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Thread: Looking for Second Opinion - Unexplained Secondary Infertillity

  1. #1
    Join Date
    Feb 2014
    Posts
    3

    Default Looking for Second Opinion - Unexplained Secondary Infertillity

    Dr. Roseff,

    My husband and I are desperately in need of a second opinion. We live in a city that only has one fertility clinic for the entire city, and the next closest clinic is over a 4 hr drive away. I have been reading through your responses to people and I have been impressed by them so I am hoping you can give your opinion regarding our case. As so many others have stated our clinic does not like to deviate from their 'norm' regarding treatments and we've had to push for everything so far.

    A little background...
    My husband and I have one son who is now 5 years old. We had absolutely no problems getting pregnant with him, in fact we were pregnant on the second cycle. When he was 18 months old we again started trying to get pregnant and again very easily got pregnant on the second cycle. Unfortuneately this pregnancy ended in miscarriage at 8.5 weeks. Following this we had another miscarriage at 6 weeks and have had repeated chemicals. At the 1 year mark we were able to start seeing an RE. Since the miscarriage at 8.5 weeks my cycles had dropped from a regular 28 day cycle to 21-23 days. She immediate jumped on premature ovarian faliure but all the test indicate that my antral follicle count was great and all the blood work came back normal. She wanted to jump right to IVF which we didn't agree with so we decided to take a break from trying. Three years later I've been able to regulate out my cycle through diet changes (gluten and dairy free) so we've gone back to my RE. HSG showed my tubes were open, and that my uterus was fine. Day 21 progesterone did indicate that I was ovulating and I had gotten positive OPKS on my own previously. DH has had two SAs. Both showed great motility, and count, but morphology was 5% and 5.5 % which we were told was fine, but on the low side.
    Following all the test my RE said she felt I was ovulating immature eggs and put me on clomid (50mg). I demanded that I be monitored while on the clomid, which they don't normally do, because I do not react well to hormones. I wanted to make sure that if I was going to be miserable than I could be sure the drugs were working. My CD10 ultrasound showed that I had a 24mm follicle on my left and I was sent home and told i would ovulate in a day or two. It was 7 days later before I had anything even close to a positive opk and I'm still not convinced it was possible. I had terrible side effects on the clomid the worst of which was that it made it impossible to have sex because it physically hurt. I called my doctor to tell her this but she said there was no way the pain was related to the clomid. I demanded she switch my meds because I couldn't handle the side effects and it was pointless to be miserable when we couldn't even make love.
    She switched me to letrozole last month (5mg) but wouldn't monitor me so I have no idea what my follicle development was. Problem is that this month it was CD18 before I even had anything remotely close to a positive OPK and even then it was definately not what I would call positive. I have never ovulated that late! I am so confused right now because I can't seem to get any answers out of my RE. What is going on?
    My husband and I would like some advise before we go back in to talk to our doctor next week. We feel like we should insist on doing IUI with the medication to increase our chances because I'm miserable on the drugs. I'm also very worried about how it seems since starting the drugs my ovulation has become very late, and weak, if it's happening at all. Any advice you can offer would be appreciated.
    Thanks
    Heidi

  2. #2
    Join Date
    Sep 2008
    Posts
    851

    Default

    Hello Heidi,

    I'm so sorry to hear you've gotten nowhere with your RE. SHE should be dictating your proper treatment and you shouldn't be having to ask for or demand tests/treatments.

    What was your AMH level? TSH? Prolactin?

    Your RE should know that someone can have a mature follicle on ultrasound but not have an LH surge to cause it to ovulate; I sequentially monitor my Clomid/Femara patients with sonograms to assure their endometrial lining is thick enough and to see if/when they have a mature follicle or follicles. When they are "ready", I give them an injection of Ovidrel (hCG) to assure the mature follicle(s) will release the egg(s). Giving Clomid or Femara (by an RE) without ultrasound monitoring is folly.

    Also, recent studies show Clomid with intercourse results in similar pregnancy rates as when NO treatment is rendered, so it's recommended that Clomid be combined with IUI to boost the success rate over the background infertility rate in patients who aren't being treated.

    I hope this is of some help and I look forward to hearing back with those three blood test results. If you don't want to post them herein, feel free to email them to me.

    As an aside, is your RE Board Certified in Infertility?

    Dr. Roseff in Boca Raton, FL
    www.reproendo.com
    www.ivfmd.com
    Dr. Roseff - South Florida Institute for Reproductive Medicine - Boca Raton, FL
    PERSONALIZED/SUCCESSFUL Specialty care....

    As you’re not my patient, information herein may be incomplete/inaccurate & I can't be responsible for your actions. This is for educational purposes & should never be used to replace information & care rendered by your own doctor. No part of this message may be reproduced, printed, or posted elsewhere without express written authorization of Dr. Roseff or INCIID.

  3. #3
    Join Date
    Feb 2014
    Posts
    3

    Default Looking for Second Opinion - Unexplained Secondary Infertility

    Dr Roseff,

    Thank you for your quick reply. I really appreciated it. While I don't know what my actual #s were for the tests you mentioned I was told they were all well within normal ranges. Our clinic charges to make copies of our reports so before now we didn't see a need to pay for copies because this clinic was the only one in the city.

    It's standard procedure for our clinic to only monitor a cycle if you're going to do IUI or IVF. If you're doing timed intercourse they just give you a script and leave you to your own devices which I really don't like but I feel like we have no option since it was so hard to even get an ultrasound on my first clomid cycle.

    My lining on my clomid cycle was 6mm at CD10 (I took a photo of the report before I handed it over to my RE). On this cycle I had a fairly close to positive OPK on CD18 and by that evening my left ovary (the one that had the mature follicle on CD10) was giving me pains so I think I ovulated, but there was no blood work done on this specific cycle to confirm it. Also it made me really sore so it was really hard to do timed intercourse. I have had blood work done on two other cycles on CD21 (it was NOT done on 7dpo) and my progesterone has always been normal but on the lower side of normal.

    I have no idea how many follicles I made on my last femara cycle or how thick my lining was. Actually on this cycle I question whether I even ovulated because I never really got a fully positive OPK.

    We have an appointment in two weeks to discuss things with our RE but it sounds to me that you would recommend at least adding in IUI to boost our chances (that's without really knowning my full history).

    Our clinic only offers two types of IUI - one with clomid/femara, or a superovulation IUI with Gonal F and an HGC trigger shot. The fist is cheaper but we're left wondering if we should just jump to the later. I know it's only been two cycles but I'm tired of terrible side effects and not really knowing if our chances of success are increasing at all. I know the risk of mulitples is higher with the Gonal F and HGC but we're at a point now that we're willing to take that risk. It's been three and a half years.

    Our RE is apparently one of the best in the city. She's young but has won a couple awards and written lots of papers. Here major area of interest is premature ovarian failure which is why I think she jumped on that when we first saw her but changed her mind when my antral follicle count came back great. For obvious reasons I dont want to mention her name on a public forum.

    I will try and get actual test numbers when we see her in a few weeks. In fact I think I may just shell out the money to get a copy of all my reports. I'd be very interested in your opinion before we spend any more time or money on our treatment.

    Thanks
    Heidi

  4. #4
    Join Date
    Sep 2008
    Posts
    851

    Default

    Hi Heidi,
    As I said, you can feel free to email me your numbers and her name so I can check her credentials for you. I mentioned I suggest IUI for my Clomid/Femara patients, but I can't tell YOU if IUI is right or not since I don't know enough about you and you're not under my care (so it's illegal).

    If you're interested in having all records forwarded to me for a second opinion consultation (which we can do via phone or over the web), feel free to let me know. Otherwise, I wish you luck and success with your upcoming regroup visit in 2 weeks. I would love to see your numbers since I see SO many patients who were told their results were fine, but they weren't.

    Best,
    Dr. Roseff
    Dr. Roseff - South Florida Institute for Reproductive Medicine - Boca Raton, FL
    PERSONALIZED/SUCCESSFUL Specialty care....

    As you’re not my patient, information herein may be incomplete/inaccurate & I can't be responsible for your actions. This is for educational purposes & should never be used to replace information & care rendered by your own doctor. No part of this message may be reproduced, printed, or posted elsewhere without express written authorization of Dr. Roseff or INCIID.

  5. #5
    Join Date
    Feb 2014
    Posts
    3

    Default

    Thank you so much!! We would actually love to have an over the phone or virtual consult. I've contacted my clinic and I will be getting a copy of my file when we go in on the 12th. Once I have them I can send them to you. Thanks so much.

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