We are one week away from two consultations. To refresh your
memory, we're meeting with two Reproductive Endocrinologists in the Atlanta area next Monday. These two guys and their clinics are basically polar opposites. One clinic (
our current clinic) is big, flashy, and touts the highest number of IVFs each year in Georgia. They have doctors consistently listed as the best doctors in Atlanta and the clinic itself is constantly in the news. Dr. Slayden (my current doctor) is younger,
extremely nice,
very optimistic and generally my favorite doctor. However, this clinic is the most expensive in Georgia
and all of the surrounding states, and their success rates took a tumble from 2011 to 2012. So with than it mind, we are looking into
Servy-Massey Fertility Institute and meeting with Dr. Massey as well. This clinic's claim to fame is low cost, and by low cost I mean literally
half of the cost at RBA. We're not sure exactly what we'd be sacrificing though. We know the practice is much smaller, the office is much less state-of-the-art, they perform a tenth of the number of IVF procedures annually, etc, but we don't know exactly how much any of that will affect success. So we are meeting with both. I'm going in with the attitude of "woo me", meaning I'm looking for each of them to convince us why we should shell out thousands and thousands of dollars and give them the
honor of impregnating me.
I'm also looking at this as a fact finding mission. I have lots and lots of questions: moral questions, ethical questions, health questions, patient contact questions, long-term questions, short-term questions... I have lots of questions!
I put this out there
before and
Suzanne came through in a big way, so I'm probably pretty set. But I thought I'd put my current question list on the blog and see if anyone can think of anything else we should ask.
- SART data- Can you explain your
SART data? Why are _____ clinics so much lower/higher than others? Do you limit
IVF candidates by AMH levels or BMI?
- Under what circumstances would you
cancel an IVF cycle?
- Are there any additional tests we
should run before IVF? Beta-3 integrin biopsy? Natural killer cells? Autoimmune
disease? Why/why not?
- Which protocol would you
recommend?
- Do you recommend ICSI, Assisted
Hatching, or other means of improving our odds? Why/why not?
- What will my contact be with the office?
Will I have a direct way to speak with someone? Email? Cell phone?
- Do you do Day3 transfers? Why?
Under what circumstances?
- Do you do Day5 transfers? Why?
Under what circumstances?
- What are your post-transfer
instructions? Do you advocate bed rest?
- Do you encourage acupuncture?
- What medicines can I expect to be
on?
- Do you perform doppler ultrasounds
to determine uterine blood flow?
- What supplements do you recommend
in preparation for IVF? Why?
- How many mature eggs do you think
we can retrieve?
- Do you think we should “pay as we
go” or invest in a “refund program”?
- How do you determine
recommendations for embryo transfers? How much say do we have?
- Does your clinic facilitate embryo
donation?
- Will you allow us to transfer any
embryo? Any quality?
- How do you/ your embryologist
determine what to freeze and what to discard?
- What is your thaw success rate
- Are there any practices Sam or I
should put in place NOW while we wait? Is there anything we can do in the
months leading up to improve our chances?
- Would you recommend a mini IVF?
Why or why not?
After meeting with these two doctors, our plan is to discuss and see if one of them clearly won us over. If we feel really, really good about one, we'll begin making our plan of action, looking at the financial situation (still bleak, but have you noticed it's growing?!), and checking out the calendar. If however, neither doctor effectively woos us, we will discuss setting up some additional consultations. Front runners on the list currently are
ACRM (slightly lower cost, higher success rates, local),
FIRM (significantly lower cost, good success rates, large clinic) and
PREG (low cost, great success rates). Hopefully, we can set these up fairly quickly, within a month or so. Then we'll go from there. I'm really, really hoping I get a warm and fuzzy feeling, or some kind of sign that this is the clinic for us. Most days I feel the
exact opposite of the way I felt the day
before. Today, I think this is all a waste of time and money and we should just move forward with RBA because we're happy there. Yesterday, the cost was so overwhelming and their success rates so underwhelming, that I was thinking about scratching RBA all together. It's safe to say that I have not made up my mind... at all.
So leave me a message if you've got any great questions or advice and wish us luck next Monday!
Obviously I'm all in at RBA for now and will stick with them for the time being, but if we decide to seriously pursue IVF I will be looking at your research instead of doing my own, SO-- do it well, friend. :) I know a lot of people IRL who got pregnant at ACRM and love love love them. That would probably be the next clinic I'd check out.
ReplyDeleteUgh, such a hard one! I had someone break it down for me once and it helped...
ReplyDelete1. Success rates are often based upon the clientelle that frequents: for instance, I went to an academic institution over the private hoity toity place despite "worse numbers" because they are at the forefront of research in the field. Also, their numbers are lower because they often get people who have tried other places first with no success then came as a last resort, or are otherwise the funkiest diagnoses that the other clinics didn't specialize in so just by having that diagnosis they have a lower success rate perhaps.
2. Success rates are overwhelmingly dependent upon the amount of embryos transferred. My clinic was big on single embryo transfer when the situation is appropriate, thus have lower success rates than clinics that transfer 2 almost always. My doctor was very honest with me on this one, as was the other clinic. With a relatively large amount of embryos, the more fancy clinic would have transferred 2 no matter what on the first try to preserve their statistics. My doctor recommended one for my first try because the complications for mom and baby are so much lower and the miscarriage rates lower once you are pregnant. As a NICU nurse who sees lots of extremely premature, very sick IVF twins and triplets, this was a big deal to me.
3. I think, like you said, following your gut is crucial. I was pretty wowed by the fancy clinic, but then I noticed just how fancy everything was...and saw where the extra money was going. It wasn't going to provide me better care, it was buying the doctor a fancy bow tie and a really nice lobby :) There IS something to be said for a fancy lobby when you spend three days a week there though ;)Go with what feels best.
Hope you get peace of mind after visiting! Hope they both go well and the decision is easy for you!
ReplyDeleteBest of luck, you are always so organized and thorough. I hope you get all the answers you are seeking.
ReplyDeleteI don't have any suggestions (real helpful, huh?) but your questions sound very well thought out and thorough! It's a tough decision-- I hope you clearly love one doctor/clinic so the choice is easier for you!
ReplyDeleteYou are getting close! Excited for you. Those are great questions too. :)
ReplyDeleteI'm pretty sure you win the Most Prepared Patient award! So impressed by your research/list of questions. Like the other ladies said, I hope you and Sam get a clear cut answer from your appointments and that it's not a hard decision to make. P.S. Excited to possibly see y'all at some football games soon!
ReplyDeletemake sure you find out their theories on how many embryos to transfer! some let you pick 1 or 2, some require 1 on the first try. most have a forumla based on your age, number of failed cycles, quality of embryos, etc that they follow. good luck!
ReplyDeleteI think you're very informed. The only thing I would add is that several doctors have told me "the secret to IVF success is the lab". The ability to grow a human in a lab is an art form and some embryologists do it better than others. Usually the thaw rate is an indicator of how good the lab is. But you might want to ask some questions about their embryologist. There are only a few protocols which all doctors use - some say the embryologist is the most overlooked part of picking a clinic and the most important. Good luck on Monday!
ReplyDeleteHoping and praying it all goes so, so well and that you have plenty of clarity.
ReplyDeleteI think you have a great list of questions started. Here are two more we would advise asking.
ReplyDelete1.If I fail to achieve pregnancy do I go back to the bottom of the waiting list or do I get a 2nd attempt?
2. If there are fees involved in a 2nd attempt other than medication and the Frozen Embryo Transfer (FET) do we have to pay the full amount, or is it a reduced fee?