The General Work-up: The Tests, The Reasons

July 19, 2005 - Tuesday
1:56 PM to 2:56 PM (EST)
Guest Speakers: Daniel Potter, MD, F.A.C.O.G., Huntington Reproductive Center in California

Categories
Donor Egg • Fertility • Infertility • IUI • IVF • PCOS • Reproductive Health

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Lisa_Rosenthal	Good evening everyone!
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julie	hello I'm new here
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Lori_Masi AFA_Patient_Advocate	Good Evening Everyone!
Catherine	Dr. Potter have you joined us yet?
julie	Hi Lori
Lisa_Rosenthal	Hi Catherine, Dr. Potter has not arrived yet.
Lori_Masi AFA_Patient_Advocate	Hi Julie
pmschue	Hi Lori and Lisa
julie	how does this work
Lisa_Rosenthal	Hi Julie and pmschue
pmschue	This is a great topic. I have my questions ready to go.
Lisa_Rosenthal	Julie, when the presenter comes on, you may post questions.
Lori_Masi AFA_Patient_Advocate	Hi pmschue!
Lisa_Rosenthal	Be ready to repost because these rooms get very busy.
Lisa_Rosenthal	cutting and pasting questions works best.
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Lisa_Rosenthal	Welcome Dr. Potter, thank you so much for joining us this evening!
Lori_Masi AFA_Patient_Advocate	Welcome Dr Potter!
pmschue	Dr. Potter - My testing began with a cd11 u/s by my ob/gyn. All clear. Next was hsg. Left tube open. Right tube "mild peritubal adhesive disease around the fimbriated portion of the right fallopian tube". What does this mean? Is my right tube okay? My RE suggested that I had an STD at some point in my life (although I've never been told by ob/gyn that I had an STD, never had symptoms, and I get tested for Chlamydia/Gonnarhea every year). Does this sound right?
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Lisa_Rosenthal	Welcome wannababy, thanks for joining us this evening.
julie	I am soon to be 40 and last yr got pregnant and then miscarried at 15weeks, now I have done 3 more IUI'S that did not work, I will be doing a IVF cyle in Aug, all my FSH levels were good, all tubes are open and sperm count is good, anything you can add will help.
Lori_Masi AFA_Patient_Advocate	Hi Wannababy!
Dr._Daniel_Potter	Hi pmschue. The tubal adhesions suggest that your tubes were probably damaged by chlamydia in the past. Chlamydia is generally an aymptomatic disease that silently damages tubes. So, yes, this sounds right.
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Catherine	I did an IUI and had some bleeding? Is that usual please Dr. Potter?
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Lisa_Rosenthal	Hi Orly, thanks for joining us. Please feel free to post questions.
pmschue	Dr. Potter, Does that mean that my right tube is shot? Or is it still good?
Dr._Daniel_Potter	Hi Julie. I would recommend that you have a clomid challenge test to determine what your ovarian reserve is. This will help your doctor tell you what your chances are prior to starting your cycle. If you have truely unexplained infertility, ICSI should be done on some or all of the eggs to ensure that fertilization occurs.
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pmschue	Dr. Potter - My initial tests at RE included complete thyroid testing, FSH and LH, but not on cd3. I was told that my levels were fine, but shouldn't I have had a baseline test first? Also, my estrodial has never been checked. I've had 5 IUI's, 3 unmedicated, 2 clomid+ trigger with u/s monitoring.
Lisa_Rosenthal	Hi Stephen, please jump right in with any questions you may have
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a	hi
Dr._Daniel_Potter	Hi Catherine: IUI's can sometimes cause bleeding but this bleeding is usually from teh cervix. It could be from an abrasion from the speculum or the catheter or it could be because your cervix was inflamed. It should not hurt your chances.
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julie	Thank you, Dr. is that clomid challenge the same as taking Gonel F drugs, I'm unclear what you mean, SORRY.::
Dr._Daniel_Potter	Hi pmschue: It means that your right tube may have adhesions around it. I would recommend moving on with treatment rather than laparoscopy to comfirm this.
Lori_Masi AFA_Patient_Advocate	Wlcome Merilyn!
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Lori_Masi AFA_Patient_Advocate	Hi Carey Welcome!
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	admin%
Catherine	Why do they not test for PCOS? I discovered I had it myself and got pregnant only to have a stillborn 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._Daniel_Potter	Hi pmschue: I am not sure of the value of random FSH levels. They should be done on dya 3 and preferably in conjunction with a clomid challenge test
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pmschue	Dr. Potter - what tests would you normally perform on a 33 year old female infertility patient, assuming no PCOS?
Dr._Daniel_Potter	Hi Julie: No, the clomid challenge test is not the same as taking Gonal-f. It is a test where the FSH and estradiol are checked on cycle day 3, you then take 100mg of clomid days 5-9 and on day 10 the FSH is repeated. Any FSH level greater than 10 indicated a diminished prognosis with fertility treatment.
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Dr._Daniel_Potter	Hi Catherine: I am not sure of your entire clincal picture but am very sorry to hear of your stillbirth. Patients that have any evidence for PCOS should be screened for it. Unfortunately, not everyone with PCOS has overt clinical signs of it.
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Lisa_Rosenthal	Hi Jenna, hope you're not having any trouble with staying in the room.
Dr._Daniel_Potter	Hi pmschue: I would perform an HSG, a clomid challenge test and a strict semen analysis at the least.
Lisa_Rosenthal	Good evening Yola, thanks for joining us this evening.
Jenna	Hi Lisa, think I'm ok now. thanks
Jenna	Doctor Potter, do I have to repeat everything if I go to a new doctor or for a consult?
julie	Is that only done when starting an IVF cycle or done with both IUI and IVF? I dont my Dr. ever told me about that. makes me nervouse to think of it. but, I was produccing alot of eggs w/gonel F does it mean IVF will or wont work
localhost	[2009] touser The American Fertility Association has free membership! Please go online and you will have access to all our publications at "No Barriers".
pmschue	Dr. Potter - Just today a new urologist ordered a strict semen analysis for my husband. He has never had one before This is after 5 IUI's. And I've never had the clomid challenge test but have had 5 IUI's. I relly feel like my RE has been irrespnsible in our treatment!! What do you think when you hear this?
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tmoore	HI Dr. Potter. How many IUI's would you attempt before moving on to IVF? At what point do the odds decrease?
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julie	great question
Dr._Daniel_Potter	Hi Jenna: You probably do not have to repeat everything but it depends on whether the testing was done appropriately. A good response to Gonal-f is a good sign that you will do the same during your IVF cycle.
Lisa_Rosenthal	Welcome Frances and Brenda. Please feel free to post questions for Dr. Potter.
Lisa_Rosenthal	Dr. Potter, thank you for joining us this evening. We appreciate your time, effort, energy and compassion!
pmschue	Dr. Potter - Before attempting IVF, is it good to have atleast one IUI cycle with injectibles to see how well a person responds? IVF isn't covered by insurance and i don't want to jump in blindly.
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Lisa_Rosenthal	Hi lisaz, thanks for joining us this evening.
Lisa_Rosenthal	How did everyone hear about tonight's session?
pmschue	Lisa - I heard through the e-mail notice.
lisaz	Thank you. I have a question for the doctor. Why would an IVF clinic want me to have a mammogram. I'll be 44 tomorrow.
Brenda	Which are the tests that are out of date?
Dr._Daniel_Potter	Hi pmschue: It is hard to comment on what your RE did or didn't do without having the whole picture but I can share with you what I would do. I do not like to make assumptions because sometimes these assumptions are wrong so I order tests like the clomid challenge test and the strict semen analysis. This is a rather shameless plug, but my book What To Do When You Can't Get Pregnant (Avalon) is available on Amazon and explains this philosophy in more detail.
Catherine	Fantastic an author you are--please plug away! What are the cutting edge trends in infertility workup? Any advancements for the over forty woman, what tests for donor egg?
Lisa_Rosenthal	thanks pmschue
lisaz	Dr. Potter, is that a new book? I thought I had read them all.
pmschue	Dr. Potter. I appreciate your response. I've read plenty of books, but RE's don't like patients that tell them how to do their job. It's rather frustrating. I quit going to that RE, am currently doing acupuncture and herbs. If I go back to RE, I'll be swicthing to a new Dr., but at the same clinic. It's the only clinic in town.
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Lisa_Rosenthal	Hi Notall, thanks for joining us this evening...
Dr._Daniel_Potter	Hi pmschue: Whether an IUI is indicated prior to IVF depends on why IVF is being done in the first place. I would personally not initiate a treatment unless I felt it had a chance to be successful. If you are a candidate for both IUI and IVF, it would be up to you to consider all of the financial matters involved and decide on a treatment course.
julie	what's your opinion on acupunture, and herbs do you think it's true that it can help you get pregnat?
pmschue	Dr. Potter - Do you always do lap on infertility patients? What would make you decide to do lap?
julie	what about stress and infertility is there a connection?
Notall	what tests would you suggest at the age of 46 with never having been pregnang?
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carey	Dr Potter, I was on the pill for 9 years. Came off and 12 months of irregular cycles (4-7 weeks) before getting pregnant - used fertility monitor for 2 months - 1st mo no ovulation, 2nd month on day 14. Got pregnant 9 months later after one cycle of clomid. Lost the baby at 11 weeks. Got pregnant again 4 months after that on 2 cycles of clomid. Never had strong symptoms so made them test hcg levels and found empty sac. Had D&C where they found no pregancy tissue so they did laparoscopy and gave me a shot of methetraxate. Levels back to 0 after several weeks. Got period 6 weeks after procedure and had a 32 day cycle. Attempted pregnancy this (2nd) cycle using fertility monitor - I had no surges a
pmschue	Dr. Potter - Have you ever heard of a prostate ultrasound being ordered to deterimne if there is a blockage. Is this a good test to have for a man with low sperm count? Or fluctuationg sperm count?
Dr._Daniel_Potter	Hi Catherine: Thanks for the compliment. In terms of cutting edge changes for the work-up, there really are not any recent major breakthroughs. SOme commonly overlooked areas include: insulin resistance testing in PCOS and recurrent pregnancy loss patients; genetic testing in severe male factor cases; performance of strict semen analyses in unexplained infertility cases; and my favorite: the clomid challenge test.
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julie	I am going into my next cycle, and and I am going to do IVF I responded good to gonel f I just want this to work so bad. any info on IVF you can offer
carey	I should have pointed out that the 1st pregnancy was uneventful and produced a healthy girl. Thanks for you help.
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. You can also e mail me at LoriattheAFA@aol.com and please don't forget to post and share with each other on our wonderful message boards. Looking forward to hearing from all of you! Lori Masi - AFA Patient Advocate
Dr._Daniel_Potter	Hi Julie: As far as accupunture and herbs, the jury is really still out. I think that they help some women, the only problem is how to find these women. There are currently no tests that would tell us who would benefit and who would not. So I would say caveat emptor but go ahead if you have a dedicated practioner that understands fertility. These treatments are adjuvants to mainstream fertility treatment rather than primary treatments.
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Dr._Daniel_Potter	Hi pmschue: No I do not alway laparoscope infertility patients. I think that it is only helpful in patients that either have pelvic pain or pelvic pathology evident on physical exam or ultrasound. In my opinion, laparoscopy should no longer be part of the routine fertility work-up.
julie	what about stress and getting pregnant? sorry so many questions, but what about produccing so many folicles from gonel f. if I did IVF would it be different because it's ivf and not iui?
tmoore	Hi. I think my question was missed. How many IUI's would you attempt before moving to IVF? At what point do your odds decrease?
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Catherine	Ops, that was an excellent questions. Thanks for your patience.
pmschue	Lori - Is Dr. Potter coming back?
tmoore	Also, as an add on to my original question: are there any studies/ tests that indicate the tops reasons why IUI's do not take?
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Lori_Masi AFA_Patient_Advocate	Yes, dr potter will be back - he has lost his connection
Dr._Daniel_Potter	HI am BAACK
Lisa_Rosenthal	Repost questions, please.... Dr. Potter is here.
pmschue	TMoore - I'd love to hear the answer to that question. Lori - I was disconnected earlier too.
Lori_Masi AFA_Patient_Advocate	Welcome Back Dr Potter!
Catherine	tmoore questions are next Dr. Potter.
Lisa_Rosenthal	Please repost questions. Dr. Potter is unable to see anything that was previously posted.
Dr._Daniel_Potter	OK
Dr._Daniel_Potter	ummm
tmoore	Repost: How many IUI's would you attempt before moving to IVF? At what point do your odds decrease? Also, are there any studies/ tests that indicate the top reasons why IUI's do not take?
pmschue	Dr. Potter - Have you ever heard of a prostate ultrasound being orderred to deterimne if there is a blockage. Is this a good test to have for a man with low sperm count? Or fluctuationg sperm count?
julie	Dr. I have done 3 IUI'S since my 1st IUI worked in 04 I wonder if after my d/c could that have now kept me from getting pregnant again
carey	Dr Potter, I was on the pill for 9 years. Came off and 12 months of irregular cycles (4-7 weeks) before getting pregnant - used fertility monitor for 2 months - 1st mo no ovulation, 2nd month on day 14. Heathly girl. Got pregnant 9 months later after one cycle of clomid. Lost the baby at 11 weeks. Got pregnant again 4 months after that on 2 cycles of clomid. Never had strong symptoms so made them test hcg levels and found empty sac. Had D&C where they found no pregancy tissue so they did laparoscopy and gave me a shot of methetraxate. Levels back to 0 after several weeks. Got period 6 weeks after procedure and had a 32 day cycle. Attempted pregnancy this (2nd) cycle using fertility monitor - I
Dr._Daniel_Potter	Hi tmoore: This is an excellent question. I would say that we would usually try 3 IUI before moving on. The pregnacy rate in IUI's 4-6 is decreased. In patients using frozen sperm, I usually try 4-6.
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Dr._Daniel_Potter	Hi tmoore: Finishing up your question, IUI's are at risk to fail if there are subtle problems with the eggs or sperm that have not be discovered. As such my old favorite the clomid challenge test is very useful. About 30% of younger women with unexplained infertility have an abnormal clomid challenge test. Also, the strict semen analysis is useful. Men with fewer than 4% normal forms on the strict test are unlikely to have success with IUI
Dr._Daniel_Potter	HI pmschue: The prostate ultrasound is useful to investigate absence of sperm in the ejectulate and irregularities found on digital exam
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Jenna	Dr. Potter, how long a wait to get into see you?
Jenna	and canyou post your phone number?
Lisa_Rosenthal	Dr. Potter, please do post your contact information!
Dr._Daniel_Potter	Hi Julie: Please restate your question, I am confused.
julie	my last question was I responded good to gonel f and my cycle before the last one, I had over 9-10 foliclesdid an iui and it did'nt work My last one I only had a few folicle, because I then started to ovulate early, this time going into IVF what do suggest? also is there truth to sperm being weakened by urine
Lisa_Rosenthal	Ladies and gentlemen, we are able to get such wonderful speakers on each week because I promise them that they will leave at 9 pm sharp. That leaves us about 10 minutes with Dr. Potter. I hope that you have enjoyed the sessions and I hope that you remember that we have message boards moderated on a daily basis by physicians.
Dr._Daniel_Potter	Hi Carey: Congrats on your baby girl and I am sorry to hear of all the trouble you are having with number 2. I would have a work-up with an RE. Elevated insulin leves can give irregular cycles and be associated with pregnancy loss.
Lori_Masi_AFA Patient_Adovcate	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. You can also e mail me at LoriattheAFA@aol.com and please don't forget to post and share with each other on our wonderful message boards. Looking forward to hearing from all of you! Lori Masi - AFA Patient Advocate
julie	I am so crazy over this and wanting it to work, I anylize everything the Dr. does. right done to the ultrasounds. I really look forward to your answer before you go, and thank you so much
Dr._Daniel_Potter	Hi Jenna: I am not sure, early September I think, but there are always last minute cancellations.
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Dr._Daniel_Potter	Hi Jenna: My phone number is (714)738-4200 and (949)472-9446
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carey	Thank you. I searched on my insurer's websites and there are no REs within a 50 mile radius. Are there other options - high risk doctor, regular OBGYN? Thanks again.
julie	I 'M BACK
Lisa_Rosenthal	Hi Julie, sorry you got thrown off!
Lisa_Rosenthal	It happens to the best of us.
Dr._Daniel_Potter	julie, repost your questin please
julie	Thanks
pmschue	Dr. Potter - Any last words of advice as far as testing goes?
Lisa_Rosenthal	Great question pmschue...
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Lisa_Rosenthal	Thank you to everyone for joining us this evening. We especially appreciate Dr. Potter's time, expertise, patience and help!!!
julie	I have had lots of folicles from gonel f and then not too many, is there any truth to sperm and urine mixing
Lisa_Rosenthal	Dr. Potter, would you please post your phone number before you sign off?
Dr._Daniel_Potter	HI pmschue: Be diligent and insist on a thorough work-up. Do not be afraid of the truth as it will point you towards your destiny
Lisa_Rosenthal	Carey, please call our patient advocate Lori Masi, for a doctor referral in your area. If there is not an RE, you can speak with her about who else you can see.
julie	that would change the strength of sperm preventing a pregnancy
Julie364	Phone number for the doctor?
Brenda	Thanks, great session. bye.
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Dr._Daniel_Potter	Hi Julie364: 714-738-4200 and 949-472-9446
Lori_Masi AFA_Patient_Adovcate	Carey Call me at 888-917-4777/3777!
pmschue	Thanks Dr. Potter. I appreciate your input.
Frances	Thanks doctor, you were great.
Frances	night
Dr._Daniel_Potter	Hi Julie: retrograde ejaculation can cause the sperm to get into the urine. It sounds as though your husband should be evaluated by a fellowship trained reproductive urologist.
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Lori_Masi AFA_Patient_Adovcate	Thank you Dr Potter for such an insightful evening!
Dr._Daniel_Potter	Good night everyone. Good luck!
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Lisa_Rosenthal	Good night everyone
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The General Work-up: The Tests, The Reasons

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