WWYD? DH doesn't want second opinion

nowthatsalady · December 2014

I'm normally very strong and stoic, but it's becoming clear that IVF #2 failure is taking its toll. We had our WTF appointment and the only new information I got was that only 1 of my 9 eggs were immature. The other 4 I assumed were immature (because they weren't mature) were actually just super low quality (can't remember what they called them, EZ or something). So my RE agreed that it's clearly an egg quality issue and really doesn't want to change anything other than adding hGH to my next cycle (which will be EPP again) after taking at least two months off and continuing supplements. I'm in Chicago at Northwestern currently and they are all about getting the best looking embryos back in on day 3. I made an appointment for 12/15 at Advanced Fertility and DH does not want to go. He thinks it will confuse us and could be salesie and he trusts and likes my current RE. I'm just so unsure about everything at this point and obviously want to minimize regret. My RE doesn't think we need immune testing, CCS, or any other embryo testing. Any advise at all is appreciated.

katers79 · December 2014

I'd try to get him in for the 2nd opinion. It would be nice to have a new set of eyes/ears reviewing your case and coming up with their own plan for you. A second opinion does not lock you into cycling with that office. I'd pitch it to him that way. If not, I would consider just going alone! GL!

Twinkie0612 · December 2014

I will tell you that my husband was very resistant to second opinions at first. When I did not like our first RE after the initial consult and wanted to switch to another RE, we was not happy. He felt like I should just listen to the doctor (who wanted me to do unmonitored clomid + IUI because it will save us money!) and that I just didn't like her because she didn't agree with what I wanted to do. Luckily he ended up talking to his boss's wife who works in the medical field, who reminded him that I needed to be seen by a doctor that I trust. My husband loved our second RE and was so happy that we switched. When my second RE gave up on us, I felt the need to look into more opinions. My husband took his opinion as gospel (downside of him loving our doc ) and thought we were wasting our time and that we should just look into donor egg. Then we met our current RE and my husband likes her even better than RE #2. Moral of my story is that my husband should just listen to me when it comes to picking doctors.

Ok joking aside, I do firmly believe what my husband's boss's wife said. You need to trust your doctor. If you don't feel comfortable moving foward with the new plan it is worth it to explore second opinions. I would try to explain to your husband that there are many different philosophies when it comes to infertility, most are not necessarily right or wrong, it's just a matter of finding the one that works for you. If you are starting to doubt your current doc's plan, see what else is out there. It could end up making you more confident about your doc's plan or it may bring up things that you hadn't even considered.

A few things that I think sound strange is that if your doc expects egg quality issues, why not recommend CCS? Lower egg quality often means a bigger chance at chromosome issues. The downside to CCS is that it is expensive and if you only get a few embryos to test it might not be worth the expense unless you want to do embryo banking. I would definitely look into immune testing since you have endo and women with endo tend to have higher rates of immune issues. Since you are in the Chicago area there are a few doctors specializing in immunological issues in your area (I see Dr. Kwak Kim). Also the day 3 vs. day 5 transfer is one that docs just don't agree on and I think it's worth it to discuss the pros and cons of both with REs.

ETA: missing an important word.

BootsOrHearts · December 2014

**Ticker warning**

First of all I'm sorry you went through 2 failed cycles, that is heart-breaking.

A second opinion can never hurt IMHO, assure your DH you will not sign anything or pay anything at that visit until you go home and discuss it or discuss what is said with your RE. That might help.

I'm also wondering why they are doing 3 day transfers? If you had 4 embryos each time, I would think waiting until day 5 to see which ones looked the best would have been a better approach. Does your lab not support 5 day? The only reason to do 3 day is if, say, you only had 1 or 2 (or maybe you had 4 but not all made it to day 3 even?).

I think your retrieval results are fairy decent for low AMH actually. Have they tried microdose lupron flare protocol? sometimes 'poor responders' do better on that than on EPP.

Have you jumped on the ISWTE book bandwagon yet? ;-) I actually saw a nutritionist before my IVF cycle who gave me all that same advice about egg quality and right now i'm looking at CoQ10 and anti-oxidants and the dietary changes they suggest. I figure it can't hurt and it might help.

Good luck whatever you decide!

mariana81 · December 2014

Twinkie0612. I also have problems with immature eggs, and unfortunately (or maybe fortunately) my ER gave up on me and I had to look for second opinions. Since this issue with immature eggs have started I wanted to listen a second opinion but my husband was totally against it, he also thought that another RE would confuse us.. Now that our RE left us, he not only wants to look for another one but he also wants to have a third opinion, I guess he felt betrayed by our RE and now he wants to be sure of the new one.. Perhaps if you share our experiences with your DH maybe he would change his mind.. anyway I really really recommend you to look for a second opinion! Good luck!

Twinkie0612 · December 2014

Buttmonkey34 said:

What everyone else said is so true. I would push him to go along with it as well. It could be refreshing to get a new set of eyes on you, and you could potentially get different opinions and more useful techniques. I'm also curious on the 3dt issue...my RE is the opposite to where they refuse to do 3dt, with the idea that if the embryo can make it to day 5 or 6, it has a much more optimistic outlook of surviving in the uterus. GL!

This is the way my clinic views it too, but I do know at least one patient that has done a 3dt with them. In addition to finding the best embryo, it can also give you some information on embryo development that you wouldn't have if you did a day 3 transfer. If embryos stop growing between day 3 and 5 I've heard that it can be a sign of a sperm issue. My embryos all look crappy quality by day 3, but the ones that continue to grow actually improve in quality by day 5. This reaffirms in my opinion that we have egg quality issues. Also it was the fact that we had transfered top grade blasts and still had negative cycles, that started pushing me towards immune testing. Top grade blasts doesn't necessarily mean they don't have chromosome issues though, so I try to keep that in mind as well.

zeynsom · December 2014

I am nowhere close to being an expert but have been researching like crazy over the past year about my situation. Our situations are similar: young age, low AMH, DOR. I am now convinced that this is all related to an immune deficiency (or more like an immune flare). Not to complicate things further for you but if your DH is resistant you may want to show him the research. Dr. Sher and Dr. Braverman are two immunologists who have extensive web-sites and tons of information there to explain why people like you and me are DOR at such a young age: our immune systems are flared and attacking the ovaries. If you are convinced with that research and if you can convince him, I would actually recommend you to see Dr. Kwak-Kim in Chicago. Many of us who have immune issues work with her. Send me a PM is you need more information. Best of luck!

nowthatsalady · December 2014

Thank you so much everyone. I really appreciate your input. I talked to dh last night, and used all of your points, and we are going to get the second opinion. I’m happy about that and I think the positives of getting a one outweigh the negatives.

@Twinkie0612 My RE said basically the same about CCS testing--that it’s expensive and unlikely to be worth the money with how few we will likely get. She also said that they usually recommend that with women who are getting pg and experiencing losses. This is the first I’m hearing about women with endo being more likely to have immune issues. That actually makes me mad because my RE is supposed to specialize in endo and she told me there is no indication that I have immune issues. I’ve thought for a while about seeing Dr. KK and I think it’s time to make an appointment. Thank you for all your feedback.

@BootsOrHeartsMy clinic will do a 5 day if you have 4 or more that look good. Each time I’ve had two that looked better than the others. So their perspective is that if they can already identify which are the best they are better off in the ute than the lab. I’m just not totally sold on that and at this point I would rather find out how they look at day 5 and give my body a shot at them then. I asked my RE about Lupron and she said it is too suppressive for DOR, so again differing opinions among docs. I’m most certainly on the ISWTE bandwagon and have made most changes, it definitely can’t hurt.

@Buttmonkey34It’s crazy how different clinics differ on 3 vs. 5 day. I’ve asked 2 docs at mine and they just keep saying with how few we get they are better of in the ute than the lab.

@zeynsomYou’ve inspired me to find out more about immune issues. I’ve naively just listened to my RE and thought about how I’m generally such a healthy person.

KM721 · December 2014

I got a second opinion recently, thinking it was a formality and I wouldn't actually switch. I was wrong. The new RE was more willing to switch things up. She is confident, but was not sales-pitchy. She was somewhat critical of the old clinic, but I think she had good reason to be.

My DH was neutral about the second opinion, but I think he just went along with it because he has learned I am right when it comes to medical stuff

Remember that it doesn't mean you are cheating on your previous RE. Remember that YOUR ability to have a baby is WAAAAAYYY more important to you than it will ever be to even the best RE even if he was also your brother. So, it's your job to be your own best advocate.

afsalinas · December 2014

katers79 said:

I'd try to get him in for the 2nd opinion. It would be nice to have a new set of eyes/ears reviewing your case and coming up with their own plan for you. A second opinion does not lock you into cycling with that office. I'd pitch it to him that way. If not, I would consider just going alone! GL!

Ditto this.

KM721 · December 2014

I was in between cycles when I went for the second opinion the week after my WTF appointment. I requested my records to be released to myself and then faxed them over to the new office. Hope this helps!

Twinkie0612 · December 2014

murrt said:

Hi ladies,

Sorry to hijack with a question myself, but for those of you who went for second opinions, was it while you were cycling with your RE or were you on a break? Did you get all of your records sent over in advance?

I'm working on setting up a second opinion appointment but thinking I'd like to continue with creating an IVF plan with my current RE as well.

@murrt I did all of my 2nd opinions between cycles. My first 2nd opinion was when we first moved on to a RE (after failed cycle with my OB), we only did minimal testing with my first RE and got a second opinion before starting any treatment. The next time we switched doctors my RE basically refused to treat us anymore (maybe he would have if we decided on DE) and pushed us to go somewhere else. We ended up trying donor embryos with another clinic, but when it failed decided to look into more extensive immune testing (I had some basic with my 2nd RE). We switched to our current RE while waiting for our appointment with the RI (took 3 months to get in to see her).

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