The Second (and Third) Opinion...Sher Institute

I am going to be completely honest here. I do not trust most doctors. Yes, they have more schooling than me and know more than I do. But they are not god and they do not know everything. It doesn't mean I don't like them or respect some of them but I go into their offices knowing that they do not know it all.

I've been through two Reproductive Endocrinologist offices in the past two years and also two OBGYNs and I have pretty much gotten the same answers from all of them, which is that they don't know why I am not getting pregnant.

All the tests (for the most part) have been done on me and I have come out with no issues or abnormalities. The same goes for my husband. So what gives?

With the diagnosis of "unexplained infertility" the doctors I have seen take a "one-size fits all" approach to infertility and just move me onto the next level of treatment. It becomes a shot in the dark for them but that isn't Ok with me because this is their "specialty" and they should know more and I am not a guinea pig.

I haven't had any treatments in 6 months and have been on a break from all of it. It's been a nice break because I've had time to calm my anxiety and just be in the moment instead of always looking one month ahead.

But over the weekend I had a chance to meet three men, one in particular who really, really impressed me with his knowledge, thoughtfulness and just general empathy for infertile couples. Up to this point, I really have not felt that way about any doctor - ever!

They were the doctors at the Sher Institute for Reproductive Medicine (SIRM). The man who started the group is Dr. Geoffrey Sher and he spoke to a room full of infertile couples on Saturday about his love of reproductive medicine and all that he knows about it.

My husband is the ultimate critic when it comes to the doctors we have met thus far and even he was  impressed.

Dr. Sher's approach is that he doesn't stop at the basic tests and he doesn't take the easy way out. He was the first to open private fertility clinics in the U.S. in the early 1980's and he studied under the men who pioneered IVF. Dr. Sher is a pioneer himself and takes to treating the cause of infertility rather than the symptom.

What I learned at this seminar is that he likely knows more about reproductive medicine than most doctors anywhere. He wasn't obnoxious about his knowledge or a "know it all" but rather he showed great compassion.

He talked about issues that you wouldn't hear your everyday RE doctor talk to you about. It is beyond some of them and sometimes people don't want to expand upon what they already do and how they treat it. But the sense you get from the doctors at SIRM is that they are always thinking ahead and beyond.

They are pushed to think outside the box and they know that not everyone is the same when it comes to infertility.

Here are some of the things I gathered from the seminar:

1. The uterus has to be receptive to the embryo for implantation and pregnancy to occur. If it is not, then continued miscarriages can occur. What this means is that if the uterus and embryo are too close genetically then the body can reject it. This is where the doctors at SIRM have pioneered tests for immune issues causing infertility. The explanation below is from Dr. Sher's fertility blog, IVFAuthority, and explains these immune issues.

There are two (2) forms of immunologic implantation dysfunction. The first and by far the most common is autoimmune implantation dysfunction. This variety is usually easily and successfully remedied through treatment with heparinoids (e.g., Lovenox, Clexane), Intralipid (IL), and corticosteroids. The second variety which is often ignored or overlooked is alloimmune implantation dysfunction.

Autoimmune implantation dysfunction is by far the most common variety. It is believed to be implicated in >90% of cases of immunologic implantation dysfunction and occurs when an immunologic reaction is produced by the individual, to his/her body’s own cellular components. Aloimmune implantation dysfunction on the other hand, arises through the reaction of the uterus to an embryo that shares certain genetic (genotypic) similarities (DQa and other HLA genes)with the recipient’s uterus causing immune cells known as natural killer (NK) cells that populate the uterine lining, to start over-producing “ toxins” known as TH-1 cytokines (TNFa and Interferon gamma). Such activated NK cells (NKa+) attack the cells of the embryo’s “root system” (the trophoblast) damaging it and so compromising implantation. Alloimmune implantation dysfunction, while far less common than the autoimmune variety is considerably more complex, much more poorly understood (even by most RE’s) and far more difficult to treat successfully. It involves a reaction by an otherwise normal uterus to the intrusion of one or more embryos that through the contribution of sperm DNA share certain immunogenetic (genotypic) similarities with the recipient.

2. This issue that arises when the uterus and embryo are too close in generic makeup leads to a "natural killer cell" issue. The good news is that in most cases this issue can be resolved with medication called Intralipid.

3. There are tests that can easily be done to find the natural killers cells and to see if you are and your partner are a DQ match. The excerpt below is from Dr. Sher's blog:

For some reason, there is a tendency to consider all couples with alloimmune implantation dysfunction (who share DQa similarities) to be incapable of achieving a viable full term pregnancy. Nothing could be further from the truth.

Let me explain: Each individual has two (DQa’s), one is derived from their mother and the other from their father. The fact that many individuals carry identical DQa's (i.e. both are the same), of necessity means their parents must of necessity have had “matching” DQa’s and yet they were born healthy and normal. The reason is that it is not the “matching” DQa that matters. It is whether upon arriving in the uterus, a DQa “matching” embryo encounters activated uterine natural killer cells (NKa+). These NKa+ release large amounts of TH-1 cytokines that attack and damage the cells of the embryo’s “root system” (trophoblast).It is the extent of such trophoblastic damage that will determine whether such an embryo will immediately “die on the vine” (implantation failure) or “limp along” for some time only to be aborted a few weeks later.

4. The SIRM doesn't just accept an "unexplained" reason for you not getting pregnant. This was the biggest factor that made me get up at the seminar and make an appt to see Dr. Peters (one of the docs at the Lehigh Valley office) tomorrow (March 30). Read below for Dr. Sher's insight:

Unexplained Infertility: True Diagnosis or Cop Out?

For about 10% of all infertile couples, the cause of the infertility cannot be readily determined using conventional diagnostic methods. Such cases are often referred to as "unexplained infertility." The truth, however, is that in most such cases, this diagnosis is in fact “presumptive” because a more in-depth evaluation would have revealed a cause.

I feel very strongly that most RE doctor's are not really looking at individual patients and their needs and are just trying what they can because it may have worked for someone else. Many patients go to the Sher Institute because they have exhausted all other possibilities. They specialize in IVF but don't be deterred if you are not at the point yet, emotionally or financially.

I am going into my appt tomorrow with an open mind. This may or may not be the answer for me but at least I am following my gut to a place where I might get more answers.

Even if you are happy with your current RE - take a look at Dr. Sher's blog. It is a wealth of knowledge and insight and you can search for any topic.