Consult with Dr. Sher

In a word – amazing. He was so nice, definitely was willing to spend as much time as needed with us. For as busy as he must be, I’m very impressed. He conferenced me and the hubs in, and was very good in his communication and explaining things. He first went over all my history, making sure that he understood everything very well. He obviously read all of the patient intake form, as well as all the labs and the medical records I sent him. He didn’t waste our time by reading stuff while we were talking to him (my current doc does this) and he spent about 40 minutes on the phone with us, and he would have certainly been willing to spend more time (unlike my current doc – longest appointment has been 15 minutes, and I sometimes feel annoying with my questions). So here is what he thought about us:

-Hubs has no problems – I’m pretty sure the doc said they were superman sperm…

-Dr. is very concerned about having another ectopic. Even if the HSG shows clear tubes, he says that my tubes are likely damaged from infections (such as bladder infections – yes, I’ve had a few) or something in my past, causing the ectopic in February. Yes, I had a regular pregnancy in May/June, but he thought I have a have a high chance of another ectopic.

-MTHFR: given that I’m heterozygous, even compound heterozygous, he doesn’t think Lovenox or aspirin is necessary. He used to recommend aspirin but he rarely recommends it to anyone anymore. He thinks additional folic acid like the Folgard that I’m currently on is good. Lovenox wouldn’t hurt, but he doesn’t think it’s necessary. If I was homozygous for the C677T mutation, then he would recommend Lovenox, but not for me. Not a big deal according to him.

-FSH – my CD3 FSH is normal (4.37; 5.45; 5.40), so it shows I will respond well to gonadotropins (like I have with the IUI’s). “We should be able to get lots of eggs from you.”

-LH – this is where he got a little concerned. He said my LH levels are elevated compared to my FSH levels. They’ve been 7.29 compared to 4.37, 6.67 compared to 5.45, and 6.97 compared to 5.40. He says when LH approaches or exceeds FSH, this is not that common, and he’s concerned about PCOS, even though I don’t have most of the typical signs. He said that the IUI’s that I’ve done haven’t had any suppression of my LH levels, and when these are high at the beginning of a cycle, that this causes increased testosterone, and could impair the eggs and their chromosomes. The increased testosterone can damage eggs that would have been otherwise normal. He said that it could increase aneuploidy, which could be the cause of the miscarriage in June – we’ll never know as I didn’t insist on karyotyping. Because of all this, he is adamant that I should have my LH suppressed with BCP and then Lupron. This should help suppress the LH levels appropriately.

-He wants to test me first for Natural Killer Cells. I referred him to the lab tests that said they were normal, and he said that most labs can only test the concentration of NKAs, not their activation. He said there are only a couple labs in the country that can test the activation. I knew this – I really did. But when I asked my local doc to be tested for NKAs, he said, “sure, no problem” and sent me to the local LabCorp. I just assumed that this lab could figure it out – apparently not… He said you have to do the K562 target cell test. Especially with my lack of family history (I’m adopted), we don’t know if there are any immunological issues, and there could be.

-He also wants me to have a fluid, or saline ultrasound. He doesn’t like HSG tests. Yes, my HSG a year ago showed everything open, but it wouldn’t show any kind of surface lesions in my uterus, and especially that I had a D&C in June to remove my baby, he insists that I have a fluid ultrasound prior to any further treatment.

-My uterine lining has been good. It should be over 9 mm, I’ve had up to 10 or 11, so that’s good.

Overall, he said it should be easy to get me pregnant through IVF. I’m young-ish. In the next year or so, my fertility will decline rapidly. I have a fertile partner. And he thinks that based on everything, about 1 in 4 eggs are normal, especially based on my age. He explained that if you wait for the blastocyst stage, then certain embryos will die off, but of the ones that are left, about 1 in 2 should be good. So if we transfer 2 embryos at the blastocyst, we have a 50% shot of one of them taking. He also said I’m eligible for their Micro-IVF. Basically it’s a full IVF, but there’s not as much monitoring, and no ICSI. It’s only available for couples with no male factor IF, and women have to be under 36. I have seven months until my 36th birthday. The cost for Micro-IVF is $4,490 + $580 for anesthesia if want (of course I do!) + meds, which is between $1K-$2K. Plus of course travel… About 12 days for me, and at least 1 day for the hubs.

And here’s where it gets really interesting. He said we have enough time to do the IVF in December… But we have to decide before tomorrow, because I need to start birth control pills tomorrow!!! Holy cow!

I got off the phone, completely overwhelmed. There’s no way we could do this in December – it’s too soon. I don’t know if I could get the time off for work, I don’t have enough vacation, I’m pretty sure this won’t be covered by the new insurance, there’s no way the hubs will agree to it so soon. And then he came home, and Mr. Rational (occasionally this is my name for him…) explained some good points. We have the money, we don’t have the time. This is barely $2K more than what we’ve been spending on each round of IUI. For the first time, we’re speaking with someone who really knows what he’s talking about, or at least that’s how it seems. I think I could convince my boss to let me work from Vegas and not have to take the whole time off. We could do 2 rounds of this before my 36th birthday, if we do it in December. If we wait until March, we could only do 1. He asked me about recommendations, and I told him about all the bloggy people who have great things to say about Dr. Sher and SIRM. And we even have an IRL friend that went to Vegas 6 years ago and we know this 5-year old really well…

And so, guess who’s starting BCPs tomorrow morning!!! We’re still going to keep the consult with my local doc next Monday, just to see what he says. And I need to go get blood work for the NKA’s and get a saline ultrasound done. Worst case, we change our minds in the next few weeks, and all we’ve lost is a month on BCP. One month of naturally trying – yeah, like that would ever work. I have absolutely no hope of that!

I don’t know why, but throughout all this TTC process, I had a feeling I was going to end up here. When we were a few months into TTC, I sat down and talked to my friend IRL that I mentioned above, and she gave me the website for Dr. Sher, and told me how wonderful he is. That was over 1 ½ years ago. My hubs scoffed at that – there’s no way we’re going to Vegas to get IVF. Fast forward all we’ve been through, and here we are. Somehow this seems right.

We haven’t completely made a decision yet, but we’re close. I’m starting BCPs tomorrow, just to be able to have the chance. And then I need to talk to my boss. I have to come clean with him to convince him to let me leave for 2 weeks and not take vacation, or much of it. Wish me luck!