

If there are clearly immune issues, why are you hesitating on whether to pick an RE who will treat them?

Because a) I still am not 100% on board with the idea of immune issues, and b) I am scared of the immune treatments, and how they may negatively affect my health and the baby's health.

I don't understand being scared of treatments for immune issues.

OP here. Well I'd like to see some long term follow up studies of maternal and child health after treatment for immune issues. Specifically, is there any increase in cancer? I truly don't understand why so many are so blase about immune treatments--they haven't been around that long and are not accepted by most of the medical community. That worries me a lot.

But you're open to DE? I still don't get it. The treatments for immune issues are not that unusual - what's unusual about them is using them to treat infertility.

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Anonymous wrote:Given that only one doctor suspects immune issues and others (including Cornell, which is a leader in the field of IVF) don't think immune issues are at play, why not listen to the majority of doctors? You haven't mentioned finances, but if I were you I would either do the two cycle package at SG or go to Cornell. It seems like your eggs aren't great based on your stats and your response to the stims for the IUIs so I don't see a reason to suspect immune issues at this point. At 38, it is much more likely to be your age/egg quality (sorry).

Others, including Cornell, don't believe in immune issues, and therefore never suspect them. Many places also don't believe in blood clotting issues, despite studies pointing to the opposite. OP said that she was tested for immune issues and multiple thing came up as red flags.

This is the PP - Cornell docs are very up on the latest research and do a lot of peer reviewed studies. If they don't believe in immune issues, don't you think there is a chance that they don't exist? Of course, even if they didn't exist, "treating" women for them would still lead to pregnancies since IVF is essentially a roll of the dice. Given that OP is older, why not start with the obvious diagnosis (age/egg quality)? It would be one thing if she failed after transferring multiple perfect looking blasts, but that is not the case here.

Not PP, but for a long time doctors didn't believe in autoimmune theories at all. My mother has lupus but for decades was told she was making it up or that her symptoms weren't connected or that she had "connective tissue disease" (a catch-all phrase for "we don't know what the hell it is"). Then science caught up. To give another example, two of my cousins died of Tay-Sachs disease in the early 70s, and doctors did not know what it was and accused my aunt and uncle of child abuse. Everyone knows about Tay-Sachs now, but back then, where they were living, no one knew. Only a few select specialists knew. Etc.

Anyway, I believe in immune reproductive stuff because it explains my issues. Easy first pregnancy, then 3 miscarriages of normal (tested) embryos back to back in a 15 month period. I got pregnant very easily with each but couldn't sustain more pregnancies -- and each terminated at earlier and earlier points. At the same time I was diagnosed with Hashimoto's (an autoimmune disease known to increase miscarriage rates) and a clotting disorder. Went to Abbasi, did her treatments, got pregnant on the first IUI and am now 32 weeks. Never did IVF. I was 34-35 for all of these with great AMH and AFC numbers. Maybe I just got lucky on the fourth try, but it seems to much of a coincidence that I miscarried three normal embryos in a row and immediately when I did her immune treatments (basically prednisone and intralipids plus lovenox and baby aspirin for the clotting) the fourth one stuck.

Anonymous wrote:

Anonymous wrote:Given that only one doctor suspects immune issues and others (including Cornell, which is a leader in the field of IVF) don't think immune issues are at play, why not listen to the majority of doctors? You haven't mentioned finances, but if I were you I would either do the two cycle package at SG or go to Cornell. It seems like your eggs aren't great based on your stats and your response to the stims for the IUIs so I don't see a reason to suspect immune issues at this point. At 38, it is much more likely to be your age/egg quality (sorry).

Others, including Cornell, don't believe in immune issues, and therefore never suspect them. Many places also don't believe in blood clotting issues, despite studies pointing to the opposite. OP said that she was tested for immune issues and multiple thing came up as red flags.

This is the PP - Cornell docs are very up on the latest research and do a lot of peer reviewed studies. If they don't believe in immune issues, don't you think there is a chance that they don't exist? Of course, even if they didn't exist, "treating" women for them would still lead to pregnancies since IVF is essentially a roll of the dice. Given that OP is older, why not start with the obvious diagnosis (age/egg quality)? It would be one thing if she failed after transferring multiple perfect looking blasts, but that is not the case here.

Anonymous wrote:Given that only one doctor suspects immune issues and others (including Cornell, which is a leader in the field of IVF) don't think immune issues are at play, why not listen to the majority of doctors? You haven't mentioned finances, but if I were you I would either do the two cycle package at SG or go to Cornell. It seems like your eggs aren't great based on your stats and your response to the stims for the IUIs so I don't see a reason to suspect immune issues at this point. At 38, it is much more likely to be your age/egg quality (sorry).

Others, including Cornell, don't believe in immune issues, and therefore never suspect them. Many places also don't believe in blood clotting issues, despite studies pointing to the opposite. OP said that she was tested for immune issues and multiple thing came up as red flags.

Anonymous wrote:Given that only one doctor suspects immune issues and others (including Cornell, which is a leader in the field of IVF) don't think immune issues are at play, why not listen to the majority of doctors? You haven't mentioned finances, but if I were you I would either do the two cycle package at SG or go to Cornell. It seems like your eggs aren't great based on your stats and your response to the stims for the IUIs so I don't see a reason to suspect immune issues at this point. At 38, it is much more likely to be your age/egg quality (sorry).

Well, except that the only doc who specializes in immune issues found actual issues -- not just "suspected." And it's not necessarily the case that Abbasi or anyone else will necessarily find lots of immune stuff if that's what they're looking for. I took her extensive battery of tests and only 2 immune issues came up of all she tested for -- one of which I already knew about -- and they were both pretty minor in the scheme of things. Numbers not wildly off.

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Anonymous wrote:Shady grove tells everybody that it's old eggs, it's their cop out. Your AMH is on the lower side but AFC is OK. What was the issue on the immune tests exactly?

You need the right protocol to get those follicles to grow. Depending on what your immune issue is, I'd go with Abbasi. But it will be pricier most likely.

OP here. I think the question is, what wasn't abnormal on my immune tests? Pretty much every number abnormal. I can give specifics from my report if anyone has specific questions.

If there are clearly immune issues, why are you hesitating on whether to pick an RE who will treat them?

Because a) I still am not 100% on board with the idea of immune issues, and b) I am scared of the immune treatments, and how they may negatively affect my health and the baby's health.

I don't understand being scared of treatments for immune issues.

OP here. Well I'd like to see some long term follow up studies of maternal and child health after treatment for immune issues. Specifically, is there any increase in cancer? I truly don't understand why so many are so blase about immune treatments--they haven't been around that long and are not accepted by most of the medical community. That worries me a lot.

It's a fair point, though my understanding is the lack of acceptance is not due to health issues but due to a belief that they don't work. Many of the treatments are, after all, used extensively in other medical contexts and have been studied in those contexts. Many practitioners don't accept them for reproductive purposes but it's not to do with their safety. I also note that there are plenty of practitioners -- including, I believe, Shady Grove -- who sometimes prescribe drugs like prednisone because they improve outcomes, even if the doc doesn't subscribe to the underlying immune theory. They just know prednisone can work when a case is otherwise "unexplained." Things like intralipids, of course, a non-immune RE won't prescribe.

So when you say you are scared of treatment for immune issues, you should first find out what that treatment would be. If it's prednisone plus a blood thinner (lovenox, heparin, baby aspirin) for example, those are really standard treatments for all sorts of issues. (Clotting issues often seem to turn up with immune issues though of course they can be separate.) If it's intralipids, IVIg, etc, then perhaps that is different.

Given that only one doctor suspects immune issues and others (including Cornell, which is a leader in the field of IVF) don't think immune issues are at play, why not listen to the majority of doctors? You haven't mentioned finances, but if I were you I would either do the two cycle package at SG or go to Cornell. It seems like your eggs aren't great based on your stats and your response to the stims for the IUIs so I don't see a reason to suspect immune issues at this point. At 38, it is much more likely to be your age/egg quality (sorry).

Anonymous wrote:

Anonymous wrote:

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Anonymous wrote:

Anonymous wrote:Shady grove tells everybody that it's old eggs, it's their cop out. Your AMH is on the lower side but AFC is OK. What was the issue on the immune tests exactly?

You need the right protocol to get those follicles to grow. Depending on what your immune issue is, I'd go with Abbasi. But it will be pricier most likely.

OP here. I think the question is, what wasn't abnormal on my immune tests? Pretty much every number abnormal. I can give specifics from my report if anyone has specific questions.

If there are clearly immune issues, why are you hesitating on whether to pick an RE who will treat them?

Because a) I still am not 100% on board with the idea of immune issues, and b) I am scared of the immune treatments, and how they may negatively affect my health and the baby's health.

I don't understand being scared of treatments for immune issues.

OP here. Well I'd like to see some long term follow up studies of maternal and child health after treatment for immune issues. Specifically, is there any increase in cancer? I truly don't understand why so many are so blase about immune treatments--they haven't been around that long and are not accepted by most of the medical community. That worries me a lot.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Shady grove tells everybody that it's old eggs, it's their cop out. Your AMH is on the lower side but AFC is OK. What was the issue on the immune tests exactly?

You need the right protocol to get those follicles to grow. Depending on what your immune issue is, I'd go with Abbasi. But it will be pricier most likely.

OP here. I think the question is, what wasn't abnormal on my immune tests? Pretty much every number abnormal. I can give specifics from my report if anyone has specific questions.

If there are clearly immune issues, why are you hesitating on whether to pick an RE who will treat them?

Because a) I still am not 100% on board with the idea of immune issues, and b) I am scared of the immune treatments, and how they may negatively affect my health and the baby's health.

I don't understand being scared of treatments for immune issues.