Waiting for nothing because that is what this cycle was, a month off in between clomid IUIs, a kind of giving up on trying naturally, and a void where a 2ww should be, or could be. We did engage in some fertile-time sex and so that ever hopeful spark does reside somewhere in me, which is why I say I am waiting (for nothing).
But I am also waiting for something because early next week F and I will travel up to Portland for a second opinion/early ivf clinic shopping appointment at OregonReproductiveMedicine. There will also be time to enjoy Portland, so really the consultation is just a small detour from an otherwise intended fun pseudo-spring break trip. On a side note, I will not be participating in ICLW for the first time since starting this blog and I miss you already.
The clinic we currently go to is actually a comprehensive Women's Care Facility with a separate entrance and waiting room for the 'Fertility Center.' Dr. A runs the fertility center with a staff of nurses and is the only RE at the small facility. The small clinic environment makes treatment very personal, Dr. A usually performs all procedures, including u/s and HSGs and inseminations and the cost of treatment is lower when compared to other centers (especially IVF, which is tempting). A possible downside, as I perceive things, is that the lab is also small and the number of IVFs per year is low. Additionally, Dr. A is not a member of SART and the lab is not accredited.
Everything I have read on how to choose a fertility clinic emphasizes the importance of the RE being a member of SART. F and I are pretty much cowards and have not asked WHY Dr. A is not a SART member and the lab is not accredited. We don't really know what it means for our treatment that he is not.
Larger clinics with a team of REs suggests that more research is happening, that there is a system of checks and balances with working with more colleagues, and that more procedures are happening and that, as a patient, you are more likely to find an RE who has expertise in working with your specific diagnosis. These are all assumptions on my part, but make sense, right? Larger clinics have downsides, too, which is why we decided to stay at a small clinic for the duration of our clomid IUIs (one more to go in April) and reconsider when the time came for more aggressive treatment (now, or after April).
What we really want is a second opinion, or maybe a fresh look, an evaluation of the treatment we have received so far and thoughts about the outcomes of that treatment, to enter a consultation already with test results, more knowledge about treatment, and some treatment under our belts. I think we will get much more out of this one than the last (just feelings of being completely overwhelmed). Hopefully I am not expecting too much. I need to get my list of questions together.
ORM is where we will most likely do IVF, if it comes to that. They have a shared risk program that we will hopefully qualify for (from my shopping around I know of one program already that disqualifies patients if their FSH level is above 7.5. Mine measured 9.3). But before that, we will need to decide if this is where we want to pursue the next steps in our treatment-- injectible IUIs-- or if we want to remain with Dr. A for this.
It is small vs large clinic. Any thoughts or advice? What are your thoughts on/experiences with SART?
5 comments:
I'm sorry I don't ahve any advice, but I want to wish you luck!
And I would imagine that a larger clinic probably is going to be more beneficial, but that is just an assumption.
This is exciting that you're going for a second opinion - I think it's always a good idea when you're looking to pull out the big guns - IVF. I had many of the same questions when I started researching docs, and I asked my step-dad, who is both a doc and has lots of health problems so is an experienced patient. He said that it's better to go the bigger places. You want a clinic that does the same thing over and over again. Doing it a lot makes people better at it. And they get to see more of the exceptions so they know how to deal with them. This is also why he doesn't tell his docs that he is a doc - he doesn't want special treatment. He wants to receive the same treatment that they give everyone - because that's what they're good at doing.
I thought it was interesting, and makes some sense too. So when looking for an RE, I pulled the SART reports (yes, I do think it's important to be accredited) for all the clinics in my city, and I went to the one with the best stats and the one that did the most IVF's in the year reported. Coincidentally (probably not), it was the same one. Yes, it would be nice to receive more personal attention, but I know that my doc and his nurses know what they're doing because they do it - a lot.
Hope that helps! Excited to hear how your consult goes.
I think the second opinion is so important, especially when making such big decisions. Though, if you are leaning toward IVF I would recommend thinking about places that have higher SART ratings. Those numbers can tell you a lot about a clinic, including how many people they treat with IVF who share your diagnosis and are in your age group.
I would also recommend finding someplace where your ultrasounds, blood draws, and everything will be done on site - in one place. It is tough enough going to the clinic every other day, but you probably wouldn't want to be running to all different locations and adding that stress. One thing I love about my clinic is that they actually have a lab on-site where they do all the blood testing, which is great cause it cuts costs and gets the info to everyone sooner.
As to big or small, I think that just depends on you, where you feel most comfortable, what your biggest concerns are, and of course what you have access to. For me, the biggest issue was the doctor. I wanted to really feel comfortable with my doctor and trust that he/she was making the right decisions for me and my diagnosis. I didn't find that with our first RE (which was a practice with three docs), but I feel very good about my current RE (who has a smaller practice - just him and one other doctor who doesn't work in this location - but a large nursing staff) and his staff.
Hope that helps a little.
I think you've got some great advice above. I went from a medium sized clinic that didn't do many cycles to a smaller clinc that does a lot more and has a much better success rate for IVF. Not that we've done it, yet, but if we do, I actually feel more comfortable with the new doctor than the old. We don't know, though, if we would stay here or go to a larger clinic farther away if we decided to do IVF. I have faith in my current RE ( his success rates are as good as the large clinic with a good number of cycles per year) but it would probably come down to price.
Regardless, a second opinion is always good!
Dr H gave some good advice on how to choose a clinic based on success rates. He suggested comparing donor egg cycles. These percentages should be high because these cycles are the most successful, so donor egg cycles will give you an indication of how good the lab and embryologist is at a clinic.
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