Dr. Braverman Recommends?

I have received so many messages and e-mails asking about Dr. Braveman’s recommendations with regards to supplements, restricted blood flow to the uterus, how he treats low morphology, and etc.  I am surprised at how many inquiries there have been when we only saw him just last week. And we only lost our baby 3 weeks ago.

I know firsthand that as infertility piles up, so does the fear and desperation.  I also understand that many of you are suffering and worried and are searching for answers.   I am also searching for these answers.  I am also suffering.   I just lost a chromosomally normal baby and I am worrying that I will never have a child of my own.   That is why we sought out Dr. Braverman and are depleting our funds (he is 100% out of pocket for us) and hoping beyond hope that we will finally get some answers.

I encourage each and every one of you to contact Dr. Braverman or a similar doctor (I have listed a few below) and have a plan tailored to your individual needs.    Our plan (which isn’t even fully formed yet, as we just completed the immunology testing today, and our follow-up appointment is scheduled for late September) from Dr. Braverman is targeted to our specific set of issues.   I am not a doctor.  I don’t feel qualified to tell people what to do with regards to reproductive immunology and the sheer amount of inquires are really stressing me out.

Here is a list of reproductive immunologists, with one on each coast, and one in the middle.  If you suspect you have immune issues or issues outside what a normal RE will treat, I hope you will seek out answers too:

Dr Braverman, NY – (516) 584-8712

Dr. Kwak Kim, Chicago – (847) 578-3233

The Alan E. Beer Center, CA – (408) 365-9500

The Issues

We met with Dr. Braverman last week.  We initially had an appointment 6 weeks from the day we called, however a cancelled appointment opened up.  It was a long day, 7 hours door to door, and there was a lot of information to process.

To  sum it up, we have a lot of issues, and we are testing for a few more:

1.  My husbands 0-1% morphology could be a significant contributor to why we lose so many embryos on day 5 and 6.   He is going to do a sperm DNA fragmentation test, and if the numbers are bad, he will start various medicines.  He will do supplements either way.

2.  My clinic suggested a possible reason for the miscarriage was a “an energy issue at the  cellular/mitochondrial level.”  I honestly feel this is their generic answer when there is a failure with a CCS tested embryo. However,  Dr. Braverman did not rule this out, but did say it’s hard to diagnose.  I am going to be taking new supplements to improve this along with CO-Q10.  This could also be a significant contributor to why we have gotten so few quality embryos during our IVF cycles.

3. A doppler test indicated restricted blood flow to my uterus.  A very important piece of (treatable) information to know prior to transfer, no?  I questioned my current RE about it and she said they are “planning to start this testing in the next few months.”    Mind you, this is testing that is part of the normal CCRM workup.

4. During my pregnancy, my lovenox dosage was too low, as indicated by my anti-Xa test.  This may have been caught too late.    Clotting factors at play.

5.  I could have immune issues, natural killer cells, etc.   I am having the bloodwork for this next week.

6.  My husband and I could have HLA matches, i.e. our genetic makeup could be too similar, and  therefore my body is rejecting our babies.  We are also having bloodwork to test this next week.  I honestly don’t think this is our problem.  I think our problems are 1-4, with a dash of #5.

So there it is.   We both liked Dr. Braverman.  He was very knowledgeable, yet personable.  He offered us cost saving options, and ruled out a lot of different repeat testing.  Having said that, his hourly rate is insanely expensive.  Vomit in your mouth, expensive.  Our test results should be back in mid-September, and we will be meeting with him again shortly there after.  We are not even thinking about another transfer.  Our first goal is to improve upon the above issues, so that in December, we can cycle again (probably at our current clinic with some rogue input from Dr. B) with better results.

Also, my beta HCG level is back to zero.   It took me 17 months at my infertility clinic to get pregnant, and only 2 weeks to get unpregnant.

What next?

I have to cycle again. Perhaps twice. If you are familiar with this blog, you know that my body hates stims and we create very few, if any, blasts. The thought of cycling again fills me with such sadness and stress. But I will cycle again. The question is (was), where? We are currently at one of the best clinics in the country: RMA of NJ. However, we did consider doing our next cycle at CCRM, which is, in my opinion, only a marginally better clinic. The biggest pro for CCRM is that unlike RMA of NJ, they will take my husbands morphology issues seriously. RMA has continually brushed off his problem as something that could be fixed by ICSI. I think we can safely say that ICSI did not solve our main infertility issue. CCRM will perform IMSI, as well as run DNA fragmentation tests on his sperm. RMA refuses to/cannot do these things. Having said that, the biggest con with CCRM is a deal breaker for us: if you do not meet their quantity requirements with blasts, you have no say in the type of genetic testing they perform. We will not move forward without 24 chromosome PGD, so CCRM is out. There are other pros and cons for both clinics, but the deal breaker is really all that matters.

Edited to add: There is some confusion as to whether CCRM will allow you to push to blast and do CCS testing if you only have 1-3 embryos. Just today they seem to have reversed their position, but it appears to go on a case by case basis.

Edited again:  Correct me if I am wrong, but CCRM will not allow you to gender select.  They can also no longer use human growth hormone during stim cycles.  These are very big cons against CCRM.

We have made an appointment with Dr. Braverman in New York. While I know some people do not believe in reproductive immunology, I have witnessed multiple friends find pregnancy success after dealing with immunology issues. Moreover, Dr. Braverman takes morphology issues seriously. He will test my husbands sperm DNA. He will offer him a treatment plan and put him on supplements, etc. And this will hopefully, finally, yield us just a few more blasts. I am not greedy, I will take 2-3. We aren’t reaching high here. Dr. Braverman will also manage my clotting factors (alongside my hematologist), as needed for pregnancy. And of course, there will be additional immune testing, on both of us. To be honest, I am hoping that Dr. Braverman takes enough of an interest in our case that he will also manage our IVF cycle remotely.

Unfortunately Dr. B is out of network and his services will be 100% out of pocket. After 17 months of infertility treatments, this is quite an expensive pill to swallow. In fact, over the next 4 months, the amount of money we will have to spend on infertility treatments (again), is overwhelming. Besides the out of pocket costs at Dr. Braverman, estimated at $3-5,000 with testing (pre pregnancy), there is the CCS testing costs at RMA, $4,500-7000, plus costs of meds and various cycle expenses, $10,000-30,000. Insane amounts of money. It makes me sick to my stomach.

To those of you that asked, I chose the D&C specifically because I wanted to send everything from the procedure to pathology. The results should be back within 2-4 weeks. We want to learn as much as we can. We could fall within the 5% margin of error with RMA’s CCS testing. It’s a long shot though. I am preparing for pathology to result in no answers.

Our 12 year wedding anniversary and my husbands birthday fall within the next 3 weeks, so we have decided to spend a long weekend in Puerto Rico. We used to do this trip often, pre-infertility treatments, and I think (hope) it can be a healing getaway for us.

It feels wrong to type these things above, because I don’t want to diminish the past 9 weeks (or 17 months really). I don’t want our little guy, and this pregnancy, to be brushed under the rug so easily. I will just ask that you do not comment that you are happy we have a plan, or that we are moving on. Please. Don’t. We are not happy. We do not have a plan. And moving on will take a good long while.

The Week of August 6

Things here are very dark right now. I have never seen my husband cry the way he has this week. In fact, in the 20 years we have been together, I only saw him this upset one other time. I am so worried about him. I’m no picnic either, on Tuesday night I snot sobbed to the point of dry heaving and then I got a bloody nose.

It is difficult to find hope moving forward when your body miscarries a chromosomally normal embryo, after polyp removal, after treating clotting issues, and after an endometrial biopsy.

Thank you to everyone who has sent messages both here, and on various online communities. It’s humbling to know so many people were cheering for us. I hope you can forgive me for not getting back to everyone individually, but please know I am genuinely touched and honored by your kindness.

Posted in IVF