Monday, October 25, 2010

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!

34 comments:

  1. Wow, that's crazy exciting!!! Good luck talking to your boss. I'm excited for you!

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  2. Wow! This is so exciting. I'm holding my breath for you, and wishing you all the best. Really, really hoping it works out for you and your husband.

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  3. Wow, that is crazy, good luck! We had 4 failed IUI's and our first IVF brought us two wonderful miracles. I hope that IVF is the answer for you, and it is great that you can do Micro-IVF! Just visiting from ICLW, I love happy posts like this :-)

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  4. Alex, this is so exciting! What a blessing Dr. Sher sounds to be for you and your hubs. Hooray for starting down a path that, by all accounts, is very likely to get you a baby! Hope everything goes smoothly with your boss.

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  5. What exciting next steps!! I hope this with is it for you!!

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  6. Yeah! I'm so glad you are moving forward. It's funny how life can take us crazy places. I hope rolling the dice in Vegas brings you good luck. Couldn't resist the reference.

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  7. Sounds like a great consult--glad to hear you feel positive about it and about traveling for IVF. Best Wishes for your plans and hope the talk with your boss goes well. I'm sending you strength because telling your boss is a big deal!! Good luck!

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  8. He sounds amazing! Good luck on this adventure, I'm very excited for you!

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  9. I am so thrilled and happy for you...Im telling you Sirm is the way to go they will make sure your covered in every area:) and if you want to email my friend abt her experience with Dr. Sher Im sure she would be more than happy to answer any of your questions/concerns...She is now almost 16wks prego:)

    With me and my lovenox I have one copy but two mutations so you are very lucky that you wont have to do the shots:) Well other than Im sure Progesterone

    Well I hope this all works out for you...I have really good feelings about this:)))))

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  10. Wow, Alex, such exciting developments! I'm glad you found a doctor who really pays attention, and has a great plan for you. Starting tomorrow -- sometimes things move so fast! We were talking to a colleague yesterday, who successfully did IVF-ICSI last year, and were on the edge of going for it as soon as possible (we haven't finally decided but probably won't do it right now after all, but our situation is quite different from yours). Good luck!!

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  11. Oh my God Alex!!! I read it all holding my breath, I could feel myself nodding at each and every point the doctor made, it perfectly fits what my doctors have said too, specially on the ectopic (you know I had two both after IVF and no real sign I had a tubal problem) so I'm delighted he'll make sure this is taken into account at transfer.

    But OH MY GOD you are staring now!!! So so happy for you and love your DH being fully on board, if you have time you don't have to waste it and I like the hands on approach.

    My friend, my heart is smiling for you!

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  12. Oh Alex this is so exciting! Good luck! I hope the boss is like "sure no prob, peace out for december."

    So happy to hear this news- and I love the Hubs' rationalization- he is right! It sounds like he is in favor of December IVF!

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  13. Wow Alex! Very exciting stuff. I am so glad that this appt went well and that you liked the RE. Keep us posted on everything and good luck. I am starting my cycle in about 3 wks so we may be cycling together :)

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  14. i hope your boss let's you work remotely so that you can do this stat. i'm 200% convinced that this is the fastest way to get you your healthy baby. when it comes to RE's, i learned the hard way that cutting corners is not the way to go. go with THE BEST doctor that you can find and he'll take care of you. hoping hoping hoping for you alex!! xoxo.

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  15. This is so exciting and wonderful. He sounds like an amazing doctor! Fingers crossed for this being it for you.

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  16. SO excited for you! This doc sounds FANTASTIC!!

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  17. Oh wow - this is so exciting!!!!! Your new doc sounds amazing!!!

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  18. Sounds like a wonderful consult. Very informative. December cycle buddy here!!!

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  19. Yay! You know how much I loved sirm. I'm so glad he was able to give you a fresh perspective on things. Let me know if you need a list of fun things to see in Vegas (besides the obvious casino/strip stuff). We've done it all. LOL!

    Best wishes!

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  20. Congrats on this new plan and on getting some hope. I think this seems to be a very wise plan for you. Ectopics are too risky- I've heard the spiel too. But, IVF gives you a wonderful opportunity, and it's the fastest way! Good luck with getting everything squared away soon my friend. I love Vegas, for the food and shows mostly. Gooooood times.

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  21. Super exciting! What a whirlwind.

    I'm glad to hear you had such a positive impression of Dr. Sher - i've heard good things and he's always been on my backup list.

    Mini IVF options are apparently quite common in Japan - my acupuncturist was just telling me about it yesterday. Some involve lower med levels, but all are less aggressive than the US ones.

    Good luck!

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  22. Wow, Alex, this is really exciting! I'm so happy for you!! I hope all goes well talking to your boss (maybe you could even discuss some FMLA non-paid time off if needed? not sure if this works or if you can swing this). It seems like it could be worth it.

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  23. Yeah! and WOW. I left a question on Dr. Sher's website and he answered it which I thought was totally cool. YEah for you.

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  24. This post makes me sooo excited! Dr. Sher is totally going to get you pregnant with your BABY. I just know it! I am feeling tingly all over. Oh, I can't wait. I am so excited that you are doing this in December!!

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  25. This all sounds so exciting...congrats on the new plan! I can't wait to watch it all unfold!

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  26. I love this post - sounds like an AWESOME consult! Can't wait for you to get started and things sound SO hopeful for you!

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  27. That's a lot of information from one phone call! But it sounds like you guys have found your match in doctors and you will be preggers in no time! Yay for being able to start so soon and I hope nothing but the best for you!

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  28. Alex, I'm so happy for you! This sounds like a great plan and Dr. Sher sounds amazing! I hope it all works out with your boss. Please keep us posted!!! :)

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  29. How exciting!! I hope this is exactly what you need!

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  30. Such great news that your consult went well. I know that it's overwhelming, but take the time you need to take the steps that you need. It's all very, very encouraging!

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  31. Alex, that's wonderful. I'm glad you had such a good consultation with him...and you're starting BCPs! This is imminent. And it's wonderful news.

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  32. What a dream doctor! I'm so happy you're going with him (probably :) and that he was so encouraging. I'm hoping for a very understanding boss tomorrow--and a beautiful Christmas present for you and your husband!

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  33. This is very exciting. This is my first visit to your blog but it definitely sounds like this doctor at this clinic was meant to be. It is a great feeling to feel like you click with a doctor and that they really get your situation. I just started BCP on friday for our first IVF round so you will be right behind me! I look forward to following along.

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  34. He really sounds like he knows what he is doing and talking about and I totally behind you 100%! How exciting!! I have read about the Mini- IVF and it sounds a little less intrusive than then rest of the IVF cycles.. I am, as always, rooting for you and keeping everything crossed for you my sweet friend!!

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