New and Nervous: Facts for patients new to ART treatment

November 14, 2006 - Tuesday
1:13 PM to (EST)
Guest Speakers: Joshua Hurwitz, M.D.
Reproductive Medicine Associates of Connecticut

Categories
Endometriosis • Fertility Drugs • Insurance • IVF • Pregnancy

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Deb	Good evening and welcome to tonight's Online Education Session, hosted by The American Fertility Association and sponsored by Fertility Lifelines.
Deb	As always, we will be starting promptly at 8pm Eastern and ending at 9pm Eastern.
Deb	Our guest tonight is Dr. Joshua Hurwitz from RMA-CT and he will be answering your medical questions! Dr. Hurwitz is a staff physician and specialist in Reproductive Endocrinology and Infertility at RMA-CT. He is board certified in both Reproductive Endocrinology and Ob/Gyn. A graduate of Cornell University, Dr. Hurwitz recieved his medical degree from the Jefferson Medical College in Philadelphia. During his residency at the Thomas Jefferson University Hospital, Dr. Hurwitz was named "Best Laparoscopic Surgeon" and recieved numerous teaching awards. We are deeply grateful to Dr. Hurwitz for being with us tonight.
Deb	I am Deb Capone and I am your moderator tonight. If you need to 'talk' to me privately, you can simply double-click on my name in the column at the left.
Deb	Tonight, Dr. Hurwitz will be lending his expertise to those new-and not so new-to Assisted Reproductive Technologies.
Deb	If you have joined us early, remember, we will be starting promptly at 8pm!
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Joshua_Hurwitz_MD_RMACT	Good evening everyone. Thank you for joining tonight's chat session
Joshua_Hurwitz_MD_RMACT	Please feel free to just jump in - there is no question that is silly or too basic
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vickalina	My husband and I are considering IVF in the new year. We are looking to have this done out of state. How far in advance should we contact the clinic?
satie37	Just a question Vickalina... are you already registered as a patient with the out of state clinic? Or are you getting a referral?
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vickalina	Hi Satie, I am not registered and I did not receive a referral to the clinic I am interested in. I think you are asking because of insurance. My insurance does not cover any fertitliy costs.
satie37	Actually I am asking because most clinics have waiting lists so it may take you time to become a patient.
Deb	Hi, everyone...I can tell already that this is going to be a very lively session. We do start at 8pm with Dr. Hurwitz, but I love that you are chatting and supporting each other.
vickalina	Ohhhhhhh! So the sooner the better would be the answer to my question.
vickalina	Hi deb. Thanks
satie37	Yes, I would contact the clinic and find out what their process is for accepting new patients... sometimes you need a referral
vickalina	OK that is really good to know. Thank you for the info
Deb	I do want to take a minute to thank Dr. Hurwitz in advance for giving so generously of his time and expertise....and to warn him to warm up his typing fingers! Thank you so much, Dr. Hurwitz.
Joshua_Hurwitz_MD_RMACT	This is a lively session! Two months so that you can get all of your old rercords sent over as soon as possible for your new physicians to look over before hand. You wil need a consultation with your new doctor, who will then start his/her evalaution and planning for your upcoming cycle. Might even be best to try to time your consultation to the 1st 2-3 days of your menstrual cycle to facilitate the evaluation. Of course all bets are off if there is a long waiting list.
satie37	Also.... IVF involves cycle monitoring a repeated trips to the clinic BEFORE the actual IVF egg retrieval and transfer so you may want to consider the distance to the clinic or if they have a reciprocal arrangement with another clinic in your area for cycle monitoring
Deb	This is also a good time to remind everyone that The AFA has incredible resources that are available 24/7 on www.theafa.org. If you are not a free "No Barriers" member, this is the perfect time to sign up. You will be glad that you did.
vickalina	This may be a silly question but does my cycle still need to be monitored if the reason we need IVF is because I don't have fallopian tubes?
Deb	I want to take the last few minutes to properly introduce our guest tonigt, Dr. Joshua Hurwitz. Of course, we can't do him justice in this forum, so here are just a few things about Dr. Hurwitz. Dr. Hurwitz is a staff physician and specialist in Reproductive Endocrinology and Infertility at RMA-CT. He is board certified in both Reproductive Endocrinology and Ob/Gyn. A graduate of Cornell University, Dr. Hurwitz recieved his medical degree from the Jefferson Medical College in Philadelphia. During his residency at the Thomas Jefferson University Hospital, Dr. Hurwitz was named "Best Laparoscopic Surgeon" and recieved numerous teaching awards.
vickalina	Or when you say "cycle" do you mean once the IVF cycle is started?
Deb	Ok, enough of me trying to keep the flood gates closed...go for it everyone!
Joshua_Hurwitz_MD_RMACT	Fo rpeople new to the process, IVF cycles can be long and emotionally & physically draining. Preparing for a cycle involves a a few ultrasounds, bloodwork and any tetsing that is warranted. you will participate in an "iIVF class" to teach you the nuts & bolts, and how to give youreself an injection (it sound s a lot worse than it is, don't worry). once the cycle begins in earnest, you need to be "monitored" with ultrasounds and bloodwork frequently for about 10-14 days. It is very easy to get monitoring done closer to your home while your own physician calls the shots for your cycle.
vickalina	By the way, Thank you DR. Hurwitz and welcome.
Deb	Thanks, Dr. H. I can see you are already in the swing of things.
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Joshua_Hurwitz_MD_RMACT	Blocke or absent tubes are avery common reasoon to need IVF. It is actually why IVF was first invented. Th emonitoring does nto chaneg in any way whether you have patent tubes or not
Deb	Welcome, Liafa. We are talking with Dr. Joshua Hurwitz about IVF and what to expect from treatment.
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Deb	Everyone should feel free to jump in at any time with your questions. That is why we are all here.
liafa	thank you! I am looking forward to get as much info as possible.
Joshua_Hurwitz_MD_RMACT	"cycle" means an IVF protocol from start of suppression though follicle stimulation with injectable meds, egg retrieval, embryo transfer and pregnancy test.
vickalina	OK. I got confused for a minute. Thank you for clearing that up for me.
Deb	Glad you could join us puja76. Thanks for taking the time to be with us tonight.
liafa	how long is a treatment cycle - is it the same as a regular cycle?
satie37	Dr Hurwitz could you comment on the technique of embryo implantation where the embryo at 5 day transfer is actually put into the endometrium during the transfer process.... has this been studied at all in terms of increasing pregnancy rates?
puja76	hi I just had my 2nd failed cycle of IVF. My 2nd IVF was Day 5 transfer of 2 embryos.I have severe endometriosis & during U/S they found some fluid in my tube which my RE was not too concerned about. I wanted to get more info on hydrosalpinx and implantation rates?
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Jillian_Day	Hi everyone
Joshua_Hurwitz_MD_RMACT	yes. the words are interchangeable. there are different types of IVF cycles with differing protocols. Some protocols take a bit longe rthan others-- these are called "down-regulation" or "long-protocols" where your brain and ovaries are suppressed in themenstrual cycle BEFORE your IVF. Othe rprotocls require 7-14 days of birth control pills to suppress you for your IVF cycle, and others have slightly diiferent prtotocols. so the stimulation portionof your IVF cycle, that part wheen you take injectable medications to stimulate as many follicles as possible (safely) is about 8-12 days. add to that egg retrieval, embryo development and embryo trasfer, plus however long was taken to suppress your ovarties beforehand, a cycle takes a few weeks.
vickalina	Hi Jillian
Deb	Hi, Jillian-Dr. Hurwitz is taking your questions about IVF. Thanks for joining us.
Jillian_Day	I am going to be doing IVF soon and I really am very new to the information. So if you are not ovulating at all would you still need to take the bc?
Jillian_Day	Hi Deb
Joshua_Hurwitz_MD_RMACT	day 5 transfers are called "blast transfer" for the term balstocyst. A cbastocyst is an embryo that has taken the next big step in development form days 1-4. It is believed that it represent sa stronger embryo since it has self-selecte ditslef to be able to develop in to a blast in the laboratory culture envrironment.
Joshua_Hurwitz_MD_RMACT	Blast trransfers typically have higher preganncy rates depending on the qulaity of the blasts. It is generally accepted to transfer back fewer blasts on day 5 than you would have transferre don day 3 becuase they are higher qulaity if they have moved onto blast. that said, the vast majority of patients get a day 3 transfer because most pt's do not make it to blast, or the risk of pushing to day 5 is too great.
Jillian_Day	So are blast transfers part of the IVF process?
satie37	Dr Hurwitz my question is directed specifically at the technique (I think it is rather new) of actually putting the blast into the endometrium during the transfer process.... so physically inserting the blast into the endo. Doing embryo implantation
Joshua_Hurwitz_MD_RMACT	A hydrosalpinx is a dilated fallopian tube that is fiiled with fluid that accumulates b/c it cannot flow out the end of the tube as it should. thsi fluid can be inflammatory in nature and it is believed to impair implantation by backflowing intot he uterus. ther eis not 100%concensus on this issue, but it is generally accepted to surgically remove any hydrosalpinx that is visible on ultrasound. liek I said, though, not evevr physician jumps to surgery as quickly as others. I would imagine that if you had good quality embryos and did not conceive on your fisrt cycle, that your RE may want to remove the hydrosalpinx.
Joshua_Hurwitz_MD_RMACT	To put it a little more simply and forcifully, there is evdience to state that implantation rates are halved by having fluid-filled tubes visible on ultrasound during IVF
Jillian_Day	Do you answer questions at the end of the chat?
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satie37	Jillian when you do IVF the embryos can be transferred either after 3 days of growth or after 5 days... there are pros/cons of each
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Deb	Jillian, this session ends at 9pm. If you are a free no Barriers member of the AFA, then you will have access to lots of information, including a dr. moderated chat room where you can get other questions answered.
Deb	Thanks for logging on akikoono and Carolily.
satie37	Your doctor will transfer a certain number of embryos back based on YOUR age and the quality of the embryos (there are guidelines for this) if you have remaining embryos you can make a choice to have them frozen for future
Carolily	Hello
Joshua_Hurwitz_MD_RMACT	Even if your are not ovul;ating at all, you still need to have your be suppressed. the analogy I use all the time with my patients is a horse race: you need all the horses to line up atthe starting gate together, youdon't want any one or jumping ahead of the pack. It is the same fo r follicles, menaing you want all of your follicles to be lined up so that hey can be stimulated and grow together as a cohesive cohort. it is bad when 1-2 follicles leads the pack by a large margin. the birth control pills-- and other suppresison meds-- line all of them up ttogtehr to faciliatte an orderly srat tot he IVF cycle.
Jillian_Day	Well I had endometriosis that attached to my colon so I had to take Lupron & I have been off Lupron for 8 months & still am not ovulating so I was wondering if I would be a canidate or do I have to wait until I ovulate completely? I am new to this & this is my first chat.
Deb	Dr. Hurwitz is helping us with our questions about ART=assisted reproductive technologies. Jump on in if you have a question. That is why we are here.
liafa	i am still looking for more basic info as i have not done a cycle yet. what determines the protocol that is used? when the cycle starts what steps are taken and how many visits to the office have to be made to check if everything works out as intended. are there possiblities that the cycle has to be stopped?
Jillian_Day	Yes I am a no barrier member
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Lisa_Rosenthal	Good evening everyone
Jillian_Day	Hi Lisa
Carolily	Dr. Hurwitz, I'm 41 and just did an IVF protocol using Follistim. I produced 9 eggs, 6 mature, and only 1 fertilized which then fragmented to Grade 3. We have MF sperm issues in addition to my age. My RE has recommended a flare protocol using Lupron, Bravelle, and Menopur. I recently read that flare protocols are sometimes not recommended for older women because it can compromise egg quality. What do you think?
akikoono	I am in the cycle with clomid + follistim + menopur + ganirelix. One follicle has aleady grown to be 12mm on the 6th day. I am afraid it reaches 18mm before the late comers grow. Do I need to ask my doctor to do something special to change the protocol ?
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wannababy	Hi, am I too late?
puja76	Thanks for the info. So to surgically remove hydrosalpinx means removing the tubes or just getting them tied. Does this impact the ovaries and the number & quality of eggs. Also can this be done laprascopically ?
Lisa_Rosenthal	Hi wannababy, nope, you're right on time!
Joshua_Hurwitz_MD_RMACT	Blast transfers are an option for any patien twho meets the criteria of that IVF center. generally, pt's have to be <35 yearsold and have many high quality embryos that are growin gwell in the lab. If you poush a pt to a day 5 transfer-- blast transfer-- wihtout a lot lof high quality embryos, you run the risk of none of them making it and getting NO TRANSFER. this is very traumatic for both pt and doctor. the idea is that no matter how good our embryology labs are, they are not as good as mother nature's, menaing your womb. so if there is not a great chanc eot get to blast, it is best to transfer them on day 3 so that teh environoment of your uteurs can help them grwo.
Lisa_Rosenthal	I'm late, and I apologize. Thanks for joining us at The American Fertility Association online educational session
Lisa_Rosenthal	Welcome to Dr. Hurwitz from RMA of CT....
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vickalina	Hi puja76- I did not have the same condition as you but did have my tubes removed laprascopically. Hope that helps
akikoono	Carolily, I used Lupron before but 4 out of 6 follicles were empty.
Jillian_Day	Well I am 24 & have been ttc for the past 4 years with no luck due to endometriosis & I am wondering does endo compromise the quality of the embryos?
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Deb	Welcome to Carol, wannababy and prospect 75. We are fortunate to have Dr. Hurwitz answering our questions about ART-assisted reproductive technologies.
Joshua_Hurwitz_MD_RMACT	Traumatically placing embryos in to the endometrium is not a well-studied phenomenom and I highly doubt its efficacy given its invasive nature and the gret apains that we all go through tot make embryo transfer as atraumatic and smoot as possioble so as not to initiate any cramping, inflammation of contractions in the utersu. I cannto comment more than that on an experiemntal technique
prospect75	wonderful
Carolily	akikoono, how disappointing!
Carolily	akikoono have you tried other protocols with better results?
puja76	thanks vickalina
Jillian_Day	Deb...How can I get a copy of this chat to bring to my doctor? Is there a way to print it once it is over?
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vickalina	welcome ::biggrin
Joshua_Hurwitz_MD_RMACT	if you are not ovualting, your RE can start you into a cycle after testing for howmone levels, depth of you endoemtrila lining and no cycste in your ovary. you do not to ovaulate on your own to get into an IVF cycle. BTW, ther eis soem decent eveidenc e to suggest that 3-6 moths of lupron improves IVF success in endometriosis patients, so it look slok eyou have all your ducks i a row
akikoono	Carolily, so far clomid + menopur + ganirelix worked best for me. I am giving a shot while typing this.
Jillian_Day	I tried clomid & still did not ovulate
Jillian_Day	what is menopur & ganirelix?
Carolily	akikoono, did you use clomid for ivf?
akikoono	Yes.
Deb	Jillian, we do post the chats about two weeks after they 'air'. You can print the transcript from the site www.theafa.org
akikoono	ganirelix is to suppress ovulation while menopur stimulate follicles to grow following clomid collecting more follicles.
Jillian_Day	Ok thanks
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Jillian_Day	Ok thanks akikoono
Jillian_Day	Maybe I will ask my dr. to try that
Joshua_Hurwitz_MD_RMACT	basics for IVF: protocols ar etailored to individual pts and are based on: age, ovarian resevre, FSH levels ,and medicla diagnoses. standadr protocls include long protocols with lupron befor eyour IVF cycle, or shorter cyles with jsut brith controls befor eyour IVF cycle. dose, duration and stimulation are diferent for each pt. once you ar ein cycle, yo ucan expect to need close monitoring with ultrasounds and bloodwork (often very early in themorning) for about 2 weeks.
akikoono	According to Cornell's doctor, there are 4,5 protocols for IVF. No one knows which works best until tried.
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Jillian_Day	Gosh I feel like I might never know all that I want to know about IVF...My husband & I really want to have children & I feel as if I need to know about everything so I know that I will be doing it right. thank goodness that I have a wonderful dr.
Joshua_Hurwitz_MD_RMACT	flare protocls are generally used when simpler protols have failed. it is a way to optimize you response after a sub-optimal stimulation. it generally stimualtes you quicker than the other protocols, so there is a aorry that your follicle wil lnot have time ot mature befor ethey are ready to be ovulated based on size and hormone levels.
Jillian_Day	Well hopefully being 24 my chances are good
Carolily	Jillian, there are tons of books out there. Thr
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Deb	Jillian, I think that everyone who starts on this road has had the same thoughts and feelings. One of the nice things about these sessions is you know that you are not alone-and you are getting great information.
Carolily	Dr. Hurwitz, that makes me think it might not be good for me, having had 1/3 of my eggs not be mature
Jillian_Day	Thanks this is very informative for me & it also helps because no one that I know is going through this & my sister in-law is pregnant with her first baby now & it is hard but I am happy for her.
Joshua_Hurwitz_MD_RMACT	when one fllicle leads the pack, we worry that the smaller ones will not catch up in time become mature before ovulation is triggered. That goes back to my earlier post about needin gto lin eall the follicles up at the starting line together. when one jumps ahead, it puts th eother sin jeapardy. you may need a differen type of suppression in you rnext cycle, but do not lose hope b/c the other fillicles can still come thorugh and surpirse you . good luck
Carolily	Jillian (sorry for the interruption) you should learn as much as you can and demystify the process for yourself. You need to be your own biggest advocate! There are some good internet BBs out there. You're definitely not alone.
vickalina	When a facility lists its success rates how much should that weigh into our decision in choosing one? Considering my Dr. has told me that I am a prime candidate and just as you stated earlier, IVF was essentially developed for someone with a similar condition. The reason I ask is because I have a local facility that I was referred to but it has a lower success rate with fewer transfers than others I have researched.
Jillian_Day	I don't want to sound like an idiot but I notice that you guys are talking about the # of follices & someone before said 4 out of 6 follices were empty...Aren't there hundreds of follices?
Jillian_Day	Thanks Carolily I appreicate the feedback
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Carolily	Vickalina, my 2 cents, it's so subjective. Some clinics only accept younger patients, so their success rates can be higher. But I'm sure the Dr. knows better.
vickalina	Thank you Carolily. I am learning so much tonight.
Deb	Thanks for joining mikeweiss. Jump in with any Assisted Reproductive Technology question you might have for Dr. Joshua Hurwitz from RMA-CT
Joshua_Hurwitz_MD_RMACT	that is atricky question. no body wants to go to the equivalent of a "mom&pop" ivf center, but at the same time, no body wants to be on a factory production line. fidn the site that fits best for what you want as a couple and as a patient. the doctor-pateitn relation ship is extrememnly important, especially in such an arduous and emotional process such as IVF. as long as a centers rates are not outlandishly bad, then I do not think that you need to go out of yor way for a bigger practice, that said, do you homework b/c there are borderline providers out ther in IVF. you can check rates at www.CDC.gov
puja76	Do success rates have to do with the embryologist? Like how the embryos are fertilized & lab conditions coz some clinics have rates as low as 20% and some close to 70%
Joshua_Hurwitz_MD_RMACT	regarding follicle numbers: a women has hundreds in each ovary. they are in difeferen tstages of development, though, so at any given time in stimulation, only a few are able to be stimulated. that number increases in IVF b/c we manipulate your system to get as many as possible.
Joshua_Hurwitz_MD_RMACT	generally, when peope talk about follicl enumbers, they mean "how many are being recruited and are growing in my IVF cycle"
Jillian_Day	Thanks Dr. Hurwitz for clearing that up
puja76	I wanted to find out if RMA of CT affiliated to RMA of NY?
mikeweiss	My wife went thru one IVF cycle and they extracted 10 eggs - all immature - we were saddend by this and decided to seek out a second RE opinion. The 2nd doc seems great and seems to know what went wrong but I am worried about changing doctors in mid stream... any suggestions?
liafa	what are possible side effects of the stimulation?
Carolily	Liafa, my side effects were fatigue, soreness in my ovaries, some moodiness, and the estrogen made my breasts really sore. really really sore. had to sleep with a bra on.
Joshua_Hurwitz_MD_RMACT	good question regaring embryologists. any ivf center worth its salt has strict quality control and has senior embryologists supervisong junior embryologists (we al have to get our start somewhere, right?) I fhtere were a large discrepancy b/w embryologist, it would be quickly picked up and fixed. all centers tale their rate svery seriuosly for both proffesional pride reaosnes and to attract more patients.
liafa	Carolily thanks for the reply. That sounds really unpleasant but still doable as it seems not to be long lasting. Is there s.th. that can last beyond the stimulation?
Carolily	liafa i was being a little dramatic. it's not that bad. it's totally worth it
Joshua_Hurwitz_MD_RMACT	regarding rates differing b/w centers, there are 2 main factors: first, the reproductive endocrinologist can distinguish themesleves by picking good protocls fo rtheir pts, stimluating them in an evdiecne-based manner that it is safe and effecient, then being adept at egg retrievals and embryo transfers. second, the embryology lab itslef is a hufge component of a centers success. good practices allways try to improve and have high quality control
Joshua_Hurwitz_MD_RMACT	RMACT is loosley affilated with RMANJ but we are fully automonomous
puja76	Thanks Dr Hurwitz. This session has been very helpful
Deb	We have about ten minutes left of Dr. Hurwitz's time for this session. This is the time to jump in with your questions.
vickalina	Yes thank you so much Dr.Hurwitz. I feel a lightbulb went on inside my head. ha-ha
puja76	Dr. Hurwitz you mentioned that women who have endometriosis may do better if they are on lupron for 3-6 months. Is this a daily subq injection - like i took during IVF? Also is being on birth control have the same effect? I want to make sure me maximise our success.
Deb	This is also a great time to thank Dr. Hurwitz again. This has been an awesome session!
Jillian_Day	Lupron can be administered on a schedule of every 3 or every 6 months
Carolily	Thank you Dr. Hurwitz
Jillian_Day	The stronger of the doses are given every 6 months which is what I had
Joshua_Hurwitz_MD_RMACT	10 immature egggs is devestaing for you-- I am sorry that you had to go through that. it is difficult to say without any more hsitroy, but you wer eliekly "hit" too early. "Hitting" means triggering your ovulation t mature the eggs and get them ready for retrieval. changing docs or gwetting second opinions is always your erogative. if you do not feel like you are gettign the care or attention you need, you should swith docs. that said, it may be as simple as your current doc switching you rprotocol or just holdin gout your ovualtion to amore appropriate time to get mature eggs. best of luck
puja76	thanks jillian
Jillian_Day	Your welcome puja76
puja76	do you get your menstrual cycle while on lupron?
mikeweiss	A quick followup - the second opinion mentioned In Vitro Maturation - is this a separate procedure outside of IVF?
Jillian_Day	no or at least I didn't but I was using it for the treatment of endometriosis on my colon which could not be lasered off.
Deb	Our session next week is on Wednesday, November 22-8pm Eastern until 9pm. This session will be hosted and moderated by The American Fertility Association's Deputy Executive Director, Lisa Rosenthal. This support session "Just Us" is the place to share your fears and hopes with people who are facing similar issues or have been down the path before you and can encourage you. The "Just Us" sessions are very popular, informative and supportive-and just the right stuff to kick off the holiday season.
Jillian_Day	Great Deb that sounds like a good one.
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puja76	i did have laproscopy last year to remove the endo it was on my ovaries tubes etc. but i think some of it is back. So lupron suprresses the Endo?
xavier2001	hello, i know i'm a bit late, is anyone still here?
Deb	Xavier 2001-welcome aboard. We have about five minutes left...so get your question in soon.
Jillian_Day	Yes puja76 that is what I had to do to get it off of my colon
Joshua_Hurwitz_MD_RMACT	as was written a little earlier, lurpn can be given daily in small doeses during IVF, or once monthly (or even once every 3 months) in larger doese when NOT doin gIVF. what I wrote earlier about 3-6 months of lupron improving chances with endoemtriosis has good evidenc eo tsuppoirt it in th eliterature, but it is not a slam-dunk. not evevry doc agrees with it, but it is defintiely a a good option. Birth contro [pills may or may not have the same effect. I cannto quoet any literature on that.
xavier2001	i had an ivf suprresion question, is there a difference between doing lupron/bcp for suppresion versus a mid cycle dose of cetrodite?
Jillian_Day	Puja76 I had to laproscopy done but my dr said if he had lasered it, it would have ruptured my colon & I would have had to wear a colostomy bag for the rest of my life.
Joshua_Hurwitz_MD_RMACT	after anintial flare effect, you should not have a bon fide period on lupron
puja76	Thanks Dr Hurwitz
puja76	Thanks Jillian
Deb	We have time for Dr. Hurwitz to answer one more question....then he will sign off. I know that we could keep him here all night!
Jillian_Day	Good night everyone & good luck with all of your efforsts.
Carolily	Appreciate your time Dr.
puja76	Thanks for your time
vickalina	Good night to you Jillian and to all! God bless
Jillian_Day	Thanks to everyone
Deb	Dr. Hurwitz-where can our guests go for more info on you and RMA CT?
Jillian_Day	Deb where on the site can I print this chat?
Joshua_Hurwitz_MD_RMACT	in vitro maturation is an experimental procedure in which your eggs are harvested prior to them naturally maturing (this normally begins when your ovulation is triggered and finsihes when the eggs are fertilized). IN vitro maturatin tries to do both of these steps in the lab. there is variable success in the literature, but if you have a maturity problem that is not related to poor cycle managemnt (menaing triggered too early) then you may need it. you and yor doc need to acknowledge that it is not standard of care and is experiemntal in nature.
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Deb	it is in the section labeled 'what's here'. It will take a while. If you don't want to wait, you may be able to cut and paste into a word doc before you log off.
Jillian_Day	Ok I will check back tomorrow
Carolily	Dr. Hurwitz, do you know of any clinical trials for IVM?
Deb	Ok, gang. I am afraid we are out of time. Dr. Hurwitz has been extremely generous with his time and expertise. We have all learned so much tonight and we thank you.
puja76	thanks & good night
Jillian_Day	good night
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liafa	thanks
Deb	Remember our next session is WEDNESDAY, Nov. 22 at 8pm. Log in for support and information.
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Deb	Thank you all and good night.
mikeweiss	thank you so much Dr. Hurwitz
Joshua_Hurwitz_MD_RMACT	there a rem nay ways to suppress endometriosis. that is an entire topic in itslef. brith control pills, lupron and othe rhormonal meds are ways to treat it. so are non-steroidal anti-inflam drugs like ibuprofen and others. your treamtne tdepend so nyour goals with endo: if you just wan tot be pain free, then those meds, plus or minus surgery is a good bet. if you are trying to conceive then the treatemnts differ and you may need aggressive fertillity treatments. good news: endo is almosy univeraslly bette rin pregnancy
Joshua_Hurwitz_MD_RMACT	there is a differenc ein how th med swork and when you need ot take them. .they are different measn to the same end: suppresiion of ovualtion until your doc triggers you. each pt shoul dbe individualized as to which is best for her
xavier2001	thanks doctor, for all that you do for this website
puja76	Thank you Dr this session was a big help to me.
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Joshua_Hurwitz_MD_RMACT	Best of luck to evevryone. I had agreat tiem her etonight and i hope it has helped. sorry for the typos. best, dr hurwitz
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Carolily	Thanks again
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New and Nervous: Facts for patients new to ART treatment

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