Maternal Age and Fertility

May 18, 2005 - Wednesday
2:04 PM to 3:04 PM (EST)
Guest Speakers: Jane Frederick, MD, Huntington Reproductive Center in California

Categories
Donor Egg • Infertility • IUI • IVF • PCOS • PGD

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Lisa_Rosenthal	Welcome, thanks for joining us this evening.
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local	[332] Maternal Age and Fertility- Jane Frederick, M.D., (Huntington Reproductive Center in California)
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Lisa_Rosenthal	Dr. Frederick, thank you for joining us this evening.
Dr._Jane_Frederick	Type here I am glad to be here.
Lisa_Rosenthal	Please feel free to post questions for Dr. Frederick.
localhost	[2009] touser Please feel free to post questions for Dr. Frederick. You may want to save your question in a word document so that you can cut and paste it. Reposting the question is fine as the room can get quite busy.
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Shanna	Hi Lisa and Dr. Frederick, I'm only 32, but my fsh is 14, am I older than I really am? If you know what I mean.
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tshekins	I'm 36 and been dx with unexplained infertility. Also been dx w/PCOS and sperm antibody. I have done several clomidw/iui cycles, 1 injectible cycle with iui and two ivf cycles w/icsi. Am moving on to 3rd ivf in june. any suggestions?
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Lisa_Rosenthal	Welcome to all of you, thanks for joining us, please feel free to post questions for Dr. Frederick!
Dr._Jane_Frederick	Shanna: The FSH level tells us about your ovarian reserve. When the level is over 10, it indicates a decreased ovarian reserve, and you should be talking with your specialist regarding options for treatment. Fortunately, age 32 is in your favor, and a repeat FSH level on the next day 3 of your menstrual cycle would be helpful.
Shanna	My doctor told me that he didn't care what my next fsh level is, even one high one is terrible!
Dr._Jane_Frederick	Tshekins: I would ask your doctor if the FSH level was checked to determine ovarian reserve. A consult with your doctor would also allow you to check the quality of embryos that were implanted in the last 2 IVF cycles, and give you a chance to ask questions on why those two cycles did not work in someone who is young, with PCOS and sperm antibodies.
Lisa_Rosenthal	Shanna, are you seeing a Reproductive Endocrinologist? If not, you should consider calling our toll free number and getting a referral in your area. These doctors are specially trained in this field.
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Libby	Am I too late?
Lisa_Rosenthal	Libby, not at all, welcome!
local	[332] Maternal Age and Fertility- Jane Frederick, M.D., (Huntington Reproductive Center in California)
localhost	[2009] touser The American Fertility Association has free membership! Please go online and you will have access to all our publications at "No Barriers".
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Brenna	Hi everyone
Lisa_Rosenthal	Brenna, welcome to this evening's session.
local	[332] Maternal Age and Fertility- Jane Frederick, M.D., (Huntington Reproductive Center in California)
Lisa_Rosenthal	Sorry about the mix-up with who is joining us this evening. Dr. Frederick is kind enough to be answering questions this evening.
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YOLA	I am 42 dx w/pcos and irregular ovulation , we have done 2 inyectables w/iui and 1 inyectables w/ivf any sugestions
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Stephen	Dr. Frederick, what about paternal age?
Lisa_Rosenthal	Welcome Megan and Catherine!!!
Dr._Jane_Frederick	Yola: At age 42, I would ask your specialist to evaluate your ovarian reserve by checking a FSH level on day 3 of your cycle. This may explain why the IVF cycle did not work. We know that the success rate of any infertility treatment goes down as the patient gets older (over age 37), and is the lowest over age 40. However, many patients do concieve, and it is important to discuss your particular case with your physician to determine that all reasons for infertility have been diagnosed.
Dr._Jane_Frederick	Stephen: The age of the male appears to be less important than the age of the egg (female). However, as the male gets over 50, the motility and the sperm count may go down, and a semen analysis would demonstrate this.
Stephen	what about genetic issues with older men? i've heard stuff about mental illness issues
smileyatc	With repeated attempts of hyperstimulating ovaries for different procedures, does a woman risk using up all of her eggs ?
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naomi	Are we too late to join the chat?
Lisa_Rosenthal	naomi, you are right on time, welcome!
local	[332] Maternal Age and Fertility- Jane Frederick, M.D., (Huntington Reproductive Center in California)
localhost	[2009] touser Please feel free to post questions for Dr. Frederick. You may want to save your question in a word document so that you can cut and paste it. Reposting the question is fine as the room can get quite busy.
YOLA	My fsh was 6 dr said it was very good, on the ivf i produce 11 egs 8 fertilized one with 8cells and 3 with 6 cells and 4 with 4 or 3 cells is this results good for my age ?
Dr._Jane_Frederick	Stephen: the genetic issues are related to the female egg. There is an increase in Down's syndrom for example as the female gets older due to the abnormalities in the egg as it ages, and attempts to reproduce. An FSH level in the patient would be helpful to assess ovarian function.
Stephen	Thanks dr, that makes me feel a lot better!
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Lisa_Rosenthal	Dr. Frederick has momentarily left, probably got bumped off, she'll be back in a momeny
Lisa_Rosenthal	moment.
Lisa_Rosenthal	How is everyone doing? These issues tend to be very loaded and a real challenge to handle emotionally.
megan	Thanks for the welcome! I just signed on - and wanted to share that I am 11+ weeks along after my first try with IVF. I used my own eggs as my FSH readings were very good (well below 10) despite my age. I will be 46 in a few months. Early CVS results showed no chromosomal deficiencies (I did CVS last week.) This is a relief as my reproductive endocrinologist and the embryologist recommended against doing PGD for some reason (not sure why) and I was worried about potential issues with the fetus.
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sandra_kirton	hi sandra here
sandra_kirton	i'm 41 2 failed ivf end of 2ww tomorrow beta
Lisa_Rosenthal	Hi Sandra, thanks for joining us this evening!
sandra_kirton	hi Lisa
Lisa_Rosenthal	Megan, congratulations, what a great story.
naomi	My FSH runs from 5 to 6, and my estradiol has been described as excellent. I turned 44 the end of March, and am just finishing what we think will be another unsuccessful IVF cycle (my 4th). I had a wonderful baby naturally conceived two months after the 2nd failed IVF, but tragically, she died a year ago at 8 weeks from an undetected bacterial infection. Right now, we have to decide whether to do donor or keep trying naturally for another year or so. Any recommendation?
TLT	Megan - Congrats and thanks for letting us know that there is still hope for the rest of us.
Lisa_Rosenthal	Dr. Frederick is trying to rejoin us. Thanks for everyone's patience.
Lisa_Rosenthal	naomi, I'm so sorry for your loss.
sandra_kirton	I feel like this 1 failed as well this will be my 3rd failed cycle, had myomectomy in Nov. was recommended by RE to do donor egg.
sandra_kirton	So sorry naomi
tshekins	My FSH levels have always been within normal limits. My first ivf resulted in 18 follicles inseminated w/16 fertilizing. 2 embros were transferred on day 5. The rest were unable to be frozen due to immaturity. The transferred embryos wer a 3AB and a 4AA. On my second attempt, 21 eggs were retrieved, 10 fertilized, half were ICsi, half were traditionally inseminated. The rate for fertilization was the same for both methods. I had a day 3 transfer with 3 embryos being transferred - (2) 8CA and one 8CB+(I think). do you feel PGD would be helpful on our next attempt?
naomi	A friend set up a memorial website for our baby, with pictures and some text descriptions. The URL is www.triroc.com/tammyjane.
Lisa_Rosenthal	Donor egg is a wonderful option that we are so lucky to have as an option. BUT, it's a process to make the decision, not something you should feel pushed into...
tshekins	Oops, I forgot to mention, on the 2nd IVF, no embryos made it to the freezing stage.
sandra_kirton	On the night of my tranfer I started cramping from 12am-5am (severe cramping) felt like my embryos were being attacked. lost hope from there
Lisa_Rosenthal	tshekins, what is your physician saying is the reason for failure to implant? PGD is not the best option, from what I understand and I am NOT a doctor, for failed IVF cycles.
local	[332] Maternal Age and Fertility- Jane Frederick, M.D., (Huntington Reproductive Center in California)
tshekins	the only reason I've been given is that it could be poor egg quality
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Lisa_Rosenthal	hopeandpray, thanks for joining us this evening!
Lisa_Rosenthal	Dr. Frederick is doing her best to rejoin the room, we're chatting meanwhile.
Randy	Anyone else here tired of hearing how perfect everything is and still not end up pregnant or with a baby?
sandra_kirton	My egg quality is always good with high fertilization. My last cycle I only retrived 5 eggs they all fertilized 4 transfered no fragmentation. My REsays it's basically my age
sandra_kirton	Randy I'm with you, once I had the myomectomy thought for sure I'll be pregnant my beta is tomorrow I'm not going I'm going to do hpt. Took one on Monday had a faint second line but took an hcg shot on friday, so that my be what's causing the faint line.
hopeandpray	I am 45 and have had one frozen and 2 unsuccessful IVF's. The fertilization rate is good, and I have had 8 eggs two times and 13 eggs the last. They are always grade 1 or 2 with very little fragmentation. Highest FSH was 8, usually it is 6. I did have high E2 twice after cycling back to back and with a residual cyst. Please advise re: definitive tests for egg quality, E2 and other thoughts. Am I kidding myself?
Lisa_Rosenthal	Sandra, please go anyway for the blood! Isn't it going to drive you crazy to get another faint line and not know if it's a real positive?
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naomi	Now that Dr Frederick is back, can she address my question, or do I need to re-post it?
Lisa_Rosenthal	Welcome back Dr. Frederick!!
Dr._Jane_Frederick	Sorry about the delay.
Lisa_Rosenthal	Everyone will need to repost their questions. Let's not bombard Dr. Frederick all at once.
sandra_kirton	I can't bear my Dr. calling me again and saying I'm sorry but the test is negative
hopeandpray	Should I re-post my question?
sandra_kirton	I'm really stressed out with all of this. This cycle has been my worst I have absolutely no faith
Lisa_Rosenthal	sandra, I do understand, I'm so sorry you're feeling so much pain.
Dr._Jane_Frederick	Sandra: let your doctor know how frustrated you are, and have a plan for the next treatment cycle. Get involved with a support group in your area so there are others who can call you and support you on the day of the pregnancy test.
sandra_kirton	I test tomorrow
hopeandpray	I am 45 and have had one frozen and 2 unsuccesful IVF's, but I had 8 eggs the first two times and 13 the 3rd. Highest FSH was 8. Did have high E2 after cycling back to back and with a residual cyst. I also had a laparotomy for fibroids. Am I kidding myself at my age?
hopeandpray	I forgot to mention that my embies are always grade 1 or 2 with little fragmentation.
sandra_kirton	if this cycle fails in would be my 3rd. If I plan to do another I think I will change My RE
Lisa_Rosenthal	sandra, please feel free to post on our peer support message board. I am there every day and so are many others in similar situations as yours.
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Lisa_Rosenthal	A second opinion at a certain point is always a good idea.
Dr._Jane_Frederick	Hope: At age 45, the chance of pregnancy is low. But your case is encouraging in that you are still producing embryos for transfer. Talk with your doctor about egg donation if you feel you have exhausted cycles with your own eggs. Egg donation will increase your pregnancy success to 50%
Lisa_Rosenthal	Hi Cath, thanks for joining us this evening.
local	[332] Maternal Age and Fertility- Jane Frederick, M.D., (Huntington Reproductive Center in California)
localhost	[2009] touser Please feel free to post questions for Dr. Frederick. You may want to save your question in a word document so that you can cut and paste it. Reposting the question is fine as the room can get quite busy.
Jenna	dr, can you post your information, how to contact you?
cath	What do you look for in an egg donor if over 40? Please let me know how to increase chance to more than 50 percent.
Lisa_Rosenthal	Dr. Frederick, please do post your phone number and where you practice....
Dr._Jane_Frederick	Jenna: you can contact me at 949-472-9446 My web site is www.havingbabies.com
TLT	I am 41, in a cycle converted from IVF to IUI, due to poor response (had 1st IUI today). Out of 6 cycles have only made it to IVF once w/5 follicles/eggs. (Only to find out after that I had thyroid and clotting issues which they felt could have contributed to our failure.) My FSH has always been normal (including CCCT), in the 5-7 range, not giving a true picture of how I respond. In the past 2 mos. FSH has popped into the double digits. Have tried both agonist and antagonist (& any other type of protocol there is). When FSH is not indicative of what’s happening, do you put credence in antral count? What would be your recommendation on how to proceed if this IUI cycle does not work?
hopeandpray	Dr. Frederick- I am not ready for donor egg yet. I feel as long as I am producing a great number of eggs, there might be one good one. Is that crazy? Is there a way to definitively know if the high E2 on day 3 is masking a high FSH?
naomi	My FSH runs from 5 to 6, and my estradiol has been described as excellent. I turned 44 the end of March, and am just finishing what we think will be another unsuccessful IVF cycle (my 4th). I had a wonderful baby naturally conceived two months after the 2nd failed IVF, but tragically, she died a year ago at 8 weeks from an undetected bacterial infection. Right now, we have to decide whether to do donor or keep trying naturally for another year or so. Any recommendation?
sandra_kirton	I've heard of success stories after 7/8 cycles I don't have that much time I'll be 42 in August, and I think I have just about maxed out my 10.000 lifetime limit
megan	Dr. Frederick - I think that several of us would like to know when PGD is or isn't appropriate. I'm 45 and am successfully pregnant with my first IVF (my own eggs). 6 embryos were implanted - I was advised against PGD and took that advice. I had to wait until I was 10 weeks along (earliest possible time for CVS) to get some reassuring early results that there are no chromosomal deficiencies with the fetus.
sandra_kirton	Dr do you believe in immunological disorders that my impair implantation
Dr._Jane_Frederick	TLT: If your FSH is creeping up over the 10 mark, then there is a reason why these cycles are not working for you. Ask your doctor to review the last cycles with you and find out if all other testing (the uterus for example was done).
Lisa_Rosenthal	Dr. Frederick, would you mind staying just a few extra minutes?
localhost	[2009] touser Please call our toll free hotline to ask our patient advocate for doctor referrals in your area. That number is: 888-917-3777 and our patient advocate is Lori Masi.
Dr._Jane_Frederick	Hope: The high estradiol on day 3 can mask a true FSH level. You need to have a low Estradiol level to allow the FSH to be read accurately.
cath	What about egg donors, do you know of pratices that have them you recommend?
Anon	doctor, please give us your phone number?
TLT	Have done SHG and all looked fine. Lining is always great - grade "A" - triple stripe.
hopeandpray	Megan- congratulations- do you mind telling me which dr. got you pregnant at 45?
Dr._Jane_Frederick	Naomi: I don't mind answere more questions at all. I would consult with your specialist to see if another cycle would be recommended.
tshekins	Not sure if you recieved my question so am re-posting. My FSH has always been within normal limits. My 1st IVF resulted in 16 eggs being fertilized w/ICSI. 2 embryos were transferred(3AB, 4AA) on day 5. The rest of the embryos did not make it to the freezing stage. Changed RE's for2nd IVF. This IVF resulted in 13 eggs being fertilized - half with ICSI, half traditionally inseminated. Both methods fertilized at the same rate. 3 embryos were transferred on day 3 (2 - 8CA's and one 8CB+ - I think) Again, none made it to the freezing stage. The only reason I am getting for it not working is that it could be poor egg quality and that I should do PGD next time. What are your thoughts?
Lisa_Rosenthal	Dr. Frederick, there are quite a few patients from your neck of the woods here, would you please post your phone number for them?
Dr._Jane_Frederick	Megan; Congrats on your pregnancy. Regarding PGD: this is a selection procedure, in that the best genetic embryos are selected out for transfer. It is important to produce a lot of high quality embryos on day 3 of IVF in order to undergo PGD for selection. Not all patients who are over 40 will qualify for this procedure
Lisa_Rosenthal	Ladies and gentlemen, we have a wonderful set of message boards that are moderated by physicians on a daily basis. They will answer your specific questions. There are also boards where you can "chat" with folks experiencing similar challenges as you. Please do check them out.
megan	hopeandpray - Are you in California?
Brenna	doctor, is PGD good for figuring out failure to implant?
Dr._Jane_Frederick	Cath: I work with many egg donor agencies and would be happy to refer you to them - just call or check out our web site for the resources.
cath	Thank you so very much. This spectacular!
Dr._Jane_Frederick	Tshekins: If you are getting at least 6 to 8 embryos on day 3 of IVF, then PGD would be a good option. I suspect that the embryos are not good quality and that is why they are not freezing. Ask your doctor to review your cycle.
hopeandpray	NO- I am in NY
Dr._Jane_Frederick	Lisa: my phone number is 949-472-9446 My web site is www.havingbabies.com
Dr._Jane_Frederick	Hope: My office is in Laguna Hills, Ca.
local	[332] Maternal Age and Fertility- Jane Frederick, M.D., (Huntington Reproductive Center in California)
Dr._Jane_Frederick	Brenna: PGD is good to figure out if there are any genetically normal embryos for implantation
Lisa_Rosenthal	We are so lucky to get such wonderful presenters, partly because I promise them that they will be off at 9 PM, EST, sharp. Dr. Frederick is being gracious enough to give us some extra time, so we will go to 9:05, which gives us another couple of minutes.
sandra_kirton	how exactly does maternal age affect an IVF cycle if everthing seems OK!
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hopeandpray	Megan- I assume you are in California?
Shanna	If I have only a %2 chance with my own eggs, isn't that still my own decision to make?
megan	hopeandpray
sandra_kirton	Megan have you ever been pregnant prior do undergoing an IVF cycle
Dr._Jane_Frederick	Sandra: Maternal age affects in this way: You are born with a finite number of eggs at birth. Menopause is a genetically determined time in all our lives as females. As we get older, our eggs are preparing to undergo menopause, and will not be able to produce a healthy baby. So we are fighting the biological clockl
megan	Yes - I miscarried early in a pregnancy just a few months before my 44th birthday.
Dr._Jane_Frederick	Shanna: It is always your decision to decide when enough is enough. I hope you can have a plan of treatment with your doctor, and can feel like you knew all the risks involved with the treatment based on your age.
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Lisa_Rosenthal	Shanna, we have a wonderful magazine called, "When is Enough, Enough" online. Please take a look at it, it covers the topic quite well.
local	[332] Maternal Age and Fertility- Jane Frederick, M.D., (Huntington Reproductive Center in California)
Lisa_Rosenthal	Dr. Frederick, thank you so much for joining us this evening. You have done a wonderful, compassionate and thorough job. I hope that you will consider joining us again sometime.
Shanna	Thanks doctor and lisa
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sandra_kirton	Thanks Dr.
Stephen	good night doc
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Dr._Jane_Frederick	Lisa: thank you for this opportunity, and I wish everyone the best. Stay positive!
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Lisa_Rosenthal	All of you, I hope to see you next week....
Lisa_Rosenthal	sandra, best of luck tomorrow
megan	If this IVF hadn't worked, I was thinking we would go straight to adoption. Unfortunately, most companies in California don't cover IVF - so I had to pay for this cycle myself. Also, I have had "morning sickness" all day and night long for almost this entire pregnancy!
Lisa_Rosenthal	I will check our peer support board, hope to see you there and hear how you're doing.
Brenna	good nite
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Jenna	lisa, great job, thanks doctor
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Catherine	Doctor, how long a wait to get into see you?
Libby	night
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Dr._Jane_Frederick	Catherine: Within a week. Call me
Samantha36	Only a week? I'm going to call you!!
Catherine	Thanks Dr., I will. nite
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Dr._Jane_Frederick	Samanatha: hope to see you- tell the scheduler you met on the chat room
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Orly	thanks doctor and lisa
Lisa_Rosenthal	Orly, as usual, a pleasure to have you! See you next week.
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Samantha36	good bye
Lisa_Rosenthal	Bye Samantha
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Lisa_Rosenthal	I hope that all of you have found tonight's session helpful. Any thoughts?
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megan	Thank you Lisa and Dr. Frederick - best of future luck to everyone else!
hopeandpray	Megan- tried to respond to private message but couldn't
megan	Hopeandpray - I'm still on - do you have any more questions?
Dr._Jane_Frederick	Lisa - thanks for your help tonight
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Lisa_Rosenthal	Good night all!!!
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