Infertility

When to seek a 2nd opinion...(long)

I'm contemplating seeking a second opinion but DH thinks we should try one more cycle at my current REs.

Some background, first IVF was an IUI to IVF conversion (antagonist protocol) and of the 7 embryos we had, only 1 made it it transfer and it was a BFN.

The second IVF we tried antagonist again and though I had 23 follicles, my E2 level after 10 days of stims was only ~800 so I voluntarily cancelled that cycle rather than have a disappointing ER and ET.

We just tested my AMH and my level was 1.2 however at 31 years old this is quite low considering my age.

RE wants to proceed with a long-lupron protocol for the next IVF; he thinks due to my past 2 performances that I may have an egg quality issue and we should change up the protocol.  Even though my practice has about 10 docs and they all reviewed my case at their weekly meeting, I can't help but think maybe I should seek a fresh pair of eyes.  Cornell has a satellite office by my work so I'm thinking of pursuing them for a consult.

Would love to hear others opinions and experiences on this, especially those that have not been successful with IVF#1.  Just kinda feeeling bummed recently...thanks for reading, enjoy the cupcake ;)

image

Anniversary Unexplained IF || TTC #1 since July 2011 || IUI#1 = BFN || IUI#2 = BFN || IUI#3 = Cx, overstimulated || IUI#3.1 = Converted to IVF || IVF#1 = BFN || IVF#2 = Cancelled due to low E2 || Changed RE, IVF#2.1 March 2013

Re: When to seek a 2nd opinion...(long)

  • A second opinion can never hurt.  Maybe there's something your RE is missing.  I did a second opinion and was so glad I did.  Good Luck to you!
     36 DH 33 TTC for over 3 years
    First mini-IVF Sept 2011... Only 1 egg! ... BFN
    Switching RE
    IVF#2 May 2012 9 eggs and only 2 sperm, WTH!
    BFN
    IVF #3 March 2013~Tesa with back-up Donor Sperm,Tesa, unsuccessful used DS~ Chemical :(   

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  • Like your RE, after my first cancelled IVF, mine met with the other 7 doctors about my case as well and decided to put me on the MDL for my next attempt.(microdose Lupron). That worked so much better and I was able to get to ER and ET....BFN but I made it that far. I'm currently going in for ET #2, with an even better % of fertilization this round so FX.

    As for getting a second opinion, it could never hurt, however if I were in your shoes I'd probably hold off another cycle since they're changing your protocol and just see what happens. Plus, although the AMH is low, I've seen stories around here of women getting pregnant with much lower AMH.

    GL!

    Me: 33, Endocrine issues & FVL       DH: 32, Nothing 
    NTNP 2009-2012         TTC since 2012:
    • Clomid, 2 IUI cycles, and 5 IVF cycles = BFN
    • FET #1   August 2013 = BFP!     EDD 5/11/14
    • Jack dx at 19w1d with Dandy Walker on 12/16/13
    • Severe Pre-e /HELLP set in Jack born sleeping at 20w1d on 12/23/13
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  • I think if you're questioning it, I would get a second opinion.  It doesn't mean you have to move for your next IVF cycle, but it can't hurt to have another opinion, and should at least give you some peace of mind moving forward.

    TTC since 5/2010
    DX with Diminished Ovarian Reserve - AMH of 1.1 - 7/2011; AMH of .42 8/2012
    BFP 9/1/10-M/C confirmed 9/8/10-Methotrexate 10/6/10
    IUI #1 (w/clomid)-9/5/11-BFN ; IUI #2 (w/clomid)-10/5/11 - BFP - 11/1/12-No sac seen; 11/2/11 and 11/9/11-Methotrexate 
    IVF #1- ER 2/2; ET 2/5;-Two 8 cell embryos transfered = BFFN
    Surprise BFP - 5/7/12
    U/S on 6/8/12 - H/B at 128 BPM; U/S on 6/14/12 @ 9wks-No H/B-D&C on 6/17/12
    IVF 2.0- ER 10/17; ET 10/20-One 12 cell, one 10 cell and one 8 cell embryo transfered
    BFP!   11/16/12 U/S- Two nuggets with perfect heartbeats! EDD 7/10/13

     

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  • image MandaS08:
    I think if you're questioning it, I would get a second opinion.  It doesn't mean you have to move for your next IVF cycle, but it can't hurt to have another opinion, and should at least give you some peace of mind moving forward.

    I agree with this. 

    Also I would say you've done about 1.5 IVFs and that makes a big difference than just 1. Going through stims twice can be useful information moving forward.

    I've got egg quality issues too and it's a very tough nut to crack but Corn.ell is a very good clinic from what I've heard and is highly respected. A 2nd opinion from them should be weighed heavily.

    Most guys are 1 or more steps behind in this process, so it's not surprising that your DH is still very hopeful with your current clinic. Mister D keeps saying he's going to "knock me up naturally in December" - gotta love his optimism!

     

    BzeetyD = 38, Mr. BzeetyD = 44 together 12/02 married 9/08
    TTC #1 since 1/10
    DX: Unexplained/??? MFI issues

    Our lil' lost sparks:
    5w3d loss 7/30/10 - EDD March 2011
    8w loss 4/15/11 - EDD November 2011
    8w3d loss 8/2/12 - EDD March 2013
    4w c/p loss 10/29/12 - EDD July 2013

    Long story: trying on our own + testing testing testing with 6 rounds of Clomid, more testing, injectables + TI, laparoscopy - one tube blocked, 2 IUIs with Follistim...BFNs.
    RPL testing all normal, Karyotyping normal

    Moving on to IVF.

    IVF #1 April 2012 = BFN, IVF #2 June 2012 = BFP. U/S 7/23 = saw heartbeat but measuring behind. Follow up U/S on 7/30 - no heartbeat. D&C 8/2. Trisomy 12. IVF #3 Oct 2012 = Chemical Pregnancy

    Phone consult with CCRM on 12/12/12 - ODWU 1/4/13 - both tubes clear(!) - AFC 24, AMH 3.2, FSH 9.6, LH 5.4, E2 25. DH has high frag rate but improved!
    IVF #4 March 2013 CCRM. EP protocol w/ Menopur, Gonal-F & Dexamethasone. ER 3/29 & IMSI, PICSI. 43R 13M 10F 6blasts bio'd. CCS testing reveals 3 normals!!!
    FET 5/31/13 of 1 4AA blast - thawed and expanded. 4dp5dt BFP.
    Beta 9dp5dt = 181, 11dp5dt = 427. 1st u/s showed a healthy heartbeat! EDD 2/16/14

    After 4 years of hoping and heartbreak, our sweet little bean was born on 2/19/14
    We are so in love with her.

    "I'm not telling you it's going to be easy, I'm telling you it's going to be worth it."

    Everybody is welcome!!!
  • image BzeetyD:

    image MandaS08:
    I think if you're questioning it, I would get a second opinion.  It doesn't mean you have to move for your next IVF cycle, but it can't hurt to have another opinion, and should at least give you some peace of mind moving forward.

    I agree with this. 

    Also I would say you've done about 1.5 IVFs and that makes a big difference than just 1. Going through stims twice can be useful information moving forward.

    I've got egg quality issues too and it's a very tough nut to crack but Corn.ell is a very good clinic from what I've heard and is highly respected. A 2nd opinion from them should be weighed heavily.

    Most guys are 1 or more steps behind in this process, so it's not surprising that your DH is still very hopeful with your current clinic. Mister D keeps saying he's going to "knock me up naturally in December" - gotta love his optimism!

     

    One can hope, right??  I'm thinking that a second opinion may be helpful while I'm waiting to start IVF 2.1.  Since I won't start stimming until at least the end of Dec, I may as well use this time to see what else can be offered.  Just the fact that they are Cornell is mighty tempting.

    Now comes the awkward process of requesting medical records...geez, this is almost as bad as breaking up with your hairdresser if it gets to that point.

    Anniversary Unexplained IF || TTC #1 since July 2011 || IUI#1 = BFN || IUI#2 = BFN || IUI#3 = Cx, overstimulated || IUI#3.1 = Converted to IVF || IVF#1 = BFN || IVF#2 = Cancelled due to low E2 || Changed RE, IVF#2.1 March 2013
  • When I requested my records, I just told them it was for my regular OB/GYN who wanted to be kept in the loop. (Which is true. I made a second copy myself.) Can you pick them up instead of having them mailed? That may make it a little less awkward.  
    Pursing Domestic Infant Adoption through a local agency. In the meantime, our dog is our baby.  Bumping from Portland, Oregon. 
  • Second opinions are always a good idea, especially if you're feeling like you need one. Either you find someone new you love! Or you find out you really did like your current RE's plan. 

    Also, (I'm not an RE so take this with a gain of salt)... An AMH of 1.2 is still good! Even at 31. Anything over 1 is considered good. There's a chart here from Advanced Fertility and a lot of great info.  http://www.advancedfertility.com/amh-fertility-test.htm

    Good luck! 

    imageimage. image 

    || 4 years TTC, 2 M/Cs image 4 failed IUIs, 1 failed IVF || 

    || DIA brought us our beautiful daughter || 

    Baby Birthday Ticker Ticker
  • image MsGMChick:

    Second opinions are always a good idea, especially if you're feeling like you need one. Either you find someone new you love! Or you find out you really did like your current RE's plan. 

    Also, (I'm not an RE so take this with a gain of salt)... An AMH of 1.2 is still good! Even at 31. Anything over 1 is considered good. There's a chart here from Advanced Fertility and a lot of great info.  http://www.advancedfertility.com/amh-fertility-test.htm

    Good luck! 

    I agree with all of the above.  My Re also told me an AMH above 1 is considered "normal."  Good luck!  

    TTC #1 7/10, Me (31)- Dx DOR (AMH 0.6); DH (30)- normal
    BFP on Cycle #8. Natural M/C at ~8 weeks
    IUI #1 and #2 (8/12, 9/12)- 50 mg Clomid + Ovidrel = BFNs
    IVF #1 (EPP) 13R/10M/9F, 5DT 1-4AA blast, beta #1-148, beta #2-322, 5 frosties! 
     image  image  
    image
  • I would highly suggest getting a 2nd opinion.  Many RE office will do a free 2nd opinion consult.  I'm currently on my 4th RE and finally feel like I've found "the one".  Another RE might have a fresh idea of what protocol to take.  GL!
    Happily married Since May 2008. TTC#1 Since May 2010.
    Me: 29, Mild DOR
    DH: 31, SE mostly normal, 1st SE morph 5%, 2nd SE morph 15%...yeah!.
    BFP July 2011, Natural MC August 2011.
    3 cycles of 50mg Clomid = BFN
    *New RE* Feb/Mar 2012 100 mg Clomid + Trigger + IUI = BFN
    *3rd RE* April-June -Break Cycles begin prep for IVF by doing 2 Heparin injects daily....fun fun!
    IVF #1 - ER 7/19, ET 7/24, 2 beautiful embies transferred. Beta 8/2 = BFN
    *New RE...yes again* FET Nov 2012 with our lone ranger = BFFN
    RE Suggests Trying IUI Again, Jan. 2013 IUI #2 =BFN
    Feb. 2013 IUI #3 = BFP!!!, Beta #1 (15dpIUI) = 90, Beta #2 (17dpIUI) = 210, U/S Scheduled for 3/18
  • image baker916:
    image MsGMChick:

    Second opinions are always a good idea, especially if you're feeling like you need one. Either you find someone new you love! Or you find out you really did like your current RE's plan. 

    Also, (I'm not an RE so take this with a gain of salt)... An AMH of 1.2 is still good! Even at 31. Anything over 1 is considered good. There's a chart here from Advanced Fertility and a lot of great info.  http://www.advancedfertility.com/amh-fertility-test.htm

    Good luck! 

    Thanks for the reply :)  My RE did relay that although the value "1.2" is within the normal reference ranges, for someone at 31 my value is typically seen at about a 3.  So compared to other healthy normals in my age group, I'm low :(

    I agree with all of the above.  My Re also told me an AMH above 1 is considered "normal."  Good luck!  

    Anniversary Unexplained IF || TTC #1 since July 2011 || IUI#1 = BFN || IUI#2 = BFN || IUI#3 = Cx, overstimulated || IUI#3.1 = Converted to IVF || IVF#1 = BFN || IVF#2 = Cancelled due to low E2 || Changed RE, IVF#2.1 March 2013
  • I am in a similar situation and just recently had a second opinion appt and switched REs. 

    For IVF #1 we did a long lupron protocol and it seems I was over suppressed.  My E2 rose very slowly and they ended up getting 7 eggs, although only 3 were mature.  All 3 fertilized, and 2 made it to freeze although they were not great quality.  We did not do an ET because we have to do PGD and wanted to do another cycle and get more embryos to test since the cost of PGD is high and they will test up to 8 embryos for that cost.

    I am 30 and my AMH is 1.17- I had asked my RE about it and he said it was fine.  I felt given my age it was low, but went with what he said.  For our next cycle I felt he wasn't being aggressive enough and sought a second opinion.  The new RE is more aggressive and said that while my AMH is considered normal (above 1 is normal), that it is right on the edge and that for my age, it is low.  I felt 100% more comfortable with this RE than I do with my previous one, and I am so happy I got a second opinion.  (He is doing an antagonist protocol with estrogen priming for IVF #2). 

    IVF is so hard because you really have no control over the situation, so I think it is really important that you completely trust the RE you are working with.  Initially I was kind of feeling "should I get a second opinion? And am I just doing this because our cycle failed?" I think that it is normal to kind of feel that way.  I also know that if we did stick with our RE for IVF#2 and had similar issues, I would be kicking myself for not getting a second opinion.  I sort of already feel like we "wasted time" with our first RE, and do not want to feel that way again.

    I totally agree with PPs about getting a second opinion.  I felt so much better after ours and feel excited about moving forward with a doctor I am comfortable with and confident in.

    As far as requesting records or letting them know you are switching - they see it all the time.  I was open with my RE and told him I was going to be seeking a second opinion because I just was not 100% comfortable moving forward at this time.  

    Phew, this was long! Good luck with whatever you decide, and keep us posted!   


    ______________________________________________________________________________
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    TTC#1 since 4/11 : m/c in 9/11 & 11/11
    DH dx with Balanced Translocation 5/12 
    Did 3 IVFs - 10/12, 1/13 & 4/13 before
    1 embryo passed PGD and transferred - BFP
    Our beautiful baby girl has arrived!
    S/PAIF Welcome

    ______________________________________________________________________________
  • image cupcake201:

    I am in a similar situation and just recently had a second opinion appt and switched REs. 

    For IVF #1 we did a long lupron protocol and it seems I was over suppressed.  My E2 rose very slowly and they ended up getting 7 eggs, although only 3 were mature.  All 3 fertilized, and 2 made it to freeze although they were not great quality.  We did not do an ET because we have to do PGD and wanted to do another cycle and get more embryos to test since the cost of PGD is high and they will test up to 8 embryos for that cost.

    I am 30 and my AMH is 1.17- I had asked my RE about it and he said it was fine.  I felt given my age it was low, but went with what he said.  For our next cycle I felt he wasn't being aggressive enough and sought a second opinion.  The new RE is more aggressive and said that while my AMH is considered normal (above 1 is normal), that it is right on the edge and that for my age, it is low.  I felt 100% more comfortable with this RE than I do with my previous one, and I am so happy I got a second opinion.  (He is doing an antagonist protocol with estrogen priming for IVF #2). 

    IVF is so hard because you really have no control over the situation, so I think it is really important that you completely trust the RE you are working with.  Initially I was kind of feeling "should I get a second opinion? And am I just doing this because our cycle failed?" I think that it is normal to kind of feel that way.  I also know that if we did stick with our RE for IVF#2 and had similar issues, I would be kicking myself for not getting a second opinion.  I sort of already feel like we "wasted time" with our first RE, and do not want to feel that way again.

    I totally agree with PPs about getting a second opinion.  I felt so much better after ours and feel excited about moving forward with a doctor I am comfortable with and confident in.

    As far as requesting records or letting them know you are switching - they see it all the time.  I was open with my RE and told him I was going to be seeking a second opinion because I just was not 100% comfortable moving forward at this time.  

    Phew, this was long! Good luck with whatever you decide, and keep us posted!   

    Thanks so much for your input; I did the opposite of you where I did antagonist first and am now doing long lupron (but I fear I may be oversuppressed).  I asked my current RE about this and because of my response to antagonist he felt we had to change protocols; I'm just not 100% confident it's the right protocol.

    I will likely go through IVF#2(2.5?) with my current RE but will get my second opinion in parallel.

    Good luck with your next round moving forward :)

    Anniversary Unexplained IF || TTC #1 since July 2011 || IUI#1 = BFN || IUI#2 = BFN || IUI#3 = Cx, overstimulated || IUI#3.1 = Converted to IVF || IVF#1 = BFN || IVF#2 = Cancelled due to low E2 || Changed RE, IVF#2.1 March 2013
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