Living and Conceiving With PCOS

August 7, 2007 - Tuesday
5:31 PM to (EST)
Guest Speakers: Rachel Bennett, MD
Westchester Reproductive Medicine

Categories
Fertility Drugs • Infertility • IUI • IVF • PCOS • Pregnancy Loss

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Moderator_DBecker	Nkobal, welcome to tonight's chat - you are a bit early we will get things going at 8:00 PM
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anitet	good evening
Moderator_DBecker	Good evening everyone - let's have a warm welcome to Dr. Beennett
smoore	Welcome! Happy Tuesday!
dideek	Hello everyone!
rbennett	thank you dan. i'm happy to be here.
Moderator_DBecker	I will be tonight's moderator - topic is PCOS and gen questions
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rbennett	tonight's chat is on PCOS - you can ask any questions you'd like, from how do i know i have it? to how can i get pregnant?
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Moderator_DBecker	Elena welcome to tonight's chat
elena0322	thank you
Moderator_DBecker	H writekeek - welcome to this AFA Chat
writekeek	Hello! This is my first time on one of these chats
Moderator_DBecker	So who want's to start things off?
Moderator_DBecker	Writekeek eveyone has to have a first time
dideek	This is my first time also.
elena0322	This is my first time also
elena0322	I am unsure how this works
rbennett	let me start. pcos is a diagnosis of exclusion. that means that someone may present with some symptoms, such as not menstruating and infertility and hirsutism, but we must first rule out that there isn't some other disorder that's causing the problems.
Moderator_DBecker	WOW Newbies - great - hopefully you will learn lots and knowledge is power!!!!
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Moderator_DBecker	Elena just follow for a short time and then ask a question
elena0322	ok thanks
writekeek	thank you
nkobal	okay i can go first, on your research and experience, do you find jumping to IVF is the best fora woman with PCOS
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nkobal	are oral fertility meds and injections worth it
Moderator_DBecker	Hi Romy welcome to tonight's chat with Dr. Bennet
rbennett	not at all. if pcos is the only problem (the tubes are open, the sperm is okay), i would usually try ovulation induction with clomid as a first line treatment.
Moderator_DBecker	nkobal - in what way??
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anitet	what if clomid doesn't work?
rbennett	oral fertiltiy meds are definitely worth it. 80% of women who don't ovulate will ovulate to clomid, and 40% will conceive. definitely worth a try.
nkobal	well ar ethey as effective as IVF? does IVF even work for women with PCOS? i mean i have forgotten the smost recent stats
smoore	How long should one be on climid to determine if it works?
miraclet	My doctor told me he thought I had PCOS but he didn't do any specific test for it, he said if it looks like a duck and sounds like a duck, then it's a duck...do you agree?
CMYPAB07	What if you don't ovulate on clomid?
rbennett	clomid is usually started at one pill a day. if you ovulate to that, then i would stick with it for up to three months, perhaps modifying some aspects of the cycle (adding estrogen or an insemination for example.
rbennett	if one pill a day is not effective at making someone ovulate, you can increase the dose to 2 a day, then 3 a day.
Moderator_DBecker	BTW, Dr. Bennett can you give your contact information
dideek	My doctor put me on Femera a substitute of Clomid. I got preg and then had a miscarriage a few months ago.
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anitet	My doc offered me letrozole, caouse I didn't ovulate after clomid? Do you think it can work?
Moderator_DBecker	Hi Sara welcome to tonight's AFA Chat on PCOS and General Infertility Questions
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rbennett	if clomid 3 or 4 pills a day don't work, you can try metformin (add it, or try it alone), or a relatively new drug called letrozole. if none of these work, you can use injectible drugs.
elena0322	is letrozole a pill?
writekeek	I am currently using letrozole
writekeek	does anyone have experience with it?
miraclet	I'm on Metformin now, but not with clomid...we've not had any luck yet...is clomid the next step?
anitet	metformin...how fast it supposed to work? I'm takin 10 months and I don't ovulate.
rbennett	miraclet, i do do some tests for PCOS - ii check male hormone levels and thyroid tests to exclude other causes of the symptoms. sometimes i do come up with a different diagnosis. however, your particular presentation may not require that.
rbennett	maraclet, yes, i would add clomid to the regimen next.
miraclet	I have hypothyroidism as well
nkobal	yes i tried letrozole with insemination. and also was on metformin at the same time. unfortunately it did not work for me.
rbennett	miraclet, well then you should be on thyroid replacement as well.
CMYPAB07	Since i didnt respond to clomid my md suggested IUI - is that a better option?
writekeek	that is what my new fertility doc wants me to try letrazole with IUI
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miraclet	yes, I'm on 200mcg synthroid, 1500 metformin and also prenatal vitamins
writekeek	why do they do IUI verses timed intercourse?
rbennett	elena, letrozole is a pill. as i said, it's rrelatively new , and most docs probably don't have too much experience with it yet.
Moderator_DBecker	aharrel welcome to tonight's chat with Dr. Bennett of Westchester Reproductive Medicine who is "talking about" PCOS and taking general infertiility questions too.
dideek	Is letrozole like metformin?
rbennett	cmy - if you ovulated to clomid but didn't conceive, i would also suggest adding an iui, as clomid can actually cause a cervical mucous problem in some women who take it, and an iui will bypass the cervix.
sara120	I have PCOS and have been undergoing IVF for the last 3 years. I have done 7 IVF's and only one pregnancy which I lost at 8 weeks. I have been on various protocols and had my fallopian tube removed due hydro. Doc at this point said anatomically all is fine and so is sperm. Does PCOS cause signifcant egg quality issues and what if anything else can be done to improve quality to achieve successful pregnancy (going to start IVF # 8 in Sept). Doc at this point thinks its all hormonel
writekeek	letrazole is like clomid
CMYPAB07	what is the success rate of IUI after clomid for pts with pcos? Do we have such stats yet?
writekeek	I would like to know those stats too
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anitet	me too
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Moderator_DBecker	Be patient, it is difficult for Dr. Bennett to read and write at the same time
rbennett	dideek - metformin is a drug that is used in women with pcos who are likely insulin resistant as well. it increases insulin sensitivity, and can reverse the anovulatory cycle in some women. letrozole has a different mechanism of action - by decreasing estrogen levels, it increases the woman's own fsh output, thereby stimulating ovulation.
Moderator_DBecker	Molotia and shaymer welcome to tonight's chat with Dr. Bennett
molotia	Thank you
Moderator_DBecker	For those who are not members of AFA please join our no barrier program - membership is free
writekeek	what is the no barrier program?
rbennett	sara - egg quality issues may be more common in women with PCOS. without knowing exactly what your protocols have been for your cycle, it's hard for me to say what can be changed to increase egg quality.
Moderator_DBecker	writekeek - check out the AFA web site home page
writekeek	ok
Moderator_DBecker	The American Fertility Association offers great programs and information - check it out!!
nkobal	related to diet, is the philosphy of maintaining stable blood sugars good for insulin resistance and in turn for ovulation
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dideek	Currently I am on Actos and Femera> my doc is going to check my tubes and my husbands sperm count next. Is this necessary seeing I had a miscarriage a few months ago, doesn't this show that I can get preg?
miraclet	I've often wondered if something else is wrong, even with thyroid meds, my cycle is very odd, sometimes nothing during the month, maybe a little here or a little there, is there a chance with some other meds that I can have a semi-normal cycle, they ask when my period is and I can't tell them bc I don't really know, it varies
rbennett	cmy - the success rate of iui after clomid for patients with pcos - i've never seen any data on that specifically. in general though, though, they're decent, as long as there are not any other issues that are know (tubal or sperm). having said that, if 3 iui's don't work, ii would move on to ivf.
writekeek	How many follicles do you think must be appropriately sized in order to perform IUI? What size of follicle do you reccomend?
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rbennett	miraclet - that is very common ino women with pcos. some women don't menstruate at all, some have irregular cycles randomly. this is typical. metformin is one drug that if \taken daily, has a good chance of increasing your menstrual regularity. also, if you are over your ideal body weight, weight loss, if possible, is probably the best way to achieve this.
CMYPAB07	What if modest wt loss still doesnt affect menstrual regularity?
molotia	I've been diagnosed with PCOS but I always get my period 28-33 days , and have an ovulatory pattern on all my temp charts., i was wondering if its possible to not ovlate or ovulate late form stress and for that to cause PCO??
miraclet	My doctor also said that the tissue on the exterior of my cervix is like the tissue on the interior which is very sensitive to bleeding, he said it happens quite often after pregnancy, but I've never been pregnant, is there a name for this? He told me the only way to fix it would be to freeze the surface of my cervix in order to stop sporadic bleeding and bleeding during intercourse
rbennett	writekeek, if your issue is that you don't ovulate at all on your own, i'm really only looking for one follicle. however, if you've had several cycles without pregnancy, i would like to up it to 2 or 3 follicles at least 18 mm in diameter, if possible.
romy_simone	i've known of acupuncture to work in conjunction to help regulate the period
writekeek	I developed good follicles on clomid in the past, but did not conceive with timed intercourse. Now my new md has switched me to femara, and wants to try an IUI
writekeek	I ovulated on 100mg of clomid. sperm counts are normal
rbennett	molotia - to be diagnosed with pcos, you need to meet at least 2 of the following 3 criteria - 1 - ovlulating irregularly or not at all 2- increased male hormone levels, or clinical symptoms of that and 3- polycystic ovaries on ultrasound, and the exclusion of other disorders. if you ovuloated regularly, which it sounds like you do, you need to have numbers 2 and 3 to qualify.
nkobal	thank you
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rbennett	it is possible to ovulate late from stress, but that is not pcos.
anitet	How long you have to take metformin to see that your cycles are more regulalrity? Is it works for everybody?
rbennett	writekeek - that sounds like a logical course of action.
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rbennett	anitet - you should try metformin for 2-3 months. if it is going to work, it should work by then. for some women it works after 2 weeks. not all women ovulate to metformin.
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miraclet	are there tests that show ovulation?
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Moderator_DBecker	Heatherdawn, welcome to AFA's Chat with Dr. Bennett on PCOS
CMYPAB07	what if i've been on metformin for 3mos and don't notice any difference? Do I need to try something different to help w/ ovulation?
Moderator_DBecker	NDWife, welcome to tonight's chat with Dr. Bennett an RE with Westchester Reproductive Associates.
anitet	What could make me resistant on provera?
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dideek	You can get a Clear Blue Easy ovulation kit that will let you know the days you are ovulating.
Moderator_DBecker	Hi KK welcome to tonight's chat
molotia	I have: Mildly high Testosterone, IR, PCO on US, mild hirsutism, Hypothyroid. But I only became symptomatic during Physician aSSISTANT SCHOOL WHICH WAS VERY stressful, and igained 20+ lbs, and hardly sleeping (studying and rotations))
miraclet	does that work though if you dont really have a regular cycle?
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rbennett	miraclet - yes, there are tests that show ovulation. you could get a fertiltiy monitor from the drug store, or an ovulation predictor kit that shows the levels of LH in your urine - LH goes up prior to ovulation, so the stick kturns pos when your just before ovulation. also, you can get a blood test after ovualtion for progesterone - this hormone goes up AFTER ovulation. I'm a fan of BBT charts which are inexpensive and give a lot of information, including whether or not you're ovulation.
molotia	Could the stress, etc, have triggered PCOS??
dideek	yes, you just have to test more often
rbennett	anitet - what do you mean by resistan on provera?
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kk31393	Thank you, I'm sorry I'm late. I really wanted to see if I could get some suggestions. I have a mild case of PCOS and have used Letrazol to get pregnant. I've had 2 miscarriage and am now having trouble getting pregnant again. It's been 8 months now. ??????
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Moderator_DBecker	Hi Hputt welcome to tonight's chat with Dr. Bennett
dideek	Sorry to hear about your miscarriages.
miraclet	Have you ever heard of the cervix issue I described before?
rbennett	molotia - weight gain may have been the cause of your development of pcos. there are women that are susceptible to it (perhaps because of genetics), who may only become symptomatic after passing a threshold weight. perhaps your stress caused your weight gain, which led to the PCOS symptoms.
anitet	I didn't get my period after 10 days with provera, doc checked my estrogens level and once again I took 10 days ...I still didn't have my period. I get it naturally later
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hputt	I have been told to use metformin for my pcos how long should I take this if it doesnt work
rbennett	kk303 - iit's hare for me to advise you whithout knowing more details about your hiostory.
molotia	Thank you, I had a feeling that was the case.
writekeek	Dr. Bennet, Do you think that it is logical for me to switch from clomid to femara for the IUI even though I ovulated on clomid? On clomid I ovualted with 100mg. What do you think the correct dosage for femara would be?
rbennett	miraclet - i've heard of the cervix being friable and as you describe, but not as related to infertility, and definitley not to PCOS. i
miraclet	are there any causes/reasons why I have this?
CMYPAB07	Is femara or letrozole approved to treatment of pcos?
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molotia	Do you know if the OV watch works as well for PCOS as for other women? I will be trying it next month
rbennett	if you ovulated to clomid and had no issues on it (such as thin endometrium for example), but just didn't conceive, it would still be an option for you to continue clomid along with adding an IUI. perhaps your doc has some reason for switching you to femara - i
anitet	I heard ovulatory test doesn't work for women with pcos, because of elevated LH. Is it true?
Moderator_DBecker	Hi Amanda, welcome to tonight's chat with Dr. Bennett on PCOS
kk31393	My insulin levels have been normal, but never got my period if I wasn't on birth control. I used femara for 1 cycle and was pregnant. Had a miscarriage at 12 weeks, blited ovum. Went back on the pill for a cycle and then 2 cycles of femara and was pregnant again. Lost this one at 10 weeks, and there was fetal tissue. this time did not go on pill, started with femara, and has now been 8 months. Have had 2 IUI's.
Moderator_DBecker	Dr. Bennett is a Reproductive Endocrinologist (RE) with Westchester Reproductive Medicine
AmandaUNCC	Hi, thank you
rbennett	femata is not approved for the treatment of pcos.
CMYPAB07	i would agree. i used the at home ovulation testing kit and never had a positive test.
anitet	I had positive test, but I didn.t ovulate
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molotia	Can I reverse the PCOS andget pregnant if I lose enough weight with excercise and Low carb with lots of veggies??
rbennett	molotia - what is the OV watch? are you speaking of an ovulation predictor kit? for women who don't ovulate or menstruate regularly, i do not recommend these strategies becuase your ovulation is so unpredictable.
Moderator_DBecker	Hi Leah welcome to tonight's chat
Moderator_DBecker	Please visit the American Fertility Association (AFA) Web Site on a regular basis
dideek	If you don't recommend the ovulation kit, what do you recommend?
rbennett	molotia - yes, it is possible to reverse the PCOS and conceive after weight loss. i do recommend this strategy for those women in whom i'm not concerned about losing too much ovarian function due to reproductive aging. (i.e. less than 35.)
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CMYPAB07	what's your suggestion if the pt is 35 and older?
Moderator_DBecker	Hi Manning welcome to tonight's AFA chat with Dr. Bennett an RE with Westchester Reproductive Medicine
AmandaUNCC	Dr. Bennett, the only symptom of PCOS that I have is poor egg quality. We know this from two failed IVF cycles. The last cycle produced 0 fertilized eggs out of 22. I'm only 28 years old. I am now taking 1500 mg of Metformin. How does metformin help?
rbennett	dideek - if you have pcos and i'm treating you with clomid, i recommend monitoring with bloodwork and/or ultrasounds - this gives you the best handle on when you're ovulating. if this is not possible/not desired, then i simply instruct the patient to have relations every other night starting on day 10 around for 1 week, and then check a progesterone level around day 21 to see whether or not you ovulated.
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rbennett	amanda, strictly speaking, poor egg quality is not one of the defining symptoms of PCOS. if you have regular cycles, don't have elevate male hormone levels or sign of it, and don't have polycystic ovaries on ultrasound, then you don't have pcos. for sure there is some other reason why your eggs are not fertilizing,
AmandaUNCC	I do have recurring cysts but could they be from my Stage 4 endo?
dideek	Okay that sounds good, relations every other day. I think we can handle that. My doc started me on Clomid, but my mucus lining was very thin. It has been thicker on Femera.
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CMYPAB07	What about fsh and lh levels? can meds improve your levels and increase chance ofpregnancy?
smoore	My MD is having me check my progesterone at day 26? Is that wrong?
rbennett	anitet - it is difificcult for some women with pcos to use the ov predictor kits, because they have chronically elevated levels of LH, so what you heard is true.
Brooke	I was looking for something to help me predict when I am fertile, as I have been trying to get pregnant for a year now. I have used lh testing but with my pcos, the sticks and the monitor are never right. I talked with Jennifer Carter at ov-watch and found out that Emory University in Atlanta just completed a study where 79% of the women had PCOS and 71% were on metformin, All were on clomid (avg dose 50mg, but some up to 200mg) and ov-watch proved to be accurate at predicting ovulation and more sensitive than LH testing. I had been using it for 1 month when I made the call to the help desk at ov-watch. About a week later, I found out I was pregnant. After a year, it was the only thing that worked while I was on clomid
Moderator_DBecker	Hi Brooke, welcome to tonight's AFA chat with RE, Dr. Bennett on the topic of PCOS and general infertility questions welcome
rbennett	amanda - if you have stage 4 endo, this could definitely be causing recurring cysts, and could also be why egg quality is not ideal.
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molotia	The OV Watch is a watch you wear that predicts when you will ovulate 4or 5 days ahead of time so you have more opportunities to try. It workwith a cloride sensor that senses changes in the amount of cloride level in your sweat.
AmandaUNCC	So is the metformin a waste of time? And a waste of all these dreadful side effects?
CMYPAB07	so dr. bennett, do you recommend bbt or the ov watch since lh seems to be fluctuating?
rbennett	cmypa - some meds increase fsh levles (clomid does this), but usually doesn't affect lh levels much.
Brooke	since I have pcos what will happen after I am pregnant will I have to go on the met again?
rbennett	smoore - no that is not wrong.
dideek	How can I get this OV watch?
rbennett	amanda - it's not fair for me to answer that question without knowing all the details fo your record. why don't you ask your doctor why he/she thinks metformin might help?
kk31393	If your insulin levels seem to be normal, is Metformin helpful fo conceive? I hear that many PCOS are using that, but I have not.
Brooke	i got mine at www.ovwatch.com they were running a special
AmandaUNCC	okay. I appreciate your honesty. Thanks for taking the time to answer my questions tonight.
dideek	Thanks Brooke!
CMYPAB07	i required provera sev months ago to cause a period. if this is needed, is is ok to continue longterm while on other meds (ie metformin)?
kk31393	Brooke, since you are pregnant , did you use medications, IUI, IVF,etc???
rbennett	cmypa - it sounds like ov watch would be better than an lh predictor, given that it isn't reliant on lh levels.
CMYPAB07	do pcos pts require metformin during pregnancy to reduce risk of miscarriage?
Brooke	no just clomid and the ovwatch to see when I was ovulating. The next step was iui if I was not pregnant that cycle
heatherdawn	What about Ovulite for Ovulation Prediction?
rbennett	brooke - it's controversial whether or not to keep patients on metformin after you conceive. like everything, there are risks and benefits. that's a for personal decision that will be made at that tyime after thoughtful consideration between you and your doctor.
Brooke	right now I am not taking it but was wondering if I needed to take it after I gave birth
CMYPAB07	if iui fails, are there other options besides ivf (b/c of cost/insurance)?
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rbennett	kk31393- metformin is probably most helpful in women with pcos who are insulin resistant, which is a very common finding in women with pcos. unfortunately, there's no good clinical test to detect insulin resistance in women. insulin levels themselves are not a good enough indicator of whether you are insulin resistant - you could be resistant, even with normal levels. many docs feel that since so many women with pcos ARE insulin r3esistant, then most womenb would benefit from metfrormin, so they might use it in any woman with pcos who doesnt' respond to clomid, for example.
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kk31393	And you can use metformin with femara or clomid? does it take a few months before it's fully effective?
anitet	If i didn't response on clomid, and on metformin..do you think I can ovulate after letrozole?
rbennett	brook - no, right now there's no indication that women with pcos should be on metformin chronically, outside of the setting of trying to conceive. however, you should be on the lookout for impaired fasting glucose, glucose intolerance, and diabetes, as all of these things are more common in women with pcos. if any of these things are detected post partum, then in THAT setting, metformin might be indicated.
Brooke	thanks for you rhelp Dr.
rbennett	kk31393- yes, you can use metformin in combination with clomid or femara. it make take up to 3 months before it's fully effective, although most women will respond more quickly than that.
Moderator_DBecker	vcald welcome to tonight's chat with Dr. Bennett
vcaldwe	thank you
rbennett	anitet - so you didn't respond to clomid or metformin, both in combination? letrozole might be effective for you. what dose of clomid did you use?
kk31393	Can you take metformin while on the pill? We are going to take a month off, would it be good to start metformin then? Thanks for the help doc.
Moderator_DBecker	vcald you still have time to jump in with a question or two
anitet	3 tablets a day
molotia	If I ask my gynecologist for Clomid 50 mg does she have to monitor me?
vcaldwe	actually I do not have PCOS (to my knowledge)
rbennett	anitet - well you were on the max dose. i would try letrozole, or gonadotropin injections.
Moderator_DBecker	vcald then how about a gen question if you want
vcaldwe	I have a friend who was diagnosed and was just trying to learn a bit about it. I sent her the link but I don't think she got it in time
anitet	Thank you
Moderator_DBecker	all questions always welcome at AFA
vcaldwe	we are on the west coast
CMYPAB07	how significant are genetics in the diagnosis of pcos? I recently find out my family history - i'm adopted and mother was type 1 diabetic. Is there any link or increased risk ?
Moderator_DBecker	OK
rbennett	molotia - i like to get a basleine ultrasound prior to starting clomid, if possible. otherwise, it's not essential to be monitored, other than checking a post-ovulatory progesterone level to see whetehr or not you ovulated.
AmandaUNCC	KK.. I am taking metformin while on the pill
vcaldwe	What is PCOS and the symptoms and how does the Metformin help
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molotia	Is that baseline to look for single cysts, or PCO?
rbennett	cmypabo7 - the genetics of pcos are still being worked out. it is possible that a gene for insulin resistance could have been the casue of diabetes in you biological mother, and might also be the cause of pcos in you.
kk31393	Amanda: are you tryihg to conceive, or take time off?
writekeek	if i ovulate on 100 mg of clomid what would the correct dosage of femara be?
Moderator_DBecker	mnh welcome to tonight's AFA chat on PCOS with Dr. Bennett an RE with Westchester Reproductive Medicine
AmandaUNCC	I am taking time off in between IVF cycles.
mnh510	hello
kk31393	Amand: how long have you been on metformin?
rbennett	molotia - the basline is to make sure you don't have cysts on your ovaries prior to starting the clomid. presumably, you've alread had an ultrasound perhaps showing pcovaries prior to your cycle start/.
AmandaUNCC	KK.. I started about a 1.5 months ago. You have to slowly increase your dose. I have been at 1500 mg/per day for only about 3-4 weeks now
mnh510	I am a 32 yo with pocs
Moderator_DBecker	We still have a few minutes - this seemed like a very short hour - on behalf of the American Fertility Association, I want to thank Dr. Bennett for taking the time out to "CHAT" with us toinight - what a great job!!!
vcaldwe	Oh I have an ovulatory cysts but never a mention of PCOS
rbennett	writekeek - i would start with one pill a day for 5 days (it's given similarly to the clomid), or whatever your doctor is accustomed to using.
mnh510	I have tried clomid with no luck
writekeek	thanks
kk31393	Amanda: good luck, I know it's hard and easy to get impatient!! thanks for the info.
molotia	I had an US over a year ago with +PCO in pearl necklce formation
dideek	This chat has been very helpful to me, THANKS
writekeek	Dr. Bennet I appreciate your time.
CMYPAB07	best of luck to everyone!
AmandaUNCC	Good luck to you too, KK and everyone else here tonight!
Brooke	thanks everyone
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anitet	good luck
anitet	thanks
molotia	Do you think I should get another one prior to Clomid?
CMYPAB07	thanks to dr. bennett for all the great information!
rbennett	you're most welcome. i sincerely hope this was of at least some help. i know pcos is a very frustrating problem, and hopefully we'll be finding out more about it as studies continue, and the best ways to treat it.
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dideek	Many prayers for everyone.....
rbennett	good luck to all.
mnh510	I am so sad that I missed the chat. I need to read the transcripts to see if any one my questions were asked and answered
Moderator_DBecker	Shingir, I am sorry that we are about to close tonight
Moderator_DBecker	DO you have a quick question for Dr. Bennett
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rbennett	molotia - i would do one more ultrasound at the start of your period.
shingirai	how can I contact Dr. Bennett?
CMYPAB07	what are the best references besides AFA website for research done on pcos?
rbennett	shingirai - please e-mail me at:drbennett@WestchesterReproductiveMedicine.com
Moderator_DBecker	Dr. Bennett - please give your contact information
molotia	Thank you so much for your time and generosity with all these questions,.
Moderator_DBecker	THanks
mnh510	IDr. Bennett I read that you have opened a practice in Westchester County. I was wondering where
mnh510	I live in Westchester and was looking into starting treatment again soon
Moderator_DBecker	Thank you Dr. Bennett it has been an extreme pleasure to be here tonight with you!!
Moderator_DBecker	Good nite everyone and best of luck
rbennett	mn510 - my practice is in yorktown heights, westchester. website is www.westchesterreproductivemedicine.com
mnh510	Thank you so much.
rbennett	dan, thanks for the great job moderating, and for your time!
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vcaldwe	Thank you all.
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heatherdawn	ok, bye then
rbennett	thank you all for joining the chat tonight.
vcaldwe	Dr. Bennett Thanks for sharing your contact info and your time
molotia	Good night everyone, and good luck
vcaldwe	I will share with my friend. Good luck to everyone
mnh510	good night all
shingirai	Thanks Dr. Bennett. Bye
CMYPAB07	good nite , thanks to everyone for the info and advice.
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rbennett	good night, everyone.
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Brooke	good night everyone
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bkschaper	I am new to this. Hos does this session work?
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