When To Change RE


#1

[FONT=Times New Roman][SIZE=3]First off I want to say I love my doc and nurses at my current clinic. I feel they truly want their patients to take home a baby at the end of everything.[/SIZE][/FONT]

[FONT=Times New Roman][SIZE=3]I have unexplained infertility and have always responded really well to medication. For my IVF cycle, I had 21 eggs, 19 mature, & 11 actually fertilize (6 with ICSI &5 w/out). I was a little shocked we only have 11 fertilize, but they said 50% fertilization was typical. We did a 3dt of 2 embryos (1 looked perfect & the other had started fragmenting). I got a call several days later that none of my embryos made it the freeze stage. I asked why, they said it happens sometimes & they just don’t make it. I got my BFP, so no left over embryos was an afterthought. I start having bleeding which they said is normal with IVF cases; I did some research online & it does seem fairly common. At the 7 week u/s no heartbeat & confirmed m/c at 8 week u/s.[/SIZE][/FONT]

[FONT=Times New Roman][SIZE=3]I called last to schedule our 2 IVF in July. I wanted to knowif we needed to have any additional testing & would change anything up.Well, they called back and stated same protocol and no additional testing.[/SIZE][/FONT]

[FONT=Times New Roman][SIZE=3]I am starting to feel like I should be concerned; we have done a basic workup nothing extra really. We pay out of pocket & have completely changed our lifestyle to pay for IVF. Dallas is a 3.5 hour drive & Denver is 10.5. I have been looking at SIRM-Dallas or CCRM; they both seem to do extensive testing. CCRM post their prices & are about $7000 more than what we currently are paying, but have great success rates.[/SIZE][/FONT]

[FONT=Times New Roman][SIZE=3]Am I jumping the gun here? Should I give my current RE another go; I did get pregnant my first IVF cycle. I am just not sure at what point we should change RE…[/SIZE][/FONT]


#2

Even though you had “only” one miscarriage, you might want to get tested for recurrent miscarriage, such as thyroid disorders, blood clotting factors, chromosomal translocation, thalassemia…
Eleven embryos is pretty good, so I can understand why your doctor doesn’t want to change the protocol. It would seem that quality is an issue but that is something that’s not so clear-cut to solving. You might want to look into taking supplements, royal jelly and accupuncture for yourself, and supplements and timed ‘release’ for your husband. There was a study that showed BD’ing several days in a row and then abstaining for 3 days gave the best sperm quality for IVF.


#3

Getting a second opinion is never a bad idea. My clinic wouldn’t have even recommended a 3 day transfer with 11 good embryo’s and the reason is because they are confident in that if they have more than 4 good embryo’s are day 3 their lab consistently has blasts to transfer on day 5 so before putting all the blame on your embryo’s consider that maybe the lab your Doc is using is substandard and that possibly could be why they are less expensive too. Additionally they may not be using the latest medium’s which are necessary in order for embryo’s to make it to freeze. I am suspicious just in reading your story.

The two clinics you are considering changing too have GREAT reputations and stats. I can’t imagine that you could go wrong transferring to them. Clearly with cost and drive time being an issue this is not an easy decision, but I think if you really are considering staying with where you are you should at least do some serious research into their lab (stats, standards, mediums and qualifications of the staff) and make sure that there isn’t a reason you are paying less money there as in the long run a reduced cost for substandard results isn’t good either.

Just some things to consider! Ultimately you just have to do what you think it right for you. Maybe going with your gut on this and switching would work out better in your favor. Who knows you could have a completely different and much more promising cycle with some to freeze at one of these other clinics and if the cycle turns out to be similar to the last then at least you will know for sure it is your embryo’s rather than the lab that clinic uses.


#4

[FONT=Tms Rmn]I too am “unexplained infertility” This will be my 3rd RE change. I have a consult at SIRM in Dallas next week which is a 3 1/2 hr drive for me from Oklahoma.

My first clinic here in OKC did 2 fresh cycles, the first one was HORRIBLE and then the second one I had mild OHSS, on paper I had a chemical pregnancy bc my beta was a 5… and then I decided I needed to move clinics. The RE kept telling me I need to lose 10lbs (my bmi was below 40) and it would then work.

My second clinic in Bedford with offices in Frisco, and Forth worth. I LOVED the RE she was so passionate for her job and seemed to really care. She had nothing to say about my weight, so I was perfectly fine. I did my first frozen cycle with them that ended in a chemical. After this chemical she stated I needed to do the recurrent miscarriage blood panel testing including chromosome testing on myself since we use donor sperm. Everything came back normal. We moved forward with another fresh cycle (different protocol than OKC clinic) and another frozen both being BFN. I asked to test for further immune problems or blood clotting she told me there clinic doesn’t believe in testing for that bc recent studies show medicine wont help… when I expressed my concern for it and told her I have read so many success stories she still had only negative things to say. The next step she said would be PGD (preimplantation genetic diagnosis) on my embryos. We agreed to move forward. I got the call from the billing dept that my ins. had been maxed so I would now be an out of pocket patient, which is when they started pressuring me to do Frozen Donor Embryo or Egg donor. Those type of cycles are ALOT more $$ and it is pure profit for them. I told everyone that I WAS NOT doing a donor and If that came down to it we would use my partners eggs. That’s when they showed me my file and the RE actually put “recommended donor embryo or egg cycle” we never ONCE discussed that. They still kept pressuring me after I refused numerous times, since the RE told my PGD testing would be the next option. They didn’t get the picture. I had a gut feeling that I needed to leave. I am now having a hard time to get them to release my FULL medical record to me, they only wanted to provide lab results. I loved the RE but I have to follow my gut feeling and I have read great things about SIRM when it comes to immune/blood problems. Even when I called to setup my consult they seemed shocked that I have underwent so many cycles with 2 chemicals and a pregnancy I achieved on my own that ended in a miscarriage and I still haven’t had success.

So YOU will know when its time to change. Don’t feel like you have to stay either. You can always go get a second opinion even if it is just a consult as to what they would do differently or if they think they see something your current RE doesn’t. Good Luck.
[/FONT]


#5

I think all of Ahhny’s points are valid, but I think it’s especially important to consider her point about the 3 day transfer. With ELEVEN (holy crap, who here wouldn’t kill for 11!) fertilized embryos, you should have waited until day 5 to transfer because then you would have gotten the “pick of the litter.” The ones that were destined to miscarry would have arrested and those that were more likely to be healthy would have persisted. Also, I’m pretty sure current technology requires that only five day embryos can be effectively frozen… they weren’t trying to freeze 3 day embryos, were they?

Like Ahhny was alluding to, there is a bell curve when it comes to fertility clinics as well as RE’s. There are those that are just starting out or are mediocre. They remain in business because, naturally, people like you and me still go to them.

Now, before considering transferring, make sure you have your information strait about what they did or didn’t do with you. Sometimes in the flurry of information that surrounds and IVF cycle, it’s easy to confuse 3-day transfers with 5-day transfers, etc.

All things aside though, it looks like you are in pretty good shape to have a successful IVF cycle. I hope this helps.

Edit: Brittany, if I may ask, what was your BMI during your cycles? I know it’s a personal question, but a lot of recent research has shown that weight plays a very big part in pregnancy success and especially IVF success. It doesn’t matter as much in older women, but it is essential in younger women, especially women your age.


#6

I would consider changing clinics after about 2 failures, or if the clinic has below-average success rates in SART, or if their success rates are not found in SART.


#7

Seems like you have good results from your first cycle. with 11 embies - I dont think he would want to change the protocol. My questions would be how come none survived past Day 3? That would just be my concern. with have that many I would think you would have at least 4/5 grow to blasts. There is some issue with quality of egg/sperm then.
I would give him another try! CCRM is obviously the best but you could give ur current RE a second chance once you get some answers to some of the questions. Good lUck!


#8

Thank you everyone for your replies. I think I am going to get two additional consults and then decide how to proceed from there. I can always stay with my current RE if I dont like the others. I also want the additional testing for m/c issues; testing is the only thing my insurance covers, so I am all about testing. My current RE doesnt feel any additional testing is needed.

Now, I know how to find stats on clinics; how do you do that for labs? To clear up a few things - I had a 3 day transfer of 2 embryos out of 11. Several days later I got a call from the IVF coordinator stating none of my embryos made it to the freeze stage. The reason for the 3 day trasfer was they could tell who was leading the pack.

I am leaning towards SIRM-Dallas & Houston fertility institute.I have realtives in both places, so I dont have to pay for hotel rooms. They seem to be the best in those areas. We decided to use CCRM as the final pull since we will really have to plan for travel and expenses with them.


#9

[QUOTE=Rae84]Thank you everyone for your replies. I think I am going to get two additional consults and then decide how to proceed from there. I can always stay with my current RE if I dont like the others. I also want the additional testing for m/c issues; testing is the only thing my insurance covers, so I am all about testing. My current RE doesnt feel any additional testing is needed.

Now, I know how to find stats on clinics; how do you do that for labs? To clear up a few things - I had a 3 day transfer of 2 embryos out of 11. Several days later I got a call from the IVF coordinator stating none of my embryos made it to the freeze stage. The reason for the 3 day trasfer was they could tell who was leading the pack.

I am leaning towards SIRM-Dallas & Houston fertility institute.I have realtives in both places, so I dont have to pay for hotel rooms. They seem to be the best in those areas. We decided to use CCRM as the final pull since we will really have to plan for travel and expenses with them.[/QUOTE]

That still strikes me as odd, as far as the 3 day transfers were concerned. If it were so easy to tell who was “leading the pack” then clinics would never do 5 day transfers, they would only do 3 days. I think Suma makes a valid point. If the embryos failed to freeze because they simply didn’t make it to day five, then there may be some egg/sperm quality issues.


#10

If there is a egg/sperm quality issues, isn’t that something they should tell you; I mean why not tell someone? I think I will feel better talking to a couple of other RE.


#11

I am curious as to your protocol. I agree you responded well, but if you were on just gonal or follistim maybe adding femara or menopur would help increase quality. I know quality is the main factor. If they could clearly tell who was leading the pack at day 3 that is typically an egg quality issue. Normally if they are showing signs of deterioration by day 3 its an egg issue but between day 3-5 its a sperm issue. With that many you should have had a lot more great embryos at day 3. Femara and Menopur have been shown to increase egg quality.

I had a miscarriage at 9 weeks after hearing HB and they said it was chromosonally abnormal.

Did they give you a grading on the embryos at day 3 you didn’t transfer? My clinic does so I knew they were likely not going to make it as they were a grade c and not past 4 cells at day 3. If that was the case, then the egg quality could have been an issue as noted above.

Best of luck to you!

Just my 2 cents. At least you know you can get prego, that is half the battle.


#12

Perhaps the lab did do the job properly.