Medications and ART

April 27, 2007 - Friday
12:45 PM to (EST)
Guest Speakers: Eric Flisser, MD
Reproductive Medicine Aassociates of NY

Categories
Acupuncture • Fertility Drugs • Infertility • IVF • Ovulation • PCOS

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moharden	I have a quick question? Can I ask?
Dr._Flisser	go
moharden	It was actually for the monitor...I got on a few weeks ago for PCOS and miscarraige and nobody was there? Was that one cancelled?
moharden	Thanks for being here Dr. Flisser... I have just started my IVF cycle and my fertility center has been very vague about the order, timing and dosage of my medications...is there a standard or typical protocol...(right now I just have a box full of drugs that I have no idea what to do with!)
Moderator_DBecker	We will officially start in just a few minutes.
moharden	Sorry
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Moderator_DBecker	Welcome Moharden and Nchrist we will start in just a few minutes
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tina13669	Is anyone there
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Moderator_DBecker	In about a minute or two we will officially start tonight's chat - I will be moderating and our guest tonight is Dr. Flisser
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Moderator_DBecker	Dr. Flisser do yo mind just "stating" where you practice
Dr._Flisser	Of course, I'm with Reproductive Medicine Associates of New York (RMA-NY)
Moderator_DBecker	Tonight's topic is ART and Medications you should know about but all general "infertility" questions can be addressed
Moderator_DBecker	I would just ask that if your question is not answered that you repeate it - it is sometime difficult for someone to read and write at the same time
Moderator_DBecker	OK here we go let's begin!!!!!!!!!!!!
tina13669	I am on my 2nd round of IVF and I am wondering what I can do to facilitate success
Moderator_DBecker	Good evening everyone and welcome to AFA chat with Dr. Flisser med director of RMA of NY at Long Island
moharden	Thanks for being here Dr. Flisser, I have just started my IVF cycle (on birth control and Lupron) and my fertility center has been very vague about the order, timing and dosage of my medications...is there a standard or typical protocol (right now I have just have a box of meds that I have know idea what to do with)
Dr._Flisser	Hi tina: a good question. Anytime you have a cycle failure (no pregnancy) you should meet with your physician (in person on on the phone) to go over possible problems with the cycle
Dr._Flisser	unfortunately, sometimes, failure is just bad luck
Moderator_DBecker	I just want everyone to know that Dr. Flisser will be presenting at this Sunday's AFA Conference
Dr._Flisser	moharden: sounds like the practice already has a plan for you. you should review with your nurse or IVF coordinator a "typical" schedule for your specific protocol, even if it can deviate somewhat
Dr._Flisser	Moharden: IVF protocols are not unlike recipies for cooking
Moderator_DBecker	Dr. it has been a few years from the days of pergonol and metrodin are there some new drugs out there now??
Dr._Flisser	although there are some basic formats, every program can tweak the order and dose and timing to best suit their own experience
nchristoffersen	Dr. Flisser, I have not done IVF yet. We are planning on starting in June if the IUI we had this weekend fails. I'm wondering what the side effects of the medication are. I'm 24 years old and my husband is 31. This month I had 7 follicles, three were over 20mm, on 50 mg of Clomid. I have heard that a lot of people gain weight. I'm wondering what is normal. Right now, I weigh 104 pounds and am wondering if that is causing a problem with getting pregnant, even though my doctor says it's not.
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Moderator_DBecker	Welcome, Happy to tonight's chat with Dr. Flisser
tina13669	Have you had any experience with Glumetza?
Dr._Flisser	New drugs: most are new variations or more purified versions of old drugs: for example hMG (human menopausal gonadotropin) was originally derived from human urine, but now recombinant technology permits making these medications without using human byproducts
nchristoffersen	One more thing, will my weight hurt my chances for success with IVF?
Moderator_DBecker	Is there general preferences between oral, IM, Sub-Q, Patch...
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Dr._Flisser	nchristoffersen: weight gain from treatment can be a combination of things, but generally has to do with water retention from the effects of the hormone (when it's not from actual pregnancy ); you can imagine that women taking birth control complain of the same side effects
Dr._Flisser	tina: I don't know what Glumetza is, sorry. is there a generic name?
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Moderator_DBecker	Sauliusp welcome to tonight's AFA Chat with Dr.Flisser
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nchristoffersen	Will my weight hurt my chances of success with IVF? I've always been small. It's a genetic thing. I've never weighed more than 110.
Moderator_DBecker	Khuger and Maggie welcome to tonights AFA Chat with Dr. Flisser
Dr._Flisser	Weight, or more specifically, BMI may relate to cycle success. Usually, patients with high BMI do less well, though the truth is that high BMI is associate with a variety of medical problems, and is a significant issue for an increasing number of Americans, even without fertility problems
tina13669	Yes, I believe it is metformin. I understand that this is anti-diabetic pill... but what is the intended purpose for treating PCOS and does it have any effect on follicle development.
Dr._Flisser	nchristoff... your weight sounds fine
Dr._Flisser	tina: metformin has been shown to increase the chance of spontaneous ovulation in women with PCOS, and some physicians believe that it can decrease the chance off spontaneous miscarriage in patients with PCOS. However, more recently, an article in the New England Journal of Medicine suggested that patients do just as well or better on clomid alone.
Dr._Flisser	tina: the problem really is that there isn't a standard definition of PCOS that accurately describes the disease
MaggieV	My husband and I are trying our first cycle using follistim later this week, we have been on Clomid 150mg for four cycles without ovulating, what are our chance of ovulating using follistim?
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Dr._Flisser	PCOS is a "syndrome" - a constellation of problems, sort of a 2 out of 3 type thing to make the diagnosis - which means depending on which 2 of the 3, we might be talking abot different disorders - a problem that medical science hasn't yet solved
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moharden	I have Follistim, Prog in Oil, Lupron, Estraderm, Methylprednisolone, Asprin, doxycylin and Ovidril? Are these all common and what are their functions?
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Moderator_DBecker	Resongirl & SaraV- welcome to tonight's AFA CHat with Dr.Flisser
SaraV	thank you
Dr._Flisser	MaggieV: follistim itself isn't going to cause ovulation, only promote follicle development. I'm guessing, but probbly you didn't have follicles grow with the clomid, so you are being switched to another medication to make the follicles grow. When the follicles reach an appropriate size, your doctor will probably "trigger" ovulation with either hCG or ovidrel (human chorionic gonadotropin.)
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Dr._Flisser	Follistim is Follicle Stimulating Hormone (makes the follicles grow)
MaggieV	does the hcg injection work to make most women ovulate?
Moderator_DBecker	Welcome Hoping welcome to tonight's chat
Dr._Flisser	Lupron in a Gondotropin Releasing Hormone agonist... to suppress the pituitary so you won't spontaneously ovulate in the middle of the stimulation
Dr._Flisser	prednisone and aspirin are antiinflammatories
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happy	Dear Dr Flisser - Have you ever heard of Lupron used for infertility putting someone into premature menpause? I was 37 years old infertile but my FS was between 7-9. Started Lupron and birth control - then had no response to mega doses of Follistim (500 per day) and after taking the Meds the problems started immediately after the cycle it has now been 10 months) - my period has been very irregular, hot flashes, and a FSH that is now in the 20"s:-( Do you think it is just coincidence that this happened immediately after taking all the Meds (esp the Lupron) ?
Dr._Flisser	doxycyclin is a antibiotic (to prevent infection after the retrieval)
Moderator_DBecker	Hi Kfenton, welocme to tonight's AFA Chat with Dr. Flisser on "ART and Medication"
Dr._Flisser	ovidril is hcg (See answer to MaggieV)
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SaraV	HI Doctor...thank you for taking the time to speak to us all. I have a question regarding a health issue i have and pregnancy/ovulation
Moderator_DBecker	HI shaymer welcome to tonight's chat
Dr._Flisser	MaggieV: the hcg mimics the body's LH surge, so ovulation is almost certain approximately 36-40hours after administration. (it's a large dose compared to the body's normal production, but safe.)
kfenton	thank you!
tina13669	I can understand that. I just had one IVF with low positive HCG of 15 and repeat of 15.2. Then menses began. I believe I had OHSS wtih 1st round. Started me on BC pills, then Lupron 10 U then Gonal F 225 x 5 days then stoped me for 5 days and then 2 days at 75. Retrieval 5 eggs, 2 fertilized immediately and one took on day 2 and had returned 3 embryos on day 2. I want to promote more eggs and get to blastocyst stage for better success
tina13669	How can I do this? (ops sorry hit enter to quickly)
moharden	Thanks! Dr. Flisser!
shaymer01	hi all !
Dr._Flisser	happy: probably a coincidence with the Lupron; lupron does induce a menopausal like state, though temporary, in the absence of any other medications, lupron will keep estrogen production low, giving menopausal symptoms. When it is stopped, however, normal function resumes. If the symptoms of menopause begin afterwards, it is likely coincidence.
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SaraV	I have multiple sclerosis, and have an extremely low sex drive. With that said, "trying to get pregnant" is extra difficult for me. The whole timing of it all, fertile days, ovulation days, etc, is extremely frustrating. Do you have any advice for me...as far as which days of the cycle are the best time for intercourse?
happy	Thank you.
Moderator_DBecker	AM welcome to tonight's AFA chat
Dr._Flisser	saraV: ask away, trying to keep up!
Moderator_DBecker	Remember Dr. Flisser will be a presenter at the AFA's Sunday Conference
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Moderator_DBecker	H Marola welcome to tonight's chat
Dr._Flisser	tina: the proper stimulation is the only way... this means that having been stimulated once, your doctor has a better idea of how you will repond to the medication in the future and can adjust the dosage in anticipation
Marola	hello
shaymer01	Any chance this conference sunday will be taped? available for download or something?
restongirl	Hello...we are just potentially getting started in this game. 40 1/2, never preg (never tried until last year) so far nothing. Tubes are clear, seman analy. good, no other issues outside of my age. Researching IVF..our RE presents it as our best option to have our own kids (non-donor, non adoption) - my concerns are 1) the short term side effects which sound a bit debilitating (I puffed up on one round of 100mg chlomid) 2) long term effects - cancer? seems the jury is out on that one. Comments please...
Dr._Flisser	Sarav: if you have regular periods and can roughly anticipate when ovulation is occuring, you should plan to have intercourse every other day starting about four days before the expected ovulation and continuing at 24 hours afterwards. No need to have intercourse every single day.
Moderator_DBecker	This Sunday is the AFA's Family Matters - The National Fertility and Adoption Conference at the Grand Hyatt in New York
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Dr._Flisser	restongirl: good questions. IVF (without any other info) is a good choice. At 40, most of the oocytes (eggs) remaining in the ovary will be genetically abnormal, so the more oocytes that can be retrieved, the higher likelihood a normal embryo will develop and be available for transfer.
Moderator_DBecker	Jandkrys welcome to tonight's chat
Dr._Flisser	restongirl: as for long term side effects of gonadotropins, the recent studies have shown that there is little long term side effect of these medications...
shaymer01	i recently had a failed IVF retrieval - 5 follicles, NO eggs. I was told this was extremely rare. Could be a faulty HCG injection, could be a fluke, could be age related. I am going to do a flare protocol next. My day three FSH was I think 6 last fall. Any thoughts?
SaraV	So, basically, Fertile day 1, 3, Ov. day1, 3 is all that really is needed?
tina13669	What is your experience with IVF and acupuncture together? I have heard statistics prove that success rates of IVF increase with the use of acupuncture.. I am trying this... but would like to hear your take regarding this?
happy	Can someone in early menopause (I am only 38) still get pregnant? I do not respond to the Meds so my doctor is pretty much dismissing me:-( Unless I want to do donor eggs which is not an option for me) Should I continue to try timed relations or is it pretty much a lost cause with FSH in the 20's? Thank you for your time.
Dr._Flisser	older studies suggested that ovarian cancer risk was increased after taking these hormones, but there was an important confounding factor: women experiencing infertility do have a slightly higher risk of ovarian cancer, but probably because of uninterrupted ovulation (no pregnancy or no birth control pill use) - who takes fertility meds? infertile women, and thus the association with cancer - but a spurious association
sauliusp	"there is little long term side effect" -- can you outline what these are?
Dr._Flisser	shaymer: no oocyte retrievals are indeed rather rare, though they do happen. be sure to store the hcg properly, and definitely review with your nurse how to administer the medication so that there are no problems on the next round
tina13669	Should the HCG be stored in the fridge?
shaymer01	I had powder and saline. Not refridgerated.
Dr._Flisser	SaraV: assuming all other things are normal (normal sperm, for example), regular timed intercourse in healthy couples will result in a 20% "fecundability" rate - which means a 1 in 5 chance of becoming pregnant in a specific month...
shaymer01	I was paranoid about the mixing and drawing up every last bit of the powder residue.
SaraV	ok thanks so much
Dr._Flisser	..after one year, 85% of couples trying this will become pregnant. the remaining 15% are investigated for infertility. However, in women older than 35, we usually investigate after 6 months.
tina13669	Also regarding the HCG, my Dr is suggesting to give the HCG SQ rather than IM as noted on the box. Is this a routine practice?
Dr._Flisser	sauliusp: about long term side effects: although the studies are reassuring that there is no increased risk of cancer, physicians know that there are no absolutes in life
SaraV	ok, well i sure hope it doesn't take a whole year for us. I'm 28 years old, and i was told that if i don't become pregnant in another 9 or so months, i have to begin the MS meds and have to be on them for at least for a full year before i can think of trying again :(
shaymer01	Tina, I was told to take it SQ as well.
Dr._Flisser	tina: re: acupuncture. the studies are conflicting. there is no evidence that acupuncture hurts a woman's chances, but the studies don't point towards evidence that it absolutely helps either (lots of conflicting data); acupuncture is difficult to test, because practitioners of acupuncture don't agree on which points should be stimulated... there are a lot of different variables.
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Dr._Flisser	happy: up to 10% of women with premature ovarian failure can conceive spontaneously. the problem of course is that ovulation may be haphazard, so impossible to time. however, it doesn't necessarily mean a good egg isn't out there.
tina13669	Thanks Dr.
Moderator_DBecker	Aijia welcome to tonight's AFA Chat with Dr. Flisser
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tina13669	Shymer01- As a nurse, it is difficult sometime to go with verbals when I have the written info in front of me
Dr._Flisser	shaymer: the dose of meds is usually more than enough, so a little droplet left in the bottle isn't likely to affect outcome. just take your time mixing and drawing it up!
restongirl	when they measure the quality of the the embryo before placing them in the uterus, do they automatically screen for chromosomal problems? Is that part of the selection process and grading of excellent, good, etc?
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Moderator_DBecker	Corey and Dee welcome to tonight's AFA CHat with Dr. Flisser
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moharden	Dr. Flisser, I've heard there is a link between OHSS and PCOS...am I at risk and how can I make sure this does not happen during our IVF cycle? Also how does this affect my egg production and/or quality?
shaymer01	thank you!
Moderator_DBecker	Hi Karen
amccloskey	I am on my 3rd cycle of FSH with IUI. My second cycle had to be cancelled due to no seen development between day 3 and 7. Is this normal to have to cancel a cycle?
Corey_Whelan	Hi everyone
Dr._Flisser	restongirl: embryos are generally graded by morphology (the appearance under a microscope): although this serves as a good proxy to choose embryos with high implantation rate, it is not a test of aneuploidy (abnormal chromosomes) - some embryos that look great are abnormal, and some that look terrible are perfectly normal. there's currently no way to know for certain that an embryo is chromosomally normal, though there are techniques for check some (but not all) of the chromosomes - an incomplete picture at best
Moderator_DBecker	Welcome to tonight's chat with Dr. Flisser who by the way will be a presenter at AFA's National Conference this Sunday in New York, NY
Dr._Flisser	the process to check several (but not all) chromosomes requires embryo biopsy, which is not a routine procedure
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aijia	We are starting a EPP protocol, and I have to wait until a LH surge then to start taking Estrace. My question is what if I can't detect a LH surge this cycle (cycle has been messed up after last IVF)?
Dr._Flisser	moharden: PCOS patients tend to respond robustly to the medications because there are many follicles waiting to be stimulated. PCOS is therefore a risk factor for OHSS, as is being thin and young. Careful monitoring (blood tests and ultraosounds) is the only way to avoid hyperstimulation. Of course, if there is a very high risk, not administering hcg will prevent hyperstimulation, but obviously cancels the cycle... a rare option usued only in extreme cases
restongirl	I bet the embryo biopsy is costly and rarely covered by insurance. Is there a high risk to the embryo to test it? ---thanks for the info by the way!
happy	Thanks. A 10% chance is better than zero.... Here is really technical question regarding ovulation for someone who is in premature ovarian failure. I have a clearplan easy fertility monitor and sometimes it shows that I am about to ovulate -usually really early like day 10. (it is able to detect a rise in estrogen and the other hormone that is indicative of impending ovulation) My question is if I am in early menopause would my hormones levels mean the same thing as "normal" female?
Dr._Flisser	aijia: can you define EPP? it might be an acronym specific to your physician's practice
moharden	Thanks
aijia	EPP is Estrogen Priming Protocol, is a protocol used for slow responders, i believe.
Dr._Flisser	restongirl: embryo biopsy does add to the cost of the cycle, unfortunately, but may be covered if it is being done for medical reasons (say, to avoid genetic diseases); whenever one biopsies an embryo there is risk in damaging it - that said, the risk is "all or nothing" meaning that the embryo could stop dividing - but not that it will develop aberrently - it does not cause birth defects, for example. the embryonic cells at that stage (8cell) are "pluripotential" meaning they can develop into just about anything, and they "know" when their partners are missing and can compensate
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Moderator_DBecker	Hi Kaylalunaava, welcome to tonight's chat with Dr. Flisser
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Dr._Flisser	happy: there can be two things going on: women nearing menopause have shorter follicular phases (when the follicle grows) and will ovulate earlier, so that the entire cycle is shortened. women in menopause have high levels of FSH, LH because of low estrogen feedback to the brain. either way will be detected by the monitor, which doesn't know the difference
shaymer01	is embryo biopsy = PGD?
kaylalunaava	Thank you.
Dr._Flisser	aijia: sounds like a "monitoring" question: meaning that you can always check a blood test to find out where you are in your cycle. otherwise, progesterone (which is produced after the LH surge) can be given to simulate being in the luteal phase... ask your doctor what he/she wants you to do.
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Dee_Dee	I'm currently on progestrone injections, heparin injections, estrace, baby aspirin, dexastrome (sp? anti addison disease medication) , medrol (starting tomorrow). Any suggestions on how to prevent soreness at injections site for both the progestrone and heparin? I understand I'll be on these injections for a long while.
Dr._Flisser	shaymer: yes, so there is a small semantic difference: PGD=preimplantation genetic diagnosis; embryo biopsy is the actual procedure performed so that PGD can be done
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Moderator_DBecker	Hi Sara and Jan welcome to tonight's AFA Chat with Dr. Flisser
shaymer01	ah, thank you
happy	I am still a bit confused as to whether I should continue to use the fertility monitor as I am definitely in premature ovarian failure and have been relaying the monitor for my timed relations?
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Dr._Flisser	DEE2: you can "ice" the area prior to injection (and afterwards); though some find a heating pad more useful afterwards; also cold progesterone hurts more, I hear, so warm the vial in your hands before administering the shot
Moderator_DBecker	Wannababy, welcome to tonight's chat
Dee_Dee	thanks
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tina13669	Is there any one ovulation predictor kit that you suggest to your patients over another?
shaymer01	As I said before, I had no eggs retrieved last (and 1st attempt) IVF cycle. I am wondering if the lupron could have oversuppressed me, especially because I started taking it 7 days before AF, but AF did not come for closer to 2 weeks later.
Dr._Flisser	happy: if you get occasional periods, it is unlikely that the LH level is always elevated - which would mean a positive test every time. it may then still predict ovulation. though it wouldn't make sense if it was positive once every week, since once you ovulate, you should get a period in about two weeks - and the LH level shouldn't rise into the detectable range during that time - if it does, the monitor isn't helping because the LH level in your body isnt from ovulation
shaymer01	so I was on for an extended period of time.
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Dr._Flisser	tina: all of the ovulation kits are roughly the same, scientifically; use the one that's easiest and most comfortable for you.
restongirl	if you had a 40 yr old patient, no issues, doing IVF, how many unsuccessful rounds would you go before suggesting donor, etc? when do the diminishing returns of the meds begin?
kaylalunaava	My abdomen is sore from all the sub-q shots. Can Igive the shot in my thigh are or my upper arm area?
Moderator_DBecker	I trust that everyone here is a member of the AFA under the "no barrier's program".
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Dr._Flisser	shaymer: "oversuppression" on lupron generally refers to the lack of follicles growing, not failure to retrieve eggs, so I don't think that was necessarily the problem; your doctor may change the protocl to increase the number of follicles produced, however - but this isn't the same issue
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Moderator_DBecker	Hey also remember it is not too late to register for this Sunday's mega AFA conference at the Grand Hyatt in New York for "Family Matters - the National Fertility and Adoption Conference" you can register right from AFA's web site!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Moderator_DBecker	Welcome back Nchristoffersen
shaymer01	thank you for clarifying, I was not aware of the distinction
Dr._Flisser	restongirl: that's a personal decision that you have to discuss with your doctor. there's no "right" time. depending on the FSH level, however, there may be a limit to how long you can try an expect reasonable chance of success
moharden	Progesteron in Oil? Is that what helps make a hospitable environment for implantation? How long will I be taking this? Is it usually after stimulation and hopefully during pregnancy?
restongirl	FSH is good now...do the gonadatropins affect your FSH going forward?
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amccloskey	If you aren't able to make it to the conference on Sunday, is there a way to get the information discussed?
Dr._Flisser	kaylalunaaava: the subcutaneous stimulation medications (FSH or HMG) can be given subq in the abdomen or thigh (not upper torso)
Moderator_DBecker	Rex welcome to tonight's chat - it is not too late to ask a question
Dee_Dee	What are any potential future medical problems that can result from the medications we are currently using to trying to achieve pregancy?
kaylalunaava	Thanks Dr. How about upper arm. Will that be ok?
Dr._Flisser	restongirl: your FSH level is not affected by taking gonadotropins (stim meds); over time, however, the FSH will rise, which is the normal physiology
tina13669	After the retrieval and return process is there any restrictions or suggestions you would encourage to facilitate success?
aijia	I think I was oversuppressed last time too, what do you think of the antegonist protocol without using BCP or Lupron?
Dr._Flisser	moharden: progesterone in oil is to maintain the receptive uterine environment. after egg retrieval, the corpus luteum in the ovary may be too damaged to secrete enough progesterone to support a pregnancy, so the injection is taken until the placenta can take over the corpus luteum's function
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Dr._Flisser	the placenta starts producing progesterone as early as the 7th week of pregnancy, but often the medication is given longer, just to make sure there is enough of a level in the blood
restongirl	40 yr old patient, no issues - IVF is the best way to go or can you think of another route with similar %ages...GIFT, ZIFT..?
moharden	Thanks!
Dr._Flisser	kaylaluaava: the appropriate locations are abdomen and thigh only
nchristoffersen	Dr. Flisser, do you suggest bed rest after embryo transfer. If so, how long do you suggest and is it strict bed rest?
kaylalunaava	Why are some pts on Antagon Protocol and others Lupron protocol?
Moderator_DBecker	Well poor Dr. Flisser's hand - its been alot of typing - the time is drawing near - a few more minutes so ask your final questions
Dee_Dee	What are any potential future medical problems that can result from the medications we are currently using to trying to achieve pregancy? ...just in case you missed this question the first time.
amccloskey	I am on my 3 cycle of FSH and IUI. My 2nd cycle was cancelled due to lack of follicle increase between day 3 and 7. Is this normal to have to cancel a cycle after a previous FSH/IUI cycle?
Dr._Flisser	tina: after retrieval, continue to take the medications as instructed. there are no magic secrets to making the cycle work - either the embryos are good or they aren't, unfortunately, and sometimes you have to leave it to Nature. that said, don't do anything that you might regret in retrospect (you don't want to be thinking, "mayne I shouldn't have done that...")
Rex	Hello Dr. Flisser,how do we keep postive during the 2ww
Dr._Flisser	restongirl: GIFT, ZIFT are rarely used procedures anymore because IVF with embryo transfer to the uterus is so successful
nchristoffersen	Dr. Flisser, do you suggest bed rest after embryo transfer. If so, how long do you suggest and is it strict bed rest?
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Dr._Flisser	Dee2: I answered the question earlier (I'm not ignoring you) - can you refer to the transcript so I can answer different questions in the limited time? Thanks!
Dee_Dee	okie dokie
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Moderator_DBecker	Well, on behalf of the American Fertility Association, I would like to truly thank Dr. Flisser for taking the time to come to tonight's chat
tina13669	Thank you Dr.
nchristoffersen	Thanks, Dr. Flisser.
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Dr._Flisser	amccloskey: despite what we would like to think, each cycle is different, so there's always a chance of a slightly different response even with the same medications. one cycle can make 5 follicles, then the next 3 and the next 6, 8, 2... it's hard to know what will happen. That said, there's rarely a dramatic difference, like 2 to 20, but usually it will hover around the same number.
kfenton	thank you! ::rolleyes
Dr._Flisser	some months may just be better than others - and I wish we could predict which ones!
amccloskey	thank you!
moharden	Thanks Dr. Flisser! Good luck everyone! You are all in my thoughts!
shaymer01	thank you very much!
Dr._Flisser	Absolutely welcome!
Moderator_DBecker	We still have a few minutes
Kelly	what are chances of successful pregnancy with uterus septum - not much no surgery at this time?
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Dr._Flisser	uterine septum is a promising diangosis: patients do quite well, though if it is real, it may deserve resection
restongirl	40 yr old w/; polyp - get it removed or don't worry?
aijia	What do you think of the Antagon protocol without using BCP or Lupron?
Moderator_DBecker	Dr. Flisser what a great job
Moderator_DBecker	This has been an excellent chat regarding ART and Medications
Kelly	thanks - I was hoping so after reading some on the internet
Dr._Flisser	aijia: sorry I remember I missed that question: the bcp is to "synchronize" the follicles and may produce a better cohort for retrieval (numberswise) - so the theory goes
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Dr._Flisser	restongirl: polyps aren't well undrstd, though may interfere. depending on the size, I might remove it
Kelly	how long after trying would you suggest medication and ART
Moderator_DBecker	Dr. Flisser will be a presenter at this Sunday's AFA national conference Family Matters on fertility and adoption at the Grand Hyatt in New York, NY right near Grand Central Station - I hope to see many of you there
Dr._Flisser	Kelly: typically trying for 12months <35 years old, 6month>35 - then we investigate for fertility problems
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Kelly	i am 36 and have had testing done and found out about the uterine septum today also husband going to see urologist
Kelly	have been trying 18 months
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Dr._Flisser	kelly sounds like you have the right plan
Kelly	thank you!
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Moderator_DBecker	Well everyone - it is so unbelievable that our hour is up - lets all give Dr. Flisser a cyber clap
Kelly	is medication really hard on your body?
restongirl	Thank you.
Kelly	Thanks Dr. Flisser
shaymer01	very informative, much appreciated
Dee_Dee	hip hip horray for the Doc!
Dr._Flisser	::wub
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Moderator_DBecker	Thanks to everyone that participated tonight - it was a very educational session - remember knowledge is POWER - take action - take charge!!!
Moderator_DBecker	Good night and best wishes
kaylalunaava	Dr. Flisser Thank you so much.
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Dr._Flisser	Thank you. It was a pleasure.
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Dee_Dee	Good night, thanks for the the valuable info
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