So I had my second opinion consult with RMA yesterday. I really liked Dr. M he knew how to balance being nice and being straight forward, not everyone can do this.
So he had me go through all of of treatment so far and he asked questions about each of my IVF cycles and here is his opinion:
First he thinks we have an egg quality issue (duh) and maybe a slight sperm issue as well (my husband's last SA showed 3% morph). His big concern is the egg issue since a good egg can fix bad sperm, but if you have a bad egg it doesn't matter how much good sperm you have you'll end up with poor quality embryos. He also disagreed with all of my protocols. He thinks Lupron and BCP suppressed me too much, he thinks the increase in stims for IVF #3 was a waste (he said studies show that anything over 450 IU of FSH can't be absorbed, so you just make expensive urine), he thinks that the ratio of FSH:LH was wrong (he say you need 3:1, mine was more like 10:1), he also thinks that I may have been triggered a day too late and that I may have had post mature eggs and that caused some embryo quality issues, and he thinks Intralipids were a waste and there was no point to testing for worrying about autoimmune when we don't even know if we were transferring normal embryos.
His recommendation for treatment is antagonist protocol with estrogen priming with no BCP. He also recommended a freeze all cycle since we often have slow growing embryos. He feels that the uterus and embryo get out of sync, especially with slow growing embryos and that it is better to wait and do a frozen transfer than to transfer fresh with suboptimal conditions. He also recommended genetic testing for our embryos. He also sent a list of tests that he recommended we have done, including karyotyping, which my RE shot down the idea every time I brought it up.
It is amazing to me that two different clinics can both have great success rates and radically different approaches to IVF. Unfortunately we won't be able to afford IVF with RMA, if money was no object I would definitely consider cycling there. The program seems top notch and I think if anything was going to work after our failed cycles, it would be their approach
We did decide to move forward with donor embryos and I am really excited. My consult with FI.RM is on Monday and I should be able to get the ball rolling after that.