Thursday, May 24, 2007

Au revior, Dismissivo!

First, please go over and congratulate Bumble on her positive beta! It looks like l’il Sureshot has grabbed tight and is hopefully hanging around for the long haul!

Second, we met with—dare I say?—our new RE yesterday. It was quite a drive, and we got stuck in 2+ hours of traffic coming home, but I think we’re going to make the switch. Both the RE and the clinic (and staff) made a fabulous first impression. They were warm and welcoming, and they were efficient and organized. (An ideal combo, if you ask me.)

The RE took us on time (I’ve never waited less than a half-hour for Dismissivo), and had our file out on his desk—-he had been reviewing it before our meeting and had taken copious notes and really knew it inside and out. And, he was already waiting in his office for us. Dismissivo always made us sit in his cold, impersonal office for a l-o-n-g time before he graced us with his presence.

Not only that, the insurance coordinator was waiting for us with our file in hand as soon as we got out of the consultation (which lasted over an hour—more time than I think I’ve ever spent with Dissmissivo combined). She had already called our insurance company and worked out exactly what was covered and what our co-pay was for every step of the process. Then the nurse met with us to tell us exactly what we’d need to do to move forward quickly—what additional information they needed, what additional bloodwork they’d like to do, etc.

Wow, was all I had to say. Maybe this is the level of service you all enjoy already, but it was decidedly NOT the level I had come to expect from Dismissivo…or even from Shorty for that matter.

Of course, good service could all be smoke and mirrors for poor medical performance, but that appears not to be the case. First of all, their SART IVF stats are great—for women under 35 they have a 55% live birth rate per transfer (which means that, assuming all goes well and we make it to transfer, we have a slightly better than 1 in 2 chance of taking home a real live baby). That was pretty exciting to me…I mean, imagine that—that doing some kind of fertility treatment would result in actually having to decorate a nursery and buy a carseat?

But, wait, I’m getting WAY ahead of myself.

What impressed me most about our RE—who I’m going to call Smirky because, well, he had this goofy grin on his face the whole meeting and kept cracking jokes the whole time—was that he had great answers to all of our questions.

For example, we asked about whether our last four IUIs were essentially a waste of time. While he wouldn’t come out and say they were, he did say they were, for a number of reasons, sub-optimal. What was most interesting, though, was his explanation of why. You see, I thought that I may have been triggering ovulation on my own before the actual IUIs. (A hypothesis that Dismissivo was quick to agree with.) He basically said, “I wouldn’t trust the OPKs when doing IUI. They have a documented 8-10% false positive rate, so we tell women not to use them during treatment. Instead we track LH with the bloodwork so we can be certain of what’s going on.” I know what you’re saying, duh! Right? I always wondered why Dismissivo didn’t track LH in the blood (since they were, you know, taking my blood). But, they insisted the OPK was good enough. Grr.

Anyhow, the reason he thought my IUIs were suboptimal was that he thought they were under-stimulating me. He said, “look, at best you had one, maybe two good follicles each cycle. Since you already ovulate on your own, we know that you produce one mature follicle every month naturally. So, with this level of stimulation, you’re getting with IUI barely a better chance than you’d have had on your own. I would have been a little bit more aggressive to try to get 3-4 mature follicles each cycle.”


But, when I asked him whether we should consider another IUI, he was pretty frank with us. He basically said, “look, while these were less than perfect, you did have a chance of getting pregnant each of these months and you didn’t. And, typically, women that are going to get pregnant with IUI do so within the first four cycles. So, at this point, I would recommend moving onto IVF.”

What a better explanation than Dismissivo’s, “well if you really want to get pregnant, you do IVF.” Double grr…

The other thing that fascinated me was that, because we’re concerned about destroying embryos, Dismissivo had suggested retrieving as many eggs as we could, fertilizing only some, and freezing the rest of the eggs. Smirky actually really discouraged that. He said that egg freezing was a very experimental process and that the chances of getting a viable embryo out of frozen eggs was actually comparatively quite low.

He also explained that the chances of having extra embryos to worry about was also quite low. He said that they do 5 day transfers for all of their patients except in extremely rare circumstances. And he explained that the likelihood of a ton of embryos making it to the 5dt and actually being suitable for freezing was low. (Of course, it’s not zero, so it’s still something hubby and I need to think about…)

Smirky also had a very long explanation of why they do 5 day, rather than 3 day transfers. I’ll spare you all the details, but essentially he said that the embryos that look good at 3 days are not necessarily the same as the ones that look good as blasts. So, the practice has put much of their time and energy into figuring out how best to grow the embryos for the full 5 days, so that you have a better idea of which have the best chance of implanting, etc. (Of course, he acknowledged the risk with growing the embryos for the extra two days, and talked a lot about the benefits of doing 3day. Again, I was impressed with the level of care he took to explain their philosophy, the associated risks, etc.)

All fascinating to me.

Anyhow, I’ll spare you the rest for right now, but the bottom line is that we both felt really good about this practice and about Smirky. The bad news is that, while I can do the bloodwork and ultrasounds at a satellite office that’s only an hour away, since this is a clinic associated with a big university, we’d have to do the retrieval and transfer further away at the university hospital. But, ‘tis a small price to pay if the level of care and service is that much better.

So, if I sound excited, it’s because I am. I can’t say that I’m excited about having to do IVF, because most of my fears remain. But, both hubby and I left the office feeling cautiously optimistic. Like maybe, just maybe we could be pregnant before the end of the summer. (See, there I go again. Not only getting my hopes up but setting yet another milestone for myself. Will I NEVER learn?!?!)

Of course, this is all assuming that I’m not, as Ms. Planner said, an urban legend in the making!


Kate said...

That is very encouraging. I hope my RE is this good!

Dianne/Flutter said...

WOW - I wish my RE was that good :). Oh well. Praying - as usual - that you won't need your super duper RE. And that you do become an urban legend. If you don't mind I am hoping for the same :).

Erin said...

Wow! Well, whether or not you end up heading down Route IVF, it sounds like you have found a doctor who will help you make the best decisions for you. It sounds like a great appointment, and well worth the traffic.

It must be frustrating getting corroboration about the ineffectiveness of your prior IUIs, but at least it was presenting in an informative way. All in all, Dr. Smirky sounds fab!

Here's to urban legends!!!!

Bumble said...

The new RE sounds absolutely FAB, and their stats sound great. Its worth the extra travelling time to feel comfortable with your guy.

And thanks so much for the congrats again x

Amy said...

Your new RE sounds fantastic! I totally think its worth the extra drive to be with someone you can trust. My husband and I are going to start the process of finding an RE clinic for IVF- I hope the doctor we find sounds as good as yours. And those are great stats for the clinic. Best of luck!

Sarah said...

congrats on finding a great RE. that's such an important peice, esp the part about how much better he communicates everything. and everything he recommended is totally in line with all that i've read. best of luck with dr. fantastic!

Laura, the (reluctant) baroness said...

Two thumbs up for Smirky! I'm so happy you found reasonable RE and professional office. They are impressively organized! I'm glad Smirky took so much time to answer your questions. His response to your sub-optimal IUI solidifies my feeling that my IUIs were probably a waste of time, too.

I'm very happy for you. Here's to a successful summer (or urban legends!)

Caro said...

Sounds good. This process is bad enough without having doubts about the people we need to trust to help us.

Reproductive Jeans said...

Wow, that is awesome...sounds like Smirky is a great doc! Reminds me of my clinic=) Hope this is a very positive step for you all--and I am sorry that IVF is going to be the next step, but we'll all hold hands along the way!

megan said...

sounds like a fantastic vist to the new RE...definitely worth the extra drive time! however, i'll hold out hope for a summer of urban legends!

Ann said...

What a great doctor. And isn't it nice to hear somebody else give their opinion, too? I feel lucky--the few times I've gone to see my RE, I've always gotten lots of face time with him. I sort of took it for granted. I never realized that so many other just pawned their patients off on nurses. Here's to Smirky! (raises her glass)

Trish said...

WOOHOO!! YAY!! I'm so glad to see you get some real care. Do you have the urge to call Dissmivo up and explain to him how real doctors work?
Good luck!

Ms. Planner said...

It was so great to read your post. I love reading the optimism shining through your words. Traffic notwithstanding, Dr. Smirky & his office sound lovely.

Coffeegrl said...

First of all, everytime I read your nicknames for the REs, all I can think of is the Smurfs. So funny! Second, I'm really excited for you two being so excited. What a positive start with the staff at the new practice. Best of luck with the new crowd!