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Inside the Laboratory - Magic or Science

November 2, 2004 - Tuesday
2:32 PM to 3:32 PM (EST)
Guest Speakers: John Garrisi, Ph.D., IVF Laboratory Director for Saint Barnabas Medical Center, IRMS

Categories
Infertility • IVF • PGD


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localhost [2009]  touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. John Garrisi, (IVF Laboratory Director for Saint Barnabas Medical Center, IRSM) joining us this evening. We will be discussing the topic "Inside the Laboratory- Magic or Science". Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
Nancy Hi LIsa
Lisa_Rosenthal Hi Nancy, thanks for joining us!
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Lisa_Rosenthal Good evening everyone, thanks for joining us for our online educational session.
Lisa_Rosenthal Dr. Garrisi will be here in just a few minutes.
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localhost [2009]  touser Please call our toll free hotline to ask our patient advocate for doctor referrals in your area. That number is: 888-917-3777 and our patient advocate is Lori Masi.
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Lori I tried IVF last march, and an FET in august, I'm looking for information on egg reteival process, alternatives, and for information on screening blood for endometriosis (i'm stage 4) This is a virgin experience for me (chat room that is!)
Lisa_Rosenthal Good evening Dr. Garrisi, thanks so much for joining us tonight!
Dr_John_Garrisi Type here
Dr_John_Garrisi it's nice to be here
Lisa_Rosenthal Ladies and Gentlemen, I'm going to post some information that Dr. Garrisi sent me earlier today for you to read while you are thinking of questions.
localhost [2009]  touser The Embryology Laboratory is unique among medical laboratories. All other medical labs perform tests on specimens; the results of those tests are utilized by physicians to direct the care of their patients. While testing does occur in the Embryology lab - semen analysis is a classic medical test, and observations of egg and embryo morphology and fertilization also qualify as medical tests - embryologists also perform treatment procedures on the embryos that are in their care. Procedures such as ICSI, assisted hatching, fragment removal, and embryo biopsy are designed to facilitate fertilization, early development, and implantation. And it is embryologists, not physicians, who are charged w
Lisa_Rosenthal Wait a second and the rest will be here...
localhost [2009]  touser The Embryoloduring the first days of their existence. All of this testing and treatment is performed on extraordinarily fragile eggs and embryos in a very carefully monitored and controlled laboratory environment.
Lori_Masi_-_AFA_Patient_Advocate Type here Hi Dr Garrisi Welcome!
Lisa_Rosenthal As a result of the unique character of the Embryology lab, laboratory science plays an integral role in the medical treatment of the infertile patient. Embryologists and physicians work in concert to provide effective care. Since the laboratory component is inaccessible to the patient (because of the controlled environment and the fragility of the embryos), the process may seem mysterious. Our discussion tonight can help to shed some light on some of the procedures, both new and old, that are performed in the Embryology lab, and to provide some insight into some of the ways that embryologic care is tailored to the needs of each patient.
Lisa_Rosenthal Whew, that's the whole thing from Dr. Garrisi. I will post this a few times more during the session.
yourtryin Hi Dr. Garrisi, how many times can i have perfect embryo's and no pregnancy?
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Lisa_Rosenthal Dr. Garrisi?
Stephen How do I make sure that the lab is good since we need to use ICSI?
Dr_John_Garrisi Yourtryin - After 3-4 attempts, we start to think that there may be come other factors at play other than chance. Remember, depending on your specific circumstances, the statistical likelihood of a delivery following IVF is 20-50% for each single cycle.
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Jenna Dr, the difference between %25 and %50 is accounted for how?
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ppolk Hi Lisa and Dr. Garisi
Dr_John_Garrisi Stephen - It will be difficult for you to independantly determine the capability of a particular lab to perform a particular procedure. You may rely on advice from sources such as the AFA, or refer to the SART reports and select a program with well established general laboratory credentials.
LEWIS Dr do clomiphene citrate help wit low sperm count
Lisa_Rosenthal Stephen,
Lisa_Rosenthal you can also call our toll free number to speak with our patient advocate. Lori can give you some great referrals.
localhost [2009]  touser Please feel free to post questions for Dr. Garrisi. Keep in mind that you mayed to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them.
Dr_John_Garrisi Jenna- there are many factors in the individual medical history that impact expected delivery rates. in general, for the groups that have the highest expectation, 50% is a reasonable expectation. The primary factor that reduces expectaion from that level is increasing female age.
Lori_Masi_-_AFA_Patient_Advocate Stephen why don't you call me on the support line 888-917-3777 for referrals and info on the SART Report.
Nancy Doctor, what are the credentials one should look for in a lab and lab director?
Lisa_Rosenthal Thanks Lori!
kkuki If there is a problem with fragmentation, how is that dealt with in the lab?
Dr_John_Garrisi Lewis - CC, when recommended by a urologist who specializesl in infertility, may be of some benefit.
LEWIS thanks you
Dr_John_Garrisi Nancy
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Lori Is female age a factor in egg quality only?
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Frieda hi everyone!
Frieda what do age/donor and lab have to do with one another?
localhost [2009]  touser The American Fertility Association has free membership! Please go online and you will have access to all our publications at "No Barriers".
LEWIS dr how many sperms does a male to make a baby
Lisa_Rosenthal The Embryology Laboratory is unique among medical laboratories. All other medical labs perform tests on specimens; the results of those tests are utilized by physicians to direct the care of their patients. While testing does occur in the Embryology lab - semen analysis is a classic medical test, and observations of egg and embryo morphology and fertilization also qualify as medical tests - embryologists also perform treatment procedures on the embryos that are in their care. Procedures such as ICSI, assisted hatching, fragment removal, and embryo biopsy are designed to facilitate fertilization, early development, and implantation. And it is embryologists, not physicians, who ar
Dr_John_Garrisi Nancy - All SART -member labs are required to have accredited laboratory directors and to have laboratories that pass a rigid inspection process. Beyond that, you need to follow some of the above advice to idifferentiate the good labs from the best labs/
Dr_John_Garrisi Lori - Yes
Bari Hi, what does it mean to be an "accredited lab director"?
Orly Fragmentation means what?
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Dr_John_Garrisi kkuki - Some labs have embryologists that are qualified to remove fragments in a micromanipulative procedure that accompanies assisted hatching. Fragments may interfere with normal developmental processes, so, absent removal, another option would be to transfer an additional embryo.
Lori Okay, so if a female (38) has grade 1 eggs that divide out and reach blast stage, would chances of pregnancy increase?
Orly and what is embryo glue?
localhost [2009]  touser Please feel free to post questions for Dr. Garrisi. Keep in mind that you may need to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them.
Lori_Masi_-_AFA_Patient_Advocate For referrals, information or just some good ol support, please call the AFA Support Line at 888-917-3777 Monday thru Friday and I would enjoy talking to all of you!
Lisa_Rosenthal Dr. Garrisi, you are doing a wonderful job keeping up with all these questions. Thank you so much for your time and energy here this evening.
Dr_John_Garrisi Many laboratory directors are accredited by the ABB, a national agency, that monitors such things as education, laboratory experience, and actual procedures performed
yourtryin are there medications/supplements that I can take to improve embryo quality?
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Dr_John_Garrisi Lori - Expectation of implantation is greater when blastocysts are transferred , compared to earlier stages, all other factors being equal
Orly is there research about blast transfers implanting more frequently?
Frieda Can you explain how ICSI is actually performed?
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Desiree hi
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Lisa_Rosenthal HI Desiree, thanks for joining us this evening.
localhost [2009]  touser Please feel free to post questions for Dr. Garrisi. Keep in mind that you may need to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them.
localhost [2009]  touser The American Fertility Association has free membership! Please go online and you will have access to all our publications at "No Barriers".
Dr_John_Garrisi Orly - Human embryos, unique among animal species, do not divide in perfect sequences of symmetrical cells -1, 2, 4, 8, etc. Occasionally, cells produce cellular fragments in the sourse of their division. When the fragments become too numerous, they may interfere with normal cell-cell interaction during development.
localhost [2009]  touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. John Garrisi, (IVF Laboratory Director for Saint Barnabas Medical Center, IRSM) joining us this evening. We will be discussing the topic "Inside the Laboratory- Magic or Science". Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
Dr_John_Garrisi yourtryin - I know of no supplements that can be taken that have been shown to improve embryo quality
Amand3 what about things to improve endometrial lining?
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Dr_John_Garrisi Frieda - During ICSI, a single sperm is aspirated into a very fine glass instrument (handmade, for single use only). The sperm is then injected into an egg that is held in place by another tiny glass instrument. The whole process is conducted under 400X magnification, using specially designed micromanipulation apparatus.
Frieda Doctor, thank! When is ICSI called for?
localhost [2009]  touser The American Fertility Association has a set of message boards, several which are moderated by a physician daily. Please feel free to stop by and ask questions there as well! Also, "Connections" will meet every week for an online educational session. Please check the schedule on our home page.
Dr_John_Garrisi Orly - There have been many studies that indicate that blastocyst implanation rates are high. Blastocyst culture is not ideally suited to all patients, however. Some patients do not produce embryos that form blastocysts at a high rate in vitro, and would be better served by transfer at an earlier stage.
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Jenna Do all labs do PGD?
Dr_John_Garrisi Frieda - We use ICSI for patients with male factor infertility. Since the succes rates with ICSI are virtually identical with those of conventional IVF, we make the decision to perform ICSI rather easily, in order to prevent an unexpected failure of fertilization
Bari Who decides on the number of embryos to transfer and how?
Lori Does freezing embryos effect the success of implantation? Can a person do a 3 day and 5-7 day transfer in the same cycle?
Dr_John_Garrisi Jenna - Many, but not all, labs offer an option for PGD. Most labs, however, send prepared post-biopsy slides to an outside PGD lab for the actual genetic analysis. There are relatively few IVF programs that perform IVF and PGD in the same facility.
Bari Does St.B offer IVF and PGD?
Bari How long is the wait there for a patient consultation?
Lori Can egg quality change much in a year's time if other health factors stay the same?
Dr_John_Garrisi Lori - Freeze/thaw success varies with the program. In the best labs, the small loss in embryo quality that attends cryopreservation is compensated for by the fact that the embryos are transferred to an unstimulated endometrium. In these labs, the pregnancy rates in thaw cycles is very close to those in fresh cycles.
Fran Do you recommend a second opinion after a certain amount of time with no pregnancy?
Lisa_Rosenthal Dr. Garrisi, you are doing a wonderful job this evening. Thanks so much for joining us!
localhost [2009]  touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. John Garrisi, (IVF Laboratory Director for Saint Barnabas Medical Center, IRSM) joining us this evening. We will be discussing the topic "Inside the Laboratory- Magic or Science". Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
Dr_John_Garrisi Lori - Most practioners would hesitate to perform a second transfer in the same cycle, for fear of disrupting the embryos previously transferred
Lisa_Rosenthal Dr. Garrisi, will you please post your program's phone number as there are people here this evening interested in getting in touch with your program.
Lori What do you mean unstimulated endometrium? Is that the same as a natural cycle? Thanks for all your answers by the way! That makes sense (second transfer in same cycle)
Lori_Masi Type here I can take care of that for you Dr Garrisi
localhost [2009]  touser Please feel free to post questions for Dr. Garrisi. Keep in mind that you may need to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them.
Dr_John_Garrisi Bari - Dr. Santiago Munne at Saint Barnabas was one of the 3 pioneers of PGD worldwide, in the early 90's. We have worked closely with him to optimize the process. I don't believe that there is a very long wait for consultation.
Fran Dr. Garrisi, will you please post your phone number?
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Dr_John_Garrisi Lori - the effect of 1 year shouldn't be too great, although the effect of each year over 40 is significantly greater than those in the 30's
Regie what are your thoughts about immune therapy?
localhost [2009]  touser The American Fertility Association has free membership! Please go online and you will have access to all our publications at "No Barriers".
Dr_John_Garrisi Fran - Yes - differences in stimulation or laboratory protocols between even accomplished programs may favor a given male-female patient combination
Dr_John_Garrisi Lori - The thaw cycle may be either natural or simulated; there is evidence that indicates that both produce a slightly more receptive endometrium than a stimulated cycle
laurie Hi Dr. Garrisi, I am late to the chat so hopefully you didn't already answer this.What questions could I ask to an RE about his or her lab to insure that the lab is high quality. Obviously, the experience of the embryologist is important but what questions would I ask specifically to assess the equipment?
Regie Doctor, you are going to post your phone number, right?
Lisa_Rosenthal The Embryology Laboratory is unique among medical laboratories. All other medical labs perform tests on specimens; the results of those tests are utilized by physicians to direct the care of their patients. While testing does occur in the Embryology lab - semen analysis is a classic medical test, and observations of egg and embryo morphology and fertilization also qualify as medical tests - embryologists also perform treatment procedures on the embryos that are in their care. Procedures such as ICSI, assisted hatching, fragment removal, and embryo biopsy are designed to facilitate fertilization, early development, and implantation. And it is embryologists, not physicians, who ar
Lisa_Rosenthal This is information from Dr. Garrisi...
Lori_Masi Dr Garrisi Perhaps it is best for you to post all your info for them. Thanks!
Dr_John_Garrisi To Fran and Regie - Of course I will post my phone number - The number at IRMS at Saint Barnabas is 973-322-8286.
Lisa_Rosenthal Thank you for posting your information!!!!
Dr_John_Garrisi laurie - I would hope that every RE would have the highest faith in the capabilities of his lab and its staff. So, the responses that you would get from every RE should be very similar. Sorry, but it is as difficult for patients to select a good IVF lab as it is for them to select a good MD<
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Dr_John_Garrisi Regie - I am not convinced by the published data favoring immune therapy
Lisa_Rosenthal Ladies and gentlemen, the simple way that I get such wonderful speakers is by promising them that they will be off the session at 9 sharp, which gives us just about 10 minutes to go.
jadams Has anyone heard of financial help to pay for egg doantion?
Lisa_Rosenthal Remember that we are lucky enough to have message boards moderated daily by physicians. One day a week, some of Dr. Garrisi's wonderful colleagues answer questions. Look for Dr. Serena Chen!!
localhost [2009]  touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. John Garrisi, (IVF Laboratory Director for Saint Barnabas Medical Center, IRSM) joining us this evening. We will be discussing the topic "Inside the Laboratory- Magic or Science". Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
localhost [2009]  touser The American Fertility Association has a set of message boards, several which are moderated by a physician daily. Please feel free to stop by and ask questions there as well! Also, "Connections" will meet every week for an online educational session. Please check the schedule on our home page.
Lisa_Rosenthal Dr. Garrisi, please post your phone information again as well before we finish.
Lori Thank you Dr. Garrisi for all of your information!
laurie I am 38 years old with "unexplained infertility" Do you think it is appropriate to do PGD on my embryos if I have fewer than 5 embryos?
Lori what's pgd anyone?
Lisa_Rosenthal Pre Genetic Diagnosis
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Lori Thanks, Lisa!
Lisa_Rosenthal Dr. Garrisi, would you take an extra minute to answer Laurie?
Lisa_Rosenthal Lori, you're welcome.
Regie Lisa and Dr. Garrisi, this has been great, thank you!
Lisa_Rosenthal Regie, my pleasure.
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Lisa_Rosenthal Dr. Garrisi, you have done a truly admirable job. Thank you so much for your time, energy, information and compassion this evening. I hope you will consider joining us again sometime.
Stephen thanks...
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Dr_John_Garrisi laurie - It is difficult for me to give specific advice without a complete medicical and embryologic picture. For some patients, theere is no need to perform PGD to help select the best embyos for transfer if the number of available embryos is fewer than the number that may be safely transferred anyway.
Lori_Masi Thank you Dr Garrisi!
kkuki Lisa, as always, a pleasure
Lisa_Rosenthal Night Kkuki, see you next week.
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Dr_John_Garrisi To everyone - You are very welcome.
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Fran It was great to learn a little bit more about the lab stuff, thanks..
laurie thank you
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Frieda Good night and thanks
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Bari bye
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Orly night
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Lisa_Rosenthal Good night everyone, thanks so much for joining us this evening. I'm looking forward to seeing you all next week!
Amand3 Good night lisa
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yourtryin bye
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Nancy thanks
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