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.

A Baby or Your Money Back...Sher Institutes

I was looking through the RESOLVE website and came across a thread on the message board about the Sher Institutes For Reproductive Medicine. I wanted to pass it along to my readers  - in case you are looking for a new fertility clinic. From what I've read so far, the Sher Institutes (there are several around the country including NYC, LA, Dallas and the Lehigh Valley Area) offer more cutting edge and thorough treatments. Not a "one-size fits all" treatment like other RE's but they look at other aspects including a woman's immune system and how that could be causing  "unexplained infertility."

I looked up the office closest to me and found this description of the doctor in charge.

The office is led by Dr. Albert Peters, a board certified Reproductive Endocrinologist (Fertility Specialist). Dr. Peters has a unique approach to treatment, incorporating various eastern philosophies such as acupuncture, massage, yoga, tai chi and herbology into traditional reproductive medicine. His patients rave about his compassionate, personalized approach to treatment.

I like the way this sounds so my hubby and I will be checking out a free seminar given by the Sher Institutes'  founder Geoffrey Sher and Dr. Peters later this month!

I also found a 2003 article published on CNN.com that talked about Dr. Sher's motivations and his unique take on fertility treatments.

The best-known of Sher's innovations is what he calls the "outcome-based" plan. He guarantees that a couple will have a baby within three rounds of IVF, or he will refund as much as half the cost, depending on the woman's age (one of the major factors that affect conception). When he initiated this concept in 1995, he encountered criticism from both members and officials of the American Medical Association. The idea of basing a fee on outcome is anathema to most physicians. The standard argument: How does one know cancer will remain in remission? But in fertility science, as Sher points out, there is a clearly defined outcome: a baby. Because only 15% of patients have insurance coverage for IVF, the outcome-based plan has also provided a canny competitive edge. About 50 U.S. clinics have emulated Sher and started offering similar plans.

Sher also pioneered research linking failed pregnancies to overly thin uterine linings and found that viagra (Yes, viagra!) helped the issue.

Years ago Sher used nitroglycerine patches as a therapy for women with that problem. But in 1999 he started recommending Viagra. That opened another chapter in the drug's twisted life: Viagra was originally designed as a heart medication, but men participating in clinical trials found that it had some interesting side effects, and then Sher discovered that it could help infertile women by increasing the blood flow to the uterus and thereby thickening the lining. Sher is the doctor behind the world's first "Viagra baby," prompting jokes from Jay Leno. Sher also receives regular potshots from fellow IVF practitioners, who say he is over-hasty and irresponsible about introducing new therapies. "If they don't agree with my practices, why are they so quick to adopt them?" says Sher, unfazed.

To read the full article click here.

To Facebook or Not To Facebook...

Recently, I've started a few sentences, as I was talking to my husband that began something like this, "so I was on Facebook the other day..." They usually end with me saying that I feel like crap. And he then replies by telling me to delete my account.


Oh dreaded Facebook...you can love it and hate it. My little dog, Ruby, loves to chase her tail and run in circles. I always say that her tail is her best friend and worst enemy. She loves it and hates it at the same time.

Facebook is my tail. I love keeping up with friends and extended family...seeing their photos, etc. But I hate it for how easily I can make myself (I blame no one but me) feel like crap by reading updates of friends, etc.

That damn tail!!

I've been logging onto RESOLVE (The National Infertility Association). They have lots of discussion groups on there and I've read quite a few and so many are about Facebook and how hard it is to read all the updates of friends who are having babies. The simple answer is: stop going on Facebook! But we are all a glutton for punishment and I am no different.

So why do we subject ourselves to it? To be in the know? To have a reason to feel like crap? I don't know. I really don't.

What I do know is that these updates, for me, don't sting as much as they used to. If I give into my dark side that wants me to run away and hide whenever I hear baby news I wouldn't see the light of any day for its real beauty. You can't live your life in darkness.

When two of my friends were pregnant and I was invited to the showers I forced myself to go. Despite the cringing I felt inside and wanting to run away and cry, I went. I had to...they would be there for me and I had to be there for them. It was a pivotal moment in their lives and I am a friend first before I am "someone trying to conceive." I know, it’s quite a hurdle to jump over and it may not happen but at least you tried.

And if you need a good laugh or are just fed up with the posts of some parents, you can always take a stroll through the STFU Parents site. (As in Shut The F*ck Up). It's for parents who over share on FB. It’s funny when you see the actual parents respond and owe up to it.

http://stfuparents.tumblr.com/

You have to laugh at yourself first, before anyone else can!

Laughter is like mercy; it heals. When you can laugh at yourself, you are free.

The Birthday Blues...

I have always been super-duper excited about my birthday. I loved having a reason for my friends and family to get together. It's always been fun.

I embraced getting a year older....30 did not faze me in the least 'cause I really don't look 30 and I really feel like I am 21 :)

But moving into my 30's was stranger than I anticipated. And really you can't complain because there is always someone older than you saying "wait till your 40 - that's really rough."

Although when you hit a certain age...it’s like whatever! My 92-year old Grammy never said to me "wait till you hit 90 - it's a bitch." I just think she was so amazed to still be around!

Ok so back to my topic....the age of 35 is daunting for a woman who is trying to conceive. It's like you reached old age already and it's creepy. The more you read the more freaked out you get as you approach 35. By now your eggs are getting old and that is the age where you are high risk...yada yada yada.

On Monday I am turning 32. I picture the day ending much like the Tom Petty video above :) I don't feel excited or particularly want to celebrate unless it comes in the form of a positive pregnancy test. Yes, ladies and gents, I would now like to have a plastic stick that was peed on for my Bday. Oh how things have changed!

I know, I have three years to go before 35 but I've already been trying for almost three years so how much longer is the process going to take??? Ok, I changed my mind. I would like a crystal ball for my birthday.

But within all this madness I had to take a step back and stop getting so freaked out about being one step closer to 35. I am also one step closer to having a full head of gray hair and major wrinkles but I am not freaking out about that so I need to calm down.

So I am going to embrace the power and beauty of the goddess and revere the vulnerable sensitivity of Mother Nature. You cannot change certain things so you must embrace them and that is what I am going to do.

I have the best mom – she is always opening my eyes to new ways of thinking and viewing what is going on in my life. She gave me her Tibetan Buddhist Pop-Up Goddess Altar.

You open to the page of the goddess of your choice, recite the mantra, or enlightened speech and vividly image yourself in the form of the deity while reciting the mantra repeatedly and mediating on the deity’s divine qualities leading to purification of all aspects of your body (actions), speech (words) and mind (thoughts).

My altar is set up to the goddess Vasudhara (see photo below) who is the goddess of prosperity, fertility, abundance and happiness. I am going to mediate on that for a while and be in a moment where I enjoy my day, be thankful I am here to live another year and know that good things are ahead for me.

So if you are feeling down about your "fertility" age...connect with nature, meditate or just plain relax. I order everyone go get a massage this weekend. I am getting mine on Friday - Happy Birthday to me!