IVF over and over again

If at first you don't succeed...

2009-06-18T09:27:00.000-07:00

And then if you don't succeed again and then don't succeed again are you crazy to keep trying?

There are only so many protocols, Gonal F, Follistim, Bravelle, Menopur, Repronex can be mixed and dosed only so many ways. In the end, at I think I am at the end, it has little, if anything, to do with the protocol. Estrogen priming, birth control, Lupron, micro dose blah blah blah blah.

I devoured this article about egg quality being influenced by protocol
and re-read this excerpt from the author's primary website.

I have an appointment tomorrow with an RE.
I hate to sound like I don't understand that my age and prior failures are huge factors, but I WANT to try again.

I want to have some optimism and I really want to succeed.

The SART statistics do show that the plus 40 categories have far less success, but there are SOME successes. In my gut I sort of feel that finding the right doctor at the right clinic is a critical key.

I am desperate for info from plus 40 women who had GREAT experiences and successes. If you are such a blogger, or follow such a blogger, please refer me to the appropriate places.

Thanks!!

Money money money

2009-06-15T06:15:00.000-07:00

It has been suggested, more than once or twice, that other than SART statistics (for which I have learned there is a bit of flexibility vis a vis "use of terms"), fertility clinics, more than any other arm of the medical profession have financial incentive to fail.

At a recent consult at a local clinic I was disappointed, but not actually surprised, to hear from at least two staff members that "all our patients start with birth control pills". I spoke to a former patient of that local clinic who advised that although she'd had a successful pregnancy, that the operation was an assembly line and with my history she could not say it was a good match. I spoke to that patient's husband who noted that the incentive to use the same protocol on all patients, and move them through in shifts coordinated by the mandated use of BCPs left little room for nurses or sono techs to be confused, but no likelihood of success for poor responders, or PCOSers, and plenty of room to make things worse. The incentive to fail was all financial, because so many people will do two or three cycles at the clinic where they started because:
a) it is a pain in the ass to change clinics... new testing, getting the old records, having a consult appointment, facing more delays, and yes, more outlay of cash.

b) most patients do not catch on to the downfalls of the assembly line one protocol for all and a nursing staff left in charge with little information or enough education about the effects of long term birth control pills on poor responders or older patients that we call over suppression.

c) most patients blame themselves for their first miscarriage or failure (I didn't eat enough pineapple, go to enough acupuncture, lose enough weight, gain enough weight, take enough vitamins, eat enough protein, rest enough after transfer, take my injections at the right time and a myriad of other reasons). It takes a bit for the average patient to begin to question the almighty "clinic" even when it is clear that often time there is no doctor driving the bus, but a group of nursing staff who make decisions about meds and cycles and when to trigger.

d) changing clinics means a bigger a failure on some level, and after the first few cycles failure gets a different taste, in any form.

The old line "we learn more about your cycles from a failed cycle and can do it differently/better next time" does have some merit, but after a while, when nothing is done better/differently or with greater success or attention it is clear you are on the train to make the clinic more money by doing more cycles where nobody with any medical expertise is really taking the time to figure things out. The clinic doesn't really care if you are running out of money, or if this is your last cycle, because, well, there is always someone on the train behind you, with money to try and try again.

IVF clinic search continued...

2009-06-13T05:00:00.000-07:00

Thanks very very much to those who posted their experiences (of the few who posted, most were positive reviews).

In a recent conversation with a fellow veteran of the IVF experience and someone who has met with more than a few clinics and doctors, the issue of traveling to a foreign country for IVF came up.

Money seems to be the driving factor in why a person might travel to the Czech Republic or elsewhere for fertility treatments.

Since many of us are paying cash out of pocket for our IVF cycles (and many of us have prior failed cycles or are TOO OLD for shared risk or any of those financial incentive programs).

A search for IVF in the Czech Republic reveals a few "IVF vacation" sites- where a liaison will facilitate your clinic experience, and even take you on local tours. It seems the price, even with airfare, is less than half a cycle at a US clinic.

A local US clinic recently gave me a break down of costs for my out of pocket IVF cycle. WTF is a "cycle management fee" of $500. Plus, this clinic seems intent on charging for all POSSIBLE services at the beginning (collecting for ICSI and assisted hatching before any part of the cycle can be started). My prior cycles did not require assisted hatching (and I got pregnant and miscarried) but upon consult at this new local clinic, I suspect they will do assisted hatching for everyone so they can be sure to keep the fee!

There are so many factors to process.

Location location (and other reasons to choose a fertility clinic)

2009-06-12T05:43:00.001-07:00

No doubt stress is a factor to be considered when undertaking invasive and ongoing fertility treatments. Recent studies show that "stressful life events" are linked to poor outcomes in IVF (sort of which came first chicken or egg since poor outcomes in IVF ARE stressful life events!!) There is a lot to be said for being able to arrive at the clinic for monitoring in the early hours of the morning without a grueling commute in unavoidable traffic.

So, the question arose, many cycles ago, do I switch from a fairly local clinic with offices each about a half hour to an hour from my front door (in traffic), because fairly local clinic seemed incapable of adjusting to dealing with a patient who had a miscarriage after IVF, and then many IUIs due to never achieving the amount of follicles achieved during that first IVF. Research showed that fairly local clinic did not have a "great" embryology lab, and fairly local clinic did not offer easy access to "my own" doctor. This clinic cycled patients in assembly line fashion, lining them up to see a nurse practitioner who was often overwhelmed and impatient. This clinic also lost some of their more compassionate nursing staff during my tenure there, and the varying level of skills amongst their doctors and nurses (from very competent to very basic and still learning) left me uneasy when the doctor I'd waited 2 hours to see during morning monitoring said he/she knew nothing about what my "own" doctor had mentioned regarding a protocol change during a separate "afternoon" appointment, complete with wait and co-pay.

That fairly local clinic made things hard, a patient having first to convince nurse practitioner that I NEEDED to see a doctor - and overcoming her threats of a very long wait, and the doctors who ended up being available at any given time during morning monitoring seemed to be either not looking at my sonogram photos (taken by the tech) or ignoring, for what I now know to be a matter of months, the fact that I had a LARGE growth in my uterus.

All of the above, plus many other failings of fairly local clinic, spurred me to seek out very very highly regarded clinic in NYC. For a period of time, optimism soothed the grueling early morning hours spent in traffic, and the increasing sums of cash needed for parking (which was free at fairly local clinic).

How much does location factor into a choice of clinic? I guess if things are going to be easy, even a careless clinic can get you pregnant, and if things are going to be difficult (or impossible) even the second or third best clinic in the USA can't get the job done.

So the question has come up again, as I am searching out a local clinic so I can try to muster up just enough eggs to try one more IVF.

In the beginning there was the fertility clinic....

2009-06-11T05:50:00.000-07:00

As I approach my (OMG) fifth (yes, fifth) IVF (three miscarriages and one negative) I am dizzy from the financial toll and indescribable emotional numbness that continues to threaten to
overtake me.

It seems, as a veteran of the reproductive war, that even if I had endless money (which I do not) I could still face ongoing failure. My experience with three different reproductive endocrinologists (and their respective clinics) leaves me certain that the SART statistics do not begin to give a prospective patient ANY inkling of what they will encounter when dealing with a given clinic.

Yes, I agree, 100%, that andrology and embryology labs are key. However, certain clinics leave all cycle monitoring to nurse practitioners and sono techs. Certain clinics require you to make a separate appointment (and pay for it, by co-pay or out of pocket, depending) to simply review a failed cycle or new protocol with your doctor.

Yes, I know, after four failed IVF cycles (and too many failed IUIs) that I might be wise to start investigating another option but still, I recently had a consult with another doctor. Fresh eyes on the situation were invaluable. However, what I failed to take into account was the "disconnect" in this new office between thorough and thoughtful new doctor, and his office and billing staff.

I live, thankfully, in an area with access to many IVF clinics and for the price of a few hours in the car and $25 to park I can be in NYC.

Still, despite exhaustive blog searches, and hours on the internet, I have yet to find one place where patients (bloggers, readers, anonymous commenters) can leave their opinions and experiences with specificity to the point of naming the clinic so that searchers can learn from hard learned lessons of veterans.

It is no secret that there is virtually NO malpractice in the field of reproductive endocrinology as there is no "generally accepted standard of care" with respect to cycles, medications, monitoring and protocols. It is all a big crap shoot and once you've failed the "basic" protocols, you consent, by continuing treatment and doing research and plodding on to submit yourself as a big old science experiment.

Although I am fairly certain I am done trying new doctors and new clinics, I'd really like to create a place, or open a dialog, where a searcher can review actual experiences and opinions of actual clinics before wasting time and money with a doctor or clinic who is not suited to the individual's situation. Even if one poster leaves a searcher with a question to ask a new doctor, and that question leads the searcher to another doctor or clinic, at least we are helping each other avoid lazy doctors, or rather doctors who have become lackadaisical.

In this economy, every penny we have saved and every bit of credit we exhaust to continue to reach for the dream of carrying a successful pregnancy and raising a happy child is invaluable. When we are newbies, first stepping in the door of our first (and hopefully last) fertility clinic, we are both at an advantage (optimism) and a disadvantage (naiveté).

I hope everyone will leave their experiences here, so that future searchers can find them.

Anonymous comments are fine.

Please leave the city, state and hopefully the name of the clinic, if not the name of the doctor, along with your experiences, comments and what you would have liked to have been told before walking in the door.

If you know if a website that already has this info in a coherent form (that for some reason isn't appearing in a google search), please leave a link to that website.