Monday 6 October 2014

If I Ever Lose My Faith In You...

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.

9 comments:

  1. This is EXACTLY how I feel about my situation. I have stayed with my clinic because I've seen progress and improved results with each cycle. I like my doctor, am extremely connected to my nurse coordinator and the entire staff there, and the idea of switching clinics not only sounds exhausting but also time consuming (and let's be honest time is NOT my friend in this situation). I did go ahead and set up the phone consult with CCRM as we wait for our December FET. My clinic takes the month of Nov off and does not cycle. So I thought I'd use the downtime. I can tell you that just getting ready for the phone consult for CCRM is a LOT of paperwork! And based on my conversations with other CCRMers you don't find out a lot until you ODW. But the phone consult is the first step so we'll go from there.

    When push comes to shove this is your body, your journey and your personal decision. Stick with you gut and follow your heart. It will always lead you down the right path.

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  2. I'm similar, although I think my inertia is due to laziness rather than conviction that I'm at the right place. I switched REs early on because I actively disliked the RE in charge of the practice, then I just moved to the biggest clinic in the area, I never looked at stats, read a few reviews, but I tend to mistrust reviews because everyone has their own agenda. The clinic I'm at in my new city is just the one I did local monitoring at. I just don't have it in me to take all that time and do all that research, when really, I kind of feel like it's a crap shoot. All the information is out there--why would one RE be better able to access it and learn from it than another. However, I do agree that the lab is important.

    I hope this is your time and I hope that it's at a clinic you like with an RE you respect.

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  3. I'm sure this is a difficult decision for you. But you're right: no one's opinion of your RE really matters except for yours. Success rates and statistics (unless they're 100%) don't really matter. It only matters if he can help you. I really hope he can!

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  4. I think at the end of the day, if you feel a good collaborative relationship with your RE then you should stick with it. Some people like being "told" by doctors what they need to do, while others (like you and me!) are researchers who want to bring our own ideas into the mix. My RE was open to a few of my ideas (DHEA supplementation, etc) which I always appreciated.

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  5. I agree with Aramis. I loved my local doctor in Boston and I really trusted her. It wasn't until three fresh IVF's and one FET later that I finally broke up with her and went to CCRM.

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  6. Having been to CCRM for two cycles, I look back on the experience and the amount of money we dropped there…and I think the outcome would've been the same had we spent a ton less and cycled at home. I just needed the reassurance of saying I did everything with my own eggs before moving onto other options. In the end, I think you'll know when the time is right to move on from your RE. Just listen to your heart! Ugh…that sounds so cliche. ;)

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  7. I also did my one and only IVF cycle in between my phone consult with CCRM and my ODWU. I didn't have the pleasure of a local RE that was of much help or with much compassion, so I felt that I had no choice but to look outside of my state. CCRM has it's ups and downs and I'd be more than willing to speak to you about those if you ever get to that point. I agree with Jessah's cliche. :) Listen to your heart and follow it. These decisions are hard enough, don't let others opinions get in your head.

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  8. I admire your outlook on things so much. I love that you weren't interested in your RE's stats because they didn't apply to YOU. So many people focus on the numbers, but when it boils down to it, the success of fertility treatments is different for everyone. The relationship you have with your own RE is what matters. Given your own background and education in this field, I'd say you are a pretty good judge of if you are in the right place or not.

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  9. If my 3rd IVF hadn't worked, we were going to switch doctors. Or at least get some more opinions. It's not that I didn't trust my doctor, I think I just needed to know I wasn't missing anything. I was not looking forward to that prospect and going through all the testing again (and paying for all the testing again). It's almost like starting from scratch and that is daunting. I'm sure we would have ended up at CCRM especially since my in-laws live in Denver. In the end you have to do what feels right for you. Are you doing another transfer soon?

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