Facts, Fiction and FSH

October 3, 2006 - Tuesday
3:50 PM to (EST)
Guest Speakers: Mark Leondires, M.D.
Reproductive Medicine Associates of Connecticut

Categories
Fertility • Fertility Drugs • Infertility • IUI • IVF

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deb	Good evening and welcome to tonight's Online Education Session, hosted by the American Fertility Association and sponsored by Fertility Lifelines. As always, we will be starting our session tonight promptly at 8pm Eastern and ending at 9pm Eastern.
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deb	Tonight our guest is Dr. Mark Leondires from Reproductive Medicine Associates of Connecticut. Dr. Leondires is the Medical Director and lead physician at RMA-CT. He is Board Certified in both Reproductive Endocrinology and Ob/Gyn. Dr.Leondires has published numerous articles and is a highly sought after speaker. It is our please to welcome him tonight for tonight's discussion, Facts, Fiction and FSH.
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deb	And of course, we won't be able to start without Dr. Leondires!
deb	But welcome to all of you early-birds.
jemshen	ok. this is new to me. Hi
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jemshen	Has anyone else been to one of these before?
deb	Welcome aboard. It is quite easy and relaxed. You just type in your questions and Dr. Leondires will answer to the best of his ability.
deb	We will be starting in just a few minutes.
liki	very new to me too, I've never done this but look forward to hearing all the details
jemshen	ijust want to hear something other than "if you stop trying, you will get pregnant"
deb	You probably won't hear that here! This is a very supportive group...and literally everyone has been where you are today.
deb	I am going to try to reach Dr. Leondires. Hang on for a minute.
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jemshen	thats a relief to hear.
liki	Is this speaker is just focusing on high FSH levels?
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jemshen	i dont think so. I think its everything.
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Mark_Leondires MD_RMACT	Hello everyone...FSH....friend or foe?
deb	Welcome Dr. Leondires...I just breathed a huge sigh of relief....you are right on time.
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Miriam	How intertwined are FSH and estradiol? Can they be lowered through TCM?
deb	Tonight our guest is Dr. Mark Leondires from Reproductive Medicine Associates of Connecticut. Dr. Leondires is the Medical Director and lead physician at RMA-CT. He is Board Certified in both Reproductive Endocrinology and Ob/Gyn. Dr.Leondires has published numerous articles and is a highly sought after speaker. It is our please to welcome him tonight for tonight's discussion, Facts, Fiction and FSH.
bumblebee2006	Day 3 labs = FSH 10, Estogen 30, LH 2.6 In the last 4 months Both my IVF cycles were cancelled - my estrogen levels did not rise at all. 1st cycle traditional they used IVF protocol with BC lead in and Lupron daily and 150 menpur and 150 gonal-f . Cycle cancelled after CD6 no rise in estrogen (Doc thought maybe the lupron may have temporarily shut done my ovaries) 2nd cycle protocol - BC lead and 500 iu's of gonal-f....(no lupron this time) still nothing happening - no rise in Estrogen. Cycle cancelled after CD6
jemshen	Wait. i am so new.. what is FSH and what is its main point
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Mark_Leondires MD_RMACT	It was a little tight. I wanted start out by saying FSH is simply a messenger of what is going on in the ovary. I think of it as fuel gauge of ovarian reserve.
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Mark_Leondires MD_RMACT	TCM can lower FSH, but so can taking estrogen. FSH is not the problem, it is what it is telling us.
liki	Which is what exactly?
jemshen	ok. that makes more sense now. I will be seeing a gynocolical endocrinologist and infertility specialest in november for the firsttime. Is this a test he will do through blood?
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Mark_Leondires MD_RMACT	Theat here are fewere reproductive fit eggs in the ovary. I am going to start with Bumblebee.
Mark_Leondires MD_RMACT	How old are you?
bumblebee2006	38
ilene	I had a historically high FSH of 17.9 but my estrogen was 71 at one clinic. I went to a top doctor in NYC and he told me he suspected that it was innacurate because if the FSH were that high the estrogen were lower. Do you think this is accurate?
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ilene	I forgot to add I am 36
DMKMEDCODE	HOW CAN ISSUES WITH YOUR OVARIES EFFECT FERTILITY? FOR EXAMPLE, I HAVE VARIOUS CYSTS ON MY OVARIES..
Miriam	So, is there some sort of correlation between a specific FSH & a specific # of available potentially functional eggs? Can you predict say, if a woman has an FSH of 12, how many months of fertility she has?
Mark_Leondires MD_RMACT	Other markers of ovarian reserve are basal antral follicle count and ovarian volume. The fact that you did not respond at all is very concerning, but not likely related to your fsh level There are 45 yo women with fsh levels < 10 with no reproductive fitness. The FSH test is not a reliable indicator in all women. In you your test of stimulation may mean you need to try one more stim and if still no response consdier other family building options.
ilene	Sorry, I mean that the doctor thought if the 17.9 FSH were that high the estrogen should have been low, not high
Mark_Leondires MD_RMACT	ilene is next.
liki	I'm 31 and also had high FSH 20, with High estrodial can't remember exactly maybe 100, as I'vebeen learning more this doesn't quite make sense either. According to the "loop", hormones etc... wouldn't one be high and the other low?
ilene	Thanks so much
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Mark_Leondires MD_RMACT	Ilene, an FSH of 17.9 is a negative predictor in the context of an FSH of 71. We accept estradiols up to 85 as concordant with cycle day 2-4 timing. Once again how old are you is important. You likley need a trial of stim, and or a clomid challeng test to get a better handle on your ovarian reserve, but I am concerned. You should pursue agressive fertility therapy.
Mark_Leondires MD_RMACT	Liki is next
Mark_Leondires MD_RMACT	Liki,
bumblebee2006	Thanks. Would you recommend something called a clomid challenge test. Do you think I should give my ovaries a long break before trying again IVF again? Note: Tried 3 iui's last year with small amounts of Gonal-F and stimmed fine? But no response to the Meds for the IVF?
jemshen	Do you have any thoughts on Soy Isoflavens instead of chlomid?
Mark_Leondires MD_RMACT	Being < 35 with an FSH of 30 is unusual. I am interested in the rest of your story. Have you been trying for a long time. have you tried fertilty meds?
sandy	I'm 36 FSH 16, first IVF cx only 4 follicles on MDL protocol 21 days of BCP, Starting again antagon 21 days of bcp, last antral follicle count 7 before starting bcp. Is there a chance that this cycle will be better, and due bcp suppress you or could it have been supression from the lupron. Also would I have a better chance going to a bigger more well know clinc, who I here deal alot with peolpe like me.
hoping	do you have any thoughts on Mannatech, herbal supplement for endocrine function
Mark_Leondires MD_RMACT	Bumble. A Clomid challenge test would def be helpful to define things further.
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ilene	So, am I understanding you correctly that chances are that FSH was in fact accurately high because the estrogen was still below 85? My past 3 FSH have been 9.5, 10.1, and 11.5 so would you say I might need need as aggressive a therapy. I have not yet done a cycle and want to try natural first. I am 36 years old. Thanks.
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jemshen	at age 28 with no family history of infertility.... with my weight at 250 and height at 5'7, would you say my weight is more of my problem than possibly anything else?
christina75	Is there any risk associated with having ovarian cysts (corpus luteal?) after each cycle of Follistim and Ovidrel and taking birth control to shrink them? Alternating between fertility meds and birth control every other month?
Mark_Leondires MD_RMACT	Ilene, From my seat I cannot recommend natural. I am also stressed about your biological clock...If you try natural don't try for more than 3 months.
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Mark_Leondires MD_RMACT	Jemshen,
Mark_Leondires MD_RMACT	There is no good study that soy isoflavons and their partial anti-estogenic action will work as well as clomid that I am aware of. so no comment here.
Mark_Leondires MD_RMACT	Sandy is next.
Mark_Leondires MD_RMACT	whew...
DMKMEDCODE	ANY INFO ON MY QUESTION :(
DMKMEDCODE	PLEASE
ilene	Thank you. I am afraid of the risk of twins though, would you say since I had a historically high FSH, even if I had a below 10 level and tried that month, chances are I would not have twins with Clomid. I also have a history of ovarian cancer (grandmother).
jemshen	Thank you, that at least is a medical opinion i have been waiting for. Others i have asked have just said they have no opinion on it at all. so thank you. ::rolleyes
jsaraceno	Why do some clinics not want to work with patients who have 1 elevated FSH. At age 31, I had passed 2 clomid challenge tests and had one FSH test come back at 13.8. My doctor at that time told me we would have to use donor egg. I swithched clinics and am currently 14 weeks pregnant, with my own eggs on the first IVF cycle.
Mark_Leondires MD_RMACT	Sandy. what dose of medicine are you on. I think you need to be on at least 300 ius if not 450 to decide on your response.
Mark_Leondires MD_RMACT	DMK...I didn't even see it and please no caps.
Mark_Leondires MD_RMACT	hold on.
DMKMEDCODE	JEMSHEN -- I SHARE YOUR SAME PROBLEM
jemshen	with weight?
DMKMEDCODE	okay -- i was wondering how cysts in the ovaries effect fertility
liki	Yes, we've been trying for 3 1/2 years. Have tried clomid for 9 months before being referred to RE which then said unexplained fertility and suggested the shots with IUI (never did). Then had abnormal periods(a few cycles later) and took day 3 fsh and found all this out. got 2nd opionion said it's not impossible to conceive on our own but again recommended ED as best option. I've been working with acupuncturist, charting BBT, changed diet, have always exercised, 5'9, weigh 128, but have small bone frame, and quit smoking. I am ovulating, have no cysts, etc....That's my story-it's been a LONG journey. ANy insight would be great. :~)
jemshen	or with doctors giving real opionions. lol
DMKMEDCODE	yes, with weight -- i have 2 children already, but it has been a battle recently
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Mark_Leondires MD_RMACT	If you have multiple large cyst they can negatively effect the ability of the fallopian tube to pick up the the egg simply based on their size. If you have multiple small ones it could mean you have a variant of polycsytic ovarian syndrome and that your ovulatons are not regular or egg quality is effected.
sandy	I will be taking repro 150 qam and 75 q pm and gonal f 75 q am and 150 q pm
DMKMEDCODE	i have a few small ones
jemshen	i have never been pregnant at all. My weight seems to have just pounded on in the last 3 years with no change in eating or excercise. I swear its like a magnet... I worry about thyroid issues... could that also affect fertility? the thyroid?
DMKMEDCODE	i have had the same concerns -- but it is compounded because i have had 2 children in the past so i'm really baffled
Mark_Leondires MD_RMACT	Liki, you may have been born with less eggs...I think you need to try naturally and consider other family building options.
Mark_Leondires MD_RMACT	Jsaraceno,
jemshen	I can see where you come from. I would think i would be confused as well
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DMKMEDCODE	so doctor what can i do to treat the cysts --- any suggestons?
jemshen	Would HPV have any impact on fertility at all?
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Mark_Leondires MD_RMACT	Clinics try to work with the best patients to get the best rates. A 13.8 would not have scared us off. I think with counseling, understanding, and patient education pts can be allowed to try. But, if the risk of IVF as about 1% and the risk of pregnancy is about the same then it is medically unethical to put tyou throught the drugs an procedures.
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Mark_Leondires MD_RMACT	Sandy...that sounds ok for a dose.
Mark_Leondires MD_RMACT	DMK...you likley do not ovulate regularly and this may be weight related or PCOS.
ilene	If clinics want to work with "the best patients" then who are they.....ones who are below 40 with high FSH levels, or would they favor above 40 with normal FSH levels??
DMKMEDCODE	i struggle with irregular periods as well
Mark_Leondires MD_RMACT	Dmk...you need to talk to your doctor about clomid or metformin to induce regular ovulation so you have a fair chance.
Mark_Leondires MD_RMACT	HPV is not a problem unless it leads to cervical cancer.
sandy	Thanks, If my cycle day 3 antral count is low, should I just go ahead or seek 2nd opinion with clinic that has higher stats?
jemshen	not yet. i have had a test at CN1.. but last pap came back ok
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DMKMEDCODE	doctor, what do these medications do? and when can you see a difference?
mimi	Good Evening everyone. I've just signed in. I'm 30 and I've just been diagnose with high FSH (30) Do I have a chance of having a biological baby? Should I try IVF?
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jsaraceno	My previous doctor told us that with FSH of 13.8, my chances of getting pregnant were less than 1%. I think that he was not truthful and did not want to take a chance on us. I just hate to think that other women might just take his opinion and give up hope because of thier statistics.
Mark_Leondires MD_RMACT	Ilene, that is a tough one. It is not ONLY fsh. It is the ovarian size, basal antral follicle count, history, sperm...the whole picture. I would rather work with an over 40 yo with an FSH of 12 than a less than 35 with an fsh of 25....I hope that helps....I would need the rest of the story.
Mark_Leondires MD_RMACT	whew...
maddie1702	Hi Dr. Leondires, How long does it take to get an appointment with you. I was thinking of a 2nd opinion ?
christina75	any answer for my earlier question? I know it's hard to keep up!
Mark_Leondires MD_RMACT	at 13.8 your ivf preg rate for less than 40 is about 25%
jemshen	Thank you fo ryour time doctor. Since ihave not been to the dr. and had these tests yet, i dont really have much to ask. Bu tyou have helped with what i have asked. THank you. Have a good night
Mark_Leondires MD_RMACT	Sandy...when dealing with such a profound issue a second opinion is always helpful.
Mark_Leondires MD_RMACT	Mimi...the high fsh is very concerning...do you have reg periods?
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Mark_Leondires MD_RMACT	Maddie ...about 3 weeks.
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mimi	yes Doctor I do
Mark_Leondires MD_RMACT	chris I will look
ilene	Yes, it helps me to understand, but unfortunately, the odds are not in my favor according to your opinion. Would you look at the fact that I have had a couple FSH wnl?
mimi	amd everything else id OK
Mark_Leondires MD_RMACT	Christina the data would say no as long as they are not painful and go away.
christina75	thank you!
Mark_Leondires MD_RMACT	In general you are only as good as your highest FSH.
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lcominet	I hate to file another missile at you, but I have one question: Could antibiotics affect a day 10 FSH level on a clomid challenge test? (Or is there not enough research on this to give a definitive answer).
Mark_Leondires MD_RMACT	Well mimi I would want to know the rest of your story and to see your ovaries and have you do a clomid challenge test.
Mark_Leondires MD_RMACT	In general abx work on another system and shouldn't effect fsh.
mimi	I live in Florida. On thursday I have an appointment w/ my Dr. What should I ask
Mark_Leondires MD_RMACT	If I have a patient with a prob I make them do 2-3 clomid challenge tests...with IUI...to get eh true answer and to give them a chance.
jholbrook	Hi. I am 32 years old. We have been trying for a pregnancy for 3 years. In April, I took the Clomid challenge and yy ER told me that I have an FSH of 16. She immediately put into the IVF program at BGW in Boston. The IVF cycle only produced 3 eggs, and it failed. What are my chances of pregnancy with a high FSH and low response to aggressive meds?
hoping	just learning of the clomid challenge test, can you explain?
Mark_Leondires MD_RMACT	Mimi,..Ask him abour your ovarian volume and basal antral follicle count and his/her experience with this.
jsaraceno	Dr., can surgery on the ovaries have a negative effect on FSH?
Sarah	question, I have a history of large dermoid cysts (most recent surgery in Dec) with significant tissue removed, I oulate montly and have been pregnant 4x in the past year (2 blighted ovums, 1 chem and the most recent just confirmed today). However I have an FSH of 12.1. My RE believes that this does not mean anything in my case and has not caused the repeat pregnancy losses (we have done every test) what are your thoughts on fsh and egg quality?
lcominet	Thanks. No more missiles from me. :o) Hope you have your virtual kevlar on.
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Mark_Leondires MD_RMACT	jholbrook...I would need access to BGW data. Ask them..they have it....somewhere between < 1 to 25%...if you are a poor responder as well it is a bad sign...sorry.
Mark_Leondires MD_RMACT	hopin...day 2-4 fsh...clomid days 5-9 and then day 10 fsh...it is a dynamic stress test of the reproductive axis.
bumblebee2006	Can you explain basal antral follicle and ovarian volume. I have not heard those terms until tonight. How are these measured? Blood?
Mark_Leondires MD_RMACT	Sarah...how old are you...You should consider IVF with PGD...you likely have a higher degree of abnormal eggs, but good fertility.
ilene	Thanks you Dr. I already understand that I am not the most hopeful case given that I am only as good as my FSH of 17.9:-(. Knowing that, what tests can I have done to reveal the ovarian volume and basal antral follicle count and will most clinics do these tests? Also, can acupuncture and Chinese herbs help me to get pregnant along with AI?
Sarah	I am 29 with one child (had her at 25) we are hoping this pregnancy will end up good however if not we are moving on (have an appoitment) with another RE because we would like to consider IVF - my RE thinks it is not neccesary since we keep getting pregnant
Mark_Leondires MD_RMACT	bumble...US...measured ovarian volume and a count of how many follicles are in the 2-8 mmm range on day 2-4 of your cycle...a visual assessment of your ovarian reserve...we like it greater than 8 we we add up both sides.
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DMKMEDCODE	doctor ---- is medication the only remedy to treat cysts if pregnancy is your goal?
Sarah	I am assuming extensive surgery has eefected my egg volume, does it mean that the quality is more likely bad? my ob-gyn thought so and refrered us however the RE says to just keep trying
Mark_Leondires MD_RMACT	TCM...acupuncture and herbs can't hurt with a respected practicioner, but no herb in cycle and we don't know about the herbs
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Mark_Leondires MD_RMACT	DMK...weight loss and exercise works in 15% of women.
mimi	Is it true that a women with high level of FSH like me, is close to menopause? I'm only 30 :(
DMKMEDCODE	will that aide in regulating the cycle?
Mark_Leondires MD_RMACT	Sarah...as long as you are getting preg you are doing better thans most, so it is reasonable simply to keep trying....it is up to you as far as how aggressive you want to be.
kaylalunaava	DR, what does clomid actually do in the CCCT and why another day 10 FSH?
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Mark_Leondires MD_RMACT	DMK...yes...inducing an endocrinlogic change and imporved ovulation.
christina75	is there an increased success rate with insemination rather than timed intercourse? I have had a pregnancy, but HcG abnormal, and it terminated itself at 5-6 weeks.
Sarah	thank you, hopefully this one will be it so we will have to go no further - good luck to all of you
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Mark_Leondires MD_RMACT	Mimi...unfort, but likely true...hard to say how early
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bumblebee2006	If the questions slow down a bit can you comment on this for me? Do you think it is odd that I responded fairly well to the Gonal-F for my multiple IUI's last year--but got absolutely no response for the aggressive IVF protocols? Also if you had a patient in my situation what protocol would you suggest when a 38 year old no other problems with an FSH of 10 has not responded at all to the the Meds in bothth a traditional IVF protocol and an aggressive IVF protocol?
Mark_Leondires MD_RMACT	Clomid tricks the brain into reading that the ovary is not working...so the brain then pushing the ovary...if the ovary can respond it keeps the fsh low...if the ovary cannot..fsh is high...
ilene	Would you recommend I ask my Dr. about doing a Clomid challenge test to get a better picture?
Mark_Leondires MD_RMACT	chris...insem has better preg rates, but not related to outcome once you are preg...
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jholbrook	Is early menopause hereditary? My Mom, her twin and my grandmother went through in late 30's, early 40's. My mom's other sister was never able to have children. I am 32 - high FSH - could this be the beginning for me?
Mark_Leondires MD_RMACT	jholbrook...yes it does have a heriditary component..sorry.
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Mark_Leondires MD_RMACT	Ilene...yes ask
mimi	does that mean that I don't have any chance to have a baby with my eggs? I was diagnosed w/ poor ovarian reserve
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Sarah	can I aks one last question - what is the difference between poor ovarian reserve and poor egg quality
Mark_Leondires MD_RMACT	mimi...there are few absolute...it may mean you need to keep trying and that our meds and technology cannot help you...don't lose hope
trutta	Does treatment with clomid any effect on mood? like mood swings or depression?
Mark_Leondires MD_RMACT	Pts can have plenty of ovarian reserve...we are able to get multiples eggs and poor quality embryos. Conversely if you have low ovarian reserve we can't get eggs so chances are lower.
christina75	trutta - it did for me
Mark_Leondires MD_RMACT	trutts..yes 20% of people have side effects.
christina75	not fun
DMKMEDCODE	thank you doctor -- goodnight
ilene	Can a woman have antibodies to the FSH assays, causing them to be innacurate? And can stress affect FSH levels. I was extremely stressed the month of the high level.
Mark_Leondires MD_RMACT	gnight
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hoping	fsh has been ok that i know of. 1 ivf switched to iui, and a early lh surge led the 2nd ivf to be cancelled. I was put on a protocol of clomid, then and now the shots, and hoping for a retrieval of
hoping	in two days. there are 6 follicles, what should the e2 be?
Mark_Leondires MD_RMACT	hoping...about...1200...
christina75	does FSH need to measured by having labs drawn or can it be monitored through watching the response by US. Is there anything that could be going on that you wouldn't see by US after the point of fertilization. I'm on Progesterone also.
Mark_Leondires MD_RMACT	Chris...labs...
Mark_Leondires MD_RMACT	don't understand the second question there are many other things going on we cannot see or know about
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Mark_Leondires MD_RMACT	bumble...have you been on a microdose luporn cycle?
christina75	I mean if the follicles measure >16 are they able to be fertilized and have the potential to implant, or could I have some hormone levels off still if I'm on Follistim, Ovidrel, and Crinone. Does that make any sense? I'm not having any labs drawn except my HcG on day 28.
hoping	i've had an opinion to be put on lupron, but my RE thought i wouldn't need more suppression. your througths?
Mark_Leondires MD_RMACT	I am confused you are on follistim and crinone at the same time...unusual
deb	I hate to be the bearer of bad news, but we have about ten more minutes of Dr. Leondires's time. If you have been lurking and yearning to ask a question, this is your opportunity.
jholbrook	side effects after failed IVF - 2 months later - currently not on any fertility drugs - I still feel like my ovaries are still "super active" - a flutter feeling from after my period until my next. Any ideas?
christina75	Crinone day after intercourse until pregnancy test
Mark_Leondires MD_RMACT	chris...but stil on follistim???
bumblebee2006	I took Lupron .025 everyday before they cancelled during my first IVF try. (Is that microdose) Doc said Lupron may have temp should down my ovaries....
christina75	day 3 until ready for ovulation trigger
hoping	can we have sex after retrieval, and how soon after transfer?
Mark_Leondires MD_RMACT	bumble...that is usu a good protocol for poor responders.
Mark_Leondires MD_RMACT	chris...please be clear are your taking crinone, follistim and ovidrel all together...in sequence is correct.
Mark_Leondires MD_RMACT	hoping....no...and usu not till preg test for sex...sorry..
Mark_Leondires MD_RMACT	jholbrook...there should be no hangover effect
christina75	follistim day 3 until mature follicles, then ovidrel to trigger ovulation, then crinone from after SI until preg test
mimi	DR please give us your phone your office phone number
Mark_Leondires MD_RMACT	offices in Norwalk and Danbury...203.750.7400...
hoping	do you think resting after retrieval/transfer makes any difference?
Mark_Leondires MD_RMACT	Good luck to you all...
mimi	THANK YOU SO MUCH
Mark_Leondires MD_RMACT	hoping...bedrest x1 day and light activity for two more
bumblebee2006	IS .025 ml everyday considered microdose?
jholbrook	Thank you Dr. Mark for your time. Good luck to all - we will be Mom's ::wub
Mark_Leondires MD_RMACT	bumble...
Mark_Leondires MD_RMACT	yes
christina75	does my med regimine not sound right? I'm worried...
bumblebee2006	Good night and thank you!!!!!
ilene	Thanks, DR. for your time and answers.
deb	As always, we are so grateful to our speaker. Dr. Leondires, you are going to need to ice down you fingers from typing. We thank you for your time and expertise.
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hoping	thank you!
Mark_Leondires MD_RMACT	yes...your med regimen is fine...now that i understand it....
mimi	that's right jholbrook!!!
trutta	thank you
christina75	ok, thanks
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Mark_Leondires MD_RMACT	Stay positive and hopeful...
deb	For all of you, we will be back next week at 8pm Eastern. In the meantime, if you aren't a "No Barriers" member of the AFA, please join now. Its free...www.theafa.org
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Mark_Leondires MD_RMACT	gnight
mimi	thank you
deb	Thanks again, Dr. Leondires. You were spectacular. We all learned so much.
Mark_Leondires MD_RMACT	::rolleyes
Mark_Leondires MD_RMACT	Deb...that was tough...I hope I did ok...
kaylalunaava	You were wonderful! Thanks a million. Very informative!
deb	As a reminder, Dr. Leondires can be reached at 203.750.7400...
Mark_Leondires MD_RMACT	signing off...
ilene	Yes, you were extremely knowledgable and gave me many more options to talk with my RE. Thank you sooo much!!! I am a bit sad about my number but I will still keep the faith....maybe good treatment and prayer will help me to get pregnant despite the odds!
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kaylalunaava	How can we read transcripts?
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sandy	scroll up there is a link
sandy	not everything is transcrbed
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