List of questions for my physician DE consult (long)

(14 posts)(3 voices)
  1. I'm starting my physician consults for DE this week and I'd love everyone's input on the list I've put together. If you have suggestions for other questions you asked or wish you had asked your RE before getting started, fire away!

    Some of the questions are clearly specific to my situation, but I thought the rest could be helpful to others.

    Questions for my DE consult:

    What testing to you require prior to being cleared for a cycle?

    Does any of that have to be done at your center or can it be done at home?

    How long are tests good for?

    I just had a d&c – is a saline hysterosonogram sufficient to check the uterus for problems, or do you prefer another test?

    Do I have to do a mock cycle or can I use the results from the FET just completed? Would you use my same FET protocol?

    Do I need to come to your center prior to the cycle for any other reason?

    Assuming I have all of the above completed, is there anything else I need to be medically cleared for starting a cycle?

    Considering my medical history, what do you feel my chances of success are? What makes me different (or not) from other patients you treat? Does using frozen donor sperm change anything? What are your current overall 'take home baby' stats? Why have your stats have improved (or not) over the past few years? Why are your stats so much better than the typical center? (or why are your stats not as good as the reputedly top centers?)

    During the cycle, can I use my OB-GYN to do the lining checks/bloodwork?

    When would I need to be at the center for the cycle (before retrieval?), considering I am using frozen donor sperm?

    Using your in-house donor pool, what are the typical number of eggs retrieved (or hoped for)? Is a previous retrieval predictive of future response rate to stims?

    What happens if a donor is not responding well during the cycle? At what point do you cancel? Do I get any notice or can I be involved in that decision-making?

    If a donor produces a much lower than expected number of eggs, how is that handled?

    What is your criteria for using ICSI?

    At what point are embryos transferred (day 3, day 5, etc)? One size fits all or based on other criteria?

    How many embryos do you typically transfer? How is that decision made? Do you ever do or recommend eSET? What is your rate of twin pregnancy with DE? What is your rate of HOM with DE?

    What type of progesterone and estrogen support do you use post transfer? What kind of monitoring do you do? When do you typically wean patients from both?

    How do you freeze embryos (vitrification or?). How strict are your freezing criteria? What percent of embryos are frozen? How many do you freeze per straw?

    What are your survival rates post thaw? What are your current FET success rates? Why have they changed (or not) over the past few years?

    Prior to an FET, what additional testing would I need to do? How long after a failed DE-IVF attempt would I have to wait to do an FET attempt?

    How often do women need to do a second DE cycle to achieve pregnancy (take home baby) (meaning, how often does an entire DE cycle fail combining fresh and FET?) Is there a typical patient that falls into that category?

  2. Kate - your list is pretty thorough, here are just a few others.

    Do you have a success guarantee plan - not sure you are considering that or not.

    If so, what are the requirements for qualifying.

    If so, is success based on HB, pregnancy reaching X weeks, or live baby?

    What is cost of FET, if needed?

    Do you take patients comments / suggestions into consideration when discussing prototcol, etc.

    For you I would ask - are you doing more than one consult, or have you decided on a clinic and are doing your consult before starting?

    Wishing you the best!

    Anna

  3. Kate your list is very thorough

    As Anna mentioned, ask about the success based plans as they may end up costing you less

    also, just my 2c, but we would only use a proven donor who had cycled several times. this takes a lot of the potential risks out of the equation if she doesn't pass the genetic tests, fda tests, doesnt show up, doesnt follow the instructions, doesn't respond well to the meds, messes up the trigger shot...there's a lot of stuff that can go wrong and with an experienced donor you really increase your chances of success

    gl w the consults and let us know how they go. who are you going to consult w btw, any of the big DE clinics on the west coast on your list?

  4. Anna, Mairead - thanks for the additional questions. You've brought up another reason why a proven donor is so valuable. I tend to forget how complicated it is doing an IVF cycle (after three IVFs and 1 FET), and wouldn't it suck if I got the airhead donor in the bunch...

    I have phone consults scheduled with ORM and SDFC. I'm also going to talk to my local RE in NY, although I think it is unlikely that I'll cycle there given the differences in success rates. I'd rather just put all my eggs in one very successful basket and take it from there. I still need to talk with the in-house donor coordinators at both places to see how that works and make a decision if I want to stay in-house or go with an agency (I'm leaning to staying in-house).

  5. Kate -

    As an FYI - we cycled at SDFC and I was very happy with them.

    We cycled locally in GA with a proven agency donor with BFN, changed to SDFC with a first time donor BFP with a FET and have 8 frosties still. Proven is nice, but doesn't guarantee success - there are things you can learn from a donor being proven, but that doesn't mean she will cycle the same from one cycle to the next.

    I found the in house donor route at SDFC much easier than our first clinic and proven agency donor.

    Both routes can be good possibilities - just sharing our experiences. If you want to chat off-line, please feel free to send a PM.

    Best -

    A

  6. Kate - did you look at CNY or IVF NJ? both have good success rates, big inhouse pools, short wait times and are reasonably priced with success guarantee packages...plus you wouldn't have to travel.

    we used an agency donor but it's a nightmare in terms of logistics and all the info you have to sift through. the biggest downside vs going in house is that you never get a full set of medical records post ER. since technically the embys are the property of the IP(s) vs the clinic/donor, you only get to know how she stimmed and how many eggs were retrieved. sometimes the donors have more info but it's hard to verify. this was important to us because twins were born after both of the last cycles for our donor, but we tx'd two grade A embys and only ended up with a singleton. if we'd known how many had been tx'd on the prior cycles we may have tx'd 3 as we would have loved twins...all things considered, i do think that going w an inhouse donor is a much easier route. especially if she's proven and has worked w the clinic before, they'll know exactly what to expect of her.

    GL, this is exciting that you're making so much progress!!

  7. ah, yes, I'm going to call IVF NJ. Does anyone know if they let you browse their donor pool or do they match you like Cornell does? CNY, probably not - mostly because their FET stats are really crummy. I have some insurance coverage for this one attempt so I'm trying to maximize my chances with one cycle (+FETs) and one batch of eggs.

    Anna, it's nice to know you had success with SDFC and have frosties to spare. That must be great.

    Thanks to you both - nice to know people who have been there, done that.

  8. i'm pretty sure that NJ IVF does let you browse their pool, i only did a phone consult w them but i remember that their coordinator was terrific. she used to work at Cornell on the DE program and moved to NJ after she got married so started working there. she was super responsive and very smart & friendly.

    btw, another benefit of inhouse is that you do the traveling. there are so few agency donors in nyc that we had to fly ours in and she needed to go back midway for an exam which was ok but expensive, the total travel, hotel, per diems etc added another $5k to our cycle.

    Anna was a great resource for me when i started!

  9. I contemplated IVF NJ when cycling, but crossed them off the list fairly early. I had made a spreadsheet and just went back and verified why - which were two reasons. At least at the time they didn't show adult pics and they didn't offer success guarantee. Since we were getting ready to do a 2nd cycle, all out of pocket, and I was much more informed at this point, I made a list of questions and sent it out to about 10 clinics I was considering.

    We were adamant about adult pics and success guarantee - and although there were some great clinics we liked, they were an automatic no if they didn't offer those two things.

    CNY has an in house donor pool and you can browse the donors online and they do have success guarantee. We opted for SDFC based on the current donor pool and their stats were significantly higher at the time. We had said if we didn't have luck at SDFC we would take our refund and probably cycle there.

    Mairead - how have you been feeling? I can hardly believe that 20 weeks is just around the corner for me. Time is going by pretty quickly and I can't wait for these little ones to get here.

    Hugs -

    A

  10. Kate - how are the consults going? have you been able to narrow down your search at all?

  11. Hey mairead, thanks for checking in.

    The consults went well. I spoke with Dr. Kettle at SDFC and Dr. Bankowski at ORM. Good conversations with both and I felt quite comfortable with both of them. I haven't called NJ IVF yet - I really should, but I have a feeling that I'll go with either SDFC or ORM. I like the donors in both of their databases (I found at least three in each off the bat) and I'd rather start with best success rates for this try. If I don't have success with these guys, then I'll explore cheaper options like donor embryo or maybe international DE (or adoption, which I'm starting to research now).

    Because I recently did an FET, I don't have to do a mock cycle with either. So I'm just waiting for my period to come - which will probably be near the end of February. Then I have to have a saline sonogram (because of my recent d&c) and make sure I'm up to date on all other bloodwork - and then I'm cleared. And can match with an available donor. I know that that could take a few months given timing of availability and the extra stuff I want to include in the contract (about some level of openness), so I'm hoping that I'll be able to cycle some time over the summer.

    The one down side to ORM is they do require you to come in for a pre-cycle visit. It's kind of stupid in my opinion, but I couldn't get Dr. B to relent (they used to waive it for some women, but have stopped because they find that the cycles don't go as smoothly). Oh well - I'll just do a really fast trip there and back.

  12. nice work. i think you are so smart to travel to a clinic with the best success rates, even if it's on the other side of the country. and how awesome that they each have more than one donor you'd be interested in, sweet!

    maybe you can send Dr B a follow up email to convince him that you're a mature, responsible individual who has done this before and can take directions well? if that fails, it's really not that hard to travel cross country. i've an office in LA and i'm out there once a week, there are lots of flights so the cost isn't too bad and you can do it in a full day - leave at 6am, get in around 9am, meetings all day, then try to get the 4pm or else it's the redeye.

    are both clinics ok w you negotiating a contract w the donor? i know some clinics prefer that the relationship is totally anonymous.

  13. maybe you can send Dr B a follow up email to convince him that you're a mature, responsible individual who has done this before and can take directions well? if that fails, it's really not that hard to travel cross country. i've an office in LA and i'm out there once a week, there are lots of flights so the cost isn't too bad and you can do it in a full day - leave at 6am, get in around 9am, meetings all day, then try to get the 4pm or else it's the redeye. are both clinics ok w you negotiating a contract w the donor? i know some clinics prefer that the relationship is totally anonymous.

    Ah, tried that! I sent a whole long email, even threw in that I'm an RN and used to complicated medication regimens and patient teaching, but he wouldn't bite... Ah well, it isn't the end of the world (what's another thousand here or there, right?). I'm impressed if you did it in one day - I was looking at doing an overnight, but I like your style - just power through.

    One thing that surprises me is It looks like ORM charges a lot more than SDFC - I need to sit down and compare the two rate sheets more closely...

    Both clinics seem open to negotiating a separate contract with the donor. I would have to hire my own lawyer (they can recommend ones that they have used) and it will add some time onto the process - a month or so most likely. But they both say that other IPs have done similar arrangements, so I'm not blazing new trails on this one.

  14. bugger, oh well, you can do it in a day if you need to for work etc. plus the west coast is so lovely you may enjoy a stay over.

    take a look at that spreadsheet i sent you that details the costs, there are lots of random little charges that sneak up on you like extra for anesthesia, meds, insurance for donor, legal for donor, legal for you, storage of embys, freezing of embys, icsi, assisted hatching that kind of thing, FETs, so you know for sure that the costs are fully comparable.

    is ORM offering any kind of guarantee to warrant the higher price? sometimes a DE clinic will do free FETs with frosties but they charge more up front.

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