Lap recovery and a second second opinion

Recovery continues slowly from the laparoscopy. My RE had said I would feel about 80 percent better by Monday, which unfortunately wasn't the case. I went into work, and during rounds in the psych ER, nearly passed out. I ended up first sitting on a patient's bed (a no-no, but thought I would fall if I didn't) and then crouching near the floor. I had a brief fear of contracting MRSA off of the psych ER hospital linoleum, but I didn't care at that point. I felt clammy, nauseated, lightheaded, had greyed vision, and was cold and sweaty. Chalk it up to hypotension, I think. Was a bit embarrassing to see the house staff spring into action taking my pulse and BP, offering fluid and crackers ("Look she's tremulous! Her pulse is weak and thready! See how pale she is!") Oops. Sorry, eager young physicians, I should have stayed at home one more day.

After crawling through the morning, Will picked me up and we went to see the head of the Other Great Fertility Center in NYC for what felt like our zillionth second opinion, but was actually only our second second opinion (so third?).

We'd seen this RE once in the past, before we even got married, just to get everything checked out. He remembered us and said, "It's been a while! How have you been?" Then he looked at our chart and said, "Oh, yeah. Oh." So things began on a somber note.

He seconded what the Colorado doctor had said a bit, stating "Given how things have gone, we really have to start to wonder about your health history and the impact it has had on you." We asked whether he'd seen others with my particular chemo treatment have this kind of problem, and he said that no, he hadn't, and that the literature didn't support it either, but that it was the most likely explanation for all of the chromosomal problems.

He said it was very unusual but not unheard of to have such a great response to the medications in terms of numbers of eggs and embryo quality (he called my response "textbook" and "beautiful"), but then to have such dismal results.

In fact, he described it as "puzzling." I have other words to describe it, but I'll keep them to myself.

We talked about PGD. At length. He was a big proponent. He does feel that we are in the small sample of people for whom it would offer additional benefit. He said he wasn't sure what he would do in our shoes but he thinks he would do PGD if it were him (we asked, as we know he's been down the IVF road himself in his personal life). He wouldn't say if he felt his clinic is better at PGD than our current clinic. He said they should both be pretty good at it. And he said microarray CGH is unproven. "Could be better than PGD, could be worse." He helped us interpret the data from a number of studies that we'd previously been reading as unsupportive of PGD. He pointed out some flaws in the study design of the articles and analytical methods that we hadn't appreciated before, which made the data in support of PGD appear a little more favorable overall. He also said that if we do PGD on a good number of embryos and all are abnormal, that we only have about a 30% chance of having anything turn up normal the time after that. So that was new information.

He spoke highly of Colorado and he spoke highly of our current clinic. Of course he was positive about himself as well.

Ultimately, he said "Because of your experiences and all of the reading and researching you have done, you know more about this field than most OB/GYNs and more than some reproductive specialists." And then he shook his head. He said that if we had come to him hoping for some answers, that we were out of luck, as he had none for us.

"The best I can tell you is that you are doing all the right things. Think of it this way: whatever path you choose - to stay at your clinic, to come to our clinic, or to go to Colorado - all are great choices. All are the RIGHT choice. I can't tell you if a baby will result from any of these paths, but I can tell you that they are all solid paths with no one substantially better than the others."

So no magic bullet, no identification of something that had been overlooked. I guess this shouldn't be surprising. If there is some peace to be found in this consult, it's in this RE's last statement. That we are facing multiple right choices and have done everything in our power to achieve a good outcome. Whatever happens, we've tried our very best. The rest of it is out of our hands.

This RE shook our hands as we left the consult and offered to speak to us by phone if we have any further questions. I wish I could come up with some questions that he would have the answers to.

Mo