Monday, December 17, 2007

And Now For Something Completely Different

A very fitting title for our meeting with Dr. Mthis morning on the topic of second opinions. Where to begin ... ah, let me consult the business card in my suit pocket upon which I jotted down a few key points of disagreement between Dr. M and Dr. S. - before diving in, a little background (just the facts):

We conducted our first, unsuccessful round with Dr. S. at IVF Michigan in October 2007. As a result of many frustrations with the process at IVF Michigan, the details of which I have only touched on in previous posts, we decided to seek a second opinion from Dr. M of Oakwood Hospital (the SART data shows Oakwood to be the second largest clinic in Southeast Michigan, by # of cycles, and it is in Dearborn, where my wife works) I dropped off our files with Dr. M a week prior to our meeting so he could see where we've been, and hopefully formulate a preliminary prognosis.

We were greeted by a pregnant medical receptionist, which was a double-edged sword: My wife wasn't pleased that this girl was pregnant (the sharper of the two edges), but there was the off chance that she became that way through the services of Dr. M (an unlikely scenario, but the more preferred of the two offered) We were escorted to Dr. M's office, down a hallway covered with baby photos, where we sat for about 15 minutes looking at some flip books of mis-shapen sperm and uterine maladies. Mis-shapen sperm, for those of you who don't know, look pretty messed up (two heads, two tails, big heads, small heads, pointy heads, etc.) Scary stuff ... makes you glad you're not an egg and that you don't have to deal with these monsters viciously swimming into your sides trying to penetrate your skin. Dr. M. greeted us with a very soft hand shake, almost as if to say "Hello. I'm a gentle man and intend to treat you as such through this difficult time." He took a seat across the desk from us and his assistant assumed a position next to him (a female Doctor, whose name I don't remember) He first asked us if we had any questions for him. What a nice start! Dr. S. always rambled on for a few minutes, before finally saying "Now I am open to answer any questions you might have." We told Dr. M that we primarily wanted to focus on our first procedure, his assessment of our files and how we might adjust course in round two. From here I will follow my bulleted list from the business card upon which I took notes - each bullet highlights a key difference between Dr. M's remarks and what was done at IVF Michigan by Dr. S. There are 4 bullets in total - I will elaborate on one bullet per day (assuming sufficient time to write, which shouldn't be a problem as it's the week before Christmas and productivity in the U.S. economy is as an all time low - an unsubstantiated theory)

"Sperm Morph + Volumes = No Problem!"


Dr. M. started by commenting on the fact that our files indicated a theme of male factor infertility, due to morphology issues. He then did some high-level math on a pad of paper using the sperm count + morphology formula to show that he had a different opinion of said diagnosis. Apparently my counts are very high (hell yeah!), but my morphology is poor ( ... ) When you combine my high sperm count with my low morphology, however, the net result is, according to Dr. M., a more than adequate amount of healthy sperm to achieve pregnancy. So, his opinion (based on data provided from 4 semen analyses) was that our issue is NOT with my sperm morphology. WTF?!?!? This is in direct contrast to the hypothesis upon which Dr. S. convinced us of the necessity to do ICSI! Dr. S. told us in convincing fashion that our problem was certainly due to morphology and that our best course of action would be to proceed with ICSI. So, here we have two Doctors in direct opposition to one another in their interpretations of a semen analysis report, which by my assessment, should be one of the more elementary pieces of information available to an infertility specialist. So, in a head-to-head comparison we felt more comfortable with Dr. M's diagnosis, but not because it is the preferred solution for my own male psyche but because the results of my semen analyses, in terms of providing a diagnosis for our inability to achieve pregnancy, are at best inconclusive - they don't tell you definitively that this is the single and only source of our problem, so therefore, IVF should not be recommended until further testing has been conducted.

Having started the meeting with Dr. M. on this note, my wife and I felt a slight sense of anger with Dr. S. (which would be the first of many during this meeting) but we also felt a sense of relief - we entered the meeting fully expecting to discuss our second round of ICSI, requiring the shifting of monetary funds, preparation for an emotionally charged start to 2008 and a great deal of angst throughout the holidays. That was not the case with Dr. M's ultimate diagnosis. In Dr. S's defense, we did have some further testing done during our first round of IVF, but the full suite of tests available to diagnose the root cause of infertility was not exhausted. This is essentially what Dr. M's final recommendation was - that we proceed through a methodical system of testing bypassed in round one to assess the true nature of our infertility issues. On this, I intend to elaborate in more detail during my remaining posts for this week with bullets 2 - 4.

4 comments:

Hekateris said...

full suite of tests available to diagnose the root cause of infertility was not exhausted.

I wish I could say I was speechless, but when you read lots of infertility blogs, it quickly becomes clear that many doctors don't give two figs about actually determining what the problem/s is/are. What tests weren't performed, and please tell me an HSG wasn't one of them?

I'm really glad you're changing clinics.

Oro

Anonymous said...

I do think Dr. M is a lot better than Dr. S for you, but for the benefit of future readers, I'd like to say something about why Dr. S's approach may make sense in some cases.

First, there's quite a bit of evidence that IVF is, despite the cost, the most cost effective way of improving fertility. Everything short of that - progesterone, clomid, IUI without and with injectables - is barely distinguishable, if at all, from just trying naturally, or maybe from temperature charting and trying naturally on the right day. For couples who have real infertility problems, skipping all the preliminaries and going straight to IVF is on average more cost effective (counting both what the couple pays and what the insurance pays).

Perhaps more importantly, many couples are much more time limited than you are. We didn't start trying until my wife was 34 and I was 44. We wasted two years on "just trying", clomid, and IUI before we got to IVF - for which we went an additional year and four cycles before getting a success. Many of the women in this situation are over 40 and every cycle counts for them; two years can mean they don't get to try for a second child, or don't get to see grandchildren within their lifetimes. Conversely, older patients often have more money, so the dollar cost of IVF, while substantial, may not be as big a barrier.

Now, I do think Dr. S is far from faultless. If your wife has always had painful cramps with her period, more care would probably have allowed the endometriosis to be diagnosed much sooner. Allowing you to think that your first IVF cycle was close to a sure thing is inexcusable - I have found no clinic with much more than a 30% overall success rate. The general manner you describe seems unprofessional. However, I think at least part of the issue is that he's looking at things from the perspective of someone who views other forms of ART as next to worthless, and is used to patients who are not as young as you are.

Anyway, as I said, it sounds like Dr. M is much better for your circumstances. Hopefully he will help you get a healthy baby within the next year or two, which will make all the effort worthwhile.

psychohist.livejournal.com

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Gravity Gardener said...

Women usually take the brunt of the infertility stigma but the male can also have issues relating to their age as it relates to the ability conceive. A study of over 12000 couples done a couple years ago concluded the age of the male was a contributing factor the number if miscarriages and issues conceiving at all.

Sperm quantity and quality was examined as part of the In-vitro Fertilization process. Miscarriages were more prevalent when the male was of 40 years of age, even if the female was not. Researchers felt the data supported the findings that the age of the male as a significant factor in the viability of the fetus. These researchers also recommended that in case where the male was over 40, couples having fertility issues should elect to have the sperm injected directly in the egg to help the chances for success.

http://gravitygarden.com/trying-to-have-a-baby/getting-pregnant-after-40.html