Improved Success in Women Over 38, and Repeat IVF Failure Using Co-culture
July 10, 2007 - Tuesday
5:38 PM to (EST)
Guest Speakers: David Kreiner, M.D.
East Coast Fertility
Categories
Acupuncture •
Endometriosis •
IUI •
IVF •
Pregnancy •
Pregnancy Loss
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| Corey_Whelan | Hi everyone and welcome to tonight's chat. Our scheduled speaker is Dr. David Kreiner of East Coast Fertility. He will be discussing egg quality and maternal age and their link. |
| Corey_Whelan | I'm Corey Whelan, The AFA's Director of Development and your chat moderator tonight. Dr. Kreiner should be here shortly. |
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| Corey_Whelan | Sorry he seems to be delayed folks. Hang in there please |
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| Corey_Whelan | Welcome Dr. Kreiner! Folks, please feel free to ask your questions of Dr. Kreiner |
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| ghelweh | are you aware of any 45 year old women having a baby using her own eggs? That's my situation and we have IVF planned for next month |
| cjm | Is there any way to test your egg "quality"? I've already had my FSH tested and it's pretty good, but I've had 2 miscarriages in a row. |
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| JADE0199 | Hi I've also had 3 early m/c's and a chemical pg. I will be 37 in August |
| Dr._Kreiner | I have had 45 yr olds have babies through IVF but they are a great challenge with much greater odds against them. Best of luck |
| irene | Hello Dr can you please explain CO CULTURE |
| Dr._Kreiner | Egg quality can be assessed indirectly by microscopic inspection and PGD. But as they say the proof is in the eating of the pudding. You really dont know unless you see outcomes with IVF. You cannot assess directly. |
| JADE0199 | After everything I have read and learned, mainly from my own experience, FSH does not indicate the quality of a woman's eggs, possibly only reserve. Is this true? |
| Dr._Kreiner | Jade. That is incredibly bad luck so it is worth investigating a medical reason for this |
| alp | Hello Dr. Kreiner, I am 45 yrs old and got pregnant three mos. ago spontaneously but had a miscarriage six weeks after conception. Two questions: is the miscarriage likely due to poor egg quality AND what is the probability of having other healthy eggs for future pregnancies? |
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| mara | hi |
| mcox | Dr. Kreiner, I'm 43 and recently completed my 4th IUI. In the most recent cycle, there were 2 follicles of 20, and I was told that I had the progesterone of a 20-year old. I'm meeting with the doc next week to discuss other methods as I have 2 vials of sperm remaining. I gave birth to a very healthy baby at 41 in 2005. Any suggestions? |
| Dr._Kreiner | FSH is a marker for the number of eggs not quality. In 1985 Dr. Georgeanna Jones told me to look at early follicular phase FSH to get an idea of ovarian reserve. This is the value of FSH |
| Corey_Whelan | Let's let Dr. Kreiner catch up, please. Hold your questions till Jade and alp have their answered. |
| kidake | I'm having IVF this month and also elected to have the PGD. Are you saying they'll be able to give me details about my egg quality? |
| JADE0199 | Had a full fertility workup with RE in Oct 06. Just did my first IVF w/PGD in May. Cancelled PGD on day 2 b/c only had 4 embryo's by Day2 that were only 2 cell. Total # of eggs retr'vd 9, 7 fert- 3 had 3 pronuclei and 4 appear normal. We transferred 2 embies, 1-7 Grade 2 and 1-5 cell grade 1. Ended in a Negative. |
| Dr._Kreiner | At 43 I would be aggressive with IVF. Time is running. We are doing well with coculture and embryo glue in this group |
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| Dr._Kreiner | im doing ok i think corey |
| AmandaUNCC | can you please explain what co culture is |
| Corey_Whelan | I think so too! |
| ghelweh | is there anything additional beside typical IVF procedures you would recommend for a 45 year old to do? |
| Dr._Kreiner | no. kidake. PGD will reveal 60% of chromosomal abnormalities. It may be useful if you have a lot of embyros with regard to saying something about your eggs in general. Otherwise, not very much |
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| jackjoe | Dr Kreiner have you seen women with FSH 14 to 16 have success with IVF. I am 36 years old. |
| mara | doctor i did i am 34 my FSH is 9 6 antral follicle i did one IVF but 10 follicle appeared then only 3mature and 8 eggs retrived only 2 ebrios on day 5 was transfered. it was not success. what can i do to make it more success this time does it mean i have poor egg and my time for getting pg is diminishing? i wanted to do assisted hatching does it improve the chances? |
| mara | thank you |
| Dr._Kreiner | jade, some people get pregnant from those transfers. you have potential. cant say any more about that. |
| dc | Is age the sole factor in egg quality? Is it possible to be in your early 30s and have poor egg quality? |
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| JADE0199 | With all of that said, we are moving onto Donor Egg now. |
| Dr._Kreiner | amand coculture is growing a different cell line in conjunction with your embryos. We use the granulosa cells obtained at retrieval |
| AmandaUNCC | dc. I'm 28 and have poor egg quality |
| Dr._Kreiner | thanks corey |
| mara | i took 400 puregone for 12 days was it a ling protocol and bad one? can i change it |
| JADE0199 | Just wondering if you agreed that I may have poor egg quality? |
| irene | Can you please explain CO CULTURE |
| rogpic | Can poor egg quality be enhanced with the right med protocol? Is metformin helpful? I am 34, have had recurrent miscarriages and 1 success with PGD, but am now being told that my chances are slim due to poor egg quality. |
| Dr._Kreiner | ghelweh sometimes IUI works as well as IVF in 45 yo. sometimes its just time to try DE |
| AmandaUNCC | so what are the benefits to co culture? |
| cjm | I'll be 38 in Nov. I've already a recurrent preg loss panel done, as well as genetic testing for my husband and I and everything has come back normal. I've already done 6 Clomid cycles, 3 of them with IUI (1 resulted in pregnancy w/ early miscarriage). I'm now debating between doing injectibles w/ IUI or just going straight to IVF. I'm very concerned about the risk of multiples w/ injects/IUI so I'm also considering doing a "low dose" injects/IUI cycle. Any suggestions? |
| Dr._Kreiner | yes jack joe it is important to remember FSH reflects number not quality |
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| alp | Hi, I think my first question may have been missed - I'm watching the string of questions and I didn't see a response - Thx |
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| Dr._Kreiner | mara, there are factors that your doctor knows about you that may be helpful. we use coculture successfully in pts with prior failure |
| JSGB | What is embryo glue? |
| mara | what is coculture? |
| sflower | What does anti -mullerian Hormone test cmpared to FSH? Is it useful in your opinion? |
| mara | and what is pts? |
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| Dr._Kreiner | dc age is very important to egg quality. Fact is you can be young with nml FSH and still have poor egg quality. sometimes dont know unless do IVF |
| Dr._Kreiner | mara i am unable to comment without seeing your stim sheet and examining you |
| Dr._Kreiner | jade, im sorry but you may. |
| dc | Does this mean that IVF should be pursued aggressively in order to evaluate egg quality? |
| mara | Waht question will you need to be answered for that but generally is assisted hatching helpful? |
| JADE0199 | Yes, thank you for answering. That is what we were thinking, my husband and I. |
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| irene | Hi can Metphormin help with egg quality and how long should it be taken to see results? I have also heard that accupunture can help egg quality? |
| Dr._Kreiner | irene coculture again is the growth of a cell line along with the embryos. we use granulosa cells obtained at retrieval |
| irene | THANKS |
| jackjoe | Dr. Kreiner Thank you, Also I am wondering if I should do IVF now I only did two rounds of IUI. I had stage 4 endo? |
| Dr._Kreiner | i think stim can help improve quality. metformin should be helpful with patients with glucose intolerance |
| rogpic | Is there anything that can be done during a cycle to improve a thin lining? |
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| mara | should i ask my doctor if they do COCULTURE? |
| Dr._Kreiner | in our experience coculture improved implantation and pregnancy rates by improving growth and development of the embryos |
| JADE0199 | Do you think that 9 eggs retrieved is good, average? other? |
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| jackjoe | what is stim sorry? |
| gertyrae | What are the advantages of coculture? |
| Dr._Kreiner | embryo glue is a culture medium which appears to improve an embryos ability to adhere and implant |
| mara | my docotr says that the result with assited hatching or without it are the same no need to do it but what do u think? |
| Dr._Kreiner | dc it depends on your case. I would speak with a doctor familiar with your case |
| JADE0199 | Who decides when to use co culture or embryo glue? The RE? |
| gandhl | One clinic told us endometrial cells were better to use for co-culture... what are your thoughts? |
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| Dr._Kreiner | we use assisted hatching with previous failures, women over 38 and thickened zonae |
| Dr._Kreiner | metformin should be helpful if you have glucose intolerance. Acupuncture might be helpful |
| thornj | I had 3 failed IVF's with ICS in my mid 30's, I am now 43 and seeing the RE tomorrow. Will you explain aggressive IVF? |
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| Dr._Kreiner | i would do Ivf jack joe with stage 4 endo |
| dc | what was the reason for the failed IVFs thornj? |
| JADE0199 | I've just started acupuncture. do you think it will help improve success with my DE transfer in October? |
| thornj | I was told unexplained IF. All egg quality was good each time. Husband has poor sperm |
| Zimmy | What is a DE transfer? |
| Dr._Kreiner | rogpic it is very difficult to improve lining. i am sure i do same things your doc does sometimes with success. maybe they didnt try gonadotropins which works sometimes or natural cycles\ |
| Dr._Kreiner | stimulation sorry |
| JADE0199 | Zimmy - Donor Egg transfer. |
| Zimmy | Thx |
| Dr._Kreiner | 11 eggs is average |
| Dee_Dee | What are the pros & cons of using a 3 day old versus a 5 day old blast (fertilized embryo)? |
| mara | docotr i have a small endometrioma for 2 .7 sm the docotr says it is too small and i did one IVF with it. now before proceeding to the second one i want to take contraceptives to stop the groth before i go for second IVF is it possible and when should i stop before second IVF? |
| JADE0199 | Thank you. Re said 9 was average. I wassn |
| dc | 11 eggs retreived or 11 fertilized |
| Dr._Kreiner | coculture improves growth and development of embryos resulting in improved implantaiton and pregnancy rates |
| JADE0199 | wasn't impressed with 9. only 4 fert. That's why we have chosen to move on. |
| Dr._Kreiner | we discuss it with all our patients with previous failure or over 38 |
| JADE0199 | Dr. why is it that some women in they're mid 30 |
| Dr._Kreiner | high dose, no suppression, embryo coculture, glue assisted hatching = aggressive IVF |
| dc | mara i had an endometrioma cyst removed by laparascopic surgery. Just finished my first failed IUI. Was the reason for the failed IVF the endometrioma? |
| JADE0199 | 30's - 40's can get pregnant without any problems, and some women just keep having problems or m/c's? I guess my question is, how do some women still have good enough quality eggs and others do not? |
| Dr._Kreiner | acupuncture may be beneficial |
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| jackjoe | Dr. Kreiner do women with endometrosis ever get pregnant naturally? |
| shaymer01 | Dr., I am 39, had 3 chem pg's in last year: one natural, one IUI/clomid, latest IVF. Have been told probably egg quality issues. I am wondering if immune testing is in order. Doc suggests donor eggs. |
| Dr._Kreiner | day 3 vs. day 5- day 5 you can select best embryos with more confidence |
| mara | no DC the ednometrioma was not |
| alp | I am 45 and have had one child via UIU at age 43. I was told at age 44 that based on my FSH my only resort was an egg donor. I got pregnant two months ago (spontaneously) but had a miscarriage shortly thereafter. Is it a good idea to keep trying on our own and was this a freak occurence? |
| Dee_Dee | thanks |
| gertyrae | As a 41 year old who hyperstimmed in January (retrieved 49 eggs, 22 of which fertilized) I am about to start my 5th FET. Am I wasting my time or is it possible that all embies were of poor quality due to my age? |
| Dr._Kreiner | contraceptives do not help endometriomata |
| thornj | What do you think about natural IVF for a 43 year old and failed IVF's in the past? |
| Dr._Kreiner | endometriosis can be reason for failed IUI |
| mara | but i just want to stop groth of it can it help? and i get functional cycts i am just scared i will get one befor procedure |
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| gandhl | After 3 failed IVF, attributed to poor egg quality, we started talking to other clinics for more info...one said they would want to do the retrieval earlier, that the eggs could be getting damaged by the follistim/menopur towards the end... is there any research to back this up? |
| Dr._Kreiner | jaded- its a fact of nature that some women have better quality eggs than others |
| dc | if the endometriosis is removed could it still cause problems with IUI failure? |
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| AmandaUNCC | WOW.. Gertyrae, you beat me.. I got 42 in Jan and over stimmed.. only one to FET later in April.. Was a negative. |
| Dr._Kreiner | jack joe yes women with endometriosis sometimes conceive naturally |
| JADE0199 | thank you dr |
| Zimmy | I'm 36, just went through first IVF cycle, retrieved 17 eggs, 14 fertilized, 9 progressed to day 3 embryos. Transferred 3 (to a gestational surrogate) and the other 6 failed to make it to day 5 (when they were going to be frozen. Any thoughts as to why they all failed? Transfer was unsuccessful, by the way. |
| JADE0199 | zimmy - i am sorry. |
| Dr._Kreiner | with egg quality issues DE probably best answer i dont see immune issues as being related |
| Zimmy | Thank you |
| mara | endometriosis grows back i removed it in january of last yea and in september the same year i got endometrioma |
| jackjoe | Thank you, not my luck so far. I wish |
| dc | what are the chances of a successful IVF with endometriosis (which was removed). |
| Dr._Kreiner | at 45- you got much better chance with DE but i cnat say that it cant work with your own |
| mara | mine want success but no idea why DC |
| gertyrae | Amanda - Only one made it to transfer? How many fertilized? |
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| Dr._Kreiner | at 41 hyperstim sign that ovaries responding so it may just be a matter of finding that one normal genetic egg |
| AmandaUNCC | Gerty.. 10 fertilized but by day 5 only two were worth saving and then one didn't survive the thaw |
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| shaymer01 | But if there are immune issues, wouldn't DE be unsuccessful also? When do you test for immune issues versus assuming it is age/egg quality? |
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| gertyrae | Dr. Kreiner - so is it worth my while to do another fresh cycle...I'm nervous about hyperstimming again. |
| Dr._Kreiner | we have not had a good experience with natural ivf |
| mara | Dr Kreiner do you think 8 eggs from 3 follicles is bad result. i responded late to medications and i used 5ml of suprefact for suppression was i suppressed too much? the doc will diminish it for next time for 2ml do you think it is good? |
| gertyrae | Amanda - I am so sorry, are you going to try again? |
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| rogpic | I, too, had mild hyperstim (I'm 34), but how do you find the one normal genetic egg? |
| AmandaUNCC | I just tried a second cyle. Took half the meds as to not over stim... Got 22 eggs.. NONE fertilized.. |
| Dr._Kreiner | zimmy thats rough but ivf still not good enough to expect success. check to make sure you are at high quality program and if so trust your doc |
| gertyrae | Amanda - I'm so sorry...are they doing ICSI? |
| jackjoe | Dr. Kreiner what is your feeling on Acupuncture for high FSH? |
| JADE0199 | zimmy - why are you using a surrogate? |
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| Dr._Kreiner | endometriosis surgery is 50% successful of course average age is less than 35 |
| mara | hwo can we find high quality programm? my doc gave me 60 % but it failed |
| AmandaUNCC | YES!!! |
| cjm | Are "low dose" gonadotropin cycles with IUI a waste of time? I'm very concerned about high order multiples. Our next step is injects/IUI or IVF. I'm wondering if I should go right to IVF. I'll be 38 in Nov. |
| AmandaUNCC | Going to try again in September with yet another approach |
| Dr._Kreiner | gertyrae if you are courageous enough i would try it |
| Zimmy | I've had 2 miscarriages - one at 15 weeks (naturally conceived twins) and one at 17 weeks (IUI). We believe it is an incompetent cervix, so prognosis is not good. |
| gertyrae | Amanda - different RE or different approach? |
| Dr._Kreiner | i wouldnt use any suppression. but 8 eggs not bad |
| Dee_Dee | What is an incompent cervix? |
| s1976 | what is considered repeat IVF Failure? Two tries? |
| Zimmy | Incompetent cervix - cervix cannot hold the pressure in the uterus, so dilates too early. |
| mara | could you recommedn any clinc in Canada which has good programm? please |
| AmandaUNCC | Gerty, different regime of meds.. same RE. I would definitely do another FET.. IT's better than stims and risking OHSS |
| Dr._Kreiner | acupuncture for high FSH can rarely make a difference |
| mara | than you |
| Dee_Dee | Zimmy - thanks |
| Dr._Kreiner | low dose gonadotropin cycles have reasonable success with iui |
| jackjoe | does it hurt to try acupunture also for relaxation? |
| JADE0199 | What are or where can I find accurate national statistics of a full donor egg IVF cycle? They seem to range from 50% to as high as 92%? |
| Zimmy | Dr K - what is considered a high quality program? What should I be looking for? |
| Dr._Kreiner | i would do acupuncture routinely if not for the cost |
| cjm | Thank you Dr. |
| ghelweh | when would you do acupuncture - prior to IVF, during? |
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| Dr._Kreiner | i would look at cdc results of programs to get an idea of quality of program otherwise it is hard for lay people to know |
| mara | why i responded well to IUI with only 125 dose of puregone and with 400 it took sooooooooo long to respond because of supression and if i dont do supression won't i get a cyst? |
| Dr._Kreiner | go to SART.org for data |
| Zimmy | Great, thx |
| shaymer01 | Dr., when do you think testing for immune issues is warranted versus assuming there is an egg quality issue? |
| Dr._Kreiner | if you could only choose 1 time to do acupuncture it would be before and after tx |
| JADE0199 | zimmy - would a stitch be an option? |
| AmandaUNCC | Good questions shaymer... waiting for answer |
| Dr._Kreiner | i recommend immmune testing for repeat miscarriages when everything else has failed |
| gandhl | Dr. K: We were considering changing clinics after 3 failed IVF... one clinic we spoke to said they would want to retrieve earlier than the first clinic as they were afraid the eggs were being damaged by the drugs towards the end... is there any research that supports this? |
| jackjoe | I am not sure about anything anymore I have two friends that did acupunture and there FSH came down I know FSH fluctutes month to month. I willing to do anything I feel desperate |
| JADE0199 | I've been told by my acu dr. to start 3 mo. before procedure for max. benefits. |
| s1976 | Dr how wouuld u define repeat failure? |
| Dr._Kreiner | i have data supporting that gandhi based on elevated LH and progesterone levels |
| Zimmy | Jade, yes, it is an option, but the prognosis is still only to get to 27 weeks, plus 100% bed rest from 12 weeks on, so not an attractive option. |
| AmandaUNCC | Gandhl.. my doc thinks he retrieved too early.. I had so many immature eggs. That is always a risk too., This time, I'm going longer on the stims meds |
| Dr._Kreiner | yes jade i agree, its a matter of cost |
| JADE0199 | yes zimmy. I understand that and it makes sense. thnk you for sharing. |
| JADE0199 | that would be difficult |
| gandhl | Our FSH is between 9 and 11, does this mean anything? |
| Dr._Kreiner | repeat failure depends on context |
| Dr._Kreiner | i was referring to one failure |
| kidake | I didn't have any problems concieving and delivering at 38. I am now 40 and have resorted to IVF with 2 failed IUI's. What are my chances for success with IVF? |
| AmandaUNCC | Zimmy, I wish you luck |
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| Zimmy | thanks... |
| JADE0199 | Good luck zimmy! |
| Dr._Kreiner | yes that you have two personalities gandi and your ovarian activity is not too bad |
| gandhl | 2 personalities? |
| Dr._Kreiner | kadake- i see many pts like that succeed i cannot give you specifics without exam or more info |
| Dr._Kreiner | good luck zimmy |
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| Dr._Kreiner | did i miss anyone |
| Zimmy | thank you, everyone! |
| jackjoe | Dr. Kreiner I want to confirm acupunture can't hurt anything? |
| mara | u missed my question |
| JADE0199 | I've given up on FSH. Mine was 6.1 on Day 3. still no success,only losses and 1 failed IVF. |
| Dr._Kreiner | no it cannot but my wife thinks its painful |
| Dee_Dee | Doc - you are doing great! |
| gandhl | Dr K: also, one clinic said to use endometrial cells for the co-culture instead of the granulosa cells... your thoughts? |
| Dr._Kreiner | mara please restate |
| ghelweh | how often would you recommend actupunture - once a week, once a day? |
| JADE0199 | Dr. does a patient continue w/ acupuncture once pregnant? if yes, for how long? |
| mara | ok |
| shaymer01 | Sorry to keep on this issue, but after 3 chem pg's in less than a year, would you suggest donor eggs PRIOR to testing for immune issues or should I be tested first? |
| Dr._Kreiner | cornell does this very successfully |
| Dr._Kreiner | quite good |
| MariaRiordan | Dr. Kreiner: I'm 42 and we have never been able to conceive. All our test are normal. Our specialist suggest IVF, since he thinks it is an implantation issue. My question is, how does IVF increase our chances of implantion? |
| Dr._Kreiner | accupuncture frequency is a matter of cost |
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| Dr._Kreiner | maybe PGD first for 3 chem pregs |
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| Dr._Kreiner | its more a matter of probabilities |
| gandhl | But other clniics don't seem to be able to repeat cornell's success? |
| JADE0199 | aside from cost. is it safe? |
| mara | i did very well with only 125 puregone for IUI but i took 400 for IVF and it took long to respond. was it becuase of supression and if i dont do supression will i respond the same goo and isn't it dangerous to get a cycst and cancel the IVF if i dont do supression |
| Dr._Kreiner | with ivf you get many eggs fertilized and with low rate of normal eggs at 42 IVF will increase your odds of fert nml egg |
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| Dr._Kreiner | i dont know anyone else doing endometrial coculture, we are repeating their success with granulosa cells |
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| Dr._Kreiner | accupuncture should be safe |
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| JADE0199 | thank you. |
| gandhl | Our clinic says they tried the endometrial without success, so they went back to the gran... |
| jackjoe | thank you |
| s1976 | what is a good number of eggs to be harvested and fertilised through IVF |
| Dr._Kreiner | ok mara i see. i have had pts respond better with less meds because of ocp or lupron suppression |
| gandhl | They're also talking about splitting our follistim and menopur into half doses, twice a day, have you heard of this? |
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| JADE0199 | what tests consist of immune testing? |
| dc | good question jade |
| Dr._Kreiner | if they are doing well with granulosa as we are then thats good. endometrial culture is more difficult to get working well |
| gandhl | Thanks |
| AmandaUNCC | gandhl.. I split my gonal-f dose (same as follistim).. and i only did it once a day |
| tsmoore | I am 44 years old just had a baby through natural conception after two failed IVF. iS THERE ANY SUCH THING AS A REBOUND PREGNANCY FROM THE IVF, EVEN THOUGH IT WAS A FAILURE? |
| mara | i didnt understand the answer docotr |
| Dr._Kreiner | 11 is ave number of eggs. numbers become irrelevant compared to quality though |
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| JADE0199 | tsmoore - i think thats considered a miracle |
| jackjoe | tsmoore. that is awesome |
| Dr._Kreiner | twice a day dosing may benefit by exposing your ovarie throughout the day |
| AmandaUNCC | unbelievable tsmoore!!!! |
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| dc | could it be possible that there were remnants of the meds in yoru system that kicked you into iverdrive |
| Dr._Kreiner | preg rates increase naturally immediately after ivf |
| JADE0199 | tsmoore - congrats!! |
| dc | wow..great |
| gandhl | So, last one, you would advise granulosa over endometrial? |
| sam | what is the egg quality of a 38 old healthy women who can conieve naturally...what are the chances of a birth defct? |
| jackjoe | so nice to hear success stories. |
| mara | i wish we all had success |
| AmandaUNCC | WE WILL!!!! |
| gandhl | Accupuncture aside, do you have any home relaxation tips, and how important is that? |
| tsmoore | Is Pregannacy 4 monthsd after the last IVF considered a rebound pregnancy? |
| jackjoe | so do I. I feel like my life is on hold which we are all in the same boat |
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| Dr._Kreiner | i think coculture helps. endometrial is better than granulosa only in lab that can do it well like cornell otherwise i would go with granulosa |
| mara | it is considered a gift from GOD |
| dc | is my prognosis good? 30 year old, recent removal of endometrioma cyst, i failed IUI, on BCP to resolve cysts from the IUI meds, and then starting 2nd IUI shortly. If all fails then IVF. There is a slight male factor (below average motility). |
| mara | DOctor can u recommedn any good clinic with good program in Canada? |
| Dr._Kreiner | dc- you have excellent prognosis |
| JADE0199 | with that said...preg rates increase imm after IVF. After my failed IVF cycle, menses was late, over a week, possibly didn't ovulate. Is it possible that IVF meds I did not ovulate at all? |
| gertyrae | What are your thoughts on a t-shaped uterus...would that inhibit implantation? |
| Corey_Whelan | Mara, you can call The AFA helplline for a referral to a Canadian program |
| Dee_Dee | Sam - you would probably want to do first trimester screening for some main genetic effects. May also want to do CVS (placentia biopsy) or amino centisis later in the pregancy. |
| gandhl | Is it OK to be taking Protonix (acid reflux) and Allegra (for allergies) during cycle? |
| AmandaUNCC | I've always been put on BCP after failed IVF.. no chance in conceiving naturally |
| Dr._Kreiner | perhaps jaded |
| mara | what is the number |
| mara | how can i find it |
| Dr._Kreiner | t shaped uteri especially do to des exposure is a potential negative factor for implantation |
| sflower | How many ivf's do you suggest before moving on to DE at 41? |
| Corey_Whelan | 888-017-3777 |
| dc | what is your opinion regarding clots during menses. Is this a sign of a possible problem for implantation? |
| dagny joined. | |
| mara | thanks |
| gertyrae | And if the T-shaped uterus is not related to DES? |
| Corey_Whelan | sorry, 888-917-3777. typo |
| Dr._Kreiner | sflower it is not just number but quality of embryos |
| mara | thanks |
| dagny left. | |
| sam | what is the chance of a birth defect in a 38-39 year old |
| mara | how can we know that the qualityt is good or bad docotr? |
| Dr._Kreiner | t shape not related to DES probably is a negative especially if associated with a hypoplastic uterus, small |
| Corey_Whelan | Folks, we're nearing the end of the chat. May I please ask that as you leave you let us know what state you are from? |
| s1976 | i have already had 2 ivfs and 2 gift treatments in the UK resulting in 1 miscarriage and I ectopic I am 31 would IVF in the united states be a better option for me? |
| tsmoore | Dr. Kreiner is there a relation to IVF and Rebound Pregnancy and if so for how long after IVF? |
| jackjoe | Thank you Dr. Kreiner and I wish you all the best of luck |
| dc | new york |
| Dr._Kreiner | NY |
| MariaRiordan | Oregon |
| ghelweh | ca |
| gertyrae | New York |
| Dee_Dee | I'm from California - Southern California |
| gandhl | NY |
| alp | Nevada |
| Sharon_ | nj |
| Zimmy | Good luck, all. From Maryland. |
| s1976 | nj |
| shaymer01 | NY |
| jackjoe | NY |
| mv32097 | 32 year old with 3 iui 2 miscarriages scheduled for surgery to remove severa fibroids, then will try again with iui because cannot afford Ivf, insurance does not pay, should i wait and save up for Ivf so my chances are greater, also some male factor with motility |
| tsmoore | TEXAS |
| Dr._Kreiner | good luck and god bless |
| shaymer01 | Thank you Dr. |
| sflower | florida |
| mara | thank you docotr |
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| gandhl | Is it safe to take Protronix and Allegar during cycle? |
| ghelweh | can we get a copy? |
| jackjoe left. | |
| dagny joined. | |
| Corey_Whelan | Dr. Kreiner, thank you SO MUCH for being here tonight. What a great chat! |
| JADE0199 | good luck and thank you dr for answering all of my questions |
| JADE0199 | FLORIDA |
| dc | thank you |
| Sharon_ left. | |
| mara left. | |
| sam left. | |
| Dr._Kreiner | jaded maybe in winter i make house calls |
| Corey_Whelan | ghelweh, do you mean a copy of the chat? The transcript will be up at The AFA site in about a week. All of the past chat transcripts are on line for your fyi |
| rogpic | NH |
| JADE0199 | ;O) |
| mlkelash | MN |
| Corey_Whelan | I wish all of you so much luck in your journey. |
| vjp left. | |
| kidake left. | |
| ghelweh | thx everyone |
| Dr._Kreiner | ditto |
| ghelweh left. | |
| AmandaUNCC | Thanks Dr. and cory.. From North Carolina! |
| Dr._Kreiner | again best of luck to everyone |
| mv32097 | Dr Kreiner can you answer my question |
| dc | thanks |
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| dagny left. | |
| Corey_Whelan | And I'm from Brooklyn, NY. A state of its own! |
| Corey_Whelan | mv, can you repeat your question? |
| Dr._Kreiner | fuhgettabowtit |
| alp | Thank you for your time, Dr. Kreiner. |
| JADE0199 | Corey, I grew up in Brooklyn!! |
| Corey_Whelan | cool. |
| JADE0199 | Dr made a funny!! |
| dc left. | |
| gertyrae | Thank you, Dr. |
| AmandaUNCC | Gerty good lucK!!! |
| Dr._Kreiner | bye |
| Dr._Kreiner left. | |
| gandhl | Thanks for everything Doc... Does Protonix affect things? |
| gertyrae | Amanda, you too!!! |
| Zimmy left. | |
| eileencb left. | |
| alp left. | |
| Corey_Whelan | sweet dreams all. See you next week. Tuesday - third party options |
| tsmoore | iS THERE ANY TRUTH TO A REBOUND PREGNANCY AFTER A FAILED ivf AND IF SO WITHIN HOW LONG IS THE REBOUND EFFECT? |
| Corey_Whelan left. | |
| rogpic left. | |
| mlkelash left. | |
| JADE0199 | Thanks corey and GOOD LUCK EVERYONE! Babydust to all!! |
| gandhl left. | |
| s1976 left. | |
| gertyrae | I hope everyone's dream comes true! |
| JADE0199 | Ditto gert!! |
| shaymer01 left. | |
| JADE0199 left. | |
| mv32097 | 32 year old 3 iui 2 miscarriages schedule for surgery to remove fibroid then will try iui again cannot afford IVf insurance does not pay. Should I just wait and save up for Ivf so my chances are greater also male factor with motility |
| Dee_Dee left. | |
| gertyrae left. | |
| AmandaUNCC left. | |
| tsmoore left. | |
| mv32097 | Can anyone answer my question |
| sflower left. | |
| mv32097 left. | |
| Inigo | hi lt3333 |
| moesbaby | Don't know if this helps a girl I know who was 31 had trouble because of a fibroid had surgery and got pregnant right after....Good luck! |
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