Tuesday, September 9, 2014

More Questions Than Answers - yet another consult

So yesterday afternoon I had my phone consult with the great and powerful Dr. Braverman.  I guess I sorta picture him like the Wizard of Oz.  Anyway, my impression was less than stellar really.

I called on time...they put me on hold to wait for him. After 2 mins I noticed that the line had hung up. So I called back...and was then on hold for about 10 more minutes while I waited for him.  He started off by saying he was sorry he was late but was glad I had called back after hanging up. I told him I hadn't hung up at all and was disconnected, probably by his staff but I didn't say that part. He launches into some chit chat about football that was entirely uninteresting before diving in. I guess he was trying to be friendly but I was more interested in his medical opinion. 

I don't think he read much of what I had filled out in that questionnaire that took me over an hour to complete.  I have to do the recap in bullets or else I'll get confused, so here goes:

  • He said that because I had endo, then I absolutely have immune issues going on.  No matter that I already have C.  No matter that the hydro was found.
  • He said that even with PGS normal embryos, there are other things going on. Endometriosis affects the quality of the embryos and even though they look good, they' really could be bad.  I should consider having the endo removed...yet another laparoscopy at one of his specialists.
  • All the immune testing I had done before was worthless and I would need to repeat it all.
  • He couldn't even begin to recommend treatment without getting all the blood tests in. 
It was a bit of a surreal conversation after that. I told him that I've got these two normal embryos left and I'm not inclined to do another surgery any time soon. He agreed that perhaps the easier course of action was to do the immune workup, treat for issues and then use the existing embryos.

I wanted to talk about the hydro and my surgery.  When I told him the HSG revealed a hydro, he said it could have been a false positive (superficial I think were the words he used) and a hydro should have shown up in an US.  To which I replied that I've already had the lap and my tubes were shot to hell and virtually "unrecognizable." No tubal issues were ever noticeable on any of my 100s of ultrasounds in the past year.  He skimmed right over this HUGE glaring issue in my background. One that the entire RE and OB community supports - that hydrosalpinx, especially billateral ones, significantly decrease your pregnancy chances - the quote is 50% success reduction. This is where I call BS if he's giving no weight to a huge, researched, documented fertility issue.

Now I've done the math (which I'll post about later) and accounting for the hydro and the PGS normal embryo, over the course of the last 5 transfers, there was still an 80% chance that at least 1 embryo would stick.   But we ended up in the 20%, so there could be something else going on of course which is why I kept the consult but to completely dismiss the hydro was whacky to me.  

I'm not sure what I expected him to say, after all reproductive immunology is his bread and butter.  So of course he's inclined to say that's the issue.  It just made him feel unbelievable to me to gloss over and not address a documented anatomical issue agreed upon by the greater medical community. 

What was also annoying was that doctors talk in hypotheticals all the time and he could absolutely have given me a preview of the immune treatments he uses. It's not like there's that many out there and even Dr. Peters from SIRM told me the course of action he'd follow if any markers came up.  Again, I didn't get a good feeling from Dr. Braverman because of this. While part of me wanted to believe that he would be objective, I didn't get that feeling at all and was really in it to take my money, test me for everything under the sun and then charge a boat load for it.

Also, we didn't really have time to go over it in the short phone call, but I'm not sure how he'd explain the fact that I conceived before via IVF with a documented case of stage 4 endo.  Aside from steroids, baby aspirin and folgard...nothing else was added to my successful protocol. These simple things I have already been using in all my subsequent FETs and IVFs so, I'm really not sure how he'd be able to explain how my endo is absolutely the thing that's causing our failures.  Besides, as E pointed out - any doctor that is THAT sure of himself without doing a comprehensive exam on the patient and of their past medical records might be a little too cocky.  

The kicker was my email from the finance lady.  Get this...
  •  When you register as a management patient, they process one fee of $3,000 for the entire first phase of care.  This will include ordering specific immune testing, completing our analysis and interpretative reports on your immune test results, having a complete consultation where Dr Braverman will discuss your testing, medical history, make a correct diagnosis and finally, design your immune protocol. 
  • In the event your testing indicate there are no immune findings, you will receive a credit for $2,000.  You will only be charge for the service that are rendered.  
I really wonder how often this happens. Even fertile women have immune markers that's why the field is so controversial.  I think they just put this in there to make you feel better about spending so much money.  So I guess I got what I paid for...nothing for nothing.

Disclaimer:  I am sure that Dr. Braverman has helped many women, he's just not the right doc for me. 


  1. WOW I can see why you'd have little confidence in that doctor, there seem to be some holes in the logic there. Why wouldn't they have taken out any endo that they could during your recent surgery? I can't imagine why they wouldn't take care of that while they were in there.

  2. Hey Melissa - I still need to have my follow up with my OB to find out exactly how much cutting he did. But before surgery, I specifically told him I wanted as little cutting as possible because it's not likely going to improve my fertility any further. Lots of research about whether or not excision surgery really helps improve IVF. It could help you achieve a natural pregnancy, but with non functioning tubes, that isn't going to happen for me anyway. So I asked him not to touch my cysts or any other endo in there.

  3. I do understand what you mean. My current FS who I do really like never reads my notes so he is always catching up during the session whereas I feel like he needs to be more on top of. And, because he is also very much immune he focuses on that as being the only thing that needs to be treated where before we even get to that I think we need to look at my extremely poor response :( I would definitely if I had two gorgeous HEALTHY embies sitting there continue as is after your current op and then if that doesn't work see what happens next. It is just so annoying to be doing this all the damn time. I am realieved to see more TTC2 getting third opinions though even after the first ones worked.

  4. Hi there. I stumbled upon your blog today and found this entry... and I felt that I had to chime in. I wrote about my phone consult with Dr. B here: http://binkymoongee.wordpress.com/2014/07/08/tearful/
    I also felt that he did NOT read the history AT ALL.... that took forever to fill out. I felt that he made a decision about my case really quickly. I don't know if it's because he's been doing it so long that he is so sure of women like me and our condition... But I was left more confused than ever with one more piece of information: to get rid of my endo (that may or may not be there) and do the immune testing. I read your post and felt similar sentiment.... I chose not to go that route and just went ahead with my next IVF cycle. Anyways, just thought I'd share. :)

  5. Thank you so much for your comment! I found your blog the other day too. He suggested the exact same thing to me - get rid of endo and then treat with immune protocol. I think that's actually his standard protocol because I know he suggested that exact same thing to another friend as well. I guess we go to these out of town docs thinking they're really looking at us as different people, different circumstances etc. but in the end, we're just their standard patient. I was happy to read that your next cycle was your best response yet. Looking forward to following along for your next banking cycle.