A few days after my BFN from FET#3, my Lead Physician approached me to ask how I was doing. I gave her a run down of my RIF research and mentioned that I had contacted the other RE who has visited our office. "Are you going to switch?" she jumped in to ask. I paused a second before answering. Initially my decision to do some outreach wasn't so much about seeking another opinion; it was laziness on my part. I had to finish a presentation that weekend and I decided to outsource the task. Fortunately, my RE had to reschedule the appointment, which gave me time to do my own work when neither responded. I hadn't admitted to myself that maybe I was also looking for some words of wisdom from providers with more years of my experience than my RE. While I have no doubt that my RE is up to date with the most current litterature, especially as he doesn't seem to have much of a life outside the office; he was born in the same year as Louise Brown, while the other two graduated medical school around that time. Perhaps advanced age can provide an extra measure of reasurrance.
I wasn't too surprised by her inquiry. She almost exclusively refers her patients to his group. "Well, we already have the embryos..." I started to explain. Husband and I had discussed that if our second stim cycle was only projecting 6-8 mature eggs again, we would cancel the retrieval. We didn't have a follow up conversation, but I would have considered CCRM at that point. Call it huburis, but I just couldn't accept that with my AFC and AMH, that my ovaries couldn't produce more. My RE made all the right adjustments to my second cyle, and he managed it brillinantly. As he himself noted that an REI is only as good as the embryology lab, they could not have performed any better at XYZ. They fertilised all 14 of my 38 year old eggs with sperm from a man with moderate male factor. Changing providers would require transporting my embies, which involves additional costs and risks, unless I enlisted with an XYZ doctor. That would involve waiting to arrange a new patient consult and getting on to their schedule, just to transfer the same embryos in the same place.
Co-worker was not so subtle about sharing her opinion. After I brought her up to speed with her RE's recommendation to do the endometrail receptor assay, it was clear to her that I needed to jump ship. "You're had three failures, and your RE wants to take you in this direction," as she motioned with her hand "and my RE wants to take you in this direction..." she motioned her other hand in the opposite direction. I found her tone a bit patronising and I thought it was an over simplified description of the situation. I discussed the limited data within the study I read. "Pursuing the test is not a straight forward decision." I commented. "Well, you shouldn't have to make the decision." She quipped "The doctor needs to make the decision." I recall during her treatments, she described that he was very proactive, but operated on his agenda. I felt that I had a more collaborative realtionship with my RE.
"Obviously, I'm biased." She admitted. I have a bit of bias too. A patient that I referred to Co-worker's RE contacted me about switching to another provider. She was frustrated that he kept forgetting that she has Premature Ovarian Failure. Sort of an important detail to remember. Additionally, I was concerned during her final IUI, as she had at least 5 mature follicles and her partner has a billion sperm on his post wash TMC. She was very lucky not only that she became pregnant, but that it was only a twin pregnancy and not higher order multiples.
I've developed such a newfound respect for the subspecialty of Reproductive Endocrinology and Infertilty. There is so much scientfic application and skill involved, but at the same time, so much of their practice, their business, their reputation, is all down to chance. I never looked up any stats for my RE, because someone else's case doesn't apply to me. I never read any reviews about him, because the only opinion that matters to me is my own. One of my younger colleagues knows him from her residency (they're Facebook friends, which has made me mindful of what I post to her page) and I've noted that she doesn't refer many patients to him, although the location is an inconvenience to most of our patient population. I've been tempted to ask about her experience working him, but I doubt it would differ from my own observations: very serious, thorough and calculating, hard worker, bland personality.
It also seemss that we have a bit more invested. Misery is nice to me on a regular basis, and Husband feels we've both connected on a personal level with New Girl. "I think she genuinely cares about us." he observed. As she has texted me from her own phone on a few occasions, I imagine I'd keep in touch with her with an update or two, should I ever become pregnant. The prospect of starting from the begining with a new clinic just feels exhausting, although I know that's not a reason to stay. We've come so far with him, and he recently acknowledged how long and hard this process has been. We're ten yards away from the endzone. We could be just one transfer away from achieving what we want, although I know how naive that sounds, given that has been our motto for the past three transfers. If the next one does not take, and there is a good chance that it won't, I'll arrange a phone consult with CCRM and I may do the endometrial receptor assay, if for no other reason than to bide time until the new year. At times, it's just so hard to have any faith in this process. It's hard to put your faith in another person, but at least for now, I don't feel that my chances would be any better in any other hands.