Why Choose High Tech-IVF; ICSI; PGD

July 6, 2005 - Wednesday
1:58 PM to 2:58 PM (EST)
Guest Speakers: Pasquale Patrizio, MD, M.Be, H.C.L.D., Professor OB/GYN and Director of Yale Fertility Center

Categories
Donor Egg • IVF • PGD

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Lori_Masi AFA_Patient_Advocate	Hi Danielle Welcome!
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Danielle	Thanks glad to be back1
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Lori_Masi AFA_Patient_Advocate	Hello Dr Patrizio - Welcome!
Lori_Masi AFA_Patient_Advocate	Dr. Patrizio - We appreciate your time and generosity of spirit in participating this evening!
Dr._Patrizio	Hi Lori
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Lori_Masi AFA_Patient_Advocate	DR we are ready to begin whenever you are - h owever Lisa and some AFA members have been calling me about having trouble logging on - but hopefully Lisa will join us soon -- but in the meantime I am ready when you are!
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Lori_Masi AFA_Patient_Advocate	Hi Heather and Rita Welcome!
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Rita	Thank you.
Dr._Patrizio	OK- We can start.
Rita522	I have heard that some programs are using PGD to increase IVF Success rates. What do you think about that?
Lori_Masi AFA_Patient_Advocate	We are very fortunate tonight to have Pasquale Patrizio, M.D., M.Be, H.C.L.D., (Professor OB/GYN and Director of Yale Fertility Center) with us!
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Lori_Masi AFA_Patient_Advocate	Hi Vicky welcome!
Dr._Patrizio	Dear Rita, This is true but PGD has precise indications and is not used in every case of IVF
heather	can it be used to increase success rates?
Lori_Masi AFA_Patient_Advocate	We are very fortunate tonight to have with us Pasquale Patrizio, M.D., M.Be, H.C.L.D., (Professor OB/GYN and Director of Yale Fertility Center)
Vicky	What about egg quality? Can you explain how to know if you have good eggs. i really don't understand it
Dr._Patrizio	Heather, the increase in success rate can be seen if PGD is used in couples with multiple failure to achieve a pregnancy after IVF, Recurrent pregnancy losses, and known carriers of chromosomal or genetic problems.
Danielle	Is it true that you are better off doing IVF than IUI because you can see the quality of your eggs?
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Lori_Masi AFA_Patient_Advocate	Hi Kevin Welcome! We have Dr Pasquale Patrizio with us tonight!
Kevin	It has been suggested that we use icsi, and I concerned about the health of our children, can you comment on this?
Dr._Patrizio	Vicky, the assessment of egg quality as is currently done is not perfect- there are many possible factors within the egg that should be properly assessed before a fianl comment can be given, Then we assess the embryo and how it develops, to gather other indirect info about egg+sperm. PGD is helping in understanding more.
Dr._Patrizio	Danielle- this is true, but mot only the quality of the gg, but also the quality of the embryo(s)
Rita522	how do the doctors access egg quality? I head about a day three FSH test. And a lot of women talk about certain numbers. What is a good number?
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Lori_Masi AFA_Patient_Advocate	Hi Nadine, Slin and Quinn Welcome!
Quinn	is the doctor here?
Quinn	can we just post questions?
Lori_Masi AFA_Patient_Advocate	We are very fortunate tonight to have with us Pasquale Patrizio, M.D., M.Be, H.C.L.D., (Professor OB/GYN and Director of Yale Fertility Center)
Lori_Masi AFA_Patient_Advocate	Quinn Yes Dr Patrizio is here - please post your questions!
Dr._Patrizio	Kevin, the ICSI children have a slight increase in the incidence of congenital anomalies (3.5%) versus 2.2% in non ICSI babies- and a slight increase in the incidence of chromosomal anomalies, about 2% compared to non ICSI babies. It is thought that this slight increase is in relationship with the reasons for the low sperm counts in the first place.
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Kevin	Thank you Doctor. I was thinking that it might be safer to use donor sperm, but my wife wants to try this
Kevin	I just want a healthy baby
Danielle	If I'm underestanding all this correctly IVF also helps to hold down on multiples?
Kevin	and i am not sure about her taking fertility medications
Lori_Masi AFA_Patient_Advocate	Hi CTB welcome!
Dr._Patrizio	Rita 522, the day 3 FSH is a test (to do together with Estradiol) to check whether the ovaries are still capable to produce eggs (i.e. is a quantitative assessment), but does not tell us a thing about egg quality.
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Lori_Masi AFA_Patient_Advocate	Welcome Ramya and Jenn!
JenniferL	Hi Lori
ramya_fruitful	Hi Lori
ctb	thanks! question for Dr. Patrizio, I understand that success rates with ICSI may be actually slightly less than without. We have a borderline morphology issue and two failed donor egg cycles with ICSI.
Lori_Masi AFA_Patient_Advocate	Hi Jenn and Ramya!
ctb	I am wondering if should let nature take over and select the best sperm this time.
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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
Lori_Masi AFA_Patient_Advocate	HI Lisa WELCOME!!
Dr._Patrizio	Kevin, I do not know the details of your case (you can let me know more if you wish) calling me or sending a fax (tel. 203 785 4708-fax 203 764 5619).
Lori_Masi AFA_Patient_Advocate	Dr Patrizio when you get a breath please post your program and contact info for everyone!
Lisa_Rosenthal	Good evening everyone. Thank you Lori, so much, for moderating. I had trouble with my internet service.
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Lori_Masi AFA_Patient_Advocate	Lisa I told everyone you would find a way on....
Lisa_Rosenthal	Thanks for the faith, Lori! I appreciate it.
Lori_Masi AFA_Patient_Advocate	Welcome Miacomet!
Dr._Patrizio	CTB, I would not be able to answer without your complete history. However ICSI-with borderline morphology if is the only problem-should be able to help you.
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Kevin	Do you recommend any sperm banks over any others?
Jenna	Hi Lisa, Lori and Doctor, I'm not too late, am I?
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Dr._Patrizio	Address info.
Lori_Masi AFA_Patient_Advocate	Hi jenna welcome! We are very fortunate tonight to have with us Pasquale Patrizio, M.D., M.Be, H.C.L.D., (Professor OB/GYN and Director of Yale Fertility Center)
Lisa_Rosenthal	Yola and Jenna, welcome, thanks for joining us this evening. You are definitely not too late.
Dr._Patrizio	Pasquale Patrizio, M.D., M.Be, HCLD
Jenna	Doctor, I have never seen those credentials before, would you mind explaining what all those letters mean? LOL
Lori_Masi AFA_Patient_Advocate	DR Patrizio please post everything - program name, address and phone number for them! thanks!
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Dr._Patrizio	Pasquale Patrizio, M.D., M.Be-Director Yale Fertility Center-150 Sargent Drive-New Haven, CT 06511. Tel 203 785 4708-fax.203 764 5619
Lori_Masi AFA_Patient_Advocate	Hi outof Welcome!
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Lori_Masi AFA_Patient_Advocate	Thanks Dr P!
Lori_Masi AFA_Patient_Advocate	Welcome Ashley!
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Ashley	Thanks Lori
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Lori_Masi AFA_Patient_Advocate	Moondreams & alstee welcome!
Ashley	Is PGD good for miscarriage problems?
Lori_Masi AFA_Patient_Advocate	Special Guest: Pasquale Patrizio, M.D., M.Be, H.C.L.D., (Professor OB/GYN and Director of Yale Fertility Center) Topic: Why to Choose High Tech-IVF, ICSI, and PGD
Dr._Patrizio	HCLD stands for High Complexity Laboratory Director (meaning that I am qualified to be a lab.director as well)- MBe is the master in bioethics- our field is so full of ethical issues that I took a master to be more prepared. Thanks
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
Dr._Patrizio	Ashley-Yes
slin	Dr. Patrizio, I'm a poor responder to ovulation stimulation (4 follicles only) and my husband has borderline morphology issue (6%). After a cancelled IVF cycle because of not sufficient number of follicles (4), we talked to two IVF doctors on next cycle try. One suggested micro-dose flare-up agonist +icsi + assitant hatching and the other recommended antagonist + icsi only. How do we choose between the two ? What would you recommend us to do to make better decision ?
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Orly	Hi everyone
Lori_Masi AFA_Patient_Advocate	Hi Orly welcome!
Lori_Masi AFA_Patient_Advocate	Special Guest: Pasquale Patrizio, M.D., M.Be, H.C.L.D., (Professor OB/GYN and Director of Yale Fertility Center) Topic: Why to Choose High Tech-IVF, ICSI, and PGD
Orly	OK, not to be a dunce, but what type of ethical issues are you referring to Dr?
miacomet	When doing ivf and pgd, how many follicles and what size do you want to see at ET?
Dr._Patrizio	Slin- If you are a true poor responder, the difference in the protocols is minimal- My preference is for the microdose+ICSI
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Lori_Masi AFA_Patient_Advocate	Hi stephen Welcome! Special Guest: Pasquale Patrizio, M.D., M.Be, H.C.L.D., (Professor OB/GYN and Director of Yale Fertility Center) Topic: Why to Choose High Tech-IVF, ICSI, and PGD
Lisa_Rosenthal	Hi Stephen, thanks for joining us this evening.
Dr._Patrizio	Orly- I mean the issues of: PGD for gender selection-Disclose or not disclose donor gametes to children-When is old too old- Post-humous reproduction,etc.etc.
alstee	Hello Dr. Patrizio, I have thrombophelia, and had a laparoscopy for endometriosos. I had conceived on first IUI, then miscarried. I have had 7 more IUIs since then with one IVF in the middle somewhere. We start off cycles with intention of IVF then wind up doing IUI.
Lisa_Rosenthal	Dr. Patrizio has a unique perspective, in that he has practiced medicine in several different countries. Dr. Patrizio, could you tell us about some of the major differences between the USA and what's been going on in Italy?
Dr._Patrizio	MIacomet, we would like to have at least 4-5 embryos for analysis
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Dr._Patrizio	Alstee, I would need more info of your specific case and the type of stimulations.
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Lori_Masi AFA_Patient_Advocate	Good evenig Janice - Welcome!
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Lori_Masi AFA_Patient_Advocate	Welcome Smileyatc!
alstee	Using Gonal-F and out of 9 cycles I have had one day where FSH level was high (I think 19). But then came down drastically after to 5.7
smileyatc	Hello, I'm new to this chatting so, I may be alittle quiet.
Lisa_Rosenthal	smileytac, hang out, ask questions, whatever you like. Where did you hear about tonight's session?
moondreams	Dr. Patrizio, How many embryos would you transfer in a woman who is over 45 using donor eggs? Do you prefer to transfer on Day 3 or Day 5 and can you explain your preference? Thanks!
Dr._Patrizio	Hi Lisa. In Italy the current law is affecting the chances of creating families to a large number of patients. Imagine that :1) only 3 eggs can be fertilized because only a max of 3 embryos can be transferred; 2) it is not permitted to freexe embryos;3)it is prohibited to use donor eggs or donor sperm. It is very sad, but many couples are travelling to Spain or other European country for treatment
smileyatc	I am a member of afa, so I always get the emails about the sessions, I'm just usually not at home during the sessions.
Lori_Masi AFA_Patient_Advocate	Smileyatc just make yourself at home with us! whatever you are comfortable with....
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Lori_Masi AFA_Patient_Advocate	Hi wanna baby!
Lisa_Rosenthal	Thanks, Dr. Patrizio. It's always good to understand a more global perspective.
Dr._Patrizio	Moondreams- I would transfer 2 embryos on day 5
miacomet	When planning on doing pgd, and you are only able to harvest 5 embryos and only 3 fertilize...do you pass on doing pgd testing and just transfer the 3 that fertilized?
Lisa_Rosenthal	With the patients here, what are the biggest difficulties that you are coming up against?
YOLA	Dr. i am 43 my husband is 48 no male factor do you recomend ICSI AND AHA
wannababy	Hi Lori and Lisa
wannababy	Is ICSI really necessary and is there research proving that our children are fine using ICSI?
Lori_Masi AFA_Patient_Advocate	Hi!
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Dr._Patrizio	Miacomet-you meaning 5 eggs and only 3 fertilized, at this point we look at the entire story of the patient/case and decide whether to go ahead with PGD for the 3 embryos or not doing it at all. We prefer to have at least 4-5 embryo to analyze.
Lori_Masi AFA_Patient_Advocate	Hi Tracie Welcome! Special Guest: Pasquale Patrizio, M.D., M.Be, H.C.L.D., (Professor OB/GYN and Director of Yale Fertility Center) Topic: Why to Choose High Tech-IVF, ICSI, and PGD
Lisa_Rosenthal	Dr. Patrizio, you are doing an incredible job keeping up with all these questions. Please make sure that you post your programs information for those folks who are interested.
slin	Dr. Patrizio, is there any way to determine (guess) whether I'm a poor responder (besides trying multiple IVF cycles) ? One doctor recommended INHIBIN B test. Is it really helpful to get INHIBIN B level test ? Does the risk in AHA outweight its benefit even when the number of follicles are not below average ?
wannababy	How long a wait to get into see you dr?
Dr._Patrizio	Yola-Yes
JenniferL	I'm sorry to be so uninformed, I know what IVF stands for, but what is ICSI and PGD? And why would you have these done?
Dr._Patrizio	Wannababy- If ICSI is indicated, meaning otherwise no fertilization,we do it. I answered earlier that the risks of ICSI babies with anomalies is slightly higher than non ICSI babies
Lisa_Rosenthal	ICSI stands for intracytoplasmic injection~ where they take one single sperm and inject it into the ovum
Lisa_Rosenthal	PGD stands for preimplantation genetic diagnosis
Lisa_Rosenthal	Jennifer, please feel free to post any questions you may have.
JenniferL	oh ok, thanks Lisa. One more question, why would you move from IVF to ICSI?
Dr._Patrizio	Slin, Inhibin B is another marker (together with FSH and E2), but as you said, if you have already tried multiple IVF cycles, your doctor has come to the conclusion of poor responder
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smileyatc	Dr.s, I am 33 husband 47. No male factors, my cycles are fine, I ovulate fine, the fertility meds actually only increased the number of eggs, been on gonal F for over a year, even had IUI, to no avail. I stopped going to the doctor b/c he couldn't tell me why I'm that percentage of unexplained infertility I haven't seen the doctor since last October. Am I a candidate for IVF?
Suzanne	Sorry to be so late. Will there be transcripts posted?
Lisa_Rosenthal	Good evening Suzanne.
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Dr._Patrizio	Wannababy, Waiting time in our practice,including myself is very short (two weeks max). The address is Yale Fertility Center-150 Sargent Drive, New Haven, CT-tel 203-7854708 and please, if you call, mention that you were on the chat session. Thanks
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Lisa_Rosenthal	Transcripts are posted about 10 days after the session under the Connections banner, where the schedule is posted.
Lori_Masi AFA_Patient_Advocate	Hi Anna Welcome!
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
anna	Is it true that the doctor here this evening is from Yale?
Lisa_Rosenthal	Hi Anna, yes, Dr. Patrizio is from Yale.
anna	Dr. Patrizio, could you give your phone number?
Lori_Masi AFA_Patient_Advocate	Anna: Special Guest: Pasquale Patrizio, M.D., M.Be, H.C.L.D., (Professor OB/GYN and Director of Yale Fertility Center) Topic: Why to Choose High Tech-IVF, ICSI, and PGD
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moondreams	Dr. Patrizio, If all Day 2 numbers were great, would you ever do IVF in a woman over 45 with her own eggs? What are your thoughts on even doing a low dose of follistim to do a one egg retrieval? Just as a last resort before moving on...Thanks.
Lori_Masi AFA_Patient_Advocate	Hi denise Welcome to the session!
Lisa_Rosenthal	Welcome Denise25, thanks for joining us this evening.
Dr._Patrizio	Jennifer, the indications for ICSI-at least at our center- are: 1)Very low sperm counts-less than 5 million; low motility and low normal forms (shape of sperm); 2) Previous case of IVF with poor or no fertilization; 3) Antisperm Antibodies.
Lisa_Rosenthal	Please feel free to post questions for Dr. Patrizio. Keep in mind that the room is quite busy. Save and repost your questions as they do scroll away.
Dr._Patrizio	Anna, the phone number is 203 785 4708-Thanks
anna	Thank you. I need to get a second opinion and I would like to come to see you.
denise25	Are there any other options outside of IVF with ICSI for us - my husband had a reversed vasectomy that has only produced very low sperm counts with extrememly low / no mobility?
alstee	I am 37 as is my husband. Been on Gonal-F - went thru 9 cycles of injections, had 8 IUIs and one IVF - first IUI I conceived but then lost the pregnancy - had one day where FSH level was high out of all those cycles. Then suddenly doctor is talking egg donor -
Lisa_Rosenthal	Dr. Patrizio, thank you so much for giving of your time, energy, expertise and compassion this evening. We so appreciate it!
Dr._Patrizio	Moondreams-If the numbers are good and you are fully aware of the chances of success and you want to pursue a cycle, then is done-
alstee	The least amount of eggs I had in a given cycle was maybe 6.
Suzanne	What do you think about natural IVF? I'm nervous about the drugs.
smileyatc	Dr. Patrizio, is there an infertility specialist that you would refer a patient to int he North Carolina area?
Lori_Masi AFA_Patient_Advocate	smileyatc please call me on the AFA support line 888-917-3777 and I will refer you to someone in your area!
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denise25	Are there any other surgicial or drug treatments for my husband who had a reveresed vasectomy with very low count and motility other than IVF with ICSI - I was hospitialized with OHSS the first cycle.
Lisa_Rosenthal	Patty, thanks for joining us this evening.
Dr._Patrizio	DEnise25- If the sperm counts are extremely low and the motility is also low, I am afraid that the answer is IVF with ICSI. If there were no sperm at all, one could have considered a redo of the reversal, keeping in mind that the redo is less effective that the first time around. Finally, it is also likely that antisperm antibodies in him may slow sperm motion
denise25	Why are the antipserm antibodies likely?
JenniferL	How do you test to find out if a man has antisperm antibodies?
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Dr._Patrizio	Alstee, perhpas you should have gone thru another IVF cycle-when you had good FSH, with microdose Lupron
Lisa_Rosenthal	Dr. Patrizios phone number~ 203-785-4708.
YOLA	How many embryos will you tranfer on a 43 year old
moondreams	Dr. Patrizio, If I have another great cycle and decide to try IVF once, with my own eggs, what is your protocol for someone over 45? ie. dose of which drug and when to start? I missed it last cycle...Thanks.
Lisa_Rosenthal	Those patients joining us this evening~ can you give us an idea of the most difficult aspect of treatment?
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Dr._Patrizio	Suzanne, It is understandable to be nervous, but at the present time going natural is not very efficient.
denise25	Easy - the negative results1
Lisa_Rosenthal	denise, thanks for a very honest answer
ramya_fruitful	What is the difference between natural IVF and Hig-tech IVF ?
alstee	are you saying since I had that one time (one day) of a high FSH level that I do not have a good chance at IVF any more - using Lupron instead
denise25	Lisa - I had 1 ivf cycle and was hospitalized for 5 days with OHSS - the worst part had nothing to do with anything physical - it was all about would this ever work and how long could we try
Dr._Patrizio	Denise 25, because is a consequence of the vasectomy, sperm enter in contact with cells that make antibody
denise25	Does that go away over time after the reversal - if so, how long?
Lisa_Rosenthal	Ladies and Gentlemen, there is only one way that I get wonderful professionals such as Dr. Patrizio to join us for these sessions, and that is by promising them that they will be off by 9 pm sharp. That leaves us just a few minutes with Dr. Patrizio. Please remember that our message boards are moderated by physicians daily and your individual questions will be answered.
denise25	Thank you Dr. Patrizio!
Dr._Patrizio	Jennifer, you test the sperm (the test is called MAR test or direct immunobead test) and many labs do it.
Lisa_Rosenthal	Also remember that the way to reach Dr. Patrizio is 203-785-4708.
Tracie_in_Cal	So what could be the cause of antisperm with no trauma to the area?
denise25	Can you do anything with drugs to get rid of the antibodies
Patty	great chat, thanks
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moondreams	Has there been any long term studies on the risks of using Lupron? Thanks Dr. Patrizio for taking the time to answer all our questions!
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Dr._Patrizio	Yola-likely 3-at the most 4
Janice	This was really interesting. How can I find out more about these subjects?
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
slin	Many thanks for your time and answers, Dr. !!
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Dr._Patrizio	Moondreams- I will opt for :1) check day 2 FSH+E2, and if they are both normal I would use minidose Lupron and recombinant FSH (about 450IU/day)
Lisa_Rosenthal	Janice, there are many, many publications on The AFA website that will give you more information.
Dr._Patrizio	Denise 25-no the antibodies do not disappear
Lisa_Rosenthal	Dr. Patrizio, thank you for your time and expertise this evening. I hope that you will join us again sometime.
JenniferL	Yes thank you Dr Patrizio
denise25	thank you for your time!
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Lori_Masi AFA_Patient_Advocate	Thank you Dr Patrizio for such a wonderful and informative session!
anna	night
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Lori_Masi AFA_Patient_Advocate	Good night All! 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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wannababy	Good night Lori, Lisa, and dr.
Dr._Patrizio	Thank you all for great questions- Wish the best for you all.
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Dr._Patrizio	Ciao
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moondreams	Ciao!
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Lori_Masi AFA_Patient_Advocate	Good Night All and Thank you!
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Lisa_Rosenthal	I hope you all join us again next week.
denise25	what is next weeks topic?
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Lisa_Rosenthal	denise, I don't know offhand, but you are always welcome to ask general infertility questions.
denise25	ok thx
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Tracie_in_Cal	What is the link to the message boards?
denise25	theafa.org
Lisa_Rosenthal	Tracie, go through the home page and join as a free no barriers member, then you can access the message boards
Tracie_in_Cal	TY
Lisa_Rosenthal	tracie, how did you hear about tonight?
Tracie_in_Cal	Email...I have joined in several times now and have enjoyed the discussions
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Why Choose High Tech-IVF; ICSI; PGD

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