Second Opinion #1

This week has been full of surprises! Right now, I am going to focus on the RE piece, and save the other stuff for later.

We had an appointment with another well-known RE for a 2nd opinion about our IVF and RPL situation this week.  Overall, it went extremely well!  He spent 3 hours (no joke) going through our records and discussing them. 

Before I get into detail, I should first start off by saying that according to ASRM, this clinics success rate for live IVF births is equivalent to the clinic we are at now (about 60% which is quite good if you research clinics across the US).

Here are some of the main points we covered at our consultation:

• I need to be tested for Vitamin D deficiency as I have never been.  Went and got this done today.
• I need to be tested for Celiac Disease.  Celiac disease can be linked to recurrent pregnancy loss, but is not on the usual RPL panel work-up & of course, I have not been tested for it yet either.  You would think since it is a simple blood test, why wouldn’t my current RE just order it? If I did end up having have Celiac disease, it would require a gluten-free diet. I also got this test done today.
• Husband needs to get his testosterone, LH, FSH, Prolactin, etc. run again so we can see if Clomid would be of any use in upping his count.  It has been about 5 years since we tested these in him. They were all in normal range before, so using Clomid was not an option (it doesn’t assist with just a low count, there has to be a hormonal imbalance happening too).  Got this test done this a.m. as well.
• This RE was very impressed with my husbands improvement from pre-varicocele surgery to now, 2 years post surgery.  He said our chances of conceiving on our own have gone from a measly 1% to about 15%.  And if we got him on Clomid, there would be an even higher chance on our own or via IUI, about 25%.  Hey, we will take what we can get here!
• At this clinic, we can pick any day for our transfer, as we go along in our cycle.  It does not need to be done in advance.  This is HUGE to us.  Our current clinic only does transfers 1 week out of the month, and hence, they try to control everyone’s cycles with BC and Lupron, picking out the exact transfer date months in advance.  I despise this! This clinic does transfers 365 days a year if needed, depending on the woman’s individual body/cycle. Just call on day 1 of your period and off to the races you go!
• He would only want to transfer 1 embryo in a future FET.  Great news!!!  Why do we need to transfer two if I get pregnant with twins every time we transfer two?  If we transferred just 1, we would most likely still get pregnant like we did the first time when we transferred 1! Obviously, I do not do very well with twins, and he felt that there is a chance that one twin vanishing could have affected the other making it.  Of course, there are lots of times where one vanishes and the other does perfectly fine, but not always.  There is no solid way to prove or disprove if losing one twin could have played a role in losing the other.  
• He would do a non medicated FET like we have been pushing for.  Since my cycles are regular, & my lining looks well post surgeries, there is no reason not to.  This could involve the use of trigger or not, which we can decide down the road.
• He wants to investigate my super high progesterone levels during each pregnancy. Our current RE said my levels are the highest she has ever seen, but also said it wasn’t an issue as far as loss goes; only low progesterone is a cause of RPL.  I know that low progesterone can cause loss, but there is something strange about how high these levels are when pregnant.  When this RE saw them, he also said they are also the highest he has ever seen.  He has been practicing for 30 years.  Hmmm…sounds fishy to me.  Our last pregnancy my progesterone level was around 300, and we are talking about with my first beta it was this high. First trimester progesterone levels are usually under 80!  They stayed consistently high like this too until every loss.  I was using Crinone for my progesterone supplementation during each cycle.  Obviously, I did not need to be doing the Crinone 2 times per day at $15 per insert for 10 weeks with a progesterone like that.  When I mentioned this concern to my current RE when pregnant, she said to keep doing them as I was regardless of how high the levels were.  Uh, OK.  The new RE said he would like to discuss the levels with his partners at the practice, which we really liked to hear.  Never once has my current doctor said she would like to consult with another person about us.  2 minds are better than 1, right??
• He wants to perform a mock transfer if we choose to move forward at his clinic, and another Hysteroscopy to be sure my uterus is all clear.
• Relocating our embryos will cost us $100 (dirt cheap in the IVF world), it’s a simple form to fill out, and takes about 2 weeks to get done start to finish (both clinics use the same transportation/storage facility which is good).  Also, the embryo medium is the same between clinics, they have had several patients transfer back and forth between the 2 before without issues.
• He feels our chances of carrying to term are still quite good; I didn’t bother asking for a percentage.  He said he has had patients that have carried to term after 3 unexplained IVF losses with no prior children.  Hope!!!
• He cannot definitively say that the submucosal fibroid caused our last loss.  Mainly because we do not even know with certainty that it was there during the pregnancy since the Hysteroscopy that identified it was not performed until 2 months after.  We figured this already.
• We discussed anti-depressants, and post-partum depression, which due to my situation, I am at high risk for. You would think it would be the opposite, but its not. More to follow on this soon. 
• Saving the best for last, his practice has a blood and ultrasound monitoring center literally 10 minutes from our house! Almost unreal, right? We are used to traveling about 70 miles per visit.

So, now what?  Well, we still have an appointment with another new RE set up for July 22nd.  However, we have started to ask ourselves if we should even go for another opinion??  Will it just confuse us even more?

In addition, we have an appointment back at our current RE August 6.  I feel like this appointment is almost a last-ditch effort; one last chance to tell us what we can do differently moving forward.  Each day though, I wonder if I even want to bother with it.  I guess the question is, if we like this new RE’s opinion & experience, should we just make the decision to go there and be done with it? Perhaps more information will just cloud our vision even further.