Surrogacy and Third Party Reproduction

March 29, 2005 - Tuesday
2:13 PM to 3:13 PM (EST)
Guest Speakers: David Tourgeman, MD, Huntington Reproductive Center in CA

Categories
Donor Egg • Egg Donation • Gestational Carrier • Miscarriage • Surrogacy • Third Party Reproduction

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Lisa_Rosenthal	Welcome to tonight's online session!
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local	[332] Wednesday- March 9- David Tourgeman, MD, (Huntington Reproductive Center in CA)- Topic- Surrogacy and Third Party Reproduction Discussed
Stephen	Hi Dr, what is the differences with surrogacy, gestational surrogacy, etc?
Dr._Tourgeman	There is traditional surrogacy which involves an egg donor and a carrier of the pregnancy being the same person
Dr._Tourgeman	and gestational surrogacy which only involves the carrier of the pregnancy
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local	[332] Wednesday- March 9- David Tourgeman, MD, (Huntington Reproductive Center in CA)- Topic- Surrogacy and Third Party Reproduction Discussed
Dr._Tourgeman	so typically in traditional surrogacy an intrauterine insemination is performed, and in gestational surrogacy in-vitro fertilization is utilized and embryos are transferred into the surrogate
Rhonda	Do you automatically need a gestational surrogate if you are of advanced maternal age- you know, OLD
Dr._Tourgeman	Rhonda absolutely not
Rhonda	Well, what are the implications of carrying a baby, when you are older?
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Dr._Tourgeman	however if you are older than 55 yo then strong consideration for surrogacy is in order
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Lori_Masi AFA_PAtient_Advocate	Hello Everyone!
Dr._Tourgeman	There are higher risks for operative deliveries (C/section), diabetes in pregnancy and high blood pressure
localhost	[2009] touser Thanks for joining us this evening- Please feel free to post questions for Dr. Tourgeman. Copy and paste them so that you can repost them if necessary. The room can get quite busy.
Dr._Tourgeman	The answer Sandy is that the uterus has no biologic clock
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
Dr._Tourgeman	Thus it does not matter how old the uterus is, it still is capable of holding the pregnancy
Dawn	I'm a balanced translocation carrier... robertsonian .... should I look to donor eggs at this point instead of using my own?
Dr._Tourgeman	At 46 Orly, using your eggs to produce a shild even thru in vitro is very small chance, thus egg donation may be best
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Lisa_Rosenthal	Welcome Shelly, thanks for joining us this evening!!
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Dr._Tourgeman	Dawn-about 5-20% of embryos that viable would be affected, thus I suggest Pre-implantation genetic diagnosis to see if they also have the mutation
Dr._Tourgeman	Dawn-an egg donor is an alternative howeber
ShellyW	Hi, this is a first time for me doing this...hoping to find out some good info.
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Sandy	I'm only 33, but a very poor responder- 1 to 2 eggs- any suggestion?
Dr._Tourgeman	What has been tried Sandy?
Lisa_Rosenthal	Shelly, please post questions!
Dr._Tourgeman	Has any one tried a microdose flare or antagonist protocol Sandy
Sandy	Everything! IUI's, injectibles, IVF- 3 times. I'm out of money and patience, and IDEAS.
Dr._Tourgeman	These protocols may result in better egg number
Allison466	om on riund 3 ivf also just had 3 frozen embryos transferred friday
Dr._Tourgeman	My pleasure
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Allison466	sry brb
local	[332] Wednesday- March 9- David Tourgeman, MD, (Huntington Reproductive Center in CA)- Topic- Surrogacy and Third Party Reproduction Discussed
Frannie	Hi Lisa and DR. Tourgeman, am I too late?
Dr._Tourgeman	No Frannie
Lisa_Rosenthal	Not too late at all.
ShellyW	Went through IVF once and failed. Trying again at the end of April. Is there anything we can do to help our chances? Male infertility in our situation
Lori_Masi AFA_PAtient_Advocate	Welcome Frannie!
Frannie	Just wanted to get some information- why not your own eggs if older, but fsh is low?
localhost	[2009] touser Thanks for joining us this evening- Please feel free to post questions for Dr. Tourgeman. Copy and paste them so that you can repost them if necessary. The room can get quite busy.
Dr._Tourgeman	Shelly-I think you are doing the right thiing, how old are you and I asssume ICSI is being done.
Dr._Tourgeman	How old are you Frannie?
ShellyW	I am 27, yes ICSI was done.
Frannie	Dr, I am 44, my fsh is 12 and I have a 2 year old and 4 year old, with no problems, now I've been trying for 14 monthsl
Dr._Tourgeman	Best of luck Frannie
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._Tourgeman	Frannie first off you ar very fortunate
Frannie	What do you mean?
epbn	similar question here re age and FSH/Estradiol, I' m44, FSH 7.2 and Estradiol was 42. Now about to retrieve from 5 follicles. If decent FSH & Estradiol, to what extent does this impact chences of pregnancy?
Dr._Tourgeman	at 44 your eggs now make more mistakes during division and thus you are more likely to have chroomosomal errors as time passes
localhost	[2009] touser Thanks for joining us this evening- Please feel free to post questions for Dr. Tourgeman. Copy and paste them so that you can repost them if necessary. The room can get quite busy.
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Dr._Tourgeman	Dawn-20-30 ponds is not that overweight and I wouldnt put it off
Lisa_Rosenthal	Thanks to everyone for joining us this evening, especially Dr. Tourgeman!
Frannie	What do you mean by markers?
RT	Hi,
Dr._Tourgeman	They are a measure of ovarin responsiveness
Dr._Tourgeman	and test for how the ovary will respond to medication
RT	what does success depend on, with egg donation??
Allison466	any chance of pregnancy dr
epbn	thank you doctor Tougeman for the explanation
Dr._Tourgeman	Allison-of course
RT	Dr,
Allison466	no
Allison466	dr thinks was genetic
Dr._Tourgeman	RT-Reaaly your uterus is the on variable that must be attended to
Lisa_Rosenthal	Based on what Allison?
Dr._Tourgeman	Also the age of the donor and if there are any difficulties with the sperm RT
RT	Dr, we're planning to go for egg donation, I'm 36 years old, please tell me,will having retroverted uterus diminish pregnancy success?
Allison466	losa i dont so mad at how the whole thing was handled actually dr says he ordered testing at time of miscarriage but hospotal says there was no order
Dr._Tourgeman	Allison-was there an evaluation of the uterus, blood clotting factors?
Allison466	no
Dr._Tourgeman	Shelly some have suggested accupuncture
Dr._Tourgeman	however it is hard to ascertain how stress can affect implantation
Dr._Tourgeman	RT-Not at all
Dawn	I had 2 misscarriages around 10wks AFTER seeing a strong heartbeat. Second miscarriage was triploidy 69XXX. Now, I've been diagnosed as a balanced robertsonian translocation carrier. Seems that the triploidy does NOT support the translocation diagnosis. what about miscarriages after a heartbeat... is that normal for translocation issues?
Dr._Tourgeman	There is no data to suggest that a retroverted uterus will impact poorly on egg donation
ShellyW	Is there any other common factors that influence IVF outcomes?
Allison466	o did have ohss and very sore and alsi developed hematoma unexplained bleeding in 7 wk of pregnancy but dr said baby wasnt effected however i was high risk and heartbeat week befir the loss was 170 bpm
Dr._Tourgeman	For those of you with miscarraiges, a work up should be done if there was a loss in the 2nd trimester or if you have had 2 or more losses
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._Tourgeman	RT-Usually 2-3 days
Allison466	dr how do i get this work up done?
localhost	[2009] touser Thanks for joining us this evening- Please feel free to post questions for Dr. Tourgeman. Copy and paste them so that you can repost them if necessary. The room can get quite busy.
Dr._Tourgeman	Allison-Should as your doctor to evaluate
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Dr._Tourgeman	Shelly what is your question
Kaley	When is a good time for a second opinion on a workup that was done?
Allison466	dr couyld it have been anything i did only thing diff i did was i took a bath?
RT	Thanks Dr, how many days of acupuncture should I go for before IVF with donor egg?
Dr._Tourgeman	Shelly this is a broad question-I am not sure where you are going
Dr._Tourgeman	Kaley---For infertility or recurrent miscarriages?
ShellyW	Sorry - Dr. Sher from this website mentioned that he wrote an article called "Factors Influencing IVF Outcomes"
Dr._Tourgeman	Allison-there is no likelihood of this affecting you pregnancy...please dont find a reason to blame yourself
Allison466	ty dr didnt think so but had to make sure
Lisa_Rosenthal	Dr. Sher is a physician that moderates one of our message boards. What I have seen over and over again, is how often physicians have different opinions about how to treat problems with conception.
Dr._Tourgeman	Again Frannie-There is very little likelihood of success (unfortunately) and if successful there are many errors that can arise (e.g.Downs) with increasing frequency...having said that it is not impossible
Dr._Tourgeman	There are so many factors Shelly that I worry that I could not answer this so simply
Allison466	dr i told u i went for transfer friday if embryo or embies implant would they have already and sorry if this soinds gross but woke up w wet undies in afternoon i have like a watery discharge ca n u tell me what could cause tyhis
Dr._Tourgeman	Impantation probably happened by now, and the discharege in all likelihood if from your high estradiol levels
Lisa_Rosenthal	Allison, Dr. Tourgeman is so right. Simple, everyday things that we do or don't do don't create success or failure with pregnancies. We as patients tend to want to know the reasons or to figure out what happened, and sometimes there is no reason. Let's not take that a step farther and find the blame with ourselves.
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Dr._Tourgeman	My leasure
ShellyW	After the embryo transfer, I had cramps the next 7 days (which my dr. said was normal). On the 8th day (day before I found out the IVF failed), a couple of times throughout the day, I had "stabbing" pains in my stomach that hurt worse than the cramps the prior 7 days. Would this have meant I maybe wasn't taking it easy enough?
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Dr._Tourgeman	Nancy in Calif
epbn	Dr can you recommend authors, universities, sources of current information (in additon to the amazing AFA site) to learn more about advances in ART? I have found many books and studies to be quite dated.
Jen36	Where in CA and how long a wait to get an appointment?
RT	Dr, how many times will acupuncture help before IVF with donor egg?
Dr._Tourgeman	Shelly-cramping is a worrisome sign
epbn	thanks Lisa!
Wannababy	Dr Tourgeman, can you post your phone number, please
Allison466	ok well im hoping i get preg of coarse ,, however i do have another iption my family member she is 26 yrs old has 2 kids of her own is willing to carry baby for us i asked dr about this he said they dint do it in nj and might even be illegal do u know anything about this?
Dr._Tourgeman	Epbn-we would be happy to send you literature
Lisa_Rosenthal	Posting your phone number would be a great idea.
Dr._Tourgeman	Rt-Im not sure please ask your accunpuncturist
ShellyW	Thank you. Should I feel anything to know that the embryo might be attaching to my uterus lining and that the IVF would be a success?
Dr._Tourgeman	Wannababy my nunber is 626-440-9161
Dawn	I'm almost 34, and while on Clomid 50mg, have produced anywhere from 3 - 8 eggs total. Is that any indication as to whether I'll be a high or low respnder with stronger drugs for IVF, like Follistim?
epbn	Do you have any views on DHEA (Rx) and increased follicle/egg production?
sblm	Dr. what can be done about a patient who is hard to stimulate? My doctor was giving me the maximum dosage and I wound up with only three eggs, two were viable. IVF attempt failed.
Dr._Tourgeman	Shelly-You shouldnt feel anything
Dr._Tourgeman	Dawn this is a good sign!
Allison466	another question i have is i have come across preg woman with pcos like me and they stay on the glucophage when i got preg dr took me off which do u think is better?
local	[332] Wednesday- March 9- David Tourgeman, MD, (Huntington Reproductive Center in CA)- Topic- Surrogacy and Third Party Reproduction Discussed
Dr._Tourgeman	epbn-There are no studies that I am aware of that suggest you use DHEAS-I would not!
epbn	why not?
Dr._Tourgeman	sblm-Did you try a microdose flare or antagonist??
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Dr._Tourgeman	Allison-The ASRM suggest that unti more info is available one should stop Metformin when pregnanat]
Michael	What are options for male factor? Severe male factor.
Dr._Tourgeman	Micheal-How severe?
Dr._Tourgeman	Has a biopsy been done Michael>
Michael	Motility is very low.
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localhost	[2009] touser Thanks for joining us this evening- Please feel free to post questions for Dr. Tourgeman. Copy and paste them so that you can repost them if necessary. The room can get quite busy.
Dr._Tourgeman	If there is some that are motile Michael, ICSI can be pperformed to provoke fertilization
Allison466	o h felt loke my period was coming dr but i was relaxed o was sleepong
Lisa_Rosenthal	Dr. Tourgeman, you are doing a wonderful job answering all these questions and keeping up with everyone! We really appreciate your time and energy this evening.
Allison466	maybe ot was nerves too o so desperately want to be preg
Allison466	yes
Allison466	ceonone and pio
Dr._Tourgeman	Ask your doctor if he recommends taking more Allison
Allison466	crinone
Allison466	progesterone in oil
Allison466	injected
Dr._Tourgeman	Got it-Ask if he thinks you need more
Dr._Tourgeman	this might sttle the uterus down
Lisa_Rosenthal	Allison, I was a patient, in treatment for 6 years. We tend to get hyper-in-tuned to our bodies. Maybe some mind/body work would be helpful and soothing, also speaking with others that are going through this can also be helpful.
elle	Hi Dr T--Are you familiar with someone having elevated prolactin levels and ovulating when on clomid, but not when they are off?
Allison466	ok om not cramping anymore doc this was only for first 2 days after trans should i still ask ?
Dr._Tourgeman	Ovulation itself may increase Prolactin levels
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.
ShellyW	What is the average for women as to how many eggs are retrieved? I've read stories about women getting over 12 eggs retrieved. At my age (27), I only had 8 eggs retrieved and of that 5 matured and 4 fertilized. Used two embryos the first time and both failed.
elle	is dostinex the only answer for normalizing?
Dr._Tourgeman	Shelly-probaly at 27 10-15 is average
Lisa_Rosenthal	We have wonderful message boards, that are peers only. Great place to go, complain, ask, help, whine, encourage and just talk, talk, talk. We all need an outlet when we are going through this. Try our peer support board, I lived there while I was in treatment.
local	[332] Wednesday- March 9- David Tourgeman, MD, (Huntington Reproductive Center in CA)- Topic- Surrogacy and Third Party Reproduction Discussed
Dr._Tourgeman	Elle-there is bromocriptine, parlodel
elle	ok thanks i didn't know about parlodel have bad migraines and they were worse with dostinex
Wannababy	Good question Shelly- Dr. could you talk about single embryo transfer? I've been hearing about it a lot lately.
Dr._Tourgeman	Sheely-the chances of success generally stay the same as for upto 3-4 attempts
Lisa_Rosenthal	Interesting, wannababy- we have Dr. David Gardener coming into NYC to speak on single embryo transfer at our April 17 conference. Dr. Gardener did some wonderful research on the subject in Colorado.
Allison466	ok dr if this 3rd attempt doesnt work what do u suggest time to give up?
Dr._Tourgeman	Allison-plese remind me of your age
Wannababy	yes, but what are the statistics for pregnancy with 2 as opposed to 1?
Allison466	oam 33
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!
Dr._Tourgeman	If blast are transferred Shelly-and you are <35yo about 50%.
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Dr._Tourgeman	But I wouldnt give up... perhaps a differnet MD & lab Allison
Allison466	what age wotld u say to give up hubby thinks egg to old after 35 is this true
Allison466	im healthy non drinker non smoker
elle	i am almost 36 and going to try injectables on my 4th iui--could the prolactin have caused the failures for the others and do I have a chance with injectables
Dr._Tourgeman	Pregnancy rates diminsh after 35 yo, but not substantially so Allsion
localhost	[2009] touser Family Matters: The National Fertility and Adoption Conference 2005--- April 17 in NYC--- over 80 professionals in the field, 40 workshops, 8 keynotes, exhibit hall--- lower price of admission this year! Check it out on our home page....
ShellyW	Was told that with frozen embryo transfer that our %age is only 10-15%, compared with it being about 60-65% with fresh embryos? Is this true?
Dr._Tourgeman	i.e injectible
Frannie	Dr, could you post your phone number again, please?
Allison466	ok big question could ot be my weight iam over weight they say glucophage helps lose weight i havent lost a
elle	ty
Dr._Tourgeman	Freezing the embryos does dimish success but usually pregnancies rates are about half the frsh
Dr._Tourgeman	Your welcome elle
epbn	Dr, thanks so much for your time and all the info. Have an early am appt for blood and u/s, so signing off!!
Dr._Tourgeman	Thx epbn
elle	is the same true with frozen sperm versus fresh with success rates for iui
Lisa_Rosenthal	Ladies and Gentlemen, we are so lucky to have professionals of such high caliber do these online sessions. One way that I do this is by promising that they will be off line, on time. That leaves us about 7 minutes. Keep in mind that if you have questions after the session, our message boards are moderated by physicians daily. They will answer your individual questions. One of Dr. Tourgeman's colleagues answers them on Sunday!
ShellyW	Is it also true that about 20% of frozen embryos don't survive after being thawed, before the embryo transfer?
Dr._Tourgeman	No elle-not the case with sperm
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Dr._Tourgeman	Shelly yes this is true-about 80% of embryos make it after freezing
jag_grotke	38/poor responder - re wants to do a lupron microdose flare protocol. I've read mixed info about this protocol b/c of the additional LH. What are your thoughts?
Allison466	i had 4 froze and only 3 survived
Dr._Tourgeman	sblm-is this for me??
Dr._Tourgeman	jag-I agree this is the next step!
Dr._Tourgeman	Allison-right at 75%
angiebyerly	using a known egg donor next and want to know if there are any concerns or issues we should be considering?
Frannie	Good night.
Lisa_Rosenthal	Good night Frannie, thanks for joining us.
sblm	Is Metformin a safe medication to be prescribed when one does not have an insulin problem? My gyn doc. suggested I take it while my RE said I should not.
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Allison466	goodnight ty dr wish u were here in new jersey
Dr._Tourgeman	Angie-many...age of the donor, has she been successful in the past, your uterus
Lisa_Rosenthal	Allison, we have some wonderful physician referrals in NJ, please call our toll free number and speak with Lori.
Kaley	Glad to have sat in tonight.
Kaley	thanks
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Sandy	great chat, 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!
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Allison466	well i guess o really shouldnt have said that my drs have been good to me im just being a bratt
Allison466	its just so frustrating
Dr._Tourgeman	Sorry was disconnected
Lisa_Rosenthal	We have just a couple of minutes left this evening. Thank you much to everyone for joining us this evening and asking such great questions! Please check our schedule and join us next week as well.
jag_grotke	Thanks!
Lisa_Rosenthal	Dr. Tourgeman, you have been just wonderful. Hope that you enjoyed it as well and will join us again sometime.
elle	thanks
Dr._Tourgeman	Thanks Lisa
Stephen	nite
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angiebyerly	ty
Dr._Tourgeman	My pleasure
Orly	Thanks Lisa, and dr.
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Allison466	ty also Lisa
Lori_Masi AFA_PAtient_Advocate	Good Night All!
Allison466	ill be back again this chat was very informative
Lisa_Rosenthal	Allison, you're so welcome!!
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Rhonda	Good nigh
Rhonda	t
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Wannababy	I just love these chats! Night
Lisa_Rosenthal	Good night Wannababy!
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ShellyW	Thanks for the great info! Will want to do these chats again.
Lisa_Rosenthal	Shelly, I'm so glad that you found it helpful.
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Lisa_Rosenthal	Please join us again, soon.
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gbodd	I have been diagnosed with PCOS after years of trying to figure out why I was gaining so much weight and why I had such difficult and irregular menstrual cycles. Now I need to know how the weight can come off. I tried glucophage but I did not feel well on the medication. Did I not give the meds enough time to work? I need help.
gbodd	Does anyone have any ideas to help me?
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