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From Low Tech To High Tech. What You Need To Know To Get Pregnant In 2008.

December 4, 2007 - Tuesday
1:07 PM to (EST)
Guest Speakers: Bradford Kolb, M.D.

Categories
Fertility Drugs • Infertility • Insurance • IVF • Pregnancy


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Melissa Thank you- I am early I know
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Corey_Whelan Hi everyone and welcome to tonight's chat. I'm Corey Whelan, The AFA's Director of Development and your chat moderator tonight. In a few minutes we will welcome Dr. Bradford Kolb, of Huntington Reproductive Center. Dr. Kolb will be on hand to help answer your questions on all aspects of infertility medicine.
Corey_Whelan Hang in there, we will be starting in about 8 minutes.
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Bradford_Kolb Hello,
Melissa Hello!
Bradford_Kolb Hello, this is Dr Kolb and I am happy to start anytime!
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Corey_Whelan Hi Dr. Kolb, welcome
Melissa Are the fertility monitors that use saliva effective?
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Bradford_Kolb Thank you ... glad to be here (forgive my spelling if I misspell anything)
Corey_Whelan quite all right!
Bradford_Kolb In regards to the fertility monitors. I still use the urinary ones, but I research on the saliva monitors looks promising. If you try it and it shows an ovulation at the appropriate time, you should be fine.
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Melissa Thank you for that answer.
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arquettej It took 3 rounds of clomid to get pregnant with #1 and six rounds to get pregnant with #2. Does that mean I can only do 3 rounds of clomid for #3 and beyond? I'm 31 but hardly ever ovulate on my own. I've been told my eggs aren't great. thanks
Melissa One other question I have, is about cevical mucus and clomid. Does clomid really adversely affect the cervical mucus that much? And if so what can be done about it?
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Bradford_Kolb Arquette, if you are not ovulatory, I think it is fine to go for 3 to 4 rounds of clomid. I will then progress to clomid with gonadotropins to keep treatment simple and costs down.
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arquettej does preseed help with the cervical mucus. Mine is pretty much nonexistent and I wonder if it caused delays in getting pregnant with clomid.
Melissa Thanks arquette! grin
Melissa Same here
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Bradford_Kolb Melissa, there is evidence that clomid adversely affects cervical mucous. It can also adversely affect the endometrial lining with persistent use. I prefer to combine clomid with inseminations to avoid this....in general no more that 3 clomid/timed intercourse cycles.
katiegirl What are your thoughts on Progesteron creams for someone that has a depleted ovairian reserve?
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Melissa Thank you Dr. Kolb. My insurance does not cover IUI. Will Preseed lubricant help?
Bradford_Kolb I am not convienced that there is anything that really helps with cervical mucous....not to push procedures, but I would go with IUI's with the clomid. Avoids the whole issue and has higher pregnancy rates associated with it.
Melissa I see.
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Melissa I have been a complete monster on clomid- My moods are terrible. Is this normal?
moaicha hello, is this a webminar
Bradford_Kolb Preseed may be OK for intercourse, but unlikely to help with the cervical mucous. You may want to change to an aromatase inhibitor instead of the clomid....less affect on the cervical mucous or the endometrium.
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Melissa Yes Moaicha
arquettej how do you favor dosing clomid 100 mg? cd 3-7 vs. 5-9 vs. 50xtwice daily vs. 100once daily? my doc doesn't seem top care if I take 3-7 or 5-9.
Bradford_Kolb Melissa, I think clomid is the worst med. While it is simple (oral), it leaves many irritable and with hot flashes.
F4vrYoung I am 30 with unexplained infertility. I have been ttc for 4 years. I have had all the tests and have found nothing wrong with me or dh. I was on clomid for a year with no result. Any advice on where to start with low cost (I have no insurance) procedures or other medications?
Melissa Yes, it affects me horribly. Thanks again.
moaicha i' just had a D&C at 7weeks after IVf is it too early for another cycle
arquettej Melissa--I took brand clomid and it was terrible. the generic has treated me better.
Melissa arquette- I am on generic and it's soooo terrible
arquettej Dr Kolb--is there any difference in function between brand clomid, generic clomid, and fertomid?
Bradford_Kolb Arquestte, I prefer to start my patients on 100mg (gets >90% ovulatory) and I use days 3 - 7. I believe it gives a better chance at having more mature eggs. Although, the data suggests days 5-9 works just as well.
arquettej Melissa--it can so different for everyone, can't it?!
Melissa Arquette - Yes it can grin
cosmiclobster Hi Dr Kolb, my wife is almost 43. We tried 2 cycles of Clomid (one with IUI) and while there were no adverse affects from the Clomid, each cycle lasted almost 2 months. Does this indicate poor ovarian reserve or something else you are aware of?
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Bradford_Kolb F4vryoung, You need to get more aggressive. Clomid for a year is counter productive and not helpful. You need to save and be willing to invest in progressing with treatment. The time delays are not worth the savings.
Corey_Whelan Hi Lisa, welcome to our chat with Dr. Brad Kolb of Huntington Reproductive Center. Please feel free to jump in at any time.
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Bradford_Kolb Moaicha, I prefer to wait 3 months after a loss to conceive again, unless you are over 38 years.
Bradford_Kolb Arquette, I am not aware of any differences in various manufactures of clomid.
katiegirl Dr Kolb, What are your thoughts on Progesteron creams for someone that has a depleted ovairian reserve
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frances1 I have had three ivf cycles - first with seven follicles that did not respond to meds, second two follicles with no eggs on retrieval and third successful with seven follicles, five grew appropriately with my estrogen level over 1000 on day 10 of meds. Five follicles were aspirated and three eggs retrieved, all fertlized, two are 8-cell and one is 7-cell. No fragmentation, and ICSI was not needed. They were frozen on day three because I have to use a gestational carrier as I had a hysterectomy. Should I proceed with the frozen cycle or try to combine a fresh and frozen and hope for another response? I am in my 40's. My first cycle was a fresh with carrier ready but not successfu which is why we tried the other two as frozen.
F4vrYoung Dr Kolb: what would you recommend as a starting point? I ovulate regularly and have no other issues and yet I don't get pg. Where do I begin to get more aggressive?
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frances1 Cost is a factor as so is my age.
Bradford_Kolb C, some women feel fine on clomid. My advise is to get into an RE and get aggressive with your treatment. Time is not on your sidde.
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moaicha it will be 3 month in january, this was my 2nd, should I try another IVF withbed rest , or it has nothing to do with my loss. Do we have a low cost IVf traetment out there
Corey_Whelan hang in there F4vr you will be answered next. Welcome sb.
moaicha I'm only 33 but have been trying for 10 years
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cosmiclobster Have you heard of Clomid making cycles last 60 days? She is quite regular without meds.
Bradford_Kolb frances1, In general I prefer fresh cycles. This is a tough one because of the costs involved.
Bradford_Kolb F, First, you need to work with and RE. Second, I would consider getting on stronger meds and combining this with intrauterine inseminations.
Corey_Whelan guys, you know you can always get a referral to a local RE by calling the AFA's helpline.
arquettej Can exercising (within your fitness level) affect implantation? While ttc, I run until I ovulate then just walk during the 2ww because I'm scared of impairing implantation. Is it a good idea to back off during the 2ww?
Bradford_Kolb F, Start with the frozens and they do not work, the go quickly to a new cycle. See if your RE will work to keep costs down.
hollie i am considering iui this month...i am currently taking 50 mg of clomid, then one 75 shot of menopur, and then one shot of ovridel, followed by the iui......i'm curious about the percentages with iui....
Corey_Whelan arguette, I can answer that - it's a ok. When you do conceive, please run with a heart monitor on and listen to what your high risk ob gyn tells you is appropriate as to heart rate levels.
stephanie I a, seeing an RE for IUI's and am having trouble with the sticks as to when I am ovulating I am concidering purchasing an ov-watch to help with that? What are you thoughts?
Corey_Whelan and no inverted poses
Bradford_Kolb Moaicha, you need to meet with your RE to see if there is anything that could be done differently to minimize a future loss. It could be tthat this pregnancy was bad to begin with (i.e. genetic abnormality that spontaneously arose)
Melissa Thank you Dr Kolb. Good luck to you all! Goodnight
Corey_Whelan bye Melissa. be well and good luck
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Bradford_Kolb Arquette, some exercise is good, but keep it light. Too much or too aggressive may be counter productive.
arquettej I did my master's thesis on exercise during pregnancy and found no data that support limiting heart rate during pregnancy, but I'm wondering about ttc...my doc's are always conservative, understandably, because they don't want to give me the full green light and then something happen.
michcole I took clomid for 7 mos, then switched doctors and found out that it was a waste of my time. I've been on injectables (150 Gonal F for 7 days) for the last year and a half. We tried 3 cycles of timed intercourse and have had 6 IUI. I just had my second laparoscopy for endometriosis 3 weeks ago and now going to try 3 more IUIs before considering IVF. IUI is not expensive compared to IVF, so it is worth it to me to keep trying as long as my RE is hopeful, which he seems to be. He found and lasered a significant amount of endometriosis this time. Do u feel we are making a good decision?
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katiegirl is my question getting through?
Corey_Whelan katiegirl, please repost
katiegirl What are your thoughts on Progesteron creams for someone that has a depleted ovairian reserve
Bradford_Kolb Stephanie, sorry, I have no experience with the watch. Have some doubts.
arquettej thanks for both answers to the exercise question.
F4vrYoung I am concerned about more aggressive treatment raising my chances for loss. I got pg after my first round of clomid,but lost the baby at 21 weeks. Is it true that more aggressive medications would increase my chances of loosing again?
stephanie thank you I will ask my RE about it
frances1 I am on 450 menopur and 150 bravelle. Ganirelex was used. Is it common to only respond to 1 out of 3 cycles at my age? Thanks for suggesting to see if my RE will work with me.
Bradford_Kolb Arquette, there have been some recent publications that show too much expercise can be a problem. No one knows how much is safe.
arquettej good I'll keep laying off then. thank you.
frances1 Also, I just keep getting older...
hollie i am curious about success rates for iui....anyone know?
Bradford_Kolb michcole, In general if I do not find success with 3 to 4 cycles on some form of treatment, I recommend getting more aggressive. Years without success is very expensive. The literature backs this approach up.
moaicha what is more aggresive than IVF with ICSI and Blastcyst transfer
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Bradford_Kolb Progesterone creams may help with luteal phase supplementation, but it will not correct any deficits with ovarian reserve (egg quality)
Bradford_Kolb F, in general no. You need to meet your a high-risk pregnancy specialist to understand why you lost the pregnancy so late and to make a plan to minimize this in the future.
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Bradford_Kolb Frances, I suspect you may have issues with declining egg viablity (quality) and this is why you are having these problems with your stimulations. Hopefully you have a good road map to follow after the last cycle.
Corey_Whelan Hi Karen and Amy, welcome.
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Bradford_Kolb unfortunately we are all getting older.....
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Bradford_Kolb Hollie, IUI's for a 20 year old are about 25% per cycle, at 35 in a healthy couple about 15% per cycle and in the 40's about 5% per attempt
frances1 Dr. Kolb, thank you for sharing your time to answer our questions. Good luck to everyone.
hollie thank you...i'm 32, my husband is 43....does iui hurt? i had an hsg and it hurt soooooo bad!!!
Bradford_Kolb moaicha, this is aggressive. I do not know all your circumstances, but you may be on the right track. the only more aggressive approach is with donor ooyctes.
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arquettej Does taking clomid along with the IUIs increase the success rate or are the rates you gave for just IUI as treatment? With those rates, I feel like skipping IUIs and going straight to IVF if this clomid doesn't work in the next few months. My husband has great sperm and the only other problem may be my barely-there mucous.
Bradford_Kolb Hollie, HSG's can hurt really badly....most IUI's are simple and only have mild pain associated with them.
Lisa Do IVF cycles typically start by taking estrogen to bring on your period?
moaicha I had 22 eggs retrieved, 15 were fertilized, 11 survived day 1, 9 day 3, and 3 were A+ for transfer @ day 6. we transfered 2, and were pregnant with twins. that's why i'm asking if bed rest help maximize my chances of keeping it.
Bradford_Kolb Arquette, these rates are for ovulatory women. The meds do not change these numbers much. In general I recomend some IUI's in women under 38 years. For those over 38, I recommend going straight to IVF....especially if you want more than one child ( you are not going to be younger the next time around).
hollie whew...thanks..i'm a little shy after that hsg!! this is my fourth month on clomid, my seconnd with the other drugs....i've really responded to the drugs...ovulation every month...but no pg....so i'm hoping that adding the iui we'll have a better chance!!
Bradford_Kolb Lisa, We often put IVF patients on pills, but these are not necessary. They help both medically and with scheduling.
Bradford_Kolb Moaicha, There is no evidence that bedrest helps conceptions rates. I prefer my patients to be "coach potatos" for several days and then to resume simple activities.
Bradford_Kolb Hollie...go with the IUI.
moaicha how many days, because my RE only recommends 24hrs
Lisa I have an underactive thyroid and take synthroid for it. Will this affect my success outcomes?
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Bradford_Kolb Moaicha, I recommend 48 hours, but there is no magic number. I prefer patients to be comfortable. I believe strict bedrest to counter-productive.
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Bradford_Kolb Lisa, if your levels are under control you should be fine. Make sure the levels get checked occationally....especially in pregnancy as the requirements will change.
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arquettej Thanks for the IUI response. So I'm 31, ovulate fine with clomid, but have already used 10 rounds in my life. Would you suggest using more clomid rounds over versus IVF? We want more than 3 kids so would probably be using more clomid in the future if we are lucky enough to have a third baby. ANd then time would be closing in because I breasfeed for one year and I know it's not advisable to use clomid while breastfeeding (or is it ok?)
hollie thank you for your time, dr. kolb.....really appreciate it!!
Bradford_Kolb Arquette, forget the clomid. you can try a few cycles of injectables with IUI or go to iVF. Clomid should not be used for more than 3 to 4 attempts.
erica for someone just starting out in the TTC process what do you suggest I do first ?
Bradford_Kolb wow....I caught up....I think.
hollie ha ha
Bradford_Kolb Erica, first, I would find an RE (not someone that does a little fertility on the side). Get a basic workup. Check the sperm, the uterus and tubes and the health of your eggs (day 3 FSH level).
erica we are waiting for insurance to go through anything we can try on our own?
Bradford_Kolb Erica....sex!
Bradford_Kolb Erica, just kidding with you a little. You can try using ovulation predictor kits and make sure your are having intercourse at the time of ovulation.
erica is there on that you think are better then the others?
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Corey_Whelan hi tubes.
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arquettej Some people may roll their eyes at this (sorry), but what do you mean forget the clomid? I can take a few shots to ovulate instead of taking clomid? Would you be in favor of me doing an IVF cycle, getting a bunch of eggs, and then using some now and freezing the rest for later use? Would that be easier than doing a bunch more of clomid rounds?
kaytee38 hello Dr. Kolb. I'm 39 and been diagnosed with low ovarian reserve (possible POF) and have had 1 cycle with injectables. This resulted in 3 follicles and IUI was performed. It did result in a pregnancy. However, miscarried at 5 weeks. My RE suggested I use DHEA (have been using it since Oct 30/07). During my last Day 3 (nov 8)...FSH=36 and only one follicle. I have been going to accunpuncture since March and have started homeopath. What would your suggestion be for what I should do next??
Bradford_Kolb Erica, the generics tend not to work as well. I would to with on of the national brands.
Lisa Is it possible for an egg to split to create an identical twin at any point in the IVF process. I feel ignorant asking, especially since I am a fraternal boy/girl twin done the old fashion way and hate when people ask me if my brother and I are identical
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sb10847 which is better, transfer of great quality embryos on day 3 or okay quality blastocyts on day 5?
Bradford_Kolb Arquette, the clomid has not worked after 10 months. To keep doing the samehting over and over without success is unlikely to work. While it is easy and inexpenisve, it is not getting you anywhere. I am OK with a few cycles of stronger meds with IUI then IVF or if you are tired, IVF is OK.
Lisa Is DHEA safe? For how long can one safely take it?
stevensracing14227 hello all
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CTJenny I'm 39 and have been trying for 3 months. How long do you recommend that I wait before trying science at my age?
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stevensracing14227 does anyone know anything about femara?? this is my wife and I 3rd month on it
arquettej I've done clomid 10x in lifetime, 3months for DD#1, 6 mo for DD#2, and last month first unsuccessful round for ttc#3. So clomid seems to work, it just takes a while and I'm wondering if it's going to take longer and longer to get pregnant with each baby...
Bradford_Kolb Kaytee, these things are OK, but they are not going to change your eggs. Are you open to donor oocytes? Your chances at a success full pregnancy is low with your own oocytes (not trying to sound mean). If you are open to donor eggs, you will have a much better shot at success.
Corey_Whelan Hi stevensracing. Your qurestion will be answered soon.
erica thank u
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Bradford_Kolb Lisa....this would be considered unethical by most. There is not data to show that it is safe.
Bradford_Kolb sb, probably the same. I would prefer the great embyros on day 3. The blasts are starting to falter in this case.
tubes I'm 33 and have unexplained infertility. we've been threw 3 cycles of ivf with great embryos and our Dr. has no idea why they won't latch on. ANY IDEAS or advice?
kaytee38 Dr. Kolb...I have no problem with donor oocytes. My RE wants to try 2 more cycles with injectables and IUI prior to trying donor oocytes. Is this wise? Or am I wasting money and more importantly time? I did get pregnant once with injectables
Lisa Dr. Kolb, Not sure what you were referring to. Can you explain? Are you speaking about DHEA?
Bradford_Kolb Lisa, DHEA is safe to use and you can use it for a long time. I do not use it so I am not aware of dosing.
Bradford_Kolb steven, Femora is an aromatase inhibitor....it stimulates egg growth. I would give it 3 to 4 cycles and then re-evaluate.
Lisa So what were you referring to when you said it would be considered unethical by most?
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stevensracing14227 thats what our dr said.... what would be the next step as he has skipped clomid?
Bradford_Kolb Tubes, this is tough. Some would consider blastocysts transfer. I take a very different approach, I put the embryos back into the fallopian tubes 24 hours after retreival and have had tremendous success (this is called a ZIFT)
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Bradford_Kolb Kaytee, This is a personal question. If your FSH was >20, then your chance of success is negligable with your own eggs.
cosmiclobster Dr, Do you have an opinio about buying frozen donor eggs?
Lisa Is Zift the newest technology?
Bradford_Kolb Lisa, I don't recall which question you are asking about.
kaytee38 thank-you Dr. Kolb
Lisa I wondered if identical twinning is possible at any point during IVF. On its own, without scientific intervention.
Bradford_Kolb Lisa....embryo splitting to create 2 embryos from one. While it happens in nature, this is very different that cutting an embryo into 2 (I would worry about the affect on the offspring).
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Bradford_Kolb Steven, injections + insmeninations
stevensracing14227 thanks doc....
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Lisa I guess what I am asking is can it happen in the petri dish, on its own accord?
bps would having a varicocele surgery for a count of 1 million help in the ivf process? is it possible that icsi could be avoided?
Bradford_Kolb cos, This is a new science, but is still very much experimental. I do frozen eggs cycles and have 10 pregnancies from patients freezing their own eggs. In regards to donor eggs....go with a fresh donor....this is the gold standard.
tubes we've had one transfer with two hatched embryos but still no luck. Our Dr. even tells me that my womb is perfectly fine.
cosmiclobster OK thanks!
Corey_Whelan folks, need to let you know we only have about three minutes left.
Bradford_Kolb Lisa, ZIFT is an old technology that many have left behind, but i have found it helpful for cases like yours
Bradford_Kolb Lisa, yes .... on its own.
Corey_Whelan I want to take this opportunity to thank you all for being here tonight and thanks especially to Dr. Kolb, for being on hand to give such great insight, advice and support. Thank you Dr. Kolb.
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arquettej thank you!
Lisa Thank you
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Bradford_Kolb bps, I would advise skipping the surgery and using the ICSI. The surgery is unlikely going to help that much.
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Corey_Whelan Folks, I need to make a request to all of you that you consider making an end of year donation to The AFA, in order to keep our chat sessions going, please. Also, do keep in mind that our message boards are open 24 7, and you can get physician advice within 48 hours.
bps thanks u very much
Bradford_Kolb It has be a pleasure. Good luck everyone!
Corey_Whelan You have no idea how important you all are to me, and how much success I wish all of you, truly.
Corey_Whelan Thanks Dr. Kolb.
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tubes thanks.
Corey_Whelan Can I also request a roll call when y'all leave of what state you guys are from?
cosmiclobster Ventura, CA
Corey_Whelan I'm typing in a Brooklyn accent, so you know.
Corey_Whelan cool. You know we're coming to San Francisco in Feb to do an all day patient symposium
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Lisa From New York or Neuuu Yawk since I am from Bklyn. too!
Corey_Whelan LOL!!!!!
cosmiclobster Hmmm, SF is only a 6 or 7 hour drive . . .
cosmiclobster see ya
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Corey_Whelan goodnight guys. sweet baby dreams.
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