What would you do?

What would you do?

Antonialisa
Antonialisa

January 26th, 2012, 6:58 pm #1

I am a bit overwhelmed thinking about what to do next.

History: TTC 2 1/2 years, 41, highest FSH 34, little endometrioma in one ovary, LUFS (need HCG to releaes eggs). In March 2011, Dr. Chec.k said that I only need TI and estinyl + HCG shot + progesterone and gave me a 75% chance of getting pregnant in 1 year. Boy was I thrilled after that meeting. His protocol seems to work great - perfect cycles and low FSH - except that that year is closing in and no BFPs.

I tried the last 2 cycles to do IVF with Cooper but a lead follicle always emerged despite others growing very nicely for awhile. Ch.eck in a recent call said that he won't change the IVF simple antagonist protocol and the problem is that all the other eggs weren't good. He also thinks TI is still best option for me since he sincerely believes the best follicle is recruited each cycle. Given Cooper's dismal success rates for IVF over 40, I'm ready to give up on them for IVF.

Just got more bad news last night: AMH test is only 0.16 which means practically no eggs left. I'm now getting an AFC of 8 or so, down from 9-10 after I started with Dr Che.ck.

I'm starting to feel panicky. I think I need to do IVF, but where? We are in Canada, living in a town without FSH friendly doctors, no insurance for IVF except 80% drugs and 100% monitoring in Canada covered. We don't have tons of money, unfortunately.

Option 1: SIRM - NY. Go to the best place we can (is it?). Do EZ IVF 2 or 3 times? Or try the full blown IVF treatment once (that's all we can afford). The cost and logistics of going to NYC and staying in a hotel for 10days -2 weeks is very daunting. My DH has a very busy job and children that we need to look after, and he would probably resist a bit but I think I could convince him if it's my #1 choice.

Option 2: Try to find an FSH friendly Dr in Montreal. My physician recommended Dr. Tan as one of the best in Canada but I don't know if he is FSH friendly. This is only about 2 hours away from us so we don't have to pay for hotels and each IVF is about $5,500. Stab in the dark but more convenient.

Option 3: Any other suggestions?

(We looked into Toronto but it's much farther and treatments are a lot more expensive than Montreal. Syracuse is also possible at 3.5 hours away but I don't think it is FSH friendly).

What would you do if you were in my shoes? Thanks so much for your help.
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MargieD
MargieD

January 26th, 2012, 8:29 pm #2

I would have a consultation with Dr. Tan and find out who he is and where he stands on your cycles.

That way - when you go to SIRM-NY - you can say that you've exhausted every option. It's also easier to justify to DH and yourself why you need to spend two weeks in NY.

Maybe Dr. Tan can monitor your cycles while you're waiting for things with SIRM-NY??


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jkl
jkl

January 26th, 2012, 9:22 pm #3

I am a bit overwhelmed thinking about what to do next.

History: TTC 2 1/2 years, 41, highest FSH 34, little endometrioma in one ovary, LUFS (need HCG to releaes eggs). In March 2011, Dr. Chec.k said that I only need TI and estinyl + HCG shot + progesterone and gave me a 75% chance of getting pregnant in 1 year. Boy was I thrilled after that meeting. His protocol seems to work great - perfect cycles and low FSH - except that that year is closing in and no BFPs.

I tried the last 2 cycles to do IVF with Cooper but a lead follicle always emerged despite others growing very nicely for awhile. Ch.eck in a recent call said that he won't change the IVF simple antagonist protocol and the problem is that all the other eggs weren't good. He also thinks TI is still best option for me since he sincerely believes the best follicle is recruited each cycle. Given Cooper's dismal success rates for IVF over 40, I'm ready to give up on them for IVF.

Just got more bad news last night: AMH test is only 0.16 which means practically no eggs left. I'm now getting an AFC of 8 or so, down from 9-10 after I started with Dr Che.ck.

I'm starting to feel panicky. I think I need to do IVF, but where? We are in Canada, living in a town without FSH friendly doctors, no insurance for IVF except 80% drugs and 100% monitoring in Canada covered. We don't have tons of money, unfortunately.

Option 1: SIRM - NY. Go to the best place we can (is it?). Do EZ IVF 2 or 3 times? Or try the full blown IVF treatment once (that's all we can afford). The cost and logistics of going to NYC and staying in a hotel for 10days -2 weeks is very daunting. My DH has a very busy job and children that we need to look after, and he would probably resist a bit but I think I could convince him if it's my #1 choice.

Option 2: Try to find an FSH friendly Dr in Montreal. My physician recommended Dr. Tan as one of the best in Canada but I don't know if he is FSH friendly. This is only about 2 hours away from us so we don't have to pay for hotels and each IVF is about $5,500. Stab in the dark but more convenient.

Option 3: Any other suggestions?

(We looked into Toronto but it's much farther and treatments are a lot more expensive than Montreal. Syracuse is also possible at 3.5 hours away but I don't think it is FSH friendly).

What would you do if you were in my shoes? Thanks so much for your help.
would be cn.y in syracuse. I wouldn't say they are expert at high FSH but they are open to trying things. I had success there (at 39, delivered at 40) and would be happy to answer any questions. The prices are really good so you may be able to do more cycles than at another place. For me, quantity was more important than quality in terms of finding the golden egg. GL

jkl
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anne
anne

January 26th, 2012, 9:48 pm #4

I am a bit overwhelmed thinking about what to do next.

History: TTC 2 1/2 years, 41, highest FSH 34, little endometrioma in one ovary, LUFS (need HCG to releaes eggs). In March 2011, Dr. Chec.k said that I only need TI and estinyl + HCG shot + progesterone and gave me a 75% chance of getting pregnant in 1 year. Boy was I thrilled after that meeting. His protocol seems to work great - perfect cycles and low FSH - except that that year is closing in and no BFPs.

I tried the last 2 cycles to do IVF with Cooper but a lead follicle always emerged despite others growing very nicely for awhile. Ch.eck in a recent call said that he won't change the IVF simple antagonist protocol and the problem is that all the other eggs weren't good. He also thinks TI is still best option for me since he sincerely believes the best follicle is recruited each cycle. Given Cooper's dismal success rates for IVF over 40, I'm ready to give up on them for IVF.

Just got more bad news last night: AMH test is only 0.16 which means practically no eggs left. I'm now getting an AFC of 8 or so, down from 9-10 after I started with Dr Che.ck.

I'm starting to feel panicky. I think I need to do IVF, but where? We are in Canada, living in a town without FSH friendly doctors, no insurance for IVF except 80% drugs and 100% monitoring in Canada covered. We don't have tons of money, unfortunately.

Option 1: SIRM - NY. Go to the best place we can (is it?). Do EZ IVF 2 or 3 times? Or try the full blown IVF treatment once (that's all we can afford). The cost and logistics of going to NYC and staying in a hotel for 10days -2 weeks is very daunting. My DH has a very busy job and children that we need to look after, and he would probably resist a bit but I think I could convince him if it's my #1 choice.

Option 2: Try to find an FSH friendly Dr in Montreal. My physician recommended Dr. Tan as one of the best in Canada but I don't know if he is FSH friendly. This is only about 2 hours away from us so we don't have to pay for hotels and each IVF is about $5,500. Stab in the dark but more convenient.

Option 3: Any other suggestions?

(We looked into Toronto but it's much farther and treatments are a lot more expensive than Montreal. Syracuse is also possible at 3.5 hours away but I don't think it is FSH friendly).

What would you do if you were in my shoes? Thanks so much for your help.
does the body choose the best one to recruit or is the best one lurking behind it? who the heck knows?

the money thing is always difficult; i am sorry not to be able to give advice here. if it were me i would go for the higher number of tries rather than one big try. but its all a gamble which sucks!

best of luck antonialisa, whatever you decide.
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Joined: December 20th, 2010, 7:38 pm

January 26th, 2012, 10:17 pm #5

I am a bit overwhelmed thinking about what to do next.

History: TTC 2 1/2 years, 41, highest FSH 34, little endometrioma in one ovary, LUFS (need HCG to releaes eggs). In March 2011, Dr. Chec.k said that I only need TI and estinyl + HCG shot + progesterone and gave me a 75% chance of getting pregnant in 1 year. Boy was I thrilled after that meeting. His protocol seems to work great - perfect cycles and low FSH - except that that year is closing in and no BFPs.

I tried the last 2 cycles to do IVF with Cooper but a lead follicle always emerged despite others growing very nicely for awhile. Ch.eck in a recent call said that he won't change the IVF simple antagonist protocol and the problem is that all the other eggs weren't good. He also thinks TI is still best option for me since he sincerely believes the best follicle is recruited each cycle. Given Cooper's dismal success rates for IVF over 40, I'm ready to give up on them for IVF.

Just got more bad news last night: AMH test is only 0.16 which means practically no eggs left. I'm now getting an AFC of 8 or so, down from 9-10 after I started with Dr Che.ck.

I'm starting to feel panicky. I think I need to do IVF, but where? We are in Canada, living in a town without FSH friendly doctors, no insurance for IVF except 80% drugs and 100% monitoring in Canada covered. We don't have tons of money, unfortunately.

Option 1: SIRM - NY. Go to the best place we can (is it?). Do EZ IVF 2 or 3 times? Or try the full blown IVF treatment once (that's all we can afford). The cost and logistics of going to NYC and staying in a hotel for 10days -2 weeks is very daunting. My DH has a very busy job and children that we need to look after, and he would probably resist a bit but I think I could convince him if it's my #1 choice.

Option 2: Try to find an FSH friendly Dr in Montreal. My physician recommended Dr. Tan as one of the best in Canada but I don't know if he is FSH friendly. This is only about 2 hours away from us so we don't have to pay for hotels and each IVF is about $5,500. Stab in the dark but more convenient.

Option 3: Any other suggestions?

(We looked into Toronto but it's much farther and treatments are a lot more expensive than Montreal. Syracuse is also possible at 3.5 hours away but I don't think it is FSH friendly).

What would you do if you were in my shoes? Thanks so much for your help.
I think a lot of the IVF failures come from financial stress, especially for people who are pinning their last hope on one single IVF cycle. From my experience, apart from superior labs, I don't see anything that the top clinics are doing differently from the less reputable clinics. They prescribed me the same protocol, the same dosage, the same gimmicks that I can convince my less reputable REs to do. My body carries 90% of the weight, not the doctors. The only thing I care about a clinic is its lab, if you are doing fresh transfer, lab doesn't even matter.

If I were you, I would choose a clinic without a price tag that stresses me out, and can allow me to cycle as many times as possible with limited resources. Better still, if you can find a doctor that YOU can influence. That's why I can never go to doctors like Schoolie because he cannot have an equal conversation with his patient, no matter how well educated and researched his patient is. I would rather have a doctor who will listen to me, and respects my input.
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Antonialisa
Antonialisa

January 27th, 2012, 12:28 am #6

I would have a consultation with Dr. Tan and find out who he is and where he stands on your cycles.

That way - when you go to SIRM-NY - you can say that you've exhausted every option. It's also easier to justify to DH and yourself why you need to spend two weeks in NY.

Maybe Dr. Tan can monitor your cycles while you're waiting for things with SIRM-NY??

Good thinking. In fact, your post makes realize that I can start to do both a bit. Maybe do Dr. Tan AND SIRM consultation in the short term. Thanks. BTW I should have mentioned but I can do monitoring here. I have a very sympathetic gynaecologist 15 min from home with an u/s in his office - thank heavens for that.
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Antonialisa
Antonialisa

January 27th, 2012, 12:30 am #7

would be cn.y in syracuse. I wouldn't say they are expert at high FSH but they are open to trying things. I had success there (at 39, delivered at 40) and would be happy to answer any questions. The prices are really good so you may be able to do more cycles than at another place. For me, quantity was more important than quality in terms of finding the golden egg. GL

jkl
That's a helpful perspective, thanks. They do have good prices, especially if you pay for 2 or 3 up front.
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Antonialisa
Antonialisa

January 27th, 2012, 12:35 am #8

does the body choose the best one to recruit or is the best one lurking behind it? who the heck knows?

the money thing is always difficult; i am sorry not to be able to give advice here. if it were me i would go for the higher number of tries rather than one big try. but its all a gamble which sucks!

best of luck antonialisa, whatever you decide.
Anne, I just love your posts! You really have a way of expressing yourself that I find refreshing. Who the heck knows indeed?

Dr.Ch.eck's theory is that your body recruits the best eggs and selects the best of the best to lead each cycle. This unfortunately leaves ovaries full of crap eggs once the supply is getting very low. Seems to be where I am. However, I don't think it is totally irreducible. Some people like Mrs. A had 9 IVFs then conceived on her first TI cycle. Others like a poster on the other board had 35 TI cycles but got pregnant on her first IVF. Maybe you just have to try a few different things...and see whether dumb luck hits.
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Antonialisa
Antonialisa

January 27th, 2012, 12:47 am #9

I think a lot of the IVF failures come from financial stress, especially for people who are pinning their last hope on one single IVF cycle. From my experience, apart from superior labs, I don't see anything that the top clinics are doing differently from the less reputable clinics. They prescribed me the same protocol, the same dosage, the same gimmicks that I can convince my less reputable REs to do. My body carries 90% of the weight, not the doctors. The only thing I care about a clinic is its lab, if you are doing fresh transfer, lab doesn't even matter.

If I were you, I would choose a clinic without a price tag that stresses me out, and can allow me to cycle as many times as possible with limited resources. Better still, if you can find a doctor that YOU can influence. That's why I can never go to doctors like Schoolie because he cannot have an equal conversation with his patient, no matter how well educated and researched his patient is. I would rather have a doctor who will listen to me, and respects my input.
There is a lot of wisdom in that. I feel as though me plus my gynaecologist here who does monitoring can do Ch.eck's TI protocol with our eyes shut and we can be more conscientious than his office.

This cycle I would like to try your protocol with the cetrotide the first few days to suppress the lead follicle. I will discuss with my local Dr. tomorrow (we will do with TI the first time to see how it goes). I think it is worth a shot. Given that I am already doing estrogen + progesterone in the luteal phase, it's hard to believe that birth control pills would do better and it's one step more gentle than lupron, right? Thanks very much for sharing it with me.

I agree that finances make things more stressful, as well as traveling far away since DH and I both have busy jobs (but I have no problem taking time off from mine) and my stepchildren. In our case, because he already has children, it's me driving the whole thing and him pulling up the rear, and that's stressful, exhausting and guilt-inducing as well.
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Jamie
Jamie

January 27th, 2012, 2:49 pm #10

would be cn.y in syracuse. I wouldn't say they are expert at high FSH but they are open to trying things. I had success there (at 39, delivered at 40) and would be happy to answer any questions. The prices are really good so you may be able to do more cycles than at another place. For me, quantity was more important than quality in terms of finding the golden egg. GL

jkl
I would get aggressive ASAP; an AFC of eight is actually a fairly hopeful situation. I'd try to talk to these people right away.

I know that Check often does no suppression in advance of a cycle; maybe doing a few weeks of BCPs would help your follicles. The other thing is that sometimes low stim is not good for evenly growing follicles. I did an IVF with Dr. Check and out of 7 follicles I only had 3 mature eggs. This was on 150 Bravelle, 150 Menopur. I had a chemical pregnancy.

My next RE said that we needed to start with higher doses of meds and try to hit the follicles a little harder up front to get all the follicles growing together right away. He had me on 225 Follistim/150 Menopur and when I had a little trouble stimming at first upped the Menopur to 225. I ended up having much better results . . . 9 visible follicles, 11 eggs retrieved, 8 mature. I also had a baby girl from this pregnancy at almost age 40.

The other thing this RE said is that Bravelle has more uneven dosing and can contribute to this problem, whereas Follistim and Gonal-F do not.

Good luck, rooting you on! Please let us know what you decide.
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