Dr. Braverman vs. Dr. Kofinas

Hi all. I don’t post much on here; but when I do; it’s usually a long drawn out question? LOL I know this question has been asked more or less; however; here is my story:

Some of you may have remembered my post back in June. After 7 years of TTC; I did my first IVF cycle in April. 12 eggs retrieved; 6 fertilized. Transferred 3 on fresh cycle; got pregnant with twins. Lost one at 6 weeks; lost the other at 7 weeks (after seeing a HB the week before). One was too small to test; and the other one was tested; was abnormal chromosomes. Embryo grades on fresh cycle were 8 cell, 8 cell and 7 cell (some grade 1; some 1/ 2).

In October, I decided to move forward and do an FET; transferring my 3 embryos that I had left. I couldn't afford PGD; so I decided to just take the chance. Embryos were frozen at an 8 cell, 7 cell and 5 cell. The day of FET; they grew to a 12 cell (grade 1), 10 cell (grade 1/ 2) and a 6 cell (grade 2). These embryos were better quality than my fresh cycle; and yet this ended up as a chemical pregnancy.

I’m at a point where I just want to say “WTF”???? Why am I constantly making abnormal embryos from what seems perfect from the start? I also conceived naturally in 2010; that was also a loss at 7 weeks (abnormal chromosomes as well). So far, I have been pregnant 3 times; and each pregnancy (besides the chemical) was tested as abnormal. Something isn’t right. DH’s sperm is beyond perfect. He even had the DNA frag test; and came back at 8%. They want it under 20%. My AMH is I think around 1.37 and FSH fortunately was below 10; until two months ago; it reached a friggin’ 11! Otherwise, up until this point; I have been perfect on paper. That’s about as far as it goes.

Anyways I was a patient of Dr Braverman 4 years ago. 4 years ago I had elevated NK. That was pretty much my only issue at the time. At the time; he put me on Intralipids and Prednisone for 3 months; my levels became normal; but I still wasn’t’ getting pregnant; so I stopped everything.

Anyway, I called him last week. After speaking with him; he mentioned how there has been so much research on immune from 4 years ago and that I should come in for additional bloodwork. I think his prices are insane. However, I have been trying to get a hold of his finance girl for better explanations of his fees; but she is giving me the run around. She’s not returning my calls; and it’s starting to really piss me off. BUT, on the other hand; I can’t understand how this would be immune related when my embryos are abnormal. I would think that has nothing to do with immune. Do I want to spend $3K for nothing? I was also on 10mg Prednisone during both IVF and FET.

While I know Dr. Kofinas is not an RE; should I start out with him? Are there specific tests that Dr. Braverman runs that Dr. Kofinas does not? Could I have an underlying issue that only Dr. Braverman would be able to notice?

What would you do? Who would you see? What are your thoughts?

Sorry for the lengthy post………..I just feel like I have been going in circles for the past 7 years; and I’m getting tired. I have seen almost every fertility doctor on Long Island (and one in NYC). I have been a patient of many RE practices; and I really just need to move forward and I need a doctor to help me do so!

Thanks in advance for your thoughts and opinions and suggestions. This board is always beyond helpful and knowledgeable!

Dr. Braverman vs. Dr. Kofinas

Sent you an fm!

Dr. Braverman vs. Dr. Kofinas

Have you been to Dr Tortoriello at SIRM in NYC?

Re: Dr. Braverman vs. Dr. Kofinas

I think you should try SIRM. If you can travel to the city I would recommend dr. T. He treats immune issues, tries different protocols, has a great lab and takes insurance. If you don't want to do pgd you should ask for your embryos to be pushed to day 5. That will give you more info on quality although that doesn't guarantee that they are all chromosomal normal embryos.
I would recommend Dr. Kofinas over Dr. Braverman. If you don't have oon coverage you can always see his brother. Kofinas fertility takes insurance and does the same work up as the peri. But you have to travel to Brooklyn, not sure if that is doable.
I'm sorry you have been through so much.

Re: Dr. Braverman vs. Dr. Kofinas

Thanks guys!

I had a consult with Dr. T last year before I even did IVF; so he wasn't of much help at the time.

I did have a consult and have been emailing back and forth with Dr. Wang since August. At this point; he pretty much suggests PGD testing. But I have no idea how long its going to take me before I save up for another cycle. I was on a grant; and that is how I was able to move forward with that.

Dr. WAng doesnt really have any answers for me as to why this keeps happening? And does suggest next time around PGD; which I clearly can't afford.

This is why I am not sure SIRM is my answer at this point; even though I think they are both fantastic doctors.

Dr. Braverman vs. Dr. Kofinas

Oh I'm sorry to hear Sirm didn't have answers for you!

Dr. Braverman vs. Dr. Kofinas

i would call Kofinas' office and explain the situation and see if you can just get in to talk to him for a consult. he is BRILLIANT and i think he would run bloodwork to see what's going on and then go from there with you. of course you'd still have to cycle with an RE (my personal suggestion is Dr. Wang or Dr. T) but Kofinas could drive the process a little bit with whatever he finds.

Re: Dr. Braverman vs. Dr. Kofinas

My issue wasn't getting pregnant it was staying pregnant so I saw kofinas rather than an RE. I have no IF coverage at all but bc I had 3 losses they were able to code everything as repeat pregnancy loss until I got pregnant again and then it was all coded as pregnancy so insurance covered it all. If you have out of network insurance coverage they work with you on the coinsurance amounts. Kofinas was very aggressive but at the end of the day my next pregnancy was a keeper and I now have a 2 week old. Happy to talk more if you want, fm me

Re: Dr. Braverman vs. Dr. Kofinas

Everyone probably has a different cause.

With recurrent chromosomal losses, I would think immune factors is less likely.

Your age must also play a role in what possible causes are (different if you are 20s vs 40s).

Dr. Braverman vs. Dr. Kofinas

I actually had chemicals and sought the help of Kofinas who would help you get pregnant but I chose to work with him and Braverman together. Call Kofinas the man in a genius in my eyes as is Braverman! Best wishes.

Re: Dr. Braverman vs. Dr. Kofinas

I saw Dr.T about a year before I used him for real. Initially, there wasn't much different he was going to do for me. A year later, I went back for another consult and was pregnant with my son shortly after. We did IVF with PGD. I highly recommend Dr.T over his associate. Fm with any questions, but be patient with a response bc I'm not on lif much these days!

Re: Dr. Braverman vs. Dr. Kofinas

Braverman and Kofinas are both amazing!!!!

Dr. Braverman vs. Dr. Kofinas

unfortunately without PGD, it is the luck of the draw if there are no other issues. I couldn't afford so I was taking a chance on my embryos. They all seemed good on paper, growing steadily and healthy however, always got negative betas except one chemical.

I am going to Dr. T in November after being with two other RE's on LI, one that didn't help me at all, and one that helped me a lot with issues even though I am still not pregnant.

Dr. Braverman is closer but his prices are $$$$$$ and I heard D. T does the same type of immune testing but takes insurance.

Dr. Braverman vs. Dr. Kofinas

im going to go out on a limb and say if you saw dr. B and had elevated NK in the past - chances are really good that you have other issues as well. i feel like elevated NK is a symptom of other issues and not generally the ONLY issue. i would def get re-tested. and then id use both him and Kofinas. although your losses appear to be due to abnormal embryos it does seem likely that there is more going on than just that and possibly better treatment options now too.

Re: Dr. Braverman vs. Dr. Kofinas

Have you and DH been tested for genetic issues yet to see if you are carriers? I know Kofinas will run the Counsyl test as well as a thombo panel to rule out any genetic/blood clotting issue. The counsyl test I believe will be a maximum of $100 out of pocket.

Re: Dr. Braverman vs. Dr. Kofinas

Dr. Braverman vs. Dr. Kofinas

i would use B to get pregnant and move to Kofinas after 14w to stay pregnant.
sometimes inflammation damages the eggs, so controlling the immune factors and inflammation helps with embryos. i also heard good things about B's embryologist (check out their lab's features on B's site)

Dr. Braverman vs. Dr. Kofinas

I saw both Dr. Braverman and dr. Kofinas for my last pregnancy with twins. Dr. B gave me my DD and my b/g twins so I absolutely love him. I then had to see Dr. Kofinas because of complications with my son during my twin pregnancy. Dr. Kofinas saved my son's life. He wouldn't be here without dr. K. He is a genius!!!! He does things that are not the norm and that's why he has helped so many. I am forever grateful for both