My break from all things IF/IVF related is officially over! After consulting the boards, family and friends regarding whether or not to seek a 2nd opinion from an RE, we decided to heed your advice and do just that & now I am back on the IVF train.
Yesterday morning we had a 2nd opinion consult at S.hady G.rove in Annapolis. I was walking in there thinking my mind was already made up, I was sticking with my current clinic and just humoring myself by "doing the right thing." At first, I was uncomfortable and the clinic seemed big and loud and impersonal. I was sitting there smugly -already dismissing them, ready to go back to my normal clinic; however once we met with Dr. M. my whole impression changed and now I am as confused as ever...
Dr. M hadn't had much time to examine my records, but at first glance he felt that we have received good care and had two good cycles so far. Then he said, "So, what can I help you with?" and I am thinking, "Great we are totally wasting every one's time." I told him that although we have been happy with our care so far, at the end of the day, we still are not pregnant and do not want to leave any stone unturned on our IVF journey.
He told me at the bare minimum he would like to repeat my HSG since it has been over 2 years since my first and he wants his own b/w panel. Then, he looked over my charts a bit more and said that there are a few changes he would make right off the bat:
1st- no more 3 day transfers. Blast transfers only - his lab does not work with with 3 days at all, ever.
2nd- Assisted Hatching- he said it can't hurt, definitely might help implantation along.
3rd - No more Lupron for me! His thoughts were that for my age and CD3 b/w, I should be producing more eggs - closer to the 12-15 range not the 8-10 that I have been producing. So instead of long Lupron, he wants to use Ganirelix. His explanation was that both Lupron and Ganirelix do essentially the same thing - which is suppress ovulation. The analogy he used was if you want to turn out a light, Lupron is the equivalent of throwing a sheet over the lamp day after day after day until you have finally blocked all the light. Ganirelix pulls the plug out of the wall! He went on to say that taking Lupron out of my cycle will allow for a "cleaner, less medicated cycle,"hopefully resulting in more eggs.
We talked some more and I asked him some questions that have been sticking in my craw about my previous cycles. I asked him about my E2 dropping off after ER and needing the HCG booster shots. He was flabbergasted and said he respectively disagrees with that plan and disagrees strongly at that. He explained that E2 should drop off after ER (I'll leave the explanation at that) & he thinks the HCG boosters are unnecessary. He does not even check E2 after transfer. He feels the only hormone that is important after ET is progesterone and he believes it should be given by PIO because that is the best way to control delivery and absorption. I know this is hotly debated in the IF community and it really doesn't matter to me. We have done suppositories the last 2 cycles with no success, so I am fine with trying PIO this go 'round.
I also asked him whether or not he uses prednisone and he said he does not. He said he conducted a study a few years ago using prednisone and he does not see the benefit of using it. He explained that the immune system is a very delicate thing and he does not like to mess with it unnecessarily.
I asked about my weight as well and Dr. P's recommendation to lose 5-10% of my body weight before cycling again to rule out weight as a factor and Dr. M said he once again respectively disagreed. He said I fall into the "So what" category and doesn't feel it is in anyway impacting implantation. His advice was to do whatever makes me feel good and of course any weight loss would have a positive effect on a potential pregnancy.
We chatted some more about life in general and Sean's varicocele and discussed his treatment at Hopkins. Dr. M said Hopkins' Urology is the best in the nation and if Sean wants to pursue a repair, he is in great hands. He also gave him some samples of a new vitamin called Conception XR - he said it falls into the "Can't hurt, might help" category. No herbs, just vitamins and minerals. We'll try it. Sean goes to Hopkins on Monday to have a pre-op visit for his varicocele embolization.
Dr. M had us meet his nurse coordinator, lay out a preliminary treatment calendar, discuss meds, meet with billing etc...
All in all, it was a great visit. We feel like we learned a great deal and walked away feeling like we have a lot to think about. Our first impressions of the clinic were totally changed in the 2 hours that we were there and we walked away feeling very positive about things.
Sean is leaning strongly towards switching clinics. I am willing to let Dr. M repeat the b/w and HSG and have follow-up appt. It is looking like I will have CD 3 b/w and HSG in the next 2 weeks and possibly cycling in late August or September...
So, that is where we are with things. I would love to hear any feedback you have for me!
In other news we had a great visit with Sean's parents over the weekend. I will post some pics later this week!
*****FYI****** success rates for clinics are similar. S.hady Grove (approx) 44%, F.ertility Center of M.aryland (approx) 41%......