Wednesday, November 28, 2007

What Happened ... / ?

I want to insert something here - I wrote this whole article and noticed a great deal of negativity about our IVF clinic and Doctor. My wife and I were displeased with the way many aspects of our IVF process were handled. I'm trying to separate the frustration and anger resulting from our failed cycle from legitimate concerns with the professionalism of the staff at our clinic. I've decided to separate out as much of the negativity as possible leaving only a few of our concerns in here. I'm opting to put the Doctor's name in, not to bash him, but to see if anyone else has had similar concerns with him. Overall I like the guy, but would consider evaluating alternatives for our second round ...

So, as noted in earlier posts, we went into the IVF process as if it would be a sure thing. In fact, I recall telling many people "If you have to have fertility problems, you want what we have (i.e. bad sperm, completely healthy female) - IVF will help us overcome the faulty, incapable sperm issue, and everything beyond that point is up to the female! No problems, right?" Wrong!

They harvested 19 follicles , of which, 9 were successfully fertilized. We arrived at the Rochester Hills office of IVF Michigan several days later for the transfer. As I was sitting next to my wife (who was stirruped) with my smock and medical garb on, Dr. S. came into the room and quickly said we had two good embryos to transfer. We had informally agreed prior to the transfer that we would like to go with two embryos, as we were somewhat excited about the option of twins, and we wanted to give ourselves a good chance at success. After briefly describing his plans to transfer two embryos, Dr. S. stated "There are some concerns with the remaining embryos, but we'll discuss that later - now, let's get you pregnant!" Then he "turkey-bastered" my wife (I could see the little jet of fluid / embryos as on the ultrasound screen as they were inserted into my wife's uterus - kind of cool) Afterwards he said "Send us pictures" as he exited the room. That was it. It all felt sort of anticlimactic, and unemotional. After a brief recovery, and my wife relieving her bladder on the bed (which was really wierd, in our opinion) we left and hoped for positive news several days later, but had that "concern with the other embryos" comment stuck in the back of our heads, and as it would turn out, for good reason.

Several days later we received our negative pregnancy results - needless to say, we were shocked. I, being a fairly optimistic person, had not prepared myself for the possibility of this procedure not working. This was partly due to lack of education, and an extremely optimistic prognosis from our Doctor (not his fault ... he was just communicating the information he had at hand) We shed some tears, bitched and allowed the feelings of hopelessness to sink in. We were devastated, at least temporarily. We wondered about the other embryos ... hopefully they would be okay and we could quickly move forward with frozen embryo transfers in the near future. We had to call the clinic to inquire about the state of our remaining 7 embryos, and were told something along the lines of oh, yeah ... your other embryos did not mature to the point where we could freeze them. Sorry." When were you planning on calling us, exactly?!?!?

There we were - out $10,000 with nothing to show for it.

We scheduled a follow-up meeting for two weeks later (that was the first time they had available) We met with Dr. S. who described to us what went wrong. Turns out my wife's follicles were not fully matured at the time of harvest. He asked us if we were certain that we administered the HCG shot exactly as prescribed - I assured him we did everything exactly as we were told to. From what I can understand based on his description, the follicles must be harvested within a ~1 hour window. Take them too soon and they won't be properly matured. Take them too late and she will ovulate, sending the follicles down the fallopian tubes, from whence they will not be recoverable. Dr. S. described the root cause of our failure as "incredibly rare" ... but then said he had another patient with what he believed to be exactly the same situation (seemed like contradicting information to me ... incredibly rare, yet he has another client with the same situation, who happens to be mid-cycle, with beautiful embryos ... hmmmmm ...) He said that on our second round he would use a different HCG medication, and might leave the embryos in my wife a bit longer. He also said that if we have the same results in round 2, we will have "a very serious issue" ... That was it ... we left his office more confused than when we entered, less confident than we hoped to be. One other thing - Dr. S. took two phone calls during our follow-up consultation, one from his wife in which he stated "Can I call you in five minutes?" - five minutes? This implied he knew he would have us out of his office in very short order. I know he's a busy guy, but we paid a lot of money, were very upset and expected nothing less than his undivided attention in a tender situation such as we were in ... after all, it was only five minutes.

Due to my frustration with the way our process was handled, I requested a copy of all our charts, files, etc. on my way out of the office. The notes on one of the documents states "Eggs polar body not completely released from cytoplasm in almost all eggs" If anyone else has experienced similar results, I'd be interested in hearing about it.

A quick disclaimer: I'm not trying to throw Dr. S. under the bus. We liked the guy very much during 90% of the procedure, and will likely go back to him for round 2, but not before exploring alternatives in the area and getting some other opinions. That's what I'm doing now. I've assembled a list of all IVF clinics in Michigan and am attempting to make sense of their ARP scores (IVF Michigan is by FAR the largest clinic in the area, in terms of number of cycles ... they are approximately eight times bigger than the second largest clinic ... they also score very well in success rates, but are not the best, primarily due to sample size - perhaps their size is part of the issue ... maybe they're TOO big ...)

Next time: Looking into other clinics - Does it make sense?


M said...

First off, I'm very sorry your first IVF. Your frustrations is completely understandable. I also get that you're trying to tease out your frustration with the failure vs the actions of your clinic. Keeping in mind I have only what you've written to go on, and you may very well have some kind of rare egg maturation issue like the doctor suggested, but I think your negativity towards the Dr/clinic is warranted and should probably be addressed. It makes me kind of uncomfortable to hear (read) that basically the only thing your doctor could come up with is that you screwed up the hCG injection. To me, that sound an awful lot like abdicating his own responsibility in your care. That's pretty insulting. I don't know what kind of hCG shot you're getting but in the clinic that I'm most familiar with, the trigger was 36 hours before the scheduled retrieval time and they had a 4 hour "window" after that to work with. Now, they obviously have a different protocol in your neck of the woods, but to me, having only 1 hour "wiggle" room is kinda tight. I mean, what if there was some kind of delay at the clinic and your retrieval started late? I have to believe it happens, especially if the clinic does as many cycles as you've said. Furthermore, eggs don't mature in an hour. Give me a break. It sounds again like the doctor is making excuses. Jeez, I seem to be getting all worked up over this. Good luck.

Hekateris said...

Um, when I had my retrieval it was something along the lines of 36 hours after the trigger shot - I think. Can't remember and don't have the paperwork in front of me to look. Did they do a 3 day or a 5 day transfer? How big were the follicles before your trigger shot?

M is right, eggs don't mature in an hour and it does sound like your doctor is making excuses - doing the trigger shot 'wrong'? The only thing I can think of as to you doing it 'wrong' would be confusing intramuscular with subcutaneous - and even then, I'm not sure that would make much of a difference?

I'm concerned that he brushed off the quality of the blastocysts before transfer, I think you usually find out how many you can freeze at the time, whether it's a lot, or not.

Or he may be one of those doctors that doesn't like to give patients the bad news, and so couches it in language that means nothing in particular but impacts the patient's well being. Now, having said that, my clinic was not into sharing many of the details either, however, they never ever failed to tell me when things were good and when things were bad.

I say, it can't hurt to look at other clinics...if I recall rightly, this is the best in MN? Is that by babies born or women treated? Do they accept all comers or only those under 30 with very specific concerns?


Joe said...

Thanks very much for your comments. IVF Michigan is the largest clinic in MICHIGAN (based on the information I've been able to dig up on-line), based on # of cycles (798 TOTAL, 59% of which were age 35 or less, 21% age 35 - 37) ... next biggest is Oakwood Hospital at 221 cycles, 40% of which were age 35 or less, 28% age 35 - 37, 23% age 38 - 40)

As I noted, I'm not at all familiar with the science behind the HCG shot ... we administered the shot at 11:30 p.m. on a Saturday evening (10/13), and went in for the procedure on the following Monday morning (10/15), approximately 36 hours later. Transfer was done 5 days after fertilization, follicles were all of the right size (I'd give you a measurement, but I can't make a lot of sense out of the documentation provided by our clinic)

I think we're going to look into some other clinics, starting with Oakwood (Dr. Magyar) - besides, this clinic is more conveniently located to my wife's job ... driving back and forth to Ann Arbor every day was getting old. I just hope the other clinics can make sense of the documentation provided by IVF Michigan ... it looks like a lot of scribbling to me. In fact, I wonder if IVF Michigan will even be able to make sense of it if we decide to do a 2nd round with them ... given the volume of cycles they do each year, how can they remember each patient, or tailor their cycles without consulting documentation of cycles past? Geez ...

Tracy said...

I read your comments on my blog. Part of the reason I'll be deleting my blog is there are people who are reading it currently that I don't necessarily WANT to find their way over to the new one. With the addition of password protect, I'll be able to further maintain our privacy. We're going to be doing some procedures that I don't necessarily want to share with the whole world (and especially people I know IRL.)

I'm sorry you've had this experience with Dr. Shamma. We've had the opposite experience. He's always taken a lot of time with us, and has explained things repeatedly. Maybe you got him on an off day? There have been things that he's told us that I've been skeptical about along the way (probably because I didn't want to believe him), but afterwards I do lots of research and what he's told us has been confirmed.

Again, I'm very, very sorry you didn't get the results that you were hoping for, and I pray that you are successful with whatever your next steps are.

Tracy said...

Oh, and you can email me at the address currently on my blog if you want me to email you a password. That's the only way I can get it to you.

Hekateris said...

I found the following stats for 2004 for MI clinics on the CDC site:

I'm terrible at math, but it seems to me that although IVF MI has a higher success rate, overall Oakwood has a high percentage of live births across the board. Oakwood also seems to treat people up to 40, with a higher success rate than my own (wonderful) clinic.

Which begs the question - what is Oakwood doing differently that gives them a better success rate with the older women? I'd have to say I'd definitely check out Oakwood for cycle 3 if you decide to stick with IVF MI for cycle 2.

I've done the travel-to-my-clinic thing, including staying in hotels for 2 weeks solid, and it bites. There's a lot to be said for home comfort.

As for your transfer, were they waiting for size or cell growth? I don't know what the difference is between day3 and day 5 transfers, it seems pretty arbitrary, but maybe someone has a better reason than me. Oo, Mr Oro wants to know if you had ICSI? Assisted Hatching?


Hekateris said...

Sorry, the end of that url is STATE=MI

futurewise said...

Our clinic is strict concerning trigger shot. They say that the aspiration of egg cells should be done after 34 to 36 hours.
I recommend you to consider second opinion because of psychological factor- if you don't trust 100% in procedure and clinic staff - change it.
Good luck!