Surgical Solutions to Fertility Problems

September 21, 2005 - Wednesday
1:46 PM to 2:46 PM (EST)
Guest Speakers: Steven Presser, MD, Huntington Reproductive Center in California

Categories
Endometriosis • Fertility • IVF

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Lori_Masi AFA_Patient_Advocate	Good Evening Everyone! We are very fortunate this evening to have the wonderful Dr Steven Presser of Huntington Reproductive Center in California with us! Our topic this evening is Surgical Solutions to Fertility Problems.
Lori_Masi AFA_Patient_Advocate	Hi Nicole and Val we will begin in about 10 minutes!
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Lori_Masi AFA_Patient_Advocate	Good Evening Everyone! We are very fortunate this evening to have the wonderful Dr Steven Presser of Huntington Reproductive Center in California with us! Our topic this evening is Surgical Solutions to Fertility Problems.
Lori_Masi AFA_Patient_Advocate	Welcome Dr Presser!
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Lori_Masi AFA_Patient_Advocate	Welcome stephanie!
Lori_Masi AFA_Patient_Advocate	We can begin Dr Presser whenever you are ready!
Lori_Masi AFA_Patient_Advocate	Good Evening Everyone! We are very fortunate this evening to have the wonderful Dr Steven Presser of Huntington Reproductive Center in California with us! Our topic this evening is Surgical Solutions to Fertility Problems.
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dr_presser	Type hereGood evening Stepahnie. Wha is your question
Lori_Masi AFA_Patient_Advocate	Good Evening Everyone! We are very fortunate this evening to have the wonderful Dr Steven Presser of Huntington Reproductive Center in California with us! Our topic this evening is Surgical Solutions to Fertility Problems.
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dr_presser	Good evening everryone. THank you for this opportunity to address your questions
Lori_Masi AFA_Patient_Advocate	Everyone please post your questions to Dr Presser!
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Lori_Masi AFA_Patient_Advocate	Good Evening Everyone! We are very fortunate this evening to have the wonderful Dr Steven Presser of Huntington Reproductive Center in California with us! Our topic this evening is Surgical Solutions to Fertility Problems.
stephanie	I recently had laparoscopy and was told that I now have a "window period" for improved chances with IVF. Can you explain how long this period typically lasts?
dr_presser	Stepahanie, it depends on what they found. If it was endometriosis your best chances to conceive is 18-24 mos post op
stephanie	Thank you, yes it was for endometriosis, polyps and fibroids.
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dr_presser	Yes. It sounds likeyou had alot going on in your reproductive tractr. good luck
dr_presser	Tgrilly3, how can I help you?
Tgrlly3	I'm wondering if you know anythig about Mullerian Agenisis andusing transabdominal retrieval to get to the eggs. Success rates, complications , etc
Wendy	Though this question may not fit the topic, but I just started OC's and will begin Lupron next week, however, during my mid-cycle US, a 20 mm dermoid was found on my left ovary. This would be my 4th. How will this impact my IVF cycle?
dr_presser	T grilly3, I am sorry that I don't have familiarty with transabl approach for Mullerian agenensis. It does sound like a reasonable one though since the goal is to get to the eggs
Tgrlly3	Also difficult to monitor cycle since ovaries high up. Using vaginal u/s's but also abdominal u/s's. Wonder if you know of any other method to monitor cycles when no uterus and ovaries high up in pelvis.
Tgrlly3	Any familiarity at all with Mullerian Agenis,(translation for those not familiar- born without a uterus but have ovaries).
nicole	surgical solutions for my husband in regards to having a zero sperm count due to undescended testicles at birth that were corrected at age 2 and the other at age 5. my thought was that the surgery to descend the testicles was done too late causing the zero sperm count.. we see a urologist in a few weeks.. in the beginning stages of this.
dr_presser	Wendy, it probabbly depends on the size of the dermoid its location and whether the ovariey on that side can be accessed for follicles
Val	I used Clomid for 6 months with no luck and just took a 3 month break, my own choice, my question is, is it safe to say that I should be checking to make sure my tubes are unblocked etc. instead of jumping back on Clomid? I am currently only seeing an OBGYN and he has not been very aggressive to the situation so far.
dr_presser	Tgilly3, Considering your anantomy, the best aproach sounds like its transabdl
Wendy	Do you recommend the dermoid be removed before going further?
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Lori_Masi AFA_Patient_Advocate	HI Joy! Welcome!
joy	hi
Lori_Masi AFA_Patient_Advocate	Good Evening Everyone! We are very fortunate this evening to have the wonderful Dr Steven Presser of Huntington Reproductive Center in California with us! Our topic this evening is Surgical Solutions to Fertility Problems.
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dr_presser	Wendy, if I understand your question, it sounds like the only way to know if there is sperm present assumming no hormonal problems exist is through a percutaneous tissue aspiration
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dr_presser	Val, That is certainlky essential. No purpose in stimulating with anything if egg and sperm cant meet
dr_presser	Wendy, that may be an appropriate choice given your circumstances. How old are you and have you ever had surgery?
Tgrlly3	I'm going to sign out. Thanks for your time.
dr_presser	My pleasure. Good luck
Wendy	I am 31 and have more then a handful of sugeries to remove dermoids as well as "free" up my tubes and ovaries which are "locked" in place do to adhesions and scar tissue.
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jmjjchase	I was wondering if you have heard of the Wurn Technique?
dr_presser	Sorry for the delay I got bumped off the net
jmjjchase	That's ok, did you get my question?
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dr_presser	Wendy, that could dependant on the findings during retrieval make for an easy or very difficult aspiraation. I am sure your md knos the position of you r ovaries and accessibilty
dr_presser	jmjjchase, I am sorry I don't
jmjjchase	No prob, wondered if you had heard of the Wurn Technique?
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Lori_Masi AFA_Patient_Advocate	Welcome Aedamar! Good Evening Everyone! We are very fortunate this evening to have the wonderful Dr Steven Presser of Huntington Reproductive Center in California with us! Our topic this evening is Surgical Solutions to Fertility Problems.
dr_presser	aedamar, do you have a question
aedamar	Yes Thank you
aedamar	I am intrigued by the notionof a surgical solution .. can you please elaborate
serenagallina	hi everyone, sorry for my english.i'm from Italy having my 2d IVF for unexplained sterility. I sur the net and discovered this website. very useful, thanks
Lori_Masi AFA_Patient_Advocate	welcome Serenagallina
dr_presser	aedamar, if someone for example has a space occupying lesion in their uterine cavity like a polyp or a fibroid that might be competing for space with an established fetus, it could predispose to miscarriage Or if ther is tubal scar tissue that can effectively block the tubal egg pick up there will be no conceptin. Therefore, surgical amelioration may remedy the problem
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dr_presser	Serenangellina thank you
Lori_Masi AFA_Patient_Advocate	Welcome Leahmary! Good Evening Everyone! We are very fortunate this evening to have the wonderful Dr Steven Presser of Huntington Reproductive Center in California with us! Our topic this evening is Surgical Solutions to Fertility Problems.
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dr_presser	Leahmary, do you have a question?
serenagallina	thanks to you
leahmary	Actually, I'm in my 2ww from IVF, and I'm here out of curiostiy.
aedamar	Thank you .. can I deduct form what you have said that there is a surgical remedy for scar tissue in one's tubes?
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dr_presser	aedamamr, potentially yes dependant on its location. If you are talking about scarrring on the outside without blockage. If there is blockage =, it depends on the locaation
serenagallina	how can surgery be useful for people with unexplained sterility in the diagnosis? I just did isteroscopy and nothig else. I wonder if there is some other surgical text to do for me. what do you suggest?
aedamar	Thank you Dr Presser
dr_presser	Seregallina, may i assume besides the hysteroscopy that was done and nothing was found that you also had a laparoscopy?
dr_presser	aedamamr, you are quite welcome.
serenagallina	no, my doctor told it was not necessary
jmjjchase	I have a two part question, not sure if you received the first time. I am 29, ttc for 2.5 yrs, hsg and vag u/s revealed bil hydrosalpinx, polycystic ovaries, fibroid uterus, endometriosis. #1 what are odds for me to conceive after salpingoplasty, ablation of endometriosis? #2 Have you heard of the wurn technique?
dr_presser	serengallina, without doing a laparoscopy, how would your dr know you dont have any pelvic factor as a cause of your infertility like scar tissue or endometriosi?
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Lori_Masi AFA_Patient_Advocate	Welcome Emma!
emma120	thanks
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stephanie	It was found that I had chocolate cysts on my ovaries during my laparoscopy. Is this really bad? How are they removed or are they?
emma120	my doc found my left tube to be dilated, but only filled with fluid when he put fluid in. I have gone through 3 IVF's without success. Should the tube be removed?
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serenagallina	thanks,, i will ask it again .Good Night everyone
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dr_presser418	I am sorry that I got bumped off again. Because of the technical difficulties, I will be happy to stay on and address those people whose issues were not addressed
emma120	my doc found my left tube to be dilated, but only filled up with fluid when he put fluid in. I have gone through 3 IVF's without success. I have read alot about hydrasalpinx and its neg effect on IVF. My doc said not to remove the tube...what is your opinion on hydrasalpinx
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stephanie	Not sure if you received this question- It was found during laparoscopy that I had chocolate cysts on my ovaries. Is this really bad? How are they removed or are they?
jmjjchase	My question for you was, i am 29, ttc for 2.3 yrs. During vag u/s and hsg, was found to have bilateral hydrosalpinx, polycystic ovaries, endometriosis, and fibroid uterus.
dr_presser418	Emma, I couldnt disagree more. There is alot of literature to support removal of the tubes as a way to increase pregnancy rates.
jmjjchase	Wondered what the odds were of coneiveing after salpingoplasty, ablation of endometriosis?
emma120	thank you dr
dr_presser418	stephanie, Chocalate cysts ar e ususally a sign of endometriosis. Ususally a cystectomy is done to remove them if nnothing else is found
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dr_presser418	jmjjchase, Have had the surgery or are you thinkin g of having the surgery
smileyatc	Dr. Pressman, I am 34, ttc for 4.5 yers. I have undergone laproscopic surgery only to reveal I had extensive endometriosis. the doctor removed the endometriosis, I still have not been able to concieve. My tibes are not blocked, I have tried ingestable and injectable meds,and my husbands sperm count is excellent. Is there any other surgical procedure that would reveal a cause of infertility? My doctore basically said there is nothing else he can do?
stephanie	thanks
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jmjjchase	I don't want the surgery-but want to know what odds are of conceiving if I do have the surgery... my gyn says 20%
jmjjchase	I am looking at having the wurn technique. it is a physical therapy kind of thing. www.clearpassage.com. I'm OR nurse, and afraid of surgery-how ironic is that.
dr_presser418	Smileuatc, first of all, endometriosis is a cause of infertility. Especially since you mentioned extensive endometriosis, that may translate into Stage 3 or 4 which definately affects overalll pregnancy rates. Secondly, if your tubes are blocked and if ther is any evidence that they are dilated, it may bebeneficial to remove them
emma120	Dr Presser - is constant pain before my period, during and after a sign of hydrasalpinx. I have left sided pain much of the time. How can I persuade my doctor to remove it.
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smileyatc	Dr.Pressman, my tubes are not blocked. I haven't been dx with anything other than endometriosis. So is there anything else I can do?
Lori_Masi AFA_Patient_Advocate	Everyone we only have a minute or two left.....
dr_presser418	jmjjchase, I believe your best shot is with IVF after your tubes are remove.d That is the pregnancy rate in your age given the right stimulation even in a 2nd rate lab is probably 30-40% consertively speaking. Moreover, the salpingostomy rate of post surgical ectopic is considerable
dr_presser418	Smileyatc, it depends on the stage of endometriosis
jmjjchase	I think maybe adoption is better alternative for me. Male factor as well.]
dr_presser418	Emma, if you need supportive articles to send to your dr you can contact me and we can send him the info
jmjjchase	Thanks for you input, still depressing. Can you recommend support group in orange county,ca area? Even online, ok.
Lori_Masi AFA_Patient_Advocate	Everyone me must say good night to Dr Presser!
Lori_Masi AFA_Patient_Advocate	Thank you Dr Presser for all the wonderful information tonight! We appreciate your time and generosity of spirit in participating this evening. And thank you to everyone for joining us this evening! Good Night!
dr_presser418	jmjjchase, I wouldnt be so discouraged. You are only 29 and male factor therapies are fantastic. Let me know how we can help
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dr_presser418	Thank you Lori and everyone chatting. It was a pleasure . SSShould anyone want to chat further, me email address is presserivf@havingbabaies.com
jmjjchase	Thanks again!
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dr_presser418	Best of luck
Lori_Masi AFA_Patient_Advocate	Thank you Dr Presser can you also post your contact info forthe program
emma120	tks
dr_presser418	My contact information is: Steven Presser, M.D. Huntington Reproductive Center- West Los Angeles Offfice 11500 West Olympic Blvd. Suite 504 LA,CA 90064 Phone (310)481-0881 and email presserivf@havingbabies.com
Lori_Masi AFA_Patient_Advocate	Thank you Dr Presser! Good Night All!
dr_presser418	Good night all!
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