Tuesday, November 2, 2010

So Confused!

We went to see our local doc yesterday afternoon, and now we’re even more confused. I was dead set on going to see Dr. Sher for Micro-IVF, and spending 2 weeks in Vegas during December. Now I don’t know.

My regular doc was great, was very open to discussing IVF, stating that I could continue with the IUI’s if I want to, but of course my chances are much better with IVF, and he said he would prefer to do conventional IVF on me, with lots of drugs, which equals lots of eggs. He wasn’t concerned at all about my LH levels being higher than FSH levels, as he said that yes, it could hurt your chances of getting pregnant naturally, but once you’re stimulating using drugs, your levels balance out, and it should be fine. He prefers not to use Lupron – he doesn’t think I need it, and he thinks women get too suppressed with Lupron, so he stopped using it about 2 years ago. Instead he would do an antagonist protocol.

He was incredibly nice, very supportive of me speaking with Dr. Sher, had nice things to say about him, and was very willing to continue to work with me, even if I went to Dr. Sher. He’s going to do the hysteroscopy on me next week, which will be useful no matter which doctor I use for IVF. He said he didn’t think it was worth it for me to travel to Vegas and see Dr. Sher, as I should be an easy case, and I would have no problem getting pregnant doing IVF… Plus now with the hubs’ new insurance, I could do IVF here in Houston very cheaply.

I called the hubs’ new insurance company today to clarify their benefits, and confirmed that both my doctor here in Houston, and Dr. Sher, are covered in-network. It’s a $700 deductible plan, and they pay 80% of everything over $700, up to a $25,000 lifetime limit. And the out-of-pocket per year, after the deductible, is $2,500. So the most we would pay per year is $3,200 per year. And I’m not exactly sure about the drugs – they couldn’t figure that out without a member ID, and we won’t have that until Monday when the hubs starts his job.

I’m so confused. Both doctors would probably be fine. But why are the docs so different in their thoughts on drugs? I’m getting tested today for Natural Killer Cells. If those come back activated, Dr. Sher would likely treat it – not really sure how. But if they come back activated, I could probably ask my local doc to treat the same way, and he would probably be fine with it. Just like he did with Lovenox. Oh that’s another thing. One doctor (Sher) said I don’t need it, one doctor (local) said I may not, but probably wouldn’t hurt with the Lovenox, might help. So what is the right answer? I wish doctors would agree on this stuff!!!

So I’m now completely confused – don’t know which way to go. It would definitely be easier to do IVF at home, I wouldn’t be alone for most of the time, and could work at work for most of the time. And it’s not like Dr. Sher is going anywhere – if this doesn’t work here, I could always go to him in the spring, right? I don’t know what to do! (By the way, I'm definitely open to opinions and advice...)

24 comments:

  1. This is a tough one, Alex. Like you, I'm often frustrated by how differently doctors see things. And you're dealing with a few things - NK Cells, Lovenox, protocols - where the thinking REALLY varies because the research just isn't there, or is inconclusive, or has yielded one study which says one thing only to be rebutted by another study that says the opposite.

    I think, in a sense, neither one is a bad option. I also think you need to consider the stress factor - though, even here, experts can't decide on the role this plays. Starting in Houston and then going to Dr. Sher makes sense to me, but I'd also go with your gut. And if your gut is saying Sher, that's what I'd do.

    (By the way, I'll be curious what Sher suggests if your NK Cells DO come back elevated).

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  2. Ugh, i so wish there was just one right answer. I totally agree with Adele on going with your gut. You have two really solid options and can't really go wrong. good luck with whatever you decide to do.

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  3. Totally, gut all the way. Your gut may be wrong, but you'll never regret going with it. And considering there are no guarantees either way, I guess it's your only option.

    I wish I had some real knowledge for you about any of this stuff. Sigh.

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  4. Ditto the three previous commenters- go with your gut... but if your gut is unsure, then maybe doing the IVF with your local RE and planning to move to Dr. Sher in the spring is a good idea.

    Good luck with your decision!

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  5. I guess the conflicting thoughts on treatment is the one downside to a second opinion. Like others, do what you think is best. Personally, I would opt to stay close to home for an IVF cycle. Since IVF is such a long process and it is helpful, IMO, to stay as relaxed and positive as possible being in my own home would be best. I am not sure how you feel about traveling, on the one hand it is an amazing distraction but on the other it may be best to be going about your daily routine where you have other things to focus on besides what is going to happen at your next dildo-scan. Either way you will be in good hands and I will be cheering you on in whatever decision you make!

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  6. I agree with all the previous commenters who say to go with your gut. I would add sleeping on it. I don't know much about IVF, but I do know that taking an extra day or two (or a week if you can) to be sure of your decision pays off. (At least it pays off for me . . . )

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  7. Wow, what decisions to have to make! So stressful. I think it seems like you won't really make a wrong one. Both options seem like good ones. I hope it all works out!

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  8. Wow - that is a lot to take in. For what it's worth, my LH was always higher than my FSH. My RE never mentioned it...it was a bit less of a gap than yours...but I most definitely do not have PCOS (the opposite, actually).

    My inkling would be to try an IVF cycle with your local doctor. IF it doesn't work, then you can think about traveling for a cycle to Dr. Sher.

    Definitely go forward with the NK testing...more information is good!

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  9. As I was reading this post, I was thinking, "Alex, you need to go with your gut." And surprise, surprise, that's what all the comments are saying, too. Lol!

    I really don't have much more advice other than that, cuz IVF is definitely not in my area of expertise. But, if I had to make this decision, I would go with your RE in town, for convenience purposes. Give him one shot, and only one, and then Dr Sher. Hopefully, he only needs one shot. :)

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  10. So many differences between the two doctors...and who knows who is right :-/. Like the other commenters have said - go with your gut on this one. Which doctor do you trust more?

    Thinking of you and hoping you come to a decision that you're at peace with.

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  11. I would wait and see how your NK Cells come up first as I am not sure local doc will treat those. Once you have all of the information do what makes the most sense for you. I think if you leave Sher as a back-up, that works too. At least your local doc is willing to work with you. Less stress during IVF seems to always be the way to go, if possible. Take care.

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  12. I have always been baffled that there's such different opinions about Lovenox (my RE said yes, my hematologist said it can't hurt, my OB-GYN said now). Also, there's much more about NK cells, too (mine came back activated after I was tested at She.r in NJ) so try not to play that "what if" game just yet. I'd also wait to make any decisions until you know exactly what yo're dealing with.

    (((HUGS)))

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  13. I know it is a tough decision. I just went through a similar one. I ended up staying with the local dr because: 1) I felt most comfortable with him; 2) the travel costs would eat away at future IVFs if needed as it is not covered by insurance
    ; & 3) I could continue with my accupuncture treatment which I believe helped me get my brief BFP with our IUI. Bottom line...just like everyone is telling you--choose the one you feel most comfortable with. YOU know which one is right for you...& we will all support your decision & cheer you on with whatever dr you use. Hang in there...sometimes we over-think the few things we actually have control over because they are so few & far between...

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  14. As someone who did her IVF cycle at home and had a fairly 'uneventful' one, I think I'd have found it much worse being out of my comfort zone too. The other thing is, beyong going with your 'gut', to me it comes down to the doctors and how they make you feel. Which doctor inspires your confidence the most? Which doctor makes you feel he genuinely listens, which one has you convinced that your treatment plan is right? Because that's the most important thing. The doctor himself will be performing the whole IVF procedure and to a degree your success depends on his level of skill and experience. That's my two cents, I know it is an incredibly hard decision!! Can't wait to see what you decide :)

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  15. Grrr. The age-old problem of disagreeing doctors. Why can't they all figure out what's really true and go with it? I wish I could offer some really sage advice but would probably be going over my head. In any case, it sounds like you have two very good options with a high likelihood of success--and great insurance--so that's a major positive!

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  16. I'm going to chime in with seconding what Adele said, and then state what is probably obvious: just wait til your test results come back. If your current RE is willing to treat them then that is obviously going to be much more convenient, and you could keep Sher as a backup. If your RE won't treat NK then you can with Sher. One step at a time, remember to breathe.

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  17. I say go with your gut, too. Have you done a pros/cons comparison of the two doctors and situations? Do any of the pros/cons "weigh" more than others when you see them on paper? That always points out a clearer direction for me.

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  18. Gotta Love all the options and different approaches right? Not the case here...I get this all the time different Dr.'s think differnt things...What I have learned is knowledge is power....the more you know and research yourself the more questions you can ask and get a better understanding of your situation....Its not right that we have to know pretty much as much as the Dr. but thats the way it is trust me...I had to do a ton of digging to get answers and real solutions....

    I can tell you if your NK cells are up that Dr. Sher will suggest either Intralipid or IVIG along with prednisone or another steroid to further lower you immune system and since this is considerd a special area most local RE's are not willing to treat such issues but if they are elevated you for sure need to make sure to treat them they will not correct themselves...So I guess that to me would be the biggest deciding factor....

    Then if thats not an issue I would just do my first IVF with my regular OB and if things dont work dont become down but instead just move onto Dr. Sher....This is if your patient enough to know that if number one doesnt work you will have to take time in between before going to number to....

    And I dont want to sound like a downer but I was always told quality over quanity is best....and I know for fact this is true...I know of a friend who had 30 eggs at ret but out of 30 only 15 were mature....me on the other hand had like 15 I think and 14 were mature...then she had to go through the whole OHSS and I did not...I got pregnant she had to sit the cycle out because of the OHSS...I have always done Lupron and always had good results as far as egg quality and always had blasts to freeze...

    I dont know your RE in Houston but I do know Dr. Sher is world recognized he has been doing this for years...he was a perinatoligist before an RE...and then he also has a background in Immune issues hes up on the latest and best protocols so he knows his stuff:) and maybe your local RE is the same way but maybe not...I just dont like when RE's tell people it will be easy to get them pregnant with IVF how do they know that....if thats the case why did he was your time for the last couple of years doing other things....I just think Dr.'s should be optemist but also not make promises that they have no idea is true or not....Ok girl enough of my ramblings...Best wishes in your upcoming choices:)

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  19. Good luck with your decision...it sounds like you have two great options, which is a good thing!

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  20. I'd definitely go with the gut. You'll be doing the hysteroscopy at the same time as me (I think), and I do think that if the results prove interesting that sticking close in Houston might be an option.

    It seems that both options are really good options and that they are both on the table even if you decide to go one way or the other to start. Keep us posted on where you end up.

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  21. I was going to say "go with your gut" but that doesn't exactly seem like unique advice over here : )

    Just sleep on in, talk it over, and make the best decision you can. There's no way to know for sure what is the best thing to do. So once you make your decision, don't look back!

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  22. Having been in a similar situation earlier this year (not with IVF, but with which doctor to have perform my repair surgery), I can say that there are a couple of things that need to go into your decision. First and foremost is which one makes you feel the most at peace? Then you need to ask yourself if the expense of traveling to go to Dr. Sher is worth it, versus having the procedure done at home where you won't have to pay for accommodations, plane tickets, etc. Both doctors CAN do it. So what it boils down to is feeling and expense justification. Once you have made your decision, stick with it and run. Tell yourself up front there is no going back. You've made your choice, and you're going to see it through. That's what I did, and I am glad I made the decision I did.

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  23. Not a lot to add, since you've gotten some great comments.

    I agree that the results of your NK levels will probably affect your decision. It's great that your local RE is open to working with you while you also talk with Dr. Sher -- it suggests that even if you decide to have Dr. Sher set your protocol, you could probably get most of the stuff done with your local doc.

    My elevated NK and TH1:TH2 levels were/are treated with Humira (immune suppressant injections), and Intralipid infusions. Not complicated stuff to administer, but you'd certainly want your local doc on board with treating the immunological issues.

    It's great to have two good options. :)

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