Consult with Cooper/Dr. Check- need opinion

Consult with Cooper/Dr. Check- need opinion

Mrs. McIrish
Mrs. McIrish

November 30th, 2011, 7:36 pm #1

Hi ladies,
I hope it is OK to post here. I am 38. I was rejected yesterday by my RE at Brigham since I am a poor responder. She won't cycle me again and gave me the DE speech again. My history: failed 4 IUI's, and 2 IVFs in 2011. I am a poor responder, FSH was 17.3 at last test in June 2011 with E2 of 82 and AMH was 0.3 in September 2011. My AFC is always under 4(no one even tells me anymore). I only produced 3 eggs on IVF1 (EPP with max stims) and one was not mature and IVF#2 yielded 2 eggs (microdose lupron with max stims). Embies were very poor quality (highly fragmented and don't grow). While I am considering DE, it's tough to know when to stop trying with OE.

I feel like I need to get that 2nd opinion from someone high FSH friendly before I can do DE. I'm limited by finances and found out that Dr. Check does take my insurance so I will go to him. I just called to make the appointment for a consult and was told that all the other RE's at Cooper will do a phone consult but not Dr. Check. How important is it to see him versus another RE in his office? Is another RE there just as good for FSH ladies? It's a 5hr drive for me so if I can do by phone, that would be ideal. I would do local monitoring in RI where I am.

I know his office is an unorganized disaster so I know what what sheer annoyance I am going to face...

TIA
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PhoebeMass
PhoebeMass

November 30th, 2011, 8:24 pm #2

Hi there. What an emotional roller coaster for all of us. I came to this board in utter despair about 4.5 years ago. I found my RE here, learned what FSH was b/c I had no clue, and went on to have our now 3 year old DD. I had an FSH of 15.8 and low AFC's. I went to Dr. Cardone in Stoneham. 4 IUI's and 1 IVF later we had our DD. I was almost 42 at the time - 41 and 3/4's. Almost 42.

I don't know if you have already been there. I was booted by Dr. Robert Weiss - of Boston Medical Center and NE Fertility Centers based on my FSH levels. Dr. Cardone didn't bat an eye at my AFC or FSH levels.

We have not had success since our DD and at 45 we are pretty much trying except naturally.

I'm assuming you are Boston based....with Brighams....? Let me know if I can help in any way.
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Mrs. McIrish
Mrs. McIrish

November 30th, 2011, 8:54 pm #3

Thanks for your response. I am in RI but traveled to Brigham. They have monitoring in Foxboro so I could go there during the week. I didn't think Cardone took my insurance but I just checked Blue Cross' website and he does. Any idea if he ever does local monitoring with someone else? My 2nd RE is in Providence and would do monitoring if I asked. I can't imagine driving up to Stoneham for monitoring several times a week if I want to keep my job(mapquest says 1hr 12 minutes each way but with morning traffic, it would be brutual).
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Mrs. McIrish
Mrs. McIrish

November 30th, 2011, 9:10 pm #4

I just made an appt with him for 12.13! The receptionist thinks they could do local monitoring with another RE. Can't hurt to go see him, right? Thanks for the suggestion!
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PhoebeMass
PhoebeMass

November 30th, 2011, 9:31 pm #5

I hear you! Ugh.

I really like Dr. Cardone and his staff. He is a good man. Definitely bring your notes and ask a lot of questions. He is a fan of high stim as he believes that it's a numbers game and you want to coax the most number of follicles and, hopefully, eggs. Heck, at age 41 it worked for me.

I am not pro high stim at my age but at 41 it worked. I never produced many follicles. Usually between 3 and 6. And 6 was banner not the norm.

They do take BCBS, sorry, I should have told you that. Though BCBS, depending on your employers plan, can be super difficult with the whole FSH thing. Jane, in Cardone's insurance office, is a sweet person that I am fond of but not overly dynamic. You'll have to work the insurance magic and do all your homework, unfortunately.

Gail runs the show and I am a fan. She can be a bit dismissive and brusque but I'm a fan. She's been incredibly good to me. Julia is their best nurse, in my opinion. She has the most longevity and "gets it". I used to be able to set my watch by their calls back - none of the craziness that you hear about at many offices. But, if you remote monitor, stay on it! As some on this board have said - it's like a 2nd job.

Good luck! Do you have children or trying for your first?

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Mrs. McIrish
Mrs. McIrish

November 30th, 2011, 10:19 pm #6

I don't have any kids. Still out for #1 sadly. Got married 2 months shy of 37 for the 1st time and been trying unsuccessfully since we got married. My BCBS is a PPO out of RI and they don't care about anything. I can't complain. My secondary is Tufts which Cardone doesn't take but Tufts is miserable to deal with. They barely approved me for IVF#1 and #2 and I know I am cut off now anyway.

Yes, this is totally a second job. It's exhausting.

I'm ok with high stims. I just can't get more than 2 mature follies. I just need one to be the golden egg though. I keep wondering when it will pop up. I feel in my heart that there has to be one in there at 38. I am going to retest my FSH when AF shows up and I'm guessing it will be much higher than 17.3.

I'll keep you posted. Thanks again for the suggestion as I totally forgot about him being high FSH friendly.
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Joined: August 23rd, 2011, 3:50 pm

December 1st, 2011, 4:12 pm #7

Hi ladies,
I hope it is OK to post here. I am 38. I was rejected yesterday by my RE at Brigham since I am a poor responder. She won't cycle me again and gave me the DE speech again. My history: failed 4 IUI's, and 2 IVFs in 2011. I am a poor responder, FSH was 17.3 at last test in June 2011 with E2 of 82 and AMH was 0.3 in September 2011. My AFC is always under 4(no one even tells me anymore). I only produced 3 eggs on IVF1 (EPP with max stims) and one was not mature and IVF#2 yielded 2 eggs (microdose lupron with max stims). Embies were very poor quality (highly fragmented and don't grow). While I am considering DE, it's tough to know when to stop trying with OE.

I feel like I need to get that 2nd opinion from someone high FSH friendly before I can do DE. I'm limited by finances and found out that Dr. Check does take my insurance so I will go to him. I just called to make the appointment for a consult and was told that all the other RE's at Cooper will do a phone consult but not Dr. Check. How important is it to see him versus another RE in his office? Is another RE there just as good for FSH ladies? It's a 5hr drive for me so if I can do by phone, that would be ideal. I would do local monitoring in RI where I am.

I know his office is an unorganized disaster so I know what what sheer annoyance I am going to face...

TIA
I'm not sure it's all that important to go directly to Check or that meeting any of their REs in person is necessary. Their protocols are pretty cut and dry (and they are listed on their website) and no matter how many questions I asked it seemed like they were going to just follow the protocols that Check created regardless. Maybe after I gain more history with them they might tweak things, but I have my doubts. At the consult I asked about being able to speak to my RE directly during the IVF process and I was told that they all do the same thing, but that I could call and ask to speak specifically to my RE if I felt the need.

If it's important to you to see the conditions of the office, then I'd say make the trip, but honestly I doubt they would have remembered me if I came back in the next day. I met with Dr. Brasile and I liked her, but there was a air of rush about her that made me feel uncomfortable. We did go over everything, but whenever I spoke I got the impression that she was just hearing blah, blah, blah until I mentioned a keyword that raised her interest. I spoke to Dr. Check on the phone once. He seemed fine, but didn't seem to offer me anything enlightening, although the conversation was limited. Dr. Choe did my ER & ET and I liked her. I've read that others say she is a little harsh, but I didn't get that impression. I didn't have any other inaction with the other REs.

They do not give you a tour of the facitlity like some offices. Nor do they introduce you to any of the nurses. So if you are monitoring OOT all the nurses who call you during monitoring are always faceless. After ER I did get to match a few names with somes faces and I now know who is more helpful and who isn't.

If I end up doing IVF with them again, which there is a good chance I will.. the things I would do differently would be that I would have my baseline at their office. I would also want to see if they would be willing to put me on a steriod longer then the five days. Possibly through the first trimester. I have my concerns that my immune system (which is always fighting my endo) might be causing some of my problems. Finally I would want a real answer to this whole post transfer Lupron thing, the nurse sprung that on me at ER, which was quite annoying considering I never heard of it and that I had to go get the meds at the last minute.

I did like the low stim and for the most part I did just as well on that as I did on 600iu of fsh. It was a much easier cycle on me, physically and mentally. If things get rough with the OOT monitoring I found that getting MH on the phone with the front desk seemed to help. That's the day Dr. Check called us himself. If you decide to go there, I have a couple of other suggestions on making things easier for OOTers. Let me know and I can send you a note directly.
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Mrs. McIrish
Mrs. McIrish

December 1st, 2011, 4:26 pm #8

Thanks so much. I have a lot to figure out. It would be so much easier to stop, wouldn't it? I just feel like I have to try again. I'm also looking into Davis as an out of network provider... I will send you an email with questions. Hope you are doing OK.
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Joined: August 4th, 2011, 8:18 pm

December 1st, 2011, 5:24 pm #9

Hi ladies,
I hope it is OK to post here. I am 38. I was rejected yesterday by my RE at Brigham since I am a poor responder. She won't cycle me again and gave me the DE speech again. My history: failed 4 IUI's, and 2 IVFs in 2011. I am a poor responder, FSH was 17.3 at last test in June 2011 with E2 of 82 and AMH was 0.3 in September 2011. My AFC is always under 4(no one even tells me anymore). I only produced 3 eggs on IVF1 (EPP with max stims) and one was not mature and IVF#2 yielded 2 eggs (microdose lupron with max stims). Embies were very poor quality (highly fragmented and don't grow). While I am considering DE, it's tough to know when to stop trying with OE.

I feel like I need to get that 2nd opinion from someone high FSH friendly before I can do DE. I'm limited by finances and found out that Dr. Check does take my insurance so I will go to him. I just called to make the appointment for a consult and was told that all the other RE's at Cooper will do a phone consult but not Dr. Check. How important is it to see him versus another RE in his office? Is another RE there just as good for FSH ladies? It's a 5hr drive for me so if I can do by phone, that would be ideal. I would do local monitoring in RI where I am.

I know his office is an unorganized disaster so I know what what sheer annoyance I am going to face...

TIA
Tripplebe gave a very thorough answer. I think with your age, you have a great shot with Dr. Check. He has fairly good results with your age category. I think his stats drop significantly once you get above 40. As far as the protocol, it is pretty standard. With IVF, they will want your FSH to be around 12 or so when you start. If it is too high, then they will give you estinyl, or you can opt to wait and see if your body comes down on its own. Once it is in range, then they will start stim meds. Most of the time it is 150, sometimes I have seen them start with 75. They continue that until cetrotide at which point they increase meds. Then they just monitor you until trigger. They have some other protocols that they use on women without high fsh like the modified lupron protocol. But with this they usually want you to use higher amount of stim meds. You can also talk to Dr. Check directly, and sometimes he will modify the protocol and put it on your stim sheet so the IVF doctor knows the directions.
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Antonialisa
Antonialisa

December 1st, 2011, 5:25 pm #10

Thanks so much. I have a lot to figure out. It would be so much easier to stop, wouldn't it? I just feel like I have to try again. I'm also looking into Davis as an out of network provider... I will send you an email with questions. Hope you are doing OK.
Thanks Tripplebe A LOT for that. I'm contemplating IVF with Cooper in January so I'd be so so grateful for any other tips you have.

One more thought on Check: the initial consult was very high value for us. He spent hours and hours with us and we figured a lot of stuff out and learned a lot. For example, he figured out that I may have LUFS (don't release eggs every time) and subsequent post ovulation check for egg release has proven that this is true (even if I take Ovidrel sometimes!) He also decided that he thinks I don't have endometriosis (and sure enough, the longstanding endometrioma was just a persistent hemorraghic cyst that's been shrinking lately). He did sperm tests that were never performed before. Anyway, sorry if TMI but you get the idea. He is way more knowledgeable than many and his focus on research comes in handy.

I think it does go downhill from there. The service delivery is not stellar and the main problem seems to be, as pointed out by others, that no one is assigned to you (Drs or nurses) - it's all collectively done. Not only is it more alienating for the patient, but it runs the risk of having things fall through the cracks or inconsistent approaches.

One more tip: we had a phone chat with Dr. Check recently, and he said that if we want him to supervise our IVF, then we should put his name down on the fax callback sheet every single time for instructions. Otherwise, instructions will be given by whomever is on duty that week. The only thing i would add is that it might be useful to call the front desk and enquire as to whether your doc is in that day before faxing the form for that person.
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