Optimizing IVF

October 24, 2006 - Tuesday
3:45 PM to (EST)
Guest Speakers: Meike Uhler, MD
Fertility Center of Illinois

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

	deb joined.
deb	Good evening and welcome to tonight's Online Education Session, hosted by The American Fertility Association and sponsored by Fertility Lifelines.
deb	We will be starting at 8pm Eastern and ending promptly at 9pm.
deb	I am Deb Capone and I am the moderator for tonight's session. If you need to 'speak' with me privately, you can simply double click on my name in the left hand column to be connected directly to me.
	Luly joined.
deb	Tonight we welcome Dr. Meike Uhler from Fertility Centers of Illinois. Dr. Uhler is board certified in both obstetrics and reproductive endocrinology and infertility. She completeed her residency in ob/gyn at Northwestern University followed by a fellowshop in Reproductive Endocrinology and infertility at the University of California, Los Angeles. Her research interests and scientific publications focus on the evaluation and treatment of male and female infertility.
deb	Dr. Uhler will be talking about ways to optimize IVF.
deb	Hi, Luly.
Luly	Hello Deb
deb	how are you tonight?
Luly	Doing well thank you - anfd you?
deb	Great. We are waiting for Dr. Uhler. You might have her all to yourself!
Luly	well I usually just sit back and observe so if that is the case we can cut her lose
	Dr._Uhler joined.
Luly	I don't really have many questions
deb	Hi, Dr. Uhler!
deb	We have a few minutes before we start. Thanks for joining us tonight.
Dr._Uhler	Hi, Deb
Dr._Uhler	Deb, it's my pleasure to be with you and AFA.
deb	We couldn't do it without you. How's the weather in Chicago?
Dr._Uhler	Cold about 40 degrees and of course, windy.
deb	Dr. Uhler, can you tell us what you mean by 'optimizing IVF'
	stephndoug joined.
Dr._Uhler	Many patients are turning to IVF for their infertility treatment due to its excellent success rates but not everyone gets pregnant on the first cycle. I see many patients for second opinion or to review their previous cycles. There is a lot involved in IVF so it's a good idea to review in detail with your doctor.
deb	how many cycles are too many?
Luly	Is there anything that is different in terms of preparation between regular IVF or donor egg IVF?
deb	Welcome, Stephndoug. We are happy to have you here. Please feel free to jump in at any time with a question for Dr. Uhler.
Dr._Uhler	Tha't s good question and it depends on the patient. In Illinois, it is a mandated state coverage for infertility so patients who have coverage are maxed at lifetime of 4 retrievals. However, many patients will stop before 4 cycles depending on the reason for failure such as poor oocyte quantity or quality.
Dr._Uhler	Luly, the prep for IVF and donor oocyte is very different because the in the donor cycle, the recipient is not being stimulated. Do youhave a specific question?
Luly	I am the receipient of a donor cycle and really wonder if there is anything special that I need to do to prepare for a good transfer and a succesful pregnancy. This would be my first cycle.
stephndoug	Dr. Uhler, I am 43 and my husband is 46. We are just starting out-after unsuccessfully trying to get pregnant. We don't even know what we don't know. What questions should I ask the RE?
Dr._Uhler	The usual protocol for a recipient is lupron followed by graduated doses of estrogen and progesterone to build up the lining to be ready for the embryo transfer. It is important that your lining looks good on ultrasound prior to the transfer.
	wannababy joined.
deb	Great to have you, wannababy. Jump on in...anytime!
Dr._Uhler	It is most important for you to ask your REI doctor what is the best approach for achieving pregnancy since you are 43. It would help you to be aggressive in your treatment.
wannababy	We are on our third cycle-and are pretty much willing to try anything. What do you think about some of the alternative treatments for fertility-like accupuncture, diet, massage, etc.
stephndoug	Is 43 really that old-for a baby. I thought women were having babies into their 50s!
Dr._Uhler	stephndoug: 43 is not too old for a baby. Those women having babies in their 50s were using donor oocyte.
stephndoug	can you explain what that is?
Dr._Uhler	wannababy: there are 3 very good studies on acupuncture and IVF which appeared in Fertility & Sterility 5/06 issue , 2 showing benefit and 1 equivocal specifically with IVF. I recommended it because I think it certainly will not hurt youa and it may help you if it decreases stress. Also massage and yoga have been suggested for alt treatments as well but not too many studies on it.
	mrswoodigit joined.
Dr._Uhler	Donor oocyte is the process of selecting a donor, usually between ages 21-30 who will undergo stimulation, retrieve her eggs and put together in the lab with your husband's sperm, and the embryos will be transferred to you. In our lab, it has an 80% success rate.
deb	welcome, Mrswoodigit. We are talking with Dr. Uhler from Fertility Centers of Illinois about optimizing IVF.
deb	Dr. Ulher, is that an 80% successful tranfer rate?
Dr._Uhler	80% preg rate per transfer
deb	Thanks for clarifying.
stephndoug	does it make sense, given my age, to cut to the chase and go the donor route. We have limited resources---and really want a baby!
wannababy	I have PCOS and I have been reading a lot about the relationship of diet to PCO and pregnancy. Will changing my diet help?
Dr._Uhler	At age 43, you would have a 15% chance of preg per transfer with IVF and an 80% chance of pregnancy per transfer with a donor cycle.
Dr._Uhler	Dieting will absolutely help with PCOS. As little as 5% loss in body wt could help you cycle regularly.
deb	Dr. Uhler, you mentioned earlier that you see a lot of patients for a second opinion or to review previous cycles-and that there is a lot involved in IVF. What kinds of questions should we be asking our REs after one, two or even three cycles?
deb	We have a lot of folks in these sessions that are frustrated and anxious because they don't know aht to do next or what to expect.
Dr._Uhler	Good questions. A lot can be learned for the first IVF cycle. Particularly a change in the stimulation protocol could be helpful, considering PGD may be an option and moving on to donor oocyte should be addressed if the problem is with the eggs. The most important thing is to choose an REI doctor you trust and with whom you explains the situation, alternative suggestions in a manner which is understandable.
stephndoug	What is PGD?
Dr._Uhler	Preimplantation genetic diagnosis. It is the ability to biopsy embryos for chromosomes to make sure they are normal prior to embryo transfer.
stephndoug	I feel that I am learning an entirely new language.....who knew having a baby could be so complicated ::mad
deb	Stephndoug, there is a lot of great information on The AFA's website. Just go to www.theafa.org and sign up as a free "No Barriers" member and you will be up to speed in no time.
Dr._Uhler	I know but your healthcare providers will guide you every step of the way.
deb	We are talking with Dr. Meike Uhler from Fertility Centers of Illinois about optimizing IVF. Please feel free to jump in with your questions.
deb	Dr. Ulher, what would trigger an RE to do PGD?
Dr._Uhler	The most common indications for PGD are: 1. Advanced maternal age, usually 38 years or higher 2. recurrent miscarriage 3. previous failed IVF cycles 4. severe male factor
deb	Ok, I get the first three...can you talk about "severe male factor"
Dr._Uhler	In cases of very low sperm counts, chromosome abnormality may play a role so it is possible to determine that the Y chromosome of the embryo is normal.
deb	Dr. Uhler, this has been a great session and we thank you.
Dr._Uhler	You've been asking excellent questions.
deb	We can take a few more questions.
deb	Dr. Uhler, to close our session, can you give us some basic advice on optimizing ivf.
deb	As a reminder, we will NOT be having a session next Tuesday, October 31st. Our sessions will resume with Dr. Uhler's colleague Dr. Kevin Lederer. Pleaes join us.
Dr._Uhler	Yes, make sure the right stimulation protocol is chosen, go to a reliable IVF program with good success rates, make sure the REI doctors take the time to explalin all the statistics, make sure the nurses are knowledgeable and can guide you every step of the way.
deb	The American Fertility Association is about YOU-our members and serving your needs. Please let us know how we are doing. Your feedback is so important.
deb	Dr. Uhler are there any resources that you could recommend to our audience tonight?
	stephndoug left.
Dr._Uhler	Yes, our own website, fcionline.com is helpful as well as pgdcenter.com for further information about PGD.
deb	Thank you so much, Dr. Uhler. We are so grateful to have you available to answer our questions and provide support. Sometimes we get so bogged down in the protocols and technology we forget that we can ASK our doctors and the nurses in the office to really TALK to you. I think your patients are lucky to have you!
deb	oops, talk to us!
Dr._Uhler	You are very welcome. I had a good time answering questions.
	wannababy left.
deb	I am glad...make sure you tell Dr. Lederer how much fun it is!!!
Dr._Uhler	Could you let people know when his session is?
deb	Good night everyone....we will see you back here on Nov. 7th at 8pm Eastern. With Dr. Kevin Lederer, from Fertility Centers of Illinois!
	Dr._Uhler left.
	deb left.
	Luly left.
	mrswoodigit left.

Optimizing IVF

Categories

Chat Archives