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Advances in IVF

October 2, 2007 - Tuesday
1:32 PM to (EST)
Guest Speakers: Mark Trolice M.D.

Categories
Donor Egg • Infertility • IVF • PCOS • Pregnancy • Pregnancy Loss


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Corey_Whelan Hi everyone. Welcome to tonight's chat on Current Advances in IVF. Tonight's guest speaker is Dr. Mark Trolice, of Orlando Regional Healthcare in Florida.
Corey_Whelan I'm Corey Whelan, The AFA's Director of Development and your chat moderator tonight. Dr. Trolice will be joining us shortly.
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Corey_Whelan Hi Sue!
Corey_Whelan And Valash too!
Corey_Whelan We'll be starting in about five minutes guys. btw, what states are you from?
valash Hello!!
valash WV
Corey_Whelan cool. I'm from NYC
valash Cool
valash this is the first time i have been to this chat
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valash Hello Dr.
dr_mark_trolice hello all!
valash I have a question I am getting ready to do IVF and my younger sister is gonna be our donor is the chances of success higher using her eggs
Corey_Whelan Welcome Dr. Trolice!
dr_mark_trolice how old is she?
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valash 23
valash and has a healthy little boy
dr_mark_trolice pregnancy rates with egg donation are dramatically higher when a patient has diminished ovarian aging
Corey_Whelan Welcome anon. We're just getting started. Please feel free to jump in when valash is finished
dr_mark_trolice particularly when the donor is less than age 30
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Corey_Whelan Hi Gigi
valash good so my chances are higher using a donor that is what i have read
Gigi hey Corey How r u?
Corey_Whelan great! We're lucky to have Dr. Mark Trolice with us tonight. Feel free to jump in at any time!
dr_mark_trolice valash, as long as your diagnosis appears to be ovarian aging and there are no other factors, including a normal uterus
dr_mark_trolice thank you for the welcome corey, and the honor to share information with your members
valash No I have premature ovarian failure
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Gigi how important is immunology when you are persuing IVF
dr_mark_trolice valash, for all intents and purposes, premature ovarian failure is the ultimate example of ovarian aging. namely, the ovaries do not produce eggs
valash I am a cancer survivor and that is the only problem I have my uterus is good
Corey_Whelan Better than mets! Welcome yankees.
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valash that is my only problem everything else is good from all my examines
dr_mark_trolice gigi, immunology is highly controversial and has limited application in evidence based medicine
valash exams
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dr_mark_trolice immunology has only been shown to be applicable in patients with recurrent miscarriagbe
dr_mark_trolice miscarriage, sorry! typing as fast as I can
Gigi ok, any other explination for repeated IVF failure? I am 42 w/ a day 3 fsh of 5.28
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dr_mark_trolice gjgi, age is the most important prognostic indicator with pregnancy. being 42 has about a 10-15% pregnancy rate with IVF. FSH is only valuable if it gives an abnormal result. it has not value when it is normal
dr_mark_trolice a better test for ovarian aging is antimullerian hormone
Corey_Whelan Welcome everyone!!!!! Please feel free to jump in with your questions about Current Advances in IVF.
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LucyHar Do you have any insight into the pros/cons of the new "Staggered IVF" currently being marketed by Dr. Sher?
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valash We have just recieved the Heart Scholarship from INCIID and are getting ready to be matched with a clinic and start the procedure
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dr_mark_trolice lucyhar i have no knowledge of staggered ivf unless this refers to comparative genome hybridization
BB1 I'm on BCP 17th days now for preparing fresh IVF. I've been spotting since 3 days ago, it will be problem for coming IVF? Tks.
dr_mark_trolice any experimental techniques need to be introduced into patient care after approval by an institutional review board and should not be represented as standard of care
dr_mark_trolice BB1, spotting on pill should be fine as long as the uterus is normal inside
LucyHar Yes, CGH is a big part of it. Retrieval happens 1 month; testing on both egg, then embryo; insertion the following. Do you see validity to it? I've heard mixed things.
dr_mark_trolice valash, congratulation. my non profit Fertile Dreams, http://www.FertileDreams.org gives grants to IVF patients
valash really that is such a great thing I am so excited we have been trying for 7 years now and finally get a chance
dr_mark_trolice LucyHar, CGH is not ready for clinical application outside of research studies. Chromosomal testing of embryos with PGD has yet to show definitive higher pregnancy rates
Karen is there a age limit to those scholarships
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aijia Doctor: I was on BCP for 12 days last cycle (failed), with Lupron, this cycle I am going to be on BCP for 15 days, how will longer BCP affect the stimulation? Am I going to be more surpressed?
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winette_montes I've been trying IVF for ten years with no results, and no explanation as to why the treatment did not work. Any help on that?
dr_mark_trolice Karen, i believe 35 or 37, please check the website, and the grant can be toward any program in the country. we have given $30,000 each year for the past two years
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dr_mark_trolice alifa, BCP for those days should be fine
dr_mark_trolice winette, i would recommend an endometrial biopys for integrin
dr_mark_trolice Corey, you didn't tell me i had to be a speed typist!!
Gigi lol
dr_mark_trolice ::biggrin
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winette_montes My doctor did that, everything is fine with me and with the embryos, but I'm only able to get top the 6th week.
winette_montes I recently lost the last treatment.
Corey_Whelan Speedy fingers!!!!!
BB1 I have 3 cysts from previous cycle left: 18mm, 11mm, right 13mm (10 days ago unltra sound). My Re let me ignoring it. My IVF schedule is begining around Oct.12 for injectable stim. Is it right?
dr_mark_trolice some may not know, that my wife and I went through 10 years of infertility and we nwo adopted two angels so in addition to my practice we are opening an adoption agency
Gigi So Dr what are the latest IVF Advances?
dr_mark_trolice winette, i'm so sorry but there are many reasons that I would need to review your records. i'm sorry
winette_montes I'm 41 do I have opportunity to another IVF?
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dr_mark_trolice gigi, the latest ivf advances are still experimental, namely egg freezing and CGH
shaymer01 Wow, how interesting that you have experienced this yourself. And congrads on your adoptions!
frances1 I am 45 and have attempted two IVF cycles. One I had poor response to the meds and the second I had a "perfect" cycle when it came to response, made it to egg retrieval good estradiol and follicle size but only had two follicles. Upon, egg retrieval both were empty. Since I had a hysterectomy we cannot determine the timing of my cycle, so I am put on bcp for a while to calm my ovaries. Could not being able to determine my cycle timing be an issue? I am going to try want to try one more time. Do you recommend no bcp's for down regulation? Next step will be adoption or donor egg. Also, what is a normal AMH level? What is low?
dr_mark_trolice BB1, i don't recommend stimulation with ovarian cysts above 15mm, ideally below 10 mm
Karen wow that is great i am 42 with many failed attempts at fertility now ready for adoption
pretzels I had a successful IVFwith assisted hatching cycle 3 years ago and now just failed my 6th IUI, my RE says it's time for IVF again. With my PCOS and no MF involved, why would iVF be better than IUI? Would the assisted hatching be a factor?
dr_mark_trolice <----------going to get some oxygen for a few
dr_mark_trolice whew!!
dr_mark_trolice i have an idea guys...............
Corey_Whelan Folks, let's let Dr. T catch up. I believe Frances and then Pretzels is next.
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anon101 dr trolice: aside from the merits of CGH, what can be said at this time about the effect of modern freezing techniques on the health of an embryo? please comment on the type of freezing called "vitrification" separately, as is compares to other freezing techniques
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Corey_Whelan Folks, hold back for a few secs please.
dr_mark_trolice let's do one question at a time so i can go into more detail
Corey_Whelan That's fine.
LucyHar Scientifically speaking, do you think there's any benefit to inserting an embryo on day 3 vs. day 5? Is the uterus really better than a controlled lab setting? I had 5 embryos implanted on day 3 and "got pregnant" w/ one, which then failed to develop. If embryos are destined to fail or succeed, won't that happen in either environment? Is it worth the extra 2 day's wait to avoid the disappointment and/or miscarriage or need for d&c?
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dr_mark_trolice frances1 amh should be above 0.7 empty follicle syndrome can be due to poor egg quality or hcg
Corey_Whelan Sandy, hold back for a few secs, please.
dr_mark_trolice pretzels, ivf is always a much higher preg rate than iui
dr_mark_trolice despite the prognosis
frances1 When are you opening your adoption agency? I reside in FL and would love to contact your agency. Thank you.
dr_mark_trolice anon101, vitrification is an advance freezing tech that hopes to prevent crystal damage on the embryos and better PR.
Corey_Whelan I think Lucy is next Dr. Trolice
dr_mark_trolice LucyHar, there is no difference of day 3 or day 5 but you transfer less on day 5 given the better embryo selection.
pretzels is there a condition with the zona around the egg that would necessetate assisted hatching?
frances1 What do you mean that it could be due to HCG? Given the injection at the wrong time? Please explain. Thank you very much.
dr_mark_trolice frances, please contact http://www.MyFertilityCARE.com
Corey_Whelan And Sandy, please feel free to fire away now. Thanks for your patience.
SANDY My RE did a chormosomal test on me to determine if I was born with an abnormality which would cause my eggs to be all abnormal . I don't remeber the name, i do not have results yet. Is there such a test and if it shows something worng, would all me eggs be bad?
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frances1 I will, thank you. But could you please answer if it could be due to the trigger shot being given at the wrong time, as that would give me a little more hope for my last attempt...thanks
valash Dr what was the name of your group that gave grants also so I can spread the word
dr_mark_trolice a day 3 or day 5 embryo should do just as well. day 5 has a higher implantation potential so you transfer less embryos. we will never know if a day 3 embryo that did not continue to grow in the lab until day 5 would have resulted in a pregnancy if transferred on day 3. day 5 "weeds" out lesser quality embryos, but is not a "cure all" for PR
dr_mark_trolice pretzels: AH is for age >37, thick zona, or failed IVF
dr_mark_trolice frances, poor lot of hCG medication or mixing, or timing is the usual cause outside of egg quality
Karen do you think 42 is to old for one more ivf attempt
winette_montes I'm 41 do I have an oportunity to do another IVF? Does peoplr from puerto Rico qualify for grants?
dr_mark_trolice SANDY.......Fragile X?
Gigi I hope not Karen....LOL
pretzels I had AH on my first IVF and I was 25, so I guess it was the zona issue, is that something that is wrong with every egg and I would need AH forever?
SANDY I don't know?. What is fragile x?
dr_mark_trolice Karen, we have no exclusion for age at our program as long as a patient is aware of realistic expectations. our oldest live birth with own eggs are several woman at age 43
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dr_mark_trolice pretzels, AH is lab decision, but is easy and not been show to be harmful
Karen good news thank you
winette_montes How can I contact you? Can I have an appoinmet with you?
pretzels right, but it would mean that i would always need IVF and could never rely on a natural pg or even IUI
dr_mark_trolice SANDY, fragile x is a mutation that can cause ovarian aging, premature ovarian failure, and mental retardation in it's fullest form but not as a carrier
dr_mark_trolice winette: you may visit our website or 1-866-9FERTILITY. but i don't want to advertise my practice since this is eduational opportunity for you all
winette_montes What is a realistic expectation for those who are 41 or 42 with IVF?
dr_mark_trolice pretzels, NO WAY. we can never tell a patient that she has no chance of pregnancy unless she has no ovaries and/or tubes!
Corey_Whelan Winette, you can contact me for Dr. Trolice's information after the chat. And Dr. Trolice, don't worry about advertising your wonderful practice!
dr_mark_trolice winette: above age 40 probaby 10-20% PR but continued to decline :-(
valash Dr what was the website with the group that gave grants I have a friend looking for ways to get IVF
dr_mark_trolice am i caught up? i may pass out!!
winette_montes I've been looking for information on the Internet to see what is happening with my case. Than You.
dr_mark_trolice valash: http://www.FertileDreams.org
LucyHar Regarding hCG med mixing being a potential source of egg problem - I'm confused about 2 views I've been told. One Dr. said they don't include androgens (such as Cetrotide) right at the start of IVF b/c those male hormones can "spoil" a lot of the eggs. Another Dr. said they have to give androgrens right at the start b/c they are responsible for production of estrogen which is crucial to follicle development. Help! Does a hormone "ruin" other eggs?
shaymer01 DR, I have read that BCPs should not be used if you have thin lining issues. However, my RE is going to have me take them for an upcoming donor cycle. What are your feelings on this. Also...I had scarring in the past, but had a 'clean' HSG. Is this definitive to determine that the scarring issue is resolved?
dr_mark_trolice Lucy: Citrotide blocks ovulation and is not an androgen. a low dose of male hormone may be helpful
dr_mark_trolice shaymer, thin lining is very frustrating. no great treatment but we use Viagra suppositories and low dose aspirin
dr_mark_trolice hysteroscopy is the gold standard to eval the uterus, but a normal HSG should be fine
LucyHar Sorry I meant Repronex..
dr_mark_trolice still Repronex is not an androgen but FSH/LH combo
LucyHar Can too much androgen "spoil" other eggs?
frances1 So if your follicles grow with stim meds as expected and your estradiol rises as well...the follicles should not be empty should they - unless HCG was impropertly given. If the egg quality is bad why would the estradiol rise?
shaymer01 so, bcp's not harmful?
dr_mark_trolice high androgen may impede egg quality
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pretzels sorry to beat a dead horse, but I just want to be clear... would a thick zona be something that happens to the occasional egg or is it something that I would expect to be on all of my eggs?
dr_mark_trolice frances, if all else is normal, than hCG may be the problem
Gigi Dr what are your feeling between using Lupron or Cetrotide? Is the success rate about the same?
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dr_mark_trolice petzels, it is prob egg dependent
aijia Can you tell me what you think about Saizen, I believe it is a growth hormone? Will it boost stimuation?
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SANDY Should someone with high FSH, not used BCP in IVF cycle?
dr_mark_trolice Gig, lupron is the gold standard. Cetrotide and Antagon have had slightly lower pregnancy rates
dr_mark_trolice aijia, i am not familiar with saizen, sorry
dr_mark_trolice sandy, BCP are often used but i would avoid more than 21 days
dr_mark_trolice i admire all your questions
winette_montes Do you have any knowledge about some new tratment were the sperm is somehow injected in the ovum by laser without taking the ovum out of the falopian tube?
dr_mark_trolice empower yourselves with knowledge and be in control. you are more than your fertility and will overcome this challenge!
SANDY Any thoughts on DHEA
shaymer01 TY doctor!
dr_mark_trolice winette, i 'm not familiar with that ........
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winette_montes ok thank you
dr_mark_trolice SANDY: DHEA is experimental to try to improve egg number. much too early to tell but I have tried on some patients
Leebird Hi Dr. Trolice. What kind of success rate is seen when using frozen embryos? Is it a better option to use frozen embryos that are "younger" - retreived at a younger age - then "fresh and older" embryos?
dr_mark_trolice fertility is a significant physical, emotional, and financial investment. it's good to have target goals so you have an endpoint and resolve
winette_montes It's a Japanese method, and is being trying with women over 40 with some better responses or results.
winette_montes But I was not able to find any else about it.
dr_mark_trolice Leebird: frozen is less PR than fresh. younger eggs are better than older
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Gigi Dr, what is the normal number retreived in a patient that is 42, and of that number what is the minimum percentage that s/b fertilized with ICSI?
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dr_mark_trolice Gigi, that question is hard to answer, but i'm sure less than 10 eggs, and fertilization is usually about 60%
Gigi ok, so I guess 9 retreived and 8 fertilized is pretty good at my advanced age? :0
dr_mark_trolice to all, try to confide in people that are good supporters and whom you know will be sensitive
dr_mark_trolice yes Gigi!
Gigi Ok thanks Dr
Karen good for you gigi
SANDY Is low stim better to use for a poor responder? Is it a good idea to use no supression for a poor responder ?
dr_mark_trolice btw, most couples will conceive if unexlained within 3-5 years
Gigi Yeah if I could only get pregnant...
valash sorry i keep getting logged out but before Dr. you said something about your group giving grants for IVF what was the site to look
dr_mark_trolice SANDY: that's a hot topic and this seems to be a trend but most still aggressively stim
pretzels is the pg rate for FET close to the same as IVF or does it pay to go for fresh instead of using up forzen embryos (in my case, I', 27 and don't respond so well to the meds)
Karen i am rooting for you gigi
Gigi ditto to everyone
dr_mark_trolice valash: http://www.FertileDreams.org
Corey_Whelan Valash, you can hit action and look back at the chat, if you wish to retrace your steps.
valash ok thanks
dr_mark_trolice pretzels: frozen is less than fresh but it is less costly
valash thanks Corey i was trying to figure that out lol
dr_mark_trolice all, what is the most important aspect of a fertility clinic/doctor for you?
aijia success.
cskains I am 35 and been trying for seven years with RE for a year. I'm starting an IUI cycle tonight (first pill) and then will try IVF in January. I read that the IUI is about 20% likely to work and IVF 30%, but I'm not sure if that is in general or for my doctor. If I have multiple issues does that lower my odds for example, endometriosis, thyroid, or possibly something else I don't know about yet. I'm trying to be informed but I'm finding that difficult.
Gigi The information received, I would rather know the excat numbers of the blood work / tests than get the call stating that everything is fine and we will see you in 2 days for blood and sono...
Karen the end result
dr_mark_trolice cskains, ivf rates are age dependent and 30% seems low unless you are above 35, and if so, i would consider injectable medications for iui to be more aggressive
pretzels good, friendly, availible support staff (nurses, receptionist, answering service), proactive doctor who seems sure of him/herself and not waffeling around, doctor taking time to talk and answer questions and not ushering me out of the office in 5 min
dr_mark_trolice so karen and aijia, since success is not 100%, you rate that higher than care?
pretzels I also agree with gigi, we are a very knowlegable and involved bunch and like to know EXACTLY what is going on, not that everything is "ok"
SANDY Prompt call backs and RE that is willing to tweak ;your protocol and discuss your case and take your suggestions seriously.
dr_mark_trolice i encourage you all to be proactive with your care, in all areas of medicine
Gigi I feel more relaxed when i know what is happening
pretzels i like to see the sonogram screen and not have to break my neck to catch a glimps of my eggs
dr_mark_trolice you all have very real expectations and should not accept anything less!
shaymer01 communication
dr_mark_trolice let's talk about FSH a bit..............
Karen no care is important but the end result is on top the care i had a my fertility office they were wonderful but honestly i wasnt there to make a friend to me i had a job to do
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dr_mark_trolice FSH is used by many clinics but only has value if it is very elevated. that means there are lower number of eggs.
dr_mark_trolice each month it can vary but it doesn't matter. one elevation is what we are looking for
cskains what is a good range of FSH?
Gigi estrogen?
dr_mark_trolice i agree karen, a directed purpose. but PR have significant limitation and teh care you receive makes the time pass more bearable
dr_mark_trolice FSH is based on the lab assay so you cannot generalize. each lab is different
dr_mark_trolice age reflect quality of egg, fsh reflect number
aijia I am 38, my FSH has always been 7-ish, but I didn't get lots of eggs on both cycles (7 on 1st cycle and 12 the 2nd cycle), what was wrong?
dr_mark_trolice aijia, you have ovarian aging that is not reflected in fsh levels, and this is exactly my point
dr_mark_trolice day 3 sonogram counting the small cysts and measuring the ovarian volume is the most accurate. BUT your response to medications is the gold standard
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dr_mark_trolice question to all: do you think a doctor should have the ability to cancel your IVF cycle if you want to proceed and know it's a poor prognosis?
Gigi If the cycle will fail, and the Dr knows that , then it should be cancelled.
SANDY Absolutly not, some need to at least have the chance, sometimes for closure at least.
dr_mark_trolice gigi, NO ONE knows if the cycle will fail. certainly the prognosis is less but i think it's your call
SANDY Should be pts. decision
kgs I agree, pt decision after full disclosure
Karen i agree it should be cancelled if he can see a problem i was cancelled onetime
dr_mark_trolice fertility problems have a way of making a patient feel "out of control" so I think it's best to give you more control in your treatment
karen76 If blastocysts have not developed enough on day for the lab to be able to grade them, should the transfer be postponed to day 6? Or should you just take the "best" or fastest developing on day 5?
LucyHar Ideally there's been a patient/dr partnership formed, so there's trust in the "diagnosis" and Doctor's reco to cancel is followed. She/He is just saving the patient from added expense and disappointment....
dr_mark_trolice Karen76, a blastocyst should be able to have a grade, otherwise it is probably not a blast
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winette_montes Yes.
aijia If FSH doesn't reflect ovary condition, then what is it? Why doctors still check it and people still talk about it?
dr_mark_trolice day 6 transfers have been successful when indicated
valash ok Thanks Dr. so much for answering my question Bye Bye and good night
SANDY Recommed cx. is fine, but not demanding a cancellation.
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Corey_Whelan folks, just want to let you know that we have about ten minutes left to our chat tonight.
dr_mark_trolice aijia, elevated FSH are very valuable, just not when they are "normal" because they fluctuate
dr_mark_trolice Right on Sandy!
frances1 Back to empty follicle syndrome...if the physicain said the embryologist saw "no companion cells" would that be HCG or age cause?
dr_mark_trolice frances, hcg is necessary for final maturation. if not "granulosa cells" were seen, they probably hCG is the problem
cbrueggie i'm sorry, i just joined
Karen thanks for all the info tonight and gigi my fingers are crossed for you
cbrueggie my dh and i did ivf a few years ago, i had 8 follies and only 3 mature eggs
Gigi Thanks Karen
cbrueggie i was hoping to learn more abot potential reasons
Corey_Whelan that's fine cbrueggie.
cbrueggie is this the empty follicle syndrome?
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dr_mark_trolice hCG is necessary to assist the egg and it's supporting granulosa cells from detaching
Corey_Whelan cbrueggie, you can read the chat in it's entirety by clicking on action. Also, the transcript will be posted in about a week.
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cbrueggie thanks, corey!
Gigi oops
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dr_mark_trolice still there? i got booted
dr_mark_trolice please remember, this journey will have an end and your clinic should guide you through
Karen good luck to all
SANDY Thanx for ur time Doc.
dr_mark_trolice my pleasure and thank you
Corey_Whelan Folks, while you are posting your last questions, I want to take the opportunity to thank you all for joining us tonight. What an amazing group! And thanks especially to Dr. Trolice, you did a fantastic job, we can't thank you enough! Folks, I also want to take the opportunity to request that you consider making a donation to The AFA to help keep the chat series alive and thriving. You can do that through our website or the mail. Thanks for your ongoing support.
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cbrueggie dr trolice, does a low fsh, few follicles and fewer eggs mean you need a different protocol?
dr_mark_trolice Thank you for the invite Corey. I always feel privileged to share information
Corey_Whelan We absolutely insist that you come back!!!!!
cbrueggie (fsh was 4.2 at 33, 8 follies, 3 mature eggs)
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dr_mark_trolice cbrueggie, the few follicles and eggs would require a higher dose stimulation. the more eggs, the more embryos for selection.
dr_mark_trolice while stimulation protocols differ, the prior response dictates the next cycle
cbrueggie how fast does ovarian reserve deteriorate? we probably will not be able to do another cycle until i'm 37 or 38. and i had SIX follicles on 100 mgs of clomid!
LucyHar thank you for your time Dr. Trolice
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dr_mark_trolice No one talked about PCOS. it's the most common hormonal problem of women, affecting 5-10%
Corey_Whelan Guys, you know I wish you all the VERY BEST of luck. Can't begin to tell you how wonderful it is to see the same names each week. Our chat is officially over for tonight. Please join us next week!!
cbrueggie yes, thank you!
Corey_Whelan xo
cbrueggie i have pcos
cbrueggie and my husband has very low counts
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cbrueggie in quantity, motility and morphology
Gigi Dr when you receive a patient that was undergoing treatment elsewhere, do you typically retest everything or do you go by the patient files?
Corey_Whelan cbrueggie, we need to let Dr. Trolice sign off when he is ready, please.
cbrueggie i'm sorry
cbrueggie thank you!
dr_mark_trolice cbrueggie, six follicles on clomid is excellent. ovarian aging can take time
Corey_Whelan good night guys.
dr_mark_trolice i'm ok corey
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cbrueggie do you need to leave?
dr_mark_trolice Gigi, no need to retest.
dr_mark_trolice i' can stay guys!
cbrueggie thanks!
cbrueggie i guess i was confused, we did ivf first and then a clomid iui (long story)
cbrueggie i expected many less follicles than on menopur
Gigi Thanks for all your answers and time
dr_mark_trolice we go over the patient files, and make recommendations based on what has been done
dr_mark_trolice my pleasure gigi
Gigi too bad you are in FL and I am in NYC
JuliT Dr, does the growth rate of follicles when stimulated an indication on the aging of egg reserve ?
SANDY Where in FL.?
dr_mark_trolice good doctors in NYC Gigi, email me if you need suggestions
cskains Where is the best place to get more information, my doctor wants me to be more informed and everyone dealing with this seems to know SO much more than I do.
Gigi Will do thanks again
dr_mark_trolice JuliT, Yes, rapid growth if part of ovarian aging
Gigi The internet is the best place for info
dr_mark_trolice cskains: http://www.asrm.org
cbrueggie so triggering on cd 14 is a sign of "young" ovaries?
shaymer01 TY very much Doctor, you type quite fast and were very informative!! smile
dr_mark_trolice cskains, the best place for more information is your DOCTOR!!
dr_mark_trolice thanks shymer
JuliT Dr, do you recommend mini IVF for poor responder (e.g. 2 or 3 eggs) ?
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dr_mark_trolice surfer beware online!! only use credible websitesw
winette_montes Than you for everythingg I will try to contact you at you WEB page.
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dr_mark_trolice JuliT, mini stim is too risky because a poor responder will not produce and we need more eggs.
cbrueggie thank you so much, i didn't know if i was too old to try again! sounds like it might still be ok!
dr_mark_trolice but there is a trend that less meds may be just as effective, it's a hot topic now
JuliT Thank you Dr !!
dr_mark_trolice my pleasure
cskains What about generic versus name brand? does it matter that I went with generic?
dr_mark_trolice for which med?
cskains Serophene
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dr_mark_trolice i think it should be ok, but i favor brand because there is less variability
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cskains Thanks for answering my questions
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dr_mark_trolice btw, we have our annual Health Fair and Embracing Hope Gala in April so check back FertileDreams.org
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dr_mark_trolice we do an monthly IVF free seminar and Fertillity101 free seminar
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dr_mark_trolice anything else guys?
cbrueggie do you take out of towners?
shaymer01 I am sure we could keep you here all night, but you are welcome to come back anytime!!
cbrueggie LOL
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dr_mark_trolice of course, any patient is welcome
dr_mark_trolice how often are you all online?
hoping how can a laparoscopy help in tx?
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dr_mark_trolice laparoscopy can diagnose an anatomical issue
shaymer01 this is a once a week session. otherwise generally online most every day.
dr_mark_trolice however, if the HSG is normal, there is less than 30% chance scope is abnormal,.
dr_mark_trolice scope can open tubes and remove cysts
dr_mark_trolice i'll try to pop in to answer more questions in the future now that i know about this
cbrueggie thank you!
hoping thanks
dr_mark_trolice my pleasure
shaymer01 thanks so much!
pretzels thank you, you were very informative and have a sense of humor - which always helps!
dr_mark_trolice well, thank you all for a stimulating and information discussion. you helped me know more what patients need and i wish you much success in your goal. please be empowered and never lose sight of your dream
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dr_mark_trolice pretzels, i always try to keep my patients upbeat because i know what they are goin through
hoping the encouragement is helpful!
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dr_mark_trolice i just wrote a forweword to a new book and the information and foreword is on our website http://.www.MyFertilityCARE.com
dr_mark_trolice hope this helps and best wishes to you all!!
shaymer01 will check it out. take care and thanks again!
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