Best Clinic for Poor Responders?


#1

Hello,

I am new to this forum.

I am 37 years old and just had my first cancelled cycle, due to only 3 small follicles (size 7-10mm) on stim day 7 (antagonist protocol with Follistim 225 and Menopur 150).

My FSH is 6.8, Estradiol 32, AFC 12. But my AMH is <0.1!

I would like to know if other poor responders have had success with specific clinics or protocols. We are willing to travel out of state (we are in San Francisco Bay Area). I have telephone consults set up with Dr. Sher in Las Vegas and Dr. Surrey at CCRM, but not for a few weeks.

I think I am planning to do my next cycle with Dr. Zouves (local for us), with a ganirelix/estrace priming protocol.

In the meantime, I would like to do my research in case we have another cancelled cycle.

Thanks!


#2

[quote=Lang]Hello,

I am new to this forum.

I am 37 years old and just had my first cancelled cycle, due to only 3 small follicles (size 7-10mm) on stim day 7 (antagonist protocol with Follistim 225 and Menopur 150).

My FSH is 6.8, Estradiol 32, AFC 12. But my AMH is <0.1!

I would like to know if other poor responders have had success with specific clinics or protocols. We are willing to travel out of state (we are in San Francisco Bay Area). I have telephone consults set up with Dr. Sher in Las Vegas and Dr. Surrey at CCRM, but not for a few weeks.

I think I am planning to do my next cycle with Dr. Zouves (local for us), with a ganirelix/estrace priming protocol.

In the meantime, I would like to do my research in case we have another cancelled cycle.

Thanks![/quote]

I suppose you can compare their success rates in older patients, who generally have reduced ovarian reserve?

You probably know of these sites:

IVF Reports | Fair and Informative Ranking

IVF Success Rates - Compare National IVF Fertility Success Rate Data Top IVF Clinics

ASRM: Infertility, Reproduction, Menopause, Andrology, Endometriosis, Diagnosis and Treatment

CDC - Assisted Reproductive Technology (ART) Reports - Reproductive Health

The SART site allows you to filter specifically on patients with diminished ovarian reserve.


#3

clinic stats

Thanks Ghost.
I have looked at these stats, but I know that many clinics reject patients and that way improve their outcomes. It looks like SIRM-Las Vegas has very good stats. I have a consult with Dr. Sher this week (telephone) and will let you know what he recommends.
Thanks!


#4

Hi Lang,
i am a poor responder AMH: 0.4 and was SIRM patient before but it was even worse!!! i live in bay area as well. I talked with Dr Zouves and he gave to me 10% so I changed my mind now I am going to Wake Forrest Uni to Dr Yalcinkaya his stats are 74% and heard CCRM good as well but they areasking too many tests so treament is very costly. Pleasse check Dy Y stats
here is the link Center for Reproductive Medicine - Success Rates - Wake Forest University Baptist Medical Center
I am going there January, my clinic will monitor me until CD8.You can e mail or call me as well.


#5

I live in SF also… was going to UCSF. I also had 2 follicles on an Estrogen primed Follistim cycle which was odd since on Clomid I got 4 follies… I had Follistim a year ago for egg retrieval and got 10 follies/eggs so it didn’t make sense…

Dr. Surrey (my new Dr., I’m now going to CCRM) said he’s seen women stall out on Estrogen priming… and that it’s important to get all the info before you start stims so you in the end aren’t wasting money due to a factor that may be treatable before you try again…

Make sure your RE is open to your individual body and what’s going on with YOU… not just average stats and a “lazy” protocol like I had with my old RE. My old RE told me after the 2 follie cycle to “just go adopt, I’m not a candidate for IVF” without even looking at the fact that a $10 RX for Clomid gave me more than his protocol…

Make sure when you check the SART stats you see how MANY cycles they’ve done and how many LIVE BIRTHS they have… Reported pregnancy is one thing… I want to bring home a baby :slight_smile:

xox


#6

I forgot to mention that I then did a Clomid-Flair protocol and got 11 Follicles (ovulated early, which is why I’m switching clinics… they didn’t give me antigon… decided I didn’t need it in their opinion…UGH!)


#7

Hi Omega Girl,
How was telephone appointment with Dr Surrey? How did he explain early ovulation with antagon?


#8

Lang - I’m a little bit older than you, but we have very similar stats. My FSH is a little lower than yours (about the same same E2), but my AFC is worse. An AFC of 12 for me would be good; my recent cycle my AFC was 8. My AMH has gone from 1.2 or so earlier this year to .5 - .6 in Sept/Oct. I had it tested twice because I thought the huge drop was wrong.

With those stats, I just did a cycle where I had 11 eggs retrieved and ended up with 7 blasts, so there’s definitely hope. I’m a novice to this myself, but I wonder if they should have stimmed you harder to start off. I started on 300 IU of Gonal-F and 150 of Menopur, and I had 8 follicles over 8 mm on day 5; I did half or less of that dose for the rest of the cycle. I’ve certainly seen women on here who do even more Follistim/Gonal-F to start out.

I don’t know which clinic you worked with here, but when I talked to local clinics and looked at stats, I had decided I’d go with Kaiser in Fremont if I stayed local. They’re #3 in the country for live birth rate for your age group (35-37) – ahead of CCRM. I was super-impressed with Dr. Farah-Eways when I talked with her, and she didn’t seem to turn anyone away. She mentioned that she’s had several patients over 45, even. I also know that she felt AFC is a better indicator than a lot of the other stats, so I bet she’d be happy to talk with you. I decided to go up to Oregon because for my age group there was a more significant difference in the success rate. Plus, Fremont / Santa Clara were going to be an hour drive each way with traffic, and if I was going to do that every time I needed bloodwork or monitoring, it was almost less hassle to go out of town.

I do have a friend who cycled with Dr. Zouves and loves him (she also had successful IVF at Stanford previously). She had 11 follicles and only 5 eggs retrieved, but she got pregnant with twins. Personally, I have an established auto-immune disorder and have done a lot of reading and talking to my specialists about some of the more esoteric immunology stuff that he does, and I personally just haven’t seen enough evidence to do all that extra testing or potential treatment, so I didn’t talk with him. His feedback in general is pretty glowing, though.

I didn’t have [U]any[/U] clinics, locally or out of state, that were not optimistic about my chances, though with a couple of them that was before we knew my AMH had dropped like a rock this year. They were all more than happy to welcome me as a patient. Personally, given the fact that I got pregnant twice (once on my own, once with Femara + IUI) during that drop and had a decent IVF cycle, I am not sure that AMH is such a strong indicator of response, or at least not always.

If you want to play with the SART data, you can filter on the cause of infertility, as Ghost mentions. CCRM, Oregon, and Cornell all have about the same proportion of DOR patients, not sure how it varies with others.


#9

It was fantastic! I feel SO much better now, he is a lot more like my RE in NYU that I used for my egg freeze… asked a ton of questions and had a ton of things he’d do differently…

He said I should have had my LH, PROGESTERONE and Estrogen tested each monitoring… so that it wouldn’t be me who’s telling them I’m feeling hot and twinges in my ovaries… He said he would then be able to double up my antigon and change up meds on a daily basis… He also said he wouldn’t do a fresh transfer he would wait the following month so all hormones/drugs are out of my system… better implantation rates this way.

Of course I hope this cycle worked (he was so cute, he said… “If you get a BFP, then I get the credit… cause I’m good luck”) but if it didn’t work, I’m all ready to go for my 1d work up there… I just need to call them on d1 of my af.

It’s SO comforting to hear him talk about knowing MY body and tracking each day what MY body is doing instead of the textbook, standard protocol and having the RE’s give me that “I just ran over your dog” look when I wake from retrieval.

Totally confident in CCRM… worth the travel and expense to be away from my business and home… :slight_smile:


#10

Ccrm

[QUOTE=Omegagirl]I live in SF also… was going to UCSF. I also had 2 follicles on an Estrogen primed Follistim cycle which was odd since on Clomid I got 4 follies… I had Follistim a year ago for egg retrieval and got 10 follies/eggs so it didn’t make sense…

Dr. Surrey (my new Dr., I’m now going to CCRM) said he’s seen women stall out on Estrogen priming… and that it’s important to get all the info before you start stims so you in the end aren’t wasting money due to a factor that may be treatable before you try again…

Make sure your RE is open to your individual body and what’s going on with YOU… not just average stats and a “lazy” protocol like I had with my old RE. My old RE told me after the 2 follie cycle to “just go adopt, I’m not a candidate for IVF” without even looking at the fact that a $10 RX for Clomid gave me more than his protocol…

Make sure when you check the SART stats you see how MANY cycles they’ve done and how many LIVE BIRTHS they have… Reported pregnancy is one thing… I want to bring home a baby :slight_smile:

xox[/QUOTE]

Will you please let us know how your cycle with Dr. Surrey goes? Who will do your monitoring locally? I have a phone consult with him Jan 7, but that’s a long ways off. And what do you mean when you say to check out all the factors before starting stims?

I haven’t heard that about the estrogen priming “stalling,” but I’m so new to all of this. Thanks for sharing your experience.

Thanks!


#11

[QUOTE=kimberf]Lang - I’m a little bit older than you, but we have very similar stats. My FSH is a little lower than yours (about the same same E2), but my AFC is worse. An AFC of 12 for me would be good; my recent cycle my AFC was 8. My AMH has gone from 1.2 or so earlier this year to .5 - .6 in Sept/Oct. I had it tested twice because I thought the huge drop was wrong.

With those stats, I just did a cycle where I had 11 eggs retrieved and ended up with 7 blasts, so there’s definitely hope. I’m a novice to this myself, but I wonder if they should have stimmed you harder to start off. I started on 300 IU of Gonal-F and 150 of Menopur, and I had 8 follicles over 8 mm on day 5; I did half or less of that dose for the rest of the cycle. I’ve certainly seen women on here who do even more Follistim/Gonal-F to start out.

I don’t know which clinic you worked with here, but when I talked to local clinics and looked at stats, I had decided I’d go with Kaiser in Fremont if I stayed local. They’re #3 in the country for live birth rate for your age group (35-37) – ahead of CCRM. I was super-impressed with Dr. Farah-Eways when I talked with her, and she didn’t seem to turn anyone away. She mentioned that she’s had several patients over 45, even. I also know that she felt AFC is a better indicator than a lot of the other stats, so I bet she’d be happy to talk with you. I decided to go up to Oregon because for my age group there was a more significant difference in the success rate. Plus, Fremont / Santa Clara were going to be an hour drive each way with traffic, and if I was going to do that every time I needed bloodwork or monitoring, it was almost less hassle to go out of town.

I do have a friend who cycled with Dr. Zouves and loves him (she also had successful IVF at Stanford previously). She had 11 follicles and only 5 eggs retrieved, but she got pregnant with twins. Personally, I have an established auto-immune disorder and have done a lot of reading and talking to my specialists about some of the more esoteric immunology stuff that he does, and I personally just haven’t seen enough evidence to do all that extra testing or potential treatment, so I didn’t talk with him. His feedback in general is pretty glowing, though.

I didn’t have [U]any[/U] clinics, locally or out of state, that were not optimistic about my chances, though with a couple of them that was before we knew my AMH had dropped like a rock this year. They were all more than happy to welcome me as a patient. Personally, given the fact that I got pregnant twice (once on my own, once with Femara + IUI) during that drop and had a decent IVF cycle, I am not sure that AMH is such a strong indicator of response, or at least not always.

If you want to play with the SART data, you can filter on the cause of infertility, as Ghost mentions. CCRM, Oregon, and Cornell all have about the same proportion of DOR patients, not sure how it varies with others.[/QUOTE]

Thanks Kimberf,

I did my first cycle at Kaiser Fremont with Dr. Shen. I did an antagonist protocol with Follistim 225 and Menopur 150. She was very optimistic for me (we had not done the AMH yet). Also, I had been pregnant with twins earlier in the year, conceived naturally. Unfortunately, they were identical and we lost them at 23 weeks due to complications. She is recommending a micro-flare protocol for the next cycle.

At this point, I think we are shopping around. I had read a lot about the estrogen priming protocol, and also heard good things about Zouves, so I thought we would switch to him. I don’t have any auto-immune issues, but I don’t mind paying extra for the workup if that’s what he requires.

I have not met with Dr. Farah-Eways, but I have also read good things about her. Maybe I will request a consult with her.

I’m wishing you the best!


#12

[QUOTE=ozlem]Hi Lang,
i am a poor responder AMH: 0.4 and was SIRM patient before but it was even worse!!! i live in bay area as well. I talked with Dr Zouves and he gave to me 10% so I changed my mind now I am going to Wake Forrest Uni to Dr Yalcinkaya his stats are 74% and heard CCRM good as well but they areasking too many tests so treament is very costly. Pleasse check Dy Y stats
here is the link Center for Reproductive Medicine - Success Rates - Wake Forest University Baptist Medical Center
I am going there January, my clinic will monitor me until CD8.You can e mail or call me as well.[/QUOTE]

Hi Ozlem,
Thanks for sharing your information. I’m wishing you the best for your cycle at Wake Forrest! Please let us know how it goes.
Lang


#13

Good luck! Since you got pregnant on your own this year, I can’t imagine that there is a clinic out there that wouldn’t be jumping at the chance to get you. At least that was my experience with similar stats. I did a consult with Dr. Surrey at CCRM as well, and he was very very optimistic.

If you are interested, I have an RE whom I love locally who did my monitoring for my cycle at ORM and worked with me for my pre-IVF stuff. She’s in Portola Valley with PAMF, not sure if that’s convenient for you.


#14

Hi Kimberf,
I wish you continued good luck at Oregon.
Portola Valley is very close to us, who is your RE at the clinic?
I think I am planning to try 1-2 cycles here, then re-evaluate based on what happens. If it seems pretty hopeless, then I will probably head in the directions of donor eggs.
Best wishes,
Lang


#15

[QUOTE=Lang]Will you please let us know how your cycle with Dr. Surrey goes? Who will do your monitoring locally? I have a phone consult with him Jan 7, but that’s a long ways off. And what do you mean when you say to check out all the factors before starting stims?

I haven’t heard that about the estrogen priming “stalling,” but I’m so new to all of this. Thanks for sharing your experience.

Thanks![/QUOTE]

If I get a BFN on 12/13 I’ll wait for af and call them for my 1 day work up. I think I’m going to go to Danielle Lane here in Marin, I’m going to set up a consult with her this week just to get me set up to jump right in should I need to. Did you send all your medical records over to CCRM yet? If so, call them back and ask to be put on the waiting list for cancellations… My appt went from 12/17 to 12/3 :slight_smile:

What I meant about Dr. Surrey saying he will check all factors, I never had my tubes checked and apparently there is some infection that women can have and not know it that sends off a fluid that doesn’t let the embryo implant (this is my way of describing…lol… he sounded much better!) He just wants to make sure there is no other reason for me to not get pregnant, especially if it can be fixed before hand.

Yeah, the estrogen stalled me… I cannot tell you how comforting it is to be moving to this clinic. They are way more like NYU Fertility… ON TOP OF IT! :slight_smile:


#16

[quote=Lang]Hi Kimberf,
I wish you continued good luck at Oregon.
Portola Valley is very close to us, who is your RE at the clinic?
I think I am planning to try 1-2 cycles here, then re-evaluate based on what happens. If it seems pretty hopeless, then I will probably head in the directions of donor eggs.
Best wishes,
Lang[/quote]
Lang, It’s Dr. Tazuke at PAMF. I really, really like her. I sent you a PM with more info.

And forgot to mention, re your consult with Dr. Surrey: if you have your paperwork in, you can ask to be put on the cancellation list. I had a six or seven week wait for my consult, but once I asked to be on the list, they had a cancellation the next week to offer me. Definitely call and ask about it.


#17

There are two Dr. Surreys in fertility medicine: Eric Surrey at Colorado Center of Reproductive Medicine and Mark Surrey at Southern California Reproductive Center in Beverly Hills. They are brothers.


#18

[QUOTE=Ghost]There are two Dr. Surreys in fertility medicine: Eric Surrey at Colorado Center of Reproductive Medicine and Mark Surrey at Southern California Reproductive Center in Beverly Hills. They are brothers.[/QUOTE]

How cute…! My Dr. Surrey is at CCRM… he’s so sweet :slight_smile:


#19

Thanks ladies for all the info. We just filled out all the paperwork for CCRM and will ask to be on the cancellation list.
Kimberf, thanks for the name of you doctor in P.V.
Best wishes and thanks again! I will keep you updated.
Lang


#20

[quote=ozlem]Hi Lang,
i am a poor responder AMH: 0.4 and was SIRM patient before but it was even worse!!! i live in bay area as well. I talked with Dr Zouves and he gave to me 10% so I changed my mind now I am going to Wake Forrest Uni to Dr Yalcinkaya his stats are 74% and heard CCRM good as well but they areasking too many tests so treament is very costly. Pleasse check Dy Y stats
here is the link Center for Reproductive Medicine - Success Rates - Wake Forest University Baptist Medical Center
I am going there January, my clinic will monitor me until CD8.You can e mail or call me as well.[/quote]

I go to Dr. Yalcinkaya, as well! You are coming here from the west coast? Wow! I absolutely love everyone at their clinic! I’ll start IVF #3 in January, as well. It’ll be IVF #2 with WFU. I had my first cycle at a different clinic! Goold Luck to you!