No Holds Barred: All Fertility Questions Answered

June 6, 2006 - Tuesday
6:55 PM to (EST)
Guest Speakers: Guy Ringler, MD
California Fertility Partners

Categories
Donor Egg • IUI • IVF • PGD • Pregnancy

Session Date:	June 6, 2006 - Tuesday
Guest Speaker:	Guy Ringler, MD California Fertility Partners
Topic:	No Holds Barred: All Fertility Questions Answered

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gringler	Testing
gringler	The session will begin in approximately 15 minutes.....ThanksGuy Ringler, MD
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deb_capone	Good Evening and welcome to tonight's Online Education Session, hosted by The American Fertility Association and sponsored by Fertility Lifelines. We will be starting at just a few minutes at 8pm Eastern.
deb_capone	I am Deb Capone and I am your moderator. If you need anything during the session, just double click on my name on the left to be connected to me privately. As always, your feedback is very important. Please let us know how we can serve you better.
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deb_capone	Tonight we are fortunate to have with us, Dr. Guy Ringler, from California Fertility Partners.
gringler	Hello everyone..
beccab96	hello dr gringler
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Luly	Hello
liz	Hi
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deb_capone	Dr Ringler is a board certified Reproductive Endocrinologist and an Assistant Clinical Professor at the UCLA school of Medicine. Dr. Ringler studied medicine in Michigan and the OB/GYN at the University of Chicago. He completed his fellowship at the University of Penn. and gained extensive experience in microsurgery and clinical fertility. Dr. Ringler has published extensively....well, he is just terrific!
deb_capone	And he is here tonight to answer as many of your questions as he can!
gringler	What topic is on everyonone's mind tonight?
deb_capone	Welcome, Dr. Ringler and thanks so much for being here. We really appreciate your time.
gringler	It's my pleasure....the AFA is a great resource for everyone..
deb_capone	This session has been billed as a 'no holds barred session. I encourage you all to ask whatever questions you might have on fertility issues, challenges, technology....etc.
liz	I am thinking of doing IVF with PGD and I was wondering what the success rate is for that
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melissa3	how soon can you take a home pregnancy test after doing a IVF transfer?
gringler	The success rate of IVF or PGD?
liz	of IVF with PGD
liz	sorry
gringler	We perform pregnancy tests 12 days post transfer.
gringler	The most important factor affecting success rate with ivf is age
liz	I am 29
gringler	PGD is a screening tool...
melissa3	can you can a home pregnancy tast sooner than 12 days
gringler	It's not for everyone...only if indicated..
Symharmony	I had a Lap done a month ago and I'm going to wait a couple of months to see if my body can do it on its own....otherwise I will resort to Clomid and IUI. What is the success rate with these procedures when they are done together?
liz	ok
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liz	thank you
gringler	PGD may be helpful for patients with history of recurrent miscarriages or repeat ivf failures...or for carriers of known genetic disease.
liz	My husband has Osteogensis Imperfecta
beccab96	i had a retrevial for ivf in 04 and got ohss and now i am going to try again im am very nervous what do you recommend that i do
gringler	Clomid plus IUI has a pregnancy rate of approx 15% per treatment cycle for patients under age 40
Symharmony	Thanks
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gringler	OHS can be prevented.....pre-treatment with oral contraceptives for 4-6 weeks followed by low dose stimulation and careful monitoring...can prevent
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gringler	PGD should be performed by a skilled an experienced embryologist with a proven track record....to minimize risk to implantation of the embryo
beccab96	i am supposted to start treament soon to try my 2nd ivf and i have to wait for a period but i dont ovulate by myself and bc make me ill do you think you can recommend anything
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melissa3	do you think taking a home pregnancy test four days after a IVF transfer is to soon? and how long does it take for a blastocyst to implant?
gringler	Lupron suppression for an extended period may be helpful
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gringler	A home test four days post transfer will be negative....
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gringler	The blastocyst should implant within 1-2 days post transfer...
deb_capone	Welcome, Tenayagirl2
deb_capone	I was disconnected for a minute...sorry.
gringler	Pregnancy tests will not be positive until there is enough hcg being made by the placental cells...it takes time to reach a critical mass of hcg producing cells to detect in blood.
deb_capone	Welcome to this evening's Online Education Session, hosted by The American Fertility Associaion and sponsored by Fertility Lifelines.
deb_capone	Tonight's guest is Guy Ringler, MD from California Fertility Partners.
deb_capone	We are asking Dr. Ringler any and all our fertility-related questions. Go for it, everyone!
gringler	Ovarian hyperstimulation risk can be reduced by using low dose gonadotropin stimulation...
eddie	I am 34 and my husband is 30. we have been ttc for around 15 months. We found out my husband has a low sperm count. 1st SA was at 3.5 mill and 2nd at 17.5 mill. we were originally headed down the In Vitro road, but now wonder if we should try IUI first. I am just worried about my age and success rates. I have had no problems that we know of thus far.
gringler	There is no harm in trying a few IUI cycles....you are still very young..
gringler	Pregnancy rates begin to drop off in the late thirties....34 is young!!
melissa3	when the egg implants do you have cramping?
gringler	Has your husband seen a urologist?
gringler	Some patients claim they can feel implantation....most patients do not have any symptoms..
loisbarrett	dr. gringler. Are you taking questions regarding pregnancy via ovum donation?
gringler	Yes, what can I tell you about egg donation?
deedee	My husband and I are looking into egg donors. It seems like it is taking a bit of time to find an egg donor that we like in our area. Is it better to use an egg donor close to where one lives?
eddie	Yes, he has seen a urologist. His blood hormones are normal, FSH is a little high. No blockage or problems there. He just isn't producing enough sperm. Volume and ph are fine. Motiltiy is at 50% and morphology is 9% and the sperm are progressive.
gringler	It's important to have a good IVF center that can monitor the donor's stimulation....
beccab96	dr do you think that if i try again for ivf for a second time that i will have a good chances of becoming pregnant. I am supposted to do retrival some time this month and implantation and i feel that im going to set my self up for a big let down i was pregnant in 03 with twins but miscarried at 2 months
loisbarrett	Can we talk about risks involved for recipient and donor, most specifically because of the meds.
gringler	She can then travel to your area, when she gets close to being ready for retrieval..
deedee	Thanks
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gringler	The egg donor undergoes an IVF cycle....the main risk is ovarian hyperstim...incidence approx 2%
gringler	The recipient's risk....is of multiple births...
deedee	What are the chances (stastics) for getting pregnant after one egg donor process? I've completed a mock cycle.
gringler	Twinning risk approx. 25-35%
gringler	Egg donor IVF pregnancy rates are approximately 65%...
deedee	Thanks
gringler	Factors include the egg quality, sperm qualilty, uterine receptiveness....
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deedee	Is there a better time of year to go through an egg donor cycle? Like would it better to avoid winter time when there are typically more flu and cold virus?
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trac1	I am 38, husband 43, I have one 19yo from previous relationship. TTC 2 yrs, male factor issue for us; are preparing for 1st IVF. My day 3 labs FSH 9.4, E2 68.6, LH 4.5. My antral follicle count was 15. I am concerned about FSH and E2 level, clinic says they like E2 below 50. Should I be worried about my ovarian reserve at this point?
loisbarrett	What about risks of ovarian cancer from estrogen. I saw this report on NightLine stating that might be a risk.
gringler	No, there havent been reported seasonal differences in preg rates with egg donor..
deedee	thanks
loisbarrett	Luly. I'm in New York City.
gringler	The recipient recieves physiologic amounts of estrogen....we miimic a perfect ovulatory cycle...should not increase your risk of cancer.
loisbarrett	Thanks. What about for the donor.
gringler	trac1-----I am happy with that data....good antral count
deedee	During my mock cycle, the progestrone injections gave me black/blue marks. I heard that there may be progestrone suppositories that may have the same effectiveness as progestrone injections. Any thoughts?
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gringler	Gonadotropins (fertility drugs used in IVF) have not been shown to increase risk for cancer
Luly	Lois - I am in Florida
beccab96	dr what are my chances of getting pregnant this ivfd cycle?
gringler	Yes....we routinely use vaginal progesterone capsules instead of injectable..
trac1	that's great to hear, thanks. Is the antral count a good indicator for IVF success?
gringler	equally effective with no pain...
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deedee	After an actual egg donor implant, how long does one need to be on progestrone?
gringler	The antral count predicts responsiveness to fertility drugs....age is most important predictor of success..
loisbarrett	Are the gonadotropins given to the donor? I'm still learning this process.
gringler	beccab---I'm afraid I need more information....
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gringler	Yes, the egg donor takes Lupron to "turn off" her natural cycle, then FSH and LH to stimulate her ovaries....
beccab96	dr gringler the injection that you give your self with the longest needle that you give in you hip buttock after the ivf implation do you really think that will help ?
gringler	So the donor is essentially undergoing an IVF cycle.
beccab96	its some type of oil i dont have the name on hand
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khugar	We have had several ectopic preganices while ttc, resulting in the loss of one tube. We are considering ttc naturally one more time before moving to IVF. If the worst case scenario happens and I loose the other tube, is IVF still an option?
gringler	Progesterone support after egg retrieval is neccessary.....it can be given as injection or as vaginal capsule three times daily.. or sometimes we use hcg boosters..
gringler	Yes.....you do not need the tubes for IVF.
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gringler	If you've had an ectopic it's impt to be monitored early in your next pregnancy
gringler	To make sure it's not another one.
deedee	Thanks ... so progestrone continuation varies with each person .... Or is there an approx length of time one might expect to be on progestrone after an egg donor cycle?
khugar	thanks
loisbarrett	Thanks so much. My sister had initially generously offered to donate eggs. She has sinced gotten married and is planning to start ttc next spring. Would it be detrimental for her to donate eggs to me this year?
beccab96	dr graingler im 28 yrs old my husband is 25 and its our 2nd try of ivf i had the 1st time i had over stimulation and had a bad time. I am starting my 2nd try in 10 days and i guess im a little frustrated and sad due to ther eis no guarentee and what i want is to make sure that i do everything correct and have a good turn out because i dont know if i could go threw this again and not have a pregnancy
gringler	Progesterone continues until the placenta starts making prog...which is between 10 and 11 weeks gestation...
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gringler	Once we see the progesterone level rise, we taper off the progesterone...the placenta will support the pregnancy itself then...
deedee	thanks ... I didn't realize the injections could be 11 weeks. Thanks
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gringler	11 weeks of gestation which is about 9 weeks from transfer....
trac1	For a 38yo day 3 transfer, how many embyros are usually transfered and what is the typical risk of twins/triplets?
gringler	beccab - you are very young which puts you in a high success rate category....don't be afraid of IVF
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gringler	38 year old day 3 transfer: four embryos .....if quality is very high consider three...if poor, consider five..
deedee	For clarification, the egg is transferred when it is 2 weeks old? I had understood that it was more like 1 week old.
trac1	thanks
gringler	risk of twins approx 20%....triplets...3-5%
beccab96	well last time i had 2.5 liters taken out of my stomach and my liver and kidneys shut down and i was not able to work for 1 month after that. so do you think that i will have a good turn out this time. i changed dr's and i likethem more
gringler	Gestational age is calculated from first day of last menstrual period which is approx two weeks prior to retrieval
beccab96	i also had a misscarriage of twins in 03 after 2 months and i just dont want to disappoint my self
deedee	thanks for the clarification
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gringler	Another option to for patients at risk of hyperstim.....is to freeze all embryos and transfer back in a non-stimulated cycle.
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deb_capone	Welcome Aboard, Tbsuds and rhh! We are talking with Dr. Guy Ringler from California Fertility Partners. Feel free to ask him your fertility questions.
beccab96	well thats an idea if i had the money but i was so sick at the time that this happened and they wanted an answer that day then would wait untill i was in the right state of mind i told then to wait till monday which i say them on a friday and they told my mom it would be 2000 to holdd and then 250 a month after that and my mom said dispose
loisbarrett	Dr. Gringler. Did you see my question regarding my sister? She had initially said she would donate eggs, but is now planning to conceive in spring '07. Would it be okay for her to donate eggs to me this year?
tenayagirl2	please comment on embryo adoption. does your clinic have a program where you allow couples to donate embryos to another couple?
sandy	I am 36 FSH 10.1, during my last stimulated IUImy progesterone dropped and the cycle was canceled, Dose this mean I have bad eggs or poor ovarian reserve? So far me have unexplained infertilty
gringler	Yes, the egg donation cycle will take approx 5 weeks then...she is ready to concieve for herself....
gringler	We currently do not have an embryo donation/adoption program....
deedee	The R.E. I've beenworking with indicates that if more then two eggs take implantation, she would do an embryo reduction. With an embryo reduction, wouldn't there be a chance to loose the entire pregancy?
tenayagirl2	doctor, can you tell me the name of any clinics/organizations in Los angeles area who does have an embryo adoption program besides snowflakes?
gringler	Sandy....your prog dropped in the luteal phase?
sandy	it dropped around 5th or 6th day of stims
gringler	The risk of reduction to the entire pregnancy is quite low....1-2% risk of miscarriage.
deedee	thanks
loisbarrett	Dr. Gringler. Did you see my question regarding my sister?
gringler	It's important to support the lutueal phase when gonadotropins are used.
gringler	It's not an indication of poor ovarian reserve, but could be a factor in your fertilitly.
gringler	Yes....your sister could donate now and still be ready to concieve herself in 07
sandy	thank you,. would IVF be a better choice for me?
deedee	Is it important to utilize an egg donor that has the same Blood RH factor or does it matter?
gringler	blood type doesnt matter.....choose the egg donor that you feel comfortable with....
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deedee	thanks
loisbarrett	Thank you so much.
deb_capone	Good evening, Russia. We are talking with Dr. Guy Ringler from California Fertility Partners.
gringler	IVF is indicated after 2-3 cycles of stimulated IUI without success for unexplained infertility..
trac1	Dr. Gringler, does having a hx of getting ovarian cysts (but not PCOS) increase risks for complications with IVF?
sandy	thank you
mrswoodigit	I am 33 years old and had a lap in Jan 06 to have both tubes opened. How long should I try naturally before moving to IVF?
gringler	No, but we want the ovaries to be clear of cysts before starting stim...so it could delay treatment a bit..
trac1	thanks
gringler	If you are not pregnant after 6 months I would test to be sure that the tubes are open....
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gringler	If the tubes are not, then IVF...
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gringler	While you are trying naturally....be sure that the sperm are normal, ovulation is normal, etc...
tbsuds	Hi..I'm 34.5 yrs, unexplained IF, Neg HSG, 1 cycle Clomid-chem preg, 4 letrozole, 3 follistim IUI's, and now on 1st IVF. How many embies would you recommend for transfer?
smiley	i had a D&C 4 years ago due to pieces of placenta that were retained after giving birth. my concern today is that there could be scarring which would prevent a future embryo from implanting. do you have any comments? thank you.
deedee	I had fibroids removed. Is there any expected rate that fibroids might return prior to an egg donor cycle?
gringler	I would transfer 2-3 embryos depending on quality on day three.
gringler	You need a hysterosalpingogram to evaluate the uterine cavity....
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gringler	A midcycle ultrasound of the endometrial lining thickness and contour would also be helpful.
sandy	what is the indication for a 5 day ivf transfer compared to a 3 day transfer
gringler	Great question....some programs prefer 5 day to 3 day.... every RE has a different feeling about this...
gringler	It's helpful in cases of unexplained IVF failure to provide additional info on embryo quality....
smiley	thank you doctor.
gringler	If you want to avoid twins....you can transfer a single blast...
sandy	which has more success?
gringler	It can prevent high order multiples by transferring only 1-2 on day five
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gringler	Pregnancy rates are similiar.....
trac1	I did 2 mos of clomid 50mg and developed lrg cyst and next 2 cycles period 8-9 days early...RE might want clomid challenge test due to E2 of 68...I'm scared this will delay my starting 1st IVF cycle...is it likely I would react same way to clomid?
tenayagirl2	doctor, you say that in unexplained IVF failure one should look at embryo quality...how would you do that?
russia	I am 25, don't smoke, eat healty, and am a good weight. I have always been healthy. Since my husband and I have been TTC my cycles started coming around 45-50 days. This time I am at 52 days. I took a test last weekend and negative. This length in cycles is very abnormal for me and I can't figure it out. What could the problem be?
gringler	We don't do clomid challlenge tests....just use baseline FSH/E2 levels on day three....don't think you need it..
trac1	thank you dr.
deedee	We were surprized that some egg donor websites only accept those that utilize their particular doctors. Any thoughts about this practice?
gringler	Embryo quality is a "hot topic"....day two look for multilnucleated blastomeres....day three look at number of cells, cell sizes, fragmentation amount.....
deb_capone	I want to ring the warning bell at the three minute mark.
deb_capone	I hate to break this session up. It has been absolutely fabulous.
deb_capone	I want to thank you, Dr. Ringler for your time and patience.
gringler	You should be able to choose your doctor as well as your egg donor!
deb_capone	Do you want to make any closing comments and perhaps you could give us the link to your website or any other contact info that you want to share!
loisbarrett	Thank you Dr. Gringler. Your time and expertise is appreciated.
deb_capone	Please join us next week: same time, same channel when Certified Holistic Counselor, Alisa Vitti discusses natural ways to enhance fertility.
gringler	Great session...interesting questions....keep reading about fertility to help educate...utilize the AFA resourcess...
deedee	thanks for all your answers!!!
gringler	My practice: California Fertility Partners....www.lainfertility.com
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gringler	Guy Ringler, MD.....GRingler@aol.com
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deb_capone	And as a reminder, if you aren't a free "no barriers' member of The AFA-there is no time like the present. Go to www.theafa.org and join right now. You'll be glad you did.
deb_capone	Thanks again, Dr. Ringler....and good night to all of our guests!
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gringler	Have a good evening everyone....dinner time here in Los Angeles...
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smiley	wow! what an awesome session! will definately be back next week! thanks everyone!
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loisbarrett	good evening.
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liz	wow that was awsome
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loisbarrett	indeed.
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liz	hit the wrong button
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No Holds Barred: All Fertility Questions Answered

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