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Ask the doctor - Ask a nurse!

April 11, 2006 - Tuesday
7:49 PM to (EST)
Guest Speakers: Nancy Harrington, RNC
Director of Clinical Service, IVPCare

Categories
Infertility • Insurance • IUI • IVF • Miscarriage


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Nancy_Harrington Hi Daniel...I am logged on
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Moderator_DSBecker Hi Nancy- nice to meet you - I am sure you are going to be wonderful tonight
Nancy_Harrington Well thank you ..I am glad to be here
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Moderator_DSBecker By my watch you are early - congrats
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Moderator_DSBecker Good Evening everyone - we will get started in a few minutes - on behalf of the AFA I want to welcome you to tonights chat with Nancy Harrington -RCN and director of Clininal Services an IVPCARE - let's have a warm round of cyber claps
danig70 clap
Symharmony clap smile
Moderator_DSBecker A note as to protocal - if you do not get an answer within a reasonable periord of time - please feel free to retype your question - sometimes when it gets busy it is hard for anyone to keep up - the key is patientence (sic)!
Moderator_DSBecker Well that said - Nancy I give you the "FLOOR" - questions anyone????
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Nancy_Harrington Thanks Daniel..Just to give the gruop alittle back ground I have worked in the field of infertility nursing for 18 years so I have been around a long time...
Moderator_DSBecker BTW to those that don't know - in NYC on May 7th, 2006 the AFA will have a faboulous symposium - I suggest all that can - should come - it will be wonderful!!!!!
girlygirl What is in general the maximum age to receive a donor egg
Moderator_DSBecker Nancy and here I thought you were only 30 y/o ::biggrin
Nancy_Harrington Hi Girly girl...some clinics allow patients to go up to the mid fifty range but it is program specific most places
danig70 I have a question...I was diagnosed with unexplained infertility. I had two miscarriages already with IUI with injectibles. I was also tested for blood disorders and genetic disorders and HUS ulttrasound. and all is clear. I will be doing IVF in August, is there a drug that will hopefully make the pg stick, if that is my problem?
Nancy_Harrington danig hello...there are some medications that md's use with your history that help with possible antibodies but you would need to have studies done to see exactly what medications would be best..there is no special glue that works unfortunately
Moderator_DSBecker Girlygirl - does that answer your question?
danig70 I see...thanks Nancy.
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Nancy_Harrington You are most welcome danig
Moderator_DSBecker Nancy - at what point should a patient ask about imunological testing e.g. ana or apa??
Moderator_DSBecker Hi qpnm welcome to the AFA chat toight with Nancy Harrington, RCN
Symharmony I'm scheduled to have a Lap in three weeks and I have a lot of fears about what will happened and what they will find. Is a Lap a scary thing that I should worry about or do you think everything will be okay?
girlygirl Yes but I have another question. What assistance can one find for insurance for someone in the late 40's. I have found most insurance stop coverage at 45
Nancy_Harrington Hi Daniel..If there is a history of repeated ivf failure and or repeated miscarriage 2 or more it is time to discuss this
Moderator_DSBecker Girlygirl - what kind of ins are you asking about?
danig70 Nancy, will IVF be able to determine if I have problems with my eggs which might be causing my unexplained infertility?
Moderator_DSBecker Thanks- Nancy
girlygirl infertilitiy coverage
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Nancy_Harrington symharmony..Hello A lap is done under anesthesia and is usually very well tolerated...the md puts a telescope in the pelvic area to see the organs and can also repair things while he is in there...I have had two and both went ver well
Moderator_DSBecker Hi Nettie - welcome to the AFA chat tonight with guest Nancy Harrington, RCN of IVPCARE
Symharmony Thanks smile
qpnmwzni What type of tests do they do for to find out about imunological testing?
Nancy_Harrington danig 70...ivf is a very good diagnosis opportunity also as the embryologist and me can see the eggs visually and also your response to the medications will tell a lot about you ovary function
danig70 That is good to know Nancy. Maybe I will find more out. Very frustrating! Thank you so much.
Symharmony Do you see women who have struggled to get pregnant have success quickly after having a Lap done?
Moderator_DSBecker Girlygirl - in states that have the "mandate" I do not think it would be legal to discriminat based on age
Nancy_Harrington girlygirl..you can go to the ASRNM website at ASRM.org and read about each states insurance mandates,,,there are 14 states that provide some coverage and you could statr there
Moderator_DSBecker in states that do not have the mandate I think you can appeal a negative coverage decision
Nancy_Harrington sorry that is ASRm.org girly girl
girlygirl Thanks Nancy I have checked into your web site, state laws and found I can not obtain coverage for infertility due to my age. I know the cost of this is high
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Nancy_Harrington yes symharmony I have...a lap can help to plan what course of treatment is best based on how things appera to look and function i the pelvis...also like I mentioned the md can repair any scarring or adhesions while he is in there...or she is in there
Moderator_DSBecker Girlygirl - in NY forinstance where there is a mandate - there is a cap on $ not age
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Moderator_DSBecker welcome back
Symharmony Thank you
Moderator_DSBecker GirlyGirl - see if there is a boarder state that has a mandate and then inquire what is necessary to change residencies while you are in treatment
girlygirl I have insurance coverage and just received information back that they only allow coverage for under 45 years of age the insurance company will not pay for any treatment for infertility
qpnmwzni What types of testing do they do to find out about imunological testing?
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girlygirl My insurance is from nys
Nancy_Harrington girly girl..I would suggest that you contact the ASRM and see if they can lead you to information about age discrimination related to insurnce covergar...
Moderator_DSBecker Girlygirl - does your carrier offer infertility coverage?
girlygirl Yes but I have received a denial of benefits for infertility coverage due to my age
girlygirl from the insurance company
danig70 I am in IL a mandated state, however, my infertility coverage isn't great..only $10k allowed for lifetime max. I have been ttc for over 2yrs now, so I am almost at my $10k yet without even having IVF yet. I will be doing the Shared Risk Plan for IVF.
Nancy_Harrington qpnmwzni..there are an array of tests that are done to look at antibodies in the blood...auto immune screening and clooting time testes...there are several and based on your history and physical the MD would determine which to dooo these are just some
girlygirl I have had this issue also in the state of ct where the age limit is 40
Moderator_DSBecker GirlyGirl - I would contact the NYS Bar Association and see if they can refer you to someone - this sounds like selective age discrimination -
Nancy_Harrington girlygirl...I am sorry that must be very difficult to accept...I hope the Shared risk program is helpful..
Moderator_DSBecker Danig - mandates are not always what they seem to be are they? In NYS companies can offer "infertility" but can exclude IVF
qpnmwzni I have Hashimotos and the thyroid doctor said something about this is caused by an inmunity issue. Are there any questions that I can ask my fertility doctor to make sure they are covering all aspects of my fertility?
girlygirl In CT the State law only requires insurance company to provide inferility coverage up to age 40. I will check the state laws of ny to see what applies thanks
danig70 I agree Moderator
Symharmony When will all the states have mandatory inferility? I unfornuately live in a state that doesn't mandate infertility and my insurance doesn't cover anything related to infertility.
Nancy_Harrington qpnmwzni..i would tell the md all about you thyroid issues and bring all of you tests with you..the thyroid and the reproductive cylcle work hand in hand and with right meds you could do fine...
Moderator_DSBecker However in most states ins carriers will pay for diagnosis stuff even if they will not cover "infertility per se"
Moderator_DSBecker Everyone is doing a faboulous job and koodoos to Nancy
danig70 Nancy: When I start the IVF cycle, how often do you go in for u/s? Every day leading up to retrival when you are on the drugs?
Nancy_Harrington symharmony..the insurance mandates have been a long time coming...I live in Mass which was the first state to mandate in 1988 and only thirteen have some type of mandate to date along with MA
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qpnmwzni I am just nervous because we have attempted 6 IVF cycles and now are looking into Donor egg.
Moderator_DSBecker Just a reminder - check out the AFA's web site for lots of great information and support with "no barriers" ALL INFORMATION IS FREE
Nancy_Harrington danig70..It is different depending on the clinic,,usually day four or three of your cycle then back on day 6 or 7 and then every other day until you take you hcg injection
Moderator_DSBecker Symharmony - i hope someday that will happen
danig70 thanks Nancy, that gives me a better idea of how many early 6:45 am appts I need to make..hee hee
Moderator_DSBecker Hi DK welcome to the AFA's chat with Nancy Harrington, RCN and Dir of Clinical Services at ivpcare!!!!
Symharmony Yeah me too
Moderator_DSBecker Danig - catch up on your zzzzzzzzzzzzzzzz'a now
danig70 lol
danig70 ok...thanks for the tip
dklaustin1 Thank you. What is tonight's topic?
Moderator_DSBecker Symharmony - remember it is never too late to "bug" your elected officials!!
Nancy_Harrington danig70...you are lucky they are that early...I have talked to some patients that have to wait until mid morning for an US...that is tough
Moderator_DSBecker DK general or specific "infertility" questions
danig70 I am very lucky..
dklaustin1 What is the cause of slow dividing embryos? Is there anyway to improve this?
Moderator_DSBecker DK - Nancy has been in the field since 1988
qpnmwzni I have heard about radon? shots because of my rare blood type. Do I only need this shot after conceiving or would I need this even after a miscarrage?
danig70 Thank you Nancy for your answers..have to run now.
Moderator_DSBecker qp - I thought radon was a gas?
Moderator_DSBecker danig best of luck to you
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danig70 thanks moderator
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Nancy_Harrington dklaustin1...a slow dividing embryo can be the result of an egg being of lesser quality than others and a bit immature...there are lab techniques that can assist with fertilization but how fast the embrto divides is pretty much determined by the geneic material in the egg..
Moderator_DSBecker yt - welcome to the AFA chat with Nancy Harrington, RCN and Dir of Clinincal Services at IVPCARE
qpnmwzni I'm sorry. I am horrible with spelling:( It is a shot that the woman recieves because of the different blood type of my husband. Any idea what I am talking about?
Moderator_DSBecker dk - in our 2nd IVF/ICSI/TESE cycle we had a slow pre-embryo who is now 9 yrs old!!!
dklaustin1 So it would be an egg quality issue? Can egg quality be improved with a new protocol?
Nancy_Harrington I am not familiar with this qpnmwzni...there are shots given some time for RH negative blood...I will have to look in to that one...
plumleedw Do you have any experience with acupuncture and IVF?
qpnmwzni yes that is it. Just wondering if it is for conceiving and after misscarrying as well.
dklaustin1 Thank you Moderator - that brought tears to my eyes! I am in my 2ww with a 5 cell grade 2 and 2 4 cell grade 2's on a 3 day transfer. Grade 1 being the best. I know my chances are less with the slow dividers but I am trying to remain postiive.
Nancy_Harrington dklaustin 1 Egg quality is egg quality...what the lab does is creat an environment which is just about perfect in ivf...you often by pass a less than perefct environment that you might find with normal conception when the egg and sperm are on there own....
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Moderator_DSBecker dk i am sending you lots of +++++++++++++ thoughts
Nancy_Harrington dklaustin1...I agree Daniel...I had several patients that had poor eggs...poor embryos...and had beautiful babies as a result...
Moderator_DSBecker dk - if looks were the determinative factor - the IVF clinic would have told us to destroy and not transfer that is how horrible it looked - the pre-embryo was very fragmented and yet Kevin is the result
qpnmwzni My husband and I are looking at Donor egg profiles and wanted to know if migraines and or allergies to penecillin are hereditary?
Nancy_Harrington plumleedw..hello I am hearing and seeing more and more about acupuncture and ivf...there is more info coming out about increased preganancy rates with ivf and acupunture...if you would like I can send you some info after the session to take alook at
dklaustin1 Thank you Moderator and Nancy. I appreciate the positive comments. Would it be okay to say that in another cycle I might produce embryos that would be of higher quality, or if you produce low quality embryos then you always will?
Nancy_Harrington qpnmwzni..I do not know if they would be considered hereditary...but could look in to it for you...
Moderator_DSBecker dk - there are so many factors - I don't think anyone could say with any degree of medical certainty that, that is likely or not - remember it is not how it looks, it is whether it sticks!!!!!!!!!!!!!!!!!!!!
Moderator_DSBecker dk after our first we tried again - the following cycle we had much better "looking" ones and yet no pg - so go figure
Nancy_Harrington dklaustin 1 no each cycle in unique...and one cycle of poor quality...I hate that term embryos does not mean that will always be the case....amny time changing your medication protocol results in better eggs and embryos.
plumleedw That would be great. Most of the information I have seen involves increased pregnancy rates with IVF when undergoing acupuncture in conjunction with the IVF. We are currently undergoing FSH and HCG injections with IUI. Have you seen anything specifically about acupuncture in that regard and/or do you think similar results could be seen?
Nancy_Harrington plumleedw...yes I believe they wuld be similar...why don't you email me at nancy.harrington @ivpcare.com with youe email address and I can send you some info...
plumleedw Thank you I will.
dklaustin1 Thanks - I wasn't sure if quality would be an issue each cycle. Maybe it will be or maybe it could change. That is good to know. Thank you for taking the time to respond to my questions. It is much appreciated.
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Moderator_DSBecker kb welcome to the AFA chat with Nancy Harrington, RCN and Dir of Clinical Services to IVPCARE - all quesitons welcome
Nancy_Harrington dklaustin 1 you are most welcome...I hope it goes well...believe in yourself..that is important...
Moderator_DSBecker dk I know that you will get through this
Nancy_Harrington since we are slow right now I wanted to second Daniels suggestion to utilize the AFA information...there is so much there that is EXPERT info ...which you do not find on all sites that provide inforamtion
dklaustin1 Thank you both. Your comments mean so much to me.
Moderator_DSBecker ::rolleyes
Moderator_DSBecker Nancy would you please post your contact information if anyone want to contact you
dklaustin1 While taking progesterone im injections is it common to feel kinda achey in your shoulders and back?
Nancy_Harrington To All there is also information on ASRM.org which has a patient section free to us which is full of patient fact sheets and info boolets...ASRM stands for American Society for Reproductive Medicine
qpnmwzni Thank you for your help.
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Nancy_Harrington dk... I have heard patients feel discomfort in the buttocks area which can be painfull...have not heard of back or shoulder pain...
dklaustin1 I know I heard the progesterone was going to be unpleasant, but I haven't experienced that up to this point - day 6. To me the menopur was much worse!
Moderator_DSBecker dk it is possible - especially if you inject near the siatic nerve - make sure you ice up and then have the shot in the muscle
Nancy_Harrington My contact information is NAncy Harrington 888 486 1340 ext 1704...or my eamil is nancy.harrington@ivpcare.com...i would be happy to hear from anyone with any questions you might have anytime...I am here to help if I can...
Moderator_DSBecker Thanks Nancy
Moderator_DSBecker Nancy what is your feeling about progesterone IM v supposatories -- just curious
Nancy_Harrington One thing that came up in the last chat was ...the suggestion to find a nurse advocate that you can work with in your treatment center..it makes it so much easier when you have a good resource to work with...
dklaustin1 good question, moderator
Moderator_DSBecker dk - i have my own feelings but I am not a medical professional just a poor former IVF patient
Nancy_Harrington I think that the progesterone suppositories are better absorbed...but you will find studies..depending on who publishes them that they are both as effective...
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Moderator_DSBecker YEY YANKEES - ::smile Welcome to the AFA chat with Nancy Harrington, RCN and Dir of Clinical Servies for IVPCARE
Moderator_DSBecker Welcome Vanessa
vanessa hello
Nancy_Harrington welcome vanessa...
Moderator_DSBecker Feel free to ask anyquestion that is on your mind
vanessa i have a question, i was recently told by my doctor that i have pcos. should i worry
Moderator_DSBecker Remember to visit the AFA's home page often - there is always great new information and support available - with "no barriers" there is never a fee for informaition
Nancy_Harrington Hi Vanessa...PCOS is the most commom form of ovulatory dysfunction and is treated successfully with medications...depending on your other hormone profiles your MD will decide the best tx
Moderator_DSBecker DK if the pain persits you can always ask your doc if you can change to supposatories
vanessa i guess my biggest question is that i have 15 cysts on each ovary. is that a lot of cysts or are there other things to look at as well?
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Moderator_DSBecker Jb welcome to the AFA chat - we are running out of time so ask a quick question
dklaustin1 Oh, no I'm sorry.. I guess I didn't explain myself well. I don't really have pain. I just feel sore in my shoulders and back. I thought maybe it was from the progesterone, but maybe it is just 2ww stress!
Nancy_Harrington vanessa...yes they are most likely little cysts...so the word cysts is a bit scarey...your md will look at you hormone levels to see why you have several follicle developing rahter that just one each month...my best frien had severe pcos...and is noe the mother of four beautiful children...
Moderator_DSBecker Well what a fabulous chat we had tonight, on behalf of the American Fertility Association, I can not thank Nancy Harrington enough for taking time out of her like to make our lives better!!!!!!!!
vanessa why thank-you so much. i call my md tomorrow for my blood results. so i guess i'll find out more then. why thanks for answering my questions:)
Nancy_Harrington I was going to mention the stress...DK
Symharmony Thanks for your help....bye
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dklaustin1 Thanks everyone - good night!
Moderator_DSBecker WOW that was a room emptieer ::up
Nancy_Harrington Best it is 9:00 pm as my typing skills are going down hilll...
Moderator_DSBecker Good Night everyone - it has been an absolute pleasure to moderate tonight and again Nancy thank you so very much - you have been just wonderful!!!!
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Nancy_Harrington Thank you to all of you...I enjoyed talking with you and thank the AFA for this great opportunity...BELIEVE....
Moderator_DSBecker Thanks - you are free to go - you were just great
Nancy_Harrington thanks again...good night
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Moderator_DSBecker Good Night Everyone - ++++++++++++++ thoughts going out to ya!
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