Thursday, December 11, 2008

my 2nd opinion appt

It's now 8 pm, and I'm just now really ready to think about my appt with Dr. S.ilber. First of all, my appt was at 3:30 and I didn't get in until after 5 pm. It was only after telling the secretary that I wanted to reschedule that they got me in. I was told "he likes to take his time with all patients and doesn't like to rush."

I FINALLY get in. The first question from him is "where is your husband." Umm...he has to work. He had planned on coming, but at the last minute he couldn't. The second question is...have you had a problem with transfers before. My answer: YES!

He thinks the ET processmay be my big issue (as far as IVF is concerned), b/c of my severely tilted uterus. . I told him about the problem Dr. R had at the fresh ET, and also about Dr. K's trouble with my FET, despite 2 trial embryo transfers. He explained (much more eloquently that I) that the cathetar can be similiar to an IUD (which obviously prevents pregnancy). When my uterus is poked so much, in an effort to get in, in can actually hinder implantion. His solution: sedate me or almost completely knock me out for an ER, so that my muscles are relaxed and so it would take little effort to insert the cathetar.

Other thoughts: He suggested mini-IVF which is essentially using Clomid for an extended period of time, and supplementing with FSH at the end. I told him that Clomid and I don't get along well. He asked why, and was surprised at my Clomid issues like hot flashes, night sweats, etc. He said it was usually the opposite, and that injectibles usually caused people the most problems. This immediately set me on alert, b/c I've always heard (by women who have experienced both!) the opposite.

He said if we do conventional IVF he would stick with a similar protocol to what Dr. K did. BUT, instead of doing 150 Follistim (a relatively low dose) all the way through, he would start out higher, and then lower it. Apparently, the FSH you take at the beginning of a cycle impacts the most, and the FSH you take toward the end doesn't do much of anything. He said if he started to see I was over-responding with the higher dose he would have me take HCG to even me out a bit.

If he had done my first IVF, with the same resulting embryos, he would have given me a 70% success rate. He also said that his protocol for freezing embryos (vitrification) gives them an almost equal FET success as with a fresh cycle. He said he can see a time when all ETs will be FET.

Essentially, he said he would be in charge of my ET (under some sort of sedation), would transfer 2, and freeze the rest with vitrification.

Overall, I would say he passive aggressively put down the WU RE's. He told me he didn't understand why they did all those tests. I asked what tests and he said the lap. I felt the need to defend Dr. K by saying I had requested it and she hadn't felt the need. He also pretty much said I had wasted tons of time with IUIs. I reminded him I was oop and he didn't say much then. He also didn't approve of their freezing method.

I also asked him about acupuncture. He said he didn't think it did much good,except to relax. He's a bigger proponent of muscle relaxation excercises.

I don't know what to think. I think I will take this to Dr. K to get her thoughts. I agree with his theory about the ET and my severely tilted uterus. Transfers haven't been easy. I'm a bit overwhelmed. He's at a hospital that is significantly farther away from us. Not that proximity is the only issue. I don't know. I didn't get a bad vibe, but also didn't get a good one. It just makes me wonder....if I wasn't happy with Dr. K how would I feel after being given all of this new info.

1 comment:

andrea said...

Wow, that sounded like an "interesting" appt. I tend to agree about sedating you during ET, but your regular RE can do that. I think it's interesting about changing your protocol, but getting eggs isn't your problem - so is he saying that changing your protocol would help? It might be cheaper to stim with clomid, which is one up side, but I wonder if your ET will be successful if your body is all messed up from the clomid?
It's tough, because you really like your RE and this guy sounds like he has a little bit of an ego. Doesn't mean that he isn't a good doc though. I don't get the impression though you heard anything that really impressed you in order to switch?