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David vs. Goliath

Today’s pregnancy test read STILL NOT PREGNANT, O PATHETIC ONE. Whatevs. Today I’m in a slightly more positive state where I’m looking forward to having my belly sliced open moving on to something that will give me a better shot. This is a temporary state, I know. I’ll be curled up in a ball in the closet weeping with despair in a few days…but I’ll also be extremely drunk. So there’s that.

Today I’m contemplating the question of whether to get a second opinion before IVF. Or maybe even before the surgery. There are two clinics in my area. Let’s call my current clinic David. David sees about 100 patients a year, right at that too small cutoff. David has an affiliation agreement with Mediocre Institution, which means I get a 30% discount on IVF. As a self-payer, this factor is not insignificant. David is across the street from my office and I walk past it every day on my way to work. Extremely convenient–as a lazy person, this factor is also significant since I hear tell IVF involves a lot of appointments. David’s rate for number of cycles resulting in pregnancy varies between 58% and 48%, and the average my RE cites is 50%. David has no shared risk program, but it’s not clear that shared risk is the right choice for people like us with (as far as we know) healthy gametes. I like my RE despite his sometimes weird manner. I trust him because his logic has always made sense to me. He’s an experienced surgeon and a researcher, which I find comforting. He says David has excellent embryologists, and I don’t think he’s lying. He encouraged me to check out other clinics, so I feel he’s being truthful.

Let’s call the other clinic Goliath. Goliath has about 300 patients a year. Goliath’s rate for number of cycles resulting in pregnancy varies between 44% and 49%, so 46% is probably a good estimate. There are no real differences between the clinics in terms of patient profile (male factor, female factor, etc.) Goliath is walking distance from my office, so not necessarily a problem for a one-car family, but would definitely add an extra half hour to any appointment. I’d pay full price at Goliath, though they do have a shared risk program. Goliath has a habit of stealing embryologists from David by paying them more than David can afford to, according to my RE, so it probably has good people.

David’s comfortable–the staff and the building feel familiar and reassuring (in a totally depressing way) now. I don’t want to switch clinics. I’m so lazy I don’t even want to investigate my other option. So I need a reality check.

My first question: is it unwise to do IVF with David before even meeting with someone at Goliath? I’d likely have time to set up a consult while recovering from the myomectomy. But here’s my second question: is it unwise to go ahead with a surgery before getting a second opinion? And here’s my third question: are there factors I’m not even thinking about? Any opinions would be appreciated.

6 Comments Post a comment
  1. JB #

    I don't think it's unwise to go ahead and plan for an IVF cycle with "David" if you are comfortable with the clinic and their success rates. Gut feeling and comfort counts for a lot. I also don't think it's silly to seek a second opinion. For my last IVF cycle, because it was "balls to the wall" time, I set up an appointment with another local RE who has great success rates and is a super nice guy….whose lab doesn't work with my insurance company. We would have gone from a ~70% covered cycle (not including drugs) to a $25k bill, which we knew we couldn't afford. But he reviewed my previous cycles and gave his opinion, which turned out to be basically the same as the RE I am still seeing. Once he confirmed he would set up my last cycle exactly the same way, with the same protocol, I had peace of mind that I could stay put and not worry over the "what ifs."So, if you can squeeze in an appointment with "Goliath" just to get another point of view, it's not overkill. However, since you trust "David," I don't think it's unreasonable to move forward and save the second opinion for later, on an "as-needed" basis. There is such a thing as information overload.Once last consideration: what is the cost comparison between a discounted "David" cycle versus the shared risk cost at "Goliath"? If you had the option of multiple cycles plus FETs for a similar cost as 1-2 cycles with "David," that might be worth considering. So, I don't think I helped at all here; the answer to your question — "David" versus "Goliath"? — is: yes.

    February 18, 2010
  2. I think you should get the second opinion just for the sake of seeing if Goliath's take is the same as/similar to David's. RE's expect that you will "step out", so to speak, and I also take it as a good sign that your doc even encouraged it. The money issue…ah, the money issue:( Between my IUI and my IVF we switched clinics. Not because we were unhappy with our first RE but because the second clinic had much higher success rates. Also, much higher fees. My situation is very different from yours but, looking back, I realize we would have had the same IVF result had we stayed where we were (and RE2 even looked at RE1's protocol for IUI and said: he did exactly what I would have done). Still, though, it's worth hearing someone else's take on it. If you can get in for a consultation before the myomectomy, why not? At the same time, it sounds like the myomectomy is so clearly the right next step and it's therefore very doubtful that Goliath would advise you differently. And if you do see G after the surgery, then he will be able to assess the post-op "terrain" (rather than merely hypothetically). Sorry – just mumbled out of both sides of my mouth there.In summary: I think you should get a second opinion at some point. But I also think it sounds like you are in pretty good hands.

    February 18, 2010
  3. David sounds good. If you trust him, and feel comfortable with him, that says a lot. I like David. He's small but mighty! You can always cheat on him though, and get another opinion before the myomectomy – for peace of mind? Might be a good idea. Good luck in any case, bunny. Sorry about the test results so far. Not over yet though! Fingers in crossed position.

    February 18, 2010
  4. I vote for a thorough drop-kicking of the pregnancy test. Like, a professional football punter's drop-kick. I'm sorry about the test results, Bun. Sigh.I don't think it's unwise to stick with David. But I also see your relationship with David as more of an open marriage. Not only is swangin' it up with another office for a second opinion perfectly acceptable, it's also encouraged. I especially think a second opinion could be valuable–mostly in terms of peace of mind. Dispelling doubt is always welcome. Ultimately, I think you'll probably be in good shape with whichever clinic you go with. For me, as far as changing clinics, it would probably come down to money. As someone with ZERO coverage for treatment/meds, I am drooling over your 30% discount with David. And it looks like David's stats (though admittedly I hate the statistics part of any of this) are a teeensy bit better. The only other "uncosidered" thing I can think of also goes back to cashola. How much will a second opinion set you back? Is this money that could be squirrelled away for treatment/medication? What about your time–how much with the second opinion take? (Although I think I remember you saying that this semester is an off semester/research semester for you?)

    February 18, 2010
  5. Just my two-cents here, but seems like you are very comfortable with David and they have a good system that works for you. Plus, the discount is nothing to disregard. I wonder if a second opinion may add more stress to the situation? I know every RE has their own ideas and every Dr. does things a bit different. I just wonder if the different ideas would confuse you rather than help? Again, just my two cents…feel free to delete my comment…I won't be offended :)Sorry about the negative test – still could be too early!!!

    February 18, 2010
  6. If you're comfortable with your clinic and the care you've received so far and you trust your doctor, I wouldn't bother getting a second opinion. I mean, if the second opinion is different will you have to find a third clinic to use as a tie breaker? Also, I believe that there's more than one "right" way to approach a situation and a different opinion may not be better or worse, just different. And a 30% discount will save you tons of cash to buy cool baby stuff when you're all knocked up!

    February 19, 2010

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