Sunday, May 3, 2009

Choosing a Fertility Clinic and Doctor

Probably half the battle is choosing the right clinic and doctor to work with. Pick the wrong clinic, and chances are you won't even get to cycle. The truth is, if you have high FSH and are over 40 years old, many doctors will flat out refuse to work with you and direct you straight to donor egg. It has happened to all of us at some point, it is called the "donor egg speech" on the message boards.

While it is true that the odds with donor egg are much better and is likely the fastest way to a baby in your arms (although still not a guarantee, which some doctors fail to mention), if you want to continue to try with your own eggs there are still options. You just need to do your homework and know where to look.

Time is of the essence here. Don't waste time with OB/GYNs, go straight to an RE (reproductive endocrinologist). Check out the list of FSH-friendly doctors on PJ's site, see if there is one in your area. Probably the majority of fertility clinics in the US are not open to treating older patients with high FSH, so this list is very useful in narrowing down candidates.

If your FSH is extremely high, like over 100, and you still want to give it a shot with your own eggs, make an appointment with Dr. Jerome Check at the Cooper IVF Clinic in New Jersey. Don’t even bother with anywhere else. He has experience with success even at these extreme levels and has published articles about it.

Message boards are a great way to help locate a FSH-friendly RE and clinic in your area. The Women Over 40 With High FSH board is a very good resource. You could post a question with the title “Looking for a FSH friendly RE in the South Jersey Area” or wherever you may be, and you will get some good tips.

Some Questions to Ask

On the first appointment with the doctor, you should be prepared with a list of questions. If you are doing IVF, it is especially important to get certain information up front. Even if IVF isn’t on your immediate radar, it may be in the future so it is still worthwhile to ask. Some ideas:

Is there a minimum number of follicles you require before going to retrieval?

Some clinics will say they will let you try IVF with high FSH, but fail to mention that they will cancel you if you don’t have a minimum number of mature sized follicles. You don't want to get caught out half-way through a cycle, vested financially and emotionally, only to find out that you don't meet some arbitrary minimum requirement (which is often out of reach of us poor responders) and then get cancelled.

There are clinics out there that let the patient decide whether or not they want to proceed with fewer follicles. If you typically only get a few follicles then waiting for another cycle isn't going to give better results. The clinics I have been to have let me go to retrieval with 1 follicle. You only need one good egg!

Is there a FSH cut-off, or any other criteria for proceeding with a cycle?

Again, you don't want to be all ready to go and then be cancelled due to the clinic's FSH cut-off that you didn't know about. Or any other cutoff for that matter. Many clinics don't even test FSH each cycle, so it isn't a hard and fast rule. Other clinics do test FSH but if it is high, may put you on estinyl to bring it down a bit, but they won't cancel the cycle on FSH value alone. Shop around if you need to.

Have you had success with patients that have similar stats as me? What protocols did you use in those patients?

This will give you some idea if the clinic is used to handling cases such as yours, or if they only take the "easy" cases. It also starts the discussion about protocols, so you can begin to understand what to expect in terms of treatment.

Does the clinic do cycles in “batches”? i.e. do they only do retrievals and transfers at certain times, like 2 weeks out of every other month some other odd schedule?

Some places put their patients on BCPs (birth control pills) in order to sync up with the clinic’s schedule. It’s one thing if the BCPs are part of the protocol, but it’s another thing entirely if the BCPs are used to delay the cycle purely to suit the clinic’s schedule for retrieval. This has the potential to waste valuable time. Not quite so bad if you are under 40, it is more of an issue for the over 40s.

There is also the potential problem of being over-suppressed by the BCPs. If you are a particularly poor responder like me, you may want to consider avoiding any sort of suppression at all.

Most clinics do procedures year round, with the exception of perhaps a few weeks of the year e.g. around the Christmas/New Year period.

Out of Town Monitoring

If there isn't a FSH-friendly doctor near you, all is not lost. This is one field where it is fairly common for patients to travel for treatment. It is possible to be a patient of a clinic in another state (or even another country). I am actually doing this now.

Even though I have good clinics near where I live, I find the cost of IVF too expensive in my area. I am an out-of-town patient and I travel to another state for treatment. Even with the cost of flights, hotel and car, it is still way cheaper than cycling in my own area. I know it sounds crazy, and when I first started this journey I never imagined I would do such a thing, but here I am.

Several fertility clinics offer the option of being an out-of-town patient. What happens is you get your ultrasounds and bloodwork done locally, and have the results faxed into the clinic where you are cycling at. Then, when it gets closer to retrieval, you would travel to the clinic and stay there for retrieval and transfer, and then fly back home.

I have to admit though, it is a pretty stressful way to cycle. I am on the West Coast and my clinic is on the East Coast, so there is also the time difference to factor in. So I get my ultrasound and blood drawn (must be STAT - same day results) in the morning, have the results faxed later that day. Hopefully the clinic on the East Coast gets the results before they all leave for the day, and they will phone me with instructions for the meds to take in the evening. All too often though, faxes get lost, or sent to the wrong place, or not sent at all. As I said, it can be very stressful and you really have to be on top of everything to make it work, but it can be done.

I’ll be starting another cycle this week and you can follow along to see how the out of town monitoring works.


IVF - CANCUN said...

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santamonicafertilityLA said...

Choosing a fertility doctor is an important step. One way to gain a better understanding of the fertility doctor you are considering is to schedule an initial fertility consultation with each of them.

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Eliana morian said...

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