PCOS: Diagnosis and Treatment

April 14, 2004 - Wednesday
2:50 PM to 3:50 PM (EST)
Guest Speakers: Ronald Feinberg, MD

Categories
Infertility • Ovulation • PCOS • Pregnancy

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Janice	Hi everyone
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localhost	[2009] touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. Ronald Feinberg, (Reproductive Associates of Delaware) and Lesa Childers, M.S.W., (CEO of PCOStrategies) joining us this evening. We will be discussing the topic of "PCOS-Diagnosis and Treatment". Dr. Feinberg and Ms. Childers will be answering general infertility questions as well. Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
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Lisa_Rosenthal	Hi everyone, thanks for joining us this evening.
Janice	Hi Lisa
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Lisa_Rosenthal	Good evening Dr. Feinberg, thanks for joining us this evening.
Dr._Feinberg	Hello everyone.
Lisa_Rosenthal	Would you give us a brief overview on PCOS? Diagnosis, treatment, symptoms?
Dr._Feinberg	Brief would be difficult. PCOS is defined in several different ways.
Lisa_Rosenthal	Welcome to tonite's chat. Polycystic ovaries is a particularly challenging, yet treatable problem for women trying to conceive. Before contemplating specific fertility treatments, however, it is important to consider the actual underlying causes. As many of you already realize, PCOS is really part of a broader "whole-body" problem which links metabolism to the reproductive system. I have named this problem 'Syndrome O', which represents a significant triad of Overnourishment, Ovarian confusion, and Ovulation disruption.
Lisa_Rosenthal	The above is a blurb that Dr. Feinberg has asked me to post.
Dr._Feinberg	When my patients are taught about the underlying issues related to polycystic ovaries, it becomes easier to partner with them in their treatment course.
Janice	Hi dr. feinberg and Lisa. my doctor is insisting that I have pcos although I have no symptoms.
Dr._Feinberg	Janice, Your doctor must have some reason to be labeling you with 'pcos'
Janice	Not blood, not symptoms, then what/
Dr._Feinberg	What was your chief reason for visiting that doctor, Janice.
orly	could you explain how metformin works?
Dr._Feinberg	Orly, metformin is a drug approved by the FDA for type 2 diabetes.
Janice	Primary infertility. no baby after 2 years. It just seems that unexplained fits better.
orly	what does that have to do with pcos?
Dr._Feinberg	Metformin (glucophage) helps the body utilize insulin more efficiently.
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localhost	[2009] touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. Ronald Feinberg, (Reproductive Associates of Delaware) and Lesa Childers, M.S.W., (CEO of PCOStrategies) joining us this evening. We will be discussing the topic of "PCOS-Diagnosis and Treatment". Dr. Feinberg and Ms. Childers will be answering general infertility questions as well. Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
Dr._Feinberg	Janice, it is hard for me to get to involved with your case, specifically, but the majority of women with pcos have irregular or absent menstrual cycles, and have a tendency towards excess male hormone production/sensitivity.
ar54	My concern is how PCOS will affect me over my whole life. I don't even want to get pregnant yet!
Dr._Feinberg	Orly, metformin is commonly prescribed to help reduce insulin production in women who are insulin overproducers.
Lisa_Rosenthal	DR. FEINBERG'S WORDS:Syndrome O could be viewed as a "sister" to Syndrome X-- the metabolic syndrome defined by insulin overproduction, insulin resistance, and high risk of diabetes and cardiovascular disease.
Dr._Feinberg	ar54, that is a reasonable concern, and you should be evaluated thoroughly for metabolic issues that could interfere with your fertility, health, metabolism, and wellbeing.
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laurajones	I have some questions about in-vitro. Are there any serious short-term side effects for the drugs used to prepare for in-vitro? Or any known long-term effects?
Dr._Feinberg	I can't ask for a show of hands, but I'd like to know how many visitors might consider themselves Overnourished?!?
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Lisa_Rosenthal	Save the date! April 25 is The National Infertility and Adoption Conference 2004 in NYC. There will be over 80 speakers, 4 sets of keynotes, and a great exhibition hall. We are also offering for the first time a free raffle. Many of the programs in the area, (RMA of NY, RMA of NJ, Sher Institutes) are donating consultations, while the pharmacies are donating as well!
wellyb	ME!!!!
Marty42	what does overnurished mean?
Dr._Feinberg	wellyb, Why do you consider yourself 'overnourished'?
wellyb	and I have difficulty loosing weight and maintaining weight loss when I do lose.
Dr._Feinberg	So it sounds like insulin is churning away in your body, wellyb?
wellyb	correct. I have insulin resistance.
Dr._Feinberg	mary42, what do you suppose overnourishment might refer to?
Dr._Feinberg	Insulin resistance/overproduction and overnourishment are like chicken versus egg. Very hard to know which comes first.
Marty42	I don't know. I was hoping to hear this information from you.
Dr._Feinberg	Marty42, You've heard of undernourishment?
Marty42	Obviously
sharon_d	Type here . Perhaps I'm arriving late, but can you tell me the link btwn overnourishment and /or insulin resistance and getting pregnant?
Dr._Feinberg	Overnourishment means that the body is taking in more calories than it actually needs on a day-to-day basis.
Lisa_Rosenthal	DR. FEINBERG'S WORDS:
Lisa_Rosenthal	Welcome to tonite's chat. Polycystic ovaries is a particularly challenging, yet treatable problem for women trying to conceive. Before contemplating specific fertility treatments, however, it is important to consider the actual underlying causes. As many of you already realize, PCOS is really part of a broader "whole-body" problem which links metabolism to the reproductive system. I have named this problem 'Syndrome O', which represents a significant triad of Overnourishment, Ovarian confusion, and Ovulation disruption. Syndrome O could be viewed as a "sister" to Syndrome X-- the metabolic syndrome defined by insulin overproduction, insulin resistance, and high risk of diabetes and card
Dr._Feinberg	Excess calories need to be processed in one way or another. Unfortunately, for most of us, that means production and storage of fat.
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Alisa	hey
Dr._Feinberg	The calories can come from carbs, proteins, or fats.
Dr._Feinberg	Overnourishment doesn't necessarily mean overeating. Many women with Syndrome O tell me that they eat very little.
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wellyb	What is the most effective way for a person with PCOS to manage their weight? I have difficulty maintaining a weight loss.
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Dr._Feinberg	Wellyb, Burning the calories is the key.
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Dr._Feinberg	Building muscle mass is key.
Ruth	how much exercise is the right amount? do I need to know my exact metabolic rate?
Dr._Feinberg	Finding the right combination of carbs, proteins, and fats for you is key. One 'diet' doesn't fit for everyone.
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Dr._Feinberg	Ruth, if you are gaining weight despite trying to 'diet', you need to exercise more.
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Dr._Feinberg	Sometimes added muscle mass from exercise slows down weight loss, but it the long run, the muscles win.
Ruth	isn't a balance between food and exercise?
Dr._Feinberg	Ruth, absolutely. Balance is key. Each person has to find their own individual balance.
Dr._Feinberg	Getting back to fertility, once insulin levels and overnourishment is controlled, the ovaries are much happier.
Dr._Feinberg	As is the uterus.
Ruth	I work out 1.5 hours a day with a trainer, eat about 1200-1500 calories a day, mainly from from protein. you can only imagine how frustrated I am. i am 35 pounds overweight
hihopes	Dr. Feinberg, my insulin levels are just barely in the "bad" range and have been diagnosed w/ PCOS. I have all of the other symptoms, except that I am an average weight. Do I need to be doing anything different than someone who has the weight problem?
Dr._Feinberg	Ruth, imagine what you would weigh if you ate more and exercised less? I know that life isn't fair.
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Dr._Feinberg	hihopes, it is impossible to really know what anyone's insulin levels are from minute to minute, hour to hour.
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wellyb	So, cardiovascular exercise, weight training and the right eating. I have found that reducing my carbohydrates will cause my menstrual cycle to return. However, I don't know that I ovulate on an unmedicated cycle. What should I do to get pregnant? I'm 37 and feel that my time is running out.
Dr._Feinberg	High fasting levels of insulin are the most ominous, in my opinion.
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Dr._Feinberg	Wellyb, at age 37 you should treat yourself to a visit to a reproductive endocrinologist who is sympathetic to pcos/syndrome o
Lisa_Rosenthal	Welcome Ms. Childers, thanks for joining us this evening. Please jump right in with any answers you may have.
lesachilders	Hello, Dr. Feinberg and Lisa. Had a little trouble getting on. But I'm here now.
hihopes	I have been on glucophage for the PCOS for about 2 years now & have had 2 IVF's that create a pregnancy only to miscarry at about 6-7 weeks, could that be causing the problem?
Dr._Feinberg	In my practice, the metabolic component is often one of several issues. A full evaluation is warranted for anyone over 35 who has been actively attempting conception for 6 months or longer.
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wellyb	I've been seeing an RE for 3 years and have had numerous Clomid cycles and one injectible cycle resulting in 4 IUIs in 3 years. I have limited access to REs in my immediate area and am unsure how to locate an RE who really understands PCOS.
Dr._Feinberg	I'd like to mention Lesa Childers as a heroic Syndrome O survivor. A chapter about her trials and tribulations is featured in my new book.
Ruth	I don't know how I could exerise anymore or eat any less and I need to lose weight.
wellyb	My current RE does not understand PCOS and I had to insist on being tested even though I exhibit numerous symptoms.
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lesachilders	Nice turn out for this chat. Congratulations to everyone who joined the chat tonight. Excellent information. I will be happy to address any lifestyle or motivational questions that might arise. Been there, done that....so to speak.
Lisa_Rosenthal	Save the date! April 25 is The National Infertility and Adoption Conference 2004 in NYC. There will be over 80 speakers, 4 sets of keynotes, and a great exhibition hall. We are also offering for the first time a free raffle. Many of the programs in the area, (RMA of NY, RMA of NJ, Sher Institutes) are donating consultations, while the pharmacies are donating as well!
sandy	Greetings - What do you think of Dr. Schoolkraft in Colorado - he claims to have a 70% success rate in IVF with people with PCO - truth or fiction?
Dr._Feinberg	wellyb, I understand your frustration. As you know, I can't delve alot further into your case specifically.
Lisa_Rosenthal	Dr. Schoolcraft's success rates are very well documented
Natalia	Hi, everybody!
Dr._Feinberg	Most women with polycystic ovaries do NOT require IVF.
Lisa_Rosenthal	Please feel free to post questions for Dr. Feinberg or Lesa Childers, M.S.W. Keep in mind that you may need to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them.
Lisa_Rosenthal	Hi Natalia, thanks for joining us...
lesachilders	Women with Syndrome O and polycystic ovaries are often some of the most fertile once their metabolic dysfunction is corrected.
sandy	What do you think of ovarion drilling
wellyb	I know and I understand and I appreciate any and all information I can get. Is there a resource available for me to locate an RE in my area that specializes in treating PCOS?
Dr._Feinberg	wellyb, try www.socrei.org
Ruth	Well, how do I lose weight? I'm exercising and eating a low carb, low calorie diet. help...
Dr._Feinberg	sandy, I have mixed opinions about ovarian drilling.
Dr._Feinberg	Ruth, do you know your BMI?
Dr._Feinberg	Ovarian drilling DOES NOT cure the metabolic problem.
Lisa_Rosenthal	DR. FEINBERG'S WORDS:
sandy	I have been told it works, others say it works because of ovarian stimulation
Lisa_Rosenthal	Welcome to tonite's chat. Polycystic ovaries is a particularly challenging, yet treatable problem for women trying to conceive. Before contemplating specific fertility treatments, however, it is important to consider the actual underlying causes. As many of you already realize, PCOS is really part of a broader "whole-body" problem which links metabolism to the reproductive system. I have named this problem 'Syndrome O', which represents a significant triad of Overnourishment, Ovarian confusion, and Ovulation disruption. Syndrome O could be viewed as a "sister" to Syndrome X-- the metabolic syndrome defined by insulin overproduction, insulin resistance, and high risk of diabetes and card
lesachilders	I had ovarian drilling during my fertility treatments. I was told by my physician that it has a 60% success rate for pregnancy afterwords. However, it did not do the trick for me right off the bat. I continued a healthy lifestyle plan and eventually was able to get pregnant. Not sure how much ovarian drilling contributed to that. Ovarian drilling can cause scar tissue.
Dr._Feinberg	Ruth, there is no standardization to how ovarian drilling is carried out.
Ruth	No, I'm five foot 4, weign 180, and am 34
Dr._Feinberg	There is the risk of destroying normal ovarian tissue.
Dr._Feinberg	Ruth, it sounds like you have a particularly stubborn metabolism. What kind of work do you do?
Frosty	How does the low carb/high protein affect overall health?cholesterol? etc
Ruth	I'm a teacher, 3rd grade
sandy	Thank you. What about metformin or letrosol for treating to lower insulin levels?
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Dr._Feinberg	Frosty, in my opinion it depends on the type of "high protein". Some proteins are healthier than others, based on the types of fats. For example, I truly believe that broiled fresh seafood is healthier than fried bacon!
Dr._Feinberg	Ruth, sounds like an active, though stressful job. Did you gain alot of weight earlier in life (i.e. as a teenager?)
Lisa_Rosenthal	Dr. Feinberg and Ms. Childers, thank you so much for joining us this evening. We really appreciate your help, advice and expertise.
lesachilders	I have helped many women with polycystic ovaries develop individualized lifestyle plans. We have a lot of success with many women becoming pregnant even without medical intervention. Don't overlook the basics -- metabolic dysfunction can most often be corrected with healthy living -- healthy diet, regular exercise and reduction in stress.
Dr._Feinberg	Ruth's problem is very interesting, however. She believes she is doing everything RIGHT!
Ruth	I was always on the high end, but when i stopped growing in height, my weight didn't stop for a while
Dr._Feinberg	Ruth, alot of us have that problem
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Lisa_Rosenthal	Dr. Feinberg and Ms. Childers, how does sleep and naps affect metabolism and PCOS?
sandy	I was fortunate enough to have PCO and have triplets - I have a daughter - what is the likelihood that she will have PCO?
Dr._Feinberg	Ruth, what do you think would happen if you added 2-3 hours/week of additional exercise?
localhost	[2009] touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. Ronald Feinberg, (Reproductive Associates of Delaware) and Lesa Childers, M.S.W., (CEO of PCOStrategies) joining us this evening. We will be discussing the topic of "PCOS-Diagnosis and Treatment". Dr. Feinberg and Ms. Childers will be answering general infertility questions as well. Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
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Lisa_Rosenthal	Please feel free to post questions for Dr. Feinberg or Lesa Childers, M.S.W. Keep in mind that you may need to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them.
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	Log on auto.log started at Wed Apr 14 17:28:16 PDT 2004
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Liz	I have always been overweight, have had two children, really want my third and all of sudden am having a problem getting pregnant. think it could be pcos?
Dr._Feinberg	I should point out that Lesa Childers initiated a program last year called SOCS--Syndrome O Coaching Services. Any of you should feel free to e-mail her individually for information: SyndromeO@aol.com
Dr._Feinberg	Patients that are committed to SOCS often make my job alot easier.
Dr._Feinberg	Polycystic ovaries and Syndrome O did not develop rapidly. Usually it occurred over a number of years, often dating back to childhood and adolescence. It takes time to gradually improve the metabolic situation. But for most women, the problem can be improved.
lesachilders	Liz -- you will need a fertility work up, but it could be polycystic ovaries. Did you have problems becoming pregnant the first two times?
Lisa_Rosenthal	Ms. Childers, could you tell us a little bit about SOCS?
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Dr._Feinberg	Please don't fall into the trap of being handed prescriptions for medications before addressing the underlying metabolic issues on your own first.
Liz	None at all
Dr._Feinberg	Liz, I see many women like yourself in my practice. How old are you?
Liz	34
Dr._Feinberg	There is certainly the possibility of age-related effects, but perhaps you've self-diagnosed the problem related to your changing metabolism.
Dr._Feinberg	As an important FYI, husbands' metabolisms change as well, and that can dramatically impact sperm production.
lesachilders	Sure, Lisa. The SOCS program was developed to help women with polycystic ovaries/Syndrome O across the country develop an individualized life management plan. My experience has been that we all have different bodies, different environments and different needs. There are basics that everyone can employ, but it is best to have a plan unique to the person.
Lisa_Rosenthal	Thanks Ms. Childers, we appreciate the information.
Lisa_Rosenthal	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.
Dr._Feinberg	Would anyone like to take a guess how many cases of 'polycystic ovaries' Stein and Leventhal first reported in 1935?
Dr._Feinberg	They were 2 Chicago gynecologists in practice for a number of years.
lesachilders	I work with women across the country -- usually by telephone conference -- develop their own plan. We begin by doing an in depth assessment which involves symptoms, treatment plans, nutritional information and exercise basics.
Stephen	My age can affect sperm production?
wellyb	I'll guess. 200?
Alisa	25?
Dr._Feinberg	Stephen, age and metabolism can both impact sperm production.
Alison	1
Dr._Feinberg	Alison, so far you are the closest.
Lisa_Rosenthal	OK, 2????
Dr._Feinberg	Drs. Stein and Leventhal first reported 7 whole cases.
Dr._Feinberg	After years in practice.
lesachilders	Through the SOCS program women everywhere can find the tools needed to overcome the challenges of metabolic dysfunction and infertility related to Syndrome O.
Dr._Feinberg	I often see 7 women/day with polycystic ovaries/Syndrome O.
Dr._Feinberg	There are probably 5-10 million women with Syndrome O in the U.S. currently, of which 1/2 to 1 million are currently having problems getting pregnant.
lesachilders	That's pretty incredible. Dr. Feinberg, why the increase in cases of polycystic ovaries...in your opinion?
Dina	Sometimes I get the feeling that PCOS is being over diagnosed like ADHD. I'm think, I ovulate, why is my physician thinking it's PCOS?
sandy	Will Dr. Lobo or others find a cure?
Dr._Feinberg	Sandy, what do you think?
Dr._Feinberg	Let's explore what has changed since 1935.
sandy	I hope so - but I have been told it is a genetic disorder at birth - no cure but only managed - agree?
Dr._Feinberg	Are Americans alot more overnourished? I would say yes.
Dr._Feinberg	Sandy, do you think you have a genetic disorder?
sandy	That is what I have been told PCO is.
Dr._Feinberg	The NIH (National Institutes of health) would like everyone to believe that PCOS is a genetic disorder. They spend millions of your dollars trying to find abnormal genes.
lesachilders	I have Syndrome O/PCO and I have incredible survivor genes. Bet you do too, Sandy.
Alison	how does one replace the nutrients that come in fruits and high carb veggies?
Dr._Feinberg	Does anyone think our genes have changed all that much since 1935?
sandy	no - what do you think is the cause if not genetic
Dr._Feinberg	Women with Syndrome O have a "clash" between their environment and their outstanding genes.
Dina	Could you respond to my question about over diagnosis?
wellyb	No, I think we have changed our diets not our genes.
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Dr._Feinberg	Dina, I missed your question earlier.
Lisa_Rosenthal	Save the date! April 25 is The National Infertility and Adoption Conference 2004 in NYC. There will be over 80 speakers, 4 sets of keynotes, and a great exhibition hall. We are also offering for the first time a free raffle. Many of the programs in the area, (RMA of NY, RMA of NJ, Sher Institutes) are donating consultations, while the pharmacies are donating as well!
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localhost	[2009] touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. Ronald Feinberg, (Reproductive Associates of Delaware) and Lesa Childers, M.S.W., (CEO of PCOStrategies) joining us this evening. We will be discussing the topic of "PCOS-Diagnosis and Treatment". Dr. Feinberg and Ms. Childers will be answering general infertility questions as well. Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
Dr._Feinberg	Women with Syndrome O have 2 sets of outstanding genes:
Dr._Feinberg	Gene set #1: Ovaries filled with lots of healthy follicles and eggs, and follicles that respond exceedingly well to insulin.
Dr._Feinberg	Genes set #2: A thrifty metabolism that generally wards off starvation.
Dr._Feinberg	Sadly, we are the most overnourished generation in the history of man and womankind.
lesachilders	I believe that there is not an overdiagnosis trend -- although it is possible to be misdiagnosed. I suspect this problem will increase as our struggle with obesity and metabolic dysfunction continues on an upward trend in this country.
Dr._Feinberg	If a woman inherited genes that allows her ovaries to work best at--pick an insulin #--2, then if her insulin runs around 10 or 15, her ovaries may not work so well.
sandy	There was a procedure for imature oocyte retrieval that I read about by Dr. Cha from Korea - any sucees?
Dr._Feinberg	It can work, but doesn't work very well.
Dr._Feinberg	We have a doctor in Delaware who has tried it about 200 times without any successes.
Stephanie	What could be the possible causes of a short follicular phase, 9 or 10 days? Would this decrease your chances of conceiving?
Dr._Feinberg	Stephanie, a shorter follicular phase might be normal.
Stephanie	So, would you expect the luteal phase to be about the same length as the follicular phase?
sandy	Would you say the answer is for women with PCO to cut down on the carbs and try to manage their weight?
Dr._Feinberg	Some women have ovulatory cycles that occur every 22-23 days. That would mean that their luteal phase is 14 days, whereas their follicular phase might only be 7-8 days.
lesachilders	Just want to make sure everyone here is aware of PCOStrategies -- www.pcostrategies.org -- you can pre-order Dr. Feinberg's excellent book there. It will arrive in late May.
wellyb	Is it more common in women with PCOS to develop follicles that mature but do not rupture?
Dr._Feinberg	Stephanie, I hate to sound corny, but it is important to consider the mind and the body. There has to be the motivation to take some personal action. It's more than just about how many carbs one eats in any given day.
Znder0	so, is it necessary to see a reproductive endocrinologist or just a really good personal trainer and nutrionist?
Dr._Feinberg	wellyb, that is a very good question. The answer is yes. Follicles sometimes can grow, but an inadequate or absent LH surge might prevent the follicles from releasing an egg (i.e. ovulation)
Dr._Feinberg	Znder, it depends.
lesachilders	Sandy, healthy diet (lower carb, healthy proteins and fats) is a good start. Regular exercise (3-5 times per week) may be even more important. Making one's health a priority is necessary.
wellyb	With diet and excercise can this problem be corrected?
Dr._Feinberg	Many of my patients have multi-faceted issues, including other problems such as male factor, tubal disease, etc.
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Alisa	I hate to think about how menopause will affect me, considering the weight issues that I battle now.
localhost	[2009] touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. Ronald Feinberg, (Reproductive Associates of Delaware) and Lesa Childers, M.S.W., (CEO of PCOStrategies) joining us this evening. We will be discussing the topic of "PCOS-Diagnosis and Treatment". Dr. Feinberg and Ms. Childers will be answering general infertility questions as well. Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
Dr._Feinberg	Tackling Syndrome O usually involves a commitment to several different avenues, including the pursuit of outstanding medical care.
Lisa_Rosenthal	The American Fertility Association has free membership! Please go online and you will have access to all our publications at "No Barriers".
Stephanie	What are the primary symptoms of PCOS? I don't know that much about it. How would it be diagnosed; which diagnostic tests should be done?
Dr._Feinberg	Lisa, Does The AFA have archived the 2-part article Lesa and I co-authored for The AFA newsletter back in 2001?
sandy	For all the women out their, I am 5'8", weigh 135ibs and BMI 21 and I have PCO - I agree that exercise and weight management is a priority but it exercise and lower weight as in my case does not make me ovulate on my own
lesachilders	Alisa -- I coach women to attempt to be as healthy as possible at whatever weight they are at. The weight will usually start a downward trend. But not all of us are going to be a BMI of 24.
Dr._Feinberg	Sandy, you raise a vital issue for the 10-20% of thinner women who also have polycystic ovaries. I would predict that you might not be insulin resistant per se, but that you might be relatively overnourished.
Lisa_Rosenthal	Dr. Feinberg, that is part of No Barriers, free online membership. It's in one of the newsletters, go and register and take a look...
Robin	Just joined in...was wondering how many embryos you reccommend replacing during the embryo transfer. My husband is very concerned that I wouldn't be able to carry twins +. I'm 5'3'', 26 years old; we're doing IVF for male factor. Do you reccomend putting back 2 embryos? Would putting back one reduce the success rates too much? How dangerous are twin pregnancies?
lesachilders	Sandy -- you are a rather thin PCO patient. I wonder, do you exercise regularly and pay attention to your carb/protein/fat ratio. It is possible to overnourished and be thin.
sandy	I am insulin resistent on a glucose tolerant test
Dr._Feinberg	Sandy, you are lucky not to accumulate alot of body fat. But thinner women with insulin-sensitive ovaries need to find their own strategies for helping their ovaries. Often, building muscle mass can help.
Dr._Feinberg	Robin, depending on the clinic you are using, one embryo might give you a reasonable chance of success. You should discuss that point specifically with your IVF doctor.
Dr._Feinberg	Sandy, what do you mean you are insulin resistant on a GTT?
sandy	I exercise about 5-7 times a week , lift weights to build mass and try to eat the right foods
Lisa_Rosenthal	Ladies and gentlemen, the way that I get such outstanding, dedicated speakers as Dr. Feinberg and Ms. Childers is to promise them that they will be done at nine pm, sharp.
Lisa_Rosenthal	Maybe if we're lucky, they will agree to come back@
Lisa_Rosenthal	!
Alison	Dr. Feinberg, where are you located?
sandy	my insulin is boarderline type 2 diabetis
Dr._Feinberg	I can stay a few extra minutes for those burning questions out there.
Lisa_Rosenthal	Dr. Feinberg, please post your phone number for those out there who may want to get in touch with you as a patient.
Dr._Feinberg	Alison, I am an RE in Delaware, at Christiana Care Medical Center in Newark.
Robin	Would I have an increased risk carrying twins because I am short? (5'3'')
Dr._Feinberg	If anyone out there is from Delaware, please say howdy!
Stephen	Yes, I would like to have Dr. Feinbergs phone number
sandy	one last question for me - will my daughter (4years old) have a good chance of having PCO
Dr._Feinberg	Robin, everyone has an increased risk with twins.
Alison	close enough
Dr._Feinberg	Twins, especially after IVF, is considered higher risk.
Dr._Feinberg	Sandy, every woman has a chance of having polycystic ovaries. I'd need to know more about her father, however.
lesachilders	Sandy, the thin PCO patient can be very frustrating. Keep up the excellent work and stay hopeful.
Lisa_Rosenthal	Robin, there are some very convincing studies that have been done recently about single embryo transfers. Dr. Gardner, out of Colorado, will be publishing a study in Fertility and Sterility in the next issue. might be worth looking at...
Dr._Feinberg	My practice is Reproductive Associates of Delaware. I have a terrific female partner named Dr. Barbara McGuirk. We can be found at www.ivf-de.org. Phone number 302-623-4242
Stephanie	Dr., what would be the possible causes/implications of a long follicular phase; 26-28 days, and then a luteal phase of 18 days? I had a cycle like this, when I was taking Gonal-F, and then inseminated on cycles days 27 and 28, because that's when the follicles were ready.
sandy	my husband is healthy, no diabetis or illness in his family - - thank you for your time.
Dr._Feinberg	Stephanie, we have seen situations like that, and pregnancies have occurred. Sometimes the follicles have a "mind of their own"
Dr._Feinberg	Women with metabolic issues have a disordered progression of follicular maturity. That can sometimes cause a very long follicular phase.
Dr._Feinberg	Also, when the 'step-up' protocol is used, the cycle may take longer, but is safer if just 1 or 2 mature follicles grow.
Alison	thanks so much Dr. Feinberg, and Lisa, of course
wellyb	Thanks Lesa, Lisa and Dr. Feinberg! I have enjoyed this so much and have learned some new things and found some new resources. I couldn't ask for anything more. I'll be emailing Lesa and looking for your book, Dr. Feinberg.
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Dr._Feinberg	Healing Syndrome O is currently listed on Amazon and B&N.com
Stephen	Dr. Feinberg, I'm going to call your practice. thanks for the help tonight, good night
Dr._Feinberg	Maybe some of you will help it rise above the one million ranking!
lesachilders	wellyb - I'll look forward to hearing from you soon. Take care...and hang in there!
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Dr._Feinberg	Hopefully, I didn't ignore anyone's burning question.
Marty42	good night
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Stephanie	Dr., what do you mean by the "step-up" protocol? Are you referring to the injectibles meds. I was on? Also, is a long follicular phase an indication of possible PCOS?
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lesachilders	I highly recommend Dr. Feinberg's book. I have the advantage of having read it already! Its so patient friendly. Buy it and tell your friends about it.
Lisa_Rosenthal	Dr. Feinberg and Ms. Childers, you both have done such an outstanding job this evening. We are so pleased to have such wonderful guests.
Dr._Feinberg	Stephanie, the 'step-up' protocol refers to using low-dose gonadotropins initially (FSH or HMG), and gradually increasing the dose to aim for just 1 or 2 follicles.
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Dr._Feinberg	Perhaps we should consider an O Rounds chat?
Janice	Doctor, thanks, you have given me a lot to think about. good night
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lesachilders	Thank you, Lisa! This is an excellent service to everyone out there dealing with infertility issues. Enjoyed the Opportunity.
Lisa_Rosenthal	Dr. Feinberg, this is something that Lesa and I can discuss.
Stephanie	Dr., thank you for answering my questions. The information is useful.
Wantababy	bye
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Dr._Feinberg	Also, everyone should visit www.pcostrategies and fill out our latest survey. The research and information is extremely important.
Lisa_Rosenthal	Thanks to everyone for joining us this evening.
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Dr._Feinberg	Lisa, thank you to you for great moderating, and all the hard work you do with The AFA.
Lisa_Rosenthal	Please remember that we have online educational sessions once a week. Check on our website, under Connections.
lesachilders	Great job, Lisa.
Lisa_Rosenthal	Dr. Feinberg and Ms. Childers, my pleasure, of course. Thanks again for your time.
Lisa_Rosenthal	Dr. Corson, thanks for joining us this evening.
Stephanie	Dr. Corson, I love your book, "Conquering Infertility." It is a great book, with alot of reallyl good information! Thanks for writing that book.
Dr._Stephen_Corson	is there a Doctor in the house?
Dr._Feinberg	Oy vey.
lesachilders	Always enjoy collaborating with The AFA. There is so much work to be done. Anyone with further questions about PCOStrategies is welcome to contact me at syndromeo@aol.com
Dr._Stephen_Corson	Lots of info
Cynthia.	Thanks to everyone.
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Lisa_Rosenthal	Dr. Corson, can I help you with something?
Liz	good night, see you next week, Lisa
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Dr._Stephen_Corson	Just catching up!
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Sybil	good night
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sandy	thank you
orly	Dr. Feinberg, do you have a waiting list at your program?
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Dr._Stephen_Corson	I was wondering if Dr. Hirschberg was here?
Ruth	Thanks, good night
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Dr._Feinberg	Orly, new patients can get seen fairly quickly. We tend to limit our practice to couples who are actively attempting conception or have suffered with miscarriages.
Lisa_Rosenthal	Dr. Corson, our online educational session was with Dr. Feinberg this evening.
Dr._Feinberg	I think at last check, Orly, the wait to get seen was about 2-3 weeks.
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orly	great, I'll give a call. thanks for letting us get to know you this evening. good night lisa
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Lisa_Rosenthal	Dr. Feinberg and Ms. Childers, I really hope that you will join us again sometime. PCOS is an issue that cannot be exhausted!!
Znder0	nite
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Dr._Feinberg	Lisa, should I turn out the lights, or will you?
Stephanie217	Good night, and thank you for your time and knowledge.
Lisa_Rosenthal	That's my job. thanks again for joining us this evening.
Alisa	good night and thank you
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Dr._Feinberg	OK, let's do this again sometime. The technology is working alot better at my end than it did in the past.
lesachilders	Lisa. Of course, I'd love to talk about a regular schedule for some chats about PCOS -- collaboration between PCOStrategies and AFA. Lets consider this further.
Dr._Feinberg	Good luck with the conference.
Lisa_Rosenthal	Again, thanks to everyone for joining us this evening, especially our wonderful speakers.
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lesachilders	Good night, Lisa.
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Lisa_Rosenthal	hope you all know about april 25?
Lisa_Rosenthal	Save the date! April 25 is The National Infertility and Adoption Conference 2004 in NYC. There will be over 80 speakers, 4 sets of keynotes, and a great exhibition hall. We are also offering for the first time a free raffle. Many of the programs in the area, (RMA of NY, RMA of NJ, Sher Institutes) are donating consultations, while the pharmacies are donating as well!
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	Log on auto.log started at Wed Apr 14 18:18:02 PDT 2004
jas	hello my wife had her second blood test and the levels increased by 43% what does that indicate?
jas	Sorry she had IVF and had a positive test
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jas	Sorry I got disconnected
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jas	Hi my wife after IVF had a positive test on Monday her Wed. teat results shoud a 43% increase of I bekieve progesterone from 261 to 391. I was wondering what the ramifications of this are. I understand that ideally the level should double...
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jas	hello mj
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mj	Hi this is my first time in an online discussion. I was diagnosed with PCOS two years ago. I could not take metaformin (stomach upset). I now take Advandia.
kostelecky	This is also my fisrt tine in an online discussion
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Lisa_Rosenthal	Hi, our online educational session was from 8-9 PM, EST. please join us next week.
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mj	Sorry. Forgot about the time difference....
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mj	Ms. Rosenthal, is there a way to see the conversation text that took place during the event? I really wanted to attend, but obviously joined too late.
sammy333	excuse me - was anyone here for tonights discussion ? If so, was there anything new that was discussed - >?
sammy333	good qustion mj - i want ed to attnd also but could not
jas	are we allowed to talk about IVF among ourselves?
sammy333	is anyone going to respong to the questions posed by mj and myself ?
jas	I was not here
jas	sorry
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sammy333	is anyone here ?
kostelecky	Is anyone doing the IVF currently
jas	sammy333 I believe there has to be a tech problem
sammy333	ya think jas ??
jas	Yes kos my wife and I
mj	I am not sure if we are allowed to talk with one another, but here goes. I just finished an IVF cycle. I got pregnant, saw a great heartbeat at 6 wks, went back two weeks later and was told the embryo died. I just had my DC Monday.
sammy333	thanks jas - i would hate to think i am being ignored
jas	well I have asked several questions over a 30 min period and got no responses
kostelecky	I just got done with my IVF and am waiting for the PG results on Monday
jas	mj I'm sorry
sammy333	im sorry MJ
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jas	my wife's PG test was positive but her results of the blood work showed 43% prog. level increase
jas	the level went from 261 to 391
sammy333	iant that a good sign ?
jas	I do not know what that means any help?
sammy333	iant = isnt
jas	I thought so but the doc wanted 50%
mj	Usually numbers should double. Not a good sign. Sorry
sammy333	oh\
mj	You are talking about hcg, right? Not sure about progesterone.
kostelecky	Well you all know my anticipation. I was bed ridden for 5 days after the IVF and felt fine. On day 6 I started feeling crampy, back ache, consti[pation and so on. My doctor says it is normal. My blood work is showing good signs. My prog is 153
jas	the resarch i did said that it could indicate twins
jas	HCG right
sammy333	wow
jas	kos sounds promising
kostelecky	Were these any of anyone elses symptoms(jas)
jas	my wifes
kostelecky	how long does the cramping and discomfort last
jas	9 months::laugh
sammy333	funny JAs
sammy333	cute
kostelecky	oh mine-Its wourth it though.
sammy333	a sense of humor is good i guess - with all the stress
sammy333	it is all worth it
jas	if you ask my mother 33 years. if I didn't ahve one i would be on a bridge
jas	have
sammy333	i can relate JAS
jas	this is our 2nd IVF and I feel it is all my fault because of my count. The guilt is tremendus
sammy333	kos it is worth it - it is
jas	ps - i can't spell
sammy333	JAS - you didnt cause it -
sammy333	you are doing fine re: spelling JAS
jas	thanks sammy I needed that
kostelecky	so much anixety-with these symptoms that I discussed above and not knowing if you are pg or not
sammy333	you are welcome - it is true
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mj	jas--My husband does not want to go through another IVF. He says the whole process and miscarriage are not worth it. I think it means we should try again, maybe better luck second time around?
sammy333	kos - just breathe -
jas	kos it was agony one day at a time...
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jas	MJ Do it
jas	Second time reslts are much higher
sammy333	is that true JAS ?
jessie	hi, am new to this chat room
jas	Yes
sammy333	hi jess
jas	hi jesse
jessie	i just had an fet on sunday
sammy333	y jas
sammy333	? jess
jas	gotta jam good luck all
jessie	i became pregnant with a fresh cycle in december but unfortunately miscarried in januarty
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sammy333	same to you
sammy333	i am sorry
kostelecky	Is there anything you can do to reduce the discomfort
cbron	Hi everyone. I missed the talk with the PCOS specialist. Anyone know if he said anything about metformin and pregnancy?
sammy333	phone bye all -
Lisa_Rosenthal	cbron, the transcript from tonight's session will be on our home page by monday
sammy333	good luck
mj	sorry jessie. I had a similar situation. It is the worst, especially since you devoted so much time and effort to get pregnant. Will try another time?
sammy333	thank you LISA
cbron	Lisa, that's great to know. Thank you. I'll check it out.
mj	Thanks Lisa!
sammy333	then can we rpint it Lisa ?
jessie	we did try again, i just had a frozen transfer on easter sunday, now all i can do is wait
jessie	and pray that it worked
sammy333	lisa -
cbron	Bye everyone. Good luck to all!
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Lisa_Rosenthal	I'm sorry that i'm only here in bits and pieces right now
Lisa_Rosenthal	the session was over an hour ago and I would have LOVED to stay and chat with you guys, but I had some other things to take care of.
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mj	You are fortunate you were able to get a frozen. Out of 12 embryos, we transferred two fresh and only one lived to be frozen. We will have to do another fresh.
jessie	it's tough, my first cycle i got nothing out of 15 eggs only 3 fertilized but non divided
jessie	so we did another cycle with different meds and got better results, 16 eggs, 11 mature, 9 fertilized to embryos
jessie	now we just put the last 3 in and are hoping that at least one takes
jessie	or we start all over again
jessie	it's so stressful
jessie	did you say before that your husband does not want to do it again
mj	Amen sister! We have only done one fresh and we are devestated emotionally and finacially. That is why hubby does not want to this again.
jessie	i understand, it's hard in every way
jessie	does your insurance cover anything
mj	Plus, my insurance only has a $25,000 life time max benefit (based out of New York, even though I live in Illinois). Now we have to save or borrow. Hubby says we should adopt--sure thing for our money. I want to keep on trying for a biological try, no matter what the cost. Crazy right?
jessie	not crazy at all
jessie	is your facility local
mj	I go to Fertility Center of Illinois, about 15-20 minutes from where I live.
jessie	i am in upstate new york and we travel to southern new jersey for ivf
jessie	it's about a 3 hour ride for us
mj	That stinks. Atleast we were close by. We had to travel up to Chicago (hour drive) for the tranfser.
jessie	but the price is right and they are very good there
jessie	i don't mind the travel
jessie	may i ask why you are seeking ivf
jessie	male factor here
mj	I have PCOS and hubby has low-count, low-motility. Double whammy.
jessie	ok, so sorry
jessie	don't give up yet
jessie	how old are you
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mj	No prob. I am 30, hubby is 29.
jessie	i am 32 and hubby is 29
mj	Did you use ICSI? I worry that is what caused our miscarriage, although the doctor swears it is not the problem.
jessie	we did it all
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jessie	icsi, assisted hatching
jessie	how far along was your pregnancy
jessie	i was 8 weeks
mj	Yeah. I know what you mean. We had assisted hatching too. We saw a beautiful heartbeat, good size at 6wks. Went back at 8wks, no heartbeat and hadn't grown much. They wanted me to miscarry naturally, but my body wouldn't let go. I had a D/C at 10wks.
jessie	sounds the same as me, had the heartbeat at 6 wks, then at 8 nothing, i had a d/c right away, they did chromosomal studies and they came back that it was a girl and she was normal, nothing wrong with her, so i don't know what went wrong
jessie	it's very upsetting
jessie	i'm just going to keep trying until it works
jessie	i have faith
mj	Waiting for a DC was cruel and unusal punishment. I wish I knew what we were having...they didn't do any chromosomal on it. I know it is upsetting. For the past two weeks I wish I could have crawled under a rock and died.
Mic	Hello, I was just watching your conversation. How many times did you attempt IVF?
jessie	i know i felt that way too
mj	Mic--Just once for me. Doc says you need to try atleast 4 times. I don't know if I can handle it, physically, emotionally and finacially. You?
jessie	i miscarried 2 days after my sisters baby shower and 2 weeks before her son was born, then my sis in law calls 2 weeks after to tell me she was preggo
jessie	ughhhh
Mic	I just thought I could give you some insight. I did IVF 7 times before I got pregnant
mj	Sending you hugs jessie. The fertile world is a hard place to live in when you are going through this.
jessie	pregnant on first successful transfer, but miscarried and i just had a frozen embryo transfer on easter sunday
jessie	really mic
jessie	wow
jessie	you are strong and determined
jessie	i will do whatever it takes
jessie	thanks mj
jessie	where do you go mic
mj	Mic--don't mean to pry, but was your pregnancy successful (carry to term/live birth)?
Mic	It was a long and expensive journey and I was determined. I just did IVF again and was successful on my 1st attempt. That makes 8 times for me. I am 11 weeks with twins.
jessie	congrats. that is wonderful
jessie	you are blessed
Mic	My first pregnancy with my 7th trial was successful. I had a son about a year again. We tried for so long and it took us many years. We decided if we were going to do it again no time like the present.
mj	Hooray! ::smile Did your insurance help cover? We are looking into that shared risk program. Have you tried that?
jessie	mic where do you go for ivf
jessie	i am in new york and go to new jersey
Mic	I know what your going through. It's really hard My insurance paid some but over the years, we have spent $50,000. That's why we could only attempt once a year. It took me 8 years until I got pregnant. I tried for 1 year before I started IVF and then it took 7 years to be successfu.
Mic	I go to Pennsylvania Reproductive Associates in Philadelphia. They are top notch. Highly rated in the nation.
jessie	i go to Cooper Center for IVF
jessie	i am pleased with them so far
mj	Mic-Do you have PCOS too? Age? Doc says I have to start trying now (30) and keep trying...not getting any younger.
Mic	We did IVF with ICSI. What is PCOS??
jessie	mic, what are you infertility issues
jessie	we are male factor
Mic	My husband is a carrier of Cystic Fibrosis and has a permanent blockage that couldn't be resolved with surgery. We were told the only way to conceive was IVF with ICSI
Mic	I am 35 now and this will be our last pregnancy. I wish we could of did more attempts early, just didn't have the money. It really drained our savings.
mj	Poly Cystic Ovarian Syndrome--It was supposed to be the topic of discussion tonight...but I joined too late. I basically produce a lot of little follicles, no mature follicles=no ovulation. It is a hormonal disorder. I have the added benefit of extra weight (causes insulin resistance), too much male hormones floating around and acne (another symptom).
jessie	you are sitll young
jessie	mic did you ever miscarry
mj	Mic, I am ready to steal from my 401k at this point. It is insane. But hearing your story gives me hope.
Mic	I think one of the things that really helped me was to stay stress free. When I became pregnant with my son it was the only time I did IVF and didn't work. I basically layed on the couch for weeks.
Lisa_Rosenthal	Ladies, we have a wonderful message board system that includes peer support and medical information. please do check them out, from our website.
Lisa_Rosenthal	like I said, I wish I could stay and talk, but I need to go. enjoy your conversation.
Lisa_Rosenthal	good night
Mic	I was pregnant with my first son with twins. The doctors detected two embryos but on the 2nd Ultrasound they only had one heartbeat.
jessie	i am taking these next 2 weeks off until the preggo test
jessie	and if this cycle doesn't work i am taking a leave of absence from work until it does
jessie	oh i'm sorry that you lost one
Mic	I really thing that's a great idea. With my current pregnancy I layed around again. I did have troubles with my first pregnancy. I was on bedrest for 6 months for bleeding
jessie	ok
jessie	what do your doctors recommend as far as rest and stuff after a transfer
Mic	I can say I know how anxious you must feel. It is one of the most stressful things you will go through. It is worth it. My doctor didn't really say not to limit activity except for a couple of days after transfer. I just decided that laying low was the best for me. I do think it really helped. I have a stressful job and a hyper personality.
jessie	i am hyper as well, and work is at a stressfull point right now
jessie	but this is soooooo important to me
jessie	so, did you quit your job
Mic	I know what you mean. I am having a little but of problems now and really have limited my activity
Mic	I am a school counselor. I did my first successful IVF over the summer. I took a sabattical this time so I wasn't working. My husband also agrees that we think the relaxation really helped.
jessie	makes sense
jessie	i have a girlfriend that left her job at the hospital and she had a successful pregnancy 2nd ivf
jessie	she basically layed around for the first 6 months
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Mic	I can say I know how you feel. I didn't go to any baby showers and stayed away from friends with children. I kept my problems private from people, so no one really knows except for my family. Although, I think people figured it out
jessie	all my friends and family know as well as my job, most are very supportive but work is the least understanding
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Mic	My boss I think was the most supportive. He is a really nice guy. I had to tell him because of missing so much work.
mj	sorry fell off here. Doing homework and flippy back to this page and lost the converstaion. Multi-tasking isn't always the best thing...
Mic	I think everyone's IVF's are different. It takes just the right amount of medication and sometimes it takes awhile to figure it out. I couldn't tell you how many medication protocols I have done.
jessie	right, that's great. my boss asks supportive but when it comes down to it she is just worried about the job getting done and when am i coming back to work, you'll never hear her say,"take as much time as you need" or "do whatever you have to"
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Summer	hi
jessie	i have faith that it will work for me it already has, i just don't kow when and will i hold on to the pregnancy
Mic	Well hang in there! Keeping positive can only help
jessie	thank you
Mic	How many did they transfer?\
jessie	3
jessie	that's all we had left
jessie	they looked good
jessie	i had a 6 cell, 8 cell and a murola
Mic	My doctors always said it not quantity it's quality. What cell division were they at transfer?
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Mic	I had four transfered and all were 8 cells.
jessie	that's great
Mic	Well... I will let you go. Good luck with everything
jessie	ok, thanks for the advice and good wishes. good luck to yo
jessie	u
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	Log stopped at Wed Apr 14 19:57:32 PDT 2004

PCOS: Diagnosis and Treatment

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