Change FS just before cycle starts - Wise?

[Cuddlepie]

Let's have a poll on this...

I am currently on Day 20, in the middle of the down regulation and lucrin starts this Friday. Tam has just given me a light-bolb moment, given DH's sperm situation (DNA fragmentation came back 30 SCSA test) should I be changing FS to a Dr. Lok at SIVF who is specialized in male infertility area right before the cycle starts? Currently I am with M. Livingstone. Seems that I don't even need a referal as both FS are with SIVF...

There are a few things that Dr. Lok's opinion is very different from what FS suggested to us on this specific problem with DH's sperm DNA:
1. Ejaculate daily till EPU vs. Ejaculate daily then abstain 3 days before EPU
2. Extract sperm directly from testicle vs. not a way to go

I wonder if the FS specilized in male infertility would have more authority but I don't want to force onto my FS. I also feel that we haven't been give sufficient time to discuss this issue with my current FS, we feel rushed (hence posts all over the place from me on BB, have to consult BB medical team...). I wonder if we will get treated better by changing to Dr. Lok.

However, I also worry if this will cause some bad-blood with my current FS then? Will this be too sensitive? Will this be too late to change just before this cycle start? I just don't want to waste my time and energy to go into another cycle without getting all the ducks in line IYKWIM...

Your thoughts ladies?

[Nixon]

Hey.

I can't really advise you on when to change - I don't know what the repercussions would be between DR Lok and you and your current FS.

What I can tell you is that we were referred to Dr. Lok especially because he deals with male infertility issues and SIVF have all the onsite facilities to deal with all the sperm stuff (as apposed to having to take samples and then trasport them off site for analysis etc.)

I may have told you before - but I rate Dr. Lok very highly. He didn't muck about - we went straight to ICSI. No trial and error trying other type of AC. We are now 10 weeks & 3 days pregnant off our first cycle of AC. We also have 3 frozen day 5 blasties.

I don't know if he will treat you better than your current FS. We only met with Dr. Lok a couple of times and the rest was organised via the nurses, but I felt very comfortable knowing that he was reviewing all my BT's and scans and in the end it has all worked as planned.

I don't know if I have helped at all with your dilema. Maybe it's worth speaking to Dr. Lok and asking him if it is normal for people to change at the stage you are at? Basically, it comes down to what YOU want and what YOU feel comfortable with. YOU are the one paying them.

Good Luck.

From the SIVF pages about Dr. Lok...

Dr Lok obtained his medical degrees in Hong Kong in 1990, and completed his PhD research in feto-maternal medicine at University of Adelaide in 1994. Derek undertook his specialist training in O&G in Sydney and Adelaide, followed by subspecialist training in reproductive endocrinology and infertility (REI) in Adelaide and UK. Derek was awarded Fellowship (FRANZCOG) in 2001 and Subspecialist Certificate (CREI) in 2002.

Derek expanded his clinical experiences overseas in 2002 and 2003, mainly as a clinical fellow/lecturer at University of Sheffield, UK. During that period he also spent time in Infertility and Endoscopic Units in Oxford, London, Paris, Germany, Montreal and Seoul, with part assistance of the travelling scholarship awarded by RANZCOG.

Derek is a consultant gynaecologist at Liverpool and Westmead Hospitals, and a senior clinical lecturer at University of Sydney & UNSW, involving in undergraduate teaching, specialist and subspecialist training for advanced trainees from RPA, Westmead and Liverpool Hospitals. He also teaches at the Master of Reproductive Medicine Course at University of Sydney.

Derek's major interests are in male factor infertility, endoscopic and sterilisation reversal microsurgeries, different modalities of infertility treatments including preimplantation genetic diagnosis and miscarriage management.

Derek also performs vasectomy reversals at the Sydney IVF city clinic. The procedure used by Derek is "microsurgical vasovasostomy", which is a unique and superior technique.

[Cuddlepie]

Nic, thank you so much for coming in and post. I seriously thought about you earlier today because I know you were with Dr. Lok and had a success...

I don't mean to criticize my FS, he is actually a very nice man but maybe the male infertility part (which only just been found out) just makes Dr. Lok so much more appealing.

I have already left a mesg with him and hopefully to get an appointment asap. I even consider postpone to next month is needed, because I just want to do it when I feel completely confident.

I have already been waiting for 5 years now, one month won't make too much of a difference, and I feel that the progress I've made in the last couple of weeks are more than in the last 5 years. Finding out DH's condition is a breakthrough of our TTC journey I have to say.

I am so happy to know your progress Nic and hope you are enjoying the pregnancy, your mood said 'stressed' I hope you are ok...

[Bel]

Cuddlepie, I was in a similar situation to you. Had done a few TF'ers with one FS at my clinic and just wasn't getting results. Then we were told about this amazing FS at the same clinic, who was achieving great results. While we didn't have any specific hurdles such as your DH's sperm results that have come back, we just felt we weren't getting the right treatment for us.

So we changed to the new FS and there was absolutely no problem at all with changing. No-one was upset or said it was the wrong thing to do. I was anxious about doing the "wrong thing" by our old FS too, but i the long run, I knew we would get better results with our new FS, so I knew we had to do what was right for us.

This was the best decision we have made on our TTC journey so far. We have even now changed clinics to follow our new FS.

In the end, the decision is completely yours. I would say though, to go with who you think is the best FS for yours and DH's situation.

I have no feelings of doing wrong by anyone in regards to changing FS and clinics. In the end we want all want a family and have to do what is right for us.

Hope I have helped a little. You and DH certainly have come a long way in the last couple of weeks. I look forward to sharing your journey with you.

Hugs Bel

[Cuddlepie]

Sweet Bel, thank you so much to share your story hun!

I have to say that at the back of my mind I have been having a little bit of doubts...which I believe in this tough journey, you need to have full confidence in the your FS. So the recent findings is just one last thing tip the scale I guess...I am still very grateful what he has done for us so far (including the fact that I know I can get pregnant), but maybe its time to move on...like you said, the end goal is we just want to have our family that all...

Hope that changing and switching is just their normal practice and no one takes too personal in that regard. I will let you know how I go.

Good luck with tomorrow's transfer , Bub is going to board on mothership now Do you know the time yet? I will be thinking of you hun!

[Bel]

I'd say if you are having any doubts then you probably know what you need to do. You never want to look back and have any "what if's". You and DH will do what is right for you both. I hope you get the appointment really soon and then hopefully everything will just fall into place. Will be thinking of you.

TF at 9.30...I love the mothership comment. That is TOO cute!!!

Big hugs Bel

[Sara69]

Hi Cuddlepie,

Can't really add anything to what Bel and Nic said, agree fully that you don't want to look back with regrets. Also think that since you now have found out about a problem it makes sense to change over to a FS who is a specialist in that area. Also agree that one moth doesn't really make a difference in the scheme of things, you just need to find a way you're comfortable with. I can't see your FS taking objection, he is most certainly professional enough to see that you just need to do the right thing for yourself.

I've also heard good things about Dr Lok, my girlfriend went to him last year and got pregnant in her first cycle, her beautiful boy was born this April.

Just to make sure when you listed the options No 1 & No 2 the first one is Dr Lok? In that case he agrees with my FS who is also from SIVF, she said extracting from the testicle is an option we can try if this cycle does not work but depending on when the DNA damage happened it may not help.

Thanks for letting me know about Dr Livingstone, he was my second choice after my FS as both seem to be very qualified in PGD, now think I was lucky that he didn't have an appointment available when I wanted to start since my DP has the same problem.

[Nixon]

Forgot to add....Dr. Lok put DH on Vitamin E, Folic Acid and Vitamin C to assist with the DNA damage.

He was on it for a couple of months before we needed to supply the sample to conceive. Also, DH had to ejaculate for several days prior to giving sample for conception to ensure that the least amount of damage was done to the sperm.

As Dr. Lok explains it - there is less protection around the sperm as apposed to the egg. Although an egg can sustain a lot more damage (smoking, environmental factors) and still be viable they cannot be renewed. However, the sperm are new each time and the fresher they are the better.

As we did ICSI the sperm was hand picked by the scientist who actually does the conception part. And in that case it really does one take one.

Anyway - let me know how you get on.....I'll be really keen to know if you end up with Dr. Lok what your experience is like.

PS: Thanks for asking sweets - I just forgot to change my mood. I got to see my baby and hear it's heartbeat yesterday unexpectedly when I had my first OB appointment. I couldn't be happier. :-)

[Cuddlepie]

Bel, good luck with 930am hun...as of that minute you are considered pregnant!

Redlady, thanks for the encouragement and your g/f's story! Yes, the first option is Dr. Lok's opinion (was told this by one of his other patient but not directly to me, her DH is very much in the same situation as mine). There you go, now 2 to 1 on this. About Dr. Livingstone, I think his specialty is in PGD and immunological testing.

Nic, so glad that you get to see your bubba again, thrilled for you! Currently DH is on Menevit and his Swiss Men's Multi but didn't take Vitamin E, C or folate on top of those, was your DH taking Menevit at the same time? Did he do a second test before giving sample on EPU day?

AFM, just a little update. I couldn't get any appoinment with Dr. Lok in the city until 13 November, but now booked in next Friday 24th in Liverpool to see him. Certainly worth the travel to see him.

So the current delimma is 'to continue this cycle and current FS' or 'stop current cycle, wait till consultation and then decide if to switch to Dr. Lok and start cycle next month'. I want to give it a bit more thought today and discuss with DH tonight if canceling this cycle is the way to go (although I know the answer now already ). At least I haven't start Lucrin yet, this means I just stop the pill (which I've only been on for 2 days so far).

I have also checked that Dr. Lok will be around the time that my next cycle (late Nov/early Dec), so if I want to do one I can still fit in one before Xmas. Another thing I more inclind to wait one month is DH will be on Menevit and other means for a bit longer (would be two months or so by then). This potentially will improve his little swimmers by the time we need it.

As much as I hate to wait, this seems a lot more appealing plan to me and will help to control my anxiety down the track too...

I will update you after next Friday my sweet BB team....

[Sara69]

Hi Cuddlepie,

That all sounds like a very good plan.

Just wondering why would you want to wait until late November with starting the cycle if you change to Dr Lok?

Maybe check on that with the nurses but I think that as long as you stay on the pill and have been on the pill for the minimum time (think it's two or three weeks) you can start anytime with Lucrin - at least that's what they told me so maybe wait with stopping the pill unless you prefer to start in late November.

Nic - Also wondering do you still remember how much Vitomin E your DH was taking and was he on Menevit at the same time?

[Nixon]

Hey CP.

I reckon keep going for the next week as though you are going to start with Dr. Lok for this month. You don't have long to wait until you see him and you'd probably be kicking yourself if you get there next week and find out that you could have continued if you'd stayed on the pill. It can't hurt and originally he told me that I could be on the pill for 2 months anyway if I wanted to delay.

DH had one Sperm analysis done at IVF Australia and then because of the results our GP referred us to Dr Lok. So, he had another analysis after our first meeting with Dr. Lok and then no more after that, so I can't tell you how much difference the vitamins made. DH was only on the ones I mentioned in previous post.

Good Luck - Super excited for you and your appointment next week.
X

X

[Nixon]

Nic - Also wondering do you still remember how much Vitomin E your DH was taking and was he on Menevit at the same time?

I'll check tonight and let you know. He def. wasn't on anything else except the ones I mentioned.

500mg x folic (same as was recommended for me.)
And Ithink it was just the recommended daily dose of C & E.

[Cuddlepie]

Thanks Redlady and Nic. The pill I mentioned is Provera, suppose to take 7 days starting from D19 as a start of the downregulation, and I suppose to start Lucrin this Friday too and stop Provera on Sunday. Is this the same protocal your girls talking about?

I certainly want to continue for this cycle than wait for another agonizing month, but don't know the implications such as 'if he will take me at this stage of the cycle though'. Would it be too late to change hands after you already starting Lucrin? Another thing is - he will be away at the end of Oct and 1st week of November, this could be my EPU time. I might check this with the nurses.

One thing forgot to ask you Nic, seems that Dr. Lok is juggling between 3 clinics, are there any implications/restrictions regarding EPU or transfer timing? ie. your day happen to fall on the days that he is not in city clinic. Has that happen to you? thanks hun!

Gee, what a decision time for me! But I am excited, finally some shake-up is going to happen after 5 long years. :-)

[Nixon]

I would ring Claudia (his receptionist) and ask her of Dr. Lok has time to speak to you. You may end up getting charged something for this, but i know that he does do phone consultations. I'm sure if you explain the situation they will be accommodating. Just tell them that you are unsure of what to do.

My EPU was a Saturday. No dramas there - Dr. Lok was there for that and then my transfer was a Thursday and he was there for that too. So, I can't really answer that one, hun. Sorry

[Sara69]

Oops sorry no, talking about the contraceptive pill, no experience at all with Provera - better check with the nurses.

[hellie]

Hi,

Just wanted to add that we are with Dr Lok - reading all of the positive feedback about him makes me feel so much better! We were referred directly to him as hubby had no sperm in his semen (we have since found it was being directed into his bladder). We found him to be very professional and thorough. I have my first meeting with the fertility nurse on the 13th November.

His receptionist is really great so I would ring her - I totally stuffed up one of my appointments and went to his office instead of the ultrasound clinic down the hall - his receptionist ran over and got me an appointment, and even got me water to drink before I went in! so nice.

I also got told to put hubby on vitamin C (500m) and E (400 - 500 IU) and folate. I got him some menevit which I think has enough Vit E and folate in it, but will need to get him some extra vit C as well.

Hellie