Need Advice----LONG

Hi! Okay, here goes! (Long Story)

I will preface this with I have a healthy 2 year old daughter who was conceived naturally on the first try... it was super quick when I was 29, I have just turned 32 and have been ttc for 10 months. I have always had a regular 26-30 day cycle... most being 28 days long. I breastfed her for 15 months. We started "trying" August of 2008... everyone assumed I would get pregnant quickly again. When it didnt happen the first month, I started using OPK's and temping... I started to notice that my LP's were only like 8-9 days long. However, on the 3rd month, I conceived... however, started staining from the beginning. Pregnancy only got to 5 and a half weeks... faint heartbeat seen. Went back a week later (I should have been around 8 weeks at the time) and was told I was miscarrying. I miscarried naturally December 30th. I then was told by my OB that there was nothing wrong with me, I didnt need meds etc. and that I should start trying again the next cycle. Something in my gut told me something was wrong. So I went to RSofNY and saw Dr. San Roman. He told me that I was on the cusp of having a luteal phase defect, he wasnt convinced that I trully had one. His protocol was progesterone suppositories for 3 months,.. if I wasnt pregnant within that time, then we would try Clomid. All of my bloods from there were normal, FSH was 2, Estradiol was slightly elevated at 98. I ovulate on my own, make a nice lining (12) and a nice sized follicle (19mm) they said everything was "normal". During that time I also went for a consult with LIIVF, Dr. Kenigsberg... he said that he did NOT think I had LPD. That I should just try on my own and he would test my progesterone once I became pregnant.
After 2 months with RSofNY, I decided to get a third opinion and went to Dr. Braverman at SIRM. He said I definitely had a luteal phase defect that he would also treat with progesterone suppositories. However, my levels he thought were a bit on the higher side... My levels on day 3 on March 11th were: Prog- 0.5, Prolactin- 8.9, FSH 4.2, LH- 2.2, Inhibin B- 29 (which he said was a little low). TSH- 0.96 and Estradiol 98. We tried that month naturally, nothing.
April- Day 3-
TSH- 0.87
Estradiol- 78
FSH- 3.9
LH- 2.7
Progesterone- 0.8
Prolactin- 9.6
Tried that month naturally, with accupuncture, and progesterone suppositories... got BFP, but ended up being a chemical. Beta went up to 21, then 26 then plummeted.
Okay, so that was beginning of May. So Dr. B, said to try Femara, HGC trigger, Progesterone Suppositories, then HCG booster. I got 2 19mm follies. Timed BD... got my beta on June 5th... it was a 10. Most likely from the HCG trigger booster. Next day went down to 5.
He told me that he now does not think this is a progesterone issue, that he thinks it is an egg quality issue due to the elevated FSH and low inhibin B. He gave me the following options:
1- Do femara, hcg, progesterone, booster for one more month at a higher dosage.
2- Do it on our own (could take up to 2 years, could have more miscarriages).
3- Do IVF.
I made an appt at NSUH with Dr. Rosenfeld the CHIEF. He took one look at all of my records from both SIRM and RSofNY (he actually trained Dr. San Roman) and said that there was nothing wrong with me. He said that I am fertile, that the two miscarriages were unfortunate, but that it was normal. He did say that my estrogen was slightly elevated which could be a slight decline in egg quality or could be due to the fact that I am overweight. I was 26lbs less when I conceived my daughter. He said that the more weight you have, the higher your estrogen is. So if I lose the weight, my estrogen level should go down. He also said that if it was egg quality that IUI or IVF wouldnt help. It would just take longer to get pregant. He did a sono and examination said everything looked perfect. Recommended that I get an HSG just to check but he was very confident that nothing will be wrong. He said I just need to keep trying. He also had some not nice things to say about the fact that Dr. Braverman is not an RE and questioned some of the tests that he runs.
Anyway... now I am so confused. I will say that no matter what we were going to take a few months to go back to trying on our own because the stress was just really hard on me. A part of me trully believes that I don't need IVF. I don't know who to believe! I have 3 "true" RE's telling me that I don't really have a problem. My DH will now only listen to Dr. Rosenfeld because he did not realize that Dr. Braverman was not a board certified reproductive endocrinologist.
I need advice!

Re: Need Advice----LONG

i can kind of relate to you in some sense.. i am a patient of Dr. Braverman.. who i love.
i know he isnt an RE.. but that doesnt concern me.

i conceived naturally the very first month of trying.. lost that one though.
then had a hard time after that.. finally conceived again 6 months later.. had a chemical.
and now here i am .. still trying..
dr. braverman had confirmed i had a slightly elevated egg quality issue too.. and i had done 4 IUI's which didnt help.
he also said i can try on our own too.. he said i would get PG.. just didnt know how long it would be.. could take a while.
and finally it all came down to IVF.. and i never thought i would need to do this.. and part of me thinks that i still might not.. but i know it will help give me more chances, and he can pick out all the "good" eggs.. (since thats my problem) and go from there.
i just dont want to keep trying on my own and get PG again just to lose it because the egg was not good .
he thinks thats how i might have gotten the chemical. so i cant keep losing babies. i refuse.
so i rather up my chances in doing IVF and get the best eggs!

Re: Need Advice----LONG--long answer

Ok, take a deep breath!! It is very confusing and hard to decide who is "right" and who is "wrong" when you have different experts telling you different things. For the record, no one has been able to get me pregnant to date despite finding nothing but annovulation to be my problem, all 3 RE's I've used have gotten me to ovulate however. Recently a missed thyroid issue was uncovered. 99% of it at this point is your gut and comfort level. You have to be totally confident in the treatment you are receiving and the staff as well.

I find it very unprofessional for one doctor to give his opinion on anothers approach--as far as I am concerned there is no right or wrong when dealing with IF and if doctors didn't push the envelope and seek alternate tests and treatments none of us would have a shot of getting pregnannt. Every person needs to be treated individually and it may take a few cycles to figure out a good plan of attack. If you are more comfortable with a board certified RE then that is where you need to seek treatment. If you feel your issues are "out side of the box" then you may want to pursure treatment with SIRM.

For me it came down to this: I was not ready for IVF but was being pushed in that direction by the 2nd RE. My gut said not now, rule out other options. Based on that I pursued a third opinion (first RE wasn't pushing IVF yet but we had other difference of opinions). So, I wnet, spoke with the new doctor and he agreed that I had a few more options before IVF and was willing to try them. I was comfortable with that plan and decided to go for it. It might work, it might not, but if/when we come to the conclusion that IVF is out next step, I feel I will be more ready for it as I will feel I did what was right for me.

So, that's the moral of the story, you have weigh your options, be comfortable with your decision and go with your gut. Remember, you can always change your mind/direction/doctors at any time!!

Best of luck to you!

Re: Need Advice----LONG

wow- how very confusing- sorry you have to deal with all this conflicting info- I'm sure it is enough to make your head spin..

I too had an 'ok' time conceiving my first child and heck conceiving my 2nd.. I went to Dr. B and he did get me pregnant after 2 cycles- so to me, he's amazing- but I also did not see any other specialists/RE's for their opinion.

I do want to say that I did start weight watchers and lost 12 pounds before I became pregnant- and I think it did contribute slightly to the success (among other things).

If you want to try a few months on your own, it wouldn't hurt to maybe try WW and go down a few pounds, even 5 lbs could help!

good luck & much baby dust to you!

Re: Need Advice----LONG

Dr. B isn't a RE, but compared to the doctors at my previous RE, he is much more educated on the latest research. I spent about 7 months with LIIVF and they weren't able to identify the cause of any problems. In one month with braverman, they found a translocation, sperm fragmentation, natural killer cells, and another immune issue. I get chills thinking about how much time I would have wasted with the RE.

Normally, I wouldn't ever consider going to an OB/GYN for infertility. I am a snob like that. However, Braverman is so much better that I can't deny his level of expertise.

I do think different doctors have different philosophies. You have to decide whose philosophy you buy into. They all interpret the research differently.

Re: Need Advice----LONG

Nicole,

I think you and DH need to take some time and think on all the information you have received.

I do agree with PP that one doctor saying disparaging remarks about another is not professional. It is one thing to disagree professionally, but to have not nice things to say is another.
Yes, I am a patient of Dr. B and I love him. Like others, I had issues LPD and MTHFR Factor V that were not diagnosed/dealt with properly at two other RE offices. I wasted 2.5 years and had 2 miscarriages, which may not have happened if the other ones had done the testing that Dr. B did. Reproductive Endocrinology is not an exact science, each specialist is going to have their own opionions, just like any other speciality of doctor.

It can't hurt to go forward with your plan to lose some weight while you make your decision, it can only benefit you. If you get PG on your own, and you are concerned about a progesterone issue, I would call your reg. OB upon getting your BFP and tell them it was suggested to you previously that you may have a progesterone issue, and let them send you for blood work to check on it to be on the safe side.

My prayers for you and DH. It's a complicated time for you.