Holy opposite 2nd opinion

peregrinefalconx · December 2014

I had my long awaited second opinion. I have been working through a well known for profit RE for all of my testing up until now. All I really got was "you have DOR, we don't think we can get any good eggs out of you for IVF, donor egg is your best bet. you may still be able to get pregnant naturally and take it to term." That's the summary. I came armed with a million questions for this new doc (Director of IVF at a well known University, I'm assuming not for profit) and he kind of blew my mind. He thinks my issue is hormonal. First place never questioned that once.

Between his thick accent, the complexity of what he was saying (as he tried to simplify it), and the way my brain turns off in these offices when I am emotionally overwhelmed, oh and the fact that I am not an RE, I cannot rectify or decide whether I think what he was saying could have been accurate. He doesn't think the DOR plays any role in this particularly and the whole low AMH thing is not really important. He has this specific protocol of hormones he uses and he says that 65% of his DOR women get pregnant within 4 months, but he couldn't assure no miscarriage obviously. I'm still trying to wrap my head around whether a hormonal issue could cause blighted ovums, or even my 3rd M with a baby--I asked but not sure I understood his response. He did a pelvic exam and said he could not see the Corpus Luteum, which he said is a sign of not enough progesterone (I think??) He also wanted to do a endometrial biopsy.

So my mind is blown--my next step was to try IVF (where the first doc didn't think he could get enough eggs from me). Second doc never mentioned it once and certainly didn't say I need a DE. Bad point is second doc is 1-1.5 hour commute each direction (=lots more time off of work). I don't even know what my question is...does anybody know about this hormone stuff (not related to CPs)? Has anybody heard of this (with my terrible description)? The hormone therapy he was talking about wasn't just sup with P after O.

I am kind of just wanting to try the 5 minutes away IVF for one cycle, as I will likely end up doing that anyway if the other thing doesn't work. Then try this other plan of 2nd doc, as necessary. Sorry...freaked out about all of this. Really was not expecting complex new info. TIA.

buggirl72 · December 2014

That is a lot to take in. Make sure you give yourself time to absorb what was said and think about it before making any decision.

Your AMH is around the same level as mine and I ended up with the same (first) dx that you had. Not a candidate for IVF with my own eggs because of odds of getting enough and then the poor quality that can be expected of any that we did get.

Can you go online to look at the stats for this new RE? They should have their numbers for rates of pregnancy along with the rates of those that ended up in a live birth by age group. 65% is a suprisingly high number. I would have a ton of questions on exactly how that is being achieved. Write down your questions and see if you can follow up with the second doctor to get some answered (does he let you send questions by email?) so you feel comfortable making any sort of decision.

The endometrial biopsy can sure a few different things. I think it is out of favor with some REs but I'm pretty sure one highly recommended RE that @HoldingOutHope was/did see wanted to do the same thing. I'll let her chime in on that. I was having abnormal bleeding this summer and my OB did one. My results came back: weakly active endometrium with glandular and stromal breakdown. Basically, that meant my hormones were wacked out and I was not really having a normal period - so the biopsy can tell you if there are hormone issues. I don't know if it can give you the cause of the hormone issues.

As far as not seeing a corpus luteum - if you have not ovulated yet, I don't think you would visualize one? Based on the biopsy, u/s, and my blood work, my doc was pretty convinced I'm not ovulating - that caused an estrogen dominance because I was not creating a corpus luteum to produce progesterone. In my case, progesterone supplements post O would not work (since their is no post O).

Finally, if you are okay with going the DE route and you were prepared to do that in January, then I would really consider staying that course. It's such a personal decision but from your OP, it sounds like that is the direction you are more comfortable with going.

rslh10 · December 2014

That is so much to take in. ((hugs)) I hope that you can wrap your head around what he said to you, and come to a solid decision.

PinkCamino · December 2014

((hugs)) this is so much to take in. I don't have much advice apart from writing down all questions you have and sending an email if our doc would reply that way. So many hugs

eliida · December 2014

Wishing you peace and sending big hugs while you make sense of all of this.

peregrinefalconx · December 2014

buggirl72PetraStonegirlmlal78 I have ovulated and the he wanted to do the biopsy on Monday, but couldn't take off work. I think I am on CD21 right now. And yes, petra, I think now that you remind me, that he was talking about an immature egg getting fertilized.

If I pursue IVF, the first round will be with my OE, regardless of what that doc thinks he can or cannot get. I at least need to know. If that is a no go, I can try #2s process. He said to email him any questions, but I was so agitated last night that I couldn't think straight--good thing I talked to you ladies first. As for his 65% rate, I took it as 65% of the DORs who tried this protocol got pregnant...not sure of the live birth rate. I am not averse to DE at all this point--it is just a LOT of money and I'm not quite there yet on my plans A-E.

As an aside, he blew all my questions about myo-isotol and DHEA out of the water. He likes CoQ10. doesn't know why I am taking a baby aspirin. AND, this is what I find unbelievable, he says not to run as an exercise bc running causes endorphins which then disrupt your endocrine system and leave hormone problems. I somehow doubt this...but my husband would say that I only agree with what I want to hear. Thanks again.

Oh, and does this mean that I should not try and get P next cycle?? If this same thing happens bc of a fixable reason, will punch something.

EDIT and UPDATE: The 2nd RE doesn't think I need IVF at all (I don't think my message was clear here and he wouldn't even talk about it), just this hormone therapy. I emailed him a bunch of questions and decided that if he can see me on Monday still, I'll take off of work.

Km380 · December 2014

That is a lot to take in. I don't have any advice but Bug and Petra are very wise. I hope you can get your questions answered (((hugs)))

ashlee113085 · December 2014

That's a lot to take in. No advice here, but sending ((hugs)) to you!

megrae12 · December 2014

I have zero advice. Just offered ((hugs)) sweetie.

Nikolie93 · December 2014

Wow, that is a bit different than what you told me your first Dr said. I can understand why you're so overwhelmed.

Many ladies here have more experience than me, I just wanted to come in and give you a big *hug*

peregrinefalconx · December 2014

Doc's response: it is difficult to say if the 2 pregnancies with empty sacs were related to chromosome problems or if due to the progesterone deficit didn't allow the embryo to growth since the early days after implantation. The last miscarriage with normal chromosome most likely was due to the progesterone deficit.

The treatment will consist of taken Letrozole for only 5 days, This medication will decrease the Estrogen production and the pituitary gland will release more FSH which is the hormone that recruit the egg and developed it until ovulation. We will monitor your response by pelvic ultrasound and LH levels. Before ovulation you will take Ovidrel , one injection, to reinforce your LH surge. After ovulation you will be taken progesterone, vaginal suppositories at night for 2 weeks. if the pregnancy test is positive you will continue on the medication for additional 6 weeks.

regardless of the treatment you could have a miscarriage but it will be related to chromosome problems for what we don't have any control.

HoldingOutHope Yeah, so he can't say about the BO. While this sounds promising, it is kind of a nightmare for me. My body hates these hormone supplements. A 10 day Prog trial a year ago left me not sleeping (which I have troubles anyway), hysterical and practically suicidal. So I am terrified--but I have to try. I guess if I can't tolerate it, then that's it. Hello anxiety disorder kicking in!

welly01 · December 2014

That's so much information! I'm so sorry that you don't respond well to hormone supplements. Sending many (((hugs))) as you go through this process.

BookishMomma · December 2014

peregrinefalconx said:
The treatment will consist of taken Letrozole for only 5 days, This medication will decrease the Estrogen production and the pituitary gland will release more FSH which is the hormone that recruit the egg and developed it until ovulation. We will monitor your response by pelvic ultrasound and LH levels. Before ovulation you will take Ovidrel , one injection, to reinforce your LH surge. After ovulation you will be taken progesterone, vaginal suppositories at night for 2 weeks. if the pregnancy test is positive you will continue on the medication for additional 6 weeks.

This is the same protocol my RE uses, for either timed intercourse or IUI. I'm considering it, but have some other hoops to jump through before we can get there. I think this is a pretty standard protocol with IUIs.

Sorry you're dealing with so many questions.

rmpar29 · December 2014

I don't have much advice, just many (((((HUGS))))) hon! I hope that with time you can absorb all of this information and choose the path that's right for you.

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