Dr. S, world-famous endo surgeon, has very different opinions from my RE about my fertility. Let's evaluate what she told me in the course of my consultations:
1. "I don't think your adenomyoma will affect implantation."
Dr. S says: FALSE! Although adenomyosis, unlike endometriosis, is not considered a cause of infertility, in my case, there is so much tissue, all balled up in one place. "It definitely could be affecting implantation."
Comments: This was my perspective all along. This was why I sought out an RE in the first place, so she could take a look at my MRI, evaluate the size and location of the adenomyoma and tell me whether it would affect fertility. Instead, she never even looked at the MRI records I had sent to her. She saw the adenomyoma during my hysteroscopy, but she didn't seem to think it would be a problem. F--- her.
2. "Laparoscopy is a bad idea for you. It will aggravation your ovarian reserve issues."
Dr. S says: FALSE! This is only true for women who have very large endometriomas on both ovaries. He knows I don't have such a problem, because none of my multiple pelvic ultrasounds, MRIs, nor hysterosonogram has ever shown any evidence of endometriomas on my ovaries. "In any effort to protect a woman's ovaries, REs often prevent women from getting the treatment they need."
Comments: My RE issued a blanket recommendation apart from the specifics of my case. DOR = avoid laparoscopy like a cloud of tobacco smoke. In reviewing the literature about laparoscopy and DOR, many of the articles emphasize that preservation of the ovarian function is entirely dependent upon the skill of the surgeon, something my RE never mentioned to me. Which is why we're traveling to ____________, rather than having my surgery locally.
My RE is one of the best in the country. Although only in her 30s, she is on the editorial board of the top journal of reproductive endocrinology. She is the recipient of a prestigious NIH fellowship. In other words, she's no small potato.
And yet, she seems to be making decision by virtual of a decision tree.
Diminished Ovarian Reserve? It's hopeless. Do not get a laparoscopy. Head straight to IVF.
Adenomyoma? Never affects fertility. Don't worry about it.
The particulars of my case, my adenomyoma, my ovaries, my (possible) endometriomas, were of no interest to her.
Of course, the most devastating things she said about me, she didn't say to my face: She told my pelvic pain specialist that I have a one percent chance of spontaneous pregnancy. Even though I ovulate every single month.
But she's been wrong about so much. I'm going to bet she's wrong about this.
You go, girl! Your faith and conviction are strong, and in the face of someone who feels that her education of statistics trumps all else, you HAVE to be willing to stick to what your heart and instinct are telling you.
ReplyDeleteCongratulations on the new surgeon - someone who believes in possibility and has a passion for working on what can be. Wow. That is intense, and I am so happy for you. Many prayers, and many praises, for a new direction and options!
I know that my RE has studied statistics, but I actually don't think her education informed the 1% number. Has there been a study that has taken 100 35-year-old women with my FSH and AMH numbers and one of them got pregnant and 99 of them didn't? I don't think so. In addition, while women with my numbers often aren't ovulating, or ovulating regular, I ovulate every month. She has never been interested in any symptoms I might (or might not) have, she's only interested in the numbers. But if a woman with my numbers is ovulating only 3-4 times a year and has limited CM when she does ovulate, then of course her chances of getting pregnant are much less than mine.
ReplyDeleteIn addition, the Making Babies book says that about 10% of women with POF get pregnant without intervention. I don't have POF (sorry, I know you do). But if 10% of women with POF get pregnant, then how can my chances be 1% with DOR?
All this is to say that I think she pulled that 1% number out of her ass. And just like she was irresponsible to encourage me to pursue IVF when my adenomyoma would have caused implantation failure, she's being irresponsible throwing around "one percent chance" with very little data to support her conclusion.
Have I mentioned that I'm done with her?