When Implantation Fails

July 26, 2005 - Tuesday
1:55 PM to 2:55 PM (EST)
Guest Speakers: Phillip E. Chenette, MD, Pacific Fertility Center

Categories
Donor Egg • Fertility • IUI • IVF • Miscarriage • PCOS • Pregnancy

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kwhite	hi
kwhite	jh05- do u know if they r doing the session on implantation tonight?
kwhite	didn't see it on the login page
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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
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Lori_Masi AFA_Patient_Advocate	Good Evening Everyone! We are very fortunate this evening to have the wonderful Dr Philip Chenette of Pacific Fertility Center in CA with us!
jh05	hi kwite--yes implantation...sorry, i was downloading a file since i logged on early
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Lori_Masi AFA_Patient_Advocate	Dr Chenette will be with us shortly - he has a little computer glitch!
Lori_Masi AFA_Patient_Advocate	Our topic tonight is: When Implantation Fails. Dr Chenette has sent me the following info to pass on to all of you:
Lori_Masi AFA_Patient_Advocate	When Implantation Fails: An introduction to early embryo development and embryo implantation. When embryos grow well, but do not attach, pregnancy cannot begin. This can occur because of defective embryos, but also because of poor endometrium. The uterine lining may not be 'sticky' enough for the embryos to attach. What are the causes of failed implantation, and what can we do about it? Tonight we are meeting with Dr. Philip Chenette, medical director of Pacific Fertility Center in San Francisco. Dr. Chenette brings his expertise in in vitro fertilization and oocyte donation to answer your questions about the very beginnings of pregnancy, embryo implantation.
jh05	hi - I've never been i na chat room before--do we just ask questions?
kwhite	thanks jh05
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Lori_Masi AFA_Patient_Advocate	Hi Jh when Dr Chenette is able to log on just type you question.
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patti_	Did the chat start yet?
Lori_Masi AFA_Patient_Advocate	Everyone please keep in mind that the room is quite busy already so you might want to type you questions in a word document and then copy and paste it, because you may be asked to repeat it! Thanks!
Lindakd	I am 41, mu husband 36. We recently completed our first IVF cycle in Homburg Germany. However it was not successfull. My question is... Is implantation more successfull, or have greater chances on a 5-6 day transferr and when assited hatching is used?
Lori_Masi AFA_Patient_Advocate	Hi Patti Dr Chenette will be with us shortly - he has a bit of a computer glitch in his office!
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dplumlee	Type here
tenayagirl2	Type here is this the talk on implantation failure?
viviane	After an IUI, does cramping last a few days or is it considered implantation?
patti_	thanks Lori - first time to this chat
Lori_Masi AFA_Patient_Advocate	Welcome Everyone Dr Chenette will be with us shortly!
Lori_Masi AFA_Patient_Advocate	Good Evening Everyone! We are very fortunate this evening to have the wonderful Dr Philip Chenette of Pacific Fertility Center in CA with us! Everyone please keep in mind that the room is quite busy already so you might want to type you questions in a word document and then copy and paste it, because you may be asked to repeat it! Thanks!
dplumlee	Can fibroids affect implantation?
abbey3	Is there a way to tell if 2 miscarriages in a row are due to uterine lining problems, endometriosis or genetic problems?
Lori_Masi AFA_Patient_Advocate	dp wait for the doc but my layman's answer is yes!
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Lori_Masi AFA_Patient_Advocate	anyone who has posted a question already - you will need to repeat it when Dr Chenette gets on because he will only be able to see what comes up AFTER he logged on - so please hold your questions until he arrives - unless they are non medical and I can answer those! Thanks!
Lori_Masi AFA_Patient_Advocate	From Dr Chenette: When Implantation Fails: An introduction to early embryo development and embryo implantation. When embryos grow well, but do not attach, pregnancy cannot begin. This can occur because of defective embryos, but also because of poor endometrium. The uterine lining may not be 'sticky' enough for the embryos to attach. What are the causes of failed implantation, and what can we do about it? Tonight we are meeting with Dr. Philip Chenette, medical director of Pacific Fertility Center in San Francisco. Dr. Chenette brings his expertise in in vitro fertilization and oocyte donation to answer your questions about the very beginnings of pregnancy, embryo implantation.
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tenayagirl2	please comment in as much detail as possible, your view of reproductive immunology as it pertains to implantation failure. specifically, do you believe that the use of enbrel and/or IVIG can overcome 'NK cell activity" if this is the cause of implantation failure? thank you
Lori_Masi AFA_Patient_Advocate	Welcome Julie we are waiting for Dr Chenette who has a computer problem
tenayagirl2	?
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Lori_Masi AFA_Patient_Advocate	tenayagirl2 please wait for the doctor to post your questions because he will only be able to see what was posted AFTER he logs on so Everyone please keep in mind that the room is quite busy already so you might want to type you questions in a word document and then copy and paste it, because you may be asked to repeat it! Thanks!
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tenayagirl2	ok-will u tell us each when to post? i'm new thanks
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dplumlee	What is Dr. Chennette's status?
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loreign	Dr. C., I am interested to find out if you know anything about a genetic link and the anti-ovarian antibody. I have tried to get pregranat for 4 years and have no success and no explanation as to why. My Aunt, My great aunt and 2 cousins all on my dad's side have not been able to have children. A nurse was explaining that this antibody could be genetic and it attacks the egg as it tries to implant. Is this correct ? Is it a simple blood test to determine it and what are possible treatments?
Kristen	I have a regular cycle-28 days. But I do not ovulate until CD20 or 21. My luteal phase is only 9 days. I took Vitamin B6 for 2 months. This month I am CD39 and I still haven't ovulated. Could this be because of the B6??? Do you have any suggestions??
Dr._Chenette	Good evening!
Dr._Chenette	Our tech guy finally got me online
viviane	After an IUI, does cramping continue for a few days or is that implantation. I did follistim and hcg shot, I'm 3 days past my IUI 20mm follicle, estrdol 200
Dr._Chenette	Welcome to all of you from San Francisco
abbey3	Hi Dr. Chenette! Is there a way to tell if 2 miscarriages in a row are due to uterine lining problems, endometriosis or genetic problems?
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Lindakd	I am 41, my husband 36. We recently completed our first IVF cycle in Homburg Germany. 6 eggs, 4 fertilized (ICSI), 3 transferred (1@ 4 cells, 2 @ more than 4 cells. It was not successful. My question is...at my age would the success rate of implanation be better with a 5-6 day transfer and with the use of assisted hatching? (In Germany they can only do 3 day transfers and they cannot use assisted hatching.)
Dr._Chenette	A quick blurb about tonight's session:
Dr._Chenette	When Implantation Fails: An introduction to early embryo development and embryo implantation. When embryos grow well, but do not attach, pregnancy cannot begin. This can occur because of defective embryos, but also because of poor endometrium. The uterine lining may not be 'sticky' enough for the embryos to attach. What are the causes of failed implantation, and what can we do about it? Tonight we are meeting with Dr. Philip Chenette, medical director of Pacific Fertility Center in San Francisco. Dr. Chenette brings his expertise in in vitro fertilization and oocyte donation to answer your questions about the very beginnings of pregnancy, embryo implantation.
viviane	i had 7 follicles all together 3 dominant
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Dr._Chenette	We're most interested this evening in implantation, how an embryo attaches, and why
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Dr._Chenette	and furthermore, what we can do about it.
Dr._Chenette	It is a common problem that a woman will make multiple embryos of good quality
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Dr._Chenette	those embryos may not always attach as we would like
Dr._Chenette	often this is because of the embryos, but it may also be becuase the uterus is not sticky enough
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tenayagirl2	please comment in as much detail as possible, your view of reproductive immunology as it pertains to implantation failure. specifically, do you believe that the use of enbrel and/or IVIG can overcome 'NK cell activity" if this is the cause of implantation failure? thank you
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Lori_Masi	When Implantation Fails: An introduction to early embryo development and embryo implantation. When embryos grow well, but do not attach, pregnancy cannot begin. This can occur because of defective embryos, but also because of poor endometrium. The uterine lining may not be 'sticky' enough for the embryos to attach. What are the causes of failed implantation, and what can we do about it? Tonight we are meeting with Dr. Philip Chenette, medical director of Pacific Fertility Center in San Francisco. Dr. Chenette brings his expertise in in vitro fertilization and oocyte donation to answer your questions about the very beginnings of pregnancy, embryo implantation.
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julie71	what is the optimum lining thickness before transfer both fresh and frozen
dplumlee	What exactly do you mean by "sticky"? Thanks
Dr._Chenette	julie71m the best thickness is about 9 mm
viviane	I don't know if my ? was answered, chatroom froze, I had the IUI question?
jh05	I'm 36 / spouse 37; 2 failed IVFs: 1st 3 on day 3 transfer / 2nd 3 on day 5 transfer with 2 blastocysts and 1 morula. I was told each time that my lining 'looked great'.is there anything I can do to help implantation if go IVF a 3rd time?
abbey3	Is there a way to tell if 2 miscarriages in a row are due to uterine lining problems, endometriosis or genetic problems?
moody	Dr. Chenette, I have been at a fertility clinic for 15 months in that time I have done actos and clomid, follistem and now am back to metformin and clomid. all these treatments have been helped by IUI.... I have two children 4 and 2 and also have poly cystic overys... how long should I try the clomid, Metformin, follistem trial before I conclude it will not work.. I am 31 so age should not be a factor and my tubes are clear
Dr._Chenette	thicker linings often are fine, but we must look for problems like polyps and myomas in thicker linings
msw5ski	What age group are you talking about, does this include the over 40 y/o women?
Lori_Masi	Everyone please keep in mind that the room is quite busy so you might want to type you questions in a word document and then copy and paste it, because you may be asked to repeat it! Thanks! Everyone please keep in mind that the room is quite busy so you might want to type you questions in a word document and then copy and paste it, because you may be asked to repeat it! Thanks! Everyone please keep in mind that the room is quite busy so you might want to type you questions in a word document and then copy and paste it, because you may be asked to repeat it! Thanks!
Dr._Chenette	thinner linings, 6 mm and below, generally will not support a pregnancy
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Lori_Masi	From Dr Chenette: When Implantation Fails: An introduction to early embryo development and embryo implantation. When embryos grow well, but do not attach, pregnancy cannot begin. This can occur because of defective embryos, but also because of poor endometrium. The uterine lining may not be 'sticky' enough for the embryos to attach. What are the causes of failed implantation, and what can we do about it? Tonight we are meeting with Dr. Philip Chenette, medical director of Pacific Fertility Center in San Francisco. Dr. Chenette brings his expertise in in vitro fertilization and oocyte donation to answer your questions about the very beginnings of pregnancy, embryo implantatio
Dr._Chenette	jh05, that is exactly the problem that we are dealing with today
Dr._Chenette	If a good embryo doesn't stick, why?
Dr._Chenette	The first answer is always to look at the embryo
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viviane	how long would cramping last after an iui?
Dr._Chenette	The embyos may have divided only a short time and not stepped into the next stage, perhaps because of a chromosome defect
Dr._Chenette	We ask a great deal of these small cells - to join sperm and egg, then divide into hundreds of cells
Dr._Chenette	they often go wrong
Lori_Masi	DR Chenette when you have a moment please post for everyone your full contact info including phone number! Thanks!
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dplumlee	If there are myomas in the lining, what affect will that have on implantation and fertility in general?
jh05	thx Dr. we were told each time that of the 3 embryos, 2 were above average and the 3rd was average, but nothing stuck...is there a recognition problem withthe lining once the embryos are put back?
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linda_li_	what's the recommedations for embryo transfer(how many,etc?)
Dr._Chenette	My contact info is Philip Chenette, MD, Pacific Fertility Center, San Francisco, (415) 834-3095, 888-834-3095, www.pacificfertility.com
julie71	I have had 3 failed IVF transfers with a lining of 8.5 and 9. Each time the doc says I am right on and the embryos grew before each transfer. Each cycle charted about the same but no luck with implantation. I have thought about doing another full cycle but don't know if there is any test that I should have before going further.
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Dr._Chenette	jh - next after embryos, check transfer technique
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Dr._Chenette	if there was difficulty in inserting the embryos, the lining could have been damaged
Dr._Chenette	there is a great deal of difference in pregnancy rates depending on where in the uterus the embryos are placed
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Dr._Chenette	the lower third is best
jh05	I'm going to NYU in NYC - they are #2 practice behind Cornell (i think) - I haven't felt a thing on transfer.
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Dr._Chenette	Next is to consider problems with the fallopian tubes
Beth_Ann	I am 33 husband 35, he had a vasectomy reversal twice. We are now up to 23 million sperm while he is taking Clomid. We have had IUI twice (failed) after I took 150mg Clomid. The doctor is asked to see us before another attempt. I suffer from PCOS and I am taking Fortamet. We cannot afford IVF and I would like to continue attempts at IUI. Are there any other medications or treatments that can be done with the IUT? What would you do next for us?
Dr._Chenette	a hydrosalpinx could cause failure of implantation - a hysterosalpingogram would rule this out
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Dr._Chenette	integrin assay is often useful
jh05	yes, i have my left tube blocked andjust went through a hysterscopy and laproscopy...would these procedures help implantation?
Lori_Masi	Sorry everyone I keep getting knocked off!
Dr._Chenette	beta3 integrin is a molecule in the uterus that binds the embryo, and is very important in implantation
tenayagirl2	does integrin assay only be done by a uterine biopsy?
Dr._Chenette	using a small tube, a sample of the lining can be obtained and integrin levels measured
Kristen	I have a regular cycle-28 days. However, I don't ovulate until CD20 or 21. My luteal phase is only 9 days. Too short for implantation. I took B6 for 2 months. Now, I am on day 39 without ovulation. Could that be from the B6??? Do you have any suggestions for me??
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abbey3	Will a sonohistogram provide the same results as a HSG?
Dr._Chenette	if the biopsy is in phase, and the integrin is not found, intervention is necessary
Lori_Masi	Dr Chenette I don't know if you saw my last post before I was knocked off - but when you get a moment please post for everyone your full contact info including phone number! Thanks!
Dr._Chenette	got it lori
tenayagirl2	what specific intervention
Dr._Chenette	Philip E. Chenette, MD
Dr._Chenette	Pacific Fertility Center
Dr._Chenette	San Francisco, CA
Dr._Chenette	888-834-3095, www.pacificfertility.com
abbey3	Will a sonohistogram provide the same results as a HSG?
Dr._Chenette	Evaluating the endometrial cavity is also important
Olga_samoilova	I had 5 IVF cycles.Each time 4-9 embrios.Uterine lining between6-8mm,most of the time5-7mm.All ivf faled.Most of them were done between age 34-39.Fsh 4,3.Very healthy.Can Viagra suppositories help improve implantation/ Even with endimetriosis?
jh05	dr...is there anything we can do for implantation? diet? exercise? like i said, i was told my lining looked good each IVF
Dr._Chenette	common problems like polyps and adhesions can interfere with growth of the lining
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Dr._Chenette	after ultrasound, a sonohysterogram is a reasonable next step
Lori_Masi	Welcome Kelly! We are very fortunate this evening to have the wonderful Dr Philip Chenette of Pacific Fertility Center in CA with us!
Dr._Chenette	often hysteroscopy is necessary, to actually see the inside of the uterus.
Dr._Chenette	jh5 - there are things that you can do to enhance implantation.
Lori_Masi	From Dr Chenette:
Lori_Masi	When Implantation Fails: An introduction to early embryo development and embryo implantation. When embryos grow well, but do not attach, pregnancy cannot begin. This can occur because of defective embryos, but also because of poor endometrium. The uterine lining may not be 'sticky' enough for the embryos to attach. What are the causes of failed implantation, and what can we do about it? Tonight we are meeting with Dr. Philip Chenette, medical director of Pacific Fertility Center in San Francisco. Dr. Chenette brings his expertise in in vitro fertilization and oocyte donation to answer your questions about the very beginnings of pregnancy, embryo implantation.
Dr._Chenette	Healthy living - good diverse diet, prenatal vitamins, essential fatty acids (DHA and omega-3)
Dr._Chenette	minimize alcohol
Dr._Chenette	stress reduction
jh05	yes, no drinking and taking natafort
Dr._Chenette	take up an exercise program
jh05	we're considerig donoe egg and want to do everything possible to try and help implantation
linda_li_	should we take mvi before and after the transfer?
Dr._Chenette	and work on your relationship - a common source of stress that one can eliminate with great side benefits
Lindakd	Does the use of assisted hatching aid in implantation?
Dr._Chenette	acupuncture may also be helpful
Shriba	How do you get more Beta 3 Integrin if you don't have a high enough level?
jh05	great - thank you
Dr._Chenette	We use assisted hatching in women over 37
dplumlee	My endocrinologist advised against jogging for exercise. Do you agree?
viviane	In how many days does implantation occur
Dr._Chenette	we think it helps the embryos attach
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Beth_Ann	I am 33 husband 35, he had a vasectomy reversal twice. We are now up to 23 million sperm while he is taking Clomid. We have had IUI twice (failed) after I took 150mg Clomid. The doctor is asked to see us before another attempt. I suffer from PCOS and I am taking Fortamet. We cannot afford IVF and I would like to continue attempts at IUI. Are there any other medications or treatments that can be done with the IUT? What would you do next for us?
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Dr._Chenette	Shriba - beta integrin development seems to be more a side effect of other conditions, so you treat those first.
Lindakd	does a day 5 or 6 transfer also have a better shot than a day 3 transfer?
abbey3	Do hCG levels begin to rise AFTER implantation, or between conception and implantation?
Dr._Chenette	If you are not ovulating well, or have a luteal phase defect, integrin will not be present. Treating with ovulation induction or progesterone will help.
Dr._Chenette	If a hydrosalpinx, take it out.
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Dr._Chenette	There are of course other treatments for hydrosalpinx, but they require more work to be sure that they work as well.
jh05	I had assisted hatching with the day 3 transfer....but extended culturing with the day 5 blastocysts. Do donor egg embryos have less of a chance of implantation bc it isn't part of the mother's egg?
Shriba	What conditions would affect Beta 3 Integrin? And really, no wine?
tenayagirl2	please comment in as much detail as possible, your view of reproductive immunology as it pertains to implantation failure. specifically, do you believe that the use of enbrel and/or IVIG can overcome 'NK cell activity" if this is the cause of implantation failure? thank you
abbey3	Do hCG levels begin to rise AFTER implantation, or between conception and implantation?
Dr._Chenette	If endometriosis is the cause, treat it - laparoscopy, gnRH agonist (Lupron) for three months
Lori_Masi	Dr Chenette you are doing a fabulous time keeping up with all the questions! Thank you so much!
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Lori_Masi	I Mean "fabulous Job"
Dr._Chenette	Shriba - no wine - ethanol is a very tiny molecule that gets into every cell of your body
abbey3	Do hCG levels begin to rise AFTER implantation, or between conception and implantation?
jh05	i agree Lori ::biggrin
Dr._Chenette	an interferes with folic acid metabolism
loreign	Dr. C., I am interested to find out if you know anything about a genetic link and the anti-ovarian antibody. I have tried to get pregranat for 4 years and have no success and no explanation as to why. My Aunt, My great aunt and 2 cousins all on my dad's side have not been able to have children. A nurse was explaining that this antibody could be genetic and it attacks the egg as it tries to implant. Is this correct ? Is it a simple blood test to determine it and what are possible treatments
Dr._Chenette	which means problems with DNA synthesis
viviane	when does the bbt start to rise when charting
Shriba	I agree, I don't know how you're keeping up!
jh05	does drinking coffee affect implantation - or any caffeine for that matter?
Olga_samoilova	dO YOU RECOMMEND vIAGRA SUPPOSITORIES TO THIKEN THE UTERINE LINIG?
Dr._Chenette	tenayagirl - reproductive immunology is a complex subject that we could spen hours on
msw5ski	I am 43 yo with two attempted IvF cycles with my own eggs,
Dr._Chenette	The immune system defintely affects embryos
Shriba	That's all I needed to hear! NO wine for me!
Dr._Chenette	There is clearly a role in miscarriage
Dr._Chenette	But implantation, no, the data is quite clear that you cannot treat the immune system and expect an improvement in implantation
Dr._Chenette	indeed you may make implantation worse
Beth_Ann	I am 33 husband 35, he had a vasectomy reversal twice. We are now up to 23 million sperm while he is taking Clomid. We have had IUI twice (failed) after I took 150mg Clomid. The doctor is asked to see us before another attempt. I suffer from PCOS and I am taking Fortamet. We cannot afford IVF and I would like to continue attempts at IUI. Are there any other medications or treatments that can be done with the IUT? What would you do next for us?
msw5ski	one clinic says that they will only go to retrival with 4 maturing follicles, the 2nd clinic said they will retrieve as many as there are...even if there is only one follicle.
Dr._Chenette	The immune systemis quite delicate, and the drugs that we have are potent
tenayagirl2	i was told that if i took enbrel and IVIG infusions that this may "overcome" the NK cells ability to attack the embryo
msw5ski	what does your clinic do?
loreign	anti ovarian antibody... how common and what can be done?
Shriba	I understand the Folic Acid - DNA link, I wish my doctor would have told me about the effect of alcohol.
Dr._Chenette	more often than not, immune therapies will knock out good factors along with bad
tenayagirl2	worse!!??? by which drug do you mean?
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Lindakd	I have Rhumetoid Arthritis and was given Medrol by my RE. I take 4 mg per day. Could this be a factor for me?
Dr._Chenette	olga - the study on viagra was quite small - four patients. I have tried it and not seen improvements in the endometrial lining
tenayagirl2	you mean good factors that would help implantation?
Dr._Chenette	There is a study of patients with radiation induced injury to the lining
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Dr._Chenette	with treatment using tocopherol and pentoxyfylline
Dr._Chenette	This is our current regimen for patients with injured linings
jh05	Does drinking coffee affect implantation - or any caffeine for that matter?
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abbey3	Do hCG levels begin to rise AFTER implantation, or between conception and implantation?
Shriba	Good question jh05.
Olga_samoilova	Can infrctions effect implantations( trichomonas,etc)?
jh05	shriba--i liked your wine Q and my husband said 'ask about caffeine'!
Dr._Chenette	jh05 - coffee is ok 1-2 cups per day, like anything in excess, it can be a problem in higher doses. Reducing the wine will likely lead to a reduction in the need for caffeine!
Kristen	I have a regular cycle-28 days. However, I don't ovulate until CD20 or 21. My luteal phase is only 9 days. Too short for implantation. I took B6 for 2 months. Now, I am on day 39 without ovulation. Could that be from the B6??? Do you have any suggestions for me??
Shriba	Someone's thinking!
jh05	abbey3- i think it is after implantation--that is what is tested for pregnancy level - the beta reading - i think?
Dr._Chenette	abbey3 - hCG is produced by the embryo at very early stages
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Dr._Chenette	the amount is so small that it is very difficult to find in the mothers blood
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Shriba	You're right about wine & the need for caffiene. I never sleep that well after a glass.
loreign	does anyone know about the ovarian antibodt?
Dr._Chenette	research studies using very sensititve assays show it as early as day 22, but these assays are difficult to do and not practical in the clininc
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Dr._Chenette	olga - infections do indeed affect implantation, and should be treated before IVF
abbey3	day 22 after conception?
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msw5ski	Can HPV effect the implantation
Dr._Chenette	Kristen - luteal phase defects are one of the important causes of implantation failure
Dr._Chenette	the best treatment is to get the ovaries working harder
Dr._Chenette	and that means fertility drugs
Dr._Chenette	clomiphene, letrozole, and the gonadotropins are all reasonable to consider.
jh05	If implantation has been an issue with my eggs, would it be more of an issue with a donor?
kelh64	Type here
Dr._Chenette	If you treat luteal phase defect without treating ovulation, you'll miss the main problem.
newdoc	Given progesterone and estrogen support during the luteal phase, could you still see a luteal phase defect causing non-implantation in IVF cycles? I am s/p 2 IVF's with good quality embryos and no stick-age!
abbey3	hCG - was that day 22 a mistype?
Dr._Chenette	abbey3 - day 22 from last menstrual period, 8 days after conception
msw5ski	A donor would be matched to your blood type ...right?
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abbey3	thanks
Dr._Chenette	msw5ski - no data on HPV
Lori_Masi	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
jh05	msw5ski we're considering bc of 2 failed IVFs
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Dr._Chenette	jh05 - maybe. It would take a thorough look at the causes
Kristen	Thank You Dr. Chenette!! I won't take any more of your time so that others have a chance that their questions be answered!!
Olga_samoilova	Is it always an egg quality thas effect embrio or the sperm quality can too?
abbey3	How long after conception should the uterine lining begin to thicken?
Lindakd	do you feel the best method for giving progestrone is the IM shot? Is it really the most effective?
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jh05	thanks dr--i too will let other s ask
Dr._Chenette	newdoc - good progesterone support is essential in IVf, since the luteal cells often give up too early, and an early period can occur
loreign	Ladies, best of luck you all,I thought I had a pertinent question and am way to frustrated to stay on. Til' next time
jh05	good luck kwhite, shriba!
jh05	good luck everyone
msw5ski	What are normal range for FSH and Progesterone?
Dr._Chenette	there are many regimens for progesterone support, and they are individualized to the patient
Shriba	Desides eliminating wine, and eating more green veggies, is there anything I can do to help implantation along? My transfer is next week, after PGD. I'm of "advanced materna age" and take 5mg of folic acid a day - overkill maybe. Thank you jh05 - Good luck to you too!!
Dr._Chenette	mswski - the blood type of the donor is not relevant to conception, interestingly enough
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Dr._Chenette	it is interesting that there seems to be seasonal variation in conception rates
Dr._Chenette	the summer is the worst
Dr._Chenette	the autumn is the best
jh05	shriba-i'll be praying for your success!
Dr._Chenette	that is from IVF statistics
Shriba	I should have waited until October!!
Lori_Masi	That is very interesting - I never heard that before....
abbey3	How long after conception should the uterine lining begin to thicken?
msw5ski	thanks, sorry about the misnomer, have you seen any patients conceiver through IVF at age 43 or older?
Dr._Chenette	olga - eggs and sperm both contribute to embryo quality
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Dr._Chenette	embryos provide most of the cellular material, and the mitochodria
Dr._Chenette	but sperm provide the system that organizes the chromosome division, the sperm aster
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Dr._Chenette	both play very important roles.
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Dr._Chenette	Shriba - a good course of stress reduction, acupuncture, and taking good care of yourself would be in order
Olga_samoilova	How sperm quality can be tested besides regular morphplogy and count?
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Dr._Chenette	abbey3 - the lining thickens very quickly, in response to the embryo, first just near the embyo, but then wideing out to the entire endometrium
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abbey3	thank you
Beth_Ann	I am 33 husband 35, he had a vasectomy reversal twice. We are now up to 23 million sperm while he is taking Clomid. We have had IUI twice (failed) after I took 150mg Clomid. The doctor is asked to see us before another attempt. I suffer from PCOS and I am taking Fortamet. We cannot afford IVF and I would like to continue attempts at IUI. Are there any other medications or treatments that can be done with the IUT? What would you do next for us?
Dr._Chenette	msw5ski - fertility over forty is somewhat of a specialty here. we get a 5-10% delivered pregnancy rate in our 43-45 year olds
Dr._Chenette	We have a pregnancy in a 46 year old
Dr._Chenette	, but tend to discourage attempts over age 45
abbey3	What could cause a false positive hCG?
Shriba	I read an article that said DHEA can help produce better quality eggs in older women, I'm 44, thus helping implantion. Have you heard anything about this? Thanks.
z	Dr. Chenette, how serious would you consider not undergoing an IVF during the summer..We're about to start one in August and I would appreciate your recommendation
Dr._Chenette	olga - we test for sperm survival as well. There are also tests such as the DNA fragmentation index, but we do not order the test here.
msw5ski	Is there a clinic in NJ that specialixes in the over 40 women, called the DIamond Institute?
Lori_Masi	Ladies and Gentlemen we only have about 8 minutes left so please repost your questions now! Thank you!
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abbey3	What could cause a false positive hCG?
Dr._Chenette	Shriba - DHEA should not affect embryo quality. Are you thinking of DHA?
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msw5ski	Dr. Chenette thank you and thanks ladies for the HOPE
Olga_samoilova	Thank you.Good luck everybody.
Shriba	It's a growth hormone.
Beth_Ann	I am 33 husband 35, he had a vasectomy reversal twice. We are now up to 23 million sperm while he is taking Clomid. We have had IUI twice (failed) after I took 150mg Clomid. The doctor is asked to see us before another attempt. I suffer from PCOS and I am taking Fortamet. We cannot afford IVF and I would like to continue attempts at IUI. Are there any other medications or treatments that can be done with the IUT? What would you do next for us?
Lori_Masi	Welcome Ladies we only have about 5 minutes left!
Dr._Chenette	z, the differences seasonally are minor. Age effects are probably more significant, and you probably should go ahead.
Lindakd	I have Rhuemtoid Arthritis and take 4 mg per day (perscribed by my RE) since this is an immune disease might this be a big factor for me.
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Shriba	Good luck to you, Olga!
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Dr._Chenette	Beth_ann, you might suggest letrozole to your doctor. Fewer effects on the lining, and you'll feel better taking it.
abbey3	What could cause a false positive hCG?
msw5ski	Do you do long distance consultatons, ie telephone, chart review?
kansas_girl	going on 4th ivf cycle wondering if any advice ??
Dr._Chenette	Lindakd - RA is a stressful condition, and stress can cause problems. I would speak with a specialist in the area to see what can be done about settling down the disease process s the best direction for treatment
Beth_Ann	what does letrozole treat, what type of drug
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kwhite	I am 29 & DH is 33 dx is blocked tubes already had them tied. My IVF #1 was a BFN (negative). Dr. thinks it may have been due to all the meds in my system or lining. Does this sound right? We are doing a FET in September any suggestions for a positive out, I'm comtemplating accupuncture.....
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Dr._Chenette	abbey3 - a false positive hCG is rare nowadays. Occasionally we measure hCG from the hCG injection, in women that are slow metabolizers of hCG
Lindakd	I just wondered if Medrol might have a negative affect on the linning?
Lori_Masi	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
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Dr._Chenette	letrozole is an aromatase inhibitor. Aromatase is the enzyme that creates estrogen. In contrast, Clomid works by blocking estrogen's receptor. Letrozole just works better, with fewer side effects
z	Dr. Chennete, Can you please answer my question re the seasonal effect on IVF
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Dr._Chenette	z - i've lost the question
Lori_Masi	Everyone we must let DR Chenette go! Dr chenette you have done a fabulous job on such a busy night and I hope you will join us again! Thank you for all the wonderful information tonight! We appreciate your time and generosity of spirit in participating this evening.
abbey3	thanks all
Beth_Ann	Thank you so much!
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Dr._Chenette	Thanks to all of you, and best wishes...
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z	We are to undergo a cycle in August and would like your recommendation on postponing it to the autumn as you mentioned
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Lori_Masi	Dr Chenette thank you to everyone for joining us this evening! Good Night!
Shriba	Thank you very much, Doctor! Good luck to everyone.
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kwhite	thanks
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Lori_Masi	Good Night Everyone! 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
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When Implantation Fails

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