Thursday, March 18, 2010

Finally -Validation for our canceled IVF cycle

Jamie and I met with Dr. O today from Washington University Infertility and Reproductive Medicine Center.  I faxed over all of my previous medical information from Dr. A's office (where we canceled our first IVF cycle).  The Dr. reviewed the records Monday night and I was called Tuesday to schedule an appointment with Dr. O.   His wait is generally two weeks, we somehow got in early.

The beginning of our conversation was basically J and I explaining what brought us to Wash. U.  It's a little hard to believe that less than one week ago we were forging ahead full steam with IVF at Dr. A's office and now we were sitting in another Dr.'s office after a cancellation.  We explained how Dr. A wanted to proceed with our retrieval with two E2's of 113 and 137 last week and 30 follicles.  We explained how J and I basically canceled our own cycle due to research we had done, and how it was really the financial coordinator that told us to cancel, not the Dr.  Unfortunately.

Dr. O looked through our records further and I gave him a copy of my IVF calendar from Dr. A's office.  We went through the calendar thoroughly and noted my E2's, the FSH (follicle stimulating hormone) injections, etc. 

He made some interesting comments. 

1.)  He said that this calendar seemed too much like a "cook book", interesting because I told him I felt Dr. A's office was like a factory.

2.)  He wondered why the FSH started on March 2 at 300 units and then reduced gradually to March 7th only to be gradually kicked back up again.  He said that a lot of times once you start decreasing the dosages to the follicles they stop responding and it's hard to get them to rev back up again even with a lot of meds, and then do you see how on March 10th and 11th I am given 375 and 300 FSH?  He boosted them again!  My follicles weren't doing what he wanted, they weren't growing so he was boosting my FSH after decreasing it to try to get them to respond. 
 3.)  He questioned the lupron dosage and wondered if he would have upped it to 20.  I was on 5.

4.)  He also mentioned that he would not put me on steroids at all, I was on dexamethasone for the duration of my ivf and was told I would stay on it for the first 8 weeks after pregnancy.

5.)  At one point while flipping through the chart the Dr. mentioned how Dr. A's records were not kept as typical Dr.'s offices keep them, there was no flow chart to show how the follicle size, fsh dosages, etc. worked in relation to each other.  All of the notes in my chart were in email format as well which Dr. O found difficult to understand.

6.)  I missed this but Dr. O also said he grinned when he saw the prescription page.  He said that and some other forms were basically taken from Wash U by someone and used by Dr. A's office.  He said he wished they would have taken Wash U's flow charts so he could better interpret our records!  Dr. O said he was going to have someone on his staff translate my calendar into a flow chart so it could be better interpreted which I really liked. 

7.)  Dr. O also asked why didn't Dr. A convert our cycle to IUI after canceling IVF?  With 30 follicles and weeks of medication it seems a shame to waste all of our hard work.  It was never even offered as an option I am sad to say. 

8.)  Finally we got to the point in the conversation where Dr. O would tell J and I if WE had made the right decision to cancel.  He admitted that some women just have low E2's, that's just how it is.  But given my age and with 30 or so follicles he said that he would have been very concerned with an E2 like mine and would have suggested canceling.  I could have cried.  I didn't!  But, I could have.  I looked at J.  Finally, something that made me feel better.  I explained to the Dr. again, that we only had google to make our decision from.   He did say that for some women with breast cancer, etc.  he might have gone forward with a low E2 due to medication but not for the general patient. 

It felt so nice to sit with a Dr. and talk for 45 minutes or an hour, I don't even know.  We had his undivided attention.  As far as when we can proceed.  I explained to him that we were placed on birth control, which seemed to confuse him.  He didn't understand why they didn't just give me provera.  Oh well.  As soon as I start my next period, if we are ready, all I have to do is give him a call and we can start the process again!  We wouldn't have to be placed into a specific months cycle, they do retrievals and transfers weekly.  How refreshing! 

A few things I have learned from all of this:

1.)  I wish I would have done a little more research regarding my first Dr. choice for IVF.  I would have checked to see if Dr. A was certified in Reproductive Endocrinology.  He's not.  He's an OB GYN.  This wouldn't have settled well with me had I known this and I found out after we canceled unfortunately.  I never thought to look to see if the only Dr. at a Reproductive Medical Center was certified in Reproductive Endocrinology! 

2.)  I should have chosen a Dr.'s office with more than one Dr..  I believe in co-workers bouncing ideas off of co-workers and I don't think Doctors are immune from this but rather it is crucial for Doctors. 

3.)  Google may be all we had to use as research and many have scoughed at the idea that we have informed ourselves through the internet, but I will keep Googling.  I believe whether it be another woman's experience or a website dedicated to research, as long as you are selective, you can learn most of what you need to know from Google.

I can't tell you how good it feels to go from a generic one size fits all clinic to a true case by case clinic.  I don't know if we will meet with the other two Doctors.  I think we might meet with Dr. Wilbois as a back up opinion but I feel great about Wash U and Dr. O.  I have peace in my heart regarding our decision to cancel with Dr. A and I have hope moving forward.  Dr. O says we aren't a difficult case at all.  :)  All smiles!

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