Should I Stay or Should I Go?

Just when I think that I have everything on track and planned out just right, I encountered yet another little hiccup -- but this one wasn't necessarily a bad one. I had my second opinion consult with Dr. Preston Sacks of Columbia Fertility Associates today. I had actually considered canceling since I felt that I was on track with Shady Grove. Plus, my husband, who has felt more strongly against me going to Shady Grove, was not able to accompany me to today's consultation. However, since it was the day after Labor Day, it might have been too late to cancel without incurring a cancellation fee. So, I decided to just suck it up and go -- it couldn't hurt to hear what another RE had to say, right?

The office is located in downtown Washington, DC, near the George Washington University and Hospital. It is not large nor fancy. The receptionist was pleasant and I immediately felt at ease while sitting in the waiting room. In addition to having completed an extensive amount of forms prior to my appointment, I had emailed an excel spreadsheet that contained a summary of my test results and protocols to date. Surprisingly, Dr. Sacks took the time to review my spreadsheet before I met with him and he was in the process of printing the worksheets out when I first came into this office. We introduced ourselves and then discussed my TTC journey to this point. While I obviously expected him to be very well versed on my situation in general, I must say that I was also very impressed with his knowledge of other things, primarily Fragile X ranges and implications and how having Fragile X could be related to Premature Ovarian Failure. I also liked the fact that he is not a fan of using birth control pills prior to an IVF cycle. I told him that SG puts all of their IVF patients on BCPs prior to a cycle because they help to "quiet" the ovaries and make sure that there are no cysts. Dr. Sacks told me that while that is true for about 80% of women, there is also a 20% chance that the birth control pills actually cause the cysts, which I figured was what happened to me. I explained my cyst theory to Dr. Sacks and he basically told me that I was spot on in my thinking and that he wished I could explain that theory to his patients.

Dr. Sacks then proceeded to give me what I've come to learn is the standard RE explanation of how our bodies work and what stims are supposed to do (he joked that he was fresh and ready to go since he just got back from being out of town for a few days) and then we started discussing protocols. While Dr. Sacks told me that he's not really sure if the protocol really makes that much of a difference (I inferred that he was implying, similiar to my thinking, that it's more dependent on how a woman's body chooses to respond to a particular protocol at a particular time), he is not a fan of the Microdose Lupron (MDL) Flare protocol because ovulation can not be controlled as well as it can be on a Ganirelix protocol (which was also one of my concerns since I feel that I ovulate early). He said that his practice relies primarily on the Ganirelix one (for people like me, I assume) in conjunction with estrogen priming.

Dr. Sacks told me that he would do a sonogram on me to check on the status of my cyst. If it was gone (and if I chose to switch practices), he would have me stop the birth control pills and get me started on stims right away!! We then kind of went on a tangent and started talking about my education, my job, Miami, Vegas, Japan, sushi and other random things for about 5-10 minutes and then he surprised the heck out of me by saying something like, "ok - let's go and see if we can figure out what's going on." He then led me down the hall to the sonogram room! I didn't realize that he was going to do the sonogram right then and there, but I was very pleasantly surprised that he was ready to get down the business, even though I hadn't yet decided if I was going to stick with Shady Grove or not.

There was another nurse who was in the room with us to whom he introduced me. She also seemed pleasant and friendly and he even pointed out that she pays very close attention to details, as well. He described what he saw to both her and me. Surprisingly, my cyst was gone (hooray!), but (and I should have been prepared for this), it looks like there is another possible cyst brewing now on my right side. Sigh. Dr. Sacks told me that this proves even further that these birth control pills are not for me. He said that if I decided to start to see him, he would keep me on the birth control pills for a few more days - if that large follicle on my right ovary continued to grow, he would have me stop taking the birth control pills, allow my body to ovulate, and then start the E2 priming. Once my next cycle started, I would be able to start stims right away. If a cyst was present, he would aspirate it and then we could begin. (Hopefully I understood all of that correctly).

So, what's next? Dr. Sacks told me that I could do whatever I felt most comfortable doing -- if I wanted to stick with Shady Grove and just share the knowledge I received with Dr. Mottla, that was fine with him. I told him that while I really do have a high level of respect for Shady Grove and do feel that they are very good at what they do - for the majority of women who do not need specialization - I have not felt that they have been able to give me that level of personalized treatment that my case needs. He advised me to talk things over with my husband and go from there. I told him that I would do that, but that my immediate next step would probably be based on how difficult it would be to switch my insurance coverage from one clinic to another since I have approval through the end of October for Shady Grove. He told me that he can have his people call my insurance provider to see how difficult or easy it would be to switch at this point.

I guess through the course of this post, I've made my decision. I will switch clinics now IF my insurance company makes it easy to do so. I was pleasantly surprised to learn that if I wanted to switch to Columbia Fertility Associates that I nor my husband have to go through the whole battery of testing again, nor would we have to wait another two cycles or so to get started again. It was also refreshing to not be directed to the financial counselor's office right after my consult with him.

So now, I wait until I hear from the insurance company. Don't you hate that the insurance companies seem to have all of the power?