Low Tech Options

March 7, 2006 - Tuesday
7:53 PM to (EST)
Guest Speakers: Michael Doyle, MD
Connecticut Fertility Associates

Categories
Infertility • IUI • IVF • Male Factor • Miscarriage • PCOS • PGD

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deb_capone	Good evening, Guest and Christine. We will be starting in a few minutes.
deb_capone	We are waiting for Dr. Doyle.
deb_capone	We will be starting in a few minutes....we are waiting for Dr. Doyle to join us.
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deb_capone	Welcome CBG, nyiap;wannababy. We are just waiting for Dr. Doyle to begin.
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deb_capone	In the meantime, why don't you all tell us a little about yourselves and your situation.
christine	My husband has male factor infertility (no sperm count at all), I have done so far 3 iui inseminations using donor sperm.
nyiap	i am 34, husband is 43, 4 IVF's, 3 negatives and 1 resulting in M/C at 6.5 weeks, we are oing IVF with ICSI for male factor
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CBG	At my age I know that my best chance is with donor eggs but my husband will not consider that. I am giving my mind and body a break and we are going to try another cycle in a few months
deb_capone	Good evening Peach, thanks for joining us....
peach	thanks, has it started yet
deb_capone	While we wait for Dr. Doyle, and as we share about ourselves perhaps we can help each other.
deb_capone	Have any of you had similar issues to CBG-where you and your partner reach a crossroads like CBG describes?
peach	hi cbg, at any age i think it's important to take a break. we did and it was the best thing we could have done.
christine	no, my husband and I have not yet reached that crossroad
deb_capone	I Dr. Doyle on the phone....he is coming..
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Symharmony	My husband and I haven't reached a crossroads yet.
peach	that's a good sign christine. i think it really depends on how long you have been on the "journey" and how it well it went
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dr._doyle	Hi everyone !!!
peach	hi dr doyle
dr._doyle	i apologize for being a bit late
deb_capone	Not to worry, Dr. Doyle....we are so glad to have you here...
dr._doyle	so much focus is on ivf, and tonight we might talk abouit simpler approaches
nyiap	Dr what would you suggest for 4 failed IVF's and male factor?
nyiap	I was told my only option was IVF
dr._doyle	it depends on why the ivf is not working.. if it is a fertilzation or embryo problem, for example, then some form of ivf is probably the only approach,,, but if there is a uterine problem, for example, then that could be addressed seperately
dr._doyle	it's important that you understand why you are doing ivf, and why it is not working
nyiap	I've been pregnant once thru ivf but m/c at 6.5 weeks, fertilization and embryo quality is usually good, no fragmentation
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deb_capone	Welcome, Dee.
dr._doyle	there are hormonal, anatomical, autoimmune and infectious issues that affect implantation,,, those are usually looked at BEFORE IVF, but not always
nyiap	we have a follow up with the RE next week to discuss options...is it possible it is an immune issue?
dr._doyle	it is, and you should ask about that
nyiap	thanks!!
dr._doyle	good luck
Symharmony	What kind of immune problems can occur?
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CBG	What are the questions to ask to see if those factors were considered?
dr._doyle	they are not entirely proven in many cases, but the concept is that sometimes, maybe, a woman creates antibodies that reject some aspect of the pregnancy
dr._doyle	they can be related to inflammation and abnormal tendencies to clot
deb_capone	Welcome, Kburton, we are talking with Dr. Michael Doyle from Connecticut Fertility Associates about low tech fertility options.
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nyiap	is it possible to have immune problems even though I got pregnant once before thru iVF?
dr._doyle	ask if there is any reason to test for them -- often there is not a reason, but your doc will consider your history and medical history to help decide
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christine	I have a male factor issue as well, my husband has no sperm I have done so far 3 iui's with no medications with donor sperm and it has not yet worked. I have had all the test done on me and all came up negative. any suggestions on how far I should go before I maybe should use clomid.
dr._doyle	may i ask how old you are
dr._doyle	::smile
christine	35
nyiap	34
christine	It's OK
CBG	CBG 43
Symharmony	33
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dr._doyle	you want to make SURE you are timing the IUI ideally, ultrasound and bloodwork can help with that; you might also ask your doc whether a medication to induce ovulation is a consideration
dr._doyle	like CLomid
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dr._doyle	but remember that many fertile couples take more than three months to conceive
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Symharmony	How well does Clomid work? I heard that it can effect the cervical mucous that is ideal for sperm to move around in.
dr._doyle	even when nothing is "wrong"
deb_capone	Welcome, Lizzyprod and mellere02: tonight we are talking with Dr. Michael Doyle from Connecticut Fertility Associates about low tech fertility options.
dr._doyle	Clomid works in about 50% of people who use it. And yes, it can thicken the mucus but if you are having intrauterine insemination, you bypass that problem. Clomid works best in people with ovulation problems because that is what Clomid fixes
dr._doyle	But... twins for 8%; and some side effects for most
maria	how long is too long to stay on lupron
dr._doyle	lupron for what purpose?
maria	i'm sorry, i meant clomid
Symharmony	I ask because I was told that my Progesterone was borderline low and Clomid could work for me. However, I'm afraid of some of the side effects. Does this have an effect on my ovulation with the borderline low Progesterone?
dr._doyle	If you are ovulating on Clomid, and have not conceived after 4-6 cycles (6 max) it is time to "MOVE ON"
CBG	I am taking a break from IVF for a few months and am looking for ways to increase my odds. Do you recommend certain diets, accupuncture, anything to help?
Dee	Are there any alternatives to IVIG for immune issues and high killer cell activity. I had luck with LIT once, but I've heard that that is not offered anymore. I did IVIG with my last pregnancy, but miscarried. Also, are there any low-tech ways to decrease killer cells?
maria	thanks
dr._doyle	One of the most common results (not causes) of ovulation disorders is low porgesterone, and Clomid is generally effective in fixing that as long as there are not other issues (like for example insulin resistance or severe PCOS)
kburton	my body produces antibodies that kill my husbands sperm. We have done two IUIs with no success. According to the disposable ovulation kits I ovulate on the 8 or 9 day of my cycle.? Is it possible that we are not timing the IUIs correctly?
dr._doyle	Hi CBG, I know it is controversial, but I do believe that acupuncture helps some people in your situaiton
dr._doyle	The effects of one certain diet over anther diet is probably less proven
dr._doyle	Dee, If you are at the point of IVIG, you probably have seen a lot of specialists, including an immunologist, or perhaps you would consider that. IVIG is often used in conjunction with blood thinners like Lovenox
dr._doyle	kburton, ovulation kits are not as reliable as follicle monitoring with ultrasound and serum estradiol and LH levels, I really think they are more dependable
Symharmony	How much does stress interfere with getting pregnant?
dr._doyle	sometimes the problem is that the LH surge comes too early or late, and if you are only using the kits, you will miss that
dr._doyle	Stress can certainly interfere with health in general, and fertility in particular, but it''s very difficult to say how much in any individual.... it vareis. Still reducing stress is always good for everyone.
Symharmony	Thanks
CBG	How can you reduce your stress during such a stressful "process"?
dr._doyle	Support group? Exercise? Counseling ? Acupuncture? The AFA ??????
dr._doyle	I think sharing your experiences and your feelings is really important, especially if it is done constructively and safely
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Symharmony	I heard too much exercise can interfere, especially intense exercising...what is safe to do?
CBG	I stopped exercising during my cycles perhaps that wasn't a good idea. Thank you
dr._doyle	i beleive that most exercise is great, and that you should never stop something good. "Intense" exercise with very heavy pounding might be better avoiding. Swimming and yoga are great.
dr._doyle	Maybe no bungee jumping
Symharmony	Thanks
kburton	Do you have any other suggestions on ways to treat the sperm killing antibodies other than (or along with) IUIs?
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dr._doyle	The best apporach is to bypass the antibody response. Raally IUI or IVF are best for that. I generally don not recommend steroids to suppress the antibodies - that used to be done more in the past, but is not highly effective, and has risks
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mellere02	I have had one cycle of injectable ovalation with no success. It has been 3 mos. would I have to start from the begaining or pick up where i left off with my meds.
viviane	Is having an IUI for the second time more of a better chance? I had one back in july with follistim, good response 3 follies at 17cm, 19, and 21cm, the iui failed.
dr._doyle	you would generally pick up where you left off
Symharmony	How effective are IUIs? Have you've seen a lot of positive results?
dr._doyle	For the first 3 or 4 efforts, each IUI has pretty much the same chance, assuming you respond the same to the medications. After that the odds go down.
dr._doyle	The effectiveness of IUI depends on many things -- age of woman, quality of sperm, quality and timing of ovulation ,,,, but when these factors are favorable, IUI can be very effective
kburton	Sorry, to revisit the Clomid topic, but would you suggest trying that to increase our chances of conception even though I am ovulating. I'm 25 and my husband has really strong swimmers. ::blush
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dr._doyle	Probably not. In young woman who ovulate perfectly, Clomid is not likely to enhance your chances that much. As I mentinoed before, Clomid is really more helpful in women with ovulation problems or hormonal issues
CBG	What can a woman do to prevent m/c?
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lizzyprod	hi - i'm 35 - have had all of my tests as has my husband - laporoscopy, hysteriopingogram (sp?) - all sperm, blood, etc analysis... have done 2 IUI's... will do one more before IVF - i know many things are not explained... but what other reasons are out there?
mellere02	what do you suggest to handle the depression that comes when the cycle has failed.
hopeandpray	I know this is the end. I had trouble logging in. what are the gems that came out this session?
dr._doyle	Very few miscarriages result from anything that a woman does or doesn't do. They are usually due to a chromosomal error within the embryo beyond your (or your doctor's) control. Or other medical factors. It's important that you don't assume that you are causing your miscarriage.
deb_capone	Welcom to everyone who has just joined us. We are in the midst of a great session with Dr. Michael Doyle from Connecticut Fertility Associates.
deb_capone	Hopeandpray, sorry you had trouble coming in....but don't worry. We do post the transcripts on our site, www.theafa.org. You will be able to read the entire thing!
dr._doyle	lizzy >> when all your tests are normal and iui fails, it is possible tha the eggs and sperm are not getting together optimally, or that there are fertilization or embryo issues, so ivf is a good idea
buonconvento	What is your opinion on IVF vs. IUI for women in their mid-40's. I've been told that (assuming the woman doesn't have tubal or other "structural" issues) IUI might have the same rate of success as IVF.
hopeandpray	Thanks- how long does it take for the transcripts to be posted?
deb_capone	It takes about a month....
deb_capone	sometimes a bit quicker...
dr._doyle	If the problem in women in the mid-40s is that egg quality is not favorable, then ivf won't really increase your odds that much unless of course you use an egg donor, which gives you GREAT odds
deb_capone	As a reminder, the AFA is here for you! Please give us your feedback and let us know how we are doing, what kind of sessions you want to see and what other resources you think would be great. Contact me directly at deb@theafa.org
Symharmony	Is there a test to determine if the sperm and the egg are getting together optimally?
dr._doyle	FSH levels are more predictive than age in predicting success
buonconvento	Is it possible to view that chat that occurred prior to my logging on? I'm having difficulty scrolling up the page.
dr._doyle	There isn't a test to tell if egg-sperm interaction is good. Unless everything else fails, adn then you get pregnant with your first IVF ycle, then you can probably assume that was the problem all along.
Symharmony	Thanks
Lori	How important are other blood tests such as estrodial and progesterone. I know my FSH but don't know the others.
dr._doyle	You're welcome.
deb_capone	If you aren't a FREE No Barriers Member of the AFA-join now...www.theafa.org. And remember, we are here every Tuesday night from 8-9pm Eastern to talk with experts like Dr. Doyle.
CBG	I am 43, I have had 1 cancelled cycle 2 IVF's and 2 m/c's at 5-6 wks, I am gearing up for another cycle. I was going to do IVF again but would you recommend IUI?
deb_capone	Dr. Doyle has time for a few more questions before we respectfully sign off for tonight.
dr._doyle	Estradiol and progesterone are more useful when monitoring a cycle in the middle and end. But an elevated estradiol level (like an elevated FSH level) at the beginning is a generally bad sign.
dr._doyle	CBG : I really couldn't say. IVF could help though. Are you considering PGD?
Lori	My fsh has been 7.4, 7.9 and most recently 9.2 isn't that fairly good for a 40 yr old?
viviane	I will be having an IUI for my next cycle (begining of April), first they put me on a month of Metformin for PCOS, Hope it works with the Follistim
buonconvento	Dr. Doyle, does your practice limit the number of medicated cycles (i.e. IUI or IVF) a patient should attempt? Or do you recommend, say, not doing more than a certain number? (If so, what is that number?) Thanks.
dr._doyle	PGD uses embryo biopsy to test the chromosomes of the embryo before deciding which one(s) to transfer
CBG	I didn't get enough fetilized embryo's 2 out of 6 both times so PGD wasn't recommended
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dr._doyle	Lori Yes those are encouraging as long as your estradiol level is also low
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deb_capone	Dr. Doyle, we want to thank you for your time and expertise. You have been a wonderful guest. We have all learned a lot. Dr. Doyle is the founder of Connecticut Fertility Associates. You can learn more about his practice at www.ctfertility.com. It is easy to see from our time wiht Dr. Doyle tonight why he is so sought after! Thank you Dr. Doyle!
hopeandpray	Thank you.
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Lori	Neither my OB or RE has checked my estradial at least to my knowledge, or they checked it but didn't tell me the number. I am a stage 4 endometriosis problem, minus an ovary now!
Della	Thank you Dr. Doyle and Deb
dr._doyle	Buonconvento >. At CFA we don't have hard and fast limits because sometimes things make sense in one situtation and not anohter. But if someone has done 6 failed IUIs, or 4 failed IVF cycles, you really have to look closely at whether more of the same is prudent
deb_capone	On behalf of your host, The American Fertility Association and our Sponsor, Serono/Fertility Lifelines, we wish you good night and invite you to join us next week.
dr._doyle	Thanks Deb for having me and GOOD LUCK to all of you.
dr._doyle	Take care.
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CBG	Thank you! You can save the text using the icon
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