Dr. NiceGuy: The second opinion appointment essentially confirmed what the first RE told me; albeit in a kinder, gentler fashion. I am a poor responder. Dr. NiceGuy agreed that additional testing would be uninformative at this point, since my lack of response is likely independent of any potential autoimmunity, and clotting mutations are primarily associated with early miscarriage. He also recommends the antagonist protocol. He is more flexible with stimulation drugs, though (follistim + menopur is more expensive and requires 2 needles, vs. bravelle + menopur which can be mixed into 1 needle). He uses endometrin and crinone too, so no more horrible PIO shots (suppositories are also cheaper).
All things being equal, I would love to switch clinics to enjoy his more open philosophy and approach to patient- (rather than clinic-) centered medicine, but it would come at a hefty price. Literally. Our insurance does not work with his clinic, so we would pay ~$20K total out-of-pocket to cycle there. Ouch. At the first clinic, the RE's communication style is a little rough around the edges, but our insurance covers all but ~$2K in medical costs (add on $5-6K for drugs). For the exact same cycle. That's a pretty stark difference. How much is kindness worth?
The Plan: Take a break until January. In the meantime, schedule another follow-up with the original RE. Have a heart-to-heart with her about her bedside manner and lay out my expectations for communication going forward. Discuss what I learned from the second opinion and plan for January. We want to try one more antagonist cycle using bravelle + menopur, then endometrin or crinone. If it fails, we will be ready to move on to a donor egg cycle. We have nothing to lose, so it's push-come-to-shove time.
If it reaches this point, we can compare the costs and protocols for a donor egg cycle at both clinics and go from there. We would probably start adoption inquiries then, too, to begin preparing for home-study and placement processes if the donor cycle should fail. I am an all-angles-covered kind of girl.
My head is still spinning, so I am grateful (if a little teeth-grinding-ly anxious) for the 2-month break before the next (and last?) cycle. The IVF cycle is dead. Long live the IVF cycle.