Testing, Testing, Testing

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March 28, 2006 - Tuesday
7:51 PM to (EST)
Guest Speakers: Harvey Kliman, MD, PhD
Yale University School of Medicine
Reproductive and Placental Research Unit

Categories
Endometriosis • IVF

	Harvey_Kliman joined
Harvey_Kliman	I am online
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Harvey_Kliman	Hi Deb, I am online
deb_capone	Hi, Harvey...
Harvey_Kliman	Did you get my document?
Harvey_Kliman	I just emailed it again
Harvey_Kliman	How do you paste into the typing area?
Harvey_Kliman	If I want to paste text or a link, etc.?
deb_capone	you can't.
deb_capone	I can't access my email or computer, so i am at another locations....
Harvey_Kliman	::sad
Harvey_Kliman	So what do we do about the text you wanted?
deb_capone	Good Evening and welcome to tonight's Online Education Session, hosted by The American Fertililty Association and sponsored by Fertility Lifelines.
deb_capone	We will be starting tonight's session at 8pm sharp. Our guest tonight is Harvey Harvey Kliman, MD, PhD Yale University School of Medicine Reproductive and Placental Research Unit
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deb_capone	Welcome, Symharmony
Symharmony	Thanks
deb_capone	We'll be starting in a just a few minutes.
Symharmony	ok
deb_capone	Tonigth we welcome, Dr. Harvey Kliman, from Yale University's School of Medicine. Thank you for joining us, Dr. Kliman.
Harvey_Kliman	My pleasure.
deb_capone	Dr. Kliman why don't you give our guest---and soon to be guests a brief description of yourself and your work.
Harvey_Kliman	OK
Harvey_Kliman	I am an MD and PhD who works in the Dept of Ob/Gyn at Yale.
Harvey_Kliman	My areas of interest are implantation and recurrent pregnancy loss.
Harvey_Kliman	Our lab has developed a test to look at the endometrium.
Harvey_Kliman	It is called the Endometrial Function Test (EFT) and is like a soil test for the endometrium.
deb_capone	That is quite an interesting analogy, Dr. Kliman, can you explain a bit more about this test?
Symharmony	Is the EFT different than the Lap?
Harvey_Kliman	Yes, the EFT is different than a lap. Here goes:
Harvey_Kliman	The embryo is like a plant, the endometrium is like the soil.
Harvey_Kliman	In order to get a plant to grow you need good soil.
Harvey_Kliman	The EFT tests the endometrium to see if it healthy and normal.
Harvey_Kliman	We need to obtain a biopsy of the endometrium, usually on cycle day 24.
Harvey_Kliman	The sample is sent to our lab at Yale and we test it to see if it is normal or not.
Harvey_Kliman	If it is not normal, we make specific recommendations to the doctors on how to fix the problem, if possible.
deb_capone	Is Yale the only place that is doing this test?
Symharmony	Are you the only place that does this test or do you know of other places that do it?
Harvey_Kliman	Yes, the test was invented by myself and my lab is the only place that performs the test.
Harvey_Kliman	Much more information can be gathered at our Yale web site:
deb_capone	At what point would an RE want to look to the EFT?
Harvey_Kliman	http://info.med.yale.edu/obgyn/kliman
Harvey_Kliman	Click on EFT at the top
Harvey_Kliman	Some REs will do the EFT after one or more IVF failures, but in my opinion it is more cost effective to do it earlier, even as a screen before an expensive IVF procedure.
deb_capone	how does the test work?
deb_capone	And should a patient request the test or rely on the RE to suggest.
Harvey_Kliman	The biopsy is sent to our lab and then we perform something called immunohistochemistry on the sample to look for the expression of molecular markers of differentiation.
Harvey_Kliman	An introduction article for patients is on our web site.
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Harvey_Kliman	I think a patient who has been infertile for a long time should go ahead and do this before IVF.
Harvey_Kliman	However, many REs like to try IVF at least once before testing.
deb_capone	Welcome, Pam and Greg.
Harvey_Kliman	The issue is which is better: doing a $450 soil test or a $10,000 IVF to find out that something is not right?
deb_capone	thanks for being here.
Symharmony	I'm having a Lap done in May to see if I have Endometriosis....I'm nervous because I don't want anything to be to wrong with me....I would hope it is minimal and I can be fixed during surgery. Is there something I can do to help my situation?
Harvey_Kliman	No. The purpose of the lap is to remove any endometriosis that may be there, which is a good thing to remove.
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lorna	hi, everyone, Sorry i am late
Harvey_Kliman	np
Symharmony	Have you seen positive results from women who have had Laps? Were they able to get pregnant once the tissues were removed?
Harvey_Kliman	Yes
pam_and_greg	I have had a couple of failed cycles...why didn't my doc recommend this test?
pam_and_greg	it seems like a no-brainer?
Harvey_Kliman	Removing endometriosis has been shown in a number of studies to improve pregnancy rates. Therefore this is a good thing for you if you have endometriosis.
Symharmony	Thanks
Harvey_Kliman	Good question Pam and Greg. I don't know.
Harvey_Kliman	As you may suspect, sometimes REs prefer to simply do another IVF rather than try to figure out why a patient is not getting pregnant.
Symharmony	After you do the EFT, what do you do if you see a lot of damage? How do you create good soil?
lorna	is there one "BIG REASON" for recurrent pregnancy loss? My doc seems stumped....and frankly it is getting kind of expensive.
Harvey_Kliman	Let me deal with the EFT for a moment, then RPL.
Harvey_Kliman	If the EFT is abnormal we try to deal with the issues that cause an abnormal soil. These include:
Harvey_Kliman	Endometriosis
Harvey_Kliman	Too much weight
Harvey_Kliman	Too little weight
Harvey_Kliman	Too much stress
Harvey_Kliman	Fluid in the tubes
Harvey_Kliman	Getting near menopause
Harvey_Kliman	Sometimes it is simply a matter of adjusting the stimulation that the transfer is done with.
Harvey_Kliman	Or how the hormones are given.
Harvey_Kliman	Vaginal versus oral P, for example.
Harvey_Kliman	For the newcomers, please see my web site for more information on the EFT or RPL
lorna	many of the issues that you describe are lifestyle related. Do you recommend yoga or massage?
Harvey_Kliman	http://info.med.yale.edu/obgyn/kliman
Harvey_Kliman	I recommend decreasing stress.
Harvey_Kliman	Stress is a well known cause of infertility.
Harvey_Kliman	Whatever works best for you, including job change, vacation, etc.
Harvey_Kliman	Back to RPL:
lorna	so at 43, three failed cycles and a high stress job, what do i do next. What questions should i ask?
Harvey_Kliman	Many cases can be solved if we look at the loss tissues. If you have had losses with tissue, please see my website for links for how to get the material to me at Yale.
Harvey_Kliman	Iorna: you might wish to consider a sabbatical.
lorna	Would that really make a difference>
Harvey_Kliman	Yes
Harvey_Kliman	Especially if you are stressed in your job.
pam_and_greg	if we sent tissue to you, what would you look for?
Harvey_Kliman	Are we talking EFT or loss tissues?
pam_and_greg	Either
pam_and_greg	or both.
Harvey_Kliman	Have you had losses? If so, is there tissue?
Harvey_Kliman	While I wait.
Harvey_Kliman	For EFT we need a biopsy of the endometrium.
pam_and_greg	yes, we have had losses
Harvey_Kliman	For losses we need to have the tissue from the pregnancy, usually from a D&C.
pam_and_greg	but what do you look for...what conclusions can you draw and how does that help?
Harvey_Kliman	Pam and Greg: please see my web site, specifically the section on Pregnancy Loss Resources. All the info is there.
pam_and_greg	us get and stay pregnant
Harvey_Kliman	I can usually find the cause for the loss.
pam_and_greg	what are the causes generally.
Harvey_Kliman	In the 1st trimester the most common cause for loss is genetic.
Harvey_Kliman	Then comes immunologic and then thrombotic.
Harvey_Kliman	For 2nd trimester it can be all of the above, plus decreased blood flow to the placenta.
Harvey_Kliman	In the 3rd the most common cause is cord accident.
Symharmony	How do you prevent cord accidents?
Harvey_Kliman	You can not prevent cord accidents, unfortunately.
Harvey_Kliman	Yes
lorna	Dr. Kliman, how common is the EFT test. Do most RE's know to order it? Should patients suggest it to their doctors?
Harvey_Kliman	At this point about 100 doctors in the US, some in Canada and Mexico are using it.
Harvey_Kliman	Some doctors use it all the time, some only after one or more IVF failures.
Symharmony	Are any of those doctors in Colorado?
Harvey_Kliman	Not sure, however, it is easy to do and we can help any doctor to get it started in their clinic.
lorna	if it so cost effective vis a vis IVF, why don't all docs use it as a regular screening?
lorna	are there any risks or downsides?
Harvey_Kliman	Great question.
Harvey_Kliman	No risks or downsides. All that is needed is an endometrial biopsy.
lorna	that is invasive, isn't it?
Harvey_Kliman	Of course that can be a bit painful and it does cost $450, but that is much less than a failed IVF cycle.
Harvey_Kliman	Yes, an endometrial biopsy is done by putting a thin catheter in the uterus and sucking out a bit of the lining.
lorna	agreed, but what information is generated and how can that be used to get pregnant?
Harvey_Kliman	If an EFT is abnormal a women has a 10 times less likely chance of getting pregnant.
Harvey_Kliman	Therefore, it tells us to stop until we fix the endometrium.
lorna	and that is weight, stress etc?
Symharmony	How do you fix it?
Harvey_Kliman	Depending on the specific clinical situation there are different things that can be done to fix the problem.
lorna	like what?
Harvey_Kliman	You fix it by going through the list of things that can cause the problem, for example:
Harvey_Kliman	Too high or low BMI
Harvey_Kliman	Endometriosis
Harvey_Kliman	Hydrosalpinx
Harvey_Kliman	Stress
lorna	what is hydrosapinx
Harvey_Kliman	And for women undergoing FET or donor we will change the stimulation protocol until the EFT is normal.
Harvey_Kliman	Hydrosalpinx is fluid in the tubes
lorna	thanks
Harvey_Kliman	fyi: my email is harvey.kliman@yale.edu if you wish more information after this session.
lorna	Thanks
Symharmony	If your tubes are blocked what can be done to unblock them? Is your only option IVF?
Harvey_Kliman	At this point, yes, IVF would be the most cost effective route
pam_and_greg	what about recurrent pregnancy loss?
Harvey_Kliman	RPL is a challenging problem.
Symharmony	Can a Uterine massage help?
pam_and_greg	how does one go about looking at the reasons?
Harvey_Kliman	My suggestion is to get as many of the loss tissue samples to my lab as possible. Often I can figure out the cause.
pam_and_greg	are there typical causes...that we might be able to fix.
Harvey_Kliman	As I said above, I look at the tissues and often find the cause by the pathologic changes in the pregnancy tissues.
Harvey_Kliman	I don't know what uterine massage is.
Harvey_Kliman	RPL: depending on what I find there may be ways to fix the problem. If not, then it may simply be helpful as part of the explanation.
pam_and_greg	what do you find?
Harvey_Kliman	Genetic causes, immunologic causes, blood clotting, infections
Harvey_Kliman	Cord accidents
Symharmony	I'm not sure myself....I've just recently heard of it. I think it is suppose to help you if you have Endometriosis, polyps, cysts, menstrual cramps....I'm not sure how effective it is.
Harvey_Kliman	Placental separation
Harvey_Kliman	Symharmony: sounds a bit flaky to me.
pam_and_greg	I have heard of it as well.....don't know how effective it is,
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deb_capone	L
deb_capone	Symharmony, you might want to go on to one of the AFA's Message boards and ask about it....our boards get lots of folks and undoubtedly you will find someone with an opinion.....
Symharmony	Yeah...I guess it can't hurt to try...if anything it could reduce stress. My insurance doesn't cover a dime towards any kind of infertility procedures or testing, so I have to try some alternative routes to see if they can help me.
Symharmony	thanks
deb_capone	Which reminds me that if you aren't a "No Barriers" member of the AFA...there is no time like the present...www.theafa.org...its free!
deb_capone	Dr. Kliman, do you know if your test is covered by any insurance company?
Harvey_Kliman	It is not at this point
deb_capone	Dr. Kliman, if a patient wants to have an EFT, when should she have it...and should she ask the RE directly?
Harvey_Kliman	Yes, the patient should and can certainly ask her RE directly.
deb_capone	when should she start to ask for the test?
Harvey_Kliman	Ultimately, in my opinion a patient needs to control her care.
Harvey_Kliman	I would suggest sooner than later.
Harvey_Kliman	But certainly if she has one failed IVF. Why wait to have another failed cycle.
deb_capone	is it appropriate to ask for right off the bat?
Symharmony	Do you recommend it before IVF?
Harvey_Kliman	I have several doctors who do it as soon as a patient walks into the clinic.
Harvey_Kliman	If it is norma, they proceed with ART.
Harvey_Kliman	If it is abnormal, they fix the problem before proceeding.
Harvey_Kliman	If I can find it, I can send you a link to a patient's web site who used the EFT and she explains how she did it first and it saved her from a failed IVF cycle.
deb_capone	that would be very helpful
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Harvey_Kliman	I'll look while I am waiting for more questions, but keep them coming if you have any.
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Harvey_Kliman	Found it:
Symharmony	Can having an EFT prevent losses during pregnancy?
deb	sorry, i dropped off for a second
Harvey_Kliman	Some patients have early losses due to problems with their endometrium. It depends on how many weeks the losses occurred.
Harvey_Kliman	http://home.earthlink.net/~cshapiro10/id2.html
Harvey_Kliman	This tells Carrie Shapiro's EFT pregnancy story.
deb	Dr. Kliman, we are almost at the witching hour and i want to thank you for ypur time.
Harvey_Kliman	My pleasure.
Harvey_Kliman	Again, for more information, see: http://info.med.yale.edu/obgyn/kliman
Symharmony	Thank you
deb	would you make a few closing comments---\
Harvey_Kliman	Best wishes and good luck in trying to reach your goals of parenthood
Symharmony	thanks
deb	thanks and see you next week
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