Our consult w/Dr. David

Though it seems like forever ago (that's how great the Grand Geneva was), we had our phone consult with Dr. Sami David just yesterday. And since we ran off right after, I'm just now organizing our notes of all that we discussed. For background on how I came to find him, read this post. If you are not familiar with him or his book, you can check out his website, but in short he was the very first RE to perform IVF in NY, and he was spent his career since trying to help couples exhaust diagnostic options before turning to IVF.

So after multiple rescheduling on both sides, we finally sat down to talk yesterday morning. He was overall not impressed with my first RE (good start). He was very impressed that my new RE was not only concerned about my septum, but removed it. He also liked her latest regimen of low dose Follistim, IUI, and Crinone. But since I had just received my negative beta, this didn't work (at least on the first try).

We talked about everything, well all that can be talked about in an hour. I had sent my 50+ pages of medical records to him several wks ago and he had obviously reviewed them thoroughly. Plus he asked us a million questions. He is concerned about implantation failure on my side (a reason he was pleased that I had asked for a P4 test and been put on Crinone), given some of pg symptoms I've had while we've been TTC (but always getting AF on time). He also said that I should be tested after I begin Crinone again to see if it's actually getting absorbed adequately, and if not switch to another kind of P4 supplement. We also talked about why my P4 might be low. Stress suppresses P4, so we'll see what we can do about that. Also the "endorphin rush" from exercise also suppresses P4, so I need to make sure I don't get in "the zone" when I exercise, which hasn't been a problem lately. ;) Sleep deprivation can also cause low P4. He recommended taking Quietude, a homeopathic sleep aid, to help me sleep through more of the night. And also to practice relaxation exercises, which I've been very lax about doing. He was very happy that I've been doing acupuncture.

He was also concerned that I'm not getting enough vitamin D based on what's in my PNV. And while I'd love just to get sunshine therapy, he recommended taking another supplement of 1000IU.

On the SA front, he was not satisfied with the one that we had done last April. Based on the evaluation, he deduced that it was not correctly performed. Our RE had just told us to go to the local hospital's lab, but he told us to either have a new specialty lab perform one or overnight a sample to him in NY. Sending it to his lab would be sufficient because he is concerned about the shape rather than the motility, so even if they are all dead, he can still find what he is looking for. He is also concerned that the WBC count was high. This could be influenced by natural contamination (from producing the sample hours after showering at the lab instead of at home just after showering). But he said he sees so many people who are struggling to TTC, when their problem is really a low grade infection, that it really needs to be tested. He wants the SA to test for simple bacteria, urea plasma, and mycoplasma. This he would treat with antibiotics (which while they are routinely given for IVF, the tests are seldom done on anyone before IVF...)

On a similar front, he wants me to be get a cervical mucus culture for bacteria as well. So I'll be asking my RE to go in around O time when there will be plenty to test.

If none of these tests turn up anything, he suggested possibly sperm antibody testing (in case I'm allergic to S's swimmers or he is (??)). Finally he would consider doing a laproscopy before pursuing IVF.

He recommended not cycling this month, since we did last month. He thought I should give my ovaries a break and take the month to get all of our additional testing done. I have yet to talk to my RE, but since AF showed yesterday, it doesn't look like we'll be getting CD3 testing done (on Sunday) or stimming as early as we did last month. She also didn't convey what dosage she wanted me to use this month, just that it would be higher, when her nurse called with my beta results. So, I guess I might just be taking June off...

I have to say that Dr. David was even nicer and more down to earth than I even imagined from reading his book. On a related note, I have to say I tear up when REs remind me how young I am and that I have a good decade of "fertile years" left, since I don't feel this way 99% of the time. They are used to seeing women who are much older than me most of the time, I guess.

So I've decided a few things over the last few days... We probably aren't doing IVF in July/August and I'm taking some time off the boards. So if you don't see me around, I'm thinking of you, but taking some time to focus on getting my act together.