Fancypants new RE fails to impress--what would you do? (v long)

pblge · April 2014

So I FINALLY had my new RE appt (R.MA in NY) yesterday, and I walked away from it unsure if I want to cycle with them or not. The biggest problem is that he's pretty sure he wants me to use the same protocol that my local RE tried last time, which I thought was a disaster. Trying to be brief, I haven't managed to sustain an E2 rise except for the cycle that included Lupron, and he wants to do another antagonist cycle. Major caveat: he is planning on plugging all of my info into their computer algorithm to see which protocol would be best, but he was pretty certain this would be the answer. If he comes back with a different protocol, I'll probably go ahead, but he made that seem very unlikely, even though I told him I was extremely nervous about trying that protocol again.

The second thing that really grated was his personality. For example, he went on a rather long self-congratulatory speech about how he had fine-tuned the lab with lots of technology--things that most people wouldn't have thought would matter, but that he believes result in an extra pregnancy or two out of one hundred patients. BUT, when I asked about things I could do--alcohol, diet, supplements, acupuncture, exercise, etc.--he was completely dismissive and almost derisive on the topic. I guess it's good that he said I could do whatever I wanted to in that regard, but it took a while for me to realize how obnoxious it seemed to me that he thought ONLY HE (and he spoke about the clinic in the first person singular, not acknowledging that it's a team effort) had the God-like power to affect outcomes, and NOTHING a mere patient could do would have the slightest effect on outcomes. And there's research to show this isn't true! If a different air filter is valuable because it can add 1-2% to success rates, why not CoQ10 or acupuncture?????

I also got some fun new diagnoses out of the meeting--slightly arcuate uterus, BOTH tubes are messed up, and, as I posted elsewhere, he really thinks I should be treated as a PCOS patient and put on metformin. (I have always had normal periods with ovulation, I have none of the physical phenotypical characteristics, I have no insulin resistance, no elevated androgens, etc.) He did reassure me that the endometriosis shouldn't matter one bit, which was nice.

I went back and compared the two clinic success rates (of course, there are other clinic options, but I'm setting those aside for the moment). This new one is definitely better, but mine really isn't too bad for a small clinic (if you assume 2012 was an off year for those 35-37).

Other considerations: The clinic is far away and it would be very expensive and inconvenient to cycle there. I know I'm a weirdo, but I also hate NYC--it's so crowded and noisy and the air feels bad. I like my trees and space, TYVM.

Part of me is tempted to take all this information to my original RE and see what he has to say about it. That seems rude, but the major reason I decided to switch was his choice of protocol last time. Since FancyPants RE wants the same protocol, my regular RE is looking much better.

Sorry this is so long. Any advice?????

penad5 · April 2014

I don't really have any advice except go with your gut. If you didn't feel comfortable with the Fancypants RE at the first appointment how confident are you going to be with them as you go through the process?

Also I can say from experience having to travel to your clinic is a major PITA!!!

Perhaps you should bring the info to your local clinic - there is nothing wrong with getting a second opinion - and see what they say

cls78 · April 2014

Did you look into RMA NJ? I go to the Eatontown office and my RE is excellent. He never pushed me into pgd/ccs testing. He also got me onto a ivf study since I am self pay.

SKLH · April 2014

Hey there. I wanted to comment b/c I can relate to alot of the things you mentioned in your post... First, I agree with having to travel to see the RE being a PITA (I drive 2 hours to mine!) but after cycling with a closer clinic and having CRAP embryos, I switched clinics (used a new protocol which I was nervous about considering my first protocol worked great) But I totally believe the second clinic cultured my embryos MUCH better. I DO think there's soemthing to be said for a better lab environment. Another thing I'll mention is that previous to switching RE's I had never been told that I had PCOS tendancies either. After a baseline ultrasound my RE said that I had several small cysts on my ovaries but all my bloodwork was normal. He put me on Metformin anyways. He said that it would also help with egg quality. I was sketpical but figured why not trust his judgement? I googled it later on and found that there was study done showing metformin helping egg quality thus pregnancy rates (I willt ry to find that study!) Also, sometimes the meds will throw off your insulin (even though you tested normal in the past) so I am all for it (I also suffer from any side effects from metformin but many girls do). Good luck to you! I was nervous to switch clinics... longer drive, new protocol, new doctor, new meds lots of nerves but looking back, I'm glad I did!

pblge · April 2014

@cls78 - my insurance doesn't extend to RM.A NJ. Not sure why.

pblge · April 2014

@MeatandBandP‌ - I was planning on going with Cornell, but they close for a lot of the summer, which is the only time I could cycle in a different city.

babydreams13 · April 2014

**Possible Pregnancy mentioned**

You totally have me wondering if we saw the same RE??? My new RE is in NYC too and at first I got a weird vibe. I LOVED my RE in Long Island but he didn't think outside of the box and I wasn't getting pregnant even though I had no major issues. I went for a 2nd opinion in NYC and was very confused as to what to do. I will say that I left the consult not really sure if I should switch but I decided to go for it. When I started cycling with my new RE in NYC he was a lot different and I felt more comfortable. NYC is not very convenient for me either but I'm making it work. My first BETA came back positive at 59 so I am happy I switched even though I was hesitant. Not sure what tomorrow's BETA will show but this is the farthest I have ever gotten (see siggy for info). So in my case I say change was good.

Please tell me or PM me who the RE is! I bet its the same one!

Tea+ · April 2014

I don't have any advice but wanted to wish you luck! I imagine it's a difficult decision to switch but what ever you decide will be right. There's no harm in getting a second or third or how many ever opinions you need to feel you're making the right decision. Sending T&Ps you're way. And to remind you we're here for you no matter what. [:

SKLH · April 2014

@babydreams13 Can I ask how much predisone you're taking? Just curious after all you've been thorugh!

pblge · April 2014

@MeatandBandP - That's right-there was another clinic that was closed for longer. I wanted to make sure any clinic could do two cycles between mid May and mid August, and I didn't think Weill could because of the period they were closed. I double checked their numbers--definitely better than my clinic, but not better than the one I just went to.

Edited image out because I accidentally included my location!

Grateful&Thankful · April 2014

Okay. I am trying to not make this a novel but....lol.

First off-I am sorry you have such a tough decision to make. I have been through many cycles myself and it has been a rough road. One thing I want to say is to go with your gut. If you don't want to do antagonist again then don't. My dx is DOR and I found that most RE's pushed me into an antagonist protocol. It seems to be one of the most popular protocols. I never did well on it. I had a pretty good response on the MDL protocol. Compared with the antagonist cycle- it was like night and day. I actually got pregnant that cycle but m/c'd.

I switched RE's after that cycle and my new RE insisted on going back to the antagonist. I knew in my gut that I shouldn't but I did anyway. I did not have a good cycle. My new RE does not like MDL so I couldn't try that again but I convinced them to let me try long lupron. They advised me that LLP is not optimal for DOR patients but since the protocol they suggested did not work, they were willing to give me a shot with sort of designing my own protocol. I did a lot better on the LLP. After some tweaks, I was finally able to come up with a variation of the LLP that worked for me. For the first time I began producing good quality embryos which I never had before. I have a separate egg maturation problem we have yet to solve so that's why despite retrieving an o-k amount of eggs, I never have many mature. Anyways, I say all this to say...go to a clinic where they will LISTEN to you and take your concerns/suggestions SERIOUSLY. My doctor is very smart, humble and a great listener. They has no problem admitting that their protocol did not work and were open to thinking outside of the box. My theories and research were not dismissed and I was so impressed and thankful that they allowed me to try my own protocol. Best of luck to you.

pblge · April 2014

@Grateful&Thankful said:

Anyways, I say all this to say...go to a clinic where they will LISTEN to you and take your concerns/suggestions SERIOUSLY. My doctor is very smart, humble and a great listener. They has no problem admitting that their protocol did not work and were open to thinking outside of the box. My theories and research were not dismissed and I was so impressed and thankful that they allowed me to try my own protocol.

THIS!!!! I think when it comes down to it, I feel like I am choosing between a better lab that is the opposite of patient-centered care, and my local clinic where my doctor is very accommodating of what I want. I really don't know which of those is more important!

beachy6 · April 2014

If you don't feel comfortable, don't go. I think you need to feel like a team with your RE and if you already have a bad vibe, don't do it. It's such a long process and if you don't like the new RE AND have a long distance to travel, you'll absolutely dread it.

We switched clinics to one with a higher success rate, but we loved the RE. This was two years ago and we travel 1 1/2 hours one way and I can't say that I minded since I loved the office so much.

Listen to your gut. It's always right. There are always other clinics if you weren't comfortable today!!

Edited to add: We also had a phone consult with CC.RM (another big wig office) We were not impressed. Fortunately, our office has higher success rates than them, we just wanted an outside opinion. However, I think we expect amazing things from these fancy clinics and often, it's just smoke and mirrors. They don't always have more to offer than regular, smaller offices.

babydreams13 · April 2014

SKLH said:

@babydreams13 Can I ask how much predisone you're taking? Just curious after all you've been thorugh!

10mg daily. I started it 2-3 weeks before transfer.

LeggyJeggy · April 2014

If it was me and I didn't feel comfortable or thought it would be easy to access, then I wouldn't switch. Is there another RE in the same clinic you can meet with or a new clinic altogether?

pblge · April 2014

@leggyjeggy - Do you mean at my current clinic? They run IVF in a team, so I see them all anyway (which has caused some problems....there's a weak link).

I'm dragging my heels about looking into other clinics for a few reasons. One is that I'd like to get started with my next cycle (2-3 weeks from now). Another is that I couldn't find a clinic my insurance covered that had much better numbers than the one I just went to. Finally, I would have to pay for the consult out of pocket, which I'm reluctant to do. We're cash poor and insurance rich--my job has great insurance, but my OH is only nominally employed. The idea was that he would be almost a stay-at-home dad, but that hasn't worked out yet. Sigh.

LeggyJeggy · April 2014

@pblge, with either clinic, any chance to meet with a different RE. My old RE's office was run in a team of 3 docs but I think the protocol/testing/etc was all just done with my RE. When I met with another RE from a different clinic, I wasn't impressed at all and he was the director of a clinic with some of the best SART numbers. I went to a 3rd RE where the numbers were comparable to that clinic but I felt the doctor was far superior. I'm sorry the new RE is making it a tough decision

and the money part doesn't help at all either. This whole process sucks.

LexiLee33 · April 2014

I'm new to the board (not new to infertility) and just wanted to wish you luck. I know what a tough decision this can be. Good luck!

pblge · April 2014

@LexiLee33 - LOL I read your first post, and LOVED it. ;-) I was going to tell you that the main reason I wanted to switch was for the better lab. I SHOULD be able to get a retrieval with a good number of eggs (although quality is still uncertain), and we had really good fert rates, so I wanted the lab to be able to culture the embryos to give me the most possible embies to work with on this and future FET cycles. It had never occurred to me when I was looking at other labs that the new doctor would want to do this protocol!

pblge · April 2014

Unsurprising update: He wants me to do the antagonist protocol. Here's what the coordinator sent:
"Dr. X reviewed your records and would like to try the Antagonist protocol with a prep month on the birth control pill (see outline attached). We’re also going to keep you on a more consistent medication dosage instead of fluctuating it in order to prevent your estrogen from “crashing” again."

At least they're addressing my concerns here, so that's something. Also, does that really say I'll be on a solid month of BCP??????

scooteriste · April 2014

I feel for you. It's a tough decision but I'd give Fancypants a shot. As I mentioned in my fail thread, I'm in a similar situation. I'm prepared that Fancypants isn't going to be the most personable doc, but what I'm hoping for is better monitoring and a better lab. As for going back to antagonist, I'm with you in that it didn't work the first time so I'm nervous to go back... But maybe with closer monitoring, better doses of meds, and someone with a better track record, it'll work. Good luck with whatever you decide.

SKLH · April 2014

I seriously feel like @IFinTN nailed it!! This may be TMI but I got a breast augmentation about 3 years ago and a lot of people warned me about the doctor's demeanor... They were right. He wasn't the most sensitive or nice guy but truthfully, he was good at his job! You got there, he made sure you were taken care of and that was it. No foo foo chat or short conversation. he was there to do one job and he did a great job! You would have NO Idea mine were fake. The reason for this comparison is b/c I had the same experience with REs. I've actually been to 3 different REs. My first one was REALLY persuasive. I could honestly convince him to do anything. He was very approachable and that was nice but he was lacking a confidence that I needed in a doctor. 3 cycles later I switched clinics. While doing consults with other clinics, I met another one. He seemed confident but I seriously felt like he was more of a therapist. He would talk with me about how I was doing, etc. I cried at 75% of my appointments with him out of frustration of my emotions during the process! lol Lastly, I met my current RE. He is KNOWN publically for being very rough around the edges. Not very approachable or "chatty" and honestly I learned that’s exactly what I need in a RE. I need the confidence to get the job done properly not the conversation. I have been more successfully and felt more confident with this doctor than any of the others. I think there's something to be said about doctors who are kinda just straight to the point and there to do their job rather than there to smoosh you. There's honestly nothing wrong with a doctor who is there to do his ultimate job and do it well! Just my $.02

RunCC37 · April 2014

I'm sorry to hear that your consult went like that. It is so important to have confidence in your doctor, and it sounds like this guy is a jerk. We consulted with several doctors before IVF #3, and one of the doctors was so horrible. I am so thankful that I don't have to face him for my WTF appointment. He's in the same clinic as my current doctor, so I have had to see him once for monitoring... I could feel my blood pressure rise. And they originally tried to schedule my transfer with him. Hell no.

I'd say trust your gut. Can you consult with another doctor?

pblge · April 2014

OH and I had a long talk last night and we've decided to move forward with Dr. Fancypants. Yes, he's pompous and dismissive of things that he shouldn't be (someone here pointed out that this is a very bad trait in both a doctor and a scientist, and I couldn't agree more), but the numbers really are fabulous. Also, the staff there is EXCELLENT--I've been back and forth with the IVF coordinator there, and she is top notch. Same for everyone else there we've talked with thus far--great staff. This is NOT the case with my local clinic.

Also, the email that she sent that I quoted above did two things. First, it showed me that he acknowledged my concerns about doing this protocol, and I appreciate that. Second, it suggested that the choice of the protocol wasn't the problem at the local clinic, but it was the fact that my meds were constantly fluctuating (VERY true!), which is bad, at least for someone as brittle as me. So that's another reason to be suspicious of my local clinic.

If I go there and have a bad experience, and especially if I DO crash on this protocol again, I'll likely switch back to my local clinic. In the meantime, I'm looking forward to seeing how AWESOME his results must be to generate such self-confidence!

Thanks sooooooooooooooooooo much to all of you ladies for taking the time to read and comment on this thread! Huge love to you all!

LexiLee33 · April 2014

pblge It sounds like you made a great decision. It seems you got what you needed which was a logical explanation as to protocol choice and the logic seems extremely reasonable. It really feels like they considered your specific case and made adjustments for you as an individual. I think you made the best decision by going with fancypants (but not just because he/she is fancypants

....I had a similar experience in that my RE had a very poor bedside demeanor but his nursing coordinator was fabulous (kind of like your situation) and was able to clean up any problems his demeanor caused, made sure my concerns were voiced and were addressed...it sounds like you picked the best team. I'm keeping my fingers crossed for a good cycle. PS, I'm new to the board and decided to edit my first post because I didn't want to ruffle any feathers with a different opinion

pblge · April 2014

@LexiLee33 - Thanks, I figured. ;-) And I didn't mean to call you out for editing! I had read what you wrote on my phone, when I couldn't respond, and thought "Wow--that's so true!" Then when I went back it was changed. I just wanted to let you know that I totally dug the original.

Btw, you're doing the same thing I used to do with tagging, and it took me a long time to figure out that it didn't work. If you copy the name from somewhere with an embedded link, it won't actually tag the person--no idea why. You have to write it afresh. Hope you don't mind this tip; just trying to spare you my frustration!

pblge · April 2014

@geordie314 - They had never used that protocol at my old clinic, but they were considering it. It didn't come up with the new RE.

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Fancypants new RE fails to impress--what would you do? (v long)

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