Moving On To IVF - A Primer for Beginning Treatment

March 27, 2007 - Tuesday
12:49 PM to (EST)
Guest Speakers: Patricia Hughes, MD
Institute for Reproductive Medicine and Science at St. Barnabas

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

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Corey_Whelan	Welcome everyone to tonight's online educational session. I am Corey Whelan, The American Fertility Association's Director of Development and your chat moderator. Hi everyone!
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Corey_Whelan	We are really lucky tonight. We have Dr. Patricia Hughes on board, to answer your questions on beginning IVF treatment. I see that Dr. Hughes has joined us.
jessica	hello
Corey_Whelan	Patricia Hughes, MD is an active participant at IRMS at Saint Barnabas, in New Jersey
Corey_Whelan	Dr. Hughes practices currently in Hackensack, NJ. Her website is www.phughesmd.com
Corey_Whelan	You guys can start asking your questions! Feel free to ask any questions about infertility treatment, and beginning IVF in particular.
Corey_Whelan	Hi Jessica!
jessica	I will be starting my treatment at IRMS soon
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jessica	I am in the process of completing my "checklist"
Corey_Whelan	you're going to a great program.
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jessica	I am very excited!
Corey_Whelan	welcome everyone!
jessica	will be doing PGD
Corey_Whelan	It's an exciting time. Do you have any questions for Dr Hughes?
Corey_Whelan	folks, feel free to begin
padi	Hi Patricia, I just had a falied ivf, would like to ask you a question on that.
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phughes	Hi, everyone.
jessica	hi missy
phughes	Padi....shoot!
Corey_Whelan	but not the moderator
padi	I am 32 and my fsh is 8.5 had poor embryos and the nurse said it was becos of poor quality eggs and she said there was no way to improve these...
missy4la	hello everyone
phughes	Hmmm. There's a lot to be learned by looking at the day-to day progress. eggs, fert embryo quality.
christalp	my husband and i getting to start our first process of ivf. do you have any advice on how to relax and deal with the waiting periods?
Corey_Whelan	the waiting periods are awful. I did a lot of Woody Allen movies.
padi	so is it solely based on egg qlty or is there any hope for me...?
missy4la	any idea how the success rate in IVF compares to IUI?
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Corey_Whelan	Padi, that is an important question. Dr. Hughes?
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phughes	Padi- you might want to specifically review the fragmentation and cell numbers by the day and see where things fell off track. I'd be surorised if your "eggs" really were to blame
Corey_Whelan	Missy next
missy4la	how does IFV success rates compare to IUI?
padi	I have one more question when missy is done...thanks
phughes	Padi- you can always get a second opinion.
missy4la	sorry
dawnymarie	what is the difference between Lupuon protocol and BCP protocol
phughes	Missy- People usually do IUI's first, & only go on to IVF if it fails. I usually think that the power of IVF is three times that of fertility drugs with IUI
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jessica	what is the success for PGD? Will be going for that soon at IRMS. Will I be taking a lot of medications? I am so excited and nervous
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phughes	Dawn.. Not much. Just different preferences per the program.
missy4la	I've had 2 IUI's
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missy4la	and was considering IVF, except that the cost is so prohibitve
padi	my doc didn't recommed iui. he suggested ivf directly. And I had none of the invasive tests done lik ehsg and endo. Do you think they are important for a successful ivf?
phughes	Jess... of course, it depends on who's doing it. Pgd increases the chance of implantation & pregnancy and decreases the chance of miscarriage (and birht defects)
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jessica	Dr. Chen
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missy4la	what is PGD?
Corey_Whelan	Preimplantation Genetic Diagnosis
phughes	Padi - the treatment choice depends directly on the diagnosis....
christalp	what is the chance of success for ive with someone that has pcos
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lucia	is a level 2.6 fsh ok for ivf
padi	the diagnosis was unexplained infertility. thanks
Corey_Whelan	christalp, ivf is used extensively for pcos patients
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moharden	I have PCOS and my doc did not recommend using metformin during our IVF treatment. What is your opinion about Metformin and its ability to help conceive?
phughes	PCO in general has a great chance.... typically lots of eggs which is important. WE just have to be VERY careful not to overdo it and get you into trouble
christalp	thank you
phughes	Lucia--- Great FSH!
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Corey_Whelan	christalp, I know I don't have to tell you to watch your carb intake!
lucia	i am 42yrs old last month my fsh level was 14 this month it is 3.6 sorry not 2.6 is it still great level for ivf
kgirl25	My friend just had a severe case of OHSS, very distended, and was in the hospital; organs shutting down. Anyway, is there anyway to prevent OHSS?
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phughes	Moharden- Metformin may be helpful is your glucose metabolism is way off.. or if the testosterone levels are dangerously high. Otherwise it probalby doesn't help much
moharden	ty!
asweeney	What is OHSS?
dawnymarie	At what age do you recommend moving to donor eggs? I am 38 with FSH of 6.5
kgirl25	Ovarian Hyperstimulation Syndrome
Corey_Whelan	ovarian hyperstimulation syndrome
lucia	also i have lupus my hsg test was normal and all other levels but i still am not coneiving i was told last month that my eggs are old what do u think?
jessica	how do you know your FSH?
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paula	Jessica, I am also seeing Dr Chen for the same procedure. How long did it take between appointments to start the procedure?
AmandaUNCC	I had OHSS two months ago. It was the sickest that I have ever been
phughes	Lucia- sure, as long as your estrogen level going along with that FSH is nice and low
Corey_Whelan	Jessica, your fsh is determined by a blood test, often on the third day of your menstrual cycle
lucia	ok thanks
jessica	paula we are still doing our 'check list'
jessica	oh okay, i will have that test done soon
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phughes	Kgirl- experience. In 20 years, I never had that happen.
lucia	it is possible to have that different ranges of 14 then 3.6 within 2 months and are my eggs old?
Corey_Whelan	Kgirl, best way to avoid ohss is to choose a good ivf program where the doctors monitor you daily or almost daily
kgirl25	so, I read that having PCOS and being thin make you more likely to get OHSS; which is what my friend is, and how I am. So, that is really my biggest concern; my friend was really really sick
jessica	paula, we are going to class on April 3rd, have you done class yet?
phughes	Dawny- No strict age, tho most IVF programs have a cut-off of 43 or 43. Donor egg is usually suggested if the FSH is high, like over 14
Corey_Whelan	Jessica and Paula, no private conversations please. Thanks!!!
jessica	sorry
Corey_Whelan	don't worry
ksmith5	I am starting my 1st IVF cycle tomorrow with Lupron, what causes some people to take Lupron until a period and others to just start follistim?
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phughes	Lucia- we know your eggs are chronologically old, but we are more intersted in the performance of the ovaries. When age is a factor the only way we can fight back is by getting more eggs to work with. That's where the FSH comes in
asweeney	After meeting with our doctor, it was determined that my husband has only 4% 'normal' sperm. What's the chance that IVF would work for us? We're in our mid 20's and all's ok with me that I know of.
lucia	if i am at day 4 and everything is ok when would i start the fertiltiy medicine how long before ivf?
AmandaUNCC	My frist transfer is on Thursday-I'm getting 2 frozen emryos. What is considered a good beta number?
phughes	Kgirl- it's not really about your physical size
padi	Hi,my doc didn't recommed iui, he suggested ivf directly. I was diagnozed with unexplained inftertility. And I had none of the invasive tests done lik ehsg and endo. He said he didn'tcare as long as my uterus was okay. Do you think it is important to diagnoze a blocked fallopian tubes or endo for a successful ivf? thanks.
Corey_Whelan	kgirl, pcos doesn't make you "more likely" to get ohss, it does however make you susceptible. If you are being monitored you should be ok.
kgirl25	How long between your first consultation for IVF, and the start of your first IVF cycle? I have already been through extensive testing, and through 5 cycles of clomid, 2 of which were IUI
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phughes	Ksmith- It's really about program preferences in choosing the protocol. Some variations depending on the patient
phughes	asweeney-
dawnymarie	I have APA and was wondering why some clinic start lovenox on cd6 and others wait to positive beta?
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lucia	also do i need to get a sonogram and histogram done prior to ivf and prior to meds?
phughes	great ? the sperm morphology is VERY subjective. Many programs Never give normal levels out... like a teacher who never gives good grades. I would expect that if everything esle in the semen analysis is normal you would do just fine with regular IVF....
phughes	Another thing is that sometimes programs give bad morphologies to justify doing ICSI even if you don't need it.
asweeney	Thanks!
phughes	A good beta? any positive is a good one
moharden	Could you explain "beta"?
phughes	Padi- Sounds like you'd be great for their IVF stats. Most would recommend less aggressive treatment first
ksmith5	Thank you. I understand that a normal motility level is greater than 40%, for men that have good motility, is there an average (is it possible to have 80%)?
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jessica	for the transfer IVF with PGD, how many eggs are a good number to retrieve?
Lotus	Hi, why does your fsh level vary? One time it was 14 and then 2 months later it was 11.
phughes	Kgirl- usually 1 monnth to get all the prelims done, then you just pick a start date ( as long as all the tests are OK)
kgirl25	cool, thanks
amccloskey	We started Fertility treatment in June. I have a blocked left tube. We have done 3 rounds of Clomid/IUI and now 1 round of HCG/IUI. This past round had to be cancelled due to lack of development on my right side. Should we continue this until we have done 3 rounds or should we be looking at IVF?
phughes	Dawny- and some don't belive in treating it at all Unless it's "real"
phughes	Lucia,,,,Yes
lucia	thanks
phughes	Moharden- BhCG.... the pregnancy test hormone
lucia	what day does meds start?
kgirl25	Do you take meds every day? Are they typically administered in the form of a shot?
phughes	ksmith. yes, and it's possible to have sperm counts of over 300 million. just doesn't happen a lot
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phughes	It's quality... not quantity . the numbers are all over the place. High and low.. Our average is 13
phughes	Lotus - much like sperm counts vary.. it just does.
lucia	what is the average fsh and lh for a 42yr old?
Lotus	How do you know the quality of your eggs?
phughes	AMcC... jjudgement call... I'd probably suggest iVF if you're working with just 1 tube
Jennifer	Why do IUI first? Why not straight to IVF?
AmandaUNCC	IUI is way cheaper and less invasive!
Lotus	What is the % rate for the IVF cycle to succeed with one ovary and a FSH level of 11?
ksmith5	After transfer, are progesterone shots taken only until a pregnancy is confirmed or not?
jessica	for the transfer IVF with PGD, how many eggs are a good number to retrieve?
phughes	kgirl. once you get started in a protocol the shots just keep going. They have been made very easy and not very painful.( EXcept progesterone)
kgirl25	thanks
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phughes	Lucia- no such thing as average. The FSH is used strictly to pick up the people who basically have no chance.... Like being shortchanged when eggs were handed out. That can happen at any age
JADE0199	Sorry I'm late
Corey_Whelan	don't be silly. welcome Jade
moharden	Are all IVF cycles pretty much 2 months? A month on the pill and/or Lupron and the IVF cycle month?
JADE0199	Hello doctor.
lucia	ok great but what day would meds start at if everything is ok?
phughes	Lotus- Eggs are assessed by looking at about 10 different parameters. when they first come out, then on a daily basis as they fertilize and grow
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JADE0199	I am 36 yo and DH is 34. I have had 3 m/cs and 1 chem pg. We are doing IVF w/ICSI and PGD in May.
Corey_Whelan	hi vandy
vandy86	Hi:
JADE0199	sorry hit enter by mistake
phughes	If it were up to me, I probably would suggest going straight to IVF. It's just expensive and emotionally challenging
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vandy86	We are a patient at SBIVF and are attemtping our second PGD/IVF cycle. I have a transolcation. How many embryos do wee need for a good sample size?
JADE0199	All b/w came up normal. Day 3 FSH was 6.1. My questions is, is the FSH # an indication of QUANTITY or QUALITY? I've heard various opinions. And what do you think our chances of success doing IVF w/ PGD? Thank you.
phughes	Jessica- when we do PGD for screening of embryos we usually like to have at leat 3 or 4 viable embryos to test to make it worthwhile
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phughes	However, some people have specific genetic problems that are being screened for, then we test all, no matter how many there are
AmandaUNCC	what's PGD again?
ksmith5	Sorry, what is PGD?
vandy86	Our first attempt was at Cornell and all 5 embryos were unbalanced.
Corey_Whelan	preimplantation genetic diagnosis
padi	why or when does one do PGD?
jessica	if we get 3 or 4 viable embryos, do they transfer all of them?
phughes	Moh- mostly they arer 2 months. some very young people do OK with short 1 month cycles, tho
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phughes	Day of med start depends on the specific protocol
moharden	thanks!
lucia	thaks
lucia	sorry thanks
babyonmymind	When would you recommend having PGD? Is there a specific age?
lucia	great name baby onmy mind
babyonmymind	thanks. It should be baby obsessed!
lucia	yea really!
phughes	Vandy- your case is what I was talking about. We test any and all, cuz these are the most challenging. Most of the embryos tend to be abnormal, and we are thrilled to get 1 or 2 normals....and that's all it takes!
jessica	what is translocation?
dawnymarie	I hear woman get cancelled from IVF because of weight. Is there a certain weight required??
vandy86	Thanks, Why do medical textbooks say 50% abnormal/ 50 balanced/normal and most are unbalanced translocations
moharden	dawny, My Dr. you had to have a certain BMI to qualify
vandy86	We have a daughter who was normal on our first attempt. Since then, we have had 5 miscarriages and one failed ivf.
phughes	Jade- I kindof missed some of the story...FSH indicates both quality and #, but mostly the number. We need good FSH's to get good #'s of eggs to combat the suspected poor quality
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phughes	BAby... PGD is offered in good programs in conjunction with a regular ivf cycle . it's offered at age 37 and recommended at 38 and up
vandy86	Dr. Hughes:
JADE0199	Thank you doctor. We both think it is strange that we have had so many losses (3 early m/cs before 8 weeks and 1 chem pg) when my FSH was so low. Husband passed all his tests with flying colors, even Sperm dna assay.
lucia	whats the % rate for ivf at age 42 with levels at 3.6 ? and how can you tell eggs are good quality once they are retracted?
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phughes	Jess. be thankful you don'tknow.
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jessica	okay thanks
phughes	Dawny... I'm not sure what u mean. too low or high?
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dawnymarie	too high
padi	thanks for your answer. have another q. my husband has a morphology (krugger) 10% and count: 100M. I have a fsh of 8.5 they did icsi saying my fsh is too high and my husband's morphology is too low. Can you comment on this? was icsi really necessary in our case? thanks.
Robin	hi how do you all know your FSH?
phughes	REgarding weight, if pts are too heavy they need to use deeper intramuscular injections instead of the easier superficial ones
vandy86	Dr Hughes:
JADE0199	I did test positive for MTHFR but not the A1298C mutation and Factor V leiden. Treating with baby aspirin and Folbic now and later Lovenox. RE does not feel m/c are due to these blood disorders. Would you agree? Also homocycstiene levels were normal as well as Protein C and Protein S.
vandy86	Dr. Hughes:
phughes	Padi... you've been had
phughes	Vandy- I don't understand your ?
vandy86	Dr: Hughes. If we don't have enough eggs to do IVF, would you recommend IUI? What happens if one embryo is normal and the other is unbalanced? Would the the unbalanced embryo disolve and let the normal survive?
phughes	Jade- get a second opinion.. Lovenox is NOT to be taken lightly. Sounds like you might not need it. But it's a coomplicated issue. Trust your Repro Endo doc
ksmith5	After transfer, how long is progesterone taken typically?
jessica	do you think I am a good candidate for PGD with IVF, I'm 38, had two m/c very early, had HSG no problems, ttc for 2 years. I carry the gene for cystic fibrosis, no children yet.
phughes	Vandy- IUI's are offered on cancelled IVF cycles to make for the best chance that month.
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amccloskey	Is there a recommended number of follicles needed for IUI or IVF. How mm should the follicles be before doing IUI or IV?
hoping	can you comment on accupuncture and IVF?
phughes	Unbalanced usually refers to translocations,,, probably not what you have in mind... If there are too few chhromosomes, monosomies.... they never implant.... Extra chromosomes are what get people into trouble cuz they do implant.
padi	I have the same Q as hoping
lanzavecchia	Dr Hughes: i have no problem simulating & fertilizing eggs in IVF, is it better to try IUI? I'm 41 and had a few unsuccessful ivfs.
phughes	Hopefully for many weeks cuz you're pregnant. But at least til the pregnancy test, then about 4 weeks after that.
lucia	is Lupus a factor in Ivf? and whats the %rate in a 42 yr old for Ivf?
Corey_Whelan	Hoping, we just did a chat on acupuncture and IVF- rather than take the time here, may I suggest you go back to that transcript?
jessica	when should I stop coloring my hair?
JADE0199	So, the lower your FSH #, the better you "might" respond to stims? If I respond well to stims and retrieve a good # of eggs with an FSH # of 6.1, what do you think our chances of getting 2 or more HIGH quality embryos? We are transferring 2 but wonder if we will end up with any to cryo. after PGD. Also, thank you for answering my other question(s). We will be signing our PGD paperwork tomorrow as well as mock transfer, we will talk to RE about the Lovenox again.
phughes	Jess. you'd be the perfect candidate for PGD
jessica	yay! thank u
phughes	Jess- was your husband tested for CF?
jessica	yes, he does NOT carry the gene
phughes	# of follicles for IUI depends on age. 2 or 3 for yougsters, and maybe 4 or 5 for older women.
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phughes	For IVF we like to have as many eggs as possible. But many of our patients are not such great "performers" and we'd be happy with 3 or 4 eggs if it's been shown that that's the best they can do
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vandy86	yes, we have a transolcation, the question is, if we only have say 3 or 4 eggs developed in a cycle would you reccommend just doing an IUI? If we have more eggs but only a few are fertilized and healthy enough to test (PGD) would you risk it and just implant them with out PGD? Either way, if multiples developed and 1 only one was balanced or normal, would it survive if the other(s) miscarried?
phughes	Lanz- I'd recommend going fo rthe most aggressive treatment possible. I'd go for IVF, and go to a really good place.
jessica	when you transfer the embryos, do you know if they are male or female?
phughes	Lucia- the lupus shouldn't be a factor.
lucia	great
ksmith5	Is PGD done in the normal course of IVF? If not, how is it discovered that you could be a carrier?
phughes	Some places don't even take 42 year olds.
Robin	How do you know you have a really good place?
lucia	really ?
phughes	Lucia- you should refer to the SART data of your local community or the CDC reports to compare how the success rates are.
JADE0199	a
lucia	ok thanks again
lanzavecchia	Thanks, Dr. Hughes! Our IVF resulted in one miscarriage and our new doctor at UCSF is recommending to do IUI instead. I was a little puzzled by it. So your opinion is IVF is definitely better than IUI? I just had one failed IUI and I had 11 follicles.
JADE0199	At what time is the cell biopsied from the embryo doing PGD? Is it 3 day?
Corey_Whelan	guys, I want to give you all a heads up that we have ten minutes left.
phughes	Jade- the trade-off with PGD is weeing the harsh reality that even tho the embryos look good most of them arent. So you probably lose out on cryo, but also don't waste time freezing embryos that don't have a chance anyway.
phughes	I meant Seeing the harsh reality
lucia	how do you know if eggs are good quality do you have to have the taken out first or is their another test to have done?
jessica	the success rate at IRMS is very good?
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Corey_Whelan	IRMS is an excellent program, if that's where you are, you can relax
phughes	Whether to go ahead with a cycle that's not going great depends on if you'd be expected to do much better if just given a chance.
Corey_Whelan	you're in very good hands
jessica	i am so there!!!
JADE0199	Thank you doctor so much. That was how we felt about having any embryos to cryo. I will be happy if we have 2 healthy high quality embies to transfer back.
jessica	the relaxing part i need help with!!!
phughes	Embryos develop independent of the others that happen to be there. One doesn't crowd out the others, or affect their development.
vandy86	That's good news. Thanks.
Corey_Whelan	Relaxing is hard but very important - funny movies help. And low carb ice cream!!! But that's just me.
phughes	Jess... We do know if PGD is done. At IRMS we are known for doing great PGD and people come from all over the world, so most of our pts have PGD and we will tell them the sex of the embryos.
Corey_Whelan	guys, five minutes. Sorry
amccloskey	Is there any food suggested to have or not have when doing IUI or IVF that can increase your chances of success?
lucia	I do not have insurance coverage for ivf are their any programs that you are aware of that discount the procedure or of any donated meds that are out there?
jessica	thank you thank you
jessica	corey why low carb food?
jessica	just weight maintence?
AmandaUNCC	Lucia, look for a "Shared Risk" program
phughes	ksmith- PGD is not universally offered. cuz most programs don't have access to the experts and facilities. The big programs in major metropolotan areas tend to offer it
lanzavecchia	Dr Hughes: is there any activities (workout, etc) you'd recomend to do or not to do when doing IUI or IVF? I have had conflicting recommendations from docs.
AmandaUNCC	You pay a set amount of money for up to a certain number of IVF attempts
lucia	thanks for the help amanda
Robin	my insurance says they will cover 70% the rest we are paying out of pocket too
phughes	PGD is done on Day 3. Good places have results by the next morning and they are put back on day 4
moharden	Move to the state of Illinois and it is covered by your HMO...requried by the state
padi	thanks Dr. and Corey for all your answers... and good luck to the rest...
AmandaUNCC	And.. if you dont take a babt home, you get a large portion of money back
phughes	I'm thrilled with our success rates. See for yourself on SART or the CDC!
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jessica	thank you doctor and corey
Corey_Whelan	You're welcome Jessica!!!!
Corey_Whelan	and Padi, and all of you too
ksmith5	I go to Cornell, is it something that is done on everyone (PGD)?
jessica	fingers crossed for everyone!!
Corey_Whelan	lanz, one thing, no inverted poses, under any ci rcumstances
JADE0199	Thank you doctor for your insight and knowledge
phughes	Activities... keep up a good healthy exercise regimen. Walking, stairs, elliptical bikes, etc. Just don't overdo it.
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lanzavecchia	thanks so much! I'll have to talk to my doc about IVF instead of IUI.
lucia	sorry i lost you
Corey_Whelan	Guys, I want to thank you all so much for being here, and for your questions. When you ask, we all learn. And thank you especially to Dr. Hughes for taking the time to answer them!!!E!E!E
phughes	ksmith- cornell certainly offers it and does a good job. Ask if they recommend it for you
moharden	Thanks all! Good luck!
lucia	whelan d what you said
Corey_Whelan	ok.
ksmith5	Thank you very much.
lucia	thanks everyone for your help
Corey_Whelan	I wish you all SO MUCH LUCK in your journey
jessica	thank u!
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JADE0199	Thank you
jessica	::smile
amccloskey	Thank you!
Corey_Whelan	our chat is officially over - good night to all of you - don't want to let you go!!! But I have you all in my prayers.
phughes	Bye everyone . Thsnks for joining me!
lucia	whelan can you send me the info again my puter went dead
Corey_Whelan	good night all.
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jessica	good night
lucia	thanks
Jennifer	thank you
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