Is SIRM (Westchester or Manhattan) a good choice for DOR and MFI?


#1

Thoughts on Dr. Browne? Or would Dr. T be a better choice? If we go with Dr. T could I monitor in Westchester? I really can’t trek into the city for all those monitoring appointments. That would be a deal breaker. As I understand it, the ER/ET themselves would be at the Manhattan office, correct? Also, if I needed another hysteroscopic polypectomy, where would that be performed?–The Manhattan office or at a hospital?

What kind of protocols does SIRM use generally? Do they offer co-culture or is that just Cornell? Can they do TESE if needed?

For both my cycles with my current RE I was on a MDL Flare Protocol (no BCP) with a high dose of Follistim (450/day). I responded well given DOR, but my embryo quality wasn’t great, which is likely the reason both of my IVFs have failed. I know my RE isn’t going to make any protocol changes/tweaks, which I think I might need to hopefully improve quality and fertilization rates. I just think it’s time we had a fresh set of eyes on our case before IVF #3.

Thank you!!!


#2

My 2nd (successful) IVF was with Dr Wang in Manhattan. I would highly recommend him. He was extremely thorough and the protocol we ended up using was very personalized. Unfortunately, I don’t know much about Weschester office. I am so glad we switched after 1st IVF!


#3

Congrats on expecting twins!!! That’s wonderful!

Dr. Wang sounds great. Thanks for sharing your experience! Can I ask, how did you conclude it was time to change Drs? That’s what I’m struggling with. I feel it may be time, but it’s scary none the less! Also, I’m amazed at the difference in fertilization rates between your two cycles. That’s awesome! What do you think made the difference?

Thank you!


#4

Actually, we were thinking of doing the 2nd IVF at the same place (Columbia). I liked my RE and thought that it is best to work with the same doctor since she (hopefully) learned something from my first cycle. We were happy after the consultation with her. However, since we had to wait 2 months between IVFs (my RE wanted to do SIS to make sure I do not have polyps). Since we had to wait, I wanted to do as many tests as I can to rule out some other issues. I did not want to go through several IVFs just to find out some sort of immune issue that was not addressed. But Columbia RE said they do not test for immune issues (or anything else that I was not tested for already). I did not even know about SIRM, when I found them on the web when I was searching for doctors doing reproductive immunology screening. I wanted to schedule an appointment with Dr. T, but he was on vacation and I did not want to wait so we went with Dr. Wang.

He went over all possible reasons why my 1st IVF might have failed and discussed the tests he would recommend. After the appointment it was obvious for us that we have to switch REs. I am so glad we did! I had such a better experience. What I liked about Dr. Wang is that he explained the reason for every drug/ dose and remembered every little detail about our case. He seems to be very skilled as well. My transfer with him was very easy, while most of my IUIs and the IVF at Columbia were a torture (my cervix has a difficult tilt).

Here is a summary of the reasons why my 1st IVF might have not worked according to Dr. Wang.
[LIST]
[]50% bad luck
[
]Potential issue with implantation. Additional tests:[/LIST] [LIST][LIST]
[]Natural killer cells
[
]Thrombophilia panel
[]TH1/TH2 Cytokine ratio. If elevated, my body could be killing embryos
[
]HLA genotype panel (HLA A, B, C, DR, DQa, DQB) (test if my genes and DH’s genes are too similar. If so, my body might be rejecting embryo. Not sure what the solution is – suppressing immune system?)
[*]DNA fragmentation in sperm (even a very good looking embryo might not be so good if DNA fragmentation in the sperm is high)[/LIST][/LIST] i. If high, we can do PICSI (Pre-selected ICSI). Pick the sperm that binds to some acid. PICSI is as successful as ICSI if there is little DNA fragmentation.

[LIST]
[]Progesterone issues (period started a day before beta, spotting started 3 days before beta)[/LIST] [LIST][LIST]
[
]Since my period started before beta (11p3dt) and while on progesterone, there is a chance my progesterone was not sufficient. Solution – do shots rather than vaginal capsules. Old RE said having period early is not a big problem and that if I want, I can take two rather than one capsule of progesterone.
[*]Another issue – high progesterone at ER. If so, implantation window is shifted (ends sooner). Then embryos do not have enough time to implant. I wonder if this was my issue. My luteal phase is always very long (15-17 days) and is very regular. Solution – monitor progesterone and do not do transfer if progesterone is too high (perform FET). More specifically, if progesterone is >1.5 on the day of ER (happens to 1 out of four women), do not transfer.[/LIST][/LIST] It turns out all the tests came back normal (except for some from Thrombophilia panel – see signature – but Dr. Wang said those were not a huge deal). I think the main reasons for my first IVF not working could have been that my follicles were too big at trigger and probably my progesterone was too high. Inadequate progesterone support could have also played a role.

I would definitely do a consultation with a new RE. I think you will know what the right decision is for you after it.

GOOD LUCK! I hope you will get your BFP very soon.
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#5

wow… I have been debating forever to switch RE’s. We are using our security embryos on Thursday for a FET. If this doesn’t work I also will switch RE’s.

DesignGirl- What RE are you using now if you don’t mind me asking. I am at RMA -WEstchester with ET/ ER in NYC