Medical Question And Answer Session

September 26, 2006 - Tuesday
3:52 PM to (EST)
Guest Speakers: Dr. Bradford Kolb
Huntington Reproductive Center

Categories
Donor Egg • Egg Donation • Egg Freezing • Endometriosis • Fertility • Insurance • IUI • IVF • PCOS • PGD

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Bradford_Kolb__MD	Hello Honey,
Bradford_Kolb__MD	It seems I should be calling my wife this, not another women on the internet. I kow we are early, but do you have any questions? This session is essentially a free for all - so ask anything you want.
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deb	Good Evening and welcome to our Online Education Session. As always, we will be starting promptly at 8pm Eastern and ending at 9pm Eastern.
Bradford_Kolb__MD	Good evening ladies. I hope all is well.
Honey	Hello, steeped away to make popcorn
deb	On behalf of your hosts, The American Fertility Association and our sponsor, Fertility Lifelines, I would like to welcome tonight's guest, Dr. Bradford Kolb, MD from Huntington Reproductive Center.
deb	Not to worry, Honey. We have a few minutes before we bombard Dr. Kolb.
deb	I am Deb Capone and I am your moderator. If you need to 'talk' with me privately, just double click on my name in the left hand column.
alb813	hello new here. just joined
deb	We are about ten minutes before our start time....any one else for some popcorn?
deb	alb813-we will begin in about nine minutes.
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deb	Dr. Kolb is a graduate of the University of Calif. at Irvine and received his medical degree from there as well. He did his Ob/gyn residency at Northwestern and a fellowship in Reproductive Endocrinology and Infertility at USC. He is board certified in both RE and OB/GYN. We are thrilled to have you here tonight Dr. Kolb! FOr those of you that want to read more about Dr. Kolb here is a link to his bio: www.havingbabies.com/staff_kolb.htm
deb	We are especially lucky because Dr. Kolb has agreed to try and answer as many of your medical questions as he can.
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Bradford_Kolb__MD	I also have 3 beautiful daughters - very blessed!
jneencruz	Hello, I am 33 years old and have an 8.5 year old daughter. We have been trying to conceive for 3.5 years. Since then, I have been diagnosed with PCOS, plus I have one blocked tube. I have undergone two cycles of IVF, unsuccessfully. The doctor said there might be something wrong with my eggs. If this is the case, is there something that can be done in order to "fix my eggs" such as medication or is this the end of the road for my eggs?
deb	Dr. Kolb, I am going to thank you profusely for your time and generosity. I think you won't have time to take a breath, nor will I have another chance to get a word in edgewise...
deb	We are really going to wait until 8pm...sorry to be the time keeper, but it is out of respect for all.
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jneencruz	sorry, my clock is fast
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griff202	Hi Everyone
deb	Not to worry...I think we all can relate to how anxious you are to get some answers. We have about two minutes and then its all up to Dr. Kolb.
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deb	are you jazzed up, Dr. Kolb! ::rolleyes
deb	Good evening again, to all of you who are waiting....we are ready to go.
Bradford_Kolb__MD	Jneencruz, This is a tough question. Basically, your eggs are as they are. We can not change them, but there are things that can be done to help the process. You may want to consider a different stimulation protocol, make sure your health is good and you may want to consider trying a blastocyst transfer if you have not. I have also found that low dose stimulations help with PCO patients. Talk with your RE.
alb813	my husband has a low sperm count, I seem to be fine, we were told by my doctor to try IUI , when they washed the sperm we only had 15,000 left what are our chances?? what will be our next step or what should we do???we have been trying for a year
jneencruz	thank you
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deb	Welcome, Yoganut....Dr. Bradford Kolb, MD is answering as many medical questions as he can.
satie37	Can you comment on cycles where E2 levels are high very early in the cycle resulting in ovulation around CD5 or so? Is there anything which can be done to lower E2 levels? Or is there something which could be causing early high E2 ???
bumblebee2006	Really would like your opinion: Just turned 38. In the last 2 years I responded very well to the gonal-f when I tried it for IUI. Also last year I got pregnant naturally but miscarried at 5 weeks. Day 3 labs =3D FSH 10, Estogen 30, LH 2.6 In the last 4 months Both my IVF cycles were cancelled - my estrogen levels did not rise at all. Never went over 20 1st cycle traditional they used IVF protocol with BC lead in and Lupron daily and 150 menpur and 150 gonal-f . Cycle cancelled after CD6 no rise in estrogen (Doc thought maybe the lupron may have temporarily shut done my ovaries) 2nd cycle protocol - BC lead and 500 iu's of gonal-f....(no lupron this time) still nothing happening - no rise in Estrogen. Cycle cancelled after CD6 I am just stumped. Could I have no eggs left? Could I already be menopausal? I had no symptoms of menopause until I took the Lupron on the first cycle --(since the Lupron my hair has been falling out like crazy and did have some hot flashes) Any thoughts? I really want my chance at IVF..
Bradford_Kolb__MD	alb813 Your counts are extremely low. I would consider having your husband seeing a urologist that specializes in male fertility issues. It you can not improve it significant, I would advise going to IVF with ICSI
griff202	what do you think of co-culture in the IVF procedure?
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Honey	I just had donor blast transfer 3 days ago (Sunday). The following day I received a call that none of the other 15 fertilized embryos could be frozen because they would not survive the freezing or thawing. Does this happen often? I am praying that the 2 transferred will be the ones that bring me child(ren). But I am so disappointed that if not, I will have to go through the whole donor selection process and cost.
kimiC	Dr, what do you think of a Natural Cycle IVF or low -dose IVF?
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misty	Hello Dr. Kolb! My problem: I am 32. After trying to conceive for last 2 yrs. I conceived last december, but In January end I had to do a DNC because the foetus didnt grow in the sack....how critical it would be to conceive again? do you reccomend IVF.
Bradford_Kolb__MD	Satie, One cause of a high E2 can be a cyst, but it might also be a sign of failing egg viability. Talk to your doc about this. You may want to consider working up the ovarian health with a clomid challenge test. You may also want to consider birth control pills or lupron prior to your stimulation.
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satie37	Thanks... there is also a large dominant follicle usually around 15mm very early in the cycle.(CD3).. RE says it is a viable follicle and not a cyst... but not sure about this.... FSH is low - below 10. Doctor has been adding estynl in the luteal phase... which does not make sense to me.
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alb813	he has seen the urologist and found a heating problem, there is a surgical treatment with a 70% chance of increase sperm?? should we just go to IVF?
Bradford_Kolb__MD	bumblebee, This is concerning. I would be very suspecious about your egg "quality". I would do a clomid challange test before proceding. I just did this on a very similar patient and found the FSH increased on cycle day 10 (a sign of failing ovarian viablity). She made 3 oocytes, so we retrieved and transferred 2 nice embryos . It is worth further investigation before proceeding.
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corgimommy	I've done 3 rounds of 50mg clomid with my RE. I always have a good amount and size follicles. But my lining is always under 8. Is this a problem? Should I request medication to help this?
yoganut	What do you think of taking DHEA for egg quality?
yoganut	Maybe I meant egg quantity...
Bradford_Kolb__MD	Honey, Your RE is trying to be practical in his approach to embryo freezing. If the embryos are not doing well, it is best not to freeze (it gives false hopes and expectations). You will need to explore this further with your RE as to why none did well. If you need to cycle again, you may do well to transfer and freeze on cycle day 3.
marial	Hi, I am 41 years old and in June had my first failed IVF. Did 450 IUI of puregon for 7 days which resulted in 15 eggs retrieved, 9 fertilized and 4 poor quality embryos, 2 to 5 cell with high fragmentation. Last Oct. I had to take mexthorate - sp?- due to an ectopic from clomid and IUI. I cannot afford to do another IVF but my doctor has said not to attempt another as it's not worth the time and expense as I will most likely get the same results. After the ectopic my right tube is now blocked right at the uterous. I did have an ectopic when I was 19 years on the left but it was repaired and two years ago adhesions removed. My docter had said he would let me do 3 more attempts with clomid and IUI, targeting the left side with ultrasound. Is there any point? Can I do clomid only without IUI??? I have consulted two other docters who said I should not give up and one has recommened using DHEA (25 mg, 3X a day, which I have been using for nearly a month. What are your thoughts on the use of DHEA? and clomid without IUI.
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bumblebee2006	Thank Dr Kolb. I will ask my RE about the clomid challenge. Any idea why I would responded well to the gonal-f for the IUI but have no reponse with the high doses for IVF? Also have you ever heard of Lupron putting a person into menopause?
Bradford_Kolb__MD	KimiC, I think natural cycles and low does cycles are definately something to consider in poor resonders and those that want minimal stimulation. One thing to consider though, it that you are putting all your eggs in one basket - forgive the pun. You may not end up with any embryos to transfer and you definately will not have any to freeze. Sometimes, the frozens are a great source for a second child.
Bradford_Kolb__MD	Alba,
misty	Is there any open forum, i can get free consultation abt evatuation of IVF
motherofdogs	do you find that PGD for aneuploidy for AMA is beneficial, in absence of genetic disorders or balanced translocations? i have had 2 cycles with "no normal embryos to transfer", and my 3rd, we didnt' have enough embies to test, so just implanted 2 embies, but BFN. Obviously, these were abnormal also.I have no facors myself, but DH using TESE sperm r/t prostatectomy.
Bradford_Kolb__MD	Alba, I would talk with your RE. I have not found varicolectomies to result in significantly improved counts.
Bradford_Kolb__MD	corgimommy, Time to get off the clomid. It can thin the lining.
alb813	THANK YOU!!!!!!!! I WIILL TAKE YOUR ADVICE.
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katie	I had a failed IVF earlier this month, 24 eggs, 18 fertilized, 2 transferred and none frozen and Dr. concluded that my egg quality was poor. I had an estradiol by the end of 4K and had mild OHSS. He wants to add Repronex to the Lupron-Follistim protocol we used. What do you think? I'm 34 and the infertility is unexplained.
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Bradford_Kolb__MD	Yaranut, DHEA is a new fad - not to say that it does not help. It may, but the data is not there to support it. I don't think it would hurt.
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griff202	how do you feel about co-culture dr.?
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yoganut	I've heard that low progesterone is a common problem for women over 40. I'm 43. My CD21 progesterone level was 10. Should I ask my RE about progesterone supplementation? I'm doing natural cycles at the moment.
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Bradford_Kolb__MD	marial, You definately have a tubal issue. You are at high risk for failed treatment with intercourse of an IUI, but more importantly another ectopic. What ever you do, you need to be followed closely. As far as another IVF, you might do well with a low dose stimulation - this can expensive as you mention.
corgimommy	This will be my last clomid cycle. I go for day 12 u/s on Friday. Is there anything I can do to help this last clomid cycle?
star	I had radiation & chemo about 10 years ago and I didn't know that they could destroy my ovaries so I am just curious what you would recommend for treatment. I was told that I'll have to get an egg donor but it's just so expensive and I'm just curious if you know of any way to afford the egg donation and IVF. It seems like all of the loans have to be paid within 2-3 years.
Honey	The option of 3 day transfer and freezing was not open to me as the advice I was given was to trust my RE and go with what he decided. Do you think frozen eggs are a good option?
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Bradford_Kolb__MD	motherofdogs, PGD is not a cure all. we do find marginally improved pregnancy rates with the process. If you have lots of good quality embryos, it is worth a shot. If I have a patient with 2 to 3 failed IVFs with good embryos, I have found that transferring to the tubes (ZIFT) works remarkably well.
Bradford_Kolb__MD	Katie,
Bradford_Kolb__MD	Katie, You need to review this with your RE, but I would shoot for a much milder stimulation (i.e. 10 oocytes). Sometimes, the excessive number of eggs and hormones can hurt the eggs.
misty	Hello Dr. Kolb! My problem: I am 32. After trying to conceive for last 2 yrs. I conceived last december, but In January end I had to do a DNC because the foetus didnt grow in the sack....how critical it would be to conceive again? do you reccomend IVF
Bradford_Kolb__MD	Griff, Co-culture - do not feel that it helps.
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griff202	thank you
marial	Is there anything you can recommend besides IVF? Should I use clomid and forego doing IUI at the same time?
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katie	thanks!
Bradford_Kolb__MD	yoganut, Progesterone will not hurt, but doubt it will help if your level is already 10. unfortunately, you have poor ovarian reserve and I would suggest being aggressive with your treatment.
Bradford_Kolb__MD	corgimommy, reduce stress and go with the flow.
deb	Dr. Kolb, Misty has been trying to ask this question...can you help out: Hello Dr. Kolb! My problem: I am 32. After trying to conceive for last 2 yrs. I conceived last december, but In January end I had to do a DNC because the foetus didnt grow in the sack....how critical it would be to conceive again? do you reccomend IVF
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amy	I had HPV as a young adult, had cryotherapy and all was resolved.Never had an outbreak again. I know i still have the virus, as the virus never goes away. Does this play any role in fertility and getting good embryos? Does it affect any part of the IVF process?
Bradford_Kolb__MD	star, if the radiation was in the pelvis, it might have affect both the eggs and the uterus. If it was outside the pelvis, it probably had little affect. Some chemos are OK on the eggs. You need to check a day 3 FSH and estrogen level.
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yoganut	I tried IVF twice (flare protocol, and estrogen priming protocol) but never got more than 6 eggs retrieved. On my second try, I only had 2 fertilized with ICSI. This was with the maximum stims (450 GonalF). Is there anything more aggressive I can try?
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Bradford_Kolb__MD	Honey, I don't want to go against your RE, but if you did not do well with a day 5 transfer, the embryos may do better on day 3 (unless they were poor at this stage as well). Some clinics do well with frozens and others do not. Our frozen pregnancy rate is nearly the same as our fresh , so for us, it makes sense.
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maddie1702	I am 39,graspingat straws.1st ivf miscarried @ 8wks,tri 10. 2nd ivf with pgd ,3 great looking normal blasts,did not take,3rd ivf 24 eggs,18 fertilized,pgd extended panel of 12 ,on 13 embroys, two normal great lookingblast. Did not stick. Dr. did some immune tests, said border line for clotting ,will treat withLovenox. Sound Good? Thank you
Bradford_Kolb__MD	Misty, I would seek the help of a board certified RE and get an appropriate work-up and treatment plan. You will problably do well with IUI's (IVF may be jumping the gun).
star	Yeah, I had brain surgery and somehow the chemo and radiation effected my eggs. They've done a few tests and somehow my system does not operate normally. I'm just curious if you have suggestions for me to have a baby?
misty	Thank you very much Dr. Kolb....thanks Deb too
melbro	I just had a day 5 blastocyst transfer (perfect eggs) per embryologist. What is the stand on bedrest? How long is recommended? I have read literature online that states only a few hours is necessary!
Bradford_Kolb__MD	marial, need much more information that I have to answer this. Reveiw this with your RE to discuss your options, but your tubes are an issue.
sonya	I was able to become pregnant but I lost the baby in my 3 month, I was told to wait another 3 months before trying again, is their a reason for this, and not at my age of 39 are the risk higher for something being wrong with the baby?
corgimommy	What do you think oif aromatase inhibitors for pcos pts with ovulatory clomid attempts?
misty	is it possible to have a secondary insurance plan who covers RE. Because mine doesnt cover it?
Bradford_Kolb__MD	amy, unfortunately you will have the virus forever. It should not affect your eggs/embryos, but the cryotherapy may have caused cervical stenosis. This can make natural conception difficult and an embryo transfer hard (if you have IVF, make sure they do a trial transfer).
deb	Misty, you might try reaching out to Fertility Lifelines for help with that insurance question....you can click thru on the banner at the top of this page.
Bradford_Kolb__MD	yaganut, these are very aggressive protocols. You man need to consider other options (i.e. oocyte donation).
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Bradford_Kolb__MD	Maddie, Sorry about the loss. The lovenox or heparin may help. I also add low dose steriods.
amy	Can the HPV virus be passed to the baby? any precautions? I am doing IVF, and transfers have not been a problem so far....thanks for your advice
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Bradford_Kolb__MD	Star, the brain cancer may have affect your pituitary gland (this controls ovulation). You may only need some hormonal therapy to stimulate ovulation. Talk with an RE.
misty	Thanks Deb..I would
sonya	I was able to become pregnant, but lost the baby at 3 months, I was told to wait another 3 months before trying again, is there a reason for this and at my age of 39 is there a chance that something will be wrong with the baby.
star	Thank you very much for your help! I'll look into that!
Bradford_Kolb__MD	Melbro, Bedrest probably does not make much of a difference. I advise my patients to relax and stay comfortable for 2 days and then go about their normal daily routine.l
Bradford_Kolb__MD	Sonya, I would try on the third cycle. An immediate pregnancy may increase your risk of another.
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Bradford_Kolb__MD	corgimommy, Aromatase inhibitors are a good option. I also add glucophage to all my PCO patients.
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sonya	Thank you! I also wanted to know if having a baby so late in life what are the downside?
Bradford_Kolb__MD	wow this goes fast.
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deb	We should have made you some popcorn, Dr. Kolb@
jneencruz	could you explain more about the aromatase inhibitors and how it helps pcos patients
Bradford_Kolb__MD	amy, There is a small risk of pass the HPV virus to the baby, but it is thought to be very uncommon.
bumblebee2006	Since it is slow right now --one more question- When I am not in "treatment" I use clearplan easy fertility monitor. It also shows that I ovulate? Have you found these monitors to be helpful to those with an FSH as high as 10? I have heard when you are "older" it can give false readings due to hormonal changes.
Honey	Thank you for your replies Dr. Kolb. One more thing. My question was about frozen eggs, not embryos, as opposed to going through the whole donor process. I see many sights that are offerring frozen eggs that wil be shipped to your IVF center. Do you have an opinion on the success rate of this method or any stats that you know of?
amy	so do our reproductive lives! just kidding....trying to lighten it up here! Hee hee
corgimommy	I have pcos and been on metformin for almost a year. There is a clinical trial using an amoratase inhibitor but you have to stop Metformin. Is that a bad thing?
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Bradford_Kolb__MD	Sonya, If you are healthy entering a pregnancy, you should be fine. There is a mildly increased risk of gestational diabetes and toxemia of pregnancy. Take care of yourself and you should be fine.
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sonya	Thank you!
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Bradford_Kolb__MD	jneencruz, Aromatase inhibitors increases your endogenous FSH release so that there is increased stimulation to the oocytes (specifically it is an estrogen modulator).
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Bradford_Kolb__MD	Deb, I would love some...save some for me.
deb	I wanted to thank Dr. Kolb for typing his fingers to the bone to keep up with your questions! This is a great session. If Dr. Kolb has somehow missed your question, feel free to repeat it. The questions are just coming at him fast and furious!
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Bradford_Kolb__MD	bumblebee, I don't find that the false positive rates on the monitors is very high. Be proactive (and make sure you enjoy the process with your partner).
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corgimommy	Aromatase inhibitors: What does an increase stimulation ot the oocytes do? What is the difference b/w Aromatase Inhibitor and Clomid?
Bradford_Kolb__MD	Honey, Egg freezing is a new process and still considered experimental. It looks like it works well and may be an option to hold off of having kids. If you have a partner, I would prefer that you freeze embryos.
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deb	As a reminder, we are here every Tuesday night from 8pm-9pm Eastern. Next week, Dr. Mark Leondires from RMA-CT will be with us discussing F
bumblebee2006	I am the one earlier who did not respond at all the to the Medication for IVF. I had recently lost 20 pounds (slowly) could that have anything to do with me not responding? Also have you heard of a person responding well to the gonal-f for IUI but not the high doses for IVF? Also have you heard of Lupron putting you into temporary menopause if so for how long? I know I am grasping at straws here??? But it has been very disappointing for me. I can't wait to get that clomid challenge test done.
yoganut	How much of an adverse affect does being hyperthyroid have on being able to achieve a pregnancy? My TSH was not monitored adequately during my IVF cycles (was <0.1) so now I am waiting for it to stabilize before doing donor egg.
Bradford_Kolb__MD	corgimommy, it is not bad to stop it unless you have noninsulin dependant diabetes. I would prefer for you to use both, but I understand the research process
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Bradford_Kolb__MD	corigmommy, they are both estrogen receptor modulators. They both lead to an increased rate of ovulation in women who do not ovulate. Both work well and many clinics use both.
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Honey	Thank you. I have a partner but we have to use donor eggs because of advanced maternal age. We thought about rather than looking for a donor maybe going through one of the agancies that freeze eggs. Sorry, I am so full of questions. I am on the waiting period. Since I did not use my own eggs so I never received hCG for stimulation, when would be the earlies I could try a pregnancy test? (Transfer of Blasts was 3 days ago).
corgimommy	What is Femera?
Bradford_Kolb__MD	bumblebee, Congratulations! Keep up the good work. It may affect your stimualation, but I doubt it makes that much difference (sorry). Go for the clomid challenge test.
motherofdogs	I know the odds of a person getting normal embryos on PGD is low, and after 2 consecutive cycles wtih no normals, do most women just quit and go with DE's? i want to keep going until we find that normal, because my RE feels that there is one out there, we just need a good batch. I would feel better if i had a cycle inbetween that had some normals, it would at least give me hope. Have you had pts' with 2 consecutive cycles without normals, get normals later? I would do 10 cycles if i knew i could get one normal!
Bradford_Kolb__MD	Yoganut, It may adversely affect implantation rates, although if you have no clinical evidence of being hyperstimulated, it was probably a minor affect. Get this treated before proceeding with any treatment.
deb	We have about ten more minutes with Dr. Kolb. And, as a reminder, we are here every Tuesday night from 8pm-9pm Eastern. Next week, Dr. Mark Leondires from RMA-CT will be with us discussing "Facts, Fiction and FSH." And if you aren't a free "No Barriers" member of The AFA, please consider joining. Just go to www.theafa.org and register!
corgimommy	How many pco pts need IVF?
Bradford_Kolb__MD	Honey, I would strongly advise against this. you will be much better served with fresh eggs. Egg freezing is still in its infancy. In the long run, fresh eggs will be much more cost effective.
yoganut	Hyperstimulated by the fertility medication or the thyroid medication? My synthroid dose was too high. I'm getting this treated before proceeding...
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Bradford_Kolb__MD	corgimommy, femora is an aromatase inhibitor.
Honey	Thank you. (second part of my question) Since I did not use my own eggs so I never received hCG for stimulation, when would be the earlies I could try a pregnancy test? (Transfer of Blasts was 3 days ago).
pujaseth76	Do women who have endometriosis have lower implantation rates? I'm getting 2nd cycle of IVF this month. I have Endo & had a Laprascopy to remove it in May 2005. After that i had 2 iui's and one cycle of IVF in Jan 2006. We transferd 3 embryos but Bfn. I'm 29yrs old.
Bradford_Kolb__MD	motherofalldogs, you might find a normal one with your own eggs . However, how much time, money and emotional stress are you willing to go through? I would seriously look at all this. Personally, I would go with donor oocytes.
corgimommy	Why would you rx progesterone after IUI?
Bradford_Kolb__MD	corgimommy, Some not most do not.
Bradford_Kolb__MD	yoganut, Hyperstimulation is due to the fertility medications.
Bradford_Kolb__MD	Honey, I would test 10 days after transfer - ealier may give you a false negative.
Honey	Thank you
jneencruz	yoganut, i used a heating pad to help with the pain and discomfort of hyperstimulation, it helped
maddie1702	Have a good night. Thank you for all your information!
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satie37	What was your opinion of DHEA to improve response to fertility meds??
corgimommy	How many cycles of an aromatase inhibitor can you do? If I'm on the clinical trial -- it's double blind so just curious about what to do afterwards.
Bradford_Kolb__MD	pujaseth76, this may depend on the stage of the endo. The other issue is rather or not surgery helps improve it. Many of us do not feel that it helps to remove the endo (it can even cause more harm to due to trauma to the ovary).
deb	We have Dr. Kolb for six more minutes...so if you are 'lurking' and want to ask a question, you will have to ask now!
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Bradford_Kolb__MD	Corgimommy, To mimimize a failed implantation due to a luteal phase defect (low progesterone levels).
Bradford_Kolb__MD	satie37, the data is unclear at this time, but I do not think that is will be harmful.
ladybug107	hi dr kolb..i have been trying to finish up some work i brought home but was so interested in being part of discussion if you have a few mins i am wondering i have done 3 IVFs get 40-50 eggs and hyperstim w/ e2 at 8000 one cycle cxl and FET which my embryos were "destroyed" in the lab due to power outage
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Bradford_Kolb__MD	corgimommy, usually 3, the injectables.
corgimommy	Do pco overstim on injectables often....I'd be scared about having a cycle cancelled after having to pay so much.
pujaseth76	Thanks. My sugery was sucessful - though I did have severe Endo with lot of scar tissue. But, my uterus is normal & I responded well to meds. My only concern is if there is an imbalance caused by the endo which prevents implantation?
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jneencruz	thank you for the information, it is nice to know I am not the only one with so many unanswered questions
deb	Dr. Kolb is there any contact information you want our audience to have if they have more questions. Of course, The AFA's site is a wealth of information (www.theafa.org) as is www.havingbabies.com (Dr. Kolb's center).
ladybug107	anyway, my frustrations are high and to get less eggs/not hyperstim my RE suggested menopur/bravelle 75IU of each this time (i responded in past VERY well to gonal-f and follistim with 14 day lupron supression) and this one cancelled as my e2 DROPPED and everyone was shocked from 70 at the first few days to 30!! RE confused as to why that med didn't work and figured no lupron so my eggs would grow better
jnshanna	I'm one of the lurkers and I don't have a specific question. I've been reading along and have learned from other's questions. I do want to thank Dr. Kolb for his time.
deb	Jneencrus....i wish we had all the time we needed to answer everyone's questions.
ladybug107	i had 2 blasts put back in june and the beta was negative so they said they want quality not quantity and the embryos look okay but only a few get to blast
Bradford_Kolb__MD	ladybug, I am very sorry about the power outage. We have equiped all our labs with emergancy generators. I would consider a much milder stimulation - you may avoid hyperstimulatiing and you may have better quality embyros. I hope you are not charged for your next cycle (not your fault about the power outage).
corgimommy	Thank you for your time Dr. Kolb--this has been very informative!
deb	Dr. Kolb, thank you so much for your time....we would love to have you back-once you recover!
Bradford_Kolb__MD	Ladybug - I agree that quality is much better than quantity.
ladybug107	no i am in shared risk so they didn't count and now have a backup power but still feels so unfair as we were the only ones affected..can you explain why the bravelle & menopur didn't work AT ALL when normally i over stim
ladybug107	any last suggestions to improve quality?
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deb	Good night all. We will
Bradford_Kolb__MD	Ladybug, I can not explain the bravelle/menopur issue. I use this periodically and have not had any issues
deb	Oops, good night. We will be back next week. Thanks to all of you for making this such a great session.
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ladybug107	ok thanks so much maybe just a fluke thank you so much
Honey	Thank you Dr Kolb and deb
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Bradford_Kolb__MD	ladybug, A gentle stimulation, reduce your stress (easily said, much harder to do) and eat well.
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Bradford_Kolb__MD	I want to thank everyone for the great questions. It has been fun and educational - I hope for you as well. Good luck everyone!
ladybug107	thanks i usually FSH at 100-225 IU is that gentle?
ladybug107	next time doing 100 probably
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Bradford_Kolb__MD	Ladybug, This is relative you what you have done before.
ladybug107	ok thx
Bradford_Kolb__MD	Good night - have to pick up my girls. God Bless.....
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