General Question and Answer Session

October 10, 2006 - Tuesday
3:49 PM to (EST)
Guest Speakers: Shahin Ghadir, MD
Southern California Reproductive Center

Categories
Acupuncture • Donor Egg • Endometriosis • Fertility • Fertility Drugs • IVF • PCOS • Pregnancy • Pregnancy Loss

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cbrueggie	Good evening!
michelea	Hi I guess I'm early?
cbrueggie	Yes, I think we have 7 minutes or so until it really starts
michelea	ah.
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bumblebee2006	Thank you for answering our questions tonight:-) History given first then questions at the end: Age 38- regular periods and my clearplan fertility monitor indicates that I ovulate. My "Day 3" labs in the last 6 months were: FSH 10, Estogen 30, LH 2.6 In the last 4 months both my IVF cycles were cancelled because I did not respond to the meds AT ALL - my estrogen levels did not rise at all. (estrogen never went over 20) 1st cycle was traditional 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 put my ovaries to sleep) I then waited 2 cycles to proceed to second try 2nd cycle was a protocol for low responders - BC lead in (no Lupron this time) and over 500 iu's of Gonal-f daily and still nothing happening - no rise in Estrogen. Cycle cancelled after CD6 Now my question(s) My physician now suggests running my "day 3" labs again and then try a protocal of Letrozil and Follistim (instead of gonal-f) as the new protocol. My questions for you: 1) Do you think I should wait a few more cycles to get all the medicines totally out of my system to see if my ovarians will "wake up" before trying again. (I really think the Lupron shut my ovaries down) 2)I still have ALOT of Gonal F left --but my doc wants to change to Follistim since I did not respond at all to the gonal-f. You opinion on this change from Gonal-F to Follistim? 3)Any thoughts on Letrozil for very poor responders? 4)Are there any other tests you would suggest other than the 3 day labs to determine why I am not responding to these very aggressive protocols? 5) Any other suggestions for very very poor responders such as myself? Thanks very much for any insight you can give.
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Lisa_Rosenthal	Good Evening Everyone! Please forgive my tardiness...
Lisa_Rosenthal	And please welcome Dr. Ghadir to The American Fertility Association's online session for this evening
cbrueggie	Good Evening and Welcome, Dr. Ghadir
Dr._Ghadir	Hello to everyone from Los Angeles!
Lisa_Rosenthal	When posting questions, please keep in mind that Dr. Ghadir is only one person.
plpilot	Hi Dr. Ghadir. I have a question for you. I have been diagnosed with PCOS and have not responded to clomid or femara. My RE suggested that I have ovarian drilling surgery. I was wondering what your experience has been with this surgery as far as the success rate and the rate of ovarian failure as a risk. I have insurance that covers IVF and wondered what you would think of the option to go right to IVF instead of doing the ovarian drilling.
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Lisa_Rosenthal	Hi Gili, thanks for joining us this evening.
Luly	What are your thoughts on AMH testing?
Lisa_Rosenthal	Everyone, please feel free to post questions for Dr. Ghadir, and remember that you may need to repost them as they do scroll away.
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Dr._Ghadir	Hi Plpilot, I think that ovarian drilling is a good procedure that helps many non-responders and I don't think it will cause ovarian failure.
bumblebee	Thank you for answering our questions tonight: History given first then questions at the end: Age 38- regular periods and my clearplan fertility monitor indicates that I ovulate. My "Day 3" labs in the last 6 months were: FSH 10, Estogen 30, LH 2.6 In the last 4 months both my IVF cycles were cancelled because I did not respond to the meds AT ALL - my estrogen levels did not rise at all. (estrogen never went over 20) 1st cycle was traditional 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 put my ovaries to sleep) I then waited 2 cycles to proceed to second try 2nd cycle was a protocol for low responders - BC lead in (no Lupron this time) and over 500 iu's of Gonal-f daily and still nothing happening - no rise in Estrogen. Cycle cancelled after CD6 Now my question(s) My physician is suggests running my "day 3" labs again and then try a protocal of Letrozil and Follistim (instead of gonal-f) as the new protocol. My questions for you: 1) Do you think I should wait a few more cycles to get all the medicines totally out of my system to see if my ovarians will "wake up" before trying again. (I really think the Lupron shut my ovaries down) 2)I still have ALOT of Gonal F left --but my doc wants to change to Follistim since I did not respond at all to the gonal-f. You opinion on this change from Gonal-F to Follistim? 3)Any thoughts on Letrozil for very poor responders? 4)Are there any other tests you would suggest other than the 3 day labs to determine why I am not responding to these very aggressive protocols? 5) Any other suggestions for very very poor responders such as myself? Thanks very much for any insight you can give.
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Lisa_Rosenthal	bumblebee, if you could please break these questions down so that Dr. Ghadir can answer them one at a time, that would be helpful.
cbrueggie	Dr. Ghadir, my husband and I have been using every cycle possible for the past year. We started with IVF-ICSI and then moved to IUIs with PAF. we did not get pregnant on our ivf cycle, but did with our first iui. I miscarried at 10 weeks (no heartbeat), and we have used every cycle since with iui's. My husbands counts have varied from 4 mil post wash to 33 mil post wash (14 mil pre to 86 mil pre) with morphology and motility (goes from 10% on a bad SA to 50% with a good one) both being issues. Is it possible to find out why my husbands counts fluctuate so much? is that a normal fluctuation? Our RE is suggesting we go back to ivf-icsi.
Dr._Ghadir	Hi Bumblebee, I don't hink waiting will make much of a difference, I think day 3 labs will give us more information , trying a new medication won't hurt and it may even help you a lot.
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bumblebee	Do you know of any other tests that can pin point ovarian reserve besides the 3 day FSH?
pqz	Just went through donor egg. Transferred two embryos. A blood test on day 10, the hcg number was 8. Not pregnant is a 5. What is your thought or explanation for the number. Our doctor did not give us one.
Dr._Ghadir	Hi cbrueggie, I think that going back to IVF with ICSI may be a more reasonable approach since IUI with a count of 4 million does not have promising outcomes.
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cbrueggie	would you suggest seeing a urologist who specializes in infertility first?
Dr._Ghadir	Bumblebee, a follicle antral count on day 3 will also tell you about haw your reserve look!
baby2be	Hi Dr,
Luly	Dr. Ghadir - What are your thoughts on AMH testing ?
bumblebee	How would changing from Gonal F to Follistim make a difference - Aren't they the same exact medicine just different brandnames?
michelea	thanks for being here Dr.... What are your opinions on PGD to address multiple (2) miscarriages (very early, one after IUI with blood clotting problem discovered at 6 weeks) then 2 failed IVF's (negative beta). I'm 42, husband is 38.(no known sperm issues, good ovarian hormones, lining good) transferred 2 of 13 embryos after PGD. thanks.
baby2be	I just had my first preg after ttc for 22 cycles and it resulted in a d&C at 8 weeks. I am going in for endometriosis surgery after my next cycle so we can start ttc again.
Dr._Ghadir	Hi pqz, by definition that is a chemical pregnancy or left over hCG from your hCG injection that has not cleared from your body yet.
Lisa_Rosenthal	Dr. Ghadir, thank you for joining us this evening and answering all our complicated questions!
baby2be	Is endometriosis a cause of miscarriage?
rebecca	Dr. Ghadir... My husband and I have been tryinc to concieve for 1 year 6 months. I did get pregnant once early on when we were trying naturally. I then miscarried. After trying for a year we went to an RE and I was diagnosed with PCOS. I have done four rounds of IUI. Three with Clomid and one with gonal-f. QUESTION: What does the PCOS do that makes it harder for some woman with it unable to concieve?? In our case, no other issues have been found.
Gili	Hi Dr., when is a good amount of time to think about a second opionion?
Dr._Ghadir	Hi Michelea, PGD can give you a lot of important information after multiple pregnancy losses and I think is a good idea.
pqz	I was not told to take an HCG shot being a donor recipient. Was I supposed to under protocol?
Lisa_Rosenthal	Rebecca, it probably is a good idea to post your age to go along with your question.
Dr._Ghadir	Hi baby2be, endometriosis is not a true cause of miscarriage
rebecca	Thank you, Lisa. I am 30 and my husband is 34.
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Lisa_Rosenthal	Billdeid and wannababy, thanks for joining us this evening with Dr. Ghadir...
Dr._Ghadir	Hi Rebecca, PCOS has underlying problems with insulin and high levels of male hormones, has your RE talked to you about trying Metformin along with clomid?
Lisa_Rosenthal	Please remember that The American Fertility Association has message boards that are moderated by professionals on a daily basis and FREE membership through our
Lisa_Rosenthal	"No Barriers" membership
rebecca	Yes, I am on Metformin and have been since seeing the RE 9 months ago.
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Dr._Ghadir	hi pqz, then it is most probably a chemical pregnancy, and no you were not suppose to get hCG
baby2be	Hidr, how soon does endometriosis tend to "grow" back? My RE sugggested we start our fertility treatments after surgery because we have a small window to ttc before it tends to grow back.Thx
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Dr._Ghadir	Rebecca, what does of metformin are you on? do you ovulate with this current regimen?
wannababy	Dr Ghadir, how many failed Chlomid cycles before I should think about IVF?
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Dr._Ghadir	Any more questions? Does anyone need more explanation to something I answered earlier?
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Lisa_Rosenthal	Sanders, Kayalunaava and christalp, thanks for joining us this evening. Please feel free to post questions for Dr. Ghadir, keeping in mind that he is only one person.
katie	Thanks for doing this, Dr. Ghadir. I had a failed IVF last month, infertility with unknown causes, and the dr said that my 2 embryos that were transferred were "moderately fragmented" and wants to add Repronex to my Follistim/Lupron regimen. Does that sound like a great idea? If not what should I do? I'm 34.
billdeid	I am 36 and have been to 2 Fertility Specialists and have had an HSG that explained my problem - my tubes are blocked due to scar tissue from an old surgery. I know of several people that have had their tubes cleared out through laproscopy and have had successful pregnancies. The specialists I have gone to want to go straight to IVF - I would really like to try laproscopy but that are feel that I should do IVF - I am not sure if I am going to the right doctors or if I should find someone that would try this first - could you give me your thoughts on this - thanks!
cbrueggie	is there any way to find out why my husband's counts fluctuate so much, or is taht a normal fluctuation? (post wash high of 33 mil, low of 4 mil)
wannababy	wannababy: Dr Ghadir, how many failed Chlomid cycles before I should think about IVF? christalp has joined
baby2be	Hi Dr, how soon does endometriosis tend to "grow" back? My RE sugggested we start our fertility treatments after surgery because we have a small window to ttc before it tends to grow back.Thx
rebecca	I take 3 a day at 500 each day. I ovulate with Metformin but I ovulated before taking Metformin. However, my RE said it would shorten my cycles - younger eggs.
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pqz	We were transferred two 1aa embryos, lining was "perfect" yet no pregnancy. Thoughts?
Lisa_Rosenthal	Dr. Ghadir has temporarily left, he will be back in a moment or two.
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Lisa_Rosenthal	katie: Thanks for doing this, Dr. Ghadir. I had a failed IVF last month, infertility with unknown causes, and the dr said that my 2 embryos that were transferred were "moderately fragmented" and wants to add Repronex to my Follistim/Lupron regimen. Does that sound like a great idea? If not what should I do? I'm 34. billdeid: I am 36 and have been to 2 Fertility Specialists and have had an HSG that explained my problem - my tubes are blocked due to scar tissue from an old surgery. I know of several people that have had their tubes cleared out through laproscopy and have had successful pregnancies. The specialists I have gone to want to go straight to IVF - I would really like to try laproscopy but that are feel that I should do IVF - I am not sure if I am going to the right doctors or if I should find someone that would try this first - could you give me your thoughts on this - thanks! cbrueggie: is there any way to find out why my husband's counts fluctuate so much, or is taht a normal fluctuation? (post wash high of 33 mil, low of 4 mil) wannababy: wannababy: Dr Ghadir, how many failed Chlomid cycles before I should think about IVF? christalp has joined baby2be: Hi Dr, how soon does endometriosis tend to "grow" back? My RE sugggested we start our fertility treatments after surgery because we have a small window to ttc before it tends to grow back.Thx rebecca: I take 3 a day at 500 each day. I ovulate with Metformin but I ovulated before taking Metformin. However, my RE said it would shorten my cycles - younger eggs. Dr._Ghadir has left. Lisa_Rosenthal: Dr. Ghadir has temporarily left, he will be back in a moment or two. pqz: We were transferred two 1aa embryos, lining was "perfect" yet no pregnancy. Thoughts?
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Lisa_Rosenthal	Sorry Dr. Ghadir, there are a few questions in there
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Lisa_Rosenthal	Ladies and gentlemen, while Dr. Ghadir sorts through what I reposted, please remember that keeping your questions a little shorter will make it easier for Dr. Ghadir to read and understand. You can always ask a follow up question
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kaylalunaava	Dr, is a lining of 14 mm to thick for implantation?
Dr._Ghadir	Hi Katie, adding repronex will not really make your embryos worse, nor better, but I don't think that it can hurt. I would try it!
katie	thanks--what can improve embryo quality, then?
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Lisa_Rosenthal	Hi Hoping, thanks for joining us this evening
Dr._Ghadir	hi billdeid, I don't think that any procedure with laparoscopy will give you perfect tubes for natural conception, but I am not sure how bad the scaring is. I think for bad scarring IVF would be safest and most helpful.
rebecca	Dr. G. I take 3 Metformin a day at 500. I do ovulate with Metformin but I was ovulating before taking it. My RE suggested that it would shorten my cycles - younger (better) eggs.
pqz	Do you recommend any additional tests for a patient with hashimotos going through donor egg?
hoping	almost missed it! just wondering if there are things I can eating, before/after transfer, which is on Thursday, to help things go well? and OK for massage and acupuncture before transfer?
Dr._Ghadir	Hi cbrueggie, I am not sure why the sperm fluctuates so much, think back about 74 days prior to see what he was doing and I recommend he sees a urologist.
julie	Dr Ghadir - What is a clomid challenge test?
Lisa_Rosenthal	hoping, acupuncture, particularly has been found to be beneficial in quite a few very well respected studies
cbrueggie	the only differences were with eating taco bell, french fries and drinking beer. could that affect it?
Dr._Ghadir	Rebecca, that is a good doese and you are right, metformin is given even to people that do ovulate and it helps the body become more sensitive to the available insulin and this helps egg quality
pqz	Does low blood sugar have any effect on IVF?
hoping	Lisa, before or after transfer with the acupuncture?
Dr._Ghadir	pqz, don't have any thought about why they did not take, but I would need much more information
Lisa_Rosenthal	cbrueggie, there are no studies that I am aware of linking fast food with a lower sperm count. Certainly, you would want to do everything possible to maximize your chances. Not so sure the beer is a great idea.
hoping	how about high blood sugar's effect on IVF?
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kaylalunaava	When should Lupron be started, on the follicular phase or Luteal phase? After BCP of 21 DAYS, My RE wanted to start me on Lupron ON THE 19TH DAY, 3 DAY OVERLAP WITH bcp?
cbrueggie	Lisa, thanks, I'll make sure to tell him! (and he'll live longer, too!)
Lisa_Rosenthal	hoping, does your REI work with an acupuncturist?
cbrueggie	thank you for your time, Dr. Ghadir!
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hoping	they say it is OK, but don't actively recommend it
christalp	My husband had a semen analysis...it was normal except for motility at 35 and morphology 42% normal and 58% abnormal. Can we still get pregnant?
baby2be	Hi Dr, how soon does endometriosis tend to "grow" back? My RE sugggested we start our fertility treatments after surgery because we have a small window to ttc before it tends to grow back.
Dr._Ghadir	Hi kayla, some people think that a lining too thick is not good, but as long as there is no abnormality to the cells groing (ie cancer) I have seen many pregnancies with thicker linings
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hoping	ok to be on your feet several hours a day post transfer?
Lisa_Rosenthal	kathrynbanke, welcome to The American Fertility Association's online session with Dr. Ghadir... please feel free to post questions.
Dr._Ghadir	hi pqz, I would recommend an endocrinologist to evaluate someone with Hashimotos
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ctina	Hello, this is my fourth IVF and my first pregnancy, I just started to experience some brown spotting on and off for two days. I am 5 1/2 weeks pregnant and I just had my first ultrasound, I started bleeding after that. I am just wondering if this brown bleeding is normal.
rebecca	Thanks you Dr. Ghadir.
Dr._Ghadir	Hi Hoping, I don't think what you eat will matter, try something tasty to make you feel good!!! masage and acupuncture are great and acupuncture can even be helpful
pqz	What percentage of embryos (Blastos) typically make it through the thawing process?
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hoping	thanks. the day before or the day of, for acupuntcure?
Dr._Ghadir	hi julie, a clomid challenge test is a clomid cycle that tests FSH levels on 2 separate days and these numbers are helpful in looking at the yuouthfulness of your ovaries
Lisa_Rosenthal	hoping, it's used at both times or just before or after, depending on your practioner
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kf220	Hello. I'm joining late so I apologize if this was already addressed. My question is about high fsh. I am 32 and just found out my fsh is 15.6. I have a 15 month old son conceived through ivf. my doctor told me IVF won't work for me now with the high fsh. Have you seen success cases in women under 35 with fsh in the 15-16 range? Thanks.
julie	I have been using one of those clearplan electronic fertility monitors to use while I am saving for my next IVF. It indicates that I ovulate. However I am concerned because I heard that if you are peri menopausal ( I am 39) it could give a false reading due to a false LH surge? Have you heard of a false LH surge for older women such as myself?
esulli	Hi Dr. Ghadir. I had a fresh IVF cycle that we got pg with in the summer, but ended up with a missed ab and a D&E on 8/15. After 32 days of spotting post-op and now 8 weeks, I still haven't gotten a period. To make things more confusing, I have had 3 positive hpts this week! Could this be residual hcg still or a true pg? So frustrating b/c I am waiting for a period to have a frozen cycle. Thanks.
Dr._Ghadir	Hi pqz, I don't think a normal level of blood sugar on the lower end can be hurtful, but an abnormal level is probably not helpful
katie	thanks--just one follow-up question from me: what improves embryo quality, then?
Lisa_Rosenthal	I hope you are all aware of the varied message boards that The AFA has, including medical information from physicians, adoption experts, peer support and pregnancy support
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Dr._Ghadir	Hi Hoping, I have see people do acupuncture both before and after the transfer with good results
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hoping	first IVF and trying to maximize our chances! thanks for your help
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Dr._Ghadir	I am back
Lisa_Rosenthal	kf220: Hello. I'm joining late so I apologize if this was already addressed. My question is about high fsh. I am 32 and just found out my fsh is 15.6. I have a 15 month old son conceived through ivf. my doctor told me IVF won't work for me now with the high fsh. Have you seen success cases in women under 35 with fsh in the 15-16 range? Thanks.
pqz	welcome back doctor. We appreciate your help.
Lisa_Rosenthal	julie: I have been using one of those clearplan electronic fertility monitors to use while I am saving for my next IVF. It indicates that I ovulate. However I am concerned because I heard that if you are peri menopausal ( I am 39) it could give a false reading due to a false LH surge? Have you heard of a false LH surge for older women such as myself?
Lisa_Rosenthal	Dr. Ghadir, you are doing an awesome job, especially given the technical problems. Anyone else having them?
hoping	ok here
Dr._Ghadir	Hi kf220, I have seen successful cases and I would not go straight to egg donor yet.
kf220	Thank you!
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Dr._Ghadir	Hi julie, I have not heard of false elevated LH in older women, if any thing it usuallu goes down with age.
Lisa_Rosenthal	Hi Dr. Ghadir. I had a fresh IVF cycle that we got pg with in the summer, but ended up with a missed ab and a D&E on 8/15. After 32 days of spotting post-op and now 8 weeks, I still haven't gotten a period. To make things more confusing, I have had 3 positive hpts this week! Could this be residual hcg still or a true pg? So frustrating b/c I am waiting for a period to have a frozen cycle. Thanks.
ctina	Hello sorry I joined so late I am just very nervous, this is my fourth IVF and my first pregnancy, I just started to experience some brown spotting on and off for two days. I am 5 1/2 weeks pregnant and I just had my first ultrasound, I started bleeding after that. I am just wondering if this brown bleeding is normal.
julie	If I do a clomid challenge test -- would I also be able to do an IUI during the cycle of the clomid challenge test?
Lisa_Rosenthal	Ctina, that kind of spotting is so very commong. Nothing reassuring about it, but very, very common.
Lisa_Rosenthal	Often, it can be implantation bleeding.
Dr._Ghadir	Hi Lisa, you should have an ultrasound evaluation of your uterus to see why you are spotting
Lisa_Rosenthal	ctina, that's to you, I'm sure!
Lisa_Rosenthal	Actually, that's to esulii, I posted a question for her
hoping	I need to have an ultrasound of my abdomen for abdomen pain, but now the transfer is here, and I don't want to slow the process. Your thoughts?
christalp	I have been using clomid for the last 8 months. Two months ago my RE increased it to 100mg days 3-7 of my cycle. I am also on metformin 500mg in am and 1000mg in pm. The past two months I have had mid cycle us and estradiol levels followed by hcg injection. How many times should this be done before moving on to IVF?
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Dr._Ghadir	Hi ctina, spotting after an ultrasound occurs, so don't panic, many healthy pregnancies have spotting
ctina	Thank you, i was wondering if it is implantation bleeding, how long does that last for?
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Dr._Ghadir	Hi Hoping, I would consult your RE about what to do next
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Dr._Ghadir	IHi christalp, I think 8 clomid cycles is enough and you need to move on
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pqz	Thank you for answering our questions.
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Lisa_Rosenthal	ctina, the pregnancy to parenting message board is perfect for you
Lisa_Rosenthal	being pregnant after infertility is a challenge, different from treatment
Dr._Ghadir	I am back, again!!!
katie	sorry to be a pest, but this is the third time i'm asking this question and I was kind of hoping for an answer: what do you think will improve embryo quality?
Lisa_Rosenthal	I spotted through my entire first two trimesters
kaylalunaava	Hi Dr, when in the cycle is Lupron started, in the follicular phase or Luteal Phase? My RE started me on 21 days of BCPs and Lupron starting on the 19th day. Is that the luteal phase already? A little confused.
christalp	what exactly is ovarian drilling? will that increase my chance of conceiving?
Lisa_Rosenthal	katie, you are not being a pest, thank you for reposting your question.
Dr._Ghadir	Hi katie, unfortunately nothing can improve your embry quality, but being at a very good embryology lab that uses the best technology can help the process
ctina	ok I'll check it out, yes I kinda got used to how i feel during treatment but pregnancy is even more stressful, but hope fully it is normal and maybe the spotting was from the ultrasound. thanks again for all your info and personal experiences! thanks
katie	thanks to you and Lisa!
Dr._Ghadir	Hi Kayla, Different protocols start lupron at different times, but yours sounds like a good protocol
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hoping	thanks Dr Ghadir and Lisa.
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pqz	What percentages of embryos (blastos) make it through the thawing process and do the lose grading or typically stay they way they were frozen.
Lisa_Rosenthal	It's our pleasure to be here... Thank you to all of you for joining us this evening.
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Lisa_Rosenthal	We are so thrilled to have such a wonderful physician as Dr. Shahin Ghadir from Southern California Reproductive Center...
hoping	what should we be looking for as we hear of the grades of our embryo's?
Dr._Ghadir	Hi christalp, ovarian drilling is a procedure that makes holes in the ovarian capsule during laparoscopy and it is supposed to decrease male hormone production from the ovary and help egg quality
chillywilly	what is the percentage chance of IVF working when there is male factor?
wannababy	Dr. Ghadir, could you tell us your phone number?
christalp	thank you dr.
Lisa_Rosenthal	Please do post your phone number and contact information, Dr. Ghadir
Dr._Ghadir	hi pqz, there is no way to answer that question not knowing the prior quality of embryos and the lab environment
Teresa	What range should your FSH be after taking Follistim
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Dr._Ghadir	Hoping, grades such as A's and B's are good, but ther are many differnet grading processes and scales used around the country
chillywilly	Hi Dr. what are the chance of IVF succeeding when it is the male facter?
Lisa_Rosenthal	Ladies and gentlemen, the only way we get such wonderful speakers is by promising them that they will be off in one hour, sharp. That leaves us about 5 minutes. Remember that we have very active message boards that you can post on and get individual questions answered.
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hoping	signing off. thanks.
chillywilly	Thanks Lisa
Dr._Ghadir	hi chillywilly, you really need to know more about the sperm problem and also the female as well
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pqz	If the quality are a's and b's, do they typically stay there and what do you mean by lab enviornment? I would think the Lab protocol would be similar at various fertility centers. Is this not true?
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chillywilly	thanks Dr.
Gili	thanks for being here doctor. night
Dr._Ghadir	Hi Wannababy, my office number in Beverly Hills, California is 310-277-2393
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chillywilly	Husband has low count and low motility, female normal, Had endo on ovary, removed endo,
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Dr._Ghadir	pqz, I mean that every lab is differnet in the medium that they use and how well the lab is run
wannababy	Thanks again Dr, this was great. night lisa
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pqz	Thank you for this evening.
Dr._Ghadir	Hi Chilly, with low numbers ICSI may be helpful!
Dr._Ghadir	pqz, you are very welcome, good questions!!!
Lisa_Rosenthal	pqz, our pleasure. Thank you for joining us
chillywilly	we are suppose to do IVF first time next month, nervous and excited...lots of questions.
chillywilly	thanks to everyone
Lisa_Rosenthal	Dr. Ghadir, you did a wonderful job. Thank you so much for all your time and attention.
Lisa_Rosenthal	I hope that you will join us again sometime?
Dr._Ghadir	Chilly, good luck!!!
chillywilly	thanks Dr. Ghadir
Dr._Ghadir	I would love to do this again, it was FUN!
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Lisa_Rosenthal	Dr. Ghadir, didn't we tell you that it would be? Except for the sore fingers from typing so fast!
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Lisa_Rosenthal	Please join us next week for the online educational session
Lisa_Rosenthal	and feel free to stop by our message boards inbetween
Lisa_Rosenthal	Dr. Ghadir, thanks again for your time and expertise and compassion this evening. It's rare to get all of that with one person.
Lisa_Rosenthal	Good night all...
Dr._Ghadir	Good night everyone!
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Lisa_Rosenthal	you are all welcome to hang out and chat
Lisa_Rosenthal	I just had to let the doctor off the hook here
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Lisa_Rosenthal	Good night all...
	Lisa_Rosenthal left.
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