Ovulation Induction Challenges

March 17, 2005 - Thursday
2:11 PM to 3:11 PM (EST)
Guest Speakers: Serena Chen, MD, Director, Division of Reproductive Endocrinology and Infertility, Institute for Reproductive Medicine and Science at Saint Barnabas

Categories
Donor Egg • IUI • IVF • Male Factor • PCOS • PGD

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MichelleA.	hello
MichelleA.	hello
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lynn	i've heard of it
Shiann	hello Ann
ann	hello
MichelleA.	I have it =/ its a pain.
MichelleA.	hello Ann
ann	hope everyone is well tonight
lynn	hi ann
Shiann	u also
cagney	hi everyone, u too
lynn	hi cagney
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cagney	hi ya
cagney	how's everyone?
Shiann	good
Shiann	u?
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MichelleA.	good
Lisa_Rosenthal	Welcome Everyone!
MichelleA.	hello, Lisa
Lisa_Rosenthal	Thanks for joining us this evening.
Lisa_Rosenthal	Hi Michelle, good to see you.
cagney	hi lisa
Shiann	hi lisa
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cagney	fine and you?
Lisa_Rosenthal	Dr. Chen, thanks for joining us this evening!!!
lynn	good, and you?
MichelleA.	Good! Hello, Lori, Dr Chen
Shiann	Hello All
Dr_Serena_Chen	Hello Lisa, nice to be here.
Lori_Masi AFA_Patient_Advocate	Welcome Everyone! Happy St Patrick's Day!
Dr_Serena_Chen	Hello everyone
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cagney	you too, thank you
hope	how many follicles do you like to see for IUI cycles?
Dr_Serena_Chen	Hope - anywhere from 2 to 5
ann	I am getting lot of lab results. is there a site to check what is normal
cagney	what are the percentages you see with those follicles of becoming pregnant on that cycle?
MichelleA.	Are we just asking questions and you answer what you can, or is there some type of order to it?
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hope	do you ever use a combo of femara and FSH drugs?
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Dr_Serena_Chen	Dear Ann - I do not know of any specific sites, but I am sure one probably exists. You have to be aware that labs must be interpreted in your context and different labs may have different levels of "normal".
lynn	Dr. Chen, how many days are you going to put patient on bcp prior to long protocol (ivf)?
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Dr_Serena_Chen	Dear Hope: Yes, I have used Femara and FSH together. Femara is so new, it is hard to know if it is better or worse than older drugs.
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MichelleA.	Dr Chen, What is the successful rate for someone with 6 past m/c and APS (on lovenox and 81mg aspirin) when doing IVF with PGD?
cagney	dr. chen, do you have any preference on which injectables seem to work the best with pcos patients?
Dr_Serena_Chen	Dear Lynn: This depends upon her age, her diagnosis, previous response to drugs, whether or not she has pcos or endometriosis and what our lab schedule and her personal schedule is. The average is usually 3 weeks.
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Dr_Serena_Chen	Dear Michelle - The average rate post pgd is 50 to 60% but can vary quite widely depending upon previous history, other conditions, age, response to drugs and embryo quality.
3sunflower	Does the chance of multiples decrease with each injectable cycle?
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localhost	[2009] touser Please call our toll free hotline to ask our patient advocate for doctor referrals in your area. That number is: 888-917-3777 and our patient advocate is Lori Masi.
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Dr_Serena_Chen	Dear Cagney: I do not really have a preference, but I do like particular protocols. For PCOS patients, I like the long lupron protocol, usually I will use ocp prior and I usually use very low doses of mixed FSH and LH. It is also important to monitor very closely - daily ultrasounds and bloodwork, even in the beginning and to be prepared to drop the dose, or consider a freeze all.
Dr_Serena_Chen	Dear Hope: The drugs may have other effects - improving estrogen and progesterone levels, but we think most of the effect is playing the numbers game.
localhost	[2009] touser Family Matters: The National Fertility and Adoption Conference 2005 is taking place at the Grand Hyatt in New York City on April 17! Please join us for 8 keynotes, over 35 workshops, and a large exhibit hall. We are lucky enough to have the top professionals in the field, including Dr. Serena Chen!
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3sunflower	How many follicles of mature size to you consider the ideal number?
Dr_Serena_Chen	Dear Sunflower: the chance of multiples is independant for each cycle - it depends upon the estrogen level and the total number of follicles each cycle - NOT the total number of LARGE follicles, but the total number of follicles over 10mm in diameter.
stephhuck	I have low progesterone and was put on clomid, estradiol, and progesterone suppositories. I was ovulating normally according to Ovulation Kits and at 50 and 100 mg clomid I never seemed to ovulate. At 50 my progesterone level was lower (4) and at 100 went to 10. On 150mg clomid it went up to 17. Of course, still not pregnant and have taken a few month break from clomid. I'm having a Endo. biopsy at the end of the month but Dr. says I'll probably go back on Clomid. Is clomid used to raise progesterone level?
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Dr_Serena_Chen	Dear Sunflower - I would like to see 2 to 5 mature follicles.
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Dr_Serena_Chen	Dear stephhuck: Clomid can help progesterone levels, but it sounds like you should be on injectables. 150 is a bit too high a dose for someone who already ovulates. You should be seeing a reproductive endocrinologist.
localhost	[2009] touser Please feel free to post questions for Dr. Chen. You may want to save your question in a word document so that you can cut and paste it. Reposting the question is fine as the room can get quite busy.
Dr_Serena_Chen	Dear Cagney: I would really need to see the protocol. Perhaps an increase in gonadotropin dose might help, but without your records, impossible to say for sure.
Dr_Serena_Chen	Dear sunflower - usually the dose is reduced to reduce the estradiol level rise and reduce the risk for OHSS.
hope	do you ever use Femara alone in normally ovulating women with regular cycles? i'm worried about Clomid's side effects and scared to go straight to injections.
MichelleA.	Dr.Chen, thank you for your answer - What other options, if any, are there for someone that has had 6 m/c and APS, besides the IVF with PGD?
lynn	Dr. Chen, do you think on bcp for 3 weeks is going to oversuppress the ivf patient?
3sunflower	How many injectables/IUI cycles would you do before moving on to IVF?
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Dr_Serena_Chen	Dear hope: Femara might be a reasonable compromise in that case. I would use the lowest dose. However, there is very little data on using Femara in this situation.
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Vicky	Good evening.
cagney	dr chen, do you have any reccomendations for a pcos patiet to reduce their risk of miscarriage
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lynn	Dr. Chen, what patient do you recommend for laminaria
Lisa_Rosenthal	Good evening to everyone. Thanks for joining us to speak with Dr. Serena Chen. We are so pleased to have her with us this evening answering questions.
localhost	[2009] touser Please feel free to post questions for Dr. Chen. You may want to save your question in a word document so that you can cut and paste it. Reposting the question is fine as the room can get quite busy.
Dr_Serena_Chen	Dear Michelle: Hard to say. Assuming you have had a very thorough evaluation, there are not really any other treatment options. Recurrent miscarriage is still a medical mystery in many ways.
hope	what are the typical sperm recovery rates for IUI in your lab? -- my local RE only gets 10%
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Dr_Serena_Chen	Dear lynn: 3 weeks should not. There are some low responders who may get suppressed but if you are a low responder, you should probably not be on a lupron down regulation protocol anyway.
localhost	[2009] touser Family Matters: The National Fertility and Adoption Conference 2005--- April 17 in NYC--- over 80 professionals in the field, 40 workshops, 8 keynotes, exhibit hall--- lower price of admission this year! Check it out on our home page....
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Dr_Serena_Chen	Dear sunflower: anywhere from 1 to 4 cycles depending upon your age - the older you are the more quickly you should move to ivf and depending upon your response - a very low or very high response should move to ivf more quickly than a middle of the road response.
lynn	Dr. Chen, do you recommend growth hormone (saizem) to increase egg quality during ivf?
Jenni	How does your program monitor a clomid cycle?
hope	can 'out of town' patients choose the Antagon protocol for convenience?
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Dr_Serena_Chen	Dear cagney: We do not have a lot of good recommendations. We have a suspicion that pcos patients might have increased rates of chromosomal mistakes in the embryos (aneuploidy) and are undertaking a study on that right now. There are numerous theories, but no real answers at this time. One thing to be careful of is diabetes or prediabetes - this is something that occurs much earlier and more often in pcos patients. All pcos patients should have a 2 hour glucose tolerance test with insulin levels, not just a fasting blood sugar.
Dr_Serena_Chen	Dear Cagney: There is not enough data to demonstrate that metformin can reduce miscarriage risk - more studies need to be done.
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delgrec	Is the miscarriage rate higher in IVF pregnancies and what is the percentage?
Dr_Serena_Chen	Dear lynn: depends upon what you are trying to accomplish.
localhost	[2009] touser Family Matters: The National Fertility and Adoption Conference 2005 is taking place at the Grand Hyatt in New York City on April 17! Please join us for 8 keynotes, over 35 workshops, and a large exhibit hall. We are lucky enough to have the top professionals in the field, including Dr. Serena Chen!
cagney	dr chen, thank you so much, have a great night everyone!
lynn	Dr. Chen, do you recommend rFSH only in long protocol?
Dr_Serena_Chen	Dear hope: We expect to recover 50% of the sperm. Some recovery is higher some lower due to individual patient or sample characteristics.
Lori_Masi AFA_Patient_Advocate	Don’t Forget to please call the AFA Toll Free Support/Referral Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Dr_Serena_Chen	Dear lynn: the growth hormone data has been disappointing. There is no clear benefit and the cost is enormous.
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KLS	Dr. Chen, thank you for your time tonight. Question when do you rule out IUI ? I will be 42 and I have had two successful IUIs. One at 36 and one at 40. Is IVF necessary? I have not been the best responder to injectibles..
localhost	[2009] touser Please feel free to post questions for Dr. Chen. You may want to save your question in a word document so that you can cut and paste it. Reposting the question is fine as the room can get quite busy.
Dr_Serena_Chen	Dear Jenni: We check an ultrasound and blood hormone levels on day 3, then repeat on day 10, then again every 1-2 days until you are ready for hcg or you have a surge. Once you have the IUI, then we check a progesterone level a few days later and a blood pregnancy test 2 weeks later.
localhost	[2009] touser Family Matters: The National Fertility and Adoption Conference 2005--- April 17 in NYC--- over 80 professionals in the field, 40 workshops, 8 keynotes, exhibit hall--- lower price of admission this year! Check it out on our home page....
Dr_Serena_Chen	Dear Sandy: Our phone number is 973 322 8286. Our web site is www.sbivf.com and www.serenachen.yourmd.com. We also invite you to visit our message board at www.sbivf.com
Grebena	Dear Dr. Chen, Goodevening! I am 45 years young, as is my husband. After 3 IVF, and 3 IUI, my husband and I conceived a beautiful healthy son. He is now 33 months and a joy! We all would like for him to have a sibling, and so far we have tried 7 IUI’s resulting in one pregnancy—which ended with no heartbeat at 12 weeks, back in Feb 04. Do you think our chances are nill at this point with my own eggs? We still hope, realizing the statistics are very low at our age.
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Dr_Serena_Chen	Dear Hope: Out of town patients can be on any protocol. We have experience using all kinds of protocols on out of town patients. We need a good local monitoring facility to send us accurate information and most patients will stay local for the first 5 days of stim. Some high responders need to be here earlier so we can watch them more closely.
localhost	[2009] touser Family Matters: The National Fertility and Adoption Conference 2005 is taking place at the Grand Hyatt in New York City on April 17! Please join us for 8 keynotes, over 35 workshops, and a large exhibit hall. We are lucky enough to have the top professionals in the field, including Dr. Serena Chen!
Dr_Serena_Chen	Dear lynn: For younger patients rFSH only in the long protocol is fine, but many patients will do a little better with a little LH. There is no definitive study right now to answer this question for certain and treatment must be individualized.
localhost	[2009] touser Please feel free to post questions for Dr. Chen. You may want to save your question in a word document so that you can cut and paste it. Reposting the question is fine as the room can get quite busy.
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Dr_Serena_Chen	Dear KLS - IVF may not be necessary, but the problem is that the biological clock is ticking. One advantage that we have at Saint Barnabas is an extremely strong PGD program. For women over 40, this can make IVF much more advantageous than IUI - IUI will not lower the miscarriage rate. In women over 40, the miscarriage rate can be well over 50% and PGD can dramatically lower that rate, while IUI will not.
keepontrying	Hi Lisa
Grebena	Dear Dr. Chen, Goodevening! I am 45 years young, as is my husband. -- unexplained infert.--After 3 IVF, and 3 IUI, my husband and I conceived a beautiful healthy son through the last IUI cycle. He is now 33 months and a joy! We all would like for him to have a sibling, and so far we have tried 7 IUI’s resulting in one pregnancy—which ended with no heartbeat at 12 weeks, back in Feb 04. Do you think our chances are nill at this point with my own eggs? We still hope, realizing the possiblity is very low at our age.
susan	what is a PGD program exactly?
hope	would an IUI with 1 egg and 100m sperm have a good chance? would it be better with 3 eggs and just 10m sperm?
Lisa_Rosenthal	Welcome keepontrying, thanks for joining us this evening!
Dr_Serena_Chen	Dear Grebena: You would be breaking most of our rules if you conceived at 45 with your own eggs. The people who are exceptions to the rule are people who have had children before and who are very high responders to drugs. However, looking for a normal egg at this age is like trying to find a needle in a haystack and we would recommend PGD. The hard part is good PGD is not yet widely available. IUI is not unreasonable, but will not lower the miscarriage rate.
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lisaann	Dr. Chen- thank you for doing this chat. DH and I just went through our fourth IVF. We are young (I am 30, DH 34) and my dx is hypothalamic amenorrhea. I have produced a good number (11 or so) eggs each time, and we always transferred 2 or 3 back, but no implantation any time. last cycle, of 11 eggs, 4 fertilized and we did pgd- found out only one was "normal." First, what are PG rates for ET with one normal embryo? Second, would you suggest we try again if this cycle fails, again with PGD, and hope for more embryos to biopsy this time? OR should we consider moving on to donor eggs?
susan	what is PGD
Dr_Serena_Chen	Dear Lisa: Ovulation induction technically means making someone who does not ovulate, ovulate with medications. Fertility drugs or ovulation induction agents are usually used in women who already ovulate - in that case we are really "superovulating" or performing "COH - controlled ovarian hyperstimulation"
lynn	Dear Dr. Chen, I failed 2 ivfs, and then I tested negative for integrin. I have endo besides that dh and me are normal on all infertility tests. And for the failed ivfs, I had perfect response and perfect embryos, but no implanation. So how sure are you that integrin is the culprit of failed ivfs?
TRD	Dear Dr. Chen, since October I've been experiencing long cycles appx 70 days and my bbt chart is not showing ovulation. I also have low progesterone. I use Prometrium to help start my cycle. What could possibly help me to ovulate and shorten my cycles?
delgrec	Hi Dr. Chen, My RE found that my estrogen levels were elevated both times I had day 3 bloodwork done with their lab. Actually, my doctor is with IRMS. The bloodwork I had done through LabCorp indicated otherwise during a previous cycle done through my obgyn (all 3 cycles were consecutive). Why would one cycle be okay and the following two be elevated? I was told that this is a "soft sign" for diminished ovarian reserve. I am 29 and totally healthy. Can you tell me more about "diminished ovarian reserve" and what it means? Is this a progressive condition? Also, I was told my FSH levels were within normal limits. I will be starting IVF in April. We also have male factor. Any insight on this would
localhost	[2009] touser Please feel free to post questions for Dr. Chen. You may want to save your question in a word document so that you can cut and paste it. Reposting the question is fine as the room can get quite busy.
hope	what impact do thyroid autoimumme problems (e.g. AMA) have on fertility?
Lisa_Rosenthal	Dr. Chen probably had a technical difficulty and will be right back.
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Lisa_Rosenthal	Please note that the conference on April 17 has scholarships available. This conference is the largest conference of its kind in the country.
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Lisa_Rosenthal	Welcome back, Dr. Chen.
Dr_Serena_Chen	Sorry - got disconnected
Dr_Serena_Chen	Dear Hope: Better with 3 eggs and 10 million total motile sperm after the wash.
Lisa_Rosenthal	Please repost questions for Dr. Chen. Since she got bounced off, she will be unable to see what was previously posted.
MichelleA.	Welcome back
localhost	[2009] touser Family Matters: The National Fertility and Adoption Conference 2005 is taking place at the Grand Hyatt in New York City on April 17! Please join us for 8 keynotes, over 35 workshops, and a large exhibit hall. We are lucky enough to have the top professionals in the field, including Dr. Serena Chen!
susan	what is PDG?
Lori_Masi AFA_Patient_Advocate	Don’t Forget to please call the AFA Toll Free Support/Referral Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Dr_Serena_Chen	Dear lynn: it is very likely that you had integrins during your ivf cycle - the hormones given during ivf usually will correct an integrin problem. Lack of implantation during ivf is most commonly due to an embryo factor.
TRD	Dear Dr. Chen, since October 2004 I've been experiencing long cycles appx 70 days long and my bbt chart is not showing ovulation. I'm 33. I also have low progesterone. I use Prometrium to help start my cycle. What could possibly help me to ovulate and shorten my cycles?
lisaann	Dr. Chen- thank you for doing this chat. DH and I just went through our fourth IVF. We are young (I am 30, DH 34) and my dx is hypothalamic amenorrhea. I have produced a decent number (11 or so) eggs each time, and we always transferred 2 or 3 back, but no implantation any of the first three cycles. This cycle, we got 11 eggs but poor fertilization- only 4 fertilized; we found one "normal" embryo through PGD. First, what is the pregnancy rate for an embryo transfer with one "normal" embryo? And if this cycle fails, should we try again and hope for more embryos to biopsy with PGD or move on to donor eggs? Thanks again!
Lisa_Rosenthal	Susan, the short answer is that PGD is Pre-Implantation Genetic Diagnosis. Dr. Chen will explain it more fully.
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susan	thank you Lisa
delgrec	Hi Dr. Chen, My RE found that my estrogen levels were elevated both times I had day 3 bloodwork done with their lab (IRMS actually). The bloodwork I had done the cycle previousley was done through LabCorp and I was told my estrogen levels were normal. Why would one cycle be okay and the other two elevated? My RE told me this is a "soft sign" for diminished ovarian reserve. I am 29 and healthy. Can you tell me more about "diminished ovarian reserve" and what it means. Is it progressive condition? I am 29 and healthy and don't understand why this would be an issue for me. Please help shed some light!
TRD	Thank you Dr. Chen. I don't have any symptoms of PCOS and u/s shows my ovaries look amazing. I was always regular ???
localhost	[2009] touser The American Fertility Association has a set of message boards, several which are moderated by a physician daily. Please feel free to stop by and ask questions there as well! Also, "Connections" will meet every week for an online educational session. Please check the schedule on our home page.
amy	Dear Dr. Chen. I failed 2 ivfs and then tested negative for integrin. I have endo, besides that dh and me are normal on all infertility tests. And for the failed ivfs, I had perfect response to medications and perfect embryos, but no implanation. So how sure are you that integrin is the culprit of failed ivfs?
Dr_Serena_Chen	Dear lisaann: the pregnancy rate will depend upon your age, the quality of your embryos and the quality and pregnancy rates of the lab performing the ivf and pgd. The rates will vary quite widely.
Dr_Serena_Chen	Dear lisaann: Take a look at www.sbivf.com and www.serenachen.yourmd.com for more information about PGD. Given your young age, I would lean towards trying pgd first, since your window of opportunity to use donor eggs is wider than for your own eggs.
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Dr_Serena_Chen	Dear delgrec: the elevated estrogen may falsely suppress the FSH, leading to a false normal FSH, which is why it is a "soft sign" for diminished ovarian reserve. DOR is a poorly understood condition characterized by infertility, increased rates of miscarriage and poor response to fertility drugs.
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Cathy45	Hi, I'm 45 and my ob wants to try clomid. is that what you would suggest?
Dr_Serena_Chen	Dear TRD - You definitely need a full evaluation by a board certified REI.
localhost	[2009] touser Family Matters: The National Fertility and Adoption Conference 2005 is taking place at the Grand Hyatt in New York City on April 17! Please join us for 8 keynotes, over 35 workshops, and a large exhibit hall. We are lucky enough to have the top professionals in the field, including Dr. Serena Chen!
Grebena	On the protocol of 4 vials of gonal-f/ 4 vials of repronex—2x day, I would produce 18-20 follicles. Does producing this many follicles help our chances, or would you say they would most likely be not viable at my age(45). Should we devote time to donor egg in your opinion?
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3sunflower	Can you explain the difference between FSH only and FSH+LH injectables? Which ones are used for which types of patients?
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Grebena	On the protocol of 4 vials of gonal-f/ 4 vials of repronex—2x day, I would produce 18-20 follicles. Does producing this many follicles help our chances, or would you say they would most likely be not viable at my age(45). Should we devote time to donor egg in your opinion?
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delgrec	What are the success rates for IVF in those with DOR? I will be starting it in April and was surprised to hear that a characteristic of DOR is poor response to fertility drugs.
localhost	[2009] touser Family Matters: The National Fertility and Adoption Conference 2005 is taking place at the Grand Hyatt in New York City on April 17! Please join us for 8 keynotes, over 35 workshops, and a large exhibit hall. We are lucky enough to have the top professionals in the field, including Dr. Serena Chen!
TRD	Dr. Chen, why don't you use Clomid in women over 32 unless they have PCOS?
Dr_Serena_Chen	Dear Grebena: You are making an above average number of follicles, but your chances of conceiving with donor egg is still many many times higher than conceiving with your own eggs, just because of your age.
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Dr_Serena_Chen	Dear Sunflower - this is an extremely controversial topic and we do not really know the answer yet. It seems that some people have very low LH levels and will need LH. Most people have normal LH levels and do not necessarily need any LH at all. There is some newer evidence that perhaps egg development is more ideal with some LH present, although this effect seems to be more important in older than in younger (< 35yo ) women
Lisa_Rosenthal	Dr. Chen, you are doing a remarkable job answering all these questions, compassionately, thoroughly, and with such honesty. Thank you for your time and effort this evening.
localhost	[2009] touser Family Matters: The National Fertility and Adoption Conference 2005 is taking place at the Grand Hyatt in New York City on April 17! Please join us for 8 keynotes, over 35 workshops, and a large exhibit hall. We are lucky enough to have the top professionals in the field, including Dr. Serena Chen!
amy	Dear Dr. Chen, would you put a 37 year old endo patient (all other tests are normal with 15 resting follicles) on a 21 day bcp, then 12 day of lupron, then 1 repronex am and 2 gonal f pm? I think this protocol is for much younger patient.
Dr_Serena_Chen	Dear delgrec: success rates vary widely with the quality of an ivf program. In general donor egg pregnancy rates are 2 to 3 times higher than ivf rates. The national live birth rate for ovum donation cycles is about 50% with a 3 embryo transfer. At IRMS at Saint Barnabas, the rate is 65% take home baby with a 2 embryo transfer.
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Dr_Serena_Chen	Dear TRD - because it does not seem to work - there does not appear to be an improvement in pregnancy rates compared to no treatment at all.
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Dr_Serena_Chen	Dear amy: I might tend to be a bit more agressive, but that keeps my lab happy - not all labs are happy with this approach and this is definitely a team effort. My favorite starting protocol for non-pcos patients is to use a GnRH antagonist protocol using ganarelix or cetrotide and no ocp.
Lisa_Rosenthal	Ladies and Gentlemen, we are lucky enough to get such wonderful speakers by my promise that they will be able to leave on time, which is 9 PM, EST. That leaves us about 10 minutes with Dr. Chen. Please remember that we have messages boards on numerous subjects that are moderated daily by physicians. If you have questions after this session, please post on our message boards.
TRD	Dr Chen, which ovulation induction meds seem to work best for women over 33 w/o PCOS?
localhost	[2009] touser Family Matters: The National Fertility and Adoption Conference 2005 is taking place at the Grand Hyatt in New York City on April 17! Please join us for 8 keynotes, over 35 workshops, and a large exhibit hall. We are lucky enough to have the top professionals in the field, including Dr. Serena Chen!
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Dr_Serena_Chen	Dear wannabeamom - I would really need to see your records. This depends on dozens of factors - where you did your ivf, how they did your stim, what your embryo quality was, etc. The bottom line is that we recommend ivf when we feel we might be able to improve upon what was done before. If we cannot, then donor egg is often the best choice.
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Lori_Masi AFA_Patient_Advocate	Don’t Forget to please call the AFA Toll Free Support/Referral Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Leece	Dr. Chen, I am 39 with m/c first repronex try, which product would you put a 39 year old with good blood levels on?
Dr_Serena_Chen	Dear jag: After numerous OI cycles it is time to try IVF.
Dr_Serena_Chen	Dear TRD - for women with pcos, clomid is still a very good choice. If your insulin levels are high or you have glucose intolerance, metformin may be a better choice. It is possible that Femara may become useful, but there is still too little data to know at this time.
Dr_Serena_Chen	Dear Leece: It might be reasonable to use the same protocol again, since you conceived and the protocol probably had no affect on whether or not you had a miscarriage. Hopefully the miscarriage was just bad luck. If you do not succeed after 1-2 cycles, I would consider ivf.
TRD	Thank you Dr. Chen.
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Dr_Serena_Chen	Dear hope: This is a crystal ball question - probably not, but there can be enormous individual variation. It might be reasonable to have a thorough evaluation with an REI and then see what the REI says based upon your testing.
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Shiann	ty all for the information good night, take care and good luck
amy	Thank you so much Dr. Chen.
Dr_Serena_Chen	Dear hope: Then you are probably ok, but there is no way to know for certain.
MichelleA.	Thank you very much for all the information, Dr. Chen!! - your www.sbivf.com is wonderful and very helpful.
Lisa_Rosenthal	Ladies and Gentlemen, we have about 2 or 3 minutes left with Dr. Chen.
grebena	Dr. Chen--Are you saying to STOP trying with my own eggs at this point(45 yrs)?
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Dr_Serena_Chen	Dear ALL - My partners and I at IRMS at Saint Barnabas answer questions every day on our message board at www.sbivf.com. There is also a lot of information that you may find helpful on www.serenachen.yourmd.com. You are welcome to visit anytime.
amy	Dr. chen, do you recommend laminaria before ET for some patients? and what patients will have this done?
Lisa_Rosenthal	Dr. Chen, thank you so much for joining us this evening. I hope you will consider joining us again sometime!
TRD	Dr Chen, I'm 33, dh is 45, low morphology, ovulation problems, 2 m/c 7 years ago, should we try IUI or IVF?
Lori_Masi AFA_Patient_Advocate	Good Night Dr Chen - Thank You!
Dr_Serena_Chen	Dear Grebena: It is something you should consider, but you should not make a decision based upon my advice since I have not had the opportunity to review your records or examine you.
localhost	[2009] touser Family Matters: The National Fertility and Adoption Conference 2005 is taking place at the Grand Hyatt in New York City on April 17! Please join us for 8 keynotes, over 35 workshops, and a large exhibit hall. We are lucky enough to have the top professionals in the field, including Dr. Serena Chen!
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grebena	Thank you for your support Dr Chen!
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hope	thanks Dr. Chen!
Sandy	Thanks
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Marcia	Good night
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Lori_Masi AFA_Patient_Advocate	Good Night!
TRD	Thank you.
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Jenni	thanks...
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Vicky	bye lisa
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Stephen	Good night
Lisa_Rosenthal	Stephen, thanks for joining us this evening.
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Lisa_Rosenthal	Hope that you found tonight's session interesting and helpful. Do you have any ideas on session topics that you would like to see?
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