What To Look For When Choosing An IVF Program

June 22, 2005 - Wednesday
1:59 PM to 2:59 PM (EST)
Guest Speakers: Guy Ringler, MD, California Fertility Partners

Categories
Donor Egg • Infertility • IUI • IVF • Miscarriage • Pregnancy

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Lori_Masi AFA_Patient_Advocate	Welcome Danielle!
Danielle	Hi Thank you!
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parvat98	Is today 's topic "How to choose an IVF program"
Lori_Masi AFA_Patient_Advocate	Special Guest: Guy Ringler, MD - California Fertility Partners Topic: What to look for when choosing an IVF Program
Lori_Masi AFA_Patient_Advocate	Hi All we are having some techinical difficulties and we will be with you shortly!
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
Lori_Masi AFA_Patient_Advocate	Welcome Paravat!
Lori_Masi AFA_Patient_Advocate	Welcome Danielle!
parvat98	May I ask a question about IVF treatment in progress
Lori_Masi AFA_Patient_Advocate	Welcome Dr Ringler - We appreciate your time and generosity of spirit in participating this evening.
Lori_Masi AFA_Patient_Advocate	paravat you may as soon as Dr Ringler is officially on!
Lori_Masi AFA_Patient_Advocate	Welcome Dr R ingler! we are ready to begin!
Lori_Masi AFA_Patient_Advocate	paravat ask your question!
parvat98	After first unsuccessful IVF(with day 3 transfer) we have one frozen embryo(reached blastocyst stage) left. In this case is it better to try embryo transfer with this or go for second attempt.I am 28 and my husband is 34
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Lori_Masi AFA_Patient_Advocate	Welcome April!
April	thank you lori
Guy_Ringler__MD	Type hereSince your embryo developed to the blastocyst stage, it should be of good quality so I would proceed with a frozen transfer.
April	I thought the topic was choosing an IVF program
Guy_Ringler__MD	April, all questions are fine.
Lori_Masi AFA_Patient_Advocate	From Dr Ringler: Tonight we are going to discuss how to choose an infertility/IVF program. Factors to consider: 1. Experience of center 2. Physicians 3. Types of treatments available 4. Support staff 5. History of success.
April	I was just wondering why someone would be unable to conceive naturallly, or with IUI, but is able to get pregnant with IVF (this is what happened to me)--tubes are open
Danielle	Hi Dr Ringler! What about the lab, is that just as important as the doctor you are using?
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Guy_Ringler__MD	April, many patients are categorized as "unexplained" infertility. Despite having normal exams and evaluations, they cannot concieve. Fortunately, IVF pregnancy rates are high for these patients..
Lori_Masi AFA_Patient_Advocate	Welcome SBLM! Special Guest: Guy Ringler, MD - California Fertility Partners Topic: What to look for when choosing an IVF Program
Lori_Masi AFA_Patient_Advocate	From Dr Ringler: Tonight we are going to discuss how to choose an infertility/IVF program. Factors to consider: 1. Experience of center 2. Physicians 3. Types of treatments available 4. Support staff 5. History of success.
sblm	Hello everyone
Guy_Ringler__MD	Danielle: The laboratory is very important. The experience of the lab and the quality of the lab conditions. The success rates of the program will reflect the lab enviroment.
Lori_Masi AFA_Patient_Advocate	Hi!
Guy_Ringler__MD	Today, many of the laboratory protocols are standardized resulting in higher success rates for more patients across the country.
Lori_Masi AFA_Patient_Advocate	sblm please post your question/s for Dr Ringler - we are having some techinical difficulties so it may turn out to be a small intimate group, so take advantage now to get your questions in!
parvat98	Can I go for 2nd IVF cycle right after the first one(failed) or do I need some time gap
Guy_Ringler__MD	The ivf culture media is commercially made and available to all labs.
Danielle	Dr ringler is that SART report a reliable tool?
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Guy_Ringler__MD	Paravat: Before proceeding it's a good idea to have a follow-up consult with your doctor to review what was learned in the prv cycle. We like to have one month rest before stimulating the ovaries again.
sblm	What are good success rates?
Lori_Masi AFA_Patient_Advocate	Wecome Nyiap!Special Guest: Guy Ringler, MD - California Fertility Partners Topic: What to look for when choosing an IVF Program
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Lori_Masi AFA_Patient_Advocate	Welcome Nyiap!
Lori_Masi AFA_Patient_Advocate	Special Guest: Guy Ringler, MD - California Fertility Partners Topic: What to look for when choosing an IVF Program
Lori_Masi AFA_Patient_Advocate	From Dr Ringler: Tonight we are going to discuss how to choose an infertility/IVF program. Factors to consider: 1. Experience of center 2. Physicians 3. Types of treatments available 4. Support staff 5. History of success.
nyiap	hi haven't been around in awhile, I am still dealing with my loss
Guy_Ringler__MD	sblm: The most important factor affecting success rate is age of the woman producing the eggs. Success rates depend on egg age; ovarian stimulation; laboratory; embryo transfer.....
Lori_Masi AFA_Patient_Advocate	Nyiap how are you doing?
nyiap	I am heartbroken, still going theu my miscarriage as we speak
Guy_Ringler__MD	Paravat: This was a general answer, did you have a more specific question about success rates?
April	what is the success rate for a 40 or 41 year old who conceived on her first IVF at 39?
Lori_Masi AFA_Patient_Advocate	I am so very sorry! Do you have a support group or therapist that specializes in fertiltiy?
sblm	How many cylcles do you think a patient should undergo? I am 33 and and just completed my 2nd failed IVF procedure.
nyiap	Lori, I am talking on line with others that have also miscarried
Guy_Ringler__MD	April: Pregnancy rate at age 40-41 years is approx. 40% with ongoing preg rate of approx 33%.
Lori_Masi AFA_Patient_Advocate	That's good! I don't know where you are located but if you need a referral to a professional please let me know!
nyiap	sblm: I went thru 3 IVF's before I finally got a positive...don't give up
sblm	Why doesn't a clinic monitor a person closely after implantation?
nyiap	Thanks Lori...I am ok for now
sblm	Thanks NYIAP
April	I know someone who got pregnant on her 5th IVF--don't give up
Guy_Ringler__MD	sblm: After each ivf cycle we learn something. The information learned can help us know how to improve your chances, or what to change, or sometimes when to stop.
Danielle	Dr Ringler i know you have alot of questions, but I was wondering about the SART report, is that a good tool?
nyiap	Dr: I am 34, we have male factor but on our 3rd IVF I was told some of my eggs were very poor but we did get pregnant, but I lost it at 6 weeks. Do you think this is a sign of poor egg quality overall? My fsh is a 3
Guy_Ringler__MD	The pregnancy rate per cycle is pretty constant through the 5-6th cycle.
Guy_Ringler__MD	Danielle: The sart report is a good starting point, but it can be difficult to compare programs with the data.
parvat98	I am 28. What are the chances of success with just one frozen embryo (blastocyst stage) transfer compared to going for a 2nd IVF cycle
Lori_Masi AFA_Patient_Advocate	Dr Ringler can you please post for us your contact info with address and phone number!
Guy_Ringler__MD	nyiap: It's common to have a few eggs of suboptimal quality each cycle. The fact that you concieved is a positive sign.
nyiap	do you think we may conceive naturally?
Lori_Masi AFA_Patient_Advocate	Dr Ringler how long should Nyiap wait to try again - I know they always say 3 months - is that still the protocol?
sblm	During both attempts my doctors said everthing looked good. I've tried to do as much research as I possibly can. Is it possible for me to trouble a possible problem for myself?
Guy_Ringler__MD	paravat: With a single frozen blastocyst the success rate is approx. 15-20%. With a fresh IVF cycle the rate will be closer to 50%
April	on my IVF, only half of my eggs were mature, and only half of those fertilized with ICSI. Is it a sign of poor egg quality or did the eggs need more time to mature? (I did get pregnant, but was very lucky, with only 2 embryos)
Guy_Ringler__MD	However, a fresh cycle is more costly.
nyiap	Lori my RE said as soon as I get a normal period it is ok to try again
Lori_Masi AFA_Patient_Advocate	sblm can you clarify your last question to Dr Ringler? Thanks!
Guy_Ringler__MD	nyiap: after a pregnancy loss, I like to do a midcycle scan to check the lining to see if it has normalized. if that isfine, then you can start again.
sblm	sorry, I meant to type trouble shoot
Lori_Masi AFA_Patient_Advocate	Nyiap that's good!
Guy_Ringler__MD	April: how many eggs total?
April	6 eggs total
nyiap	Dr, my RE has said they will not do a HSG or a scan, just to try on my own, does that sound normal? I was diagnosed with a possible eptopic.
April	sorry--4 were mature, 2 immature
Guy_Ringler__MD	sblm: ask you doctor if everything has been checked and what else can be done.
Lori_Masi AFA_Patient_Advocate	sblm It is always good to be informed but without a medical background and knowledge you may be doing yourself a dis service!
Guy_Ringler__MD	April: With 6 eggs totatl, it's acceptable to have 4 mature. Fertilization rate with ICSI is usually about 70%, but with a low egg number it can be less than that.
Danielle	Dr Ringler where in CA are you?
Guy_Ringler__MD	nyiap: I must not have all the history because something doesnt sound right.....
Guy_Ringler__MD	Our praactice is in Los Angeles, CA
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Lori_Masi AFA_Patient_Advocate	Welcome kathyF!
Guy_Ringler__MD	Web site: LAinfertility.com
Lori_Masi AFA_Patient_Advocate	Special Guest: Guy Ringler, MD - California Fertility Partners Topic: What to look for when choosing an IVF Program
nyiap	had IVF, 4 embies transfered, miscarried at 6 weeks, could not find fetus in uterus or tubes but was given methotrexate as a precaution
kathyf	hi first time here.
Lori_Masi AFA_Patient_Advocate	From Dr Ringler: Tonight we are going to discuss how to choose an infertility/IVF program. Factors to consider: 1. Experience of center 2. Physicians 3. Types of treatments available 4. Support staff 5. History of success.
sblm	What is methotrexate?
Lori_Masi AFA_Patient_Advocate	Welcome kathy just jump in and ask Dr Ringler anything you wish even if it is not on the topic!
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Guy_Ringler__MD	nyiap: After the hcg decreases to zero, you should do an HSG to check the tubal status.
Lori_Masi AFA_Patient_Advocate	Welcome Yola!
nyiap	drug to disolve pregnancy in case of eptopic
Lori_Masi AFA_Patient_Advocate	From Dr Ringler: Tonight we are going to discuss how to choose an infertility/IVF program. Factors to consider: 1. Experience of center 2. Physicians 3. Types of treatments available 4. Support staff 5. History of success.
Lori_Masi AFA_Patient_Advocate	Yola - Special Guest: Guy Ringler, MD - California Fertility Partners Topic: What to look for when choosing an IVF Program
Guy_Ringler__MD	Methotrexate is used to treat ectopics medically.
nyiap	Dr, they said they would not do one for a few months in case the tubes are damaged. I thought that sounded strange
kathyf	I have been on birth control waiting for egg donor to get af. started bc pills over 1 month ago. Is there a limited time you should be on pills or is it safe to stay on for almost 2 mos?
Lori_Masi AFA_Patient_Advocate	Yola please feel free to jump in and ask Dr Ringler anything you wish even if it is not related to choosing a program!
Guy_Ringler__MD	They are just being safe. Want to give everthing time to heal and any inflammation to decrease.
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Guy_Ringler__MD	Kathy: are you the recipient?
nyiap	but it's ok to get pregnant as soon as I have a normal period? What are my chances of another eptopic?
kathyf	yes i am recipient
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Guy_Ringler__MD	Kathy: There is no definite time limit on pills....hopefully you wont have to wait much longer.
kathyf	thank you for info I feel that my clinic isn't as attentive as I think they should be.
Guy_Ringler__MD	Nyiap: It sounds like they are not sure where the pregnancy was located. Did they see it in your tubes?
nyiap	no they could not see it there or in my uterus and my levels rose slowly and were low
april	I want to thank you too, Dr. Ringler, for giving me hope of having a second child through IVF
yola	How many months without medication you recomend betwin one first ifv and 2nd ivf cycle
Guy_Ringler__MD	yola: one month is fine.
Guy_Ringler__MD	april: you're welcome!
Guy_Ringler__MD	nyiap; ask your doctor about recurrence risk once he/she has hsg results...
parvat98	Generally is some analysis performed on failed IVF attempt to find out the cause of failure. In other words can we expect our doctor to tell us the most likely reasons for failure
sblm	What is considered a normal period after a failed IVF?
Danielle	Dr Ringler I have an FSH of 8 I am 43 but a low responder, have only had 3 eggs to retrieve but 2 fertilized with a twin miscarriage, what do you think about donor egg?
nyiap	parvat: after my 2nd failed ivf they did not know why. All they try to do is change your protocol based on previous cycles
Guy_Ringler__MD	paravat: It is difficult to pinpoint the cause of a failed cycle - most of the time. However, your doctor should be able to review your egg/embryo and cycle date and tell you the possible causes.
sblm	Dotor what is a good fsh level for a woman of 33?
nyiap	Dr, are you saying if they find no damage to my tubes it's possible that another eoptopic wont occur?
Guy_Ringler__MD	Danielle: I think donor egg is a great treatment option for you based upon your age and FSH level.
nyiap	can you have a low fsh and poor egg quality?
Guy_Ringler__MD	nyiap: the good news from what you describe is that they didnt identify any problem...it can be frustrating, but if they feel it looks optimistic then you should continue.
Danielle	why with a FSH of 8 do I only make 3 viable eggs on the highest dose of meds?
Guy_Ringler__MD	sblm: FSH levels on cycle day three should be 5-15. In some labs the upper limit of normal is 10
Guy_Ringler__MD	nyiap: Yes, FSH predicts how responsive the ovaries will be to stimulation drugs. The egg quality is affected by an indiviuals genetics and by stimulation somewhat.
kathyf	Can fsh levels fluctuate from one month to another more than a few points?
Guy_Ringler__MD	Danielle: Some women are low responders to ovarian stimulation. This does not mean the eggs are of lower quality, just that fewer will be produced per cycle.
nyiap	Dr my estrogen level was always around 3700 right before retreival and usually only making it until day 8m can this affect quality?
parvat98	Do fertility clinics have policy of attempting only limited number of IVF cycles(2 or 3) on a given patient because it will reflect on their success rates. If such a policy exists are they required to disclose
Guy_Ringler__MD	kathy; FSH levels fluctuate by a few points month to month unless you are peri-menopausal thenthey can have greater range.
yola	I am 43 I have FSH 7 and on fy first IVF 8 eggs fertilized 5 transfered but no pregnacy should I try my 2nd IVF at same clinic and same doctor ?
Guy_Ringler__MD	parvat: I hope programs are not doing that. I am not aware of such a practice policy.
Danielle	Dr Ringler my other problem is my estrogen level, both before and after retreival, even after positive PG test , why doesn't my E2 go up?
april	can having been on ovarian stimulation meds affects FSH on the following cycle?
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Lori_Masi AFA_Patient_Advocate	Welcome lilly!
april	my FSH was always low until the cycle after I did an injectable IUI, when it skyrocketed, only to come down again the following month
Lori_Masi AFA_Patient_Advocate	Special Guest: Guy Ringler, MD - California Fertility Partners Topic: What to look for when choosing an IVF Program
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Lori_Masi AFA_Patient_Advocate	From Dr Ringler: Tonight we are going to discuss how to choose an infertility/IVF program. Factors to consider: 1. Experience of center 2. Physicians 3. Types of treatments available 4. Support staff 5. History of success.
Guy_Ringler__MD	Danielle: Estrogen reflects the number of devloping follicles. If you have a low number of follicles your level will be low. The absolute number is not that critical.
Guy_Ringler__MD	April: No it shouldnt. Estrogen therapy will lower it though.
Guy_Ringler__MD	April: Was it only elevated the one time?
april	it was elevated twice, with low numbers all the other times tested (about 6 other times)
Danielle	what about after a positive PG test, shouldn't my estrogen be high, i think it was nyiap that said hers was 3700 I have never gotten anywhere near that? Could the estrogen be the cause of my multiple miscarriages?
nyiap	Danielle, I had 21 eggs...that caused my E2 to be high, plus 13 were maure
Guy_Ringler__MD	April: The two elevated readings suggest that the ovaries are showing some resistance and beginning to show some change...
nyiap	mature
Danielle	thanks nyiap!
nyiap	Danielle, what about your progesterone level?Was that ever checked?
april	well the high FSH reading caused me to jump into IVF before my fertility window closed--I"m glad I did, because it worked when nothing else did
Guy_Ringler__MD	Danielle: The estrogen level doesnt need to be high in early pregnancy.....in the luteal phase many programs will check it and add replacement hormone to keep it in the normal rang.e
Danielle	my progesterone is always good
lilly	IÕm starting my 4th ivf cycle. IÕm almost 41, (3 years of trying) good fsh but poor respondent. In the next cycle we are going to use only follistim (600) should I use more medication in order to get more eggs or less medication, less eggs but maybe better quality of eggs.
sblm	Doctor, I take medication because I have a prolctinaoma, can that affect an IVF cycle?
nyiap	danielle did they check your miscarriage material for reasons why?
Guy_Ringler__MD	A healthy corpus luteum will make both estrogen and progesterone until the placenta takesover.
Lori_Masi AFA_Patient_Advocate	Folks we only have about 5 minutes left so please post your final questions to Dr Ringler!
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Guy_Ringler__MD	sblm: No the medication will not have an adverse effect.
nyiap	sblm, what is prolctinaoma?
Lori_Masi AFA_Patient_Advocate	Welcome Jpooh we only have 5 minutes left so please post your question!
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sblm	tumor causing prolactin levels to be high
april	if meds don't affect the ovaries, why do most doctors recommend a rest cycle between injectable IUI or IVF cycles?
sblm	prolactinoma
nyiap	my prolactin level was 50 during most of my cycles but they put me on parlodel and still got pregnant 3rd try
nyiap	they've never tested me for a tumor though
Guy_Ringler__MD	My practice information: California Fertility Partners, 11818 Wilshire, Suite 300, Los Angeles, CA 90025 310-828-4008
Guy_Ringler__MD	Guy Ringler, MD GRingler@aol.com
Lori_Masi AFA_Patient_Advocate	Thank you Dr Ringler for all the wonderful and informative information tonight! We appreciate your time and generosity of spirit in participating this evening. And thank you to everyone for joining us this evening!
sblm	good NYIAP
lilly	IÕm starting my 4th ivf cycle. IÕm almost 41, (3 years of trying) good fsh but poor respondent. In the next cycle we are going to use only follistim (600) should I use more medication in order to get more eggs or less medication, less eggs but maybe better quality of eggs.
Guy_Ringler__MD	You're welcome. Good luck to everyone.
nyiap	thanks DR for your time...you too Lori
sblm	Has your prolactin level always been high?
nyiap	I wasn't aware until I started IVF
Lori_Masi AFA_Patient_Advocate	2 minutes folks!!
Lori_Masi AFA_Patient_Advocate	Sorry but Dr Ringler has to get back to his patients!
Guy_Ringler__MD	lilly: Good questions. Above four amps there is not a direct correlation between amt of medication and response.
sblm	What is 10m?
nyiap	the parlodel really helps though, brings my level to normal (under 25)
Guy_Ringler__MD	I never use more than 5 famps.daily.
Guy_Ringler__MD	Too much medication can actually decrease egg quality in some patients.
Lori_Masi AFA_Patient_Advocate	Thank you Dr Ringler for all the wonderful and informative information tonight! We appreciate your time and generosity of spirit in participating this evening. And thank you to everyone for joining us this evening! Good Night!
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
nyiap	good night
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What To Look For When Choosing An IVF Program

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