Which Treatment is Right for You

December 8, 2004 - Wednesday
2:26 PM to 3:26 PM (EST)
Guest Speakers: Medical Director for L.A. Sher Institutes for Reproductive Medicines

Categories
Acupuncture • Donor Egg • Infertility • IUI • IVF • Male Factor • PCOS • Pregnancy

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katz	Ready for questions yet? I had 2 Estrogen-only Mock cycles and my lining was only "faintly trilaminer" both times. All of the suggestions I have received for improving it focus on increasing blood flow. But no one actually measured the blood flow. How do we know if increasing the blood flow is the right approach to improve/increase the triple stripe? And what would be the protocol that you would recommend? I am 41 but will be using donor eggs. Thanks.
chrissy	I have been ttc 2 years, am 33, tried clomid and letrozole and 1 IUI, on glucophage also, now i am on b/c trying to get rid of cyst, we have follistim ready to start inj., and wonder if we should go straight to IVF or is it worth giving IUI a few more chances? thanks
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katz	p.s. Lining was 8 mm both times.
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jeannie2375	I've been ttc for 19 months, #1, have "unexplained infertility", mainly very mild PCOS possibly, poor cm, ovulate most months, not all, corrected by Clomid. I've been on Clomid for 5 cycles (1 rest cycle in the middle), w/last 2 cycles having a trigger shot. I've had 2 IUIs, and am now on BCP, preparing for IVF#1 in January. I'm 29. Am wondering if we're jumping the gun w/ IVF? Main reason is possible loss of insurance, which covers 90% of infertility treatment....
jeannie2375	Was very responsive to Clomid & trigger, husband had great S/A
Dr_Brian_Acacio	Katz, There are several approaches to help enhance the lining of the uterus. These have included the use of terbutaline, acupuncture and miedcations such as viagra suppositories. At our institution, we prefer viagra. In our experince we have had great success with viagra in women who previously had linings less than 8 mm. Uterine blood flow directly contributes to the thickness of the lining. Some of my colleagues in fact do doppler flow studies on the uterine blood flow to evaluate the lining. However, Measuring the lining itself is an indirect way of measuring the blood flow as well. In addition to viagra, we also used estradiol valerate injections, twice a week. I hope this helps.
merlin210	Type here
katz	I was using Estrogen troches from Freedom pharm + patches. The injections are better? Would you recommend the terbutaline or just start with Viagra? Thanks
Dr_Brian_Acacio	Chrissy, the general recommendation is to try 3-6 cycles of IUi before proceeding to IVF. The one thing I do tell my patients, however, is that IVF does have a higher chance for success than IUI. On the other hand, IVF is more expensive and invasive.
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Robin	Is glucophage ever a help if you're not IR and don't have elevated androgens? I don't know if I have PCOS, but my doctor did think my baseline u/s looked like my ovaries were polycystic. My androgens were normal, and my insulin low. I develop OHSS very easily, though (last IVF on 150 IU).
Robin	p.s. I'm meeting w/ you next month
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Dr_Brian_Acacio	Jeannie2375, As I mentioned in the previous post, the general recommendation is 3-6 cycles of insemintation before proceeding to IVF. The one draw back of clomid is that prolonged use can lead to thinning of the uterine lining. Your RE should be checking your lining every month to make sure this does not happen. I do not think you're jumping the gun with ivf. After your experience, I think it is a reasonable way to go.
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Nic	Does injecting Ovidrel (250 mcg) always induce ovulation? If the treatment does not end with pregnancy, does the MC come exactly 2 weeks after the injection?
mmb	I am 29, hubby is 31. We have severe male factor, have been ttc for 3 years, on our 4th IUI, last two with Repronex. Last month on 75 IU qd had 1 egg. This month on 75IU bid have 5 - 16,15,14,12,12. Today MD says ?endometriosis also. (that's a new dx, based on the fact that my uterus is tipped backwards and to the side?) We have 100% coverage for IUI/meds....no coverage for IVF. Any suggestions to improve here? Would you consider donor sperm at this point? Thank you in advance
jeannie2375	My endo lining has been average 8.5 mm
laurajones	I have a question.
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Lisa_Rosenthal	Welcome to everyone. I'm sorry that I'm late. Please feel free to ask questions...
laurajones	I am 34, and with no observable problems. I've been tested for everything and my doctor says I look fine. However, I have had 6 inseminations without medicine utilizing donor sperm and no pregnancy.
laurajones	This last cycle I tried injectable hormones. Made 8 eggs - 3 of which ovulated - still no pregnancy.
cyn	Hello and thank you. I am 42 and I had a cycle canceled last month because I developed a cyst during the 21 days of BC right before I was to start antegon. Are there any other protocols that do not use birthcontrol prior to stims that would be appropriate for a woman over 40? I have had cysts removed in the past as well as fibroids. My FSH and estrodol levels have been normal for the past 6 months.
local	[332] Which Treatment is Right for You?- Brian Acacio, M.D., ( Sher Institutes for Reproductive Medicine)
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katz	how long of a trial of acupuncture (# of sessions or # of months) to improve lining? Would you recommend terbutaline or start with Viagra only? (Goes back to my earlier question) thank you. That's all my questions!
laurajones	Just wondering why that could be - that everything medically is fine but no pregnancy.
Lisa_Rosenthal	Dr. Acacio, thanks for joining us this evening!
Dr_Brian_Acacio	Robin, up until 2003, RE's use to insist on demonstrating insulin resistance before placing their PCO patients on glucophage. The problem is that most of the tests we have to detect Insulin resistance miss a lot of patients who may have insulin resistance. If patients demonstrate at least two of the following three criteria ( polycycstic ovaries on ultrasound, anovulation or androgen excess) should be on glucophage.
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Robin	I ovulate on my own (but about 35 day cycles) and androgens are low...so pco and tendency towards OHSS don't necessitate glucophage? I'm not keen to take additional meds if not necessary, and am switching doctors soon, any anyway.
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Lisa_Rosenthal	Hi ladies and gentlemen, please feel free to post quesitons for Dr. Acacio, just keep in mind that this session is quite full. Cut and paste your questions as you may have to repost them....
laurajones	Did you get my question?
localhost	[2009] touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. Brian Acacio, (Sher Institutes for Reproductive Medicine )joining us this evening. We will be discussing the topic "Which Treatment is Right for You?". Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
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.
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Lisa_Rosenthal	Please remember that Dr. Acacio is just one person who is answering many questions. Feel free to repost if you do not get an answer.
mmb	Lisa...I'm sorry, but could be my computer. Did the doctor leave?
mib	Why is IVF an advantage over IUI? I have had 3 IUI's. 1pg then mc. I have unexplained infertility. My RE is suggesting another IUI. He doesn't believe doing IVF would give my any better chance than IUI..Your thoughts
Lisa_Rosenthal	mmb, I have the sinking feeling that Dr. Acacio has been thrown off the session. I'm sure he will be right back.
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Lisa_Rosenthal	mib, the doctor is not here right now, but what is your diagnosis? I would imagine that he will need that information.
mmb	smiles Not a problem at all...just wanted to make sure it wasn't my computer.
localhost	[2009] touser Please feel free to post questions for Dr. Acacio. 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.
Lisa_Rosenthal	Where did everyone hear of the session this evening?
mib	I am unexplained. No tube problems, no MF, I stim well..first IUI I got PG. Then mc at 8 weeks.
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mib	Boards
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Robin	email
katz	email
jeannie2375	I have same diag as MIB, but have not gotten pg. yet
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mmb	I got an enmail...and am very glad you have these sessions....a new voice/opinion is welcomed after trying so long
Lisa_Rosenthal	thanks for the answer, to all of you!
jeannie2375	email
llc	email
Lisa_Rosenthal	mib, IVF can also be diagnostic, in terms of seeing how eggs fertilize, then sometimes the problem can be pinned down to implantation.
Lyndibugg	message board
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katz	...guess I'll go. thanks.
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cyn	email
Lisa_Rosenthal	Dr. Acacio is trying very hard to rejoin the room, please be patient
chrissy	email
mib	My RE may believe I don't have either issue since I got PG on the first IUI....just was wondering about the advantages...of IVF over IUI..
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Nic	Dr. Acacio, does injecting Ovidrel (250 mcg) always induce ovulation? If the treatment does not end with pregnancy, does the MC come exactly 2 weeks after the injection? My wife felt several sting pains in the lower belly in the weeks after injecting Ovidrel. Is this normal?
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Lisa_Rosenthal	Please repost questions for Dr. Acacio as he is back with us.
mmb	Sorry about the disconnect, doctor...my question is as follows: I'm 29, hubby 31. Severe male factor (poor count, motility and morphology) ttc 3 years, 4 IUIs, last 2 w/Repronex 75IU. Last month on 75 IU qd had 1 follicle. This month on 75IU bid, have 5- 16,15,14,12,12. Today by u/s MD is questioning endometriosis also, due to tipped backwards/to the side. We have 100% cov'g for IUI/meds, no cov'g for IVF. Any other suggestions? Donor sperm? Thank you!
cyn	Hello and thank you. I am 42 and I had a cycle canceled last month because I developed a cyst during the 21 days of BC pills right before I wa to start antegon. Are there any other protocols that do not use BC pills prior to stims that would be appropriate for a woman over 40? Is suppression really necessary or can you start stims on day 2 or 3 of your menstrual cycle? I have had cysts removed in the past as well as fibroids. My FSH and estrogen levels have been normal for past 6 months.
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".
reena	Dr. Acadio, are there any disadvantages to trying ICSI? We are unexplained, preparing for our first IVF, and my RE has suggested ICSi for at least 1/2 of the eggs retrieved.
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jeannie2375	reena, from parentsplace?
reena	yes jeannie
Dr_Acacio	mmb, the chances of success with IUI is highly dependant on the sperm count and morphology. in genral if the counts are below 5 million or the krueger morphology is less than 4%, the chances for pregnancy are very low ( less than 5%). I fthis is true for your husband and if IVF is out of the question, then donor sperm is the way to go.
jeannie2375	:o)
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grebena	Dr. Acacio--I am 45 years young / husband is 46 and we are blessed to have a 2 1/2 year old son (after 3 IVF, and 3 IUI--we conceived with the last IUI)--Diagnosis-Unexplained infertility. We have tried 6 more IUI 's since our first and we got pregnant and mc at eight weeks this past Feb. --Should we keep trying ourselves or should donor egg/adoption be the direction we turn to?
jeannie2375	Is it true that most 1st IVF cycles are unsuccessful? If so, why?
Dr_Acacio	Cyn, you can have a natural cycle start and use antagon earlier in the cycle to prevent the dominant follicle syndrome
Dr_Acacio	Reena, we perfomr 100% ICSI on all our IVF patients. When ICSI first introduced, tehre were some concern about it causing chromosomal problems in embryos. More recent studies have shown this not to be true. Using conventional IVF without ICSI has to potential risk that not all your eggs would fertilize
mib	Why is IVF an advantage (if it is) over IUI? I have had 3 IUIs. Got pg on the first IUI, mc at 8 weeks. My RE is suggesting another IUI as he doesn't feel IVF would give me any better chances. I am unexplained infertility...no tube problems, no MF..Your Thoughts.
irishslp	Dr. Acacio, my RE has not prescribed meds. for either of my IUI's because she doesn't want to overstimulate. What are the risks of overstimulating.
nat	Hello Doctor, how many embryos do you recommend to transfer for a 40 y.o woman? I have recently done one IVF (ended in possible ectopic). Thank you.
Dr_Acacio	Grebena, At 45 your chances of pregnancy with IUI or IVF using your own eggs is less than 5%. I you do get pregnant, you have an over 50% chance of miscarriage.
cyn	Exactly how would that go. After a natural cycle start what day would I start the antegon and are BC pills eliminated from the process? How does antegon prevent early follicle syndrome?
Dr_Acacio	jEANNIE2375, tHE SUCESS RATE IN IVF is highly dependant on the clinic. Most good clinics have a 40-50% sucess rate with the first IVF
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laurajones	I am a 34 year old woman with no known medical problems. Doctor has tested for everything and says everything is fine. However, I have had 6 IUI w/o medication and no pregnancies. This last cycle, we used injectable hormones. I made 8 eggs - 3 ovulated. Still no pregnancy. I am using donor sperm. Any thoughts about why I still might not be getting pregnant?
jeannie2375	Does the success rate increase w/age and diagnosis? I'm 29, unexplained, husband has great s/a
localhost	[2009] touser Please feel free to post questions for Dr. Acacio. 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.
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localhost	[2009] touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. Brian Acacio, (Sher Institutes for Reproductive Medicine )joining us this evening. We will be discussing the topic "Which Treatment is Right for You?". Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
Dr_Acacio	MIB, the chances for pregnancy with IUi is 10-20%. With IVF it is around 50%.
grebena	Dr. Acacio--How are my chances carrying a donor egg/husband's sperm full term at 45?
Lisa_Rosenthal	Dr. Acacio, thank you so much for joining us this evening. We really appreciate your help and advice.
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cyn	Can ICSI cause damage to the outer shell of the egg?
mib	Why are the chances for pregnancy greater with IVF, if an egg is going to fertilize and implant wouldn't it happen either way?
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_Acacio	irishslp, if you received too much medication you could develope a condition called ovarian hyperstimulation syndrome where you retain fluid and in worse case scenario, could get very sick. The chancesnof this are very small.
jeannie2375	Is there anything a woman can do, after egg transfer, to increase chances of implantation? diet? bed rest? progesterone? etc.?
Dr_Acacio	Nat, deciding how many embryos to transfer depends highly on the quality of the embryos. In general, we transfer 3-4 in a 40 year old
mmb	Keeping in mind our MF (last IUI had less then 1 million post-wash sperm) - should we try or not try naturally before IUI? Last "attempt" was yesterday....trigger Hcg is tomorrow evening between 4-8pm, with IUI Saturday am @ 10. I want to make sure timing is good, and don't want to risk decreasing count more than it is?
emma	have pcos. 2 mc. 10 wks & 21 wks. preg w. gonal-f, hcg & IUI both times. Babies went through every test known. no chromo problems w. babies. only prob w. me MTHFR homo. was on 5 mg fa & 81 mg BA both preg. Am petrified to m.c again. But so badly want to try again. Am 37. Does it make sense to start off slowly w. clomid (hyperstimmed badly w. both pregs) or go straight back to gonal-f??
Dr_Acacio	Cyn, it lasts for 10-14 days. Antagon prevents your pituitary gland from produxing LH and FSH which could cause your ovary to produce a dominant follicle
Lisa_Rosenthal	jeannie- part of the non-medical answer to that question is to make sure that you do things that you are comfortable with. If your physician says that something is OK, but you don't feel comfortable doing it or will blame yourself if the cycle doesn't work out, than you need to make some decisions as well.
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mella	I am 38 soon to be 39. first IVF BFN second BFP but ended in m/c. In your opinion should I go right to IVF #3 or try IUI's.
jeannie2375	Thank you Lisa.
irishslp	Thank you. Does it increase chances of pregnancy? I am 42 and my husband is 48. All of our bloodwork is good. Any suggestions? Could IVF be more successful?
Lisa_Rosenthal	Jeannie, you're welcome
Nic	I'm reposting my question: Does injecting Ovidrel (250 mcg) always induce ovulation? If the treatment does not end with pregnancy, does the MC come exactly 2 weeks after the injection? My wife felt several sting pains in the lower belly in the weeks after injecting Ovidrel. Is this normal? 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".
grebena	Dr. Acacio--Are there any long term effects (taking 8 vials total --4-gonal f/75 IU and 4-repronex 75IU-) for 2 years? thanks
Lisa_Rosenthal	Nic, thanks for your patience. It's a busy session, with complex questions.
Dr_Acacio	laurajones, you might waqnt to condiser testing for immune issues. Also laparocopsy to evulate endometriosis should be considered
laurajones	What are immune issues?
Dr_Acacio	Jeannie 2375, the success rate is higher in women less than 35 and those with tubal factor infertility
sunita80	Hi, I.m 36 and got pregnant with IUI this February; Unfortunately the baby suffered fetal demise at 36 weeks gestation. I am thinking about trying IUI again, but is it too soon? I have had two regular menses after the fetal demise, and all the testing are normal.
cyn	Thank you doctor but I am still unclear on which day I would start the antegon. On day 3 of the natural cycle?
Dr_Acacio	Grebena, if there are no ther issues, your chances would be 50-60% at our center. i can't speak for other IVF programs of course
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Dr_Acacio	Cyn, in unexpereinced hands, ICSI can damage the eggs. A good lab should do at least 30% ICSI to have adequate expereince
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Dr_Acacio	MIB, the reason IVF has a higher chance for success is that the infertiliy may be due to the interaction between the egg and the sperm. with IVF and ICSI, this is overcome
Lisa_Rosenthal	sunita, I am so sorry for your loss, aside from your medical issues, are you ready emotionally?
emma	My ? was skipped. Was it too complex or detailed?
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Lisa_Rosenthal	emma, please save your questions so that you can repost them. Questions do scroll away.
mib	Thank you. Since I got pg the first IUI, I think my RE doesn't believe there are any issues between the egg and sperm...your thoughts, have you seen otherwise in your practice?
Dr_Acacio	Jeannie 2375, we have our patients one bed rest for 24 ours after the transfer, and just relaxing around the house for 48 horus after that
sunita80	Thank you Lisa. I think I am emotionally ready to try again.
localhost	[2009] touser Welcome to The American Fertility Association's online educational session. We are pleased to have Dr. Brian Acacio, (Sher Institutes for Reproductive Medicine )joining us this evening. We will be discussing the topic "Which Treatment is Right for You?". Thanks for joining us this evening! Lisa Rosenthal, Educational Coordinator for The AFA.
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localhost	[2009] touser Please feel free to post questions for Dr. Acacio. 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.
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Dr_Acacio	MMB, with low sperm count ( less than 5 million) the only treatment that will give you a realistic chance for success is IVF with ICSI. It's possible that the sperm counts may come up on the day of insemination so I would go ahead with it
emma	2 m.c w. unkown explaination. 37 years old. PCOS, 1 tube, homo for MTHFR. both preg on IUI w. gonal f & HCG, 5 mg FA & 81 mg BA. Petrified to try again. Want to stat slowly, but is Clomid too much of a wait? Or should I go straight to IUI, or even IBV w. PGD?
Lisa_Rosenthal	Dr. Acacio, thank you so much for your time and attention this evening. We all really appreciate it.
emma	PS mc @ 10 wks $ 21 wks
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jeannie2375	Thank you Doctor, you've been very helpful.
dh_princess3	Dr. Acacio I have PCOS no other medical problem. I'm on letrozole have you had any good sucess with it. I can't find a lot about it on the internet. Thank you for your time
Dr_Acacio	Emma, recnet studies have shown that women with PCO have fewer miscarriages if they take metformin in the first trimetseter. Also, homozygous patients for MTHFR should be on @ mg of vitamin B 12 and 25 mg of vitamine B6 in addition to folic acid
Lisa_Rosenthal	Ladies and Gentlemen, we have another 10 minutes left with Dr. Acacio. Keep in mind that we have physician moderated message boards that you are welcome to use as often as you like.
ck3642	I have not made it to retrieval twice due to poor follicle growth using repronex and follistim. In January we will try low dose Lupron with the follistim and repronex. I am 40 years old with FSH levels between 9-18. What are your thoughts on this?
Dr_Acacio	Mella I would wait a month before the third cycle to let your system reset
sunita80	I was really suprised when I became pregnant after the first attempt at IUI. I was intending to try invitro but i did not develop sufficient amout of eggs for retrieval after using repronex and gonal F;am so afraid to go through the process again.
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emma	Thank you. But my insulin is fine. So still metformin? I'm 105lbs.
Dr_Acacio	irishslp, the chances of success ina 42 year old with IVF is around 20%, but it's still higher than IUi
cyn	Lisa, What does MTHFR stand for?
mmb	Doctor....can endometriosis be diagnosed with just one ultrasound of uterine position? Only other question asked of me was whether I cramp with periods. Weighing options, am wondering if this is going to be yet another obstacle? Seems like there should be more testing before diagnosis is made?
irishslp	So, it sounds as if IVF is the way to go. Thank you for you time.
dclarke	is there ever a way to unblock a tube that was clamped?
Dr_Acacio	Nic, in women who are overweight (BMI > 30) or have PCO, 250 ug of ovridel may not induce ovulation . If no pregnancy occurs, the MC usually comes a week later but can be delayed up to one to two months.
Dr_Acacio	Grebena,
Lisa_Rosenthal	cyn, I have NO idea. Dr. Acacio??????
ellerw	Dr. Acacio- have you had any instances where you have ICSI'd an egg twice.? I had a tranfer in October, 3 eggs, 2 were icsi'd twice, l got pregnant, but, MC'd @ 7 weeks. Am 44, (4th IVF, 3rd MC)
mib	Thank you Dr. Since I got pg on my first IUI (BFN on next 2) I don't think my RE believes there are issues with the sperm and egg interaction...your thoughts? Should I try IVF?
irishslp	Dr., my last two months were of a light pink bleeding. Should i be concerned about this? This last month was very different than in the recent past. I guess i am concerned about a chemical pregnancy. I had one last january. Any thoughts?
Dr_Acacio	Grabena, t\no studies have shown any harmgul effects of prolonged use of gonal f or repronex, two studies in the early 90's showed a weak assoication between clomid and a type ovarian umors called LMP's but these studies have been discredited.
emma	methylenetetrahydrofolate reductase
emma	Metroformin w. pco even tho fasting insulin good? am 105 lbs. 5'3".
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Lisa_Rosenthal	Ladies and Gentlemen, thank you so much for joining us this evening. Please check our schedule for the coming weeks....
Dr_Acacio	laurajones, some women have an elevation in natrual killer cell activity in the blood. some studies suggest that women who have this condition may benefit from IVIG therapy
Lisa_Rosenthal	Dr. Acacio, thank you so much for joining us this evening. We appreciate all your help and advice...
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_Acacio	Sunita80. I would wait 3 months before trying again. I'm veryn sorry for your loss
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Dr_Acacio	cyn, start atagon at a lower dose 125 ug in stead of 250 0
Dr_Acacio	Cyn, you start the antagon on cycle day 2 along with the stims
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cyn	Thank you so much Dr. Acacio
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Dr_Acacio	emma, I would need a lot more information to give you an accurate answer. Feel free to call me 818-291-1985 and set up a free consultiaon with me or my assoicate Dr Nouriani
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sunita80	Thank you
emma	i will thank you very much for your time
Dr_Acacio	We've used letrazolein PCO. We've had some pregnancies with it
Lisa_Rosenthal	Dr. Acacio, thanks again for joining us this evening. Have a wonderful holiday season.
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nat	Thank you!!!
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Dr_Acacio	ck3642, you need to to be on a poor responder protocol. We use something called the agonist antagonist conversion protocol ( a combination of lupron and antagon which minimizes androgen levels and improves egg quality.
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ck3642	I will have to ask my RE about this, Thanks!
Dr_Acacio	sunita 80, you may need a higher dose of Gonal F
Dr_Acacio	Emma, if you PCo, you shoud try metformin even if the insulin level is OK. Some women with normal insulin levels still have insulin resistance
Dr_Acacio	cyn methionyltetrahydragfolate reductase. How's that for a mouthful? it's the enzyme necessary for making folic acid
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Dr_Acacio	mmb, the only way to diagnose endometriosis is by laparoscopy. However, you can sometimes detect cysts called endometriomas which sometimes are associated with endometrisosis
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mmb	That's what I thought...thank you for confirming it
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cyn	Lisa how can I get a copy of the transcript
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Dr_Acacio	Thank you all. I'm sorry I couldn't respond to all your questions. Please feel free to email me at losangeles@haveababy.com or my partner at moryn@sherinstitute.com for any other questions
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Lisa_Rosenthal	the transcripts are under the old online session schedule...
Lisa_Rosenthal	it takes a few days to get a new transcript up, but that is where they are residing.
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