Medical Questions Answered

January 10, 2006 - Tuesday
8:01 PM to (EST)
Guest Speakers: Tina Koopersmith, M.D.

Categories
Acupuncture • Infertility • IUI • IVF • PCOS • PGD • Pregnancy

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annacoats	Hello
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Moderator_DSBecker	Good evening everyone - welcome to AFA's on line chat - tonight we are very lucky to have Dr. Koopersmith join us to answer General Medical Questions
drkoop	hello and welcome
Moderator_DSBecker	Please feel free to just jump in - there is no question that is silly
annacoats	Ok great thanks. and thanks for your time. I have gone through 2 IVF cycles - both resulting in numerous eggs being harvested and fertilized, PGD, and transfer of 2 seemingly healthy embryos. but no pregnancy
annacoats	i'd like to know if there's anything i can do to help get pregnant
annacoats	post-transfer
drkoop	IVF and all fertility treatments are a stressful and frustrating time, especially when they dont work--when i analyze IVF cycles I like to look at embryo quality, embryo transfer (ie how difficult), uterus--lining and myomas or polyps or not etc. IT is also important to remember with PGD whle a good analysis it cant yet measure all 23 pairs of chromosomes so "normal " embryos may not truly be normal (especially if the person had a lot of other abnormal embryos or was of advanced maternal age
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drkoop	anna--other things that people try w IVF cycles are acupuncture and mind body workshops--some studies have shown improved outcomes with these additional modalities
Moderator_DSBecker	Welcome Jenniferl
jenniferl	Thanks! Hi everyone.
annacoats	ok thanks
drkoop	anna--good luck
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annacoats	any particular journals or studies showing these results?
Moderator_DSBecker	Welcome leanne
annacoats	would be helpful for me to read up on this
Moderator_DSBecker	Please welcome Dr. Tina Koopersmith from Valley Center for Reproductive Health in Sherman Oaks, CA
Aruna	Thank you Dr. Koopersmith for participating in this educational session. I have had one successful pregnancy (6 year old boy) that was conceived without treatment (had stopped fertility treatment and was going through adoption application when I became pregnant). I have not used birth control but do have a septate or bicornate (sp?) uterus where the septate muscle goes completely down to my cervix. I have only my left ovary and fallopian tube (I lost the other last March due to infection), and my question is, as my biological clock ticks (I'm 35) should I have that septate removed, even with the risk of scar tissue, or would artificial insemination be a possibility? I don't want to use hormones to harvest eggs. I've only been pregnant once and am assuming that my septate muscle is serving to block fertilization. I appreciate your thoughts and advice.
drkoop	annacoats--Fertility and Sterility published some articles about acupuncture in 2004/2005 and there were abstracts at pacific coast reproductive society in 2004 also in F&S--Alice Domar from Harvard has written extensively on the MindBody connection--a book and some papers as well
Moderator_DSBecker	Tongights topic is "anwers to general "infertility" medical questions"
annacoats	ok fantastic thanks
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Moderator_DSBecker	If the Dr. does not respond to your question - please post again - it is very hard to write answers and read questions at the same time - thanks
Moderator_DSBecker	sblm - Welcome
sblm	Thank you
drkoop	Aruna--septums are associated with miscarriage and there is some controversy regarding their role in infertility. I cant specifically advise you on your particular anatomy, because each case is unique.
Moderator_DSBecker	Any Medical Questions - you have come to the right place!!!!!
drkoop	aruna--septums we dont think block fertilization
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Moderator_DSBecker	It is ok to just jump in with a question
Moderator_DSBecker	slgraves - welcome to tonights chat
Moderator_DSBecker	tonights topic is "general medical questions answered"
Moderator_DSBecker	Our guest tonight comes all the way from California
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Moderator_DSBecker	Sunnydayz - welcome to tonights chat
sblm	Is there any way to test why fertilized eggs do not impmant?
sblm	Sorry, Implant
leanne	how do you know if the medication metformin works
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Moderator_DSBecker	We are very lucky to have Dr. Tina Koopersmith join us from Valley Center for Reproductive Health in Sherman Oaks, CA - tonights topic is "General Medical Questions Answered"
Moderator_DSBecker	If you post a question and you have not gotten a response in 10 minutes then please feel free to post it agian
jenniferl	How much of a role does a thyroid conditon play in infertility? I have hypo-thyroidism, that is being treated with lyvoxel, but my TSH values are constantly fluctuating. How does this effect my fertility long term? We have not used birth control in over 3 years, but no pregnancy.
EM	Can low morphology effect embryo grading after icsi? My dh has low morphology so we are icsi ivf-ers, we never seem to get good grades. Could this be as a result of the morphology, or should we be looking for other answers?
drkoop	sblm--implantation is the million dollar question, much research is being done in this field but we dont have specific answers yet--many embryos dont implant or die very quickly becuase of chromosomal abnormalities in tje embryos and PGD has begun to evaluate this part of the equationl.. There are some specific endometrial (uterine lining) proteins that are looked for in some biopsy specimens to see if the uterus develops normally or not --but as of yet we dont really have the answer to that elusive question
Aruna	Thank you Dr. Koopersmith, it's good to know about the association with miscarriage and that it's unlikely to be blocking the fertilization. I've found very little information on them, and as always, it is frustrating to be an "unexplained" infertility patient. It will help in my choices. Has there been much information generated on the long term effects of using hormones for treatment in fertility? My mother died of breast cancer at 42 and we have family members with the BRCA1 gene mutation, so I've avoided using more than Chlomid. Do we really have enough info to know if the medication options couldn't contribute to cancer risk?
Moderator_DSBecker	EM - I would not put too much stock in the GRADING SYSTEM -
leanne	while under medication metformin what is the do's and don't to be done to be more successfull
Moderator_DSBecker	The pre-embryo that became my son who is almost 9 years old - was horrible - so go figure
drkoop	Jennifer--we do try to correct thyroid function to optimize the endocrine system and the ovulation process and in the extreme ends some women dont ovulate when their thyroid is way off--so its best to get in control but we also have pregnant patients with thyroid disese diagnosed on routine prenatal tests so it s not a 1-1 correlation--i would fis the thyroid but not necessarily blame your infertility on it
nyiap	what is your feeling on Menopour during IVF/ICSI...what does it do or not do for that matter?
EM	It just seems that the best we can get is a heavily fragmented 6 cell after 3 days. The best we ever got was a day 3 four cell with no fragments. It's kind of frustrating. I just don't understand why?
Moderator_DSBecker	These are all great questions - we are very lucky to have Dr. Tina Koopersmith join us tonight from CA
Moderator_DSBecker	EM - I know personally how frustrating this is but the "whys" are the million dollar question that no one really knows
Aruna	We are very lucky to have Dr. Koopersmith. Thank you for participating. I just discovered the AFA this afternoon, read through several of the other educational transcripts, and couldn't believe my luck that there was a session tonight. Thank you.
drkoop	about emryo grading--its not a direct correlation to pregnancy outcome--but again PGD may help to determine why the embryos may not look good. Also some studies suggest that abnormal sperm with abnormal DNA seen in a special test called the SCSA may lead to lower pregnancy rates, higher miscarriage rates and this may be assoc w some abnormal embryos or difficulty in the embryo making to blastocyst
Moderator_DSBecker	Aruna - please vist the AFA as often as you like - with NO BARRIERS all information is FREE
jenniferl	Thank you Dr. Koopersmith for answering my question.
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Moderator_DSBecker	Don't worry I am sure that Dr. Koopersmith will be right back
Aruna	Since Dr. Koopersmith is experiencing a technical difficutly, I'll ask a technical question. The past 2 times I posted I got the Err 3585 message that my actions may prevent further access - what did I do? I thought that all I did was hit "send." Any advice?
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Moderator_DSBecker	Aruna - I have no idea but you may want to try to reboot your computer if it happens again and then log on again
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sblm	Is metformin safe? When I first began trying to conceive my Endo. prescribed metformin for me and my 1st RE asked why. He did not seemed pleased with that prescription.
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Moderator_DSBecker	Welcome back DOCTOR
Moderator_DSBecker	Everyone please repost your questions
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Moderator_DSBecker	Welcome InPatientNC
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Moderator_DSBecker	Tonight we are pleased to have Dr. Tina Koopersmith of Valley Center Reproductive Health in Sherman Oaks, CA
Moderator_DSBecker	lizzyprod - Welcome
drkoop	Sorry igot disconnected--regarding menopur--it is a purified urinary product. there are others which are recombinant and others that aer less purified. There are 2 pituitary hormones FSH and LH--some of tjhe meds have avtivity for both hormones, and some products are specific for just one ie GONAL F and FOLLISTIM are recombinant SFSH only, menopur is urinary highly purified FSH and LH activity
sblm	Is Metformin safe? When I first began trying to conceive my endocrinolgist prescribed metformin for me and my first RE didn't seem to pleased.
Moderator_DSBecker	tonights topic is "General Medical Questions Answered"
Moderator_DSBecker	Feel Free to Just JUMP RIGHT IN!!!
Moderator_DSBecker	All Questions are welcome
jenniferl	My GYN prescribed metformin for me, but I was never diagnosed with Pecos. My endo suggested I may have Pecos, but never has tested me to confirm, would a person w/o Pecos still have success with metformin?
drkoop	SBLM--metformin is a diabetes drug--it helps the body deal better with glucose and insulin. Many doctors are using it for PCO patients who may have troulbe w glucose and insulin. However, we dont have large numbers of patients with exposures in pergnancy so many docrots are nervous baout using drugs in pregnancy--amny others are using metformin w fertility meds
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lizzyprod	Hi there - i was wondering what you could tell me about the Kruger test and low scores / fertility
sblm	Correct me if I am wrong, but isn't metformin used for people who have a high level of glucose?
drkoop	Jennnifer--metformin for infertility is usually used fro PCO pts--some folks who are obese may be givien it b/c obestity is also associated with insulin resistance
sblm	Disregard my second question Dr.
sblm	Metformin helps you to develope more eggs?
drkoop	lizzyprod--the kruger test is a way to do a semena analysis--Kruger was a doctor who was very strict in calling a normal sperm a normal sperm..IF a man had 14% normal sperm in an ejaculate that was consider wnl and he had a goo dchance of fertilizing an egg in IVF--on the other hand if there were less than 4% normal sperms--the likelikhood of fertilization failure was high in an IVF cycle (w/o ICSI)--so its just a sctricter way to evaluate the morphology or shape of sperm
InPatientinNC	If my husband was in a hot tub 2 months before he had a semen analysis, could that cause a bad test result.
Moderator_DSBecker	These are great questions and answers
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lizzyprod	are there any ways to increase your Kruger ratings?
Moderator_DSBecker	I am sure that Dr. Koop wll be back soon
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Moderator_DSBecker	InPatient - that is a good question - it is possible because if the water was too hot it could effect the little ones - it takes 90 days to produce sperm
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EM	OK, this may be a basic question, but the itchy welts on my butt (from PIO injections) is what really bothers me everyday. I feel like I've tried everything. What is the best way to deal with this literal pain in the a** issue?
drkoop	i keep geting disconnected sorry
Moderator_DSBecker	EM tell me what you have tried already
Moderator_DSBecker	Welcome back Doc
EM	Heating pads, ice packs, benedryl, vaseline, regular lotion, nightly massages
EM	I should add that I've just done 3 fets back-to-back, so I'm in extra bad shape
drkoop	inpatient in NC--hottubs and sperm are not great for each other--sperm and the scrotum are outside b/c they like to be cooler thna body temp--if there is a ?? repeat the SA--BY THE WAY GO DUKE (if your from NC)
Moderator_DSBecker	EM - hmmmmmmmmmmmmmmm
Moderator_DSBecker	EM what about asking your doc for a local numbing agent
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Moderator_DSBecker	I am thinking of a spray topical
InPatientinNC	Does Duke do a strick morphology test? We currently go to UNC
Moderator_DSBecker	Hi Plumleedw - welcome to tonights chat on General Medical Questions answered about fertility
lizzyprod	Dr. - wondering about ways to increase the Kruger rating?
drkoop	for EBM--ice the area before the shot--make sure you are using a 25 gauge to inject and see if your PIO is in sesame oil --ask your doct if some of your prog can be given vaginsally
Moderator_DSBecker	Our Guest tonight is Dr. Tina Koopersmith of Valley Reproductive Health in SHerman Oaks, CA
plumleedw	Thank you
drkoop	INpatient NC--I am now in California--so i dont know what the DUKE team does.
Moderator_DSBecker	EM BTW - if you ICE make sure you do it long enough so that the COLD DOES NOT BOTHER YOU - generally 15 to 25 minutes
plumleedw	Could you please comment on the effects of exercise on fertility?
Moderator_DSBecker	IN other words when you can't feel your finger
drkoop	lizzyprod--increasingthe kruger rating means improving the sperm--no alcohol, tobacco, drugs or other toxins, limit caffeine (altho less proof of this affecting sperm as opposed to eggs) one can try the new products such as fertile one, fertility blend, or proxeed
EM	OK, that's good advice. I'm currently using a 22 g needle. I'll try the pre-ice. I started with olive oil, moved to sesame and now I got gestone in veg shipped in from the UK so I'm trying that. My RE doesn't like the vaginal, but I may have to push for that if this continues
Moderator_DSBecker	lizzyprod - tell dh to wear BOXERS
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drkoop	lizzprod--also has he seen a urologist or internist--occasionally there is an occult prostate infection and antibiotics may cure this--especially if there are white cells in the semen--we somentimes use nonsteroidals too fot the white cells
Moderator_DSBecker	Doc what is your feeling about the use of "Proxseed"
Moderator_DSBecker	I think that is the way it is spelled
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Moderator_DSBecker	Welcome back Aruna
drkoop	plumlledw--exercise and fertility--everything in moderation--gerater than 7 hours of exercise a week may lead to ovulation problems--so keep it moderate--also competitive sports amy incerase stress which affects ovulation--but exercise in moderation may relieve stress too
lizzyprod	are fertile one, fertility blend and proxeed - over the counter or is this all through the clinic? and no, he doesn't wear boxers.
plumleedw	Thank you
Moderator_DSBecker	Proxseed is over the counter - don't know too much about it - never tried it myself since I had sever male factor and nothing other than ICSI would do it for us
drkoop	proxeed--it seems to be a good supplement, weve seen improvement in a number of male patients in their SCSA and their preg rates--the new products fertilie one and fertility blend also have some studies behind them now too--so i think none of these have dangerous substances in them and may help
sblm	I have a prolactinoma and I take dostinex .75mg per wk. My prolactin level is under 30. I continue to wonder if that plays a role in my lack of fertility. Any advice?
drkoop	these supplements for men are all over thecounter--go to the internet--GNC or yr fertility pharmacy
drkoop	sblm--once prolactin is controlled we think women should ovulate normally and that prolactin should nt be interfering
lizzyprod	thank you - that's great.
Moderator_DSBecker	Lizzyprod - as a general rule of thumb I think it wise that you tell your doc or preferably his doc (urologist) if he is using any supplement just to make sure that it is ok to do so -
drkoop	lizzyprod--I AGREE
sblm	Thank you.
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lizzyprod	i agree as well.
Moderator_DSBecker	My former Urologist, Peter Schlegel would always tell me that "we just don't know enough about alot of the supplements available"!
Moderator_DSBecker	Hi Dawn welcome to the CHAT
Moderator_DSBecker	Tonights topic is General Fertility Medical Questions Answered by Dr. Tina Koopersmith of Valley Center for Reproductive Health in Sherman OAKS CA
drkoop	lizzyprod--regarding the supplemnets for men they may not increase the count miraculously but they may help the quality--agian only if you have a pregnancy or have improved embryo number/quality do you know--but sometimes the SA or the SCSA improves
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Moderator_DSBecker	Hi Joydill Welcome to tongights chat
Moderator_DSBecker	Dawn and Joydill feel free to just jump right in
drkoop	i think dr shlegel is right but the supplements are not outrageously expensive and have little drawbacks/side effects so for many its a good start or a good supplement during ART
Moderator_DSBecker	Tonights topic is General Fertitlity Medical Questions Answered by Dr. Tina Koopersmith of Valley Center for Reproductive Health in Sherman Oaks, CA
EM	Just a clarification - would you recommend the sesame over the british gestone for pio? What kind of topical spray should I look at?
Moderator_DSBecker	Dr. Koopersmith - I agree but you also know that "fertility" patients sometimes take some weird stuff
Dawn	how common, or how concerning is it to not get your period naturally after a failed IVF attempt? After about 45 days and a neg hcg test, I was put on Provera and did get my period after those pills. Is it common for this to be needed? What should I be concerned about? Will I likely continue to need help getting my period now?
drkoop	em--i dont know enough about the british gesstone
Moderator_DSBecker	EM TRY to ice, I mean really ICE untill the area is NUMB
lizzyprod	Dr. i'm pretty sure I have a parasite of some sort - would this impact fertility... it is in my colon.
EM	OK, I gotta go, but thanks for all of your help!
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plumleedw	In your opinion, how helpful is intrauterine insemination if the sperm count and motility are excellent but there is an elevated FSH (10) in the female?
drkoop	dawn --after IVF there are a number of corpus luteum cyst--physiologic cyst from ovulating a lot of eggs- also there are often hi prog levels tso sometimes the next cycle is delayed--most folks revert to their normal pattern after that
drkoop	plumlleedw--regarding ovulation induction and insem--alot depends on yr age and response to meds--for the older woman or the poor responder we are quicker to move to IVF wiht a elevated FSH --but for the women in their mid 40s some only do the IUI b/c IVF may not be much better if they are older have a hi FSH nad a poor response--for the younger women w poor response we are quicker to move to IVF
drkoop	lizzyprod--if you have a parasite--go see a GI doctor and have it evaluated
joydill	does a cycle of IVF or 2 have an impact or effect on the subsequent ovarian quality besides delayed menstrual cycle?
drkoop	joydill--i dont think an IVF cycle will affect egg quality in future cycles
plumleedw	I am 42 and my FSH is 10. We have completed one unsuccessful IUI with Clomid. My husband's counts were excellent. I just wonder how helpful IUI is in this situation.
joydill	do you recommend acupuncture? what are the benefits?
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jenniferl	Thank you for your time Dr Koop, have a good night everyone.
drkoop	plumdeedw--you are 42--make sure you are w an REI nad consider stronger meds or treatments
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plumleedw	Thank you.
Moderator_DSBecker	WOW what a great job - cyber claps to Dr. Tina Koopersmith - thank you so much for being here with us tonight - on behalf of the AFA, I thank you. And to all our questioniers - cyber luck to you! ::rolleyes GREAT JOB EVERYONE !
drkoop	acupuncture is unproven but there are some small studies touting it--speak w yr doctor regarding his/her take on it as a supplement
joydill	thanks!
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drkoop	GOOD LUCK ALL YOU FOLKS
Moderator_DSBecker	PLEASE VISIT THE AFA OFTEN - its a great place !!!!!!!!!!!!!!!!
drkoop	i agree
joydill	getting ready for donor IVF.. will need a lot of luck!
Moderator_DSBecker	Good NIght EVERYONE
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joydill	gd night thx again
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drkoop	GOOD NIGHT ALL
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