Dilemma--WWYD?

So (as you might know from other posts) I'm planning to try IVF again in June. In January I switched from RMA with a doctor I really liked to LIIVF because the monitoring hours/locations were really stressful with RMA. When I went to my consultation with Dr. Brenner to talk about the IVF and I mentioned my concerns about how I have been a poor responder in the past and what my last doctor had to do protocol-wise to get a good amount of eggs out of me. His response, in bullet points, was essentially the following:

* The fact that you have had so many losses AND you're a poor responder probably means that you have an egg quality issue even tho your FSH isn't high
* There isn't much we can do about egg quality
* I recommend a gentle stimulation since protocol isn't going to help your situation much
* The drugs are poison and too much of them can hurt the chances of implantation
* You should take the 5% risk and spend the money on PGD because at least then you will know whether it's an egg quality issue
* If all your eggs from the IVF come back chromosomally abnormal, you need to use donor eggs

I left there (devastated at the mention of donor eggs and) with a general vibe that he didn't think I had a very good shot, and this has been festering in my belly since the appointment a month ago. I made another one in 3 weeks to revisit the conversation. I just don't want to go through IVF with a doctor who doesn't believe in me. But at the same time, he is my THIRD doctor. I don't even know who I would go to. Or if changing docs is just running from the truth. I just feel like I'm 32 and I've been pg 4 times and I still have coverage for 4 more IVFs and it's a little early to be talking gloom and doom and donor eggs. Also, I have a sinking feeling "gentle stimulation" is going to result in a cycle that doesn't produce enough eggs to be an IVF and will get converted to an IUI, like the cycle in August did. But I have also read that the too much of the stim drugs can make for an unfriendly environment for a perfectly good embryo and maybe I ought to try it his way.

WWYD?

Message edited 3/10/2012 5:41:39 AM.

Re: Dilemma--WWYD?

Have you been to Dr. Braverman? I saw Dr. Brenner and did two IUIs and one IVF with him. I got BFNs. I switched to Dr. Braverman and he did much more testing and got a BFP with my first IVF. Dr. Braverman really thinks outside of the box.

Re: Dilemma--WWYD?

Its tough to hear that it might be an egg quality issue.....especially at your age and you don't have high FSH. I don't know if I completely agree with Dr. Brenner's plan but I do think PGD is something you should probably do. At least it can rule out or confirm egg quality issues. I know its pricey so its not an easy decision to make but why waste more of your IVF coverage on cycles that won't work if it is egg quality issues?? IDK, maybe try 2 more cycle before PGD? I only have coverage for 3 cycles.....my 1st cycle no embryos made it to freeze and Dr. Brenner said since I responded perfectly the fact that none made it could be an embryo quality issue but since it was our first cycle he didn't push PGD. I am in my 2nd cycle now, if I get the same results even with the little adjustments to protocol I think I will do PGD for my last cycle. I am also 32 and was in complete shock at the mention of having an egg quality issue......

Re: Dilemma--WWYD?

You've had 4 losses? If that's the case, I'd HIGHLY recommend you booking a consult with Dr. Braverman, who specializes in recurrent losses. Remember that a consult is just that - a consult. Doesn't mean you are making a commitment to switich - just another perspective, and in this case, from a slightly different angle. If you're waiting till June anyway, you definitely have time to get another opinion.

Good luck!

Re: Dilemma--WWYD?

Re: Dilemma--WWYD?

I can't do the Dr. Braverman thing. The fact that I have to go through OON benefits means that he'll charge the full 12-15k or whatever rather than the ins negotiated 7k, and I'll have to use up what would amount to 2 chances with an in-network doctor because I'm working with a lifetime max.

This is part of my ethical issue with the fact that he dropped all insurance.

Re: Dilemma--WWYD?

Re: Dilemma--WWYD?

What a difficult situation. On the one hand, I think we all want our doctors to be truthful and not give us false hope. On the other, we want to feel as though our doctors are determined to do whatever they can to try to help us achieve our dreams of being mothers.

I understand your concern about OON coverage. Perhaps different ins companies work out OON benefits differently, but I know my ins will pay 75% of what is "usual and customary." Maybe you want to call and clarify how OON would work with your ins carrier.

Also, have you considered either Genesis Fertility (Drs. Seifer or Grazi) or Kofinas Fertility - NY Methodist Hospital (George Kofinas) ? Both are consistently rated among the top 2% of REs in the country. Both are also rated very highly on SART. I mention them because, until I started reading this board, I had never heard of Braverman, while I repeatedly read about Grazi, Seifer, and Kofinas during my research. They all accept insurance, and a fresh perspective may be what you are longing for.

Re: Dilemma--WWYD?

This was his attitude with me when I was his patient. I did not have a great experience with him and glad I had moved on.

My advice, go elsewhere if you are having doubts. There are other facilities, even if you have to go out of your way to go to them. Also, I would not do PGD. He talked me into doing it and I was told by quite a few well known NYC drs that was a big mistake. To this day, I have major regrets about doing PGD.

As for out of network with Braverman, you are correct that you will be using much more of your infertility allowance and not get as many cycles from the amount the insurance company gives you.

Good luck to you!

Message edited 3/10/2012 12:21:29 PM.

Re: Dilemma--WWYD?

I agree with the Dr.Braverman rec.. At very least for a consult to see what he would have to say!

I'm so sorry you're in this situation now... I know what it's like to be on this path for so long, just to feel like you are literally back to square one with consults, etc.. .It's super frustrating!!

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I honestly would do a consult with Dr. Braverman too. Dr. Braverman was my 4th doctor. I think it takes time to find the 'one' that works for you and he may be the one. I paid out of pocket since my insurance does not cover any IVF. He was able to work with us and we get pregnant on my 3rd IVF with him. I have poor egg quality and immune issues too. Good Luck!!

Re: Dilemma--WWYD?

If you can't consult with dr Braverman I'd definitely try SIRM in manhattan. It's definitely a hike and a pain to monitor but it's worth it.

Also like others said, dr braverman will consult you and treat the immune issues for the consult fee (I forget how much. I want to say 1200). And you can do an ivf with another dr.

Re: Dilemma--WWYD?

Posted by InShock

Posted by bookworm

I can't do the Dr. Braverman thing. The fact that I have to go through OON benefits means that he'll charge the full 12-15k or whatever rather than the ins negotiated 7k, and I'll have to use up what would amount to 2 chances with an in-network doctor because I'm working with a lifetime max.

This is part of my ethical issue with the fact that he dropped all insurance.

Do you know this for sure? Have you spoken with someone from billing there? Also, a *consult* would not be that much. He is willing to work with patients who use another doctor and you just pay him a consulting fee (I don't know what it is). He has also made some OON agreements with some insurance carriers, so maybe yours is one of them.

And also, just something to think about - if Dr. Braverman can get you pregnant in ways a standard RE can't/won't, wouldn't it be worth every penny of your IF coverage?

And just to be clear, I am not saying Dr. B is the begin-all end-all of fertility doctors, but GIVEN your history, it seems he may be a really good fit for you, and at the very minimum, worth a consult.

This isn't easy, I know. Good luck w/ whatever you decide!!

Message edited 3/11/2012 7:51:13 AM.

Re: Dilemma--WWYD?

Dr B actually told me that immune issues can cause other parts of the body to be more hospitable for the egg to implant rather than the uterus. Just going by no blockage i would say that he would make the same suggestion for your ectopics.

Re: Dilemma--WWYD?

if u can afford the consult with dr b i would def go for it..

i wish i had better answers for you