Phone Consult with SIRM

I had a really productive phone consult with Dr. Albert Peters of SIRM (Sher Institutes for Reproductive Medicine) this afternoon. He was very personable and let me ask as many questions as I needed to ask him. After I provided him with my a summary of my medical history and a more detailed TTC history, he told me that he would put me on an LA8E2V or LA10E2V protocol. These protocols are basically the same with the exception that the LA10E2V uses a higher does of stims. The letters correlate to Lupron, some sort of Antagon med (e.g., Antagon or Cetrotide), and Estrogen. Each of these drugs would be administered prior to starting a rather aggressive dose of stims (between 600 - 750 IUs/day). I just realized that he didn't tell me what the V represents. This protocol sounds similiar to the MDL flare protocol and I'm wondering if this protocol name is a name that is used just within the SIRM network. I'll have to consult Dr. Google for some more information on this.

When I told him that my RE wanted to put me on the Ganirelix Acetate protocol, he said that his practice typically doesn't like to use this protocol because the Ganirelix has to be administered at the right time - it can't be too early, nor can it be too late.

The conversation was very informative and I really appreciated his taking the time to talk to me, even though I'm not his patient. I like that SIRM also puts a lot of emphasis on immunological testing, which makes sense if you want to make sure that you have the best chance for a successful pregnancy that makes it to term. If I lived closer to an SIRM location (and if I wasn't worried about any insurance transition headaches), I think I probably would change clinics - mostly for the personalization aspect:

Why Choose SIRM?

Despite my frustrations with Shady Grove up to this point, I am willing to continue working with them - at least until I can actually make it to an egg retrieval. They have great success rates, a top notch lab, and I have developed a better working relationship with the staff. I am hoping that now that they know me on a more personal level, they will be more on top of things and not let things fall through the cracks. My RE has started to show that he is more invested in my success, so that's a good start - I just wish it didn't take a year of TTC. I hope that he will be able to be more personally involved in and in charge of my treatment decisions. Having at least five other doctors' input, who don't even know what my diagnosis is or the journey I have traveled so far, simply can not be effective.

I am trying to give Shady Grove as much credence and faith as possible. One thing that concerned me about Dr. Peter's suggestion is the high dosage of stims they would use on me. My research has led me to believe that, in most instances, anything over 450 IUs/day is ineffective. So why inject so much more into your body if it's not necessary? I actually did better when I was on 225 IUs/day of Follistim for my first IUI than I did when I was on the 300 IUs/day of Follistim for my second IUI. I think the general dose won't make that much of a difference - it all depends on where you body is at the beginning of a cycle to know if it's going to respond well or not. Shady Grove doesn't go over 450 units - SIRM would put me on something between 600-750 units. I think I'm starting to see a trend with Shady Grove - and it's not necessarily a bad one (unless you don't have much time left). I think that they do not like to be too aggressive unless they simply have no other alternatives. That's probably why they didn't do anything about my TSH level or aspirate the cyst right away. It seems that they like to wait and see if our bodies can naturally take care of stuff before forging ahead because, in most instances, things will work themselves out. I can actually see the benefits of that because you don't want to put yourself through stuff unnecessarily if you don't have to - unfortunately it looks like in my case, we may have to do so.