Ovulation Detection and Treatments

August 8, 2006 - Tuesday
6:38 PM to (EST)
Guest Speakers: G. Wright Bates, Jr.,M.D.
Atlanta Center for Reproductive Medicine

Categories
Fertility • Fertility Drugs • Infertility • IUI • IVF • PCOS • Pregnancy

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Dr._Bates	Hello Everyone.
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deb_capone	Good Evening Estelle61 and to all of you early birds. We will be starting in just a few minutes.
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deb_capone	Sorry about all the type...once again, technology is interesting!
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deb_capone	Of course, our guest is quite distinguished and deserving of two bios:)
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Dr._Bates	Good evening. Great question/ comment to start the evening. Timing is so crucial...not everything but important!
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Dr._Bates	I would like to start the evening with brief overview. As many of you know, up to 1/4 couples may have some difficult with fertility during their lives.
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Dr._Bates	Timing especially plays a role as many women now wait to begin their families in their late 30s or early 40s.
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Dr._Bates	The delay in trying to conceive raises the chances that a couple will need addition evaluation or treatment.
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Dr._Bates	In addition, to age, "time" is important in that correct timing of sexual relations is crucial for overall success but also to shorten the time to reach pregnancy. One study estimated that with proper timing pregnancy can be achieved in one month versus SIX months for 3 out of 4 women.
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lilliepena	hello everyone
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deb_capone	Welcome all. Thanks for joining us.
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Dr._Bates	Finally, on the TIMING theme, proper timing of intercourse also allows a woman to identify a potential problem with fertility....if she is not getting pregnant despite evidence of ovulation and well timed intercourse, she might want to seek care or testing sooner!!
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lilliepena	Good evening Dr. Bates
Dr._Bates	Welcome, again and please feel free to submit questions
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deb_capone	Our topic for tonight is New Advances in Technology for Ovulation Induction and Treatment. Our Guest is Dr. G. Wright Bates from Atlanta Reproductive Medicine.
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estelle61	I have the OV watch and it is the first day of ovulation, is this a good day to have sexual relations? Thanks.
Dr._Bates	Before we move to technology, I want to stress that simple things are also important.
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lilliepena	Dr. I have POCS I have NEVER had a regular period. The question is this. MY gyn prescibed Provera and Clomid 50mg will the OV watch help me identify my ovulation date? I am not even sure if I am ovulating when I have my period. What do you mean simple things?
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Dr._Bates	A regular predictable menstrual cycle with signs such as breast tenderness, bloating or moodiness.....predicts ovulation in most cases
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Dr._Bates	Likewise, if a womans periods are crazy....ovulation is probably not occuring each month
rmhurle	If I seem to be having sex on the correct day (14 - 15 days prior to the first day of my period), then what is preventing me from getting pregnant?
msmith	I have the OV watch and it has read not fertile for the entire month..could it really be true that I did not ovulate this month and how often does this occur?
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vadim	Dr.Bates i've miss my period for 2-3 months happen last 2 period.i'm 30 i really want to pregnant.
Tiffani	Hello Dr. Bates. I am 35 years old and I have been trying to get pregnant for almost 2 years. I have been using the OV watch for going on 3 months now with no luck so far. I have to say I am beginning to get frustrated. Should I seek fertility treatment at this time or should I contiue to use the watch for a few more months. I suspect that my timing may have been off in the months prior to the OV watch.
Dr._Bates	In addition, to ovulation, the number and function of the sperm maybe an issue. Likewise, a woman's uterus and tubes are crucial so any abnormality or blockage may make it harder to get pregnant.
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estelle61	Once you start to ovulate as shown by the OV watch, is it too late to have sexual relations to get pregnant, or should you? My periods are normal and regular.
Dr._Bates	Regarding the OVWATCH, it is one of the lastest generation of methods to detect ovulation by testing a woman's sweat or sodium chloride on the skin.
Dr._Bates	You can also test these salts in the saliva but with that method a vaginal sample is also needed. (OvuCue)
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Dr._Bates	so to answer the question of timing
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mim	I had an OV watch and found it to be inaccurate. I checked it against OV sticks, and found that the watch said I ovulated at day 14, while the sticks (and doctor's visits) said it was day 12. I returned the watch. I don't know why it didn't work.
Dr._Bates	Pregnancy can occur with intercourse 4 -5 days before ovulation but not after so Fertile days 3, 4 and day of ovulation are best
rmhurle	How many doses of clomid do you recommend to your patients?
Dr._Bates	This is also why many LH kits may not be helpful. A recent study in a major journal found that up to 1 in 5 women using LH kits may miss their ovulation
laura	If the sperm count and motility are low when and how often do you recommend intercourse.
Dr._Bates	However as someone pointed out NO method is full proof and monitoring with ultrasound and blood work by your doctor is the most accurate
tiffany	Hi everyone. Dr. Bates I have a question. I am 32 and fortunate enough to have a 22 month healthy, wonderful daughter. It took us just about 1 year to conceive her (husband and I had just embarked on some testing, all of which came back clear). Now we're trying to conceive again and it's been 6 months so far. I breast fed our daughter for a year and it took quite a while for me to menstruate again. I've been using ovulation predictor kits and timing intercourse around the positive results. However, the back half of my cycle is always shorter than 14 days, sometimes as little as 9. My OB did a biopsy which came back a bit off and then followed up with progesterone level testing, one day which was fine and the 2nd day which was low. He does not feel comfortable diagnosing me with Luteal Phase Defect but on the other hand something seems off. He recommends considering Clomid but I am very ambivalent about going on this medication. I prefer the "all natural" route but my patience is also wearing thin. Any thoughts to share about clomid in general? Any Clomid users out there care to weight in? Side effects, success rate, etc? Many thanks.
Dr._Bates	but once again, even that is not absolute as the only 100% indication of ovulation is pregnancy
Cyndi	Dr. Bates, I am currently breastfeeding, but only some of the time, in addition to my child's solid foods. Do I need to completely wean my child before I begin using the OV Watch?
Dr._Bates	that being said, if anyone is getting conflicting information ...that is a signal to me to recommend evaluation and possible treatment
vadim	Dr.Bates pls what's make my period irregular. i've been married for 6 years.i really want to pregnant
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Dr._Bates	Regarding missing periods..... after a negative pregnancy test, your doctor might want to check your thyroid or pituitary as well as ovarian function with an FSH, LH and estradiol
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Dr._Bates	The timing of intercourse BEFORE ovulation is the key. IN addition, it is very important not to abstain too long...if an man has not ejactulated in more than 7 - 10 days the quality decreases, conversely waiting 48 hours before a semen analysis or IUI is helpful so intercourse every couple of days is ok but again the key is not to get too stress and time it before ovulation
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vadim	our Dr. check my thyroid & is ok what should i do
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Dr._Bates	The diagnosis of Luteal phase defect is difficult at best. In fact, almost 1/2 of FERTILE women will have an abnormal biopsy and 1/3 fertile women will have several abnormal biopses so many experts are doing fewer endometrial biopsies. Likewise, progesterone supplementation is often a grey area but is done by most.
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Dr._Bates	Clomid and progesterone supplementation are the mainstay for treatment of a short second half of the cycle.
Jen_S	Tiffany - 6 months on Clomid with no results. I did not have any side effects, but I have heard that some have.
msmith	Again..my OV watch has read not fertile the entire month..do you think the watch is malfunctioning?
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Dr._Bates	The accuracy of any ovulation predictor may be affected by the elevated hormone levels associated with breastfeeding.
leanne	Dr. Bates have you heard about Fertiblend for women?
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tiffany	Dr. Bates - After how many "short 2nd half cycles" do you typically prescribe Clomid and progesterone supplementation? And thank you Jen for sharing your experience. I wish you all the best!
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rmhurle	Tried clomid for 3 months with no luck. I have heard success stories too though - typically the 2nd or 3rd try. How many doses do you recommend, Dr. Bates?
Dr._Bates	If someone is getting a persistent not fertile reading on the OVWatch or not showing signs of ovulation on urine sticks, I recommend seeing a women's healthcare specialist for an evaluation.
angela	dr bates, i was on clomed for 4 mos, had all kinds of mood swings, and my cycle was irregualr as well as had severe headaches, decided to stop first month stopped, used ov watch, not fertile entire month possibly from clomed?
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Dr._Bates	The length of time one should continue any treatment (clomid included) depends on several factors. Chief of which is age. In general, 3 - 6 months of Clomid with or without an IUI is the maximum before I least discuss other options.
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Dr._Bates	Many fertility specialist are using a drug called Femara or letrozole for women who do not conceive with clomid or have bad side effects. It is an off label usage but prelim data on effectiveness and safety is very good. You might want to ask your doctor about it.
leanne	Is taking metformin and clomid together have ahigher chance of conceiving
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jeanapowell	Regarding Thyriod, my doctor just had the TSH test ran. Is there any other tests you would recommend to get an accurate reading?
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Dr._Bates	If the second half of the cycle is less than 11 or 12 days, I would at least consider first confirming ovulation and then clomid or progesterone supplementation.
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laura	About 4 years ago I tried cycles on clomid with no pregnancy, 2 IVF's resulting with low egg count and no pregnancy. There is also the issue of low sperm count. Are there any new treatments?
Dr._Bates	In addition, to TSH, many routinely perform a prolactin. I also recommend checking ovarian function with an FSH, LH and estradiol...done early in the cycle.
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angela	Dr Bates, is it possible that i skip a month of ovulation? my first month i read not fertile all month last month ok, this month i am reading not fertile during what i believe to be my fertile time i am 41 so will be a late age first try for getting pregnant..also, is there truth that you should have intercourse ever other day during fertility period or 1x every 24 hrs??
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Dr._Bates	angela, absolutely,,,,many many fertile women do not ovulate every month. However, if you skipping more than a rare or occasional month I would seek care
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Dr._Bates	sorry, I missed the PCOS question...
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yurge	My ov watch showed this morning as fertile day 01, we had intercourse last night do we have to do it tonight?
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leanne	Dr. Bates i read in a magazine that a supplement drug called fertilityBlend can boost fertility is this true
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Dr._Bates	Yes, metformin regardless of size as well as weight loss and exercise if a woman is overweight increase the chances of conceiving if she has PCOS
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Dr._Bates	More evidence also suggest that metformin lowers the chance of miscarriage also
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leanne	Thanks Dr. Bates
angela	Dr. Bates if urine tests show that I am ovulating but the OV watch indicator does not show the same, what could be going on??
Dr._Bates	Yurge, If you husband has normal counts daily intercourse is fine if not or you don't know every other day is also ok...the peak fertility is fertile day 3 , 4 and day of ovulation if you are using the watch
ovwatch	There seems to be a lot of questions on OV-Watch. If you find that you need to talk with someone at OV-Watch about your specific questions, you can email me directly at jennifer@ovwatch.com. I used it myself to conceive my daughter and now I work for the company as Director of Customer Care. Dont forget that if you want to purchase an OV-Watch, you can enter code afa25 at checkout at www.ovwatch.com or by calling 877-249 baby FOR $25.00 OFF OF THE PURCHASE PRICE. valid until Aug 22, 2006 only.
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deb_capone	I am so sorry, I have been off line
Dr._Bates	Regarding PCOS.... classically, women with this condition do not ovulate and have signs of hormone imbalance.....acne and excess hair to name a few....so if you are not ovulating any method of detection with be inaccurate or indicate no ovulation. However, PCOS may cause high LH levels so the pee stick may give you a false positive
yurge	Thanks Dr Bates,
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leanne	Does metformin regulate menstruation
Dr._Bates	Tiffany....BTW congrats on your 22 month old....you must be a busy lady.
deb_capone	I wanted to remind all of you that there is a special offer from OV Watch for all of our audience. OV Watch has generously offered a discount on its product to those of you in this session. You'll get $25 off the purchase of a 2 or 3 sensor starter kit . Just go to www.ovwatch.com or call 877 249-baby. Use promo code AFA25 at www.ovwatch.com or by calling 877-249- baby
Dr._Bates	Regarding clomid.... many women have hot flashes, moodinessheadaches and stomach upset are less common. about 8 out of 100 pregnancies are twins and less than 1% of clomid pregnancies are triplets
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deb_capone	If you have specific questions about OV Watch, you can contact jennifer@ovwatch.com
yurge	Dr Bates, I had an appoin this morning for an ultrasound to check for follicles my Dr told me I have a big cyst on my left ovarie and told me we could not do the hsg shot because it will cause me to retain water, I am also taking Metformin with Clomid but I am not overweight my question is what are the percentage of my getting pregn this month.
viviane	can someone with PCOS use OV Watch????
Dr._Bates	In several studies, metformin regulates the cycle in up to 8 out of 10 women regardless of body type. Some GYNs also use it to decrease hair growth but that is more controversial... Bottom line...it increases pregnancy and loweres miscarriages for many..... initial GI upset is an issue and you need your liver and kidney checked before you start
tiffany	Thank you, Dr. Bates. It's a blessing indeed. When I get anxious/impatient about how things are going this 2nd time around, I look or think about her and it gives me a bigger/better perspective. I think she is also the reason holding out on starting Clomid b/c we know it happened naturally the 1st time. Then again it's the patience factor that get's tough - I'd rather it not take another 6mos.
viviane	if my Dr. told me to take Metformin 3 times a day, and sometimes i only take it once a day does that make a difference, I get very light headed if I take the three
Dr._Bates	Yurge, It is impossible for me to give you an accurate chance of success but the fact that you made a follice (a cyst with an egg) is encouraging and I assume you doctor was refering to hyperstimulation (OHSS) which means you responded very well...so good luck
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viviane	i am on my two week wait, I had the iui on Friday I had two follicles at 16mm the night of the hcg shot, what are my chances
Dr._Bates	viv - I prefer the Metformin XL so that my patients can take up to three tablets at one time (with dinner) MUCH less side effects so trying to remember to take a med 3 times a day is not an issue (I couldnot do it
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yurge	Yes, he was supposed to give me the shot to triger it I guess! but he decided not to because he thought the cyst was to big.
leanne	Im taking metformin ER is that the same as XL bec. im taking it 3 tab. with dinner
Dr._Bates	Sorry it is the extended release version or ER
viviane	dr. I am also taking bromocriptine 2.5mg a day, should I stop this while on the two week wait, I forgot to ask my doc
laura	If clmind and IVF treatments didn't work are there any new forms of treatments or medicine on the market?
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Dr._Bates	But do keep in mind that many dose the ER version by taking all three tablets at dinner. You can't do that with the standard release ...well you can but you will spend your evening and night sitting in the bathroom
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Dr._Bates	Parlodel or bromocryptine is managed different ways. Many stop it if pregnancy is an options, others continue it until pregnancy is confirmed, others might go longer...check with your doctor but I do not stop it until pregnacy is confirmed.
sk	laura after IVF the next step I guess its donor egg progamme...
viviane	thank you
Dr._Bates	laura and sk..... I agree, depending on the circumstances....a donor egg is often the next step when IVF fails.
viviane	2 follicles at over 17mm in each ovary, is this a good chance for the iui to work?
deb_capone	We only have Dr. Bates for a few more minutes, so if you have been lurking---the 'clock is ticking' as they say!
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sk	right now there is no medicine... 2 max 3 IVF after that go for something else,

laura	Would being diagnosed with Ulcerative Colitis play a role in ovulation/infertility?
auntiecan29	Dr. Bates - we've been ttc for 2 yrs - just finished taking round 3 of clomid with current gyn - if unsuccessful, we go to specialist. We've timed everything right for the last 3 cycles - still no luck. Have had the clomid challenge test, came back normal; sperm count is good. Could recurrent BV be part of the issue?
Dr._Bates	as follicles approach 20 mm and beyond they often have a mature egg so lets all hope this is your month!
deb_capone	Again, I want to remind you of the generous offer made by OV Watch to offer a $25 discount on their 2 or 3 sense starter kit simply by going to www.ovwatch.com or calling 877 249-baby and using AFA 25 for the discount code.
deb_capone	You can also direct any questions about ov watch to Jennifer@ovwatch.com
viviane	very much hoping , I will know on the 18th if I have a bun in the oven
deb_capone	Dr. Bates, can you please make some closing comments for our group....
zoe208	I did 4 IVF's-1 failed, 1 chem. pg, 1 miscariage-turners syndrome, and finally 1 healthy baby. Are my odds better the next time i do IVF for it to work?
deb_capone	We can't thank you enough. You have been a spectacular guest and we are indebted to you for sharing your time and expertise with us tonight.
Dr._Bates	A successful cycle predicts good things in the future. Likewise, even a miscarriage may increase subsequent chances.
viviane	yes, thanks doc, u are very informative, hope to have u again
ovwatch	If you want to talk with Dr. BAtes again, register with us at ovwatch.com for our newsletter, we will have him on again!
Dr._Bates	Thanks everyone for the great questions. I hope to have a return engagement.
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deb_capone	As a reminder, Dr. Bates will continue on this topic in an article he penned for The AFA's electronic newsletter....the newsletter is free to all "NO Barriers" members
yurge	thanks for all your answers
deb_capone	Dr. Bates, we definately want you back.....thank you so much.
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deb_capone	We are here every Tuesday night from 8pm Eastern to 9pm. Next week our guest is Joan Winograd, who will be discussing strategies to handle conflict between partners in family building options.
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deb_capone	So you all have a few resources at your disposal: the folks at OV Watch-jennifer@ovwatch.com;
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deb_capone	and don't forget to take advantage of their generous offer of the newsletter and the discount.
deb_capone	Good night all and we will 'see' you next week.
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sk	deb-capone what time will be for the carribean this 8-9pm pls?
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sk	yurge can u pls tell me about this east time.. I live in Jamaica .pls
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yurge	What time it is in Jamaica right now?
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sk	its 8 pm
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yurge	ok then I think you have to log on at 6:00 pm next time
yurge	I love Jamaica I went there on my honeymoon
sk	cause of dont understanting this east time thing I missed some other conference
sk	oh ok 6pm.... . yes jamaica its a nice place to live.
yurge	yeah I am pretty sure you have to log on 2 6:00 PM IF NOT you can always log on off and on to check
sk	I will do that.... 6pm . thanks ::smile
yurge	you welcome!
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sk	next time u come to jamaica... come to Ochorios.
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yurge	Thats what my husband and I were taking about
yurge	we want to go back in 2 years, the first time we went to Montego bay? sandals resort? was very nice
yurge	I mean to say talking
sk	if u want a nice lay back resort stay in Sans souci couples resort ... its a real nice hotel
yurge	thanks for the info
sk	or if u want a nice a small hotel just room and b/f stay in "rooms" in ochorios town
sk	any time...
yurge	nice talking to you and I hope we can talk again next tuesday
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sk	nice talking to you too.... see you again
yurge	Sk? do you have the ov watch?
sk	no not really....
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yurge	I bought it and today it showed as fertile day 01, i think is just programed to say that
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sk	i will read about it and see what is it about.
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sk	yurge... if u want u can have my yahoo id... smvillaveces@yahoo.com
yurge	are u trying to get pregnant? do you have any kids?
yurge	ok
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