High FSH and Low Ovarian Reserve

November 20, 2007 - Tuesday
12:58 PM to (EST)
Guest Speakers: Marcus Jurema, M.D.

Categories
Acupuncture • Fertility Drugs • Infertility • IVF • Pregnancy

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Moderator-DBecker	We will get things started in a few more minutes
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Moderator-DBecker	Well on behalf of the AFA, I want to welcome all of you to tonights chat with our guest Dr. Jurema of IVF NJ - tonight's topic is "High FSH and Low Ovarian Reserve" however all general infertility questions can be asked
Moderator-DBecker	as a matter of protocall, if you do not see a response to your question after a reasonable time please resend it - it is often difficult to type and read at the same time
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Chris	Dr Jurema, what do you consider High FSH?
cindy	Does one bad reading indicative of your overall ovarian reserve?
Moderator-DBecker	Hi Suzanne welcome to tonights's chat
Dr._Jurema	Cindy, usually >10 is considered high
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Moderator-DBecker	Hi Lilies welcome to tonight's chat
ivfhopeful	I had a baby girl 2 years ago, concieving naturally. When we had trouble getting pregnant again, I sought fertility treatment. When we first started fertility treatment, my day 3 FSH was 8. I had three cycles of IUI, during which time my day 3 FSH started creeping up, with the highest reading reaching 16. I will be proceeding with IVF. For my IUIs, I was on as much as 600 units of gonadotropins/day, 1/2 FSH and 1/2 FSH-LH combination. On this dosage, I produced only 3-4 follicles. My questions: Would you recommend the same type of protocol to be repeated, with/without Clomid added, or some other type of protocol altogether since I am a poor responder with high FSH? Do you think there is any merit or drawbacks of taking DHEA?
Dr._Jurema	One high reading is indicative of low reserve
meisha	I wanted to ask if you recommend combining Clomid WITH a stim, like Follisitim--does that increase the success?
Chris	My FSH was 13 at 33 and still 13 at 37, should I take it as a good sign that it hasn't changed in 4 years? I conceived twice after 33. One is my 3 year old DD and one is my deceased son, he was born prematurely at 30 weeks and lived for 6 days. I also have a 6 year old DD. Now since the birth of my son 2 years ago we have been unsuccessful in conceiving and will do a round of IVF in January.
hils	I am also interested in thoughts re DHEA, and using Clomid in addition to FSH in a poor responder with low ovarian reserve
Moderator-DBecker	Doc when you get a chance if you want - can you give your contact information
marciatmann	Hello Dr. Jurema. Is having a 16.8 FSH on cycle day 10 considered high? My FSH on cycle day 3 is 4.
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cindy	is it possible to be successful with ivf and high fsh
Moderator-DBecker	Hi flo welcome to tonight's chat with Dr. Jurema
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Moderator-DBecker	Hi Ems welcome to AFA's chat with Dr. Jurema
Dr._Jurema	Dear ivfhopeful, there is no proven protocol for improving poor response, but in general we prefer one that does not cause excessive suppression, so we prefer an antagonist or microflare protocol as opposed to a long luteal phase lupron protocol. No merit to DHEA!
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SANDY	Is BCP with IVF contraindicated for those with high FSH? If not, what is its purpose?
ShannonE	I have heard that different labs have different scales for measuring FSH which makes it difficult to see how yours stacks up against others'. Is that true?
katiey	Dr. Jurema, I was told by my RE that the first time doing IVF is the most effective but many women are only successful after multiple attempts -- Why is this? (I have 12.1 fsh and diminished ovarian reserve) I am also interested in your thoughts about DHEA. thank you.
Moderator-DBecker	Hi RM welcome to tonight's chat with Dr. Jurema
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Dr._Jurema	meisha- adding clomid was never proven to increase success, that is live birth rate
Moderator-DBecker	Hi Satie welcome to tonights chat
satie37	Hello
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Moderator-DBecker	Although tonight's official chat is on "high FSH and low ovarian reserve" all questions are welcome
Dr._Jurema	Chris, FSH has limitations, eventhough it has not changed in 4 years, we know for a fact that your egg supply has decreased with age, unfortunately
meisha	I had a baseline FSH level of 20.8 and it went down to 16 on Clomid--my first IUI failed. I am currently doing 225 iu of Follistim and we are going to do the 2nd IUI next week--do you think there is any chance with this high of FSH level?
ems31602	i was never given my fsh levels...i had ivf done in april and they told me i had 9 prior to retrieval and when i had it done there was only 3. at day 3 they were only 4 cells and everything else was "where it should be". i was told that i should try DHEA but after having progesterone shots the area where the shots were given became hived from the DHEA. Would I be considered to have low reserve because they only got 3 when they saw 9 prior?
satie37	Dr. Becker isn't it true that we never actually run out of eggs but rather our ovaries become less responsive to the hormonal signals prompting them to produce follicles?
Dr._Jurema	hils- no proven benefit to DHEA or clomid in protocols for women with high FSH or poor response
Moderator-DBecker	Satie - I am not a doctor - just a Board Member to AFA and tonight's chat moderator
Chris	With an FSH of 13 and injections of 150 ius I responded nicely with 3-4 follicles. I am scheduled to start IVF with 300 ius of Follistim. How does that protocol sound to you initially?
Dr._Jurema	marciatmann- a day 3 or day 10 FSH>10 is considered abnormal as part of a clomid challenge test
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Moderator-DBecker	Hi wanna welcome to tonight's AFA Chat with Dr. Jurema of IVF NJ
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Moderator-DBecker	Hi Joanna - welcome to tonight's chat with Dr. Jurema
marciatmann	Dr. Jurema, so day 3 or day 10 fsh reading makes no difference then?
satie37	What about other measures of ovarian responsiveness such as AMH?
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meisha	also, my DR told me that IVF would not be an option with an FSH level this high--do you agree?
Dr._Jurema	cindy, it is possible. Chances do decrease the higher the FSH. Granted some women high high FSH for different reasons- consider a 20 year old who had one ovary removed- half of her eggs are gone, her fsh increases but the other ovary probably has many good quality eggs
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Dr._Jurema	Sandy, bcps are not contraindicated, in fact some protocols claim that it helps, while others feel that they suppress you unecessarily.
asia	hi
Moderator-DBecker	Hi Suzy and Asia welcome
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flo	right now taking clomiphene and metformin what my chance to get pregnant ?
hils	Thanks Doctor - I have previously taken DHEA with no observable increase in follicle numbers!! My FSH is only 7 but at age 41 with LOR (antral follicle count 5, AMH very low + poor responder even at age 37) I have just had my best cycle (6 eggs, 3 mature, 2 fertilised by ICSI, transfer tomorrow) by doing acupuncture every second day, on a lower stim protocol (200 FSH from day 5) - but it seems to me that it is quite random as to which protocol would work best. Any thoughts re acupuncture?
Moderator-DBecker	Hi Runuke
EG	i am 43 yr old, with day 3 fsh 8.9, did one round ivf on large dose menopur 3 x225 and repronex 1 x 225 (2 times per day). had difficult retrieval with 3 retrieved, 2 mature, 1 injected but did not grow past day 2. they told me better not try another round ivf, but donor eggs or IUI. would another medication protocol be worth trying ivf again?
joanna	Hi, I'm 41 and had an FSH of 11 last Feburary. After 2 IUI attemps, I was set for IVF but then my FSH shot to 91. Is it unusual for it to jump that much so fast. My last FSH reading was in the 30's. I'm assuming donor eggs are my only option at this point.
SANDY	If your are suppressed enough from high FSH, should you use BCP? Would it be better to take it for 10 instead of 21?
Dr._Jurema	ShannonE- that is partially true- but today almost everyone is using the same lab assay to measure FSH- however, each clinic must look at their FSH threshold individually.
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EG	in addition, a recent fsh was 11.7 then back down to 8.
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Moderator-DBecker	With AFA's "No Barrier" Program - I hope all participant's to tonight chat are members to AFA
Dr._Jurema	katie-ivf may require multiple attempts simply because it does not guarantee a pregnancy 100% of the times. I am not in agreement that the 1st cycle is the most efficient simply because the second cycle may allow improvements after information is gathered from the first one. My final on DHEAS is that it does not work.
Moderator-DBecker	Hi Woodigit welcome to tonight's chat
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Moderator-DBecker	Hi to stacie, katie, arquette and olga
ShannonE	Dr. what are your thoughts on taking chinese herbs in addition to acupuncture if not taken during a cycle (I'm thinking stopping them when you are supposed to start the BC pills)? Do you have any experience with patients seeing improvements when they added herbs or only acupuncture? (My RE had a patient show great improvement after starting acupuncture.)
Moderator-DBecker	While tonight's chat topic is "Hight FSH and Low Ovarian Reserve" all general infertility questions are welcome
Dr._Jurema	meisha, there are statistics to show that once your FSH is ever >20 the chances of a live birth is virtually zero. I do think that in this case IUI may be better than IVF, though. Good luck.
meisha	Yes, I am curious about the accupuncture and chinese herbs as well-- I have been doing accupuncture for almost 2 months and have heard it really does make a positive difference--even my RE agrees
Chris	How do you feel about exercise and IVF? Does exercise affect FSH? I exercise 6 days a week. Running and weight lifting.
Moderator-DBecker	Does everyone understand the terms being used?
Stacie	Hi Dr. Jurema,
Moderator-DBecker	It is perfectly alright to ask some basic questions about this stuff
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ivfhopeful	Dear EG, may I ask how many rounds of IVF you had? Did you say that you produced 6 follicles using a LOWER dose of drugs than you had previously used? I have also tried acupuncture, but not every other day.
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Stacie	I am 35, been trying since 31. FSH 12.3, 6 miscarriages, 4 IUI's, 3 IVF's. Moving on to donor egg. Just looking for affirmation this is our next best step.
Dr._Jurema	ems31602 retrieved less than 6 eggs is considered by many a poor response, however the definition of poor response varies widely
Moderator-DBecker	Hi Dazzeee welcome to tonight's chat
dazzeee331	hiya !
EG	dear ivfhopeful: 1 round ivf only.
arquettej	I used to run marathons in my 20s and my ob said that I still don't ovulate because maybe the running aged many of my eggs and the quantity and quality is worse comapred to another 31-year old's. I've had two clomid babies and ttc #3. Is it possible that ru
Dr._Jurema	satie 37- by menopause, there are virtually no detectable eggs in the ovaries
arquettej	nnning damaged my eggs?
Chris	Dr Jurema, how many embryos do you or would you transfer back? I live in Tokyo and they are very conservative here. Hoping to retrieve 8 eggs and will only put back 2..
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Olga	Dr.Jurema, and anyone seeking hope, I am proof that a higher FSH than 20 can result in a live birth--I conceived on my first IVF, after a single high FSH of 27 (it had been normal previously, and has been "bouncing" every since--FSH on my successful IVF was 6 and I was 39
Dr._Jurema	Chris, 300IU is considered by many the maximum dose the ovaries allow to intake. However, many centers use up to 600 in women with high FSH.
katiey	Dr. Jurema, why do the number of follicles fluctuate each cycle? Why do some women get nothing in 1 cycle then get 5 or 6 in another? thank you.
ems31602	i was on 450 iu gonal-f, 6 vials of menopur 75 iu, and did BCP prior along with cetrotide during ....is that a normal response for those drugs?
dazzeee331	dr jurema.. have u ever given your high fsh patients cetrotide ? if so.. have u found that it shuts the body down for too long following a failed ivf cycle ?
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suzy	I have taken cetrotide for an ivf cycle 2 months ago and my fsh has been high since and estrogen below 10. i have taken provera to get my period. How long does it take for cetrotied to leave your system?
Dr._Jurema	marciatmann, that is correct as long as it is part of a clomid challenge test- that is how we interpret it- either a day 3 OR day 10 elevation is abnormal
Chris	arquetttej, I still ovulate and never had trouble ovulating. I can't take clomid because I already have a thin lining and clomid can thin the lining.
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hils	hey ivfhopeful, I have had my BEST response using a low dose of FSH - previously have had NOTHING on 450 and recently 3 good eggs on 200 + frequent acupuncture + chinese herbs + small dose LH
Moderator-DBecker	Hi Shaymer welcome to tonight's chat
shaymer01	thks!
Dr._Jurema	satie37- other measures are available, none by itself is a perfect predictor of outcome. AMH is a newer one and still finding its place as a predictor of egg supply. I believe antral follicle count is an important one as well
dazzeee331	i have a question regarding male factor infertility.. what do u think the chances of concieving naturally after a varicocelectomy of bilateral varicoceles ?
Chris	Dr Jurema, on top of the elevated FSH of 13, I have a very thin uterine lining. It was 6mm when I concieved my DD naturally, we know through monitoring. I then went on to conceive my DS naturally. What can be done for a thin uterine lining? My periods are so little now at about 1.5 days.
Chris	What antral follicle count do you like to see? What should I be looking for when I go in January for IVF?
EG	dear ivfhopeful: my one ivf was on a BIG dose, 775 menopur and 225 repronex 2 times a day, then increased for a couple days.
Dr._Jurema	meisha- i agree.
EG	moderator, what is DD and DS abbreviations?
ivfhopeful	Dear EG and Chris, thank you for sharing, very interesting.
EG	am i hearing that lower dose may be better?
Chris	EG Dear Daughter and Dear Son
Dr._Jurema	flo- if you have been diagnosed with PCOS and you ovulate on these medications your chances are 40% after a few months of trying as long as everything else is OK- such as sperm and fallopian tubes
EG	thank you!
hils	my understanding is that the theory is high dose might push a whole lot of useless eggs while lower dose might coax a few good ones!
meisha	Why would my RE think I should not do an IVF if it is possible to conceive with a high FSH using IVF? How many IUI's should we try w/stims before going to donor egg or donor embryo?
Dr._Jurema	hils- I agree with you. As far as acupuncture, there are no definitive studies showing that it helps but I believe in it as a technique to relieve some of the stress associated with infertility treatment
dazzeee331	i have a question regarding ewcm... i have noticed that on 4 days post ovulation ive had an abundance of clear slippery mucus.. is that normal ?
Olga	Dr. Jurema, given my history--conceived with IVF despite high FSH, do you think it is worth trying IVF again for a second child, or should I go to donor egg? I am now 42 years old, FSH varies, I had 4 antral follicles on a recent day 3 scan
dazzeee331	i am a firm believer in acupuncture as i concieved my son while doing it .. i did 6 ivf cycles and on my 6th cycle.. a frozen cycle i concieved my son
Dr._Jurema	joanna, donor eggs would be your best option at this point
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EG	dr. Jurema, did you say that one elevated FSH is indicative of low ovarian reserve. if so, what is high FSH
flo	yes i have been diagnosed with PCOS i'm on my fourth circle of clomiphene and my doc have not check on my progress since she i start taking the medication do you think i should change or not?
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Dr._Jurema	Sandy- i don't think 10 or 21 days makes a difference but I would choose 10 if I had the choice
Moderator-DBecker	Hi hilary and lorib welcome to AFA's chat with Dr. Jurema
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runuke	Dr. Jurema: I was interested in knowing what you felt would be an appropriate assay range for estradiol. I understand from the IVF perspecitive, having a good upper range >1500 pg/mL is important. But what about the lower end of the range. What is an acceptable sensitivity for IVF needs. Do you see IVF patients with estradiol lower than 100?
lorib62	hello
dazzeee331	is anyone in here suffereing from secondary infertility?
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arquettej	yes to secondary infertility
Chris	dazzeee, I am. I have 3 children. 2 living and one was born early at 30 weeks 2 years ago
hilary	Dr. Jurema- I have been told that I am not really a candidate for IVF because I responded so poorly to high doses of medication. My FSH is high and I have had 5 IUI's and took the meds for an IVF cycle recently but only made 2 follicles. Before I go forward with using donor eggs, do you think there is anything else I can try to conceive biologically?
dazzeee331	my son is almost 2 and we are trying to do this all natural.. i just cant put my body thru ivf again.. i got too overstimmed all three fresh ivf .. we are hoping that my hubbys sperm will be better now that he has had varicoceles removed
Chris	Dr Jurema, my estrodial on CD3 was 20...a bit low. What concern is that?
hils	thanks Doctor, I am in Australia and have to leave to go to work!! Will check back and read the transcript. My final comment - I can actually physically feel something going on in my ovaries in the hours after acupuncture, sounds weird I know but after 7 IVF cycles I am VERY tuned in to my body lol. And won't do any harm - so I say go for it. Cheers, Hils
Dr._Jurema	Shannon- as you mentioned I do not recommend herbs in conjuction with treatment. Using it before treatment is OK but there are no reliable information showing that it works as far as helping fertility treatment outcome. Same for acupuncture.
EG	thanks for your helfpul comments hils
dazzeee331	<<< proof that acupuncture can help lol
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Moderator-DBecker	Hi Poppi welcome to tonight's chat
Poppi	Thanks!
Dr._Jurema	Stacie-given this information it sounds like it is. Good luck.
EG	Dr. Jurema, how to interpret antral follicle count?
Dr._Jurema	arquettej- i do not believe that is so. You were simply not ovulating due to youe ovaries not receiving the right signals form your brain. The egg content should not have been affected.
ShannonE	hilary - my cousin and I are both poor responders and I (and I think she) have elevated FSH. Her 1st IVF cycle had to be cancelled because she only had one egg. My first cycle was a bust because they only got two of a possible 4 out of me and one wasn't mature and the other didn't fertilize. My cousin though got pregnant on her 2nd IVF cycle on which she only had 2 good eggs and 3 eggs total. She is about 26 weeks now. My doc told me another patient of his had a terrible cycle just like me but she started acupuncture and she wound up with 16 eggs and is now pregnant! Just thought it might be helpful...
hilary	Thanks Shannon
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Chris	Dr Jurema, is it true that miscarriage rate is higher in IVF pregnancies? If yes, why?
Dr._Jurema	Chris- I tipically transfer only 2 embryos at the blastocyst stage but would consider 3 on the day 3 stage.
arquettej	Two questions: We did 3x clomid for DD1 and 6x clomid for DD2. Should we go the full six cycles of clomiphene for ttc#3 or go to IVF after 3 rounds? I'm only 31 but have been told many of my eggs are "old" . Also is there any difference between clomid and fertomid?
ShannonE	Oh, Hilary - FYI I guess my cousin was put on a microflare protocol the second (successful) time, which is what I'm slated for my next round.
Moderator-DBecker	Hi Ross welcome tonight's AFA Chat with Dr. Jurema
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hilary	Shannon-what is microflare protocol?
dazzeee331	dr jurema.. are u seeing my questions ?
Moderator-DBecker	Welcome Hoping, to tonight's chat
ShannonE	No problem Hilary. GOOD LUCK! ::biggrin
Dr._Jurema	dazee- chances depend on the results of the semen analysis and how much of an impact the varicoceles were making
ivfhopeful	Dr. Jurema, thank you. Offhand, would you be able to point to any studies that might indicate that lower doses of stimulation produce higher quality eggs than higher doses?
dazzeee331	ty dr
hilary	Shannon- Im not sure how many more cycles I can go through unsuccessfully, its been 3 years now..thanks though. What is a microflare protocol?
suzy	Dr Jurema did you see my question?
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hilary	Dr. Jurema- were you able to see my question? Thank you.
flo	Dr Jurema did you see my question?
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ShannonE	hilary - Oh, I think it's when the suppression is shorter than other protocols? Dr. Jurema should clarify for you.
Olga	and mine?
dazzeee331	dr jurema... my hubbys last semen analysis before undergoing surgery came back at 250,000 all dead.. could that be because we took too long to get the sample to the re's office ? it was an hour car ride with the container in my bra
hilary	shannon- thank you
dazzeee331	the prior semen analysis back in feb or 2005 came back at 98 million
Dr._Jurema	Chris, thin uterine lining is a relative problem. There have been succesful conception with lining as thin as 3mm. However, if the lining is thin because it has been damaged by surgery or Asherman's syndrome then rarely anything works. If one's circulating estrogen levels respond to therapy so should the lining.
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Dr._Jurema	Chris a good AFC is at least 4 in each ovary, the more the better.
Moderator-DBecker	Hi Aglick and Kaytee - welcome to tonight's chat
Chris	Thanks, Dr. Jurema. I have had a hysteroscopy recently and the uterus looks great even after 3 c-sections! Makes me feel better about the thin lining
cindy	Dr. Jurema--what do you think of estrogen priming protocol for elevated fsh
runuke	anyone. What were some of your estradiol levels pre-stimulation. Did anyone have levels below 20?
Dr._Jurema	EG- lower doses is relative- to some 300IU is high and to others it is low. "Low dose" IVF is still not standard of care so one must be careful.
lorib62	Dr. Jurema- I have high FSH (13.8), tubal reversal and age against me. I just finished first ivf at 725 gonal f for 15 days. started with 4 follicles on left nothing on right. wound up with only 1 after first u/s. at ER nothing was recovered. Dr is talking about doing low stims to see if we can get R ovary to respond. is this too low a dose?
lorib62	sorry forgot to add the dose. he wants to do 150 gonal f
Dr._Jurema	hils- however, high doses will give the best chance that you will also harvest the good eggs in addition to a few not so good ones.
aglickpt	I am 38 and completed a recent antagon/BCP cycle that failed. I didn't respond as well as my RE would like. I have a borderline FSH and a history of mild Asherman's and Endometriosis. My RE wants to try a Microdose Lupron protocol with me. How successfull is this protocol? and is it the last "Ditch" effort before DE?
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hilary	Aglickpt-I did a microdose lupron protocol last cycle
Dr._Jurema	Olga- you might consider IVF again, at least one try before donor eggs.
aglickpt	My FSH was 12.3 last time tested (2 months ago)
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hilary	mine was 14.9 last time tested and Im only 31
Dr._Jurema	dazee- acupuncture may work fine, we just do not have enough information to suggest it to everyone yet.
aglickpt	Hilary-Have you tried Accupuncture?
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Moderator-DBecker	Hi Melsnext - there is still time to get in a question
hilary	aglickpt-I went once, didnt love it ..wasnt sure if it did anything
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hilary	Dr.Jurema- any chance you might be able to get to my question before this chat is over? Thanks so much.
kaytee38	Hi, I'm 39 and tried my first cycle of hyperstimulation via injectables (300iu gonal-f) and IUI in July. I did get pregnant but lost it at 5 weeks. Since then my FSH=35-36 at day 2, only 1 follicle. My doc told me to take DHEA to increase follicle #'s. Will this work? Also, is there anything I can do to decrease FSH? I have been going to acupuncture and taking chinese herbal tea.
aglickpt	Dr Jurema...Mine too?
Madeline	Dr. Jurema, it seems alot of people here FSH level is going throught IVF. My fsh was high and my doctor pretty much said there is no hope except donor egg. Even the fertility specialist would not consider anything else. What do you think ?
Dr._Jurema	EG- FSH>10 is indicative of low ovarian reserve. FSH>20 is indicative that fertility therapy may be futile, although around 2% of women will still conceive despite high FSH. it simply means that therapy is not very effective.
ems31602	Dr... since i responded poor, is there a different protocol i should try next time instead of the gonal-f/menopur/cetrotide?
melsnext	Wondering if after 3 failed IVFs and low ovarian reserve (age 40.5) if donor eggs should be next step
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Dr._Jurema	flo- maybe you should contact your doctor. Your doc maybe expecting that you try for longer before doing something else. I would suggest no more than 6 months.
suzy	madeline find yourself a RE how is hight fsh friendly
melsnext	BTW my FSH is less than 10
hilary	my last cycle I was taking menopur/bravelle and microdose lupron and mad eonly 2 follicles
aglickpt	I have a friend who was told DE because her FSH was over 20 several months in a row...She conceived with IUI the following cycle at 39...and then again naturally at 41 (with a husband whose count was about 150,000!!!)
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Madeline	suzy, what is an RE ?
shaymer01	There are always exceptions (miracles)...
hilary	reproductive endocrinologist
Moderator-DBecker	reproductive endocrinologist
aglickpt	Reproductive endocrinologsit
Dr._Jurema	Chris- I am not aware that IVF pregnancies miscarry more often than natural conception, but if it is true, one could explain this by the fact that those who seek infertility treatment may have other underlying problems that lead to miscarrriages compared to the general population
suzy	DR Jurema can setrotied shut the ovaries down if you have high fsh and love resreve?
suzy	cetrotide
suzy	low
Olga	madeline--I agree--get a doc willing to let you try--one doc told me donor egg so I found another one, did IVF, and got pregnant on the first one
melsnext	Dr. with a poor responder who has had 3 failed IVFs ( no implantation) normal FSH and other levels but told low avarian reserve is donor eggs the way to go now???
Dr._Jurema	arquette- I would limit clomid cycles to 12 months at the most. If there has been a suggestion of "old eggs" I would move on to IVF at once.
flo	Thank you Dr Jurema
aglickpt	Dr. Jurema-I was told only 6 cycle of clomid due to side effects later on in life...
arquettej	thank you dr. jurema
hilary	what causes premature ovarian failure or diminished ovarian reserve? I was told this at only 29
suzy	I was too hilary
Dr._Jurema	hilary- microflare is a modification protocol where lupron is used to initially stimulate tour ovaries which is then followed by other gonadotropin stimulating injections.
aglickpt	Dr. J...is this the last effort protocol? How successfule is it?
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Dr._Jurema	dazee- I am and I have sent responses!
hilary	Dr. Jurema-Im pretty sure thats what my last cycle was
hilary	suzy-what did your dr. say? What have you done?
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lorib62	Dr. Jurema- I have high FSH (13.8), tubal reversal and age against me. I just finished first ivf at 725 gonal f for 15 days. started with 4 follicles on left nothing on right. wound up with only 1 after first u/s. at ER nothing was recovered. Dr is talking about doing low stims (150 gonal f) to see if we can get R ovary to respond. is this too low a dose?
suzy	I have done iui's and tried ivf but ovulated early before ER
ShannonE	aglickpt - Thank you so much for that story. My husband has a y chromosome microdeletion and his highest count was 900,000 total. It's nice to hear of other people who have actually had success with extremely low sperm counts! ::smile
Dr._Jurema	ivfhopeful- no good studies available!
aglickpt	Shannon-Her RE was speechless when she came in PG!!
hilary	at what point do you move onto donor eggs?
ivfhopeful	Thank you so much Dr. Jurema for all your generous assistance and information.
Dr._Jurema	dazee- one hour is not too long. I think there were other reasons
Chris	Thank you, Dr. Jurema, for you help and time.
Olga	Thank you Dr. Jurema
meisha	Thank you for the great info, Dr. Jurema
Moderator-DBecker	Well, our time is just about up. On behalf of the AFA, I want to thank Dr. Jurema for taking time out of his life to share in ours. And thanks to all of our guests and participants, this was a really active and informative session. I wish everyone a safe Thanksgiving.
Dr._Jurema	cindy- estrogen priming artificailly suppresses the FSH but does not improve the underlying problem, unfortunately
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Moderator-DBecker	Good night everyone
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hilary	Ive been here for 40 minutes and my question was not even answered...
Dr._Jurema	runuke- a low estrogen level is not a predictor as long as your FSH is <10
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ShannonE	Thank you doc!
shaymer01	Ithink the questions were flying to fast.
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shaymer01	Thank you Dr. Jurema for your generous outlay of time and responses.
suzy	mine was not either
melsnext	mine wan't either
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hilary	can we contimue chatting when this is over or does this chatroom "close"?
suzy	i'm not sure
Dr._Jurema	hilary- i answered your questions- not sure why you are not getting the answers
katiegirlruss	Dr. I see your answers to hilary's questions
hilary	maybe its my computer-its going very slow
lorib62	you should be able to pull it up in the chat archives afterwards
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hilary	thank you-how do you do that?
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Poppi	Hilary, the chat transcripts hang about a week after the chat has ended.
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hilary	thank you-I will have to check that out
Poppi	good night and good luck everyone!!!!
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Dr._Jurema	good night everyone
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lorib62	where can we email you at?
lorib62	oh well
hilary	sadly I did not find that too informative..Im getting so frustrated going from doctor to doctor and nobody is able to help me
hilary	does anyone else feel that way?
lorib62	yepp
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lorib62	they all seem to push DE
hilary	and sadly thats where Im at right now is most likely going forward with DE because I dont know if there is anything else to try
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hilary	I would continue with IUI or IVF but I barely respond to even the highest doeses of meds
hilary	so what else can I do? I just want someone to answer that..
lorib62	thats why my dr is going to try low stims if that doesn't work then I guess it is DE for me
hilary	lori- if you dont mind me asking.how old are you?
lorib62	45
hilary	Im 31
hilary	and Ive been trying for 3 years
lorib62	where are you at?
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lorib62	have you consulted with Dr. Fisch at SIRM in vegas? he is high fsh friendly
hilary	I did 6 IUI's and we were going to try IVF last cycle but I barely responded to the meds...my RE said he couldnt give me any more meds safely
hilary	I consulted with SIRM in New York
hilary	they wer not very helpful
hilary	and with Cornell in NY
flo	Hi Hilary where in New York SIRM locate?
lorib62	what was your dose? I was on 725 gonal f....who did you consult with? thats surprising..what about with Zhang in NY I hear he's pretty good too....I would give fisch a call if I were you. you have nothing to lose
lorib62	its a free consult
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hilary	I will, thanks
hilary	I was taking 4 vials of menopur, 4 vials of bravelle and lupron twice a day
hilary	I was a super %%%%%
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lorib62	I was actually in a better mood on the meds then normal
hilary	flo-New York City, in Manhattan
hilary	where are you from?
lorib62	who are you asking?
hilary	I consulted at SIRM with their "head" doctor who has left since
hilary	anyone who answers I guess
flo	its free consult, i live in New York, NY
hilary	I live In NY also
hilary	in Albany
lorib62	lol..Im in mass...SHER is actually the founder. I think he splits his time between new york and vegas...you can always post a question on their websites message board
hilary	I actually have before
hilary	I used to live in MA
lorib62	I would do it again....its unusual you didnt get a response
lorib62	I emailed fisch directly and he answered within a couple of days
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hilary	I just went to a seminar in Boston on stress and infertility with Aly Domar the head of the Domar Center at Bostob IVF
hilary	I will try e-mailing again
lorib62	here is fisch's email jeffreyf@sherinstitute.com ....I went to boston ivf for a consult and didn't like them at all. never went back
hilary	thanks lori
lorib62	no problem
hilary	what didnt you like about them? I was thinking of going there for a consult
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hilary	Ive been at CNY Fertilty and Albany IVF and went for consultations at Cornell and SIRM
lorib62	I thought Dr Alper was an A**. because of my age (4 yrs ago) he said go directly to DE
lorib62	wouldn't even try anything
hilary	and you are right. everyone pushes DE
hilary	that stinks. Im sorry
lorib62	Im happy with Dr Fisch even tho Im older now and know my chances are extremely low I know he's doing everything he can to help me
hilary	I think I may have made peace with DE. I dont know how many more cycles I can go through to be honest
hilary	you have to go to vegas every time you see him?
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lorib62	I went on cd9 last cycle for my 1st ivf. of course it didn't work so this month we are doing medicated cycle at home and then jan I will go back for anpther ivf round. not really much more then I would shell out if I were doing IVF in boston cause I live on nantucket
hilary	well, I am beginning to look for a donor and we are thinking of going forward with DE in March or April-Im taking a few months off to get myself back to normal emotionally
lorib62	I can understand that. its definately difficult
flo	lorib62 would you recommend dr fisch if so can you provide me the phone and dr full name please thank you
lorib62	hilary have you checked on ivfconnections to see if anyone could help with your questions?
hilary	would you like to keep in touch lori? I could really use a friend to vent to and talk about this stuff...
hilary	no, whats that?
lorib62	his name is jeffrey fisch jeffreyf@sherinstitute.com 702-892-9696 and yes I would recommend him...www.ivfconnections.com....flo you can also check on www.haveababy.com go under las vegas....theres a message board etc there that disch answers questions too
lorib62	sure hillary lori_brude@yahoo.com
lorib62	theres an underscore between my names
hilary	mine is bcgradgirl@yahoo.com
flo	thank you for the info lorib62
hilary	yes, thanks Lori
lorib62	no problem flo..wish I would've found him 3 yrs ago...lol
lorib62	I got your addy hillary
hilary	I think I will look into him tomorrow
lorib62	check out the ivfconnections website...lots of help there
hilary	thanks so much
hilary	I should probably get going, but I hope to talk to you soon Lori...thanks!
lorib62	yepp i need to go too. DH is ready for bed...look forward to hearing more from you
hilary	goodnight everyone and good luck with everything!
lorib62	flo good luck with Dr fisch email me and let me know how it turns out
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flo	good night and thank you
lorib62	good night and your welcome
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