Monday, April 18, 2011

My consultation with Dr. Sher

Friday night was my consult with Dr. Sher. He called me at about 7 EST, and we talked for an hour and a half! Well, he talked. I listened and learned.

I will try to summarize this as best I can, but forgive me if I get long-winded (does that saying even work when typing?). It really felt like a year of medical school crammed into an hour and a half. He just rained his knowledge down on me, and I really probably only absorbed 10% or so, but even with that, I feel much more enlightened than I did previously.
 
In short, he thinks it is likely that I have Diminished Ovarian Reserve, or that I have difficulty responding to injectibles. And those may in fact be linked together. Also, I really realized what a tool my previous RE was.

At first I was surprised that he thought I was under responding. I mean, I had 8 mature follicles last time, right?! Well, he was baffled by several things. One, that my estradiol was so low (it was 975). It should have been over 2000. That shows that my eggs weren't very good quality. Also, he said in all of his years of doing this, he's never seen a woman get pregnant having less than 7 days of stimulation (injects). My last cycle I had 6. Basically, the longer you stim, the better quality eggs you are getting. He said that he would have expected me to have 15 or more eggs with that protocol I was on last time, not 8.

He believes that even though my FSH levels were normal the one time I had them tested a couple years ago, that my LH and FSH levels are out of whack. If that's the case, all of these medicated cycles I have done (seven in total) have been pointless. Clomid, Femara and Menopur all raise LH levels considerably. I was doomed from the start with those! (If his theory is true, that is). 

If I were his patient, he would use the agonist antagonist protocol on me, which would include:
  • Birth control pills (to lower FSH & LH)
  • Lupron (the agonist)
  • Stims + Lupron and/or Ganirelix (blocks pituitary gland from producing LH & FSH)
  • FSH (Follistim preferably) + 1/2 vial of Menopur (for some LH)
  • Continue the above until 2 follicles are greater than 18mm, and half of the others are above 10 or 15mm (I can't recall exactly what he said!)
  • 10,000 iu hCG trigger shot or double dose of Ovidrel (He was very insistent on explaining that the normal one dose of Ovidrel, 250mg, is not enough to be effective. According to Dr. Sher, it requires a double dose of Ovidrel to work).

He doesn't like the "diagnosis" of unexplained infertility. He definitely thinks there is an explanation, it's just a matter of finding it. He sent Buster and I lab work to have the following tests completed:

  • APA (antiphospholipid antibodies) Report 1.0 Expanded Panel (ACA/aCL, APhL, aB-GPI, aPE, aPS, aPA, aPG, aPl)
  • AMH (anti-mullerian hormone)
  • NK (natural killer cells) Activation w/ Intralipid & IVIg
  • Advanced Semen Report 2.0 (SDFA [Sperm DNA Fragmentation Assay] and OSA [Oxidative Stress Adduct])
  • CD3 FSH, Estradiol & LH
After I send these away and we get the results, I will have a follow-up consultation with Dr. Sher to discuss them, and what my next step should be.

I'd like the next step to be IVF with Dr. Sher, but if I go with him I'd have to spend 12 days in Vegas, and I won't have the vacation time until next year. I may be able to do it sooner if I opt for a clinic closer to home. Those decisions are still up in the air, though, until I get the test results back.  


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Some other interesting points from my consultation with Dr. Sher:
  • Dr. Sher informed me that, when taking fertility medication, women who ovulate normally and on their own are NOT at risk for multiples. Women who do not ovulate on their own are the ones with increased risk of multiples (i.e. Kate Gosselin). From what I understood of his explanation, women (like me) who ovulate on their own, their body is already accustomed to the idea of having one dominant/lead follicle. The rest fall behind. When a woman who does not ovulate properly is on fertility meds, her body does not know which follicle should be the dominant, so many lead follicles emerge. I am really tempted to call my RE and divulge this little nugget of wisdom.
  • Dr. Sher asked if I had had a post-coital test performed. I told him no, that my RE said there is differing opinions on how effective the test is. Dr. Sher responded with, "Oh, come on..." He didn't like that at all! 
  • He mentioned that, in his 27+ years in this business, he has NEVER seen a successful pregnancy in a patient who stimmed for less than 7 days. Apparently the longer you stim, the better the egg quality. My last cycle, I stimmed for 6 days. What a waste of time/money/effort/emotions!!!!






11 comments:

  1. You just blew my mind with all that info! Talk about the most knowlegeable RE in the world! You deserve some real answers, and I hope you find out in this battery of tests.

    Best of luck!!!

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  2. He made it rain on you!! Sorry - I had to go there :)

    I, also, am not a fan of "unexplained infertility" - there HAS to be a reason. I hope you find it!! <3

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  3. I am really glad to hear Dr S had some good info and new ideas for you. I am quickly learning not all REs are created equal! I have a consult w his associate here in Dallas next week. I think it should be pretty informative. What is most interesting to me is that like you, my E2 has never been very high. Although mine has been really low - only 600 at CD12. Anyway, i'll be really interested to see what else you learn from Dr S.

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  4. How interesting!!! I'm so glad you got the chance to talk to Dr. Sher. I hope you continue to follow up with his test suggestions and further consults. Definitely sounds like you're on the right path now Kara!

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  5. That is all so interesting! Especially the part about women who ovulate on their own not being at risk for multiples. Makes sense when I think about the people I know that got multiples doing IUI... I myself didn't ovulate on my own and had a cycle with 2 mature follies and another with 3. Most gals I know that ovulate on their own only get 1 dominant follie each time. Crazy!

    I'm so glad you got to at least talk to a doctor that knows what he's talking about!!! Doesn't it make you wonder how many shitty docs are out there that don't do any research, don't theorize, just go with whatever they learned in med school 20 years ago???

    I hope your tests come back great.

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  6. It's crazy how many doctors there are...and all the varying levels of expertise. I'm wondering about my own...I wish you the best of luck with this one!

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  7. Im glad you had the consult. I think your old RE was an Idiot!! Sending good vibes that you can find the right clinic or doc or get off work to go to vegas!!!

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  8. That's some really interesting information.
    Sounds like he really knows what he's talking about and is willing to get to the bottom of your infertility though which is awesome!

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  9. Wow, that is amazing!!! Dr. Sher knows what he is talking about!!!!
    I am glad you have this info, but I bet it really pisses you off about your time adn money wasted with your stupid RE!
    At least you are headed down the right path!
    And I hate the diagnosis of Unexplained too, that just means "I am not smart enough as a Dr. to have figured it out yet"

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  10. Love love love Dr. Sher - and I love your consult! This is all great info! I'm interested to hear what the results of the tests show, and what he thinks. So glad you talked with him!

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  11. Interesting stuff. I am considering seeing Sher's head RE in NYC so please keep me posted on how things are progessing and your experience with him and the practice in general. best of luck to you....

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