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The Current Debate: Dr. A or Dr. B

07/19/2012

Belle

Grab a snack, ladies, this is going to be a long post.

My two consultations in Ohio yesterday were really good. At 12:30 I went to the Cincinnati Institute for Reproductive Health and at 3:30 I went to the Bethesda Center for Reproductive Health and Fertility.

Honestly I was a little leery of The Institute. This clinic offers a money back guarantee and I was terrified they would spend the entire appointment trying to convince me to ditch my 5 embryos and make new ones with them, using their program. Instead I was greeted with a bunch of genuinely nice nurses, staff and a doctor who knocked my fertility socks off (actually I forgot my socks!)

We’ll call this doctor Dr. B. I instantly felt at east with Dr. B. He spent well over an hour going over my weird history, previous IF treatments/diagnosis and the pros and cons of transferring my embryos to his clinic.

I told him about the debate over whether or not I have PCOS – one doctor gives me a definitive yes, the other gives me a definitive no. Dr. B took one look at my ovaries and said that they are “HUGE!” and that I “absolutely have PCOS.” He showed me the string of pearls around each ovary and then the huge numbers of follicles that were too many to count. This, he said, is why I have not had a period and why despite all my efforts am still gaining weight (currently up + 14 since I started this nightmare).

Dr. B is the first doctor to offer to actually test and treat my PCOS. He ordered some blood tests and based on the result, we will decide if and how to medicate me prior to my FET cycle to help reduce the risk of PCOS-related miscarriage. He recommended I start on Pregnitude now and, based on the test results, potentially adding Metformin to the mix. He also said that a low carbohydrate diet is the only way I will lose weight and suggested reducing my soy intake (I’ll post about diet-related stresses later). Who knew that there are RE’s actually interested in treating the root cause of a problem AND helping you achieve pregnancy?

A big concern of mine was finding a clinic that did not only transfer embryos two days a week. Dr. B assured me that they do transfers 364 days a year, including weekends. They are closed on Christmas, which I’m pretty damn baby-crazy but even I would not interrupt my holiday to have my ute stuffed with an embryo. J

Dr. B did explain that, quite simply, FET success rates are highest when done at the clinics where the embryos were created. However, his clinic works with transferred embryos on a regular basis and his team of embryologists are very experienced and are constantly keeping up with the latest advances. Today I spoke via phone with the director of embryology and she was very confident in the embryologists experience and capability to use embryos created at another lab. She was also extremely confident in the embryo transfer service that she uses.

Then cost was discussed and, ugh, changing clinics is going to be expensive. The transfer of embryos will be $450 plus another $600 by the lab to actually accept them and get them settled for storage. The FET cycle will cost $3,400 plus the cost of meds. For comparison, an FET with Dr. A is only $2,000 meds and there is not the $1,000 in embryo shipping costs.

Our second consult of the day with Bethesda was also good and the doctor seemed knowledgeable and capable, however, I did not feel the same connection with this doctor nor was there as much interest in treating my funky ovaries. His FET price was $2,600 but this did not include monitoring, embryo transfer/storage and several other things. He also requires an onslaught of blood tests before his lab will accept my embryos, thereby adding more costs to the process.

Ultimately I’m left completely unsure of what to do. First, let’s review the reasons why I am considering changing clinics:

  1. I want to find a doctor I feel comfortable with and a clinic with a positive, caring atmosphere.
  2. I want to find a doctor actually interested in what the heck is wrong with me.
  3. I want to find a clinic with an interest in one day restoring my fertility, not just signing me up for another IVF package when it is time to have baby No. 2, if we ever get to baby No. 1.
  4. I want to find a clinic that will work with my existing embryos.

Based on this list, Dr. B is the guy. I’m still torn, though, with the statement that ultimately FETs are most successful at the labs where the embryos were created. Then I think about the tender loving care study and what a big impact feeling well tended to can make.

Then there is the actual cost of switching. Lord have mercy, this cycle will end up being close to the cost of my IVF cycle.

Ugh, I am making myself crazy with all these thoughts. Without the thought of money, Dr. B really seems like the guy for us. Not only will he hopefully knock me up, he also wants to try and fix me. No one has shown interest in fixing me. Ever.

So what do you all think? Assuming any of you made it this far, Dr. B or Dr. A? Or just give it up already, Belle, and move on with a child-free life?

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33 Comments

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  1. July 19, 2012

    It sounds like a little over $3,000 difference between staying where you are and going with Dr. B. (I am assuming Dr. A is out, since you didn’t connect with him, but let me know if I’m wrong!)

    Only you can make this decision, Belle, but in your place I would lean toward Dr. B. We could lose $3000 and still pay our rent, and after all you’ve been through, finding a competent and caring doctor could be so important.

    That said…you did get pregnant with your last FET, and you could get pregnant on your next staying with your current doctor. So, that $3000 may be paying “only” for the TLC and future PCOS care.

    Agh. This *is* a really difficult decision.

  2. July 19, 2012

    After reading this it seems to clear hun, you’ve got to go with your gut. Being treated by a doctor that cares about you and really wants to TREAT you, in addition to knocking you up… seems like you can’t put a price on that. The reality is you may end up paying less in the long run if it works the first try with Dr. B. The money definitely sucks, but finding a place where you’ll be nurtured and taken care, ultimately giving you a baby just can’t be beat. I’m a big fat vote for Dr. B.

  3. 35life #
    July 19, 2012

    Can I just say that in reading this, I could already sense you know the answer. 🙂 Dr. B all the way. Having a connection is worth the extra $ in my opinion. The notion that transferring embryos from one facility to another results in a lesser success rate is similiar to the fear I have of choosing one hospital over another for my next IVF. Is it really the hospital? Both of them that I’m considering are top-notch. It’s gonna happen when it happens and where it happens, and might as well be at a place where you feel most comfortable with. If anything, the comfort will help with the stress and we already have plenty of that! Good luck with your decision.

  4. July 19, 2012

    Dr. B!! you want to feel that TLC and to have a dr. in that line of work who wants to fix you as well! not just nock you up and send you on your way! I would choose Dr. B if I were you. Though I understand about the money thing man they get you but to be treated as a woman and not a science project migh be worth it. Good luck to you lady! =)

  5. July 19, 2012

    It seems pretty obvious to me which way your heart is telling you to go. Dr. B baby! I love he is actually looking into what is actually going on with you and is interested in helping you FIX the problem. (Welcome to Metformin…enjoy the poop) They also seem confident that they can help you achieve a healthy pregnancy. Not that your other Dr. doesn’t…it just seems to me in your writing that you have connected with this clinic and feel comfortable with them. Let us know what you decide!

    • July 19, 2012

      Lol! Sadly, the first thing I thought when he said Metformin was “YAY! Maybe I’ll poop!” 🙂

  6. July 19, 2012

    I love, love, love that Dr. B is putting you on myo-inositol as a first line of treatment for PCOS. Research clearly indicates that it is as effective as metformin, but without the awful side effects. Hooray for a doctor actually utilizing evidence based medicine!! I’ve read so many women’s accounts of doctors putting them on metformin for infertility – women that don’t even have PCOS! It is a pernicious, nasty drug and I really hope that the myo-inositol works to restore ovulation and reduce your androgen levels. That would be awesome. Also, I have some brief lit reviews of other supplements for PCOS under the supplements tab on my blog if you wanted to read up on different treatments.

    As for using your current clinic or Dr. B, that is a really tough call. Sass brings up a great point. You did get pregnant with your current clinic, and, sadly, it wasn’t the lack of care that hurt Pip’s chances. However, I am currently working with a clinic that I really don’t trust at all, and I can see how reassuring it would be to make an investment in healthcare based on solid research and the potential for compassionate care.

    Best of luck in making a touch decision!

  7. July 19, 2012

    I have not come anywhere close to this step, but I would go with Dr. B. You and Mr. Husband are the only ones who can make the actual decision, but I think the connection you feel and his willingness to really treat you will provide so much peace of mind. But it’s a lot of money. So I guess you need to figure out what is most important. Hugs and good luck sweetie!

  8. babyfeat #
    July 19, 2012

    It seems like your instincts are already telling you which doctor you want to go with, it’s just the money that mankes you second guess. Extra expenses suck, but the money is worth it if you can not only get pregnant, but actually get treated for PCOS. And in your blog, you sound so comfortable with Dr. B. That is huge in itself! I’m glad you found this clinic

  9. July 19, 2012

    Only because you specifically asked, I would say to go with Dr. B. he may cost more but he also might be able to help you with your underlying problems. And you can’t really put a price tag on feeling healthier. Of course only you can decide what is best for you and your husband.

    Good luck in making a decision.

  10. July 19, 2012

    Everybody votes for Dr. B and it’s easy to see why. Only you can weigh for yourself what the cost means to you and how you feel about moving those precious embryos. Short of going Dr. B all the way, is there any middle ground? Like is it possible to consider getting the transfer done where the embryos currently are but move forward with Dr. B’s treatment plan? I don’t know if that sounds wacko because I’ve never had embryos outside of my body.

  11. July 19, 2012

    I am a huge believer in gut instinct with doctors and Dr. B. sounds incredibly good for you. I actually want to go see him myself! It’s up to you and I know financially it is a hit but there is no price tag on confidence in your medical team. For serious. Good luck!

  12. Jay #
    July 19, 2012

    I’d go with Dr. B. In this process, you have to say, in for penny, in for a pound. But what is truly priceless is finding a doctor you can trust, and moreover, one who is gung-ho about treating PCOS. Women don’t randomly start having problems in this department for no good biological reason. If you are young, PCOS is the the #1 suspect behind most women/s problems, and has such a varied crazy presentation that nobody has a good handle on ALL the cases just yet.

    I hate to even THINK about this, but this CAN turn into an incredibly prolonged journey. Best to do it with somebody you feel great about. All of us, I think, to be on the safe side, are best off if we think in the long term, not the short.

  13. ozifrog #
    July 19, 2012

    Been there, done that, got the tshirt!! Sit with the decision a little while. Don’t feel pressured to rush it. The money… Forget it. Decide on the other treatment reasons. Dr B is quite wrong about the low carb diet… Actually really wrong. You need a low glycemic index diet, low carb is quite bad for you. There is a lot of double blind peer reviewed research behind this. (try the Bump to Baby book on amazon). And I have to say metformin has seriously changed my life, in a good way. I am not familiar w the other drug. My doctor showed me miscarriage graphs with metformin, and without, in a woman with pcos… The difference was incredible. And it would be good if you saw an endocrinologist as well as a fertility doctor. They are much better at pcos management. You don’t go to a builder to get your drains unblocked… Don’t only go to a fertility doc for an endocrine issue!

    • July 20, 2012

      I mistyped. He recommended the South Beach Diet Plan to me as a good diet plan to manage PCOS and emphasized the good carbs vs. bad carbs. I shudder to think what a mess my ovaries would be if I ate things like white bread and such!

      I have done some reading about the coloration between miscarriage and PCOS since getting your comment last night and it is staggering and alarming. The thought of popping embryos in to this ute with the ovaries as they are right now with no attention to them seems like a foolish waste of money. The second doctor I saw also stressed the importance of having a cycle at least ever 3 months. I guess going for a year without a period is NOT good and can increase your risks of certain cancers.

      I will take your advice to see an endocrinologist, too. Do you think this doctor would be able to better guide me in diet choices?

  14. July 19, 2012

    No to option C. No, no, no.

    I think you should sleep on it for a few nights. I think what it comes down to is how you’re feeling with each of the REs. On that note, I think Dr. B sounds wonderful. REs should be interested in treating your condition, not simply getting you pregnant. The reality is that PCOS is due to an imbalance in hormones and treating this condition will only improve your quality of life as well as increase the chances for a successful pregnancy.

    Good luck with the decision!

  15. July 19, 2012

    Based on your meeting with Dr. B, I’d say it’s almost a no-brainer IF you can afford the difference in cost. If you don’t really feel comfortable with your original lab, then there’s no great reason the FET will be more successful there. I think that connection and feeling “heard” by the doctor is everything. Convenience is also extremely important. How can you only have transfers 2 days a week? What if your follicles don’t fit that schedule? (Not that it matters for a FET.)

    If you’d like another cost comparison. My clinic is San Diego was $3500 for a FET, so about the same. They are also open 364ish (maybe one less) days a year.

    My biggest piece of advice…trust your gut. And then afterwards, don’t doubt your decision (so much easier said than done).

    Good luck!!

    • July 20, 2012

      Two days a week would be great! The current doctor only transfers two days A MONTH! It is ridiculous. September, October and Novembers “transfer” dates all fall on work things that I can’t miss. It is extremely frustrating.

  16. July 19, 2012

    For what it’s worth, I’d choose Dr. B and run like hell towards the warm fuzzies. Money is just money. Yes, I hate spending it and have a laundry list a mile long of things I’m saving for, and another list just as long of things I would hate to spend money on. But you’ll make more money. In the end, he is treating you like a human being and he’s seeing you as a whole person and not just a ute and some ovaries.

    I agree with what others say and think it’s good to not rush into a decision, but I feel like this is a good “next step” for you to heal in more ways than one. Best of luck!

  17. Mel #
    July 19, 2012

    I would definitely go with Dr. B… feeling a connection with your RE is so important. You have to feel like they actually care what happens to you. Money (although a huge issue) shouldn’t matter when it come to this…a healthy happy baby is priceless. Trust me I know how crappy it is not to have unlimited finances and I know there is a fine balance (don’t want to go crazy in debt, someday I need to buy diapers) but in the end being a mom is my goal and I am willing to sacrifice having a nice car or nice things in order to achieve it. I always tell my husband…when this is all over we will be rich with all the money saved by not having to do anymore treatments 🙂

    I am glad you are getting closer and closer to your next step!!! When is your goal to do your FET??? I am a few weeks behind in my recovery and I am looking to October hopefully (if my body cooperates) to “bet back on the horse” 🙂

    • July 20, 2012

      I would LIKE to do my next FET in September, however, after seeing my ovaries on the ultrasound screen I suspect it might be more along the lines of October or November. I feel we have some work to do to beat them into submission first 🙂 I’ll keep you posted, though!

  18. July 19, 2012

    Dr. B, Dr B!!! 🙂

  19. July 19, 2012

    Definitely Dr. B. If you can afford the difference (which it sounds like sass calculated to be $3,000), then absolutely go with him. You like him, you connected with him, and that is HUGELY important. Plus, the fact that he takes you seriously as a whole patient and not just a uterus is a good thing. And, wow! If your ovaries were so clearly PCOS-y I wonder why nobody said anything to you before!!!

    It sounds like you want Dr. B anyway! 😀

  20. July 19, 2012

    After my 19 different doctors in just the past two years, there would be no question. Dr. B all the way. I can’t put a price on a doctor who actually cares and is willing to listen, find problems, and solve them. But you know no matter what your decision is, we’re behind you 100%!

  21. Jen #
    July 19, 2012

    Sounds like Dr. B is the natural choice – you’ve got to feel comfortable with your doc and it sounds like this one really showed an interest! Plus I am familiar with that practice (as I mentioned IRL) and they have a GREAT reputation around the ‘nati!

    • July 20, 2012

      You were absolutely right in all your premonitions about the clinics! Thank you so much for the tips. I’ll holler at you when Mr. Husband and I head back up for another appointment. Maybe we can all grab supper!

  22. July 19, 2012

    Of course money is always a consideration, but it sounds like your gut is telling you to go with Dr. B. You mentioned baby #2, which says you’re in this for the long haul, and it sounds like Dr. B is more willing to work with you to get you healthy, which, to me, is worth the extra cost. Best of luck to you and Mr. Husband in making this decision.

  23. millionbabysteps #
    July 19, 2012

    I would say either go with dr B or stay put. $$ wise obviously staying put is ideal – and they do know how to get you pregnant. If tender loving care is your thing (which I totally get) then dr B is your guy. If I were to try to think totally rationally and best bets etc – I would stay put. Cheaper and they have gotten you pregnant, hell if it weren’t for a rare chromosomal thing you’d be almost half done by now. I have read embryo quality is key…..which you’ve got. So if you are just looking to get pregnant as soon as possible I’d stay put – but if you ever had to do another fresh cycle I’d move. That said, I’d back you either way, I am also all for ditching shitty drs and clinics. Good luck. Tough decision for sure.

  24. millionbabysteps #
    July 20, 2012

    Ps – you should talk about the recommendations from dr B with your current dr and see what he thinks too. See if he’s willing to try other protocols.

  25. July 20, 2012

    Having been in your shoes before I would highly recommend switching to Dr. B. I went from a clinic where I cried every time I went to one where I really looked forward to seeing the staff. Since I had to drive 2.5 hours each way to go to the new clinic I was often staying at a hotel and when one of the nurses found out she offered a room at her house for free. Just knowing that the clinic cared that much about me changed everything. It wasn’t an easy ride and I still had three failed IVF cycles with my new clinic but every time a cycle failed the nurses and doctors were devastated for us and that showed. They wanted to fix the core problems (also pcos) and get me pregnant – that took time but in the end it worked.

    The research is out there and it seems like you’ve read it – how you’re doing emotionally matters in this journey so even though $3,000 is a lot I do not think you’ll regret it.

    Good luck!

    Marisa

  26. July 20, 2012

    It sounds like Dr. B is your man. We had the same EXACT issues when choosing our clinic- PCOS vs not, more expensive vs less etc. We’d never had a successful pregnancy until our new RE opted to treat my PCOS. I would go with your gut feeling on this one. Good luck!

  27. July 20, 2012

    Just echoing what everyone else is saying….Dr. B sounds like the man and I would go with him. Good luck! 🙂

  28. July 22, 2012

    Go with B! I know the money is big issue (would be with me too). You gotta look at not just the immediate future, but the long term too. Who is going to take care of you? Good luck!

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