Mini IVF

September 4, 2007 - Tuesday
5:14 PM to (EST)
Guest Speakers: John Zhang, M.D.

Categories
Acupuncture • Donor Egg • Endometriosis • Fertility • IUI • IVF • PCOS • Pregnancy Loss

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misslauren	hello
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Corey_Whelan	wow, hi early birds!
Corey_Whelan	I'm Corey Whelan, your chat moderator tonight. I am also the Director of Development for The AFA. Tonight we will be discussing Mini IVF with John Zhang, M.D., who is the founder of New Hope Fertility. The chat will start at 8 p.m.
Corey_Whelan	If you guys would like to post your questions early, please go right ahead.
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suc07	ok - thx corey
suc07	Hello Dr Zhang - just completed an ivf cycle - the protocol was - no medications till the follicle was size 13 and thereafter was on Ganirelix and 2 vials of Menopur and took HCG a day before the retreival - is this considered a natural cycle or mini ivf cycle? One egg was retrieved but did not fertilize - what is the fertilization rate in natural / mini ivf cycle?
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Corey_Whelan	Dr. Zhang should be here in five minutes.
Corey_Whelan	btw, what states are you guys from? I'm in Brooklyn NY
suc07	does wheatgrass juice, fertility blend help during ivf?
Iamjus4u	I'm in VA
misslauren	I'm in New York City.
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misslauren	Hi Dr. Zhang - I had a laporoscopy in May, and then was scheduled to do three rounds of IUIs. But my FSH went from 11 to 19 and my doctor would not allow me to go ahead. The next month my FSH was 15. Still could not go forward. I'm just 39 y.o. How could Mini IVF give me a better possible outcome than regular IVF?
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Corey_Whelan	Hi everyone. We are waiting for Dr. Zhang, he should be here shortly.
misslauren	Just 39 meaning just turned 39. Ok, thanks
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Dr._Zhang	Hello everyone, sorry I'm a bit late, I'll be right with you.
Corey_Whelan	Hi Dr. Zhang, welcome. We have a very enthusiastic group waiting for you. Can you start with Suc07's questions, please?
Corey_Whelan	When Misslauren
Corey_Whelan	I mean then, not when!
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luciay	Hi
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Dr._Zhang	Just one more minute, sorry folks, just finishing up.
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amikula	Dr. Zhang,
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Dr._Zhang	Hello, please go ahead with your questions.
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cutebaby	Hi Dr. Zhang,
suc07	Hello Dr Zhang - just completed an ivf cycle - the protocol was - no medications till the follicle was size 13 and thereafter was on Ganirelix and 2 vials of Menopur and took HCG a day before the retreival - is this considered a natural cycle or mini ivf cycle? One egg was retrieved but did not fertilize - what is the fertilization rate in natural / mini ivf cycle?
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Corey_Whelan	hang in there guys and welcome to all.
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aglickpt	What is the advantage or disadvantage to doing a mini IVF cycle?
cutebaby	Had 3 failed high stim IVFs, 9 failed IUIs, 1 miscarriage. Age 42, FSH 7.3, E2 47 on CD3. Have been doing acupuncture and taking Chinese herbs for 4 months, body in optimum condition. Antral follicle count is 7 - 9. Should I use natural, low stim, or med stim to get the best quality embies? How many embies should I expect to be good quality? What's the difference between Clomid and Letrozole? Which is more preferrable?
Dr._Zhang	First of all, a real natural cycle means no drugs at all - not even triggers. However, you can then ovulate at any time within a 24 hours window so even in a natural cycle we do use some small amount of medicaion to control ovulation timing so that we can do a timed egg retrieval.
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Dr._Zhang	Let me tell you all what Mini-IVF is before we go on.
luciay	Hi Dr.Zhang i had an ivf procedure in may 4 follicles were taken and 2 planted everything was good till they didnt attach to the uterus unknown what happened i am 42 yrs. old and going to try next month again with meds repronex and bravelle
Dr._Zhang	It is an intermediate protocol, meaning that it includes more medication than a natural cycle, but much less than in conventional IVF
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suc07	so what i did would be considered as mini ivf?
Dr._Zhang	Let me tell you three basic points.
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Dr._Zhang	A good egg which will give you a live birth, is limited in each group. For example, for somebody 38 years old, normally they will not make 2 good egss in any cycle, no matter how much medication.
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Dr._Zhang	Generally speaking, the best egg in a given cycle will come from the largest (lead) follicle, no matter what the medication.
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Dr._Zhang	So no matter what stimulation medication you use, or even with no stimulation medication, if you have a good egg it will develop in that partciular cycle.
aliangel	Can someone with PCOS have a mini IVF?
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Dr._Zhang	So Mini-IVF attempts to coax the best eggs out of you in each cycle, while leaving your body in as natural a state as possible.
Dr._Zhang	Okay please start your questions.
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cutebaby	Had 3 failed high stim IVFs, 9 failed IUIs, 1 miscarriage. Age 42, FSH 7.3, E2 47 on CD3. Have been doing acupuncture and taking Chinese herbs for 4 months, body in optimum condition. Antral follicle count is 7 - 9. Should I use natural, low stim, or med stim to get the best quality embies? How many embies should I expect to be good quality? What's the difference between Clomid and Letrozole? Which is more preferrable?
luciay	me again so do you think i should try again
Dr._Zhang	You asked about letrozole and clomid
RoseNYC	Do you think that egg quality could be improved by lifestyle changes, acupuncture, yoga etc.?
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cutebaby	yes
aijia	Do you do ICSI to fertilize the eggs?
aliangel	Can someone with PCOS have a mini IVF and can a mini IVF still be used when there is severe male infertility like Sertoli Cell Only.
Dr._Zhang	For stimulation, both are good. The main difference is that Clomid has the ability to control ovulation and Letrozole does not. So using letrozole can be tricky in terms of timing during a retrieval cycle.
Dr._Zhang	Yes, we do use ICSI in our lab when it is necessary.
suc07	i have done 3 ivf's - but no fertilization - first cycle none of egg were mature, and last 2 cycles did ICSI without fertilization. am 35 years old but am poor responder. any suggestions?
Dr._Zhang	please slow down
cutebaby	can one use cetrotide to control the ov?
cutebaby	with letrozole?
suc07	does wheatgrass juice help in fertility?
Dr._Zhang	RoseNYC: I do not bleieve that egg quality can be improved by specific lifestyle changes, but generally speaking leading a healthy lifestyle will promote overall health and wellbeing which can only help you with pregnancy and fertility.
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silviam	is it ok to use frozen sperm in a Mini IVF cycle?
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Dr._Zhang	suc07: when fertilization does not take place using ICSI, it is most often a problem with egg quality.
luciay	Is 4 follicles and 2 implants good for my age 42
Dr._Zhang	cutebaby: Letrozole does not control ovulation timing, but clomid does.
helene	What success do you have with Menapur in getting several good-quality eggs to develop?
Dr._Zhang	silviam: yes, it is okay to use frozen sperm in an IVF setting.
suc07	if i have egg quality problem - can i keep trying - or will the eggs always be bad?
Dr._Zhang	luciay: do you mean 4 follicles and 2 fertilized eggs and 2 embryos good for transfer? If so, yes that is fine for your age.
luciay	yes
luciay	thanks
cutebaby	do you do med stim, e.g. 300 IU follistim?
Dr._Zhang	helene: We do not generally use menopur by itself in a cycle. We use Clomid or Letrozole, and we supplement with FSH and/or LH if it is necessary.
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luciay	Is it true you should wait 3 months in between trying ivf again and if so any advice
misslauren	My doctor has not allowed me to do IUIs or IVF because right before treatment to begin, my FSH went from 11 to 19. The following month, back to 15. Still not allowed to treatment. He maintains that no data supports that people my age (just turned 39) with High FSH will be helped at all by IUIs or IVF, and that the best recourse is donor eggs. How could mini IVF help me? Thank you.
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aliangel	Can a mini IVF be used in someone with PCOS?
suc07	whats the success rate with mini ivf?
Dr._Zhang	suc07: not necessarily. If you have diminished ovarian reserve, based on my experience, you may still may good eggs bu much less frequently.
kpoole	What do you mean by clomid has the ability to control ovulation and letrazole does not. Aren'r both used for ovulation induction?
suc07	does wheatgrass juice help improve egg quality?
Dr._Zhang	luciay: with our mini-ivf protocol, there is no reason to wait between cycles. However, with conventional IVF, due to the use of HCG and heavy medication, it is often advised to take a break between cycles. One of the advantages of Mini-IVF is that it is usually not necessary to take a break.
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suc07	what is the fertilization rate at your lab?
luciay	ok thanks
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cutebaby	If body is healthy, according to what you said that one or two eggs are good each month, then that egg of the month should be of good quality?
sydney	If you have diminished ovarian reserve, why wouldn't high stim. IVF cycle, where you might get 10 or 11 follicles mean a higher chance of getting one of the good eggs?
Dr._Zhang	misslauren: our experience shows that a woman of 39, even qwith high FSH, as long as she is ovulating, will still produce viable eggs but not frequently. The idea of Mini-IVF is to try to get that "golden egg" without damaging the body for future cycles.
aliangel	How can a mini IVF help when PCOS is a female factor.
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helene	can mini-IVF help with a slight sperm morphology problem?
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Dr._Zhang	Clomid works by controlling ovulation, by influencing the hypthalmus. Letrozole does not work that way.
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aijia	How does mini-IVF overcome male factor?
Dr._Zhang	su07: wheatgrass is a vegetable and like other vegetables it is a healthy thing to consume, but it has no specific fertility use.
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misslauren	so the advantage of mini fsh is primarily that it is less invasive and you can easily do back to back, less costly cycles?
misslauren	sorry, mini IVF i mean.
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Dr._Zhang	cutebaby: not necessarily, it depends on your age and some other factors. As women age, egg quality deteriorates no matter what the health is of the woman.
suc07	can anything be done to improve egg quality?
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Dr._Zhang	aliangel: re PCOS: mini-ivf is safer than conventional IVF. PCOS p atients make many eggs usually but of poor quality. conventional ivf has a risk of hyperstimulation.
eliza	I assumed mini IVF was the best protocol when traditional IVF was not affordable. Are you saying there are timeswhen it is the better alternative?
aliangel	Thank You.
Dr._Zhang	aijia: mini-IVF does not overcome male factor. IVF generally helps with male factor.
slinda	Is there an age cut off or fsh level that is considered too high for mini IVF? What is the oldest patient age who had success with it?
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suc07	does mini-ivf help patients with egg quality issues?
Dr._Zhang	misslauren: that is not the only advantage of mini-ivf. Because the number of good eggs every month is limited, to produce more eggs will not further improve your chance for preganncy. In fact, high stimulation meds can recruit more follicles that should "cook" in the ovary longer in order to be ready to produce a good egg.
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Drmitch2006	Maybe this question has already been addressed --I apologize for my tardiness-- but I was wonderfing what is the cost differential between traditional IVF and the mini IVF?
Dr._Zhang	Also when you are very stimulated, the body is "under fire" and may not be the most favorable environment for receiving an embryo.
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silviam	so, is Mini IVF an option when you have a limited amount of frozen sperm and poor egg quality?
amikula	Dr. Zhang-I'm 39-in the last 10 months i've tried 4 months of clomid producing 11 follicles 4-6 eggs each time. then tried IVF twice and produced 0 eggs the first time and only 1 egg the second time (did IUI for that one). am I a good candidate for mini-ivf since i respond better to chlomid than injectables?
Dr._Zhang	slinda: there is no age cutoff for mini-ivf, however we feel that the patient must be realistic about the chances of success with advanced maternal age. The oldest patient who has succeded with a live birth using mini-ivf is 44-45 here at our clinic, and at our sister clinic in Japan, using the same techniques, they have had a live birth with a 47 year old patient. But this is very unusual.
dr.sweettooth	I have poly cystic overian syndome and with the assistance of daily 150mg of Clomid I ovulate some months. My husband had a vasectomy reversal and has an effective count (on a good month) of about 2.5 million. With those numbers would you suggest IVF.
cutebaby	what do you mean by "under fire", meaning NKa flared up?
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Dr._Zhang	First of all conventional IVF costs can vary greatly from clinic to clinic and city to city. it dpeends a great deal on the amount of medication, and insurance coverage. Mini-IVF uses much less medication and therefore is much less expensive.
suc07	if my husband has sperm motility issue and ICSI is done - do you think even then the fertilization can be affected?
Dr._Zhang	silviam: If you are running out of sperm?
silviam	only 4 frozen vials
aglickpt	The "underdeveloped" eggs you talked about that are produced by the ovaries during a traditional IVF cycle...Are you suggesting that these eggs can produce not only poor embryos but could go on to develop into a baby with issues? I have been told by a few RE's that a women can get pregnant and produce a live birth with a poor quality embryo. That they can't always predict the success with good or bad quality embryos????
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Dr._Zhang	amikula: it is difficult to answer that question without knowing more about your fertility issues. But generally speaking, you should stick to a protocol which seems to work best for you.
ciaobella	I'm 45, pregnant 3x(in my 20s&late 30s) but elected not to carry to terms. I started TTC end of last year but have no success with Donor eggs so far. I was presribed low dosage of Synthroid (slight hypothyriod) before starting IVF. Everything tested fine ever since but not sure why I'm not having any success with implantn. My IVF center is very reputable and have relatively high sucess rate. I read some medical data that Asian has a lower rate of pregnancy through IVF. IS THIS SOMETHING I SHOULD BE CONCERN? I eat a well balanced diet and have cut down on seafood..
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RoseNYC	Is the quality of eggs deteriorates as woman ages because the egg is also aging on its own even it is not selected for ovulation in this particular cycles or because when it is selected the egg is not in the optimal environment (older woman body) for healthy development?
Dr._Zhang	aglickpt: let us define what is meant here by poor quality embryo. Visual inspection cannot tell us if an embryo is genetically compromised or not. Many "bad-looking" embryos do make healthy babies.
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Drmitch2006	This is my first time hearing about the mini-IVF. Is this a new procedure or is it just one that has not garnered much popularity?
Pauline	if you have done IUI's with chlomid and have not been monitored while on it, will I be able to try mini ivf?
Dr._Zhang	ciaobella: Asian women do have a lower rate of pregnancy with IVF.
cutebaby	why?
Dr._Zhang	But just because you use a donor egg, that doesn't mean every donor egg is of high quality.
Dr._Zhang	Perhaps you should try different donors.
suc07	if my husband has sperm motility issue and ICSI is done - do you think even then the fertilization can be affected?
Dr._Zhang	rose: we don't really know the mechanism by which eggs deteriorate in quality as women age.
Dr._Zhang	drmitch: it has not gained a lot of popularity. This approach really is a go back to nature approach. As you may know, the first IVF baby was produced in a drug free cycle.
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misslauren	How does Mini IVF potentially benefit women with high FSH? Is it in the lab technique of egg extraction? I'm still confused by that.
Dr._Zhang	Pauline: Yes you can.
aglickpt	Does a woman with endometriosis respond better to traditional IVF or mini IVF? In addition, I have been told that if you have conceived before with a live birth that your body is more accepting to a pregnancy the second time around. Any thoughts on this? Thanks...
aijia	Why do Asian women have lower rate of pregnancy with IVF?
Dr._Zhang	suc07: if you use ICSI, the fertilization should not be affected by motility.
Pauline	even with 2 succesful IVF's but miscarried both times? Will MINI IVF be diferrent?
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suc07	does natural ivf / mini-ivf help patients with egg quality issues?
cutebaby	Also when you are very stimulated, the body is "under fire" and may not be the most favorable environment for receiving an embryo. Do you mean the meds kick up NKa?
Dr._Zhang	misslauren: Let's discuss FSH for a second. First of all high fsh means you are producing fewer eggs p er cycle, and fewer good eggs. Logically the only way to increase the chances is to try multiple cycles in order to catch a good egg. Mini-IVF allows multiple cycles at less cost and less difficulty on the body.
Dr._Zhang	pauline: No. Unfortunately, miscarriage is not realted to the act of fertization and implantation. You may have gotten pregnant but that does not m ean the embryo was genetically okay.
suc07	do you recommend HCG or nasal spray?
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Dr._Zhang	aijia: We don't know why Asian women hae a lower success rate.
RoseNYC	Is it known how the dominant follicle is selected? Is it random or the most healthy follicle wins in the fight with its cohorts?
Pauline	do you think the ICSI affected the eggs?
amikula	Dr. Zhang, I'm 39, never had fsh problems, in the last 10 months i've tried clomid 4 months producing 11 follicles and 5-6 eggs each time. tried ivf twice and both were canceled due to only 1 egg reaching optimal size. how many eggs must i produce to make retrieval with mini-ivf worthwhile?
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silviam	low ovarian reserve, poor egg quality, 4 frozen vials of sperm, 4 failed IVFw/ICSI.... Mini IVF or Traditional?
Dr._Zhang	aglickpt: based on our experienc,e patient with severe endo does not make many eggs. Conventional IVF will not improve your quantity. There is some evidence that you may get pregnant more easily if you have been pregnant before, but that is only because you already don't have a problem.
Pauline	I have had genetics on both my husband and myself and they have found nothing. I seem to h ave had problems witht e progesterone both times, do youthink this is what might be causing it?
aglickpt	What are your thoughts on a fluctuating FSH? is it definitely Dimished ovarian reserve? or can a women's FSH fluctuate at times due to stress etc...?
Dr._Zhang	suc07: regarding HCG and nasal spray: they will both trigger final egg maturation and ovulation - but the nasal spray (synarel) triggers your own natural ovulation system, rather than imposing on your body as HCG does. Also, HCG stays in the body much longer than Synarel, and therefore can affect your next cycle or cause you to have to wait.
Toshiko	I am a patient at your sister clinic (KLC) in Tokyo. How is your protocol different from theirs (luteal support, etc)
slinda	Can acupunture and herbs help egg quality? My acupuncturist tells me that as long as I have a period, I can have a baby. If I eat a healthful organic diet it is possible to make a healthy baby. She tells of a 50 year old conceiving when her husband practiced acupuncture on her and she had a healthy girl. Despiration leads one to want to believe anyone who offers hope. It's hard to believe that something as natural as having a baby has to be so difficult. If I do one day lose hope, does mini ivf work for donor cycles, and is there a minimum age cut off for doing mini ivf?
Dr._Zhang	amikula: we have no minimum number of eggs required for mini-ivf. Because we feel taht in any cycle there are only a couple of good eggs no matter what, it doesn't sense to cancel a cycle because of only one follicle mature.
Drmitch2006	After three years of trying, we conceived once without medication, but miscarried at about 10 weeks. We have not been able to concieve since then. After 2 failed IUI's, I'm not sure what's happening. I have used both Femara and Clomid and, according to my temp chart, I ovulated each time. Last December, I had surgery to remove endometriosis and my RE was confident that I would have more regular cycles. I have not. I know you probably need additional information on my situation, but at first blush, do I appear to be a possible candidate for the mini-ivf? I'm 35.
suc07	whats the cost of mini ivf cycle?
Dr._Zhang	pauline: you may have a luteal phase defect. This is uncommon.
Dr._Zhang	Toshiko: there are medicatioins available in Japan that we cannot use here in the US, and vice versa. Principally we are doing the same work but some mdification are needed at times.
amikula	can i see you for mini-ivf and have bloodwork and ultrasounds done closer to home? i live 2 hours outside manhattan.
Dr._Zhang	slinda: acupuncture can promote calm and wellbeing, but it does not specifically affect egg quality. Some herbs are estrogenic and can have a negative influence.
dr.sweettooth	how does mini ivf differ from traditional ivf?
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Dr._Zhang	However just because you are ovulating does not mean you produce good eggs.
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Dr._Zhang	drmitch: yes we do need more information but generally speaking, yes.
Drmitch2006	that's reassuring
Drmitch2006	thank you
Pauline	what is the latest new patien appoiuntment your center offers?
suc07	does mini-ivf help patients with egg quality issues? what is the cost of mini ivf at your clinic?
Leebird	Hi Dr. Zhang. It sounds like mini-IVF would help prevent multiple births. Would that make it a good option for someone with an unicornuate uterus?
Dr._Zhang	suc07: costs depend on what kinds of treatment you require - icsi or not, fresh or frozen transfer, day 2 or day 5, lab work, medications. Best to call our office to discuss specific financial issues.
Dr._Zhang	pauline: i'm sorry I don't know, you'll have to call the office to schedule.
cutebaby	how many cycles do most women go through for a success in mini-ivf?
Dr._Zhang	suc07: mini-ivf can help with egg quality under certain circumstances, it dpeends on yoru issues.
Pauline	you do nto use progesterone with your cycles correct?
caz	I've heard that there's more empty follicles with Synarel trigger (opposed to HCG). Can you comment on what causes empty follicles?
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Dr._Zhang	leebird: it depends on how many embryos you transfer.
Dr._Zhang	But we promote single embryo transfer to reduce multiples.
Dr._Zhang	cutebaby: it depends on yoru diagnosis, your ovarian reserve, and your age.
misslauren	so mini IVF extracts eggs you have and focuses on quality extraction, as opposed to reg. IVF which gives you meds. to produce multiple eggs. Is this true?
Dr._Zhang	pauline: we sometimes use progesterone, and almost always vaginal suppositories, not injections
Dr._Zhang	misslauren: yes
babaies	How many states actually perform mini ivf?
Dr._Zhang	caz, re synarel: since mini0-ivf is only trying to get a few follicles, that means that already there are fewer eggs to work with. Generally speaking we get 70% eggs from follicles. And there are many reasons for this: cyst, egg immaturity, etc
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Pauline	i have reactions to the progesterone, injection site becomes inflamed and feels like it is on fire, and suppositories create terrible cramping in which I cannot stand up, would progesterone be verty necessary?
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aijia	I had a traditional IVF but it was chemical pregnancy. Will mini-IVF reduce the chance of chemical pregnancy?
Dr._Zhang	babaies: I don't know anything about states, but there are very few clinics using this protocol in this country,
bean1230	What is the success rate for a cycle of mini-ivf? I'm 29, we are unexplained, all tests normal, all counts good.
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Dr._Zhang	pauline: first of all we would ahve to evaluate you to see what progesterone you need. If you need it, there are oral agents you might respond to.
Dr._Zhang	aijia: No. No IVF can change the genetics of an egg.
Pauline	I have used the oral also, made me go numb and pass out. Also dizziness was terrible while on it.
Corey_Whelan	Hi folks, this is a very crowded chat room, but I do need to let you all know that we have just about ten minutes left.
Dr._Zhang	bean1230: success rate depends on many factors: if a patient is a good candidate, age, clinical diagnosis, etc. We have a very diverse poplation.
SANDY	is mini ivf the same as low stim ivf?
cutebaby	every time I have severe cramping during implantation; not sure what caused it. Will natural/mini IVF help since there is less medication?
pamela	Dr. Zhang- I'm planning on starting a mini IVF cycle this cycle. I normally have a regular cycle but this month I ovulated early. Then about 9 days after ovulating I had dark brown spotting for 2 days. Now I have reddish clotting. Will this affect my mini IVF cycle's chances? Is it best to wait till the next cycle?
Dr._Zhang	But you are 29 if you have normal ovarian reserve, you should have aabout a 35% chance each cycle with a single embryo transfer.
ciaobella	do you have Asian donors?
pamela	I did take a HPT and it was negative.
silviam	low ovarian reserve, poor egg quality, 4 frozen vials of sperm, 4 failed IVFw/ICSI.... Mini IVF or Traditional?
suc07	would you let a patient choose whether to use HCG & Progesterone VS Nasal Spray & suppositories
Dr._Zhang	sandy: no it is not. There is no definition of minimal stimulation IVF - it's just a question of quantity of medication. But mini-ivf is different in that we emphasize orarl medication and only supplement a bit with injections.
babaies	Where are the clinics located and are there any prereques? I just turned 36, unexplained, normal everything, except dx with endometriosis? Been unsuccessful for 7 years
Dr._Zhang	cutebaby: If you have lots of cramping, that could mean uterine problems. But generally speaking the fewer hormonal changes via medicaiton, the less disturbance to the uterus and the body in general.
Dr._Zhang	ciaobella: yes we have Asian donors
volatti	Dr. Zhang, what is the difference between mini-IVF and naturqal IVF?
Drmitch2006	I read what you said earlier about Asian patients and traditional IVF. Has there been any noticeable discrepencies with mini-ivf success rates across ethnic groups?
Dr._Zhang	silviam: you would really have to be evaluated here in order to me to answer your question.
Dr._Zhang	babaies: we are in NYC you can read our website newhopefertility.com
Dr._Zhang	volatti: that question was answered above you can read the transcript later on or read about it on our webiste
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amikula	dr.zhang-is 11 follicles and 5-6 eggs on clomid good for age 39? my doc said i had low ovarian reserve when the injectibles didn't work. What is the best indicator for low ovarian reserve?
volatti	Would miniIVF be a better choice for a 43 year old?
Toshiko	Are New Hope success rates similar to those stats reported by KLC at 12/06 Mini Stim World Congress? Page 18, here: http://www.naturalcycle.org/December%20Congress%20Programme.pdf
silviam	see you tomorrow , thanks ::smile
pamela	Dr Zhang- will an irregular cycle decrease the chances of mini IVF success? I normally have a regular cycle but this month it's been irregular. I was planning to cycle this month but am not sure if it's an optimal time.
misslauren	For women over 35, with high fsh, can you generalize a better outcome for mini ivf, with own eggs, or doing traditional IVF with donor eggs?
Dr._Zhang	amikula: yes that is fine
Pauline	what if i cannot take the oral progestrone because It affects me the same wasy the injection and the suppositories, what are my options?
Dr._Zhang	volatti: yes, we beliee that mini-ivf is advantageous for older women.
Dr._Zhang	pamela: it depends, but you may need to take breaks between treatments.
bean1230	Are there any clinics in CA doing mini-ivf?
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Dr._Zhang	you cannot compare donor eggs with one's own eggs
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pamela	I've had dark brown spotting for about 3 days and now have some red clotting. Is this a bad cycle to start?
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Dr._Zhang	pauline: you may have no choice but to tolerate the effects of preogesterone if you do need it.
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slinda	I just read that you offer donors. Do you have a photo data base to select from? How much do donors charge?
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Dr._Zhang	pamela: i cannot answer that question without knowing much more informaiton.
Dr._Zhang	slinda: not at this time, but our program is growing.
Dr._Zhang	bean1230: not that we know of
misslauren	meaning donor eggs of a young, healthy women will alwys give statistically better outcome?
pamela	For your patients just starting cycles, do you usually advise them to wait if they have an off cycle?
suc07	would you let a patient choose whether to use HCG & Progesterone VS Nasal Spray & suppositories
volatti	Between mini IVF and natural which would be better for a 43 year old?
Dr._Zhang	misslauren: yes
bean1230	Thanks Dr. Zhang!
caz	Could you tell me if New Hope offers embryo donors?
Dr._Zhang	pamela: it depends on what caused the problem
Wenqi	Dr zhang, I am 34, my husband is 37, tried 9 months and nothing happened, all tests are normal. what do you suggest?
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Dr._Zhang	violatti: it would depend on your situation
pamela	Not sure, that's the problem. I was on an antibiotic for 5 days (cipro for a UTI).
Dr._Zhang	caz: no
Drmitch2006	Maybe I missed your response--have you noticed differences in success rates with mini-ivf across ethnic groups?
misslauren	thank you very much Dr Zhang for your time
Dr._Zhang	wenqi: you should see an RE and don't wait
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Wenqi	what is RE?
Dr._Zhang	reproductive endocriniologist, like me
Dr._Zhang	Asian patients have lower success rates
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caz	Thank you for the chat, Dr. Zhang
pamela	What is the success rate for a 37 yr old w/mild endo (my husband was diagnosed w/MF due to morphology)?
Wenqi	thanks I will do.
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Corey_Whelan	Folks, I think we have time for one more question only.
Drmitch2006	Outside of the Asian race, were there any other noticeable differences?
Dr._Zhang	pamela: for single embryo transfer, maybe 35%
Dr._Zhang	drmitch not that we have noticed
pamela	Thanks for your time Dr. Zhang.
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Dr._Zhang	my pleasure
suc07	thanks Dr Zhang
Drmitch2006	Thank you
Dr._Zhang	you can read much more information on our website
Drmitch2006
cutebaby	thank you
Dr._Zhang	or email askdrzhang@gmail.com
aijia	Thank you, Dr. Zhang.
Corey_Whelan	Yes Dr. Zhang, thank you so much for taking the time to be with all of us here tonight. This was a huge chat and we are very grateful for all of the information!
ciaobella	thanks Dr Zhang!
slinda	thank you
Dr._Zhang	My pleasure, good lu ck to everyone
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amikula	thanks dr. zhang!
misslauren	thank you
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Dr._Zhang	There is an article we wrote perhaps Corey will post it
Corey_Whelan	good night everyone. Our chat is officially at an end. Best of luck to all of you!!!!
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pamela	Corey, will you post it on the website?
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Dr._Zhang	I can stay another minute i
pamela	Dr. Zhang, I know it's hard to answer my question
pamela	but in your opinion w/an irregular cycle
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pamela	is it best to continue on w/the cycle or wait?
pamela	Especially since I'm not sure what caused it. I had an ectopic pregnancy back in Feb but have had normal cycles since
Dr._Zhang	pamela you need to be evaluated, i can't answer that without knowing much more about you
pamela	I understand.
pamela	Are you familiar w/the Cooper Institute?
Dr._Zhang	pamela I am not comfortable discussing other practices here.
pamela	sorry..
Dr._Zhang	Okay ladies good night
Dr._Zhang	good luck to all of you
pamela	Have a good night
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Dr._Zhang	feel free to read our site and email askdrzhang@gmail.com
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Dr._Zhang	good night
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