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.