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Is my doc okay?

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Is my doc okay?

Postby confused0809 » Mon Aug 03, 2009 6:21 pm

My doctor was rated in the "top doctors" list for my state - one that has many infertility doctors. The doctor is Ivy League educated, been practicing for over 20 years and been through the process for their own child. I thought that I had a good doctor, but right now, I am not sure. Can you tell me if these things sound normal?...

I am 31 years old, in fine health. This was my first round.
- During the Bravelle/Menopur stage, they dropped me sharply suddenly and I didn't even take any the day before my HCG. I feel that this caused me to have OHSS later on, but they mentioned nothing about it to me and didn't even warn me.
- Upon egg retrieval, I had 12 eggs, 10 matured, 8 fertilized. We had PGD, which can delay development by a day. We had 2 that made it to day 5, and then they stopped. Net = ZERO. The doctor and lab tech says this is the low side of the average, but completely possible.
- After egg retrieval, I had a lot of pain, became extremely bloated and had some shortness of breath. I only know that this is mild OHSS from reading forums. My doc, without ever asking to see me, just kept telling me to drink a lot of water and eat mostly protein. 10 days later (now), I am less bloated, but still need a safety pin for any pants to fit.
- I had egg retrieval on a Friday. On Monday night, I discovered that they left gauze in me and I pulled it out. I was, and still am, furious. My doc apologized profusely but said I was not in danger and they would have found it when they checked me out.
- Once we determined that I had no embryos for transfer, they told me to just call when I got my period and to proceed from there. They still didn't ask to see me and didn't mention anything about testing to see why none of the fertilized eggs developed completely - especially the 2 that made it 5 days.

I am trying to determine if this all complete possible and I was jsut too optimistic about the process or if some fault may be with the doctor.

Any thoughts or similar experiences would be greatly appreciated!
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Postby Ghost » Tue Aug 04, 2009 4:35 am

That's a great post, and it contains many great points and common themes of problems with IVF. Communication, stimulation, OHSS, optimistic appraisals, and more.

First off, the halting of stimulation could not have caused your OHSS, if you had OHSS (that diagnosis is up to your doctor, but he does not seem to be communicating effectively). That's a practice called "coasting" (going the last 1-5 days with little or no FSH meds). It's claimed and widely used to reduce OHSS risk. Maybe it does reduce OHSS risk, but that claim has never been proved.

Your OHSS (if you had it) resulted from too many follicles being stimulated by hCG for too long. There's more too it, but that's the start of it.

Coasting can, however, compromise the follicles and resulting eggs and embryos. I wonder if this is what happened to yours?

To get no viable embryos at all is odd for a 31 year old with enough response to risk OHSS, assuming she is properly stimmed. We've probably seen it at my clinic, but it's rare. Patients with OHSS risk usually produce lots of eggs and have lots of embryos, more than enough for just the fresh transfer.

PGD might have impacted embryo development. It certainly can. But it's unusual for PGD to wipe out the entire embryo cohort.

Doctors tend to paint a positive picture. It's natural to be positive and encourage people. But it can lead to unrealistic expectations. Most IVF cycles fail.

My suggestion would be to find a better clinic, one that has knowledge and experience in various approaches for dealing with young high responders with OHSS risk.

If you are anywhere near the University of Connecticut, they just may be the best anywhere for that type of patient.
Note: I am not an MD and not an expert.
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Postby confused0809 » Tue Aug 04, 2009 3:01 pm

Thank you very much for responding. I know no one who has done this and its been tough not to know if what I am thinking makes any sense.

The one other thing that I didn't mention about the bravelle/menopur stage was that the doc was out of town that week. The night of my first blood results I'm pretty sure that the nurse just told me to use the same thing as the night before without the doc reviewing the results. The next day they dropped me sharply.

Getting to CT would be difficult. Are there any other clinics that may be good for this situation in NYC or DC.
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Postby Ghost » Tue Aug 04, 2009 7:57 pm

confused0809 wrote:Getting to CT would be difficult. Are there any other clinics that may be good for this situation in NYC or DC.

I don't know of another in that area that can touch CT for getting good birth rates without any OHSS in very high responders. They set the benchmark for the rest of the world to try to match.
Note: I am not an MD and not an expert.
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Postby dys24 » Wed Aug 05, 2009 1:19 pm

Hi, I just wanted to jump in because Ghost mentioned UConn. I went to UCONN for my 2 cycles, its good to hear something positive about them :D . For my 1st cycle i had 28 mature follicles retrieved with E2 in the high 4000's and didnt even have the slightest symptoms for OHSS but they triggered me with Lupron which they say reduces the chances of getting OHSS. But wow I didnt know they were the best at it I guess I was lucky I went there!

confused0809- so sorry about your BFN :( , but dont feel bad for my 1st cycle like I said I had 28 follicles 23 fertalized I had 17 great embryos on day 3 and NONE made it to day 5 for freeze. Next cycle they changed my protocol and here I am almost 20 weeks. Also, every time I went there for screening I had a different doctor or nurse so don't feel bad about your doc not being there and the reason for your BFN. My doc was out that week too and I talked to someone else different everyday. I think they all know what they'r doing especially if you have alot of doctors in your clinic (UCONN does) for some its a - and for others its a + I personally didnt like that I wasn't with the same doctor throughout my cycle but I guess at the end it didn't matter. Every cycle is different and I hope the next one will be the one for you!
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Postby poohgirl » Thu Aug 13, 2009 5:41 pm

I know how upsetting this can be--request a meeting with your RE and talk to him about your concerns ask for him to explain it to you and the issues that you had. Sometimes doctors assume that we know everything or understand everything and talking to him helps. since you can't get to Conn. Interview RE doctors ask them what thier typically protocol is and why, explain the concerns you had with this cycle and ask how they would do it different and why. Find a RE you are comfortable with and is willing to answer your questions you will feel better with the process the next time.
me 36 Husband 40
8 IUI's all BFN's
1st IVF March 08 BFN
1st FET June 08 BFP!!! m/c October 08
2nd IVF Jan 09 cancelled
2nd FET March 09 BFN
Oct 09 BFP Beta 11dp5dt 1149.8!
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