Preserving Your Fertility Options

October 17, 2006 - Tuesday
3:46 PM to (EST)
Guest Speakers: Rabat Abbasi, M.D.
Columbia Fertility Associates

Categories
Donor Egg • Egg Freezing • Fertility • IUI • IVF • Male Factor • PGD

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deb	Good Evening and welcome to tonight's Online Education Session hosted by the AFA and sponsored by Serono.
deb	We will be starting in about four minutes. Thanks for waiting.
deb	I am Deb Capone and I am your moderator. You can contact me directly by double clicking on my name in the left hand column.
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deb	Tonight we are fortunate to have Dr. Rabat Abassi from Columbia Fertility Associates. She will be taking your questions and discussing what you can do to preserve your fertility options.
deb	Welcome, Dr. Abassi. Thank you for joining us tonight.
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deb	I would like Dr. Abassi to start off with some opening comments about tonight's topic and then we roll from there. Sound like a plan?
deb	glad you could join us Colleen and Christalp and poornimabs. We are happy you are here.
Dr.Abbasi	Hi Good evening. I am here!!!
deb	Thanks goodness....we thought you might be lost in cyberspace!
colleen	thanks, just dropping in to check out tonight's topic! i'm so glad you offer these forums!
poornimabs	Hello Doc, Deb & all here
Dr.Abbasi	How would you all like to proceed?
deb	This will be a good one Colleen...and keep joining us and giving us feedback. It is so important!
christalp	good evening everyone.
colleen	hi di ho!
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deb	Dr. Abassi, can you tell us what we can do to preserve our fertility options. It sometimes seems that it is the questions we don't know to ask that come back to haunt us.
deb	Welcome abour caira01.
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colleen	so true,deb, i feel like i'm a bit too old to preserve anything at this point.....39, i know it could be worse, but.....
deb	And remember you can ask Dr. Abassi your questions...so feel free to jump in.
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Dr.Abbasi	Firstly make yourselves aware that there is a sense of time. Most women forget that there is a clock. Second, educate yourselves and ask your doctor questions.
deb	Colleen, i think that lots of us in this room understand exactly what you are going thru.
Dr.Abbasi	There are several techniques to further your quest by freezing eggs and or embryos.
katie	Dr., how important is it to be precise about that 'magical' age 35? for instance if I have to schedule a 2nd IVF should I do it now, at 34 and 10 months, or can I wait until next summer?
caira01	I am 32 and find that I don't have much to preserve... but I try to let my friends know that they shouldn't wait too long. What else do they need to know?
poornimabs	My First IVF was unsuccessful in Aug , Iam about to start my next in Nov - Iam 31 yrs now
Dr.Abbasi	That depends on other factors a s well as your FSH and E2 levels. If all things are equal it will not hurt to wait.
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Dr.Abbasi	Caira01, they need to see a RE at a center that is able to offer this option.
katie	thanks. what are the other factors? Do you mean those levels right now, or as they were this past august/july when i did my first IVF?
colleen	Dr. Abbasi: i'm 39, have had 2 rounds of PGD/IVF with 4 and then 6 embies tested, all came back abnormal, but we also have a sperm problem, TESE sperm d/t radical prostatectomy. I work in healthcare using radition. I fear that radiation exposure may have hurt my eggs. 3rd IVF didn't do PGD because we had poor fert rate, only 2 embies, transferred and BFN. Looking to do another TESE within the next month.
Dr.Abbasi	All of those factors but specially the current levels/
Dr.Abbasi	colleen, it sounds like you are on the right track and several attempts are usually what patients go through. Unless they end up with donor eggs.
poornimabs	Iam planning to include Accupunture - Will that help
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Dr.Abbasi	I am abeliever in alternative methoda. Acupucture has been known to be successful.
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colleen	Hopefully egg freezing will become more readily available. When do you think it will no longer be "experimental?
poornimabs	Thanks Dr Abbasi - cross my fingers this time
Dr.Abbasi	Well that depends upon common usage and the ASRM. Many centers including ours now offer it to certain patients.
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Dr.Abbasi	No Im still here
colleen	I just wish we could educate more younger women on NOT WAITING! But then, with women taking on careers first, then a family, it's a whole new way of living!
Dr.Abbasi	Absolutely correct. Believe me that is the most important part. Public education.
poornimabs	My RE also suggested PGD - EMBRYO BIOPSY fish - how efficient is this
deb	Colleen, it is so interesting that you say that. One of The AFA's 2007 initiatives centers around doing just that!
Dr.Abbasi	Poornimabs That is the best that is available at this time.
colleen	I already know the answer is NO, but is there anything a woman can take or do, no matter what their age, to prolong some of the "good years?"
Dr.Abbasi	Not yet.
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colleen	THat's good to hear, deb.....i am already talking to women i work with and socialize with to not wait.....
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deb	Hi, amccloskey and buonconvento and kaylaunaava. Welcome. We are talking with Dr. Rabat Abassi from Columbia Fertility Associates about preserving fertility options. Feel free to jump in with your questions for her.
colleen	Do most women with no normal embryos on PGD go towards DE because of the emotional side of it all and not being able to take it anymore? Do some of them who persist EVER find a normal embie to transfer? I think i'm willing to do about 5 cycles, 3 under my belt already, but so afraid not to have a biological child, but fearful of DE too!
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Dr.Abbasi	The reason to got to DE after several PGD is either that there are no normal eggs or the exhaustion factor.
deb	Dr. Abassi, You said that your center offers egg freezing to certain patients. What would make a patient a good candidate?
Dr.Abbasi	Someone who is young with healthy ovarian function. Or a young infertility patient who has numerous eggs and want s to save some.
Dr.Abbasi	By young I mean both age wise and FSH levels.
katie	what does "moderately fragmented" eggs mean in a report on a failed ivf? will they always be bad and unfreezeable?
caira01	I know of someone who found one normal embie out of 13 through PGD and is now due in December. Sometimes you just have to get the right combination.
colleen	I think one factor that would make me pursue more PGD cycles or moving towards DE more readily would be to rule out the MF, but having a hard time convincing RE to test the sperm, like SCSA test....RE now thinks we have a sperm problem, because we ran out of epididymal sperm and had to use testicular, with the worse fert results yet! But can't convince him on the SCSA. What is your opinion about SCSA or other sperm tests? I think if i knew the sperm was really bad, we might lean towards DS instead first, d/t the cost difference.
poornimabs	my RE does not want to use the frozen embroyo - but start a new fresh cycle - Since my first cycle ended up in DNC - shoud it mean I should re-consider usinf the frozen and consider a new fresh IVF cycle
Dr.Abbasi	No not so. Fragmneted eggs maybe related to PCOS or the stimulation but certainly oyu can have subsequent cycles without fragmentation.
Dr.Abbasi	Poornimabs A fresh transfer generally has a higher success rate.
colleen	Thanks caira01...i know it can happen, i guess maybe i have to have more patience....i had 2 cycles with no pgd normals, but also had a low number of embies to test. Thanks for that encouragement
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Dr.Abbasi	Colleen, the SCSA is a good test but fgor ejaculated sperm. Sperm from TESE or PESA is already immature. Donor sperm does sound like a plausible option.
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colleen	Oh, that makes sense, no wonder my RE didn't want to do the SCSA. I wish he had just said that! Thanks....
colleen	Can fragmented eggs also be caused by the sperm?
Dr.Abbasi	Yes they can but generally more so from eggs.
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hoping	hello, 5 days post tranfer, yesterday's progesterone was 42, why would i be asked to add oral progesterone in addition to the shots?
katie	is there anything you can do to improve these frag'd eggs?
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Dr.Abbasi	In your case though it could very well be the sperm
Dr.Abbasi	Katie, trying to change the stimulation protocolis the first step.
katie	thanks!
colleen	I'm also leaning away from PGD, but RE says we are "the poster couple" for PGD? any benefit from just transferring without PGD, considering age of 39 and poor sperm?
deb	Glad you could join us hoping and only1sarah...and you to Dan! We are so fortunate to have Dr. Rabat Abassi from Columbia Fertility Associates. Please feel free to jump in at any time!
kaylalunaava	If sperm from TESE or PESA is immature, will it have a lower chance of fertililizing an egg?
Dr.Abbasi	I would hesitate re the PGD. Sounds like there ia a sperm issue and I am not sure how many embryos you will have
Dr.Abbasi	kaylalunaava Yes that is why a lot of programs have donor backup/
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colleen	I was always on the long lupron protocol with follistim starting at 450, luveris 75/day, produce 18 eggs usually with 12-15 mature. RE now suggests changing to the antagon protocol. Will i still get the same number of eggs, or should i expect to see my egg production drop. Just curious if i can expect same stim results or expect less
kaylalunaava	Thanks for clarifying that, Dr Abbasi.
poornimabs	if the embroyo does not grow in uterus after 6 wks, is it the sperm/egg quality issue
Dr.Abbasi	Colleen sounds like you are a good responder so not much should rally change. But why the change anyway?
Dr.Abbasi	poornimabs. Could be both / Or the uterus if it is that late.
colleen	RE said he might do it, not sure. He is waiting for our consult with the urologist to see if we can retrieve more epididymal sperm, and then he will make his decision. I guess i thought he was thinking a different protocol might yield better quality embryos/eggs? Will be following up with RE after that appt.
Dr.Abbasi	Ok
hoping	Dr, why would I have to add oral progesterone after my progresterone level was 42 yesterday, day 4 post tranfer?
colleen	My DH also had a spermatocele repaired at the time he had his TESE, as "long as they were in there." he originally thought it was a hydrocele, but once in there, it was a spermatocele. Do you know if a spermatocele acts the same way that a variocele does, and if so, is it possible our next TESE or MESA sperm could actually be better?
Dr.Abbasi	I don't understand,what do you mean? Were you already on?
Dr.Abbasi	Colleen yes to both questions.
hoping	yes I am on shots since the day before transfer, now adding oral p. 3 grade 5 embroys were tranferred
Dr.Abbasi	If you are taking shots that should be enough. Unless they are trying to wean you off the shots/
hoping	is there any indication of multiples with progesterone, or only with the hcg?
Dr.Abbasi	only with the hcg.
Dr.Abbasi	hcg levels you mean/
hoping	thanks
hoping	yes
JanJ	I have unexplained infertility, suspected endometriosis and am 38yrs old. My RE wants to skip the laproscopy after three attempts with clomid/IUI going to IVF. I have stopped responding to clomid, and was wondering if there were other med's to try along with IUI.
Dr.Abbasi	Only the gonadotropin injections.
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JanJ	Also, if endo is the reason preventing implantation, wouldn't that prevent implantation during IVF? Thanks.
colleen	At this point, i'm not sure if i have any implantation issue, as i've never been pg...but IN THE EVENT that they do find a PGD normal embie, or even if we opt NOT to have PGD done, is there anything a woman should be on as a proactive measure, to ensure or help with implantation? My lining is usually good, but like i've said, i have no idea if i would have a problem getting one to stick....so just thinking ahead....
Dr.Abbasi	it is possible but generally you can bypass the endo if it is Stage 1 or 2.
colleen	what is the success rate with freezing a woman's eggs? i've heard varied reports.....just curious.....
Dr.Abbasi	Some programs actually check a Thrombophilia panel to make sure of such issues and also move onto immunological tests. I think one of the upcomingtopics is about implantation/
colleen	thank you Dr. Abbasi!
Dr.Abbasi	colleen. it depends upon which center. Success rates vary. Ours is about 40 %.
colleen	Not bad.....
poornimabs	what is the success rate with PGD
colleen	I think all of this "freezing" stuff is so amazing, i can't believe how far science has gotten us....
Dr.Abbasi	Depends. I know I am sounding wishy washy but truly there are many factors.
deb	We are getting down to the wire-we have 15 minutes of Dr. Abassi's time. If you have been lurking you might want to get your questions in.
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colleen	What is your opinion about PGD for age factor only? No genetic stuff at all...
deb	Remember, The AFA has TONS of information on the site (www.theafa.org) and it is free to everyone who joins our No Barriers program. Please spread the word that we are here to help and support you.
poornimabs	Are there any clincal studies + Success rate for an IVF cyce +PGD - no frozen
Dr.Abbasi	Screening for Aneuplody? Very poor success. Single gene disorders are best screened with PGD.
amccloskey	I have been through 3 cyles of clomid with the hope of doing IUI. But I have a blocked tube on the left. I have only had eggs once on the right, but then I didn't get the LH surge. So we have not been able to go throught IUI yet. I am on day 65 of my third cycle. They have put me on Provera twice to try to start my next cycle and no success yet. Should there be any concern?
kaylalunaava	Dr. Abbasi, what is the difference b/w a Luteal phase Lupron protocol over an Anatagon Cycle? Why would one prefer one or the other?
Dr.Abbasi	amccloskey No concern but sounds like you are anovulatory and may need gonado tropins for stimulation
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Dr.Abbasi	kaylalunaava. One is a suppression protocol and is more flexible. The Antagon is a sjhorter protocol, and is less flexible. Younger patients generally do well with either.
Dr.Abbasi	Another reason would be pCOS these patients do better with lupron.
colleen	Can too much LH interfere with embryo qualtity?
kaylalunaava	Thanks again Dr. Abbasi.
Dr.Abbasi	poornimabs. Yes there are several. You canlook at ASRM web site for pertinent info.
poornimabs	Thanks Dr.
JanJ	My sister is 35yrs old and has elevated FSH (just 12). What would you recommend for her efforts to have her own child?
Dr.Abbasi	colleen. Definitely. That is the issue with PCOS patients.
Dr.Abbasi	JanJ Hurry up/
JanJ
Dr.Abbasi	Also to try with a RE.
deb	Great answer, Dr. Abassi...
JanJ	Thanks again!
colleen	Thanks for your answers tonight Dr. Abbasi, have to run...but you've been very helpful
Dr.Abbasi	Great participants. Stimulating discussion. Thank you all.
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deb	I want to thank you, Dr. Abassi for giving so freely of your time and expertise. As you can, there is a great hunger for both information and support. We are so grateful to you for being with us tonight.
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Dr.Abbasi	My pleasure.
poornimabs	Thanks Dr. Abassi it was very helpful
JanJ	Thanks Dr. Abbasi
amccloskey	Thanks!
deb	Dr. Abassi, is there anything else you think our guests should know or ask their drs-besides, hurry up of course.
Dr.Abbasi	Always try to keep up with the latest. Patients (at least mine) are always one step ahead of me.
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katie	how to do that? what journals do you recommend?
kaylalunaava	One more quick question. If one mature follicle is 24 mm and the others are 16, RE wants to go one more day, if the 24 mm foll ovulates, will that stop the others from growing?
Dr.Abbasi	I think. AFA and ASRM offer great resources.
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katie	fertility and sterility a good one?
Dr.Abbasi	No it wont/ That is the correct thing to do
Dr.Abbasi	Yes and also Human Reproduction.
katie	thanks! i wish i knew how to evaluate their methodologies but thats a topic for another time.
kaylalunaava	RE said, he wants to let the others grow so there will be more mature ones and risk the other big foll.
Dr.Abbasi	That is correct.
kaylalunaava	Thanks again for clarifying. I thought that if one ovulates, the others will stop growing.
deb	See you all next week, same bat time, same bat channel (now you know MY age!). Next week we will be talking about Optimizing IVF. Please join us.
deb	Thanks to everyone-especially, Dr. Abassi-for this terrific evening.
Dr.Abbasi	Good night and thanks again for letting me participate.
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kaylalunaava	Thanks so much for everything1
poornimabs	::rolleyes
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caira01	Thanks
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