Please advise: how to manage second opinion appt?

KM721

Hey ladies, I'd appreciate your input on the following (esp second paragraph). 

I went to see my RE on Wednesday and am still processing through what he said. Before going in, DH and I had decided to give some lifestyle changes (inspired by It Starts With the Egg) a try for a couple of months while we take a much needed break, gather some more new info via second opinion and urologist, and then cycle again in the spring with more info available. I also had a long range plan to possibly travel to CCRM over the summer, since I spend time in CO anyway. Then we went to see RE and basically he totally opposed all parts of this plan (even the ones we didn't share with him!). He disagrees with the premise of ISWTE entirely and says that the book assumes that women have done something wrong to get themselves in this situation, which he does not believe to be the case. And, he told us it would not add anything to go see a urologist. Also, he brought up CCRM and how they inflate their statistics using the CCS process. However, he did suggest making changes to an antagonist protocol and adding treatment for insulin resistance (which he suspects based on low E2 from my first check last cycle). Basically, I left totally destroyed emotionally, even though the medical news was not that bad. He doesn't think we should give up, and he has two adjustments to suggest moving forward. 

However, this brings me to this first week in December, when I have scheduled with a doctor for a second opinion consultation. I am finding it hard to prepare for 1) because I totally broke down after our consult last week and 2) because I don't really know what to ask. I don't distrust our current doctor even though our appointment was a disaster. I respect his opinions and his management of our case. In addition, I am pretty confident I will keep getting treatment at my current clinic. You may be wondering why I am even getting the second opinion (I sort of am, too!), but I really feel like I should after three failed cycles. So, for those of you who have ever gone for second opinions, what did you ask? Did it feel like the doctor was giving a sales pitch at all for switching to their clinic? How open were you about what you were looking for out of the appointment? These and any other thoughts would be greatly appreciated!

Justone13

First off I want to say I'm sorry your re isn't willing to listen to your other iswte ideas. Most re's are not willing to listen to adding supplements because they aren't specifically approved by their clinic. I started saying "will it hurt me if I try it" "you might not think it will help but I do so can if it's not going to hurt I want to try". Maybe try that approach with your current re and see if he will agree to that at least. I would be careful with the DHEA but the coQ10 shouldn't cause any issues and the melatonin during stimming shouldn't hurt either.

Unfortunately I don't have any advice of what to say or do for a second opinion. I thought about doing one myself about 6 months ago but after I changed my approach to the re I decided to stay because he was willing to work with me on my terms. Don't forget that you are in charge of the care provided to you doctors need to understand they work for you and it's ok to work together. Wishing you luck with either choice!

katers79

Ugh. How frustrating for you. I'm sorry your appt left you feeling like that.

I don't think it would hurt at all to go for the 2nd opinion, armed with your previous cycle info, and see what a fresh pair of eyes/ears has to suggest. I would be looking for honesty, bedside manner, and knowledge. Be open. Ask what his/her plan would be based off our your dx and history. We when went to our first appt with our 2nd (and current) RE, he did most of the talking and gave us so much insight on our situation that we trusted him immediately. Can you do a phone consult with CCRM? I'd go for it.

If you break down, you break down. There's absolutely no shame in that. IF sucks, and a good RE will be supportive, tears or not.

GL and ((hugs))!

pblge

***PAIF response***

Hope it's okay that I respond here. I'm a big proponent of second opinions, and the same RE can give you wildly different results using very similar protocols. For me, I think the biggest differences were in the dosing decisions and probably the quality of the lab, too.

My second RE, known as Dr. Fancypants, got outrageously good results from me, but he also didn't believe that I could do a single thing to improve my own outcomes--really sort of a God complex in this guy. He seemed to think that alcohol intake, healthy habits, and possibly supplementation were all totally irrelevant to the quality of my eggs, which is patently ridiculous based on even my lay reading of the research. I will say that I appreciate your Dr's position that he doesn't want women to blame themselves--I applaud the sentiment, but I don't like that both of our doctors made us feel powerless to control any of our own outcomes. I firmly believe that we have the ability to improve our egg quality, although the exact actions and their potential effects do seem to be areas of open research. I think following the suggestions in ISWTE make a lot of sense, although I would check with whatever RE you go to about some of the more potent supplements it recommends, like DHEA. That's contraindicated for some women.

When you say that your doctor recommended treatment for insulin resistance, do you mean Metformin? Dr. Fancypants put me on that, too, and I do believe it helped improve egg quality (it helps protect the eggs during stim cycles, although I don't remember exactly how).

I don't think the bedside manner is a particularly important determinant in this process. My first doctor was truly gifted in this regard, but he could never have gotten the results that Dr. Fancypants did, who was kind of an arse, but who cares? He wasn't really giving me a sales pitch, as he was confident (arrogant) enough to know that the clinic's SART data speaks for itself.

If you have misgivings about your current doctor's plans, you should definitely get another opinion, although it doesn't have to be CCRM (I've had friends have terrible experiences there). I agree that after 3 failed cycles it's time for a fresh set of eyes. With the second doctor, you could just ask basic questions like what treatments they would recommend, including all your ideas that Dr. #1 rejected. You'll eventually want to ask nittygritty questions, like when they do transfers and how they decide, and that sort of pragmatic thing, but there's no reason you have to prepare all that for a first visit.

I'm sorry you're in this position. I hope that a second (or even third or fourth) opinion will give you hope again. Sending lots of (((hugs))).

KM721

Thank you for your replies, ladies. 

@Justone13--My RE basically did say that the only thing he think it may help is to make me feel better, and that it wouldn't hurt. I sort of agree with him and even think there is value just to me feeling like I'm doing something. The way I put it to him is that he can go to sleep at night knowing that he has done everything he can for us, but I can't do the same. If there are lifestyle factors that I can even TRY in hopes of helping, it will make me feel better to do so. 

@katers79--I am actually shocked that this is the first time I have cried in the RE's office. I apparently prefer to cry everywhere else

@pbige--Thank you for your response. I agree re: bedside manner. DH and I agreed long ago that we don't really care about that. Frankly, we don't even see our doctor for most of the procedures, so it really doesn't matter!  Yes, he is going to put me on Metformin starting in mid-January. When insulin resistance is present, it sort of blocks the medication from getting in and being effective, particularly in the beginning of a cycle. I appreciate your perspective. I think I will be open and just ask some general questions as you recommend.  I wish you the best with your pregnancy! 

ronniesgirl1981

Out of curiosity, where are you getting the second opinion? I just got two second opinions and it is truly amazing how different medical professionals in the same field can see your case totally differently. Both thought my original RE was not aggressive enough with the stim levels and both strongly recommended EPP which my original RE did not recommend/was not willing to try.

KM721

@ronniesgirl1981--I am in the Boston area. I am going to Brigham & Women's for a second opinion and am currently with Boston IVF. How about you? 

Justone13

@KM721‌ I do believe that the supplements and lifestyle changes helped me. My re will never admit it but honestly I don't think I would have 5 frozen if I hadn't made the changes. If it might help id say go for it!! GL!'

ronniesgirl1981

While I am at SG in Maryland, I got my seconds from two clinics in NJ: RMA and SIRM. Both were great, but quite possibly way too far for you to consider.

emmuffy

I'm very much in favour of a second opinion. Different perspectives are helpful. You need to have confidence that you've done everything you can and that you have the best possible approach. The two REs I have consulted did not think much of lifestyle changes such as avoiding BPA, in the basis that they felt there was no supporting evidence. However, there is certainly no harm in using glass etc instead of plastic. You may decide to cycle with another RE or you may decide your current RE offers the best approach, but at least your decision will be informed. Hugs. I'm sorry this process is so hard.

nowthatsalady

I understand your predicament and I appreciate you starting this discussion because I've been wondering the same thing. My DH and I trust our RE but I just want to go see what someone else has to say. DH is against it and says that it may just confuse us and will likely be a sales pitch. I disagree and might even just go on my own. I started supplements months ago, but just implemented most of the changes in ISWTE. I just don't think it can hurt. My family lives in 

CO so CCRM has always been the last resort in my mind too. 

hoff0079

I've had quite the frustrating journey with my IVF. I live in CO and initially went to CCRM after ttc for 1.5 years and 1 mc. They did my surgery (had hydrosalpynx right tube) but I felt like a number and a $ so I went to Rocky Mtn Fertility. I did Estrace priming and day 5 ultrasound showed 3 follicles so she cancelled the cycle. I'm really frustrated b/c what if I'm just a slow responder? So I'm getting a second opinion f/CCRM this Friday. I chose to go back b/c they've done thousands of IVF cycles whereas other clinics have only done hundreds. I'll let you know how it goes, but keep in mind CCRM has the marketing $ to promote themselves, their results are comparable to many other clinics. I highly recommend the 2nd opinion (I'm getting a 3rd) but also take a look at the stats before you spend the $ coming out here. Food for thought