Preimplantation Genetics

May 11, 2005 - Wednesday
2:05 PM to 3:05 PM (EST)
Guest Speakers: William G. Kearns, MD, Director Shady Grove Center for Preimplantation Genetics

Categories
Donor Egg • IVF • Male Factor • Miscarriage • PGD

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susannealia	hallo - is anyone online for the PGD chat?
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Lisa_Rosenthal	Hi Susanna, yes we are here!
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Lisa_Rosenthal	Welcome to Dr. Kearns, thanks for joining us this evening...
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Stephen	Hi Doctor, how is male factor indicated in pgd?
Dr_Kearns	Susannealia, you should have at least 4 cells in the embryo to biopsy.
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Lisa_Rosenthal	Thanks to all of you for joining us this evening... Please feel free to post questions for Dr. Kearns.
Dr_Kearns	We monitor embryo quality in regards to cell number, etc
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sganson	Type hereI just had my first PGD ivf cycle and out of 6 fertilized eggs I got only one mormal embryo. Could this be the reason for all my past four to date miscarriages?
Dr_Kearns	Stephen, PGD for severe male factor is suggested. This is primarily based upon sperm concentration.
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Franny44	Is maternal fetal age a reason for pgd, even if fsh is low?
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Isabel	Hi Lisa
Dr_Kearns	Franny, maternal age is an indication for aneuploidy screening. However, not the only indication.
Lisa_Rosenthal	Hi Isabel and everyone. Thanks for joining us this evening.
sganson	My husband has been told to have a sperm integrity and sperm antibody test even though we are getting pregnant why?
Dr_Kearns	Sganson, What type of PGD?
Dr_Kearns	sganson, i respectfully disagree.
newdoc999	Hi Dr. Kearns: I recently underwent an IVF cycle with PGD for gender given a high risk of autism in my family and its higher risk in males. I had six of seven high grade embryos, all of which were 8 cells except for 1 4 cell at time of biopsy. After biopsy, four male embryos failed to progress at all and weren't freezable and the three female embryos that were transferred failed to result in a pregnancy. The embryologist (not the person who did the PGD) said acid tyrodes were used which I guess can be controversial. In any case, I now feel like this technology is too damaging to the embryos. What is your experience in this regard? The PGD lab says their efficacy rate is only 1 % embryo demise. I h
sganson	It was through ny fertility and they did # 11, 21 x, y, and I believe one other I am not quite sure. It seems they didn't test the usual 7 or 9 whihc is frustrating.
Dr_Kearns	newdoc999, we estimate the risk of damaging the embryo to be approximately 1%.
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Dr_Kearns	For aneuploidy screening, one should screen for at least 10 chromosmes. If not, a high percentage of abnormal embryos are missed.
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.
sganson	Can I conclude that if I make 1 normal embryo per six eggs that if I had a better stim cycle I would have had more normal from a larger sample size. If you make normal embryos can I conclude that I don't need a donor egg. When do you know if you need a donor egg?
localhost	[2009] touser Please feel free to post questions for Dr. Kearns. 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.
newdoc999	So what do you make of the experience I just had? The embryologist was impressed by the damaged appearance of the embryos post-biopsy. Was this just a total fluke? The ART Center in Beverly Hills is supposed to be among the most experienced in PGD around but this was just disasterous for me and I can't imagine doing it again to my embryos unless I can be assured that something would go differently.
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Brenna	Am I too late?
Katienic	My husband was a former cancer patient, his cancer was retinoblastoma, which I believe is something PGD can screen for. Due to severe male factor, we're already doing IVF./ICSI. Should we do PGD as well?
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Dr_Kearns	sganson, one can't predict from one cycle. you must screen for more chromosomes.
Lisa_Rosenthal	Hi Brenna, not at all. Please feel free to post questions for Dr. Kearns.
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Lisa_Rosenthal	Welcome Z, thanks for joining us this evening.
sganson	What are the 10 chromosomes to be tested exactly? I will be doing it agian if this cycle fails.
localhost	[2009] touser The American Fertility Association has free membership! Please go online and you will have access to all our publications at "No Barriers".
z	Thanks for providing us with all those important sessions
Dr_Kearns	newdoc, are they telling you that the acid tyrodes damaged the embryo? perhaps they had genetic abnormalities.
cath	What is happening to ensure success at Shady Grove of healthy babies?
Dr_Kearns	sganson, 13, 14, 15, 16, 17, 18, 21, 22 x and y. very soon we'll be able to screen for all chromosomes.
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Dee_Dee	Hello?
Dr_Kearns	cath, please explain your question.
sganson	What percentage of miscarriages are chromosomal abnormalities?
Dr_Kearns	sganson, approximately 50% of first trimester losses
newdoc999	No the embryos were all either normal male or normal female with no aneuploidy on 13, 18, 21, or sex chromosomes. The embryologist noted the steep change between day 3 pre and post-bx and mentioned the controversy about the tyrodes though I know ART strongly believes they are fine. NewDoc
cath	You worked at Shady Grove, I had an IVF and failed and am over 40 would I have more success with egg donor. I had a stilborn baby with congential heart defect? Can anything you offer at Shady Grove help me? Coming back to Shady Grove.
Lisa_Rosenthal	Hi Dee Dee, thanks for joining us this evening. Did you have a question for Dr. Kearns?
sganson	How does pgd help with implantation failure? I get the PGD for miscarriages, but not failed ivf cycles.
Dr_Kearns	newdoc, we'll do approximately 1200 cases this year. the largest ivf centers in the country send us their cases. several use acid with no detrimental affect
Blair	Dr. Kearns, where are you affiliated?
Dr_Kearns	cath, aneuploidy screening for women over 40 will decrease your miscarriage rate by 33%.
Lisa_Rosenthal	Dr. Kearns, can you post your phone number and affiliation for those people who may be interested in reaching you?
Dee_Dee	Is it a good idea to have an amimo centis if one is going to use a donor egg?
sganson	Are you familiar with St. Barnabas in n.j. I live in ny and all labs in manhatten send out to nj for pgd?
localhost	[2009] touser Please feel free to post questions for Dr. Kearns. 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_Kearns	sganson, chromosome abnormalities likey contribute to implantation failure...due to gene imbalances, etc.
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Dr_Kearns	whew .... i can't type this fase
Dr_Kearns	haha
Libby	Hi, can I ask questions about pgd?
Lisa_Rosenthal	Libby, please post questions....
sganson	Any body out there have repeated miscarriages with normal pgd tested embryos?
Lisa_Rosenthal	Dr. Kearns, you are doing so, so, well!! You are just a popular guy... LOL
Dr_Kearns	blair, i'm the director of genetics for shady grove fertility . we're in the washington dc area. we're the largets ivf medical practice in the country.
localhost	[2009] touser Please feel free to post questions for Dr. Kearns. 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.
Dee_Dee	Where do you post the question?
z	Dr. Kearns, your website pls
Dr_Kearns	de dee, i know that approximately 52% of donor egg embryos are aneuploid.
Dee_Dee	What is aneuploid?
Lisa_Rosenthal	Ladies and gentlemen, please remember that Dr. Kearns, as wonderful as he is, is still ONE person. Remember to copy and paste your questions so that if they scroll away, you can repost them...
Dr_Kearns	www.shadygrovefertility.com or www.pgdcenter.com
Dr_Kearns	aneuploid is too many or too few chromosomes
sganson	Is it a good thing to get one normal embryo?
Cynthia	Thanks Dr Kearns, for posting your information, how long a wait to get an appointment?
Katienic	My husband was a former cancer patient, his cancer was retinoblastoma, which I know is something PGD can screen for. Due to severe male factors, we are already doing IVF with ICSI. Should we do PGD as well?
Dr_Kearns	katienic, i'd also do pgd for rb.
Dr_Kearns	sganson, it's a numbers game.
Dee_Dee	Thanks for your answer ....
Dr_Kearns	welcome
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Dee_Dee	What types of testing are recommended if one is going to use a donor egg?
sganson	That was a great answer becasue I have been saying that exact response for two years. I feel it is also trial and error with this ivf, ivig, stims, shots, etc.
Dr_Kearns	dee dee, one doesn't normally do aneuploidy screening for donor egg. just do routine blood work and leve; ii ultrasounds
Dee_Dee	thanks
Dr_Kearns	sganson, i do think the stim protocol can play a role. however, i have no data to prove it. yet .....
Lisa_Rosenthal	Dr. Kearns, we so appreciate your joining us this evening and sharing your expertise...
Katienic	If someone's clinic does not offer PGD, can that part be done separately? Can my home lab send embryos anywhere to have this done, or does it have to be an in house lab?
susannealia	hi again; at 43, we had 1 pgd=ok embryo to transfer - 3 others were chromosome abnormal + 1 downs; they also transferred 1 embryo that developed too late for pgd. The doctor has said its up to us if we do IVF ourselves or go to donor egg - but how would do we evaluate that?
Dr_Kearns	cynthia, it takes approximately 6 weeks to get an appt. perhaps sooner with cancellations.
sganson	What is the fee for PGD where you are located?
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Dr_Kearns	katienic, we do pgd for over 50 outside ivf clinics.
Libby	hi dr, what's the story with pgd and a younger patient? I'm only 27 and pgd is being recommended because I'm not responding that well to clomid.
Lisa_Rosenthal	Welcome Susan, thanks for joining us this evening...
Dr_Kearns	susanealia, at tour age pgd will decrease you miscarriage by a third
localhost	[2009] touser Please feel free to post questions for Dr. Kearns. 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_Kearns	sganson - the fee is 2000
Blair	What about sex selection?
sganson	My husband and I were tested for chromosome/ karyotype all normal. How can we have so many abnormal embrtos/
Dr_Kearns	libby, i respectfully disagree. do at least one ivf cycle first.
Lisa_Rosenthal	Where did everyone hear about tonight's online session?
Dr_Kearns	blair, we don't do sex selection for family balancing.
sganson	I was e-mailed at hotmail.
Susan	I received an e-mail from AFA
Dee_Dee	Lisa, heard about it via email
Libby	Thanks doctor, didn't make sense to me either.
Dr_Kearns	sganson, it's called gonadal mosaicism. this means abnormal sperm and / or eggs.
Lisa_Rosenthal	Thanks for the answers about where you heard, I appreciate it.
Susan	What is pgd?
Dr_Kearns	pgd is preimplantation genetic diagnosis
Susan	Thanks!
susannealia	Lisa, I heard about the session via posting on e-mail infertility newsletter
Blair	I wouldn't need sex selection for family balancing, but breast cancer is a very high risk in my family, and I would prefet not to have a daughter for that reason.
sganson	Is it true that once potentially normal embryos can become abnormal as a result of the probing of the egg during PGD and that it is not really a chromosomal abnormatlity after all , but faulty lab techs?
Katienic	Is it better to ask your doctor for PGD and have them arrange it, or to tell them you just want it done at a specific clinic, and make some arrangements yourself?
Dr_Kearns	blair, we do sex selection for medical reasons. we'd do your case .. but remember that males can also get breast cancer.
susannealia	Blair - men can also succumb to breast cancer by the way - be aware..
Dr_Kearns	excuse my typos
Lisa_Rosenthal	Dr. Kearns, you are doing a wonderul job~ please stop apologizing!! We are so pleased to have you with us this evening!!
Dr_Kearns	sganson - i totally disagree. one can't make an aneuploid embryo by biopsy.
sganson	That is good to here becasue I have been told otherwise by reputable labs.
cath	What is cutting edge at Shady Grove?
Cynthia	Dr, you are teriffic, don't worry about spelling
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Dr_Kearns	sganson, i'm biting my tongue ..... or stopping my typing finger ..
Dr_Kearns	cath, what do you mean by cutting edge at shady grove?
cath	What exciting new development in the last 6 years?
laurie	hello, i just logged on. where is shady grove, what state?
Katienic	Wash DC
susannealia	hi Dr_Kearns and De Dee, if approximately 52% of donor egg embryos are aneuploid, wouldn't it make sense to do pgd if using a donor egg? In our case we do not know if chromosomal annomalies are due to sperm or egg - if using a donor, wouldn't it make sense to still use pgd to verify in case it is the sperm that has been causing this?
Lisa_Rosenthal	sganson, a second opinion at critical points is something to seriously consider. Even highly reputable labs have different opinions. Just as highly reputable doctors do!
Lisa_Rosenthal	Hi Laurie, Shady Grove is in the Washington, DC area.
Dr_Kearns	cath, our success rate speaks for itself. we also offer a full 100% refund for shared risk patients if you don't get a healthy baby.
sganson	It seems I have been to the best according to the infertility world and am still struggling with so many issues about my own infertility. Like they say they call the student who graduates bottom in their medical class a dr..
cath	How does that work with egg donors?
laurie	i am in san diego. do you treat long distance? are you discussing donor embryos?
Dr_Kearns	sussannealia, test your husbands sperm for aneuploidy.
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Lisa_Rosenthal	Sganason, please consider calling our patient advocate, Lori Masi, at our toll free number...
Dee_Dee	What are the main birth defects that one is looking for during the preimplantation time period?
Dr_Kearns	sganson, have you been to shady grove/
localhost	[2009] touser The American Fertility Association has free membership! Please go online and you will have access to all our publications at "No Barriers".
sganson	How do you test husbands sperm for aneuiplody prior to ivf cycle when? I am confused?
Dr_Kearns	ho laurie, we do treat across the country.
Dr_Kearns	dee dee, the birth defects vary based upon the genetic issue.
sganson	Does Cornell send out to anything other than their own? Like your facility would be great!
Dr_Kearns	more typos .. geeze .. sorry
z	Dr, it's the first time I hear about pgd, & this is great info that u are sharing w/us...
susannealia	hi Doctor K and sganson, yes - is that karotyping? we did karotyping and both of us had normal results. if other test - what is that exactly?
Dr_Kearns	sganson, we do fish on the sperm
Dr_Kearns	sganson, cornell does their own
sganson	Half way done and I am thrilled to be part of this ! What is FISH? Never heard of this before.
laurie	dr. kearns, any information on donor embryos? that is my option, however, they are difficult to obtain. you have to be chosen?
Dr_Kearns	a lab technique
Katienic	Is it better to ask your doctor for PGD and have them arrange it, or to tell them you just want it done at a specific clinic, and make some arrangements yourself? I use a smaller clinic, but that is all that's available to me in terms of location and financially. They seem a little slow to the newer technologies, and might be hesitant to send us for PGD
Dr_Kearns	fish is fluorescence in situ hybridization
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localhost	[2009] touser Please feel free to post questions for Dr. Kearns. 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_Kearns	laurie, i don't understand your question
Lisa_Rosenthal	epbn, thanks for joining us this evening...
epbn	Type herehappy to be here
susannealia	hi Dr_Kearns and De Dee, if approximately 52% of donor egg embryos are aneuploid, wouldn't it make sense to do pgd if using a donor egg?
Lisa_Rosenthal	Dr. Kearns, I think that Laurie means that it's difficult to find a donor. Is that correct?
laurie	it is difficult to find 'donor embryos'
sganson	Why wouldn't you aneuploid a donor egg like it was your own.
Lori_Masi AFA_Patient_Advocate	Good Evening Ladies and Gentlemen and Dr Kearns - sorry to be so late - I got stuck at an appointment!
cath	Do you know of any overseas treatment programs.
Dr_Kearns	when you check into pgd labs ask if the director is a board certified medical geneticist
Dr_Kearns	and where they did their train ing
Brenna	What do you mean by a money back refund?
Dr_Kearns	i did my fellowship and joined the faculty at johns hopkins/
Dr_Kearns	i don't mean to impress you, i just want you to be certain a good lab is doing your testing.
nyiap	is there a reason why a particular hospital would not do PGD?
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_Kearns	nyiap, people don't do it because it's VERY DIFFICULT
sganson	Has anyone ever gotten PGD testing covered by insurance?
Katienic	Brenna - Look up shared risk, they give you so many tries with refunds based on your success.
Lisa_Rosenthal	Another good place to check is with Lori, our referrals are only to the type of people who are trained the way that Dr. Kearns has described.
Dr_Kearns	brenna - money back refund means that .. you get a healthy baby or receive all your mobey back
Dr_Kearns	whew ... tired here
epbn	Dr Kearns, thanks for being here with us, would you explain the predictive value of preimplantation genetics, in other words, what can we learn about an embryo's chances of success?
Isabel	What's the possibility of harm from PGD? Aren';t you removing cells? Any long term studies? Is this being done all over the world?
Dr_Kearns	sganson. some insurance companies cover a portion of pgd ..
sganson	Why do PGD on day three not day 5 to balst stage?
Lisa_Rosenthal	Isobel, you're quiet, quiet, quiet, and then boom.... great questions, get ready to repost if necessary.
Dr_Kearns	epbn, pgd negates the transfer of genetically abnormal embryos
Lisa_Rosenthal	Dr. Kearns, I have heard that it is good to breathe, we really won't mind waiting while you do so... You have all ready given so much information here this evening.
Katienic	Is it better to ask your doctor for PGD and have them arrange it, or to tell them you just want it done at a specific clinic, and make some arrangements yourself? I use a smaller clinic, but that is all that's available to me in terms of location and financially. They seem a little slow to the newer technologies, and might be hesitant to send us for PGD
susannealia	If opting for pgd, what info should we be sure to get as the process goes on? I was told after implantation that embryos were 7-cell division stage - yet on screen, the embryos were later stage, just 1 larger circle with fizz at edge - is that merola? Why would they have appeared different than what I was told? (I had other embryos more advanced than 7-cell, but they were aneuploid).
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Dr_Kearns	isabel, their is no late effect evidence that suggests that removing a single cell from a day-3 embryo leads to an increased incidence of major or minor malformations.
Dr_Kearns	the cells removed are all fully able to differentiate ...
Lisa_Rosenthal	For all of you here this evening, I hope that you are aware of the message boards that are answered on a daily basis by a physician. The physician answers all the questions that are posted there, please make good use of this wonderful service...
susannealia	hi Dr_Kearns and De Dee, if approximately 52% of donor egg embryos are aneuploid, wouldn't it make sense to do pgd if using a donor egg?
Dr_Kearns	katienic, some ivf clinics are slow to react to change.
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Joanna	How many babies have been born having had PGD? How old are they? Any studies following those children?
Joanna	I know that ICSI has shown some possible problems.
epbn	does PGD bring miscarriage rates down?
Dr_Kearns	sussanealia, i don't understand your question
sganson	Do you need to do assisted hatching when doing PGD/
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Dr_Kearns	susannealia, one could consider pgd for donor egg cycles. it's just noy our first choice.
Dee_Dee	Sussanealia, I believe the Doctor suggested to have the sperm donor tested for aneuploid issues first.
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Lisa_Rosenthal	Welcome Colleen, thanks for joining us this evening....
Dee_Dee	Can a bipolar condition be determined prior to birth? My father-in-law is bipolar.
Colleen	Hi, how many years has pgd been around?
Dr_Kearns	joanna, i'm on the steering comm for a world-wide group of pgd. over 6500 cases have been reported ... and it's more like over 10,000. the live-bady rate is approximately 28%
sganson	If you test the egg and sperm separately for aneuploid what does that show?
kearns	Type hereHi Bill this is your father nice job
Dr_Kearns	dee dee, we don't know the specific gene mutation for bi-polar
Dr_Kearns	so we can't do pgd
Dee_Dee	thanks
Dr_Kearns	colleen, pgd began in 1990
Lisa_Rosenthal	Dr. Kearns, we are so proud to have you here with us this evening. The information that you are giving is so valuable. For all of you, all the online sessions have transcripts posted about 5 days after they are live. Please check them out.
Lori	Hi Dr. Kearns I have done 1 ivf cycle and 1 fet, both unsucessful. Getting ready to do second ivf after removal of endometriomas on ovaries. Last ivf 6out of 6eggs fertilized, grade 1 and 8 cell stage when transferred (fresh) my age is 40, should i consider pgd testing?
Dr_Kearns	sganson, one will test the sperm separately
epbn	what is the effect of pgd on miscarriage rates?
Dr_Kearns	lori, pgd will reduce your miscarriage rate by 1 thied
cath	What about any mental illnessses? Can they be detected?
localhost	[2009] touser Please feel free to post questions for Dr. Kearns. 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_Kearns	epbn, pgd reduces the miscarriage rate by a third
epbn	that's outstanding
Dr_Kearns	cath, it depends what you mean my mental harmness. we can test for several causes of mental retardation.
susannealia	If doing pgd, what information about our results should we be sure to get, in case we look for a 2nd opinion elsewhere? (what info from previous pgd cycles would you want to know)?
Libby	How old is the oldest pgd baby and how do we know that this procedure doesn't harm them?
localhost	[2009] touser The American Fertility Association has free membership! Please go online and you will have access to all our publications at "No Barriers".
Dr_Kearns	sussannealia, get a copy of the egg sheet showing embryo development .. and the actual pgd worksgeet, report.
Dr_Kearns	if anyone wants to call me and discuss... feel free
Dee_Dee	What are the questions should one ask when using donor eggs regarding genetics? Do donor agencies need to screen better?
Dr_Kearns	the number is on my website
Lori	Does ICSI have negative results
Lisa_Rosenthal	Dr. Kearns, please post your phone number and website address here for those who want to contact you.
Dr_Kearns	dee dee .. no one screens for aneuploid eggs
Colleen	I would love to be able to call you, please post the information.
susannealia	I didn't catch the website where we should look for info on Shady clinic - can you repost that Lisa?
Dr_Kearns	www.pgdcenter.com
Dr_Kearns	301-545-1260
Blair	Dr. Kearns, if I am doing the IVF with someone else, can I still get you to do the pgd?
Dr_Kearns	yes blair
Dee_Dee	Is Cost an issue that no one screens for aneuploid eggs?
Blair	Thanks, that would be a comfort. Many programs do not consider breast cancer risk enough to do sex selection.
Dr_Kearns	dee dee, men can easily produce a sample for testing. why do a surgically invasive proceedure on you to test your eggs?
Dee_Dee	that makes sense.
Dr_Kearns	test your husbands sperm
Lisa_Rosenthal	Ladies and gentlemen, please remember that we are lucky enough to have several medical message boards where doctors answer each question daily. A big help.
Dr_Kearns
epbn	thank you for sharing your time and intelligence, very meaningful!!
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
susannealia	hi Lisa,
Dr_Kearns	time yes .. intelligence .. some may disagree haha
susannealia	hi Lisa, is there an e-mail address for the patient advocate Lori, or is she just for this hour?
z	Dr. as conclusion my question is Would you consider that a strong reason to do pgd is unscuccessful IVF cycles
Lisa_Rosenthal	Also, the way that I am honored enough to get such highly qualified speakers, such as Dr. Kearns, is by promising them that they will be off by 9 PM, sharp. That leaves us about 8 minutes. Please feel free to post questions and to follow up on the message boards.
cath	What academic research are you working on currently?
Katienic	Thank you Dr Kearns for all your help and advice...
Lisa_Rosenthal	Susannealia, Lori is available via a toll free number many hours of the day.
Dr_Kearns	research includes gene expression profiles ....
susannealia	(lisa, is an 888 number accessible from Canada)
Lori_Masi AFA_Patient_Advocate	Hi Sisammealia my e mail address is Loriattheafa@aol.com or 888-917-37777- please write or call!
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Dee_Dee	What is an (gene) expression profile?
Dr_Kearns	microarrays
Dr_Kearns	mosaicism
Lisa_Rosenthal	Thanks Lori for putting that in, susannealia, use Lori's email address if the toll free won't work.
Dr_Kearns	etc
Dee_Dee	cool
Lisa_Rosenthal	check our home page for the Connections online schedule, we have one, once a week.
Dr_Kearns	dee dee, i want to see what genes are turned on or off during embryo development
Dee_Dee	really cool
z	Lisa, and great ones" sessions"
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susannealia	thanks to all for interesting questions and answers and appropriate contact info to follow up.
Dr_Kearns	my pleasure
Lisa_Rosenthal	Thanks Z and to all of you for joining us this evening.
Lori_Masi AFA_Patient_Advocate	I would love to hear from everyone and I am a talker so I do prefer the phone to e mail but whatever you are comfortable with works for me! 888-917-3777
Lisa_Rosenthal	Dr. Kearns, you were just a pleasure, I hope that you will join us again sometime?
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Dr_Kearns	i'm happy to join you anytime
z	Thanks a lot Dr. Kearns for all the valuable info
Blair	Thanks for your help tonite
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Dr_Kearns	welcome
Libby	Lias, as usual, a great session. Thanks dr. kearns.
Dr_Kearns
Lori_Masi AFA_Patient_Advocate	Thank you Dr Kearns - I am so sorry I missed so much - but look forward to reading the transcript. Thank you so much for your time and expertise!
Lisa_Rosenthal	Libby, as usual, my pleasure, thanks for joining us!
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vseach	Thanks, Dr. Kearns. I'll be contacting you with a couple of questions!
Dr_Kearns	call anytime
Colleen	Lots to think about, thanks
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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 - LoriattheAFA@aol.com
sganson	Thank you for all your information.
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laurie	what are your hours at AFA free support?
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Dr_Kearns	excellent questions everyone
Dr_Kearns	i enjoyed it
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Lori_Masi AFA_Patient_Advocate	Laurie I am here Mon, Wed, Thur and Fri 9 am - 5pm and tues evenings from 5 - 10 pm EST
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Lori_Masi AFA_Patient_Advocate	Good Night all!
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Dr_Kearns	good night
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