When is Enough, Enough? When You Should Consider Stopping Treatment

April 27, 2005 - Wednesday
2:06 PM to 3:06 PM (EST)
Guest Speakers: Michael Doyle, MD, Connecticut Fertility Associates

Categories
Egg Donation • Fertility • Infertility • IUI • IVF • PCOS

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Lori_Masi AFA_Patient_Advocate	Hi Stephaway Welcome!
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Lori_Masi AFA_Patient_Advocate	Hi Dr Doyle - Welcome! Lisa should be with us shortly!
Dr._Michael_Doyle	Hello !
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	Dr Doyle please let me know when you are ready to begin!
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Lisa_Rosenthal	Welcome Everyone, thanks for joining us this evening!
Lori_Masi AFA_Patient_Advocate	Stephaway do you have any questions for Dr Doyle? Why don't you post them now before we get busy!
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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
local	[332] When is Enough, Enough? When You Should Consider Stopping Treatment with Michael Doyle, M.D., (Connecticut Fertility Associates)
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Dr._Michael_Doyle	I think one concept we will visit tonight is that what is "enough" for one patient may be very different for another, depending on motivation, desire, and of course resources -- emotional, physical, and financial -- would you agree?
Lisa_Rosenthal	Dr. Doyle, thanks for joining us this evening!! And what a great way to start, with a question. Ladies and gentlemen, do you agree?
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olga	I agree totally
Orly	Yes, I agree, but where does medical supervision come into play?
Dr._Michael_Doyle	I think the MDs must be very accurate and honest in his or her assessment about your options, but that so much of what a patient then decides to do is personal
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
Dr._Michael_Doyle	Medical supervision is critical to help guide responsible and realsitic choices, based on factors like previous treatment, FSH, age, etc...
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Orly	How or why is it so different for an infertility patient than any other type of patient? Why more say in this treatment?
Dr._Michael_Doyle	Fertility treatment may often not as strightforward as other types of medicine because sometimes the diagnosis is not certain, and often there a several reasonable choices which a patient can choose
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Dr._Michael_Doyle	Unexplained infertiltiy for example. Can be treated with meds / IUI, or IVF, or less traditinoal modalities, and all may work, at different rates
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Venn32	What about maternal age issues? I"m 32, but my fsh is that of a 45 year old. What then?
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Dr._Michael_Doyle	venn, since the fsh level is generally much mnore predictive than chronological age, you need to consider treatment options for a woman in her 40's
Sandy	What is your feeling about second opinions? How long before you should consider one?
local	[332] When is Enough, Enough? When You Should Consider Stopping Treatment with Michael Doyle, M.D., (Connecticut Fertility Associates)
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Andy	Male factor is less of an issue with age, right?
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Dr._Michael_Doyle	Second opinions can very helpful, and should be considered whenever you feel the need for information or support which you are not getting from your doc... i don't think a certain amouint of time needs to go by for you to know that,,, and i think when the opinion is a critical one -- like whether to use egg donation, or discontinue treatment, for example -- a second oponion might be very reasurring, so you know you got more than one assessment
Connie	Hi, am I too late?
Dr._Michael_Doyle	Andy, in general, yes, age has less of an effect on male fertility
Dr._Michael_Doyle	hi connie, no you are not too late ::smile
Lisa_Rosenthal	Hi Connie, you are most welcome and definitely not too late.
olga	how many IVF attempts do you think are reasonable before giving up? I heard success decreases after the 3rd unsuccessful attempt
Brenda	Dr. Doyle, my husband is older and we understood that there are some increased risk factors, especially with ICSI?
Lisa_Rosenthal	Ladies and gentlemen, please feel free to post your questions for Dr. Doyle. Consider pasting and copying them so that you don't have to retype them as they will scroll away when the room is busy.
Dr._Michael_Doyle	Olga, I think that depends on your age, and what happened in those cycles. e.g., if embryo quality improved with cycle changes, or worsened. In general, though, you are right that if you have not succeeded after three good tries, your chances do go down. Whether that means you should stop depends on how you feel about your alternatives like egg donation or adoption, and what your resources are.
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Lisa_Rosenthal	Welcome Stephanie, please feel free to post questions!
olga	if an IVF is not successful, do you recommend a protocol change?
Dr._Michael_Doyle	Brenda, that is correct. there are slighly increased risks with age of the male.
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Kate	Hi Dr, my doctor does not want me to continue treatment, but I want to, what do i do?
Lori_Masi AFA_Patient_Advocate	Hi stephanie and Kate! welcome!
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local	[332] When is Enough, Enough? When You Should Consider Stopping Treatment with Michael Doyle, M.D., (Connecticut Fertility Associates)
Dr._Michael_Doyle	Olga, protocol changes can make sense if you did not respond adequately to the original meds, but less so if you have elevated FSH or diminshed ovarian reserve. But it always make sense to consider changing meds-- especialy decreasing or removing lupron.
Lori_Masi AFA_Patient_Advocate	Welcome carla!
carla	thanks
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Stephanie	dr. doyle, how long before I can get an appointment?
Dr._Michael_Doyle	kate, you need to understand why the doc is suggesting you discontinue, and try to be as objective as possible.. what are the reasons?
Dr._Michael_Doyle	hi serena
Lisa_Rosenthal	Dr. Doyle, will you please post your phone number and address for folks here tonight who are interested?
serenalugo22	good evening dr doyle (c:
serenalugo22	disregard my IM i sent you
Lori_Masi AFA_Patient_Advocate	Welcome serena!
Kate	He says I'm too old and i don't respond well
Kate	I think he just cares about his numbers
Dr._Michael_Doyle	Sure Lisa, our norwalk office is 855-1200, bridgeport is 373-1200, and orange is 799-1200. website is www.CTfertility.com.
serenalugo22	thank you for the welcome.....
Dr._Michael_Doyle	Kate, how many follicles do you produce?
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olga	is the maximum response for IVF limited by the number of antral follicles? I seem to only have about 6 antrals, and that is how many egg I got on my IVF with long lupron. Would I have more eggs without lupron?
serenalugo22	welcome Jessie
Lori_Masi AFA_Patient_Advocate	Welcome Jessie!
serenalugo22	i never had a lot of follicles or eggies
Dr._Michael_Doyle	probably, another way to predict your "ovarian reserve" is with your baseline FSH and a Clomid Challenge Test.
serenalugo22	it is quality not necessarily the quantity correct dr. doyle?
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Dr._Michael_Doyle	That's what I meant, about second opinions... giving up based on one doctor's opinion (especially if you don't try) might not always be the best approach, even if you end up following the origiinal advice
olga	I heard that IVF and/or ICSI are more likely to result in girl babies--is that true?
Lisa_Rosenthal	Dr. Doyle, thank you so much for your time and knowledge here this evening. This is a particularly difficult and sensitive subject, I appreciate your taking it on!!
Dr._Michael_Doyle	serena, yes absolutely, egg and embryo quality are the most important factors
Dr._Michael_Doyle	olga, not really true, olga, pretty much 50/50
olga	I almost gave up based on one doctor's opinion, but changed doctor's and had success on my first IVF. Thinking of trying for a second, but have limited resources, that's why I am interested in this discussion
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Diane	Hi Lisa and Dr. Doyle
serenalugo22	with my one ivf i only had 4 retrieved; all 4 fertilized and i got my daughter out of it; my son we got 5 retrieved; all 5 fertilized and got my son....i have seen women end up with only 1 and get pg
serenalugo22	welcome diane
Lisa_Rosenthal	Hi Diane, good to see you again!!
olga	so, quality may be more important than quantity--only had 2 embryos available and transferred--so don't give up, ladies
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._Michael_Doyle	none of us can predict the future, and your story is common ... BUT we hopefully try our best to give realistic expectations. Still there are lots of people who have your experience. Wellness and balance are important. And you have to believe in your treatment.
Lisa_Rosenthal	Olga, there is more and more data and research about the success of single embryo transfer and how successful that can be and of course, it cuts down on the complications of multiples.
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
Dr._Michael_Doyle	Absolutely.
olga	thanks you, Lisa and Dr. Doyle
Diane	Doctor, who is a good candidate for single embryo transfer? I realize that this is sort of the opposite of the topic! LOL
Lisa_Rosenthal	Great question, Diane!
Lisa_Rosenthal	Your welcome Olga...
Dr._Michael_Doyle	Hi Diane, Patients who don't want or can't have twins for whatever reason are ideal candidtates. For medical or persnal reasons. As long as embryo quality is good, preferably using day 5 blastocyst transfer.
Kate	If I am paying, don't i get to decide how many embryos' to transfer and when I should stop treatment?
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Dr._Michael_Doyle	Of course regardless of who is paying or not paying, everything is eventually your choice. But if you have the right doctor-patient relationship you hopefuly feel that your doctor has partnered with you to make the choice that is right for you.
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Kate	I think it's time to move on with doctors. Can you post your information again? Also, how long to get an appointment?
serenalugo22	i agree with dr doyle; i have always trusted his judgement and he got me pregnant 3 times...so 100% success rate for IVF for me and one surrogacy i did
Dr._Michael_Doyle	We have to follow some medical and ethical guidelines, and would have to agree that a menopausal women, for example shoudl not take fetiltiy injections, regardless of wheher she wants to or can pay
Libby	What about that 56 year old who carried twins in New Jersey?
olga	if a woman is in menopause, then how can she get pregnant? Would fertility drugs do anything for her? I didn't know that was possible
Dr._Michael_Doyle	appointments are available within a few weeks .... norwalk 855-1200, bridgeport 373-1200, orange 373-1200 ... www. CTfertility.com
serenalugo22	that is 203 area code...btw
olga	if my FSH is elevated sometimes (sometimes not), does that mean that I am getting close to menopause?
Dr._Michael_Doyle	hi libby, a truly menopausal woman will not make eggs, but can become pregnant by carrying the embryos that arise from an other woman's eggs (i.e., by being a gestational carrier (previously called a surrogate)
Dr._Michael_Doyle	olga, fluctuating fhs levels do suggest perimenopause, but not necessaily time to give up !!!
Dr._Michael_Doyle	perimenopasue can last 5-10 years
Dr._Michael_Doyle	olga, how elevated?
olga	I hope 10 years, since my FSH first shot up at 39!
olga	27 was the highest, 4 the lowest over the last 1 1/2 years
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Dr._Michael_Doyle	that is concerning, have you done a clomid challenge test or any stimulation?
olga	could it be fluctuating so much because of having taken fertility drugs the cycle before it shot up?
Dr._Michael_Doyle	those are the kinds of predictors which can help guide your decision
olga	or because of stress?
Dr._Michael_Doyle	genreally the treamtent you receive should not affect the next baseline
olga	I was a low responder to stims, but did get pregnant on my first IVF after 2 high FSH readings
Dr._Michael_Doyle	good for you ::smile
olga	My FSH was only 6 on my successful cycle though
Dr._Michael_Doyle	even better
serenalugo22	that is awesome olga; congrats
Jessie	Hi Doc, what about situations where you and your spouse disagree, any suggestions?
olga	thank you serena--I surprised both myself and my doctors
Lisa_Rosenthal	Jessie, not a bad time to get some mental health counseling! It's hard when you are not on the same page as your spouse, but not at all unusual.
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serenalugo22	infertility is such a tough thing to go through; both emotionally and physically....
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. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
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serenalugo22	welcome Kari
Kari	Hi, is it too late to ask a question
Lori_Masi AFA_Patient_Advocate	Kari ask away!
Dr._Michael_Doyle	that's very common jessie welcome to marriage, right? like any conflict, i think it requires listening and compromising, and deciding the pros and cons of treating and not treating.. unfortunately sometimes there is not enough time to really decide lesiurely, if age is a medical issue... counseling can really help, both from your MD (hopefully) or other professionals, and from groups like AFA
Lisa_Rosenthal	Hi Kari, thanks for joining us, please ask away!
serenalugo22	Jessie, if i may pipe in.... one thing you might do is sit your hubby down and ask what his true concerns are and why.... it might be misinformation or his concern for your health that is pushing him one way
Lisa_Rosenthal	Ladies and gentlemen, thank you so much for joining us this evening! We are lucky enough to get wonderful speakers like Dr. Doyle because I promise to get them off at 9 sharp. That leaves us about ten minutes. Dr. Doyle, please post your contact information again!
Dr._Michael_Doyle	jessie, men often see fertility and childbearing in general in very different terms,,,, you have to explain how importnat it might be to you, and why .. don't assume it's obvious... lots of men feel they could be happy with or without children -- "whatever is meant to be" -- and it hurts them to see their partner suffer
Dr._Michael_Doyle	so all this fertility stuff can actually be very intimidating
serenalugo22	dr doyle; linda says hi (i am in instant messaging with her right now)
Dr._Michael_Doyle	Lisa, the best way to contact me is via our website, www.CTfertility.com -- or by calling the numbers on the website
Connie	dr,how does PCOS factor in this????
Lisa_Rosenthal	Thanks Dr. Doyle...
Dr._Michael_Doyle	PCOS is a hormonal imbalance which can interfere with ovulation, affect the quality of the eggs, or even interfere with implantation
Dr._Michael_Doyle	Once it is diagnosed though, it is hghly treatable !!
Connie	and how does that factor in with the issue of stopping treatment? donor?
Dr._Michael_Doyle	Patient with severe PCOS,,,, with no response to all the fertility meds including Metformin, and failed IVF, might consider egg donation -- but this is not very often necessary, unbless there are other factors as well, including age
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Lori_Masi_AFA Patient_Advocate	Dr Doyle Thank you for all of the insight and sensitivity in this subject matter! We all really appreciate it!
Lisa_Rosenthal	nyiap, thanks for joining us this evening!!
Dr._Michael_Doyle	Thank you for having me
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Lisa_Rosenthal	Dr. Doyle, you were just wonderful this evening!!! Thank you for joining us, will you do it again sometime???
Dr._Michael_Doyle	absolutely ::smile
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. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
serenalugo22	hey guys, he is wonderful ALL the time. i have known him for 6 years and have never seen him different
Dr._Michael_Doyle	::wub
olga	ty too, lisa and lori, for hosting these informative chats
Dr._Michael_Doyle	good night everyone, if there are any more questions, email me.
Lori_Masi AFA_Patient_Advocate	Good Night Dr Doyle and thank you! Good Night Everyone and thank you for joining Lisa and I
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serenalugo22	have a wonderful evening dr doyle
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Lisa_Rosenthal	Good night!!!
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Lisa_Rosenthal	Serena, email me at lisa@theafa.org
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serenalugo22	got it....
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. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
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serenalugo22	have a good evening all...now i am going to check out the website.....buhbye
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Lisa_Rosenthal	Good night!!!
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When is Enough, Enough? When You Should Consider Stopping Treatment

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