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The Medical Work-Up for a Woman Experiencing Difficulty Conceiving
November 9, 2004 - Tuesday
2:29 PM to 3:29 PM (EST)
Guest Speakers: Spencer Richlin, MD - Reproductive Medicine Associates of Connecticut
Categories
Endometriosis •
Infertility •
IUI •
IVF •
Pregnancy
| jmr | i can give you the link if you want? |
| Lori | yes, please |
| jmr | i just did my 6th iui yuesterday but i only had 2 follicles but ya never know last cycle i had 4 follicles and it failed but ill just have to wait and see |
| jmr | http://www.babycenter.com/homeper/?_requestid=509704 go to community drop down and go to chat |
| Lori | when i did iui they never checked for follicles, the more i research the more i am comfused as to what protocol is , do you ever feel that way? |
| Lori | thanks for the site, i bookmarked it |
| . cedsgirl joined | |
| jmr | noproblem |
| . bean joined | |
| jmr | hey ceds |
| jmr | the dr comes at 8:00 |
| bean | Type herehi ladies |
| bean | hey ced and jmr |
| cedsgirl | hi |
| jmr | hi bean |
| cedsgirl | hi bean |
| bean | AKA mara |
| jmr | so whats new ceds? |
| Lori | hi bean |
| jmr | ohh hey mara lol |
| bean | hi lori |
| bean | lol hi |
| cedsgirl | im still not sure if i o'd or not |
| jmr | ceds did you chart this cycle? |
| bean | I was going to ask if you oed yet ced |
| cedsgirl | hey mara! lol |
| bean | lol hi |
| jmr | bean i was telling lori about the baby center chat |
| cedsgirl | yes i did chart |
| bean | it great most times! |
| jmr | lori they are from baby center |
| . Lori_Masi_AFA_Patient_Advocate left | |
| jmr | post it ceds let me take a look |
| Lori | i'll definitely give it a shot |
| cedsgirl | my chart said i o'd on friday but i had my trigger shot on saterday and sat. am i had 3 follicles |
| cedsgirl | http://www2.fertilityfriend.com/home/48ef0 |
| jmr | ceds when was the last u/s they did? |
| cedsgirl | saterday. and i had the 3 |
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| cedsgirl | then i took the shot when i got home on saterday. so im lost |
| bean | ced for me FF always is wrong on my O date I O 2 days before FF says so..so it be reading yours wrong as well |
| jmr | ceds did you do iui? |
| cedsgirl | no just trigger shot and bd |
| jmr | ceds i would say ff is reading it wrong then if they saw them sat how big were they ? |
| cedsgirl | and im scared that i missed o. but how can that happen if i had my trigger shot on saterday |
| cedsgirl | 18, 18, 19 |
| jmr | or ceds you could have had more follicles and that was the rise that one might have been ready friday and they did not see it . |
| cedsgirl | thats what i was thinking |
| bean | Ty for inviteing me jmr! |
| cedsgirl | b/c my cm dried up too |
| jmr | thats probably what it was your doing clomid ceds? |
| cedsgirl | follistim injections |
| jmr | no problem mara = 0) |
| jmr | i try to share good stuff lol |
| cedsgirl | thanks |
| cedsgirl | lol |
| bean | lol |
| jmr | ceds i bet you had mopre follicles then dont orry as long as you bd. |
| jmr | * dont worry |
| cedsgirl | do u think i had enough bd if i did o on friday |
| jmr | 1 sec let me look again |
| cedsgirl | i missed friday. and i could kick myself for it. |
| bean | your beding looks good asumeing the sperm lives 48 to 72 hours in EWCM |
| cedsgirl | and if i o'd after my trigger shot would it still work with dry cm? |
| bean | My OB said to bed every 48 hours.. |
| jmr | yes ceds wed could have done it and you had more w the trigger sat and you bd then so dont worry |
| bean | I agree dont worry |
| jmr | yes ceds it could with dry cm |
| cedsgirl | i missed friday b/c i knew i would get my shot on saterday so i wanted dh to have better s/c |
| jmr | yeah |
| cedsgirl | i hope it work |
| jmr | oh ceds did i tell ya i had my iui yesterday? |
| cedsgirl | do u girls have your charts |
| cedsgirl | no. |
| cedsgirl | thats great |
| bean | I read some intresting info last night I am not sure how true it is tho..the sperm hangs out in the mucas galnds on the cervix and is litrally timed realsed into uteras |
| jmr | ceds i stopped chartying my re said to take a break from it and let him worry about my o lol |
| cedsgirl | lol |
| bean | chart www.fertilityfriend.com/home/1b97e |
| jmr | ill show you my old chart |
| jmr | http://www2.fertilityfriend.com/home/4065a |
| jmr | lol i am up to my 6th iui |
| cedsgirl | bean we are right behind eachother |
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| jmr | if this iui fails i have to move to ivf.=( |
| bean | I saved your chart ced to keep track lol |
| cedsgirl | thanks |
| cedsgirl | i dont know how to do that |
| cedsgirl | jmr i hope u dont have to do ivf |
| jmr | ceds just save it to your fav |
| jmr | me either ceds lol |
| cedsgirl | ok |
| cedsgirl | ok i saved it |
| bean | yes save to favs lol |
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| bean | wb lori |
| jmr | ::biggrin ::bi |
| cedsgirl | bean why the name change? |
| bean | I used to be marabean lol |
| cedsgirl | oh |
| cedsgirl | lol |
| cedsgirl | jmr do u have to pay for your iui's |
| bean | acually bean is what my family calls me as well |
| jmr | i am trying to figure out what i am gonna ask lol |
| bean | I am here to watch and learn |
| jmr | ceds yes and my meds but ins covers the blood and u/s |
| Lori | thanks |
| cedsgirl | how much are your meds |
| cedsgirl | mine are like $1600 |
| cedsgirl | but ins. covers them |
| bean | jmr any reason for your infert..it was unexplained right? |
| jmr | ceds they are very expansave i paid over 1200$ last 3 cycles |
| bean | yikes |
| jmr | yep unexplained |
| jmr | and 500 for the iui itself so 1500 a cycle |
| bean | if no pg by the time the clomis refills are done OB wants to do HSG then IUI |
| cedsgirl | thats about how much it would be for me to have iui |
| bean | and injects |
| jmr | i will be happy in a way to move on to ivf |
| jmr | yes mara i used injections |
| cedsgirl | ill do ivf next jan |
| jmr | my ins paid for my clomid |
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| bean | I am not sure what is covered for cost..taht will the decideing facyor for us |
| bean | mine is covered as well |
| jmr | mara the hsg is not to bad i had that just take strong alive b4 you go |
| bean | hi kemq |
| cedsgirl | right now everything is covered but as soon as i do iui or ivf nothing is covered |
| cedsgirl | not even my dr. visists |
| bean | he was adiment it useing trigger shot lol |
| jmr | thats stinks ceds |
| bean | thats awfull ceds |
| cedsgirl | yes it does |
| jmr | ill find out if this iui worked nov 23 my sil goes for her csec nov 24 lol |
| cedsgirl | i dont really understand why. |
| jmr | ins are weird ceds |
| bean | alot of inserance dont see infert a s a acuall health issue..and taht so false |
| cedsgirl | if i still o'd after trigger shot will i see another temp change? |
| Dr._Richlin | Hi I am Dr Richlin, how are you? |
| jmr | probably not ceds it might go up a bit but not much |
| jmr | hi dr. |
| bean | hi Dr |
| Lori | hello, well thanks |
| cedsgirl | hi dr. |
| Dr._Richlin | Hi |
| jmr | do we have to ask a ?? in order? |
| Dr._Richlin | I want to answer questions you have |
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| bean | hi jen |
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| Dr._Richlin | Hi everbody |
| bean | hi deanna |
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| deanna | hello all |
| Lisa_Rosenthal | Dr. Richlin, thank you so much for joining us this evening! |
| Dr._Richlin | thank you |
| Lisa_Rosenthal | jmr, please feel free to post a question... |
| Lori | what is the protocol to test for immune disorders |
| bean | I have a ? About clomid and useing a saliva scope .Does the clomid affect the ferning? Mine just shows as a dense mass of Crystals |
| localhost | [2009] touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. John Garrisi, (IVF Laboratory Director for Saint Barnabas Medical Center, IRSM) joining us this evening. We will be discussing the topic "Inside the Laboratory- Magic or Science". Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA. |
| jmr | hi i am 29 years old my husband is 31 and we have unexplained infertility been with a re fior 8 months i had 6 iuis done he says next step is ivf i was usung bravelle injections last 3 cycles do you think ivf is the right move? |
| Lisa_Rosenthal | ooops, sorry, that was from last week, give me a second and I will post the right information. |
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| bean | sorry jmr I didnt mean to butt in |
| localhost | [2009] touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. Spencer Richlin, (Reproductive Medicine Associates of Connecticut) joining us this evening. We will be discussing the topic "The Medical Work-Up for a Woman Experiencing Difficulty Conceiving". Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA. |
| Dr._Richlin | for example aniphospholipid disorders -- would check lupus anticoagulant and anti cardiolipin antibodies |
| Lori_Masi_ AFA_Patient_Advocate |
Type here Welcome Dr Richlin! |
| localhost | [2009] touser Please feel free to post questions for Dr. Richlin. Keep in mind that you mayed to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them. |
| Dr._Richlin | JMR I think ivf is the right move. You have done enough iui |
| jmr | ok ty. |
| Dr._Richlin | JMR is you fsh ok |
| Lori | are those checks lupus and anti car. in regular blood work ups by the RE? |
| jmr | yes he says all the blood work looks fine |
| Lisa_Rosenthal | Dr. Richlin was kind enough to send me some information to post. So, in his words: A Basic general infertility evaluation from your Reproductive Endocrinologist may include 1) HSG to evaluate for tubal patency and for a normal uterine cavity 2) Semen Analysis to make sure your partner has a count, and good motility 3) Hormone evaluation which will include a menstrual day 3 Follicle stimulating hormone and estradiol. In addition if you have irregular cycles he or she may include thyroid and prolactin studies. 4) We always want to make sure our patients are ovulating. If you have regular menstrual cycles you can assume that you are bleeding 5) If there are any other factors in your history |
| jmr | but i only had 2 follicles last cycle |
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| Dr._Richlin | jmr 2 follicles with what |
| Orly | Hi Lisa |
| jmr | bravelle injections 3 ampls to 1cc of diluite |
| jmr | last cycle with same i had 4 follicles |
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| Lisa_Rosenthal | Orly, Leece and Stephen, thanks for joining us this evening! |
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| Dr._Richlin | jmr Well what you should do before doing ivf would be to do a clomid challenge test to check you ovarian reserve |
| Lisa_Rosenthal | Hi Rick |
| localhost | [2009] touser Please feel free to post questions for Dr. Richlin. Keep in mind that you mayed to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them. |
| jmr | i was on clomid 7 cycles |
| susang | checked for chromosones after second miscarriage came back abnormal do I have to check anything else. plus unexplained infertilty can that be a cause? |
| jmr | 100mg had 5 follicles was the most i had |
| Lori | I have satge 4 endometriosis, did 1 IVF and FET, I understand there is a possiblity that there can be an immune disorder associated with endo. that keeps the blasts from planting. When should i ask to be tested for that or should I just try a second IVF? |
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| bean | . |
| Dr._Richlin | susang for loss, chech HSG, male/female c-somes, day 3 fsh and testing for antiphospholipid syndrome |
| Lisa_Rosenthal | Here are some other words of wisdom from Dr. Richlin- might provoke some questions... IVF cycle Every month most women make one follicle (1 Egg) midcycle naturally. With IVF we superovulate the ovary to make many follicles (Eggs) approximately 4 to 30 depending on how a patient stimulates. This is done by utilizing vaginal ultrasound, hormone levels and medications to grow follicles. When the follicles are mature, we use a vaginal ultrasuond with a needle (while you are sleeping) and remove the follicular fluid and eggs. The eggs are exposed to sperm in the lab. 3-5 days later, we replace embryos back into the uterus under ultrasound guidance. |
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| Sandra | Hi Dr and Lisa |
| Lisa_Rosenthal | Hi Sandra, thanks for joining us!! |
| Dr._Richlin | lori--with endo nothing specifically to test for, I would do another ivf cycle, do you hane ovaries with endometriomas |
| Leece | I have just completed 5 cycles of clomid and two bravelle, all my blood work numbers are "good" but I am 39, I need help deciding whether to stop trying to preserve my sanity |
| Lori | ??? sleeping on the egg retrievel? Where can I go to be put all the way under. Last one I had Dalatid and could have killed teh dr. Sorry but true! |
| Dr._Richlin | leece I would do a clomid challenge test if it was ok, think about ivf |
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| jmr | do they always put you to sleep durning egg retrivel? |
| bean | I am on my 3rd round of clomid 100mgs cd3 to 7 I only get a cd21 P4 serum..is it ok to NOT have u/s monitering? |
| Dr._Richlin | lori at my center patients are "a" sleep, makes it very comfortable |
| jmr | whats a clomid challenge?? |
| cedsgirl | hello. i am on follistim injections with timed intercourse. i am doing my BBT charting and my chart says that i ovulated on friday. but i had my ultrasound and trigger shot on saterday. i had 3 follicles on saterday. could i have ovulated on friday? and will i still ovulated again with the hcg trigger shot from saterday? |
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| susang | can infertility and miscarriage have a connection? |
| localhost | [2009] touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. Spencer Richlin, (Reproductive Medicine Associates of Connecticut) joining us this evening. We will be discussing the topic "The Medical Work-Up for a Woman Experiencing Difficulty Conceiving". Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA. |
| Dr._Richlin | bean i like to monitor with clomid cycles |
| Lori | yes, I have ovaries and produce 6 cells, all 6 fertilized and 3 were placed back on day 3 transfer. 2 were frozen at blasts stage. all grade 1, no explanation why it didn't work just mentioning of the lining being too thick? |
| bean | ok thank you I am going to ask because I have a great deal of pain dureing the cycle and never had any pains not even O pains before |
| Lisa_Rosenthal | Here is a wonderful, detailed, explanation of IUI from Dr. Richlin....IUI is intrauterine insemination. IUI is usually used during a clomid cycle. Once the lead follicles/follicle is approximately 20 mm, HCG is given to mature and release the egg/eggs. The next day a semen sample is washed and placed into the uterus with a thin catheter. This does not hurt. Remember that with natural relations, 90% of the sperm die in the acidic vagina before there is a chance to to enter the uterine cavity. Thus, IUI bypasses this acidity and can help when a sample has poor motility |
| Dr._Richlin | jmr day 3 fsh/E2 clomid 100md day 5-9, than a day 10 fsh. fsh on day 10 and 3 should be under 10 to be normal, and rule out diminished ovarian reserve |
| Lori | I had one endometrioma removed during the exploratory lap |
| Rick | Had HSG showing possible blockage on left side. Did IUI's on clomid cycles. Should we do IUI with injections or skip to IVF as doctor claims I have juicy ovaries and w e are concerned about multiples |
| Leece | what information does the clomid challenge provide |
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| 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. |
| jmr | ok ty dr i did have that |
| Dr._Richlin | rick with tubal issues, surgery can at times help, but ivf was created for tubal issues |
| Lori | unconcscious would be comfortable for me, because of the endo my ovaries are misplaced, egg that's released can't reach the tube, but the retrivel was barbaric I think. Very painful |
| Dr._Richlin | leece it tells us that a patient does not have decreased ovarian reserve which is related to decreased pregnancy rates and poor stimulation |
| Lisa_Rosenthal | Dr. Richlin, you are doing a wonderful job answering questions. Thank you so much for joining us here this evening! |
| Leece | thanks, dr. |
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| jmr | so i should move to ivf if my last iui fails then thank you! |
| Dr._Richlin | lori try a group that will retrieve you with anesthesia assist |
| Emily | Hi Doctor, why would my doctor suggest another cycle of clomid when i've all ready done 5? |
| localhost | [2009] touser Please feel free to post questions for Dr. Richlin. Keep in mind that you mayed to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them. |
| Lori_Masi_ AFA_Patient_Advocate |
For everyones convenience I am here on Tuesday in the evenings, from 5 - 10 pm eastern time, so we can speak from the privacy of your home. The toll free support line number again is 888-917-3777. Hope to hear from all of you soon |
| Dr._Richlin | jmr we try 3-6 iui cycles before moving on |
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| jmr | ok i just did my 6th iui yesterday i did 3 with clomid and 3 with bravelle |
| Dr._Richlin | emily it is ok to do up to 6 cycles, after that we have low success |
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| Leece | dr. one more question, please, if I have been producing multiple follicles each time would that negate the need for such a test (clomid challenge) |
| bean | is it possable to have blocked tubes even if you had apg recently? |
| Margie | Dr. Richlin, are you in the area? How long a wait to get into see you? |
| Dr._Richlin | leece still do it |
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| Leece | ok, thanks |
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| Dr._Richlin | I am in Norwalk 203-750-7400 |
| Stephen | My wife's RE said there was no reason to do more than 3 cycles of clomid since it can cause changes in the endo lining, what do you think of that? |
| Dr._Richlin | Margie I am available |
| 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". |
| Dr._Richlin | stephen clomid can thin out lining, but you would see this on sono. the reason to limit it to 3-6 cycles is that pregnancy rates fall after 4-6 failed iui cycles |
| Stephen | Thanks for explaining the discrepancy, Dr. Richlin |
| cedsgirl | dr. i am on follistim injections and timed intercouse. i am also doing my BBT charting. my chart says that i ovulated on friday but i had a ultrasound and trigger shot on saterday. could i have ovulated on friday still? and would i then ovulate again with the trigger shot? |
| Dr._Richlin | stephen if endo lining is above 6 mm it is probably ok |
| Lori | What factors should I consider if I am thinking about switching RE's or facility centers? I really loved my RE, but I think they are growing too fast to keep up with good quality and I think there maybe more progressive centers out there. I'm 39 and worried the clock is a ticking. |
| Lisa_Rosenthal | Words of wisdom from Dr. Richlin!! A Basic general infertility evaluation from your Reproductive Endocrinologist may include 1) HSG to evaluate for tubal patency and for a normal uterine cavity 2) Semen Analysis to make sure your partner has a count, and good motility 3) Hormone evaluation which will include a menstrual day 3 Follicle stimulating hormone and estradiol. In addition if you have irregular cycles he or she may include thyroid and prolactin studies. 4) We always want to make sure our patients are ovulating. If you have regular menstrual cycles you can assume that you are bleeding 5) If there are any other factors in your history |
| Dr._Richlin | cedsgirl I would bank on the ultrasound and trigger, BBT not that accurate |
| bean | I was given 4 refills of clomid and 1 lab request for blood work cd 21..with out proper monitering am I wasting my time..In Canada it seams clomis is not monitered as closely |
| cedsgirl | thanks. also my cervical mucus dried up on saterday. is that normal to happen with a trigger shot?? |
| susang | Can infertility and miscarriage have a connection |
| Dr._Richlin | lori you want to go to a center where you see the Dr and also has good pregnancy rates |
| irishslp | My RE wants to complete 2 IUI cycles without medication. My follicle size, lining, and estrogen level has all been within their criteria. When is it time in your opinion to begin medications. I am 42 and I know that my time is limited. Thank you |
| Dr._Richlin | susang not really |
| jmr | is there any other testing i should get done since they say we have "unexplained"i did hsg,laposcopy,hystoscopy and 6 iui's my husband had a s/a they said he has really great count i just woinder why none of this is working any suggestions b4 ivf?is there something we are missing? |
| Dr._Richlin | irishslp I would move to ivf now |
| Lisa_Rosenthal | There are some great questions here this evening. Thank you to everyone for joining us! |
| irishslp | Can IVF be completed without meds? |
| Dr._Richlin | jmr day 3 fsh, prolactin, thyroid test |
| Leece | ok, I lied, but not on purpose, I have another question. I was extremely uncomfortable with the effects of the injections, but my doctor says 5 unsuccessful clomid cycles means it's not working, following a clomid challenge should I try that route again despite what my doctor says? Do "good" numbers in my blood work really mean anything? |
| Lisa_Rosenthal | iriship- here is some information from Dr. Richlin about IVF IVF cycle Every month most women make one follicle (1 Egg) midcycle naturally. With IVF we superovulate the ovary to make many follicles (Eggs) approximately 4 to 30 depending on how a patient stimulates. This is done by utilizing vaginal ultrasound, hormone levels and medications to grow follicles. When the follicles are mature, we use a vaginal ultrasuond with a needle (while you are sleeping) and remove the follicular fluid and eggs. The eggs are exposed to sperm in the lab. 3-5 days later, we replace embryos back into the uterus under ultrasound guidance. |
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| Lori | but how do you get honest rates? I know that my paper work stating IVF failure was never "collected" from me anyways. Plus the drs. rotate and it's luck of the draw, but they are very nice and seem knowledgeable |
| Rick | I had 6 iui, how do I know that they were timed to my exact ovulation can it be it that it was off by a few hours, maybe my wndow is less then 24 hours |
| Dr._Richlin | irishslp for ivf need meds to super ovulate |
| jmr | they always do day 3 but i will ask about thyiord |
| 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._Richlin | lori check SART data |
| irishslp | Thank you for explaining. Is IVF better secondary to my age? |
| Dr._Richlin | rick well sperm last 72 hours in the female tract enough time to work |
| Lisa_Rosenthal | The SART report is a great place to start, but please keep in mind that it is from 2001. It is not the only way to get "honest" data. Speak to Lori Masi, our patient advocate, she can help a great deal. |
| Dr._Richlin | lori go for it |
| jmr | so your thyroid can prevent you from conciving are there any symptons that could tell u b4 testing? |
| Rick | the sperm used for iui was washed I was told that it can only survive a few hours |
| Dr._Richlin | leece I would not do more than 6 cycles and then do shots/iui or ivf |
| Dr._Richlin | rick not so |
| Lori | are there oral meds you can take vs. injectables for IVF? and can a patient request a 5 day fresh transfer vs. 3 day? I know its a gamble to see if the eggs make it but was wondering |
| Dr._Richlin | jmr usually if thyroid or prolactin were off you would have irregular cycles |
| Lori_Masi_ AFA_Patient_Advocate |
I would like to invite everyone to call our toll free support line at 888-917-3777 for referrals in your area, information or if you need some support. I am here live M, W , Th, Fr 9 - 5 and on Tuesday evenings 5 - 10 pm EST. Hope to hear from you all soon! |
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| jmr | oh ok my cycle are 28-31 days always |
| 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._Richlin | lori only injectables, pts can request, but it depends on how the embryos look |
| Rick | how soon after a lh surge do you do iui |
| Dr._Richlin | rick the next morning |
| jmr | concerdring i had so many iui's well i dont know if my 6th one failed yet but if it did what are the odds of ivf working? |
| Dr._Richlin | rick we have ourpts check lh in am if pos do iui next am |
| Lisa_Rosenthal | Here is some information from Dr. Richlin about a woman's workup A Basic general infertility evaluation from your Reproductive Endocrinologist may include 1) HSG to evaluate for tubal patency and for a normal uterine cavity 2) Semen Analysis to make sure your partner has a count, and good motility 3) Hormone evaluation which will include a menstrual day 3 Follicle stimulating hormone and estradiol. In addition if you have irregular cycles he or she may include thyroid and prolactin studies. 4) We always want to make sure our patients are ovulating. If you have regular menstrual cycles you can assume that you are bleeding 5) If there are any other factors in your history i.e. exce |
| Rick | the next morning meaning 12 hours or 24 hours |
| Dr._Richlin | jmr depends on your age and ovarian reserve testing |
| jmr | oh ok |
| . schnauzerpal left | |
| Dr._Richlin | ivf has excellent pregnancy rates 50-60% under 35 |
| Lori | what is involved in ovarian reserve testing? i might have bypassed that stage? |
| Dr._Richlin | rick 24 |
| Leece | what about over 35 |
| jmr | i am 29 and the most eggs i had with clomis was 8 4 on each side but only 5 were ready for the iui |
| Lisa_Rosenthal | IVF words of wisdom from Dr. Richlin IVF cycle Every month most women make one follicle (1 Egg) midcycle naturally. With IVF we superovulate the ovary to make many follicles (Eggs) approximately 4 to 30 depending on how a patient stimulates. This is done by utilizing vaginal ultrasound, hormone levels and medications to grow follicles. When the follicles are mature, we use a vaginal ultrasuond with a needle (while you are sleeping) and remove the follicular fluid and eggs. The eggs are exposed to sperm in the lab. 3-5 days later, we replace embryos back into the uterus under ultrasound guidance. |
| Dr._Richlin | lori at least check day 3 fsh to make sure it is under 10 |
| Dr._Richlin | leece over 35 depends on exact age? |
| bean | oh so 7.3 cd3 FSH at 34 yrs is fair then |
| susang | Would you rather work on finding the problem or move to medication after all basic test show everything fine. for infertility |
| Leece | 39 |
| Dr._Richlin | lori and if you are above 35 do a clomid challenge test |
| Lori | ok, thanks |
| Dr._Richlin | leece 30-40% a cycle |
| Leece | my fsh was 7 |
| Dr._Richlin | leece that is good but at 39 do a clomid challenge before ivf |
| jmr | so i should have a good shot then with ivf its just hard that they say we are "unexplained" |
| Leece | thanks so much |
| Dr._Richlin | jmr with unexplained ivf works great, depending on age |
| Rick | is it true that hsg is not 100%accurate that thereisa possible blockage, ould you consider laparossopy or ivf |
| Lori | should i go back and do a clomid challenge test if I already did one IVF |
| jmr | i have been at this 5 years now we tried all the "natural way first then been with dr a year with re 8 months |
| jmr | ok ty ill keep my fingers crossed |
| Dr._Richlin | rick if hsg is open, than tubes open, hsg does not tell you the relationship between ovary and tube. so a normal hsg can still havew a distorted pelvis |
| bean | my infert comes in spurts the longest was 5 yr..I was afraid to seek help |
| Dr._Richlin | lori yes |
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| Lori | what's the clomid challenge test look for exactly, eggs in the ovary? |
| arlynda | hello |
| Dr._Richlin | rick if nl hsg and have tried for years or did not get pregnant with iui/clomid--do ivf |
| 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._Richlin | lori a hormone test to assess ovarian reserve. |
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| cedsgirl | should u always do iui before ivf? |
| jmr | dr is it normal to only have 2 follicles with bravelle 3 amples to 1cc my re says he would have liked to see more but 2 is good i had one in each side but i was wondering why last cycle i had 4 with same med |
| . schnauzerpal left | |
| Dr._Richlin | lori also an ovary with few follicle on baselione may mean diminished ovarian reserve |
| Rick | do I forget about laparopsky |
| Dr._Richlin | cedsgirl depends, but usually if you are under 40-39, depends on how aggressive you want to be |
| arlynda | I'm going on my 4th cycle of clomid (I'm now at 200 mg) and have yet to ovulate. My dr thinks I might have PCOS. Any suggestions? I have taken all the tests and I very healthy. |
| walkerbaby | I have a scheduled exploratory laperoscopy. Last sono showed 1 ovarian cyst which - the shading of which suggests a posibility of endometriosis. If that is the case, can it be removed during the lap or by a separate procedure? Thanks. |
| Dr._Richlin | arlynda do metformin wit your clomid or try letrozole |
| Leece | does your age out weigh |
| Dr._Richlin | walk it can be removed during lap |
| Leece | sorry, "good" blood work numbers |
| Dr._Richlin | leece fsh under 10 on day 3 and 10 |
| Rick | do I forget about laproscopy?? |
| bean | if FSH was just done on day3 and not day as well is it still valid? |
| Dr._Richlin | jmr each cycle will be different |
| Leece | yes, Sir, my doctor said my "numbers" are like a 25 year old even though Im 39 |
| localhost | [2009] touser Please feel free to post questions for Dr. Richlin. Keep in mind that you mayed to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them. |
| Lori | is a DC a good idea to do before IVF or FET if lining is suspect/ |
| irishslp | My last and 1st IUI cycle we were told that our numbers were perfect, but it did not work. Is there anything else that we could be doing to improve our chances with the natural IUI before IVF? Thank you |
| arlynda | thank you. Will talk to my dr about it. |
| Dr._Richlin | bean clomid challenge is more provocative looks at day 3 and 10, some people will have a nl day 3 and ab day 10, thus an ab test result |
| Leece | Me too irishslp |
| Dr._Richlin | lori do a sonohysterogram |
| bean | ok thank! I will talk to my Ob about that |
| Dr._Richlin | irishlp clomid iui or shots iui |
| jmr | with ivf my re says that he will only but 2 follicles in at a time i thought they but back more is 2 enough? |
| Lori | had one or HSG before the IVF, reported to be ok |
| irishslp | Thank you. Is there any research supporting accupuncture for infertility? |
| walkerbaby | Dr., do you have any stats about how much accupuncture improves chances with IUI & with IVF (if at all)? Thx. |
| Dr._Richlin | rick do laparoscopy if you are not going to do ivf |
| Dr._Richlin | accupuncture has been shown to increase preg rates, still a new science in inf med |
| Dr._Richlin | at our center we encourage it for relaxation and to possible improve rates |
| Rick | is the risk great so I was told by my doc that does not pushh me for it |
| Leece | can you address the correlation between blood work numbers and age, if there is one |
| Lori | in my opinion accupuncture is awesome! |
| Tory | Dr. Richlin, can i get your phone number, please |
| irishslp | Dr., is there a better time during the cycle to have accupuncture completed, such as closer to the surge time? |
| Dr._Richlin | There are papers to support better ivf rates with accu before and after transfer |
| Dr._Richlin | tory 2037507400 |
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| Dr._Richlin | iris do it before iui or transfer and even before or during stimulation |
| cedsgirl | dr. i had great cervical mucus all last week. then right after my trigger shot it all dried up. is that normal?? should i be worried? |
| bean | what area is affected by accu regarding the possability in assisting fertility? |
| Dr._Richlin | cedsgirl are you doing iui |
| Lisa_Rosenthal | Ladies and gentlemen, please just keep in mind that Dr. Richlin is one person and there are 27 of us who are asking quesitons. Please be patient. |
| 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". |
| cedsgirl | no |
| cedsgirl | just timed intercouse |
| Dr._Richlin | bean possibly increasing blood to uterur and relaxing uterus, better receptive |
| irishslp | Dr. do you mean to do accu the day of the surge or the day of IUI? |
| bean | intresting I will research that! |
| Dr._Richlin | iris I would do it morning before iui |
| jmr | how many cycles of ivf should i do b4 saying enough i am 29? |
| Dr._Richlin | ceds hard to say, but I would do iui's |
| Dr._Richlin | jmr how many have you done |
| irishslp | Great! Thank you. I have been reading a little and will go to a seminar tomorrow about it, but that is probably the best advice that i have heard. Thank you |
| Lori | is there financial help available for IVF? |
| jmr | i have done 6 iui's 3 with injections ivf is next |
| Dr._Richlin | lori there are some programs that offer a cetain number of cycles for a fee, and after 3 cycles if you are not pregnant you could get back 75% of your money |
| Rick | is there anything to a extra potien diet that will help conceive |
| Dr._Richlin | jmr if you are 29, I would assume that you will get pregnant within first 2 ivf cycles |
| 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. |
| irishslp | Is there anything diet wise that i should stay away from ie: low carb |
| Dr._Richlin | rick not that I know of, but need to take prenatal vits with folic acid |
| Lori | wow! where can i find that information out. I'm in cols, ohio and am not sure of other centers available |
| Dr._Richlin | call my office for number near you 203-750-7400 |
| Lisa_Rosenthal | irishsip, there is a lot of research that supports that women who have PCOS or PCOS like symptoms do very well on a low carb diet |
| jmr | i take prenatal vit and a fiolic acid is that to much should i just take the prenat? |
| irishslp | I do not have PCOS, so is it still safe? I know that it can change the cycle. |
| judy | Hi Doc! I'm 37 and have tried several different protocols. We just completed first microdose flair protocol with Gonal-F, I went in for an IUI this morning. The follicles were only 16, 17, 18 mm (this is the first time my follicles were under 20mm after meds). Have you seen this before wtih a Lupron flair cycle? Did we do the IUI too soon? Since the follicles are smaller, does this effect pregnancy rates? |
| Dr._Richlin | judy usually with flair we trigger below 20 |
| Dr._Richlin | jmr just take prenatals unless you had a previous child with NTD |
| Lori | Dr. Great, I'll give a call. Thanks so much for your time and information tonite. It's been very helpful and interesting. Thanks again! |
| Lisa_Rosenthal | Ladies and Gentlemen, thank you so much for all of your wonderful questions and for being here this evening. I am able to schedule wonderful speakers like Dr. Richlin because I promise that I will have them off in an hour. That leaves us about 5 minutes. Please keep in mind that we have message boards that are moderated daily by physicians who will answer your exact questions. |
| jmr | ok ty no children "yet" lol |
| Dr._Richlin | lori call thanks |
| 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". |
| . judy left | |
| irishslp | Dr. Richlin and Lisa, thank you for your time and sharing your knowledge. |
| Dr._Richlin | I hope I have helped |
| jmr | this was very helpful ty dr. |
| cedsgirl | thank u |
| irishslp | You helped very much. This can be so very confusing the first time around. |
| Leece | does good blood work mean anything |
| Lisa_Rosenthal | Dr. Richlin, you have been just wonderful. Very patient, compassionate and knowledgeable!!!!! |
| bean | Thank you Dr Richlin for your answers and time! |
| Dr._Richlin | jmr keep up the good work |
| walkerbaby | Dr. Richlin - you were absolutely wonderful! Thanks. |
| jmr | ty dr =0) |
| Dr._Richlin | thank you |
| Lori_Masi_ AFA_Patient_Advocate |
Thank you Dr Richlin for a wonderful session! |
| Petra | Good night Doctor and Lisa |
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| Dr._Richlin | Thank you but i am still here for last min ? |
| Leece | glad to hear that |
| 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. |
| . Rick left | |
| bean | Dr can it be possable to have blocked tubes after a recent pg? |
| jmr | is 2 follicles enough to put back with ivf or should more be put back? my re says he will only put 2 at a time. |
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| Dr._Richlin | bean unlikely, at least one tube is open, if recent preg had an infection in labor or after? |
| bean | nothing I am aware of |
| . Sandra left | |
| Dr._Richlin | jmr usually 2 depending on quality, sometimes three |
| jmr | ahh ok |
| . walkerbaby left | |
| Dr._Richlin | three depending on age and embryo quality |
| jmr | ill put my order in for twins boy and girl |
| jmr | lol |
| bean | lol |
| Dr._Richlin | jmr sounds good |
| Lisa_Rosenthal | jmr, please go to our publication on multiples, and then we'll talk! |
| jmr | ok |
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| Lisa_Rosenthal | I know it's a joke, but multiples are not what to wish for, really and truly.... |
| Dr._Richlin | I agree |
| jmr | well i have tons in my family |
| Dr._Richlin | we strive for one |
| jmr | they say i am next anyway just the meds up the chance lol |
| bean | really??I am so worried as I have strong twinning history on my mom saide and useing clomid unmonetered |
| jmr | i really only want one |
| Dr._Richlin | Goodnight |
| bean | I will glady take 1 |
| Lisa_Rosenthal | jmr, the statistics on problems with multiples are overwhelming and sobering, please do look at the issue. |
| cedsgirl | good night |
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| jmr | but if i did get twins i would love one of each so i would not have to do fertility treatmenats no more |
| bean | good night Dr. Thaqnks again |
| jmr | yes lisa i will do that. |
| Lori | good night all and good luck to everyone |
| Lisa_Rosenthal | bean, you should consider looking at monitoring... |
| bean | I have asked but the OB says 100 mg is not enought to be monitered for |
| cedsgirl | jmr and bean are u going back to BC to chat |
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| . Orly left | |
| jmr | yes ceds are u? |
| jmr | ill meet you all there |
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| cedsgirl | ok |
| jmr | good night everyone! |
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| . Lori left | |
| . cedsgirl left | |
| Lisa_Rosenthal | Good night, and thanks to everyone for joining us this evening!!! |
| bean | Night everyone Thank you for this wonderfull chat and I will be back again |
| Lori_Masi_ AFA_Patient_Advocate |
Good Night All! |
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| . Leece left | |
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| Tory | good night, and thanks.... |
| . Tory left | |
| . ALison left | |
| Stephen | nite |
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