Secondary Infertility - How and Why it Differs

May 5, 2005 - Thursday
2:05 PM to 3:05 PM (EST)
Guest Speakers: Andrew J. Levi, MD

Categories
Fertility • Infertility • IUI • Miscarriage

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Lisa_Rosenthal	Hi
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katrum	Hello, my name is Katrina. Is the session on Secondary Infertility starting now?
Lori_Masi AFA_Patient_Advocate	Welcome Dr Levi! Lisa will bed with us shortly!
Dr._Andrew_Levi	Welcome! We will be starting soon!
Lori_Masi AFA_Patient_Advocate	I mean Lisa will "BE" with us shortly!!
Lori_Masi AFA_Patient_Advocate	Welcome Everyone I am Lori Masi - the AFA Patient Advocate
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gracie	Hello
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Dr._Andrew_Levi	hi gracie.
Lori_Masi AFA_Patient_Advocate	While we are waiting for Lisa - does anyone have any questions?
Lisa_Rosenthal	Good evening, sorry for the delay, I got thrown off. I hate that.
Lori_Masi AFA_Patient_Advocate	Welcome Gracie!
Lori_Masi AFA_Patient_Advocate	Welcome All! Please call the AFA Toll Free Support/Referral Line at 888-917-3777 for information, a referral in your area or just some good ol fashioned support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
gracie	Should the time trying for a second child be the same as for a first one ?
katrum	It's great to have this opportunity to talk about secondary infertility. I find that the infertility field is not particularly geared to addressing the needs/issues of those of us with this problem.
Dr._Andrew_Levi	hi gracie -- can you be more specific?
Dr._Andrew_Levi	i agree -- secondary infertility is not given enough attention by most physicians.
Lisa_Rosenthal	Folks, I'm having major technical problems, I apologize for being basically absent.
gracie	I guess the question I am asking is how long is normal for trying for a second child ?
Lori_Masi AFA_Patient_Advocate	Lisa I am here if anyone needs any assistance!
Dr._Andrew_Levi	gracie -- i think the criteria for trying is the same as the first child -- in theory -- one year if <35 years old, 6 months is >35. however, if a woman is a bit older (approaching 40) or if there is a known problem, thev window should be smaller.
katrum	To give you some background about myself, I had my first child at age 33 (no problems conceiving). I've been trying for a second child for 3.5 years and have had 3 miscarriages. There's nothing definite on my side as a problem, although I have had pretty irregular cycles all my life. My husband's sperm count is okay (a little on the lower end), but he's recently had a DNA fragmentation test that was high (36). I tried 2 cycles on medication, being monitored at a fertility clinic with no luck and have since turned to alternative approaches: acupuncture, and naturopathy. I am now 38. What I would like to know is, what are the recommendations for people in our situation? I really don't want to have
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Lisa_Rosenthal	Hi, it appears that there are many folks who cannot log on, we are the lucky few! Many folks are now lurking, but unable to participate, so I will ask some questions that are being fed to me... Sorry that this is happening.
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Lisa_Rosenthal	Welcome to Patty and Heather, thanks for joining us this evening!!!
Dr._Andrew_Levi	hi katrum -- i am sorry about your losses -- have you had an evaluation for miscarriage? what tests have you had performed the last 3+years?
Patty	I had a baby when I was 37 with no problem..I don't understand why I am having trouble now at 40. 40 is not old.
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katrum	I have had various blood tests, and a sonohystegram. Everything is normal.
Dr._Andrew_Levi	hi patty -- 40 is not old. but regardless, in any patient -- things can change in 3 years . . . a proprer evaluation and appropriate treatment is most important.
Lisa_Rosenthal	Mandy, who is off-line, would like to know if she has had two miscarriages, is her inability to get pregnant a secondary problem?
Dr._Andrew_Levi	katrum -- did you have your tubes checked to see if they are open? did you have a recurrent miscarriage evaluation? all are very important.
Heather	I had one child through IVF- and I am trying again - am I secondary or primary? I am confused
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Dr._Andrew_Levi	mandy -- i would not think of that as secondary -- again -- a thorough evaluation for recurrent miscarriage should be your next step.
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Dr._Andrew_Levi	heather -- sorry you had to go . . usually secondary means no problems with a 1st, 2nd. or even a 3rd child -- but problems the next time.
katrum	My understanding is the sonohystegram included injecting liquid through the tubes to make sure they were clear & they were. I don't know what a recurrent miscarriage evaluation is. My fertility specialist gave me the workup for a recurrent miscarriage as far as I know. I'm located in Toronto, Canada. Things may work a little differently up here. What do you recommend?
heather	Type here Did I miss my question being answered?
Lisa_Rosenthal	Dr. Levi, Orly, who is off-line would like to know whether the work up is different for primary and secondary fertility issues.
heather	oh I see it now
Patty	Why is my fertility so different now than a few years ago? I had no trouble with my first conception..now at 40 it just isn't happening...should I see a doctor?
Dr._Andrew_Levi	katrum -- a sonohysterogram is not so good for checking tubes. i recommend a hysterosalpingogram. the evaluation for recurrent miscarriage checks anatomical, genetic, endocrine, autoimmune, infectious, and clotting disorders as possible problems.
localhost	[2009] touser Please feel free to post questions for Dr. Levi. 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._Andrew_Levi	Orly -- the work-up is basically the same except one needs to take into account the patient's history to a greater extent with patient's with secondary issues. the key is to assume nothing and be thorough in secondary cases. also with secondary -- age is very important to keep in mind. and if the patient had a c-section or problems with removing the placenta with the prior child.
Dr._Andrew_Levi	Patty -- you are young -- but at 40 -- i would definitely see a fertility specialist is it's been 6 months without conceiving.
katrum	If I have been able to get pregnant (with miscarriages following), doesn't that suggest that my tubes are clear?
Lisa_Rosenthal	Kathleen, who is off-line- would like to know about immune testing and your opinion on it...
Dr._Andrew_Levi	katrum -- if you don't have problems conceiving, you are right -- you don't need an HSG. if a patient has secondary infertility -- she certainly should. if miscarriage is the issue, a recurrent miscarriage profile is indicated.
Dr._Andrew_Levi	kathleen -- i am very leery of immune testing. it just hasn't panned out yet. i do belivee in testing for antiphospholipid antibodies and related disorders.
Robert_s_Mom	Hi Dr. Levi - how long should we use ovulation predictor kits?
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Lisa_Rosenthal	Tanya, who is off-line, would like to know whether having a baby affects unexplained infertility and especially ability to have another child? In other words, will having a baby possibly keep her from having trouble conceiving the second baby?
localhost	[2009] touser The American Fertility Association has a set of message boards, several which are moderated by a physician daily. Please feel free to stop by and ask questions there as well! Also, "Connections" will meet every week for an online educational session. Please check the schedule on our home page.
Dr._Andrew_Levi	hi robert's mom -- not too long! they can be wrong up to 10% of the time! if patients are young and not in a hurry -- a number of months are ok. otherwise -- i would recommend seeing a fertility doc for an evaluation.
Robert_s_Mom	what about the fertility monitor?
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Lisa_Rosenthal	Is anyone else having trouble with staying on our session?
Robert_s_Mom	I am not having a problem
Dr._Andrew_Levi	tanya -- having a baby shouldn't cause problems. however -- the event surrounding the delivery -- a c-section, retained placenta, a postpartum D&C, a pelvic infection -- these could all impact conceiving the next time around.
katrum	Yes I just got bumped off & now I can't see our previous messages.
Robert_s_Mom	Do you have to have a complete work up if you have had a baby already/ Does my husband have to have a sperm test?
Dr._Andrew_Levi	r's mom -- the fertility monitor is similar but more accurate -- but the same hold true re: the timeline -- there may be other issues aside from ovulation.
Lisa_Rosenthal	Roberts mom- please keep in mind that any physician can call themselves a fertility specialist- what you really want to do is see a reproductive endocrinologist- who has had special training in this field
Dr._Andrew_Levi	r's mom -- yep -- i'd start from scratch and repeat the analysis -- things can change!
Lisa_Rosenthal	katrum, repost your question, sorry you're having trouble, me too!!!!
Robert_s_Mom	He is going to hate doing one. He never has as we did not have problems with our first child
katrum	I have had 2 D&C's after miscarriages. Would the sonohystegram have picked up any scarring after this, or do you recommend any other tests? I am not keen on invasive tests, but would like your opinion of whether this is good idea.
Robert_s_Mom	I was hoping to avoid it and he said it's obviously not him since he got me pregnant already once
Dr._Andrew_Levi	r's mom -- if there is a problem with him -- you will be spending a lot of time trying . . . an analysis is not too hard for a guy to do, you know. just think about what women with infertility have to go through!
Lisa_Rosenthal	Dr. Levi, correct me if I'm wrong- but Roberts mom- I would not assume it is you!
Robert_s_Mom	it's not a problem with me...he is putting up a big stink about it..thanks...I will make him read this...
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.
Dr._Andrew_Levi	katrum -- i perform office hysteroscopy to directly visualize the uterine cavity. but the SHG is pretty good too.
heather	hi
Dr._Andrew_Levi	hi heather.
Lori_Masi AFA_Patient_Advocate	Welcome All! Please call the AFA Toll Free Support/Referral Line at 888-917-3777 for information, a referral in your area or just some good ol fashioned support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Lisa_Rosenthal	Hi Heather, please feel free to post questions!
heather	do you think i just have old eggs?
Dr._Andrew_Levi	heather-- how old are you?
heather	how do i know..my mother said that I waited too long
heather	40
heather	I am really scared to find out and i have one kid...but i am frightened of the testing
Dr._Andrew_Levi	heather -- you should have a baseline ultrasound and ovarian reserve screening testing -- that would be a good place to start/
katrum	To repost my previous question, I was wondering whether IUI and IVF have lower success rates for couples with secondary infertility / history of miscarriages. And whether there is a greater risk of miscarriage with these procedures than for women without this history.
heather	does that hurt?
Lisa_Rosenthal	Orly would like to know whether it is reasonable to expect a complete workup 14 months after having your first with no problem and not using protection?
Dr._Andrew_Levi	heather -- i think you will feel better once you have it done . . . it does not hurt.
Dr._Andrew_Levi	katrum -- the success rates are the same. again, iui and ivf do not help with miscarriage. defining the cause of miscarriage should be the next step.
Dr._Andrew_Levi	orly -- after 12 months, <35 years old -- this warrants a thorough evaluation!
Betina	My fsh number vary from month to month...some people I know have said that it is better if i try on months that my number is lower and some people said that a high number is a high number and that is what matters
Dr._Andrew_Levi	betina -- it is true -- your highest fsh is who you are reproductively. however, fsh is not the only factor. a baseline ovarian volume and antral follicle count is quite important too. treatment should not be based on fsh alone!
Betina	what isa antral follicle count? how do you get one? it is internal?
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._Andrew_Levi	betina -- antral follocle count (afc) is done by vaginal ultrasound on day 2,3,or 4 of your cycle. if there are few seen -- not good. an antral follicle is a samll follicle, usually 4-8 mm in size.
Dr._Andrew_Levi	uggh. sorry for the typos. it's been a long week, i guess.
Betina	thanks
katrum	The main test that has been outside of the normal range for us is my husband's sperm DNA Fragmentation test. Is this something you could comment on - is there anything we can do to improve this?
Lisa_Rosenthal	Dr. Levi, you are doing a wonderful job!
Robert_s_Mom	I have got to say that the baby making business was much easier and less complicated the first time around::biggrin ::biggrin ::biggrin
Dr._Andrew_Levi	katrum -- there are no data supporting the dna fragmentation is linked to miscarriage. it has to be pretty significant to cause infertility. there are a lot of guys with a lot of fragmentation who have lots of kids . . .
Dr._Andrew_Levi	r's mom -- 2nd time's a charm.
Lisa_Rosenthal	Not with secondary infertility, it's not!!!!! LOL....
Lisa_Rosenthal	Dr. Levi, you have done a wonderful job here this evening~ we are so pleased and honored to have you with us for this hour.
katrum	can you recommend any books/resources/articles on secondary infertility?
heather	I heard that we should have a test to make sure that the tubes are open, that sometimes after a first pregnancy the close. I had a C section. And I was told that my tubes could have scar tissue. Could that be true? What is the test for that?
Dr._Andrew_Levi	you are right. but is can be "a charm" if it's evaluated and treated appropriately. i see too many pateints are who arev not taken seriously because they have been successful in the past. too often they are told to "just keep trying" or are given a meager evaluation.
Dr._Andrew_Levi	lisa -- many thanks, as always.
Lisa_Rosenthal	Ladies and gentlemen, I am able to get such wonderful speakers by promising them that they will be off at 9 sharp, that leaves us about 8-9 minutes left with Dr. Levi.
Dr._Andrew_Levi	katrum -- the internet is always a good option. just make sure you have a good resource, i.e., a doc, who can help you weed through and interpret the information.
heather	Did u see my question Dr? or should I repost it?
Lisa_Rosenthal	Heather, please repost your question....
Dr._Andrew_Levi	heather -- yes -- i would recommend an HSG to check your tubes. even if you didn't have a c-section -- all women with secnndary infertility should have one!
Dr._Andrew_Levi	i am going out for ice cream at 9:01pm. promised my wife.
katrum	Thank you for your time.
Dr._Andrew_Levi	my pleasure!
Lisa_Rosenthal	Dr. Levi, you have been wonderful, as usual, will you do this again with us?
Dr._Andrew_Levi	if folks have questions after the chat -- feel free to email me at andrewlevimd@yahoo.com.
Dr._Andrew_Levi	lisa -- i am always available!!!
heather	Thank you
heather	Good night
Betina	thank you
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Lisa_Rosenthal	Thanks to all of you for joining us this evening!
Dr._Andrew_Levi	you are welcome!
Patty	thank you
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Lisa_Rosenthal	Please check our connections schedule about next week's session.
Lisa_Rosenthal	Thanks again Dr. Levi, enjoy your ice cream...
Dr._Andrew_Levi	oh, it will be good. have a great night!
Lisa_Rosenthal	Good night...
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Secondary Infertility - How and Why it Differs

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