IVF Failure

November 6, 2007 - Tuesday
1:04 PM to (EST)
Guest Speakers: Daniel Potter, M.D.

Categories
Donor Egg • Endometriosis • Fertility Drugs • IVF • PCOS

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FET3	Hi ::smile
airforcewife090302	hi
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airforcewife090302	sorry
airforcewife090302	was talking to my husband on the phone
airforcewife090302	how r u tonight FET??
Corey_Whelan	hi early birds.
airforcewife090302	Hi Corey
Corey_Whelan	Tonight's speaker should be here in about 13 minutes. I'm Corey Whelan, The AFA's Director of Development and your chat moderator tonight
airforcewife090302	oh cool
airforcewife090302	this is my first time in here
airforcewife090302	I just had another failed IVF
Corey_Whelan	Tonight's topic is IVF Failure. And our speaker, when he arrives, is Dr. Daniel Potter of Huntington Reproductive Center in CA.
FET3	I'm doing ok. Yourself?
Corey_Whelan	I'm sorry to hear it and welcome.
FET3	Hi Corey.
Corey_Whelan	We will officially begin in a few minutes
airforcewife090302	Im ok I guess could be better
FET3	Looking forward to it. This is my first time here as well.
FET3	airforcewife - sorry about your IVF failure.
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airforcewife090302	May I ask how long have you been trying to concieve??
FET3	Hi bganze.
airforcewife090302	ty
Corey_Whelan	I'm so glad you guys joined us tonight.
bganze	hello all
Corey_Whelan	what states are you from?
airforcewife090302	hi bganze
bganze	TX
FET3	Officially, since seeing a RE, a little over a year.
airforcewife090302	Florida here
FET3	FL
airforcewife090302	what part of florida? Im near panama city my husband is in the airforce as my name says he he!
FET3	I'm in my 2WW of FET #3
FET3	I'm in Pensacola! We're practically neighbors!
airforcewife090302	GL Hope it has worked for you!
airforcewife090302	r u seeing dr Ripps?
FET3	Thanks.
FET3	Yep! Are you?
airforcewife090302	no used to
airforcewife090302	I started seeing him Feb of 2003
airforcewife090302	im going to Jacksonville now.. Well not anymore we no longer have the money
FET3	That's quite a drive for you. Good luck!
airforcewife090302	yesah it is
FET3	If you don't mind my asking, what fertility issues do you have?
airforcewife090302	PCOS, Endometriosis, I dont ovulate on my own and blocked tubes
FET3	We're male factor. I've done 1 IVF/ICSI/PGD and this is my 3rd FET.
airforcewife090302	we have a male factor as well just found out about it
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airforcewife090302	oh wow
FET3	Oh I see. I am so sorry that we all have to be here. This just sucks.
airforcewife090302	yes it does!
bganze	i second that!
airforcewife090302	My husbands count was fine and after his deployments to Iraq his count and morph has dropped!
Corey_Whelan	afw, you know that some programs give discounts to the military?
airforcewife090302	really?
airforcewife090302	may I ask where?
Corey_Whelan	yup. Make sure you ask.
airforcewife090302	k
airforcewife090302	ty!
Corey_Whelan	I don't have a list, it changes.
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airforcewife090302	ok ty!
FET3	I've heard from another infertility board that military get special pricing or discounts.
airforcewife090302	oh wow
FET3	We're all self-pay.
airforcewife090302	we are so broke now!
FET3	Aren't we all? LOL
airforcewife090302	our first IVF was cancled due to OHSS and was scheduled surgery for the PCOS
FET3	I was told that I hyperstimmed b/c I have PCOS, but when the RE did the metabolic tests, everything came back normal; so I don't know what's going on.
airforcewife090302	my 2nd went through transfered 2 blasts failed.. and this last cycle FET we transfered 2 blasts as well
airforcewife090302	hmm
FET3	OMG! I was hospitalized for severe OHSS with my IVF last year. So I never made it to ET. And FET#1, I never did suppress. FET#2 was a BFN. And so I'm on FET#3.
airforcewife090302	well I hope that this cycle has worked for you guys!!
airforcewife090302	I am so sorry
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airforcewife090302	Never been put in the hospital for OHSS just bedrest
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FET3	Oh I was really bad off. I was in the hospital for 8 days.
airforcewife090302	omg!
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airforcewife090302	wow I am really sorry
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FET3	Thanks. But it was the most painful thing I've ever gone through.
airforcewife090302	it is painful!
airforcewife090302	i know all the times I had it I could harldy move
FET3	Yep, know exactly how you felt. How many follies did you have?
FET3	I had 34 follies.
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Corey_Whelan	Hi all. Dr. Potter should be here shortly.
FET3	Hello everyone who just joined!
leslies75	Hi everyone!
leslies75	airforcewife - I am one too!
airforcewife090302	with my IVF cycle im not sure way to many though my ET levels were almost 4,000 and he said I was no where near done yet and said if i finished my levels would be well over 5,000
airforcewife090302	hi leslie
airforcewife090302	but one of my others I had 6 but 4 of them mesured for 40 mm
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FET3	airforcewife- wow.
Corey_Whelan	I have Dr. Potter on the line, he is on his way!
airforcewife090302	ty corey!
HB	Thanks Corey
FET3	Thanks Corey.
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airforcewife090302	may I ask how many embies you got from your IVF FET3?
Corey_Whelan	Welcome Dr. Potter!
FET3	The RE transferred 2 PGD normal blasts this time.
FET3	Hi Dr. Potter!
airforcewife090302	hi Dr. Potter
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Corey_Whelan	Dr. Potter, this is an eager bunch. Guys, please feel free to post your questions for Dr. Potter of Huntington Reproductive Center.
FET3	Ok, thanks Corey.
Dr_Potter	Glad to be here. Let's get started. IVF failure is a painful experience, there are many reasons patients fail. I would like to try to lend some insight to your users.
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HB	On my 5th IVF I had emergency surgery to remove my gall bladder, 6 days post transfer - is this most likely the reason this cycle failed?
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HB	Or do you think they are completely unrelated?
FET3	I had to have my gallbladder removed as well but not before transfer.
HB	And did the first 4 fail due to an ongoing low grade inflammation from my gb?
HB	(I can't believe I was sabotaged by my own gb!!!)
Dr_Potter	Having major surgery is certain not going to help. Why did you fail the other 4 cycles?
HB	#1 I only had 1 embie, #2 no transfer occurred, #3 was a chem pg, #4 failed for unknown reasons
Dr_Potter	Hi HB, Low grade inflamation from you gall bladder is an unlikely cause for IVF failure.
airforcewife090302	wow HB I am so sorry!
sb10847	For a 39yo woman who has had 1-2 failed IVF cycles (2 blast transfers each time) with no genetic history - when should she, if ever, consider PGD
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FET3	HB - So sorry!
HB	Thanks Dr. P and AFW & FET
airforcewife090302	I dont know what to really ask I guess I am just confused and dont understand why mine failed
moesbaby	I am starting my first IVF and am on a Estrogen priming protocol. I am, supposed to track my LH surge this month well I got a positive surge on CD7, CD8, CD9 then neg on CD10 & 11 then positive on CD12 & CD13 today is 14 and that was negative........what could this mean?
airforcewife090302	yw HB!
FET3	Dr. Potter - Can you tell me what PGD normal blasts are supposed to look like after the thaw?
airforcewife090302	each cycle we transfered 2 blasts
Dr_Potter	Hi SB10947, in its current state, PGD is not really going to alter outcome. It is not going to help you get pregnant unless you have so many nice embryos that your REI does not know which to choose. Even with PGD, only 10 or 11 or the 23 pairs of chromosomes will be tested. You can still have genetic failure even with PGD.
bganze	We have not yet begun IVF - waiting on my hysterscopy first to remove multiple polyps. Also have sever male factor infertility. Can anyone tell me what we can expect? We can't afford very many cycles and RE told us this was our best if not only option to concieve. Advice?
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christalp	hello everyone...i am a 30 yo with hx of pcos. my 1st ivf failed after i miscarried from a blighted ovum. i just completed my fet with 3 embryos transfered with a bfn. we are talking about doing another fresh ivf since i don't have any frozen left. i just don't know what to do at this point.
aijia	After taking BCP, my baseline blood test yesterday showed my P4 was 1.6, my doctor said it is a little elevated, but he didn't see cyst at ultrosound. Should I be worried about it? ( I had two failed IVF before)
leslies75	I have had 2 IVF cycles, 1 frozen transfer. I am on stims for IVF # 3 right now. My RE has adjusted my protocal each time, but they have not yieled any success. MF issue - low count. Any thoughts?
Corey_Whelan	I believe dganze is next, then christalp
Dr_Potter	Hi airforcewife, the most important determinants of IVF success are the age of the female partners and her ovarian reserve.
RoseNYC	Eggs Quality. Why it is affected by age? Are there any ways to slow the process: acupuncture, yoga, herbs, diet etc?
airforcewife090302	I am 24 years old and im not sure with ovarian reserve the docs have never said anything about that
airforcewife090302	they just keep telling me im young
red	Hi Dr Potter do have any stats or could you lead me in the direction of which procedure is best for a male factor with a count of less than 1 million with a varicolcele... a varicocelectomy or ivf with icsi?
airforcewife090302	I do have endometriosis and PCOS
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Dr_Potter	Not smoking is the only thing that has a proven benefit to prolonging normal ovarian reserve
Dr_Potter	HB, what is your ovarian reserve??????????
HB	Do cycles using the antagonist protocol generally have a higher failure rate than cycles using a lupron protocol? And at what point should surrogacy be considered?
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Dr_Potter	Hi Christalp, are you taking metformin???
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HB	I'm 37 and (supposedly) have an fsh of 9 (though my ovaries seem to responding more like a 16) all protocols were antagonist & hey got betwen 9 and 20 eggs
HB	I am DES exposed, PCOS, Immunology issues 17 pregnancies, 1 child
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airforcewife090302	thats what I need to ask you dr potter I aksed about going on metformin he told me no b/c i was doing an FET and said they only use that to help with ovulation
Dr_Potter	Hi bganze, to determine your prognosis, I need your age and your ovarian reserve.
christalp	yes, i am on 500mg q am and 1000mg q pm plus a baby asa q day
bganze	Age 26 - Reserve ??? Noone has mentioned that to me. Other than the polyps, they have noconcern with my reproductive health.
aijia	Dr. Potter: After taking BCP, my baseline blood test yesterday showed my P4 was 1.6, my doctor said it is a little elevated, but he didn't see cyst at ultrosound. Should I be worried about it? ( I had two failed IVF before)
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HB	The live birth was my 10th pregnancy, accomplished by suppressing my immune system, metformin, baby aspirin, heparin & total bedrest - made it to 7 months
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Dr_Potter	Hi moesbaby, why are you doing estrogen priming? It sounds like there is a problem with the test. Very strange to get 2 positive LHs like that. Are you PCOS?
HB	And I was 34 at the time
leslies75	More on me: I am 32, my husband is 35. I am taking 300iu of follistim and 150 iu of menopur right now
christalp	with my fresh cycle they retrived 34 follicles and only 13 fertilized and only 7 made it. i had a day 6 transfer with 2 embryos and 5 frozen. with my fet, 2 didn't survive the thaw and we transfered 3.
FET3	Corey, not sure if there's a line but here's my questin for Dr. Potter - I'm 33 and DH is 37, severe male factor (Robertsonian translocation). So we did PGD. I hyperstimmed and didn't make it to transfer that cycle. FET #1 was canceled due to nonsuppression. FET#2 was a failure (transferred 1 PGD normal blast). I'm on FET #3 - transferred 2 PGD blasts. Currently in my 2WW. What are my chances? And why did FET #2 fail? How can you tell if the embryo is good after PGD/freeze/thaw? What does a good blast embryo look like after all that?
moesbaby	not that i know of just old 42
RoseNYC	How ovarian reserve could be measured?
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leslies75	oh, and for this cycle, we're using frozen sperm because my husbnd is in Iraq : (
Dr_Potter	Hi FET3, we thaw them the night before to give them a chance to re-expand. Immediately after thawing, blasts are still collaped with the blastocyst (the space in the middle) without much water in it. If you wait, this space will refill with water and the blast will re-expand
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Corey_Whelan	ok. I think leslies and then christalp. and then you're up FET
Corey_Whelan	or now!
moesbaby	Funny you said PCOS I did a lot of research and it seems that happens to gals with PCOS
Dr_Potter	Hi ajjia, Nothing to worry about
airforcewife090302	if you have PCOS dr potter should you be on Metformin???
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Corey_Whelan	Welcome to our chat, negrita
Dr_Potter	Hi Chrisalp, are you PCOS? Are you on metformin?
negrita1417	thank you how's everyone doing tonight
airforcewife090302	I have PCOS and not on Metformin
christalp	yes, i have pcos and i am on metformin 500mg q am and 1000 mg q pm plus a baby asa q day
airforcewife090302	I asked about it before I started my FET doc said I didnt need to go on it
Dr_Potter	Hi FET, I must say that in my experience, the pregnancy rate with translocations of any type using PGD is about half of what I would normally expect based on age and ovarian reserve.
tanyadockter	Dr Potter...I am 31, I have one ovary but my tubes are blocked, just failed my first fresh cycle and am debating about using my 3 frozen embryos for my next cycle or doing another fresh cycle...do you have any recommendations?
airforcewife090302	brb
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Dr_Potter	hi tanyadockter, it is usually much cheaper to use the frozen embryos. That is what I would do.
airforcewife090302	i am back sorry
aijia	Dr. Potter: I heard some clinics are experimenting CGH, which they say is more thorough than the traditional PGD. What are your thoughts on CGH?
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airforcewife090302	hi sherylt and hoping!
moondreams	my husand, myself and donor all have no health issues and passed extensive testing. we had 8 great quality 5 day blasts. i got pregnant with with a fresh cycle for 9 weeks, heartbeat stopped. then chemical pregnancy with frozen, then perfect thaw and another failed FET. i have 2 embryos left. what are the chances of a success? anything i should do/know before my last attempt? could all 8 be non-viable?
Dr_Potter	Airforce wife, at 24, your ovarian reserve is most likely fine. How many eggs and embryos do you make? Do you have regular periods??
FET3	Dr. Potter - Thank you for your answer. My day 3 FSH was 5.5. I was on 150 Follistim, 75 Repronex, 10 Lupron. There were 17 embryos that went to PGD. Out of 17, only 8 were normal (remember DH has Robertsonian translocation). My lining was 14, estrogen 295 for this FET cycle. Is there anyway you could look at a picture of the transferred blasts for this cycle? Thanks.
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airforcewife090302	no regualer periods i have to take provera.. with my IVF they got 18 eggs and 14 fertlized
bganze	26 yrs old - unsure of ovarian reserve - severe male factor - uterine polyps to be removed in 2 wks - IVF to follow. Chances for success? Advice?
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airforcewife090302	and I had 7 frozen 2 and blast and 5 and 3 day stage and when they thawed out the first 5 none made it and they used my blasts and said no problems with thawing twith those 2
leslies75	at each of my retrievals and transfers everything looks great and my RE is very optimistic. Why all the failures?
airforcewife090302	thats me leslie!
Corey_Whelan	We have a question from red that needs to be answered please, Dr. Potter. She is reposting it for you
airforcewife090302	I dont get it!
Dr_Potter	AIrofrce wife, if you have PCOS, metformin can improve your response to medications (prevent hyperresponse), improve egg and embryo quality. We do a 2 hour glucose tolerance test with insulin levels at each draw to determine the need for metformin.
sb10847	What is the correlative data with regard to Day 5 Blastocyst grading (my institution grades 1-4 with 4 being the best) and IVF success?
leslies75	i know. I just want to know why those embryos won't STICK!!!
airforcewife090302	I have never done the glucose screening
red	me- 25, dh-28 he has an extremely low count less than 1 million, he also has a varicocele present.. are there any advantages to having a varicocelectomy vs. ivf w.icsi?
Dr_Potter	crisalp, the therapeutic dose for metformin would be better taken as 750mg three times per day. A low carb diet and daily exercise also may help.
airforcewife090302	I was extremly upset with my last failed cycle I couldnt even talk to the nurse I feel defeted!
frances1	My first attempt failed to due to poor response to stimulation (600 Bravelle and 200 Menopur). My second
airforcewife090302	not to mention the PIO shots hurt so %%%% bad!
hoping	hi. we've had day 3's grade 5, with 3 embryos put in both times. once pregnant for a short time, then the other time nothing. Will do the laparoscopy soon. Will that help?
airforcewife090302	should I ask for the screening dr. Potter???
Corey_Whelan	red next, please
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frances1	My first IVF attempt failed to due poor response to stims. 600 Bravelle and 200 Menopur. My second cycle went beautifully accept I only had two follicles and (yes I still continued the cycle) and wen
frances1	hit the send button too soon. I had empty follicles upon egg retrieval
Corey_Whelan	guys, fyi, low carb is a life saver for pcos'ers. NONE of you should be eating sugar of any kind, it makes a huge difference.
leslies75	lsat failed cycle my RE put me on Endometrin instead of PIO. Much less painful, as it was a vaginal insert!
airforcewife090302	I dont think I eat alot of sugar
Corey_Whelan	keep your carb intake to around 40 grams a day. That includes potatoes, corn, bread. Those are all sugar sources
airforcewife090302	really leslie
HB	makes a difference how specifically, Corey? I try but about once a month, right on schedule I NEED a snickers bar.... Otherwise I do ok.
Dr_Potter	CGH is not yet ready for prime time. It requires the freezing of embryos. It is a transitional approach that will bridge the very short gap between FISH and snp-based technology. Snp will be commerically available in 2008. It will test for all 23 pairs of chromosomes and an unlimited number of genetic disease simultaneously and in real time. It is going to be the next big thing.
frances1	Are empty follicles due to poor egg quality or the trigger shot. There was no evidence of the eggs releasing too soon.
tanyadockter	No sugar, even if PCOS isn't your problem??
Karen	I am 34, just failed my first IVF. FSH 14.7, 10 follicles, 4 eggs, all fertilized, 3 transfered, none took. Wondering at what point I should consider donor eggs or should I try another cycle with my own eggs?
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airforcewife090302	oooooh ok corey ty!
claire	I had three failed IVF and also two frozen failed IVF. I have a UU and mild case of endometris, other than that MD is not sure of why I have the failures. I also had 4 failed artificials. wondering why I'm not responding?
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Corey_Whelan	low carb diets help with insulin resistance and can actually help you to ovulate. Weight bearing exercise to build muscle and cardio are key as well. Dr. Potter is right about that
Corey_Whelan	cool name, welcome lamoomoo
HB	thanks Corey
airforcewife090302	I am not overweight but I have gained alot o f weight when I started the injectables
Corey_Whelan	I did too, it's very common
airforcewife090302	when I actually started out I was underweight
ems31602	I am 33 and did IVF in April. 3 eggs retrieved - 2 grade 1 and 1 grade 2. Day 3 they were 4 cells. Levels were all where they should be. Why would I have 4 cells on day 3 if they were good grades????
ems31602	of course they didnt take or i wouldnt be here lol
Corey_Whelan	it's not about your weight always, it's about your carb intake. You can be thin but still be eating too much carbohydrate.
Dr_Potter	red, I cant find your post; resend
airforcewife090302	ok!
airforcewife090302	is it ok to eat potatoes but just limited?
Corey_Whelan	no
HB	Are antogonist protocols generally less successful than lupron protocols?
airforcewife090302	k
Corey_Whelan	sorry. Keep it to around 40 grams a day.
airforcewife090302	ooh ok
bganze	26 yrs old - unsure of ovarian reserve - severe male factor - uterine polyps to be removed in 2 wks - IVF to follow. Chances for success? Advice?
airforcewife090302	I will have to try that then
Corey_Whelan	guys, hang on. Red, then HB, then bganze
leslies75	what about me corey?
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airforcewife090302	My husband just bought me a treadmill since my FET failed so I can loose some of the weight I have gained
Corey_Whelan	smart husband
Dr_Potter	Hi bganze. Honestly it is impossible to know your chances without some measure of your ovarian reserve. I use the clomid challege test. Others use the antral follicle count. Both of these are better than a simple cycle day 3 FSH/E2 although day three labs are better than nothing at all.
airforcewife090302	lol yes he is amazing!
red	me- 25 dh 28 severe male factor sperm count less than 1 million w/varicocele.. considering ivf.. are there any advantages to either a varicocelectomy vs ivf w icsi besides cost.. the varicocelectomy is covered by insurance ivf is not
Corey_Whelan	leslies, sorry I missed you. Let's get you on line too
frances1	First IVF failed due to poor response to stims (600 Bravelle, 200 Menopur). Second attempt the cycle went beautifully - size of follicles and Estradiol level - however I only had two follicles and both were empty upon retrieval. There was no evidence of the eggs having released. Would this be due to trigger shot error or poor egg quality? Thank you.
ems31602	any answers for little old me??
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airforcewife090302	leslie may I ask where you guys are stationed at??
Corey_Whelan	Let's give Dr. Potter a chance to catch up, all of your questions are amazing. You're a very educated patient group, I'm impressed with all of you.
leslies75	we are in NJ - husband works at McGuire AFB
FET3	airforcewife - May I ask you why you changed doctors?
Corey_Whelan	FET and aFW - off line, please
HB	I'm sorry frances.
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Dr_Potter	Hi Red, thanks for your patience. Varicocoelectomy is not going to return your husbands sperm count to the non-IVF/ICSI range but it may slow furher deterioration. With a count below 1 million, make sure that your husband has been screened genetically (karyotype and yq deletion study). Genetic abnormality can make it a 'no go'
frances1	HB, thank you.
FET3	Oops. Sorry Corey.
sherrylt	what is a yq deletion study
red	it may make ivf a no go or the varicocelectomy?
Corey_Whelan	no sweat FET
Dr_Potter	Hi Frances1, it sounds as though you have poor ovarian reserve. Has this been measured? Empty follicles can be due to either poor egg quality or faulty trigger shot.
Dr_Potter	yq deletion study is a study looking for microdeletions in the long arm of the Y chromosome. This is the area that has most of the genes for sperm production
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moharden	Hi Dr. Potter, I have had one successful IVF attempt (we are pregnant with one). What is the likelihood of being successful again? (Am I more likely to be successful?) Our embryo development was very slow. We had a five day transfer with two "poor" embryos, none to freeze.
airforcewife090302	Dr potter I have a ? when you get a chance... with my FET i didnt go on lupron and with both IVFs I didnt do baby asprin I know alot of docs use this protocal could this be a reason why mine failed??? and I also have endometriosis could that be a factor
shaymer01	Dr, now that the questions have stopped flying! What is your protocol for building the endo lining for donor cycle? And do you have a cutoff minimum acceptable lining measurement?
Dr_Potter	It sounds as you also may have diminished ovarian reserve. 3 eggs is a very poor response and 4 cells on day three is also very poor. The grade relates to the degree of fragmentation in the embryo. So you have slow embryos with little fragmentation.
Karen	Corey - can I get in line with my earlier question or should I repost?
ems31602	Is IVF even an option then...prior to retrieval it looked like i had 9 but my RE then said he only got 3
ems31602	only one was fragmented the other 2 were perfect
Dr_Potter	leslies75, please repost your question, I don't see it
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bganze	Thanx - Day 3 labs are all I have - FSH 5.8 MIU/ML
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HB	Should I also repost, I thought I was #3 in line
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Corey_Whelan	Hi Karen, please repost
Dr_Potter	Hi sb10847, the correlation of blastocyst grade on day 5 and implantation rate should be very strong unless your clinic is not applying there grading criteria in a consistant manner.
Corey_Whelan	I know someone was just off screening me, I clicked it off by accident, sorry, not sure who it was
leslies75	i have had 2 IVF cycles and 1 FET. I am in the middle of stimming for IVF #3 now. After each failed cycle my RE had changed my protocal a bit. Now I am on 300IU follistim and 350 of menapur. I am 32 my husband is 36.
leslies75	We have MF issue only - low count
Karen	Dr. Potter - I am 34, just failed first IVF. FSH 14.7, 10 follicles, 4 eggs, all fertilized, 3 transferred, none took. Should I try another cycle with my own eggs, or with this FSH move on to donor eggs? Should I even bother with other measures of ovarian reserve you discussed?
Dr_Potter	airforcewife, do not let yourself be defeated. If you can make blasts, you should be able to get pregnant. Hang in there!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
frances1	My FSH, Estradiol and fine. However, I had a hysterectomy, with no removal of ovaries, and am using a gestational carrier therefore testing for Day 3 was done every week for two months to get the best idea. One problem, anti mullerian hormone level is low.
moondreams	i'll repost mine too - can't see it...my husband, myself and donor all are healthy and passed extensive testing. 8 embryos 5 day blasts produced. had a pregnancy until 9 weeks with fresh and heartbeat stopped. had a chemical pregnancy and then another failed FET with a perfect thaw. 2 embryos left - what are chances for success? could all 8 be non-viable? what should i do/know before my last attempt?
leslies75	every time, the RE says everthing looks great and is very optimistic. Ijust want to know why the embryos won't stick!
ems31602	i'm sorry to keep butting in...but wouldnt my RE have told me prior that I had diminished capacity. he never mentioned any problems with my blood work prior
airforcewife090302	thank you Its just the money factor now we have spent everything!! I am trying to.. I just never thought it would take this long to get pregnant! its been 5 years 5 monhs now!
HB	What is a "good" fert rate, assuming ICSI? How much of this number is due to an embryologists skill? What is the average fert rate?
Dr_Potter	Hi Karen, at my clinic the success rate for a patient with the age and FSH you have mentioned would be about 15% per attempt with egg donation being 75%. Whther you try with your own eggs would also depend on the quality of the embryos that were transfered
Dr_Potter	Hi Claire, help me out, what is a UU
shaymer01	75%!!
Karen	Thanks. I wasn't given a measure of quality other than REI called them "B students" - guess I should ask about grade?
claire	Unicorn uterus.
leslies75	Dr Potter : I reposted
airforcewife090302	Leslie I meant to tell u where I am from we are stationed at tyndall AFB which is panama city have you heard of it?
Dr_Potter	Hi Claire, it may be time to consider a gestational carrier.
Corey_Whelan	guys, I need to give you a heads up that we only have around 4 minutes left tonight.
sb10847	Still curious about the HB's question - comparing lupron vs antagonist protocol - may not be that easy to compare.....
airforcewife090302	ty corey!
Corey_Whelan	my pleasure
airforcewife090302	Dr. Potter I would like to say thank you for all of your information and help tonight!!
FET3	I second that!
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Corey_Whelan	Did anyone's question get missed? If so, now is the time to repost
moondreams	yes mine was posted 2x
airforcewife090302	I have one more ? if we were able to do another IVF how many embies would you recommend transfered with both of mine I transfered 2 blasts with each cycle
leslies75	me, me
Dr_Potter	Hi red, both. If he has an abnormal karyotype, you may need to use donor sperm. Therefore surgery nor IVF would be a indicated. Chances of an abnormal karyotype in this case would be 10% or so.
ems31602	would my RE have told me with blood work that i have diminished reserve? thought i had 9 but only got 3
Corey_Whelan	ok moondreams next Dr. Potter, and then leslies
moondreams	thanks
Corey_Whelan	hang in
bganze	based on FSH levels - what is good ovarian reserve? Mine was 5.8 MIU/Ml on day 3
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frances1	Is anti mullerian hormone a good indication of ovarian reserve. Mine was low.
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hoping	expecting to do a laparoscopy after 2 failed ivfs will this help?
HB	Generally, do antagonist protocols have a less positive outcome than lupron protocols?
moharden	Hi Dr. Potter, I have had one successful I\|VF attempt (we are pregnant with one) What is the likelihood of being successful again? Our first IVF attempt we had slow developing embryos, day 5 transfer (not blastocytes), and "poor" embryos, none to freeze. I'm afraid we were just "lucky" this time? Is there anything you would suggest changing for our next IVF cycle?
Dr_Potter	Hi Fraces1, the blood supply to your ovaries may have been compromised by your hysterectomy. You can still time a clomid challenge test with no uterus, it takes serial ultrasound and blood tests, but it can be done. Also, and inhibin b on day three would be helpful.
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Dr_Potter	Hi Moondreams,
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juls253	Found a Donor but did Botox 1 month ago, any worries??
Corey_Whelan	no new questions folks, sorry.
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Corey_Whelan	I want to thank you all so much, you are an amazing group. Dr. Potter, thank you so very much for being here tonight. You did a wonderful job and we are grateful.
airforcewife090302	thank you so much!
Corey_Whelan	If you all could let me know what states you're from as you're signing off that would be terrific.
christalp	goodnight...from NC
Corey_Whelan	Dr. Potter, can you let us know your website address please?
ems31602	thanks Dr. I am in NYC
claire	Illinois
sb10847	New York
airforcewife090302	I am in Florida
Dr_Potter	Hi Moondreams, it is not likely that all of the embryos from a donor cycle are abnormal. Has your uterus been evaluated? What type of hormone replacement is being used? Have you been screen for immunological issues? Endocrine issues? In a case like this, one must start looking for unusual things as this is an unusual case.
FET3	Thanks so much, Dr. Potter and Corey! Have a good one! FL
aijia	OH. Thank you Dr. Potter.
airforcewife090302	FET I wish you all the best!
HB	Florida
bganze	Thanks from TX
airforcewife090302	I hope that this one worked for you guys!!
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Corey_Whelan	good night all. Thanks again
moondreams	can i email you offline?
tanyadockter	Thank you from North Dakota
airforcewife090302	GL to all of you I hope that your dreams of becomming parents come true!
FET3	Good luck everyone and I hope we all get our dreams!! Love to all.
Corey_Whelan	corey@theafa.org
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moondreams	if so, what is your email address? thanks for the feedback....
moharden	Monica Chicago, IL
cskains	living in TX
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airforcewife090302	thank you dr. Potter again!!
Dr_Potter	Hi moharden, the chances for success depend on your age and ovarian reserve. The fact that you and your husband have a child together would also be factored positively into the equation.
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airforcewife090302	leslie do you like where you guys are stationed at??
leslies75	i have had 2 IVF cycles and 1 FET. I am in the middle of stimming for IVF #3 now. After each failed cycle my RE had changed my protocal a bit. Now I am on 300IU follistim and 350 of menapur. I am 32 my husband is 36. leslies75: We have MF issue only - low count
leslies75	every time, the RE says everthing looks great and is very optimistic. Ijust want to know why the embryos won't stick!
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Dr_Potter	Hi arifromce wife, we use aspirin but I am not sure that it is really that important. It is cheap and harmless and there are theoretical reasons why it might help so why not. I use lupron for all of my FETs because I feel it is more precise than leaving things to chance. You can form a follicle and have premature progesterone secretion if lupron is not used.
airforcewife090302	oooh ok
airforcewife090302	how many embies would your recomend tranfereing if I ever got the chance to do another IVF?
moondreams	i was screened for everything immunological & endocrine, uterus is fine, respond perfect to meds. lining was a 10!. no lupron since i'm supressed naturally due to advanced age. i do estrace/P10 medrol and doxy and with a clinic with excellent success rates. anything else unusual to look into? i'm so stumped and trying to be optimistic, as i can't financially afford to keep doing this.
leslies75	airforcewife: my husband is in the National Guard - we both have liven in NJ our whole lives!
airforcewife090302	oh wow ok!
juls253	Dr. Potter, should I be worried if I did Botox 1 month before IVF attempt with donor egg?
airforcewife090302	hubby is active duty
HB	Are antagonist protocols less successful than lupron protocols generally speaking? How much of fert rate (with ICSI) is due to the skill of the embryologist? (I've been skipped a bazillion times!)
airforcewife090302	Has your hubby had to deploy any??
airforcewife090302	Im not sure what the diffrence is sorry
leslies75	my husband is in Iraq right now on a six month deployment
Dr_Potter	Hi leslie75, what are the factors involved in your infertility? How old are you? WHat is your ovarian reserve? Do you have insulin resistance? Do you have uterine factors or endometriosis? Could you have hydrosapinges? Could you or your husband have an abnormal karyotype?
airforcewife090302	I am really sorry!
airforcewife090302	mine has been to iraq 2 times and possibly going for a 3rd
airforcewife090302	what is a Karyotpe??
leslies75	I have no issues on my side, it;s just the male factor of a low count, that's why we went straight to IVF w/ ICSI. I am 32.
Dr_Potter	ems31602, did he look for diminished ovarian reserve? Were you tested?
ems31602	i had all the normal tests
ems31602	i dont know any numbers because i wasnt given any
ems31602	he told me with last U/S there were 9 but he only got 3 out
moondreams	i actually had a follicle when they started me on the last FET cycle and didn't give me lupron. they said the estrace/p10 would knock it out and it shrunk. you think that could have screwed things up?
leslies75	I don't know about ovarian reserve, I don't think there's a concern as my RE never brought it up. I'll definitely bring it up at my appt. tomorrow.
airforcewife090302	My hubbys last semen count was 62 million with 2% morphology
Dr_Potter	HB, 70% is average, that is 70% og the injected eggs become 2pn
ems31602	im just afraid because i dont seem to know haolf of what these other women know
HB	thank you Dr. P
airforcewife090302	ems when I first started out I didnt know anything! I went to the store and bought some books started doing reasearch!
ems31602	im not getting any numbers
ems31602	i never did actually
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HB	EMS - There are a lot of us infertility veterans in here. We were all at the place you are now once, don't worry. (And most of us are also happy to help with answers too)
ems31602	great because im freaking out
ems31602	i want to do ivf again and the only thing he told me to do was take DHEA and maybe we would hold off longer on putting eveything back in
bganze	i didn't get any numbers from my gyn - got them all from my RE. Still don't kow what most of them mean. We are all in the dark to some degree. You aren't alone.
Dr_Potter	ANTAGONIST vs. AGONIST. In my hands, the agonist is the first line protocol. I feels that there is better endometrial development, less OHSS, more eggs and embryos for patients with normal ovarian reserve. Better pregnancy rates also.
ems31602	like instead of doing it at 7 am like we did last time to wait til later to give them chance to split again.....everything else was good from what he said
airforcewife090302	does endometriosis affect you getting pregnant???
sherrylt	omg airforce could you ask any more questions?
HB	Hmmm, I thought DHEA wasn't proven yet, but I may not be up to date either... Dr. P, can you weigh in on DHEA?
HB	Thank you Dr. P
ems31602	i started it but i got hives
Dr_Potter	DHEA is not yet ready for primetime
ems31602	he told me i may be allergic to an ingredient but it was only where i had the progesterone in oil shots that flared up
airforcewife090302	it could be the type of oil ems
ems31602	nothing like scratvhing you butt constantly
airforcewife090302	they make diffrent kinds
airforcewife090302	cottonsead oil I believe is the one I used
Dr_Potter	LADIES, you were great. Thanks and good night ::laugh
ems31602	i had sesame
HB	I think there are different kinds of prog in oil that you can use, where the type of oil varies. You may be allergic to the type of oil used, like sesame oil.
airforcewife090302	g'night dr potter and thank you so much dr potter!!
ems31602	i didnt scratch til after i did the dhea - never an issue when i took them
HB	Thank you Dr. P
ems31602	Thanks DOc!!!
airforcewife090302	yes HB thats what I was trying to say!
ems31602	are you ladies stick around a little?
moondreams	Thank you.
airforcewife090302	yes ems!
bganze	Thanks!
airforcewife090302	I can for a little longer!
HB	yes, for a few min ems
airforcewife090302	take care dr potter!!
ems31602	should i be asking for numbers?
HB	Hell yes
airforcewife090302	I would ems!
HB	oops, heck
bganze	It always helps to have them - even if you don't know what they mean
ems31602	im married to a ny cop - hell is where i live LOL
airforcewife090302	after I have labs done .. Ultra sounds I ask ?'s
HB	It's your body, your healthcare, you have a right to know
airforcewife090302	lol ems
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airforcewife090302	yep HB your right!
bganze	Labs esp.
HB	And if you ever switch docs you'll at least know the basics
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ems31602	it was my first time so i guess i dont know better
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airforcewife090302	your fine!
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ems31602	youre all like muiuml and im like huh??
bganze	Good for your records. I didn't know to ask at first either.
HB	Any time I have anything done - bloodwork, labs of any kind, e2's rogesterone levels and of course results of laps, hsgs, hysteroscopies etc. etc. I ask for copies of the results. Also for every SA.
airforcewife090302	when I started out I was scared to ask!
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bganze	I have my labs in front of me - otherwise I wouldn't know a thing.
airforcewife090302	I do the same!
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ems31602	god i hate this lol
airforcewife090302	I like to know where im at and if my levels are good!
HB	And then you have everything
HB	at your fingertips
ems31602	all he said was everything looked great
ems31602	levels were where they should be
HB	sigh... I hate docs who do that!!!! It's so... demeaning!
airforcewife090302	If you wanna know ask! you have the right to know!
bganze	They still have all your records - ask for copies next time you go in
ems31602	i will
ems31602	i have some time before i do the next round
HB	Did he also say "don't worry your pretty little head about it, dearie"? lol
airforcewife090302	yep bganze i agree
ems31602	god no
ems31602	he just told me next time we will wait a little longer before we put them in....considering he told me he saw 9 then after anesthesia he says we got 3
HB	I agree too, ask for copies of everything done so far and then ask for them every time you go in from now on
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ems31602	he almost got kicked
HB	Can I go on a little rant here?
ems31602	please do
ems31602	we all need to %%%%%
bganze	it can be really frustrating when doc is male. They act like nothing should bother you - even bad numbers. Mine told my surgery wouldn't hurt at all - how would he know?
HB	About embryologists (I was asking some pointed questions earlier which were sort of glossed over..)
airforcewife090302	bganze I was told that before as well!
airforcewife090302	it will be no problem you will be fine!
bganze	Thanks
HB	ok, so here's my rant... What the docs never really tell you is that ICSI (and embryology in general) is an art and a skill as much as it is a science.
airforcewife090302	really
HB	a good fert rate (assuming ICSI) is about 30-50%
ems31602	well they did that to me and it worked - the bastards just didnt stick
HB	a better fert rate is 50-70%
HB	and an xcellent fert rate is about 80%
bganze	Does anyone have other message boards or chats that they go to for support? There are so many to choose from it is overwhelming.
HB	try ivfconnections.com
airforcewife090302	ty hb
bganze	How many of you had those ovarian reserve tests? This was the first I've heard of that
airforcewife090302	I dont think I have im not sure
HB	I had a cycle where I got 9 eggs but only 2 fertilized because the embryologist at that practice sucked.
airforcewife090302	omg I am so sorry HB
ems31602	that sucks
HB	I changed practices and have gotten 17 of 20, and 14 of 15 fertilized.
bganze	wow - what a difference
ems31602	holy crap
ems31602	i wish i had your doctor
airforcewife090302	my first IVF was cancled my 2nd I made it to transfered got 18 eggs and 14 fertilized
ems31602	at least id have a shot
airforcewife090302	wow HB thats great!
HB	The difference is amazing and it all comes down to the skill fo the embryologist. After 3 cycles (one of which was nearly cancelled, the 2nd didn't make it to transfer) I had NO totsicles. After 2 cycles with the new practice (and new embryologist) I suddenly have 17 totsicles.
airforcewife090302	wow
ems31602	whats a totsicle
ems31602	or am i that dumb
bganze	what is most important when just starting IVF? I'm new a the treatment phase
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HB	Forget the doc, research the embryologist! Well, ok, don't forget the doc, but don't neglect to research the embryologist when picking a doc (if you're planning ICSI)
ems31602	they just did icsi for me i didnt ask for it
HB	totsicle is a frozen embryo (not a technical term! LOL)
HB	like popsicle
bganze	ha ha!
HB	but with a (potential) tot!
go4three	is their a dr in here tonight?
airforcewife090302	but when they thawed my embies they didnt tdo so hot! the first 5 died and then my 2 blasts did great
bganze	not anymore
HB	he just left
airforcewife090302	he has left already
go4three	what was the topic?
HB	usually about 50-60% survive the thaw unfortunately, on average.
airforcewife090302	wow!
bganze	topic - IVF failure
ems31602	%%%% youre knowledgeable
Rita_Etchie	Where do you research the embryologist?
HB	bganze... the doc and the embryologist.
HB	I can recommend a doc (and embryologist in Fl) and can tell you some others in FL to NEVER go to - anyone interested PM me
go4three	anyone have experience with clomid?
ems31602	gave me hot flashes
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HB	I just reread what I wrote about how many survive the thaw - you guys got that I meant, unfortunately ONLY that many survive, not what I wrote which came out wrong, right? lol
go4three	affect your lining?
ems31602	like menopausal worthy
airforcewife090302	yes I only ovulated once with it
airforcewife090302	lol yeah we knew what you meant!
go4three	airforce - once out of how many times?
airforcewife090302	lol
ems31602	dontknow how it worked because i had bad tube that i found out about after i took it
airforcewife090302	5
airforcewife090302	I had to move onto injections
airforcewife090302	HB did you get my message?
ems31602	i did 2 iui with inject and 1 ivf that sucked
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go4three	ive taken it 2x and i ovulated but had a chemical pregnancy so now im worried that i should take projesterone with it
HB	You ask the doc about their fert rates, thaw rates, ask to speak to the embryologist, find out where they were trained, if they have a PHD (many don't), and look at the lab. Ask how many ICSI's they do, all of their numbers and compare them to other embryologists at other clinics.
ems31602	a friend of mine wiht PCOS took it for the first time and got pregnant....lucky %%%%% LOL
HB	Mostly, look for a fert rate (with ICSI) over 70% is possible.
HB	if
go4three	im trying for my third - did ivf for first two babies but dont want to go through that again so now im trying with just clomid
Rita_Etchie	Thanks HB
bganze	thanks all - I have to go now. Good luck in your pursuits!
ems31602	thank for the advice
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HB	usually clomid doens't work well for people with PCOS., letrozole can work better, or stims of couse
HB	no problems, good luck everyone
ems31602	she got prego on first round of clomid can you believe that
go4three	if i have pos ovulation predictor kit, then does that mean its working?
HB	bleh, ems, don't torture yourself with it. I know I know, it's hard not to, but youll just drive yourself nuts with how easy it is for other people even when they use fert. treatments...
ems31602	oh trust me i already went into therapy for it
HB	(((ems)))
ems31602	i went bananas - i still dont like pregnant women but i love babies
ems31602	my cousin just had a baby and barely spoke to her during pregnancy but i love my little Logan
go4three	im not willing to move onto ivf this time, so clomid is the end of the road for me
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ems31602	best of luck
ems31602	i hope it works for you like it did my friend
go4three	ive already done 2 cycles and no baby yet
HB	good luck, go 4 - but remember that if clomid doesn't work, letrozole is a similar option (oral med also, similar cost)
HB	especially if you have PCOS
go4three	ive never heard of letrozole
go4three	i have pcos but im not insulin resistant if that makes a difference
HB	it's similar to clomid and sometimes works when clomid doesn't. Also less chance of multiples since it usually only produces 1-2 follies
HB	not really, if clomid doesn't work though, try letrozole though, you might have better luck
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ems31602	my friend is insulin resistant with pcos....is that something she should look at
go4three	well, i make a lot of follicles which is why i did ivf for first two kids so maybe that would be a good idea----luckily both ivf's were single births
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HB	yeah and also metformin to get that insulin under control ems
go4three	i dont want twins
HB	you could change your name to "go44"
go4three	they would have to committ me
ems31602	shes on metformin
HB	lolol
HB	good ems
ems31602	she has tried ivf but cant actually get to the point where they retrive
HB	high insulin levels contribute to miscarriages so it's good to have it under control
ems31602	the meds make her crazy
HB	why? poor reserve? what protocol?
ems31602	shes on im let me ask her
HB	the meds make us all crazy
ems31602	i did great
ems31602	no problems outside of sore boobs
ems31602	only 1 outburst of anger in 3 cycles of injectibles
go4three	was fine on the meds too
ems31602	considering im an evil redhead with a bad irish temper, thats amazing
HB	wow, lucky you - I tend to cry over dog food commercials...
ems31602	well i cry at the ASPCA commercials with the sad doggies
ems31602	im a sucker
go4three	but was overstimulated with my first so i paid my dues
HB	and then scream at DH for not thinking fast enough (not responding to me instantaneously, God forbid he actually think about his answer!) lol
ems31602	im just really wondering if i should change doctors
ems31602	no levels given, take dhea
ems31602	its like im a guinea pi
ems31602	pig
HB	Well, maybe maybe not
ems31602	im 33 with 1 tube due to ectopic
HB	Find out if he's willing to give you info, tell him you're more comfortable knowing more and not being kept in the dark in general
ems31602	the remainer is baddddddddddd
ems31602	which is why im stuck here
HB	and if he's resistant to that, leave
ems31602	but this diminsihed reserve is freaking me out
HB	you're paying too much to accept being kept in the dark about you're own healthcare - plenty of other fish in the sea who will teat you better
HB	treat
go4three	how do you know if you have a diminished reserve?
ems31602	i dont
ems31602	the doc thought that because i only had 3 eggs at retreival
ems31602	even though he said he saw 9 2 days before
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HB	At least he should have done an day 3 FSH on you, ask what that number is - you're looking for it to be under 10. Anything over 10 you have diminished ovarian reserve
ems31602	i had them
ems31602	he never said boo about it
airforcewife090302	can I ask a retarted ?
ems31602	what the hell LOL
ems31602	go for it
HB	I wonder if you ovulated, seems strange he woul see 9 but only retrieve 3. I can see the numbers being closer together, but that seems a little off to me
ems31602	i was doing the trigger shot
go4three	were you on lupron?
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ems31602	no, gonal-f, menopur and cetratide
HB	of course afw! lol
airforcewife090302	Ok I have endo pcos and blocked tubes.. Can there be a way to get my tubes fixed and go back to injectables and timed intercourse????
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airforcewife090302	Im sorry
HB	ems - no ganerelix????????????????
airforcewife090302	im just not sure what to do anymore
ems31602	what is that
go4three	ask about lupron - it supresses your cycle so you dont ovulate before the hcg shot
HB	afw, yes but not as likely to work (or work as fast) as IVF
airforcewife090302	ok
ems31602	i had an HSG, and they surgically fixed my blocked tube but told me to do ivf instead
airforcewife090302	we cant afford another IVF is why I am asking
HB	go 4 - no no no - not if she;s a poor responder - lupron will oversuppress her and she won't have any follies
airforcewife090302	we have been ttcing for 5 years 5 monhs
HB	She was already on the antagonist protocol, no way in hell she should go backwards to lupron!!!!
ems31602	what is the antagonist
airforcewife090302	ooh and hubby has a sperm factor now we just found ou last nov
ems31602	see i dont know %%%%
go4three	but if shes ovulating before the shot....
ems31602	told you LOL
HB	ems - ganerelix prevents you from ovulating, you take it a few days before trigger, when the lead follie is about a 14
ems31602	i thought that was what the cetrotide was for
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ems31602	i type really fast sorry
go4three	i did a very different protocol for both my ivfs
go4three	did lupron and gonal f
HB	ok - lupron suppresses the ovaries so you won't ovulate and lose the eggs. Ganerelix does the same thing. The difference is that luron is taken before you stim, ganerelix (also called antagon) is taken the last few days of stimming.
ems31602	oh instead of lupron he had me on the pill the month before we did the injectibles
go4three	the pill is not too suppress, its to avoid getting ovarian cysts and having to sit out a cycle
ems31602	im catching on
ems31602	yeah well i had one
ems31602	so big they were going to pop it
HB	Using lupron, suppressing at the beginning is lovely for people who's ovaries are fine, pretty young things. For those of us whose girls are talking about retirement, the protocol using ganerelix works better (called the antagonist protocol)
go4three	but i thought ems was 33
HB	ems, right, the bcp;s suppress you less than lupron does and is standard lead in to antagonist protocol
ems31602	i am
go4three	i was 33 too, now im 36
laurak	according to the website there is a discrepancy about Dr Potter's session tonight... in one place it says it hasn't occured yet in anothet it says it aoccured at 8-9PM eASTERN time which has passed. Can anyone tell me which is accurate?
airforcewife090302	I just wanna say thank you so much ladies
airforcewife090302	I am going to go!
ems31602	33, no kids, one bad tube and the other removed
airforcewife090302	have a g'night! I wish you all the best! I hope your dreams of becomming parents comes true!
HB	yes go 4 but the pill also suppresses, ever so slightly - and it's just enough suppression for ovaries not as eager to respond. Lupron would be too much suppression for said ovaries and they wouldn't respond at all. Hence the antagonist protocol
ems31602	by AFW god bless my cuz is in AF in Pensacola
airforcewife090302	ty! we are in panama city at tyndall afb
HB	8-9 east happened, it passed
airforcewife090302	bye bye
laurak	Has DrPotter had his session??
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ems31602	yes
HB	good luck everyone
ems31602	so im guessing my eggs are crappy arent they
laurak	okay thax... were any of you here for it?
HB	any other questions - I've got to go to bed
ems31602	hb are you a nurse or doctor?? LOL
ems31602	thank you so much for everything
HB	Nooo lol, just a veteran. 8th year of fert treatments.
ems31602	youre a fountain of knowledge
HB	it's just experience, I'e made every mistake along the way there is to make.
laurak	did any of you get to talk to Dr Potter?
ems31602	well thank you so much
HB	hope you have success and quickly too
ems31602	me too!!! same for you
HB	good luck to all, good night
go4three	can someone explain a chemical preg?
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