Had my consult at SIRM- SUPER LONG

So after a year of failures with my RE (6 IUIs,2 IVFs, 1FET) I decided its time for a new practice. Being unexplained its not really easy to find someone who will do much differently or find out whats wrong with you.

I went to SIRM and met with Dr. Tortoriello on Friday. When I walked into the office the first thing he says is SO UNEXPLAINED INFERTILITY. He then gave me options of different tests and things we can do. I have already had many tests over the past year (HSG, Saline sono, hysterscopy, RLP, endo biopsy).

-His plan is to do a Lupron protocol where I start Lupron on CD 21. He wants to stim me higher at 450 of Gonal F and 75 on Menopur and then drop me down. His goal is to get 15 mature eggs. My former RE suggests the Lupron protocol as a next step also.

-He strongly suggests the EFT- Endometrial Function Test through Yale. He said even though my endo biopsy came back fine this test could show implantation issues. The test can determine if your endomtrium is receptive to implantation. Dr. T said if it came back abnormal we may have to put me into a menipausal type state for a few months and then start again. He says we did have implantation twice but it wasn't long enough to rule out implantation issues. I had a had a very bad experience with my endo biopsy and had pain for months and still feel it at times today. So scared to do this again. $600

-He said DHs SA looks good and he strongly doubts the problem is with DH. He said we could do the DNA Fragmentation test if we want but he again doubts the issue is with him. $500. ALso you could do PICSI for $1000

-I asked about immune testing- He said we could do it if we want. He would test NK Cells and DQ Alpha Match- $400 something. We are going to do this.

- He suggest PGD. He says it won't improve our chances but will give us a better idea what is going on. $4000- My thinking is we had 4 decent emrbyos from IVF 2- 2 to transfer and 2 to freeze- either way we have 1 ivf left and 2 fet so IDK if I can spend another 4k on top of all the other fees I'll already be spending- about 5k.

- HGH- Human Growth Hormone- MAY improve the egg quality. He said no guarantee and it works in some women. $400+

-I asked about supplements- He suggested ubiquinol (I'm already on COQ10 and he said I can continue the dosage I'm taking) and Pycnogenol (not sure what this is have to look it up)

- I asked about 5d or 3d transfer. He said 5 day and he would transfer 2.

I was a little overwhelmed with all the things he was throwing out and the pricing. I asked some of my questions but definitely not all of them. I liked that he would work with my schedule as to when I can get there and also was willing to work an IVF around my April break. I guess I just didn't get the sense if he thought we had a good chance of this working or not. I guess he doesn't sugar coat which is fine but I'm not used to that. He said the pluses were I didn't have DOR, I stimmed well, and DH is fine. I hope a new protocol and a new lab will do the trick.

Any advice in regards to all of the things he suggested? We will definitely do the immune testing but what about the other stuff? I have been looking up the EFT test and theres conflicting info about it. Anyone do it?

I need to get this right this may be our last shot and we need a miracle. Hating UNEXPLAINED IF!

Thanks ladies!

Re: Had my consult at SIRM- SUPER LONG

I'm obviously biased bc after a crazy road, Dr.T helped bring me my miracle. I think no matter what you decide to do, you have to trust your doctor and feel comfortable investing yourself emotionally, financially, and of course physically. You pay them the big bucks, you need to trust the dr will put together a protocol that will work.

I went for MANY second opinions and it was very hard for me to decide where to go because what did I know? I was just the "stupid patient" and all the doctors I saw had ideas that seemed to make sense (except for Cornell- who I admittedly hated for various reasons...)

I went with Dr.T because I knew his protocols catered to thrombo issues. I also knew of people who used his office and were so impressed with how well they run- seriously like a well oiled machine!!!!! Dr.T's bedside manner was also fantastic, similar to Dr.B who I was with previously. I knew he saw me as a person, not a number. I think you need to be comfortable, wherever you decide to go.

Re: Had my consult at SIRM- SUPER LONG

SIRM was our next step, if it came down to it. If I remember correctly, you can't cycle until summer, right?

I would do te EFT, so that if you had to go into a menopausal state, you could do that now and be ready for IVF in the summer.

I wouldn't suggest any testing for DH, it doesn't seem necessary. You you can decide on PGD at a later time, but I wouldn't either unless you got a good amount of eggs. We only had three, so it wasn't worth it.


Your egg quality is good, HGH can only help.

Re: Had my consult at SIRM- SUPER LONG

Had my consult at SIRM- SUPER LONG

How do you feel after the consult? Hopeful? Do you think they will help? Would you want to get another consult? I know you only have one Ivf left with coverage so are you sure this is the place you want to do it?

Had my consult at SIRM- SUPER LONG

DH had the sperm fragmentation test. To us, it was worth it to only rule it out. We paid about $360 for it. They say it is recommended with multiple failed IVF's or multiple chemicals.
We did not want to proceed without checking if that was an issue or not. It has nothing to do with semen analysis, so you would not have any indicators if that is an issue or not.

Good luck!!!

Had my consult at SIRM- SUPER LONG

I have a good feeling about you switching. I think a new protocol and lab is exactly what you need... XO

Re: Had my consult at SIRM- SUPER LONG

Re: Had my consult at SIRM- SUPER LONG

Re: Had my consult at SIRM- SUPER LONG

Posted by babyfever24

Posted by PennyCat

so impressed with how well they run- seriously like a well oiled machine!!!!! Dr.T's bedside manner was also fantastic, similar to Dr.B who I was with previously. I knew he saw me as a person, not a number. I think you need to be comfortable, wherever you decide to go.

THIS! Another biased SIRM patient. As you know! Still waiting on my miracle but the staff at SIRM have made my life a little less hellish. I would say go for the eft and to skip the DNA fragmentation…..def do the immune testing.

Re: Had my consult at SIRM- SUPER LONG

Re: Had my consult at SIRM- SUPER LONG

What it comes down to is, no RE could predict the future. They can even come across sounding as confident as ever, but if they don't work, their word is worth nothing. I'd go to the RE with the best reputation for helping women in your situation. The rest is out of your hands.

Message edited 2/9/2014 8:40:12 PM.

Re: Had my consult at SIRM- SUPER LONG

Re: Had my consult at SIRM- SUPER LONG

Re: Had my consult at SIRM- SUPER LONG

I did ICSI with Dr Z both times. He picked the best sperm abd fertilized each egg. We were dealing with some male factor too.

Re: Had my consult at SIRM- SUPER LONG

Re: Had my consult at SIRM- SUPER LONG

Re: Had my consult at SIRM- SUPER LONG

Re: Had my consult at SIRM- SUPER LONG

Hmm, I had never heard of the EFT he mentioned. I wonder how it's different from the E-tegrity test (just had that done).

I considered SIRM. A lot of my blog and Resolve DOR pals swear by Dr. Wang (same practice) and they have a good lab. I appreciate their open-mindedness about testing and digging for answers vs. the common practice of blaming the egg despite good morphology and growth.

Best of luck! Even with good doctors, it's a crapshoot, but it makes sense to give yourself the best chance always

Re: Had my consult at SIRM- SUPER LONG

Posted by bookworm

Hmm, I had never heard of the EFT he mentioned. I wonder how it's different from the E-tegrity test (just had that done).

I considered SIRM. A lot of my blog and Resolve DOR pals swear by Dr. Wang (same practice) and they have a good lab. I appreciate their open-mindedness about testing and digging for answers vs. the common practice of blaming the egg despite good morphology and growth.

Best of luck! Even with good doctors, it's a crapshoot, but it makes sense to give yourself the best chance always

Re: Had my consult at SIRM- SUPER LONG

Posted by babydreams21

Posted by bookworm

Hmm, I had never heard of the EFT he mentioned. I wonder how it's different from the E-tegrity test (just had that done).

I considered SIRM. A lot of my blog and Resolve DOR pals swear by Dr. Wang (same practice) and they have a good lab. I appreciate their open-mindedness about testing and digging for answers vs. the common practice of blaming the egg despite good morphology and growth.

Best of luck! Even with good doctors, it's a crapshoot, but it makes sense to give yourself the best chance always

Thanks for your response. I think the test you did seems similar. If you don't mind me asking what did your results show? What was your experience? I had the endo biopsy and it came back fine. I had pain for months and not sure if I should do it again. I also think I would have to do a mock cycle and then do the biopsy. IDK so many decisions... CGoing to do immune testing first and then go from there.

This is the info I got from Yale's website:Article for Patients: The Soil Test for Your Endometrium: the Endometrial Function Test® (EFT®)
From the introduction: A healthy pregnancy is like a successful garden. The successful garden starts with healthy plants and a nutrient rich soil. Likewise, the healthy pregnancy depends on a quality embryo and a normal endometrium. Just as gardeners have always been able to test their soil to optimize plant growth, patients can now have their endometrium tested with the Endometrial Function Test® (EFT®). This patented test can optimize a patient's chances of having a successful pregnancy by using molecular markers to assess the endometrium's potential to support implantation and its ability to contribute to the nutrition of the developing embryo.

Does that sound like the test you had?

Thanks!

Message edited 2/12/2014 5:41:21 PM.

Re: Had my consult at SIRM- SUPER LONG

Posted by bookworm

Posted by babydreams21

Posted by bookworm

Hmm, I had never heard of the EFT he mentioned. I wonder how it's different from the E-tegrity test (just had that done).

I considered SIRM. A lot of my blog and Resolve DOR pals swear by Dr. Wang (same practice) and they have a good lab. I appreciate their open-mindedness about testing and digging for answers vs. the common practice of blaming the egg despite good morphology and growth.

Best of luck! Even with good doctors, it's a crapshoot, but it makes sense to give yourself the best chance always

Thanks for your response. I think the test you did seems similar. If you don't mind me asking what did your results show? What was your experience? I had the endo biopsy and it came back fine. I had pain for months and not sure if I should do it again. I also think I would have to do a mock cycle and then do the biopsy. IDK so many decisions... CGoing to do immune testing first and then go from there.

This is the info I got from Yale's website:Article for Patients: The Soil Test for Your Endometrium: the Endometrial Function Test® (EFT®)
From the introduction: A healthy pregnancy is like a successful garden. The successful garden starts with healthy plants and a nutrient rich soil. Likewise, the healthy pregnancy depends on a quality embryo and a normal endometrium. Just as gardeners have always been able to test their soil to optimize plant growth, patients can now have their endometrium tested with the Endometrial Function Test® (EFT®). This patented test can optimize a patient's chances of having a successful pregnancy by using molecular markers to assess the endometrium's potential to support implantation and its ability to contribute to the nutrition of the developing embryo.

Does that sound like the test you had?

Thanks!

E-tegrity tests (primarily) for the presence of beta 3 integrin, a protein this one doctor posited is necessary for implantation and a claim a lot of docs don't agree with. It also tests to see if the lining is "in phase," which is the part that sounds like it might mimic this Yale test. I'm not sure how they're different, but I have a follow-up with my doctor next week, so I will definitely ask him. My results were all on the up and up: beta 3 integrin present and endometrium in phase, and that was after an IVF cycle with tons of Clomid that thinned the lining like crazy. Secretly I was hoping for this test to reveal a problem because treatment is easy and effective, and we learned that I made a bunch of normal blasts after 4 (now unexplained) IVF failures and 6 chemical and/or ectopic pregnancies.

Re: Had my consult at SIRM- SUPER LONG

Thanks for your thorough post. I've been researching this place too in case things don't work out with my current doctor that I love.

Re: Had my consult at SIRM- SUPER LONG

Re: Had my consult at SIRM- SUPER LONG

Exactly how I feel. I really love my doc and her practice but if this round doesn't work, I need to at least get a second opinion. I'm running out of cycles and want to minimize my out of pocket.