All of Your Medical Questions Answered

November 16, 2005 - Wednesday
1:38 PM to 2:38 PM (EST)
Guest Speakers: Alan Penzias, MD, Boston IVF, the Waltham Center

Categories
Adoption • Egg Donation • Fertility • IUI • IVF • Pregnancy

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Lisa_Rosenthal	Dr. Penzias, welcome and thank you for joining us this evening!!!
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Orly	hi
guest_77	hi
Lisa_Rosenthal	Hi Orly, thanks for joining us tonight...
Alan_Penzias	Thank you Lisa and Orly
Lisa_Rosenthal	Hi guest, we'll be starting in just a few minutes. thanks for joining us....
guest_77	what are the areas that this chat will cover
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Alan_Penzias	The forum is open Guest_77. Your questions will drive the discussion
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Lisa_Rosenthal	guest~ tonight is really for our guests.... Dr. Penzias will answer the questions that he is asked...
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starr	i"ve had 2IVFs, both failed, doctors say my ovaries is hard to see, respond well to meds, have you had patients with this problem and how have you helped them?
Lisa_Rosenthal	Please feel free to ask Dr. Penzias the questions that you would like...
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Alan_Penzias	Well Starr. Thank you for your question. In general, the ability to see the ovaries by ultrasound is unrelated to the ability of the ovaries to respond to medical treatment. As long as the ovaries can be accessed and eggs retrieved there exists a chance of becoming pregnant.
guest_77	I am 43 and am in my TWW on my third IUIMy FSH is 3 no other problems, is the IVF sucess rate at my age worth the money it cost? or should I continue doing IUI's?
guest_77	should everyone use Progesterone vaginal suppositories after IVF and IUI? or just those who have problems with progesterone?
Diana	Is there a base line FSH that is too high that is accepted by all doctors?
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guest_77	I dont want to use donor eggs
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Alan_Penzias	There are a number of factors that we consider when recommending IVF vs. IUI. Sometimes the chance of succes is not different between them. If the odds of success are no greater with IVF than IUI, then the choice is clear.
starr	i have been told my next option is either adoption or egg donor, right now i am pursuiing egg donor , what is the best lining cm for implantion?
guest_77	I guess my question is at my age with no other issues and a FSH of 3, are the odds for IVF allot or any great than IUI
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Alan_Penzias	Hi Diana, each medical practice knows the range of FSH levels in their own or local lab above which success is almost zero. In general levels above 20 mIU/ml are worrisome.
Lisa_Rosenthal	Dr. Penzias, there are lots of questions tonight about FSH. Is there a general rule that is uniformly followed?
Amanda	20? My doctor was freaking out about a FSH of 14! Why is that?
guest_77	Amanda..most of the RE's I've spoke to don't see anything over 10 as ok for FSH
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Alan_Penzias	Thank you Lisa - the FSH level must be interpreted with respect to the age of the patient. For example, a study in England showed that women under age 38 with FSH levels in the range of 20 had success with IVF while women above age 38 in that study had zero pregnancies. If you want to generalize, FSH levels correlate with quantity of eggs while age correlates with "quality".
Lisa_Rosenthal	We are thrilled to have all of you joining us this evening. Dr. Penzias is a wonderful physician with Boston IVF and a board member of The American Fertility Association. Thank you so much for joining us this evening, Dr. Penzias...
Alan_Penzias	Hi Amanda, when I see a patient with an FSH level of 14 in my lab her age makes a world of difference. For example if the patient is 32 I interpret the level of 14 as a sign that we must move aggresively. If the patient is 46 I interpret the level of 14 as a sign that the window of opportunity has already past.
Amanda	thank you dr. Penzias, I am 37 and this is the highest the fsh has been. I've had 6 other tests with the highest of 9. could it just be a fluke?
guest_77	Dr. Penzias, In my case, how much longer do I have to get pregnant naturally or should i go directly to IVF asap?
Alan_Penzias	Well Amanda, FSH levels fluctuate. Several studies have suggested that the likelihood of success corresponds to the highest level of FSH that we record. Another important point has to do with statistics. I am going to take a little survey with my next comment.
Alan_Penzias	How many people in the chat room tonight have ever been 8% pregnant? I
guest_77	what does 8% pregnant mean dr?
Alan_Penzias	Excellent question Guest. We quote pregnancy rates all the time but when it comes down to it, an individual is either 100% pregnant or 100% not pregnant. When we use FSH levels to counsel patient as to what therapy we recommend, we are really saying that if you were one of 100 patients being treated there would be 8 who are 100% pregnant.
guest_77	Good explanation Dr....thanks
guest_77	makes me feel better
guest_77	!
Alan_Penzias	To continue, if I tell a patient who is 37 that with an FSH of 14 that her odds of success have now fallen from
trhillman_gwi.net	I'm considering a 2nd opinion. I've recently tried two IVF cycles both of which were unsuccessful. The 1st try (8/05) I made it to retrieval but only one embryo fertilized but didn't develop. The 2nd try (10/05), I didn't stimulate so the cycle was cancelled. I'm 36 years old, and 10/31/05 I had day 3 labs done again which resulted in FSH of 3.7, and Estrodial was <35. I'm not sure if I should try again. I have tubal issues. The right tube is closed, and the left is open but torteous. Is there any other alternative such as correcting the tubes?
Alan_Penzias	oops, I hit the enter button too quickly. If I tell a patient at age 37 that her chance of success is 35% and three months later she records an FSH level of 14 and I tell her that her odds of success are now 8%, she still has a chance but for her she will either be pregnant or not. What is an acceptable pregnancy rate? That is the question we all debate.
Alan_Penzias	Hello trhillman, I think that second opinions are great. It's very reassuring for a patient to hear a different viewpoint even if the answer is the same.
trhillman_gwi.net	I'm from Maine - can you explain how the treatment cycle would work as for the monitoring etc . . .
starr	what is the best range of uterus lining for implantation?
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Cynthia	Am I too late?
Lisa_Rosenthal	Hi Cynthia, you are right on time! Thanks for joining us this evening...
Lisa_Rosenthal	Please feel free to jump in at any time with questions for Dr. Penzias.
yola	I am 43 I failed 2 ivf and I going for the 3rd ifv we a donor but my egg donor is 36 with an exelent fhs do I have a good chance or is my donor or I too old
guest_77	Dr. Is your clinic open 7 days a week?
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Lisa_Rosenthal	Welcome June and Karen, thanks for joining us this evening.
Alan_Penzias	Thank you trhillman, we make arrangements in several Maine locations. Our office can answer your questions more specifically.
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Lisa_Rosenthal	We are very pleased to have Dr. Alan Penzias, from Boston IVF and a member of the board of directors for The American Fertility Association, joining us tonight.
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Lisa_Rosenthal	Starr and Julianne, thanks for being here tonight. Please feel free to ask Dr. Penzias any questions that you may have.
Alan_Penzias	Well Starr, in general as long as the endometrium is 6mm or more implantation is possible. Endometrial assessment is only part of the implantation story.
Cynthia	Dr. Penzias, I am lucky enough to live in MA and would like to make an appointment with you. Could you please post your phone number and other information?
Lisa_Rosenthal	Great idea, Dr. Penzias, please do post your information for our participants this evening.
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Lisa_Rosenthal	Hi Kath and vivianne, thanks for joining us this evening...
vivianne	hi
Alan_Penzias	Thank you - my office number is 781-434-6500. Our website is www.bostonivf.com
Lisa_Rosenthal	Dr. Penzias, you are doing a wonderful job this evening. Thank you so much for being here and sharing your expertise, time and compassion...
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Kath47	hi, I just moved to MA and am looking for a RE. What are the out of pocket costs that will be involved in treatment in this state?
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vivianne	Dr., I am taking Bromocriptine and dexamethasone for prolactine high levels and testostorone levels, what are the chance of concieving with these meds?
KarenS40	I'm 40 years old, never been pregnant, my fsh is only 4, what's your suggestion?
cbertin	Dr Dr P Had second ivf ( first eggs either did not fertilize or progress when fertilized)and all follicles were empty....Dr said this would not happen again.....anythoughts? i am 44 fsh 3
Lisa_Rosenthal	Ladies and gentlemen, please remember that Dr. Penzias is only one person. Cut and paste your questions in case you need to repost them as they do scroll away.
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Lisa_Rosenthal	Hi F.Rabin, thanks for joining us tonight
Alan_Penzias	Yola - your question about a donors age is a good one. We generally look for donors who are under age 32. That doesn't mean that a 36 year old couldn't be quite successful.
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Lisa_Rosenthal	HI karinc, thanks for joining us this evening...
karinc	Hello, we're late. Is there a way to see the previous discussion?
guest_77	lisa...how long does this chat go till?
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localhost	[2009] touser The American Fertility Association has a varied set of message boards that are moderated and answered on a daily basis.
Alan_Penzias	Vivianne - bromocriptine and dex to treat prolactin and testosterone when recommended by a doctor who knows your history can be quite useful.
karinc	Dr. Penzias, do you recommend prometrium following an IUI and if so should it be started the day of or the day after the IUI?
guest_77	what is Prometrium?
karinc	This is a progesterone supplement that is used to help you maintain your lining. I have been instructed to take it as a vaginal suppository.
guest_77	oh ok - I'm on that toothe side effects are horrible
vivianne	I tried an IUI first time with follistim and ovidrel all levels showed great numbers and had 7 follicles one at 22cm but the IUI did not work.
Alan_Penzias	cbertin, thank you for your question. Your normal FSH is less of a concern. Your age is the primary factor. You have as good a chance of success as anyone at age 44 which would be in the vicinity of 5% per the SART statistics.
localhost	[2009] touser "No Barriers" is The American Fertility Association free membership. All of our publications are available online, free. Go to our homepage and see what we have to offer...
Lisa_Rosenthal	guest 77, the online session will run until 9:00 PM, EST.
trhillman_gwi.net	I was disconnected - was the treatment in Maine answered?
Lisa_Rosenthal	Keep in mind that all of our online educational sessions~ like the one we are having tonight~ are kept as transcripts online.
Alan_Penzias	Hi Vivianne - What you describe sounds like a nice response. You should discuss with your doctor whether more IUI is right for you.
Alan_Penzias	Hi trhillman - I posted my office phone number: 781-434-6500, if you call we can give you the answers that you seek.
Lisa_Rosenthal	Ladies and gentlemen, I am able to book speakers like Dr. Alan Penzias, because I make sure that they are able to leave on time, which is 9:00 PM. That leaves us about 5 minutes in this session. Keep in mind that we have an online educational session once a week. Please check our schedule on our home page. And join me in thanking Dr. Penzias in sharing his knowledge and time with us this evening.
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cbertin	Thanks Dr for your time!
guest_77	Hi vivvian, how old are u, if you dont mind if I ask, cause those are the same results i had on my IUI...just curious
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starr	thank you Dr. Penzias for your time
vivianne	he said first one's are not always successful, he said a second one may have more of a chance. But he wants me to take an mri of my adreanal glands he told me last mri showed something that usually shows with people with PCOS but it was nothing to worry about just to keep monitoring it, what do adreanal glands have to do with fertility
vivianne	32
Lisa_Rosenthal	I also want everyone to know that we have a wonderful message board for peer support that is quite active. It's a great place to make friends and "chat".
Lisa_Rosenthal	Dr. Penzias, thank you so much for being here this evening. I hope that you will consider joining us again....
Alan_Penzias	Thank you one and all! Good Luck
F.Rabin	thanks doctor
guest_77	vivviane - what is the Ovridel for?
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guest_77	thanks Dr.
vivianne	makes u ovulate
guest_77	oh ok
vivianne	after your follicles are mature
guest_77	oh i thought that was called something else
guest_77	thanks
Lisa_Rosenthal	Just because Dr. Penzias will be leaving doesn't mean that any of you have to. Please stick around and chat for as long as you like.
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F.Rabin	good night
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vivianne	Guest 77 e-mail me at elvt28@msn.com or IM at kassy1020 Yahoo
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guest_77	I will
vivianne	guest 77 e-mail me at elvt28@msn.com
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guest_77	vivianne - sent u an email
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guest_77	vivanne - do you receive it?
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Lisa_Rosenthal	guest 77, where did you hear about the session tonight?
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guest_77	I joined fertiltiy life lines and heard it from Brooke Shields interview
guest_77	I belive she's ur spokes person?
guest_77	is that correct?
Lisa_Rosenthal	Brooke is actually Fertility Lifelines spokesperson, we do a lot of work together and they underwrite these online sessions
guest_77	I heard her talk about it on an interview
guest_77	i was interested cause I knew that she went through 7 IVF's and so I know if she had been though that and trusted your site, I should check it out
guest_77	Why do you ask?
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Lisa_Rosenthal	I'm always interested in how people hear about the sessions. It makes it easier for us to know where to place advertisements and how effective our email blasts are.
guest_77	I also registed with AFA and got this email about this chat
guest_77	hope that helps
guest_77	I attend these all the time
guest_77	Can i make a suggestion? hope i'm not out of line
Lisa_Rosenthal	do you usually atend as guest? and of course make a suggestion
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guest_77	but other chats I've seen have someone typing for the Dr. so that he can get more questions in and get my answers outand there's a system when you post ur question, it gets screened first and then if its chosen, only then can everyone see it
guest_77	it makes for a smoother chat for the Dr. and the partifipants.
guest_77	I just signed in as a guest cause I did not have time to find my AFA into
guest_77	hope that helps
Lisa_Rosenthal	Thanks for the suggestion, we are looking into different software. I guess great minds think alike!
Lisa_Rosenthal	who do you usally sign in as?
guest_77	absolutley
guest_77	my user name for AFA? This is the first AFA chat I have participated in
guest_77	I've done chats with Resolve usually and the SHRM group, and others
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Lisa_Rosenthal	what is the SHRM group?
Lisa_Rosenthal	I'm glad you joined us this evening.
guest_77	Sher Institute for reproduction Medicine..there in LA, NY all over the US
guest_77	they are very aggressive at persuing patients on their chats
Lisa_Rosenthal	I am very familiar with Sher Institute, just haven't seen them referred to that way.
Lisa_Rosenthal	How are the Resolve chats?
guest_77	they offer participants to email dr directly and a 1/2 phone free consult....
guest_77	they are very nice, a little to mass production approach for me
guest_77	they are growing like crazy
guest_77	they do allot of free drug studies and things like that...so people go there alot
guest_77	Oh Sorry
guest_77	Resolve chats are good, they are VERY crowdedthe problem that i see is that there are too many levels of patient knowledge
guest_77	they should have differnt chats for differnt levels
guest_77	and if you sign in late you cannot see the transcripts until they post them 2-3 weeks laterthe focus allot on adoption and donor eggs by their RE"S ...I know RE"S just want to help get people pregnant, but thats too easy of a solution to me
Lisa_Rosenthal	I understand what you mean. I'm actually glad to hear that RE's are talking about adoption
guest_77	It does not make sense to me why RE's dont hold these chats more often...they appear to be a great recruitng tool for the Dr.s...look how many people on this one want to go to this RE that you had...why do you think that is?
guest_77	I think adoption is important
guest_77	to give as an option
guest_77	So I hope that helps
Lisa_Rosenthal	I can only speak for us, we do these once a week and they are usually with RE's. They certainly are busy and it is their time AND I don't think that they really get that patients will come to see them as a result of the sessions.
guest_77	Oh that must be why
guest_77	I have not gotten emails then on ur weekly chat
Lisa_Rosenthal	Did you get a reminder yesterday or today about tonight's session?
guest_77	this is the first one I got and thats why i signed inof course the topic is alwalys import as well...
guest_77	no i did not
guest_77	i just got the original one
guest_77	it could have got spammed
guest_77	that happens alot
guest_77	let me check my email and see if i can confirm that..hold on
guest_77	sorry its gone
guest_77	i look forward to more chats with AFA....I know that Resolve takes off the next couple of weeks....u might try advertising on the BabyCenter site as ALOT of people go there daily and post on their boards
Lisa_Rosenthal	What's the Babycenter site? And thanks for all the helpful suggestions.
Lisa_Rosenthal	Please feel free to email me at Lisa@theafa.org if you ever want to ask me or tell me something. I will no longer be moderating the sessions, but please feel free to get in touch with me...
guest_77	Babycenter.com is a great board for posting
guest_77	very active
guest_77	lots of people participate they have many boards with many subjects
guest_77	I will...good luck to you
Lisa_Rosenthal	Again, thanks for the helpful suggestions and ideas. Hope to see you again.
Lisa_Rosenthal	good night
guest_77	absolutely
guest_77	good night to u
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