Nancy: hi everyone.......waiting for expert chat??
Nancy: i do not know about af...i am actually kinda new to ttc---4 1/2 months and came to get some answers about stress and ttc and spotting when period is due and when to see a doctor......any ideas in this???
Pamela: Hi everybody! The chat will begin in about 25 minutes! I will be hanging about until then....Dr. Grunfeld is wonderful. It should be a great chat!
Nancy: oops that was supposed to say i don't knoiw about ivf....hello SHIN, robyn, and Pamela
Nancy: is the doc an RE?????
Pamela: Hi Nancy! I am going to stay logged in...but I am going to do a few things until we get a little closer to the time.....
Pamela: Yes, the doctor is an RE!
ang25: hi girls
Pamela: Hi ang25! Only the early birds here!
ang25: i am new to this wondering how this is done do we each take turns asking ?'s angie
ang25: when does this start ang
Pamela: The chat starts at 8pm est....everyone posts their questions and the docter does his best!
Pamela: Hi Ang...it is still early, but I am hanging out..
ang25: hi how much longer until this starts?
Pamela: ten minutes
ang25: hi janet
ang25: pam what is your dx?
Pamela: my dx?
janet: Hi -- what stage is everyone at? Im at 0dp3dt (I think that means day of transfer)
ang25: what type of infertility are you dealing with?
janet: Ang, we have MF.
Nancy: HI everyone--I've finsihed my dishes...now just waiting for chat to start!!
Pamela: Ang25,
It was unexplained, but I am retired. I am now the mother of two ivf kids, not twins, and I am the executive director of AIA. I am here to support and help.
ang25: i have pcos ttc 14 months i am on clomid and met ang
Nancy: i am either 12 dpo or cd 1......having spotting doesn't feel or look like AF but might be??!! ttc 4 1/2 months, no dx or tx!!
ang25: hi heather
Pamela: Hi Heather! I paged him!
Pamela: We are waiting for Dr. Grunfeld so that we can begin the chat!
Nancy: Pamela--you work with aia? what do you do??
Heather: Good evening everyone. Wanted to introduce myself-i am a volunteer at the NEW South Jersey meeting site for AIA. Any New Jersey women out there?
Heather: HELLO
Nancy: yes.......Nutley NJ (Essex County)
Pamela: I am the founder and executive director.
William: howdy folks!
ang25: hello Dr
Pamela: Hi Bill!! I am waiting for Dr. Grunfeld. He is a little late!
Nancy: Pamela--that is wonderful!!!
Heather: Let me be the first to invite you to our new meeting site and soon to be resource center in South Jersey (medford) although New York may be closer for you
Nancy: Any other Jesey guys or gals besides Pamela and me??
Pamela: I love what I do. AIA is wonderful and the people who give of their time to AIA are incredible....like Bill and Heather!
Nancy: oooops I meant Heather and me...sorry!!!
William: no problemo, sorry I couldn't make the Tuesday chat, I'm trying to get some exercise regularly and have a tuesday evening softball league now.

Heya rond!...isn't it bedtime for the triplets? :o)
Nancy: Heather and Bill- how did you get involved in aia??
rond: Bill - i am still at work...
ang25: tami are you tamik from the boards? ang
Nancy: Heather---NY is probably closer to me, but my hubby says dh is doable too!! Where is aia in NY or do you have a north jersey center???
Nancy: oops that's NY is doable....duh...sorry!!! Bad typing tonight!!
Heather: I meant Pam through a mutual friend. Myself being in treatment for 3 years and really no support here in NJ to turn to i wanted and needed to do something so I tried to start my own support system until i meant wonderful Pam and joined AIA with all their knowledge and support i can now help a lot of people here in NJ and the surrounding areas.
Pamela: Welcome Dr. Grunfeld!
William: rond, that's not good, you have a long trip home (on the train?)

Nancy, I started working with Pam about 20 months ago on the Saks v. Franklin Covey case, and I did a consult for her in Albany about a year ago. We've been working on the NY and NJ mandate efforts and are planning a larger study of the effect of mandates on lowering multiple gestation pregnancy rates due to IVF.
William: rond, that's not good, you have a long trip home (on the train?)

Nancy, I started working with Pam about 20 months ago on the Saks v. Franklin Covey case, and I did a consult for her in Albany about a year ago. We've been working on the NY and NJ mandate efforts and are planning a larger study of the effect of mandates on lowering multiple gestation pregnancy rates due to IVF.
Nancy: so, how long has everyone been ttc?? dx? tx?? any kids?? Me: ttc 4 1/2 months, no dx or tx--doc won't talk to me til i've been ttc for 1 year!! No kids yet :(
Nancy: Hi Doc!
Pamela: Dr. Grunfeld is from Reproductive Medicine Associates in Manhattan and he is associated with the Saint Barnabas Program in NJ. He is here to take your questions!
Heather: AIA has a wonderful web site with the locations. The New Jersey (closer to PHL) has a brand new site that is opening.
Nancy: I have a question abotu deciphering between a light period and spotting (as in implantation) How does one tell the difference??
rond: Dr. Grunfeld Hi. Whats your view on treating Anti-bodies with respect to infertility?
ang25: hi i have been ttc 14 months i have 1 child 4 yrs old dx pcos did 3 rounds clomid failed now doing clomid 100mg with met my ? is do the opk's work while on clomid? angie
Pamela: Note to all---If your questions do not get answered right away, please resend them, it gets hard for the doctor to keep up!
Heather: Dr. Grunfeld
I was in treatment for three years ending my treatment with an IVF in NOV (failed) and was wondering do my chances increase by trying more than once? I am really unexplained but do have ovulatory problems and when on drugs stimulate to well and the eggs mature too fast
DrGrunfeld:

A question was asked about antibodies and infertility. Remember that this is a large category. There are antibodies to sperm, antiphospholipid antibodies, antibodies to thyroid.
Nancy: Dr. G--how does one decipher the difference between a light period and spotting (as in implantation)? Is there a way to tell or should a person just test if their flow doesn't look normal??
janet: Hi Dr. G, thx for being here tonite. Question about transfer, had mine but RE had difficult time getting the embs in b/c of severe angles of uterus (odd shape). Seems he got them in, but should I be worried?
Heather: Janet- are you in the "two week" wait right now?
ang25: my question is how accurate are the opk's while on clomid ttc 14 months dx pcos on clomid 100mg and met 1500mg ang
Pamela: Remember everybody to hit the refresh button!!!
janet: Heather, yes in 2wk wait, transfer today.
DrGrunfeld: Somebody asked about PCOS failure on clomid after a succesful pregnancy. Remember that clomid only achieves a 40% succes rate. Patients who fail 3-6 cycles of clomid should be treated by an RE
rond: With respect to the anti-bodies - true. Its a general question as there are a doctrine that discard the whole issue of anti-bodies (Cornell do not "believe" in it). So I was curious to here what is your stand on this issue.
Sarah: Doctor, Let me lay it on the line for you, please give me an honest opinion. We have been ttc 5 years. I am 24, hubby is 25 with great sperm count. 4 years ago, had a ectopic, went on so long left tube was removed. April had our first IVF. Beta started low but grew rapidly. Saw sac at 5 1/2 weeks & that night went to the ER with pains. Had a "stub" left of my left tube & one baby was in there. I lost a lot of blood due to internal bleeding. RE said my right tube looks normal. Oh yeah, we had to do rescue ICSI as zero eggs fertilized. Should we try again? My present RE makes me nervous, she doesn't say why we're not conceiving. Are my eggs bad? Any suggestions would be greatly appreciated. Thank you so much. Sarah
Jessie: Dr G-I was wondering if I had a good chance of pg with DIUI. I just had to have a lap to unblock my tubes. I had scar tissue from a silent infection. They are both open now
OMalley: Doc-Thank you for taking the time to do this. I have had 2 pregnancies, both of which ended in m/;c at about 6 weeks. Antibody testing was negative, HSG was fine, b/w was fine. Do you recommend any further testing? Statistically, what are my chances of carrying to term?: I am 32.
april: Hi Dr. I have been on metformin for 3weeks now for insulin resistance. My RE told me that it should help regulate my cycles and possibly stimulate ovulation. Today is cd 49 so I am wondering how long the medicine takes to "kick in"?
Tamara: Hi, REB. I see you made it. I had problems with my browser.

DrGrunfeld: Regardin a light period vs. implantaion. Anytime you are not sure that you are menstruating a pregnancy test is mandatory.
Anyone trying to conceive should have access to an RE who can sort out the menstrual cycle in a rapid fashion.
ang25: dr does clomid efect opk results?
shelly: Hello! Dr.Grunfeld!,
We have been trying for yrs.now, as of yesterday. We are currently waiting to see if our !st FET was a success!. My question is in regards to having a laporoscopy, you see my RE has never much pushed us to have one. I have had the dye test & all looked well, but just to make sure our RE had us do hysteroscopy , shortly afterwards, too be double sure because of some growth he thought, he might have seen in the dye procedure. Both tests showed everything looked good. I have also had endo.biopsies done & all was well.I feel like we should cover all of our bases & have a laporoscopy done. Would you agree?

Nancy: Thank you doc (for the answer to ? about implant spotting) No OBGYN or RE will discuss infertility with me becaseu I have only been trying for 4 1/2 months. I have long irreg. cycles and have history of cysts and family history of endo, but no one will talk aboyt this with me becasue I have not been trying long enough!!
William: Thanks for reminding folks, Pam; sorry for being so out of it I'm managing a raving 4 year old here :o)
shelly: Dr.Grunfeld that was 3 years we have been trying.
Pamela: Note to all!!! There are 30 visitors in the room right now! Please keep your questions saved so that you an repost them if Dr. Grunfeld misses it while he is answering another question. Please be patient! I have found that these chats can be stressful for the doctors!!!!
DrGrunfeld: To the person who had an ectopic, did IVF and needed rescue ICSI. Your most significant comment is that you don't communicate well with your RE. When things don't go well with your cycle it is important to seek out a program that evokes confidence and with whom you can communicate.
ang25: pam how do you save stuff
Kell: Dr. Grunfield, does taking Clomid increase ones chances of having a miscarraige?
Pamela: You can go into your word processing file. That is what I do. Bill could have a better suggestion. Bill?????
DrGrunfeld: Clomid can give a false ovulation predictor result because it can trigger LH release. I prefer to rely on sonographic assessment of the follicle.
Jessie: Dr G-I was wondering if I had a good chance of pg with DIUI. I just had to have a lap to unblock my tubes. I had scar tissue from a silent infection. They are both open now and are in good shape. Husband has NO sperm so we have to use donor
sherrie: Hi Doctor! I'm 32 y.o. and have POF. I'd really like to concieve on my own, producing a mature follicle or two, then doing IVF, but keep being told there's no hope in that. What is your opinion??
DB41: Dr G - I did 9 IUI cycles with one pg that resulted in miscarriage. Is it possible for clomid to hinder pregnancy? In the past twelve months I've been pg three times (each have resulted in miscarriage). Thanks.
Pamela: Note to All---remember to refresh to keep up with the chat---later if you still have questions, please visit out physician moderated message board where Dr. Grunfeld helps out on a regular basis at https://americaninfertility.org and if you stop by, please stop by the homepage and give us your name and address so that we can send you an complimentary newsletter.
DrGrunfeld: There are more miscarriages in pregnancies achieved through ovulation induction than in the general population. The rate of miscarriage is primarily predicted by your age. Remember that it may be the infertility rather than the drugs that account for the miscarriages.
Sara: Jessie i woudl give it a try
DB41: I'm sorry, I neglected to mention that I have achieved pg without any drug assistance.
laslanian: I would like to know about the relationship between mild endometriosis and infertility- we are about to try our first IVF- I am 34. I would also like to know how poor morphology(my husband has that) prevents the sperm from reaching the egg- I do not know if there are agreed upon answers to these questions but I am curious what you think, or what is the most agreed upon answers.

Lisa
LeslieM: I was just curious...when people get a positive beta and then it doesn't work out (chemical pregnancy) is that a good indicator that a person can get pregnant. That happened to me and I am trying to decide how much treatment I should really do. I got a + on my first injectable/IUI cycle. I have endo and an elevated FSH at age 30.
DrGrunfeld: To the individual who had a laparoscopy to remove scar tissue. Tubal surgery is most succesful if the scar tissue was mild and if the fimbria in your tube is preserved. If the tubes were severely damaged IVF is a better alternative.
Jessie: Sarah-Thanks. I just hate the thoughts of spending more money on IUI when I need IVF. Ins doesn't cover anything so everything is out of pocket
janet: Dr. G.--all other factors being equal, does odd shape of uterus (making transfer a real challenge for the RE) inhibit environment for embryos, or the chances of implantation?
Sher: Hello everyone!
Jessie: Thanks Dr G!!
mag: Dr. Grunfeld, We are about to go through our first IVF/ICSI cycle. We are using 4 vials of frozen sperm that was removed through TESE during my husband's vasectomy reversal. I was given the option of using donor sperm as backup. Why would I need donor sperm if we have 4 vials of our own frozen sperm?
ang25: dr have you seen good results with using the metformin to trreat pcos?
Nancy: what does high prolactin mean?? My level was 21, I think and doc said that was kind of high...it was only a university health center doc and I don't know how good they are...I had the genral blood work---LH, FSH, Prolactin and TSH.....Prolactin was the only abnormal thing and wasn't that bad...just on the high end of the spectrum!!
jking2: I am having to use donor egg. Quick question, my donor had 2 small cysts which were drained today. She hasn't started stim meds, but has been on lupron. Will this affect the follicles since it was taken care of before stims were started?
DrGrunfeld: A 32 y/o woman with POF asks about the prognosis for pregnancy with her own eggs. Rarely women with POF ovulate on their own and conceive. Most of theser pregnancies were conceived with low technology approaches like estrogen replacement. IVF never works. It is difficult to compare the excellent results achieved with donor eggs to the poor results achieved with your own eggs. Only you can decide when it is time to move on to donor eggs.
OMalley: What work-up, if any, do you suggest after 2 m/c in a 32yo?
Kell: Dr.G- it must be difficut to keep up with all of these questions! :)
DrGrunfeld: A positive beta that ends quickly is called a chemical pregnancy. This reassures us that fertilization is occurring. It does nor reassure that the uterus or the eggs are normal. If your FSH is elevated the prognosis is mostly based on your degree of altered ovarian reserve.
Liz: I'm preparing for a 2nd IVF attempt, and this time I'm on a high responder protocol. Can you tell me if this protocol will reduce my risk of OHSS? I suffered a mild case during the first attempt. Thanks.
Nancy: the prolactin (I found the lab results) was 21.7 at 6 dpo in a cycle where I got period at 13 dpo. I am 22
Pamela: Mark Your Calendar! The next on line chat will be on June 8th..PCOS: Understanding Insulin Sensitizing Medications. During July and August, AIA supported by Fertile Thoughts will be running a weekly on line chat expert chat on different subjects. Please check with us often to get the entire schedule!
Paloma: Dr. Grunfield, Does 0% morphology (Kruger) affect the % of fertilization with ICSI? I had 8 mature eggs and only 4 fertilized. Shouldn't at least 75-80% of the eggs fertilize with ICSI? This IVF was done at Cornell. Thank you.
Emjay: Hi everyone :)
DrGrunfeld: IVF/ICSI post TESE is excellent if the cause is obstructive azoospermia. It the azoospermia is not obstructive then the results are less good. At ST B we have not achieved liveborn when less than 10 sperm are recovered by ICSI. If the prognosis is not favorable inseminating some eggs with donor sperm is reasonable.
LeslieM: Does an altered ovarian reserve indicate poor egg quality?
ang25: dr what are your thoughts on tx pcos with met?
DrGrunfeld: For women who have hyperstimulated in the past limiting the gonadotropin stimulation is very helpful. Lupron downregulation with a low dose of FSH works best.
William: [back now, massive system crash here, such is life with an ancient 200mHz machine :o)
shelly: I don't know why the computer said I left after 3 minutes of idle time? I ahve only posted 1 question & have just been hitting refresh button & patiently waiting for my answer.
Nancy: shelly---ask again the doc gets bombarded!!!!
DrGrunfeld: A 0% kruger is associated with poor fertilization. Generally, this finding triggers the need for ICSI. 0% kruger is not associated with poor results with ICSI.
Emjay: William needs an upgrade :)
Emjay: Shelly, if you don't hit refresh for a few minutes the next time you refresh will show you re-entering :)
Paloma: Thank you for answering, Dr. Grunfeld!
Pamela: Our expert tonight is Dr. Lawrence Grunfeld. He is from Reproductive Medicine Assocates in NYC. His program is assocated with the Saint Barnabas Program in NJ. After the chat you can reach Dr. Grunfeld at . Or you can post to him after the chat on the aia message board where he is a regular moderator at https://americaninfertility.org
janet: Dr G: all other things being equal, does odd shape of uterus (such that RE has hard time getting embryos in at transfer) affect implantation or chances of survival?
Sher: Dr G....This is a very interesting site and I am a children's advocate and leader at the state level of my organization. I am looking at this subject as one to bring to our members attention...
april: how long does metformin take to get a cycle started? i've been on it 3 weeks and today is cd 49. Thanks
Nancy: okay i will ask my 2 part ? together: (1) No doc (RE or GYN) will discuss ttc with me since I am 22 and only trying for 4 1/2 months--history of ovarian cysts and long irreg cycles, family history of endo; (2) My prolactin level was 21.7 at 6 dpo when I had ti tested in Jan....doc said it was alittle high but not to worry too uch..I aj worried...should I be and what can I do??
DrGrunfeld: Poor ovarian reserve as detected by an elevated FSH is associated with a high proportion of eggs with chromosomal problems. There is no FSH that is completely inconsistent with ever releasing a healthy egg.
Sher: What would be your suggestions to begin with as far as materials besides this site which I will recommend
DrGrunfeld: The metformin data is very encouraging. It is become almost routine to treat PCOS with metformin, if you can tolerate the side effects.
Pamela: Sher--what kind of work do you do?
Pamela: Sher, if you email later, I will send you information along with our newsletter. We also have an 800 number for referrals, peer support etc...
jking2: I am using a donor this cycle. She had 2 small cysts drained today. She is on lupron, hasn't started stim meds yet. Is this cycle still OK to continue if the cysts have been drained?
William: hehehe...I'll put it in the budget, thanks emjay
ang25: dr i am on 100mg clomid my dr told me to be doing an opk starting day 11 do you think i am wasting my time and money since the clomid can alter results?
Melissa: What are the chances of my 1st ivf working? I have had 4 ectopics in the last 1 1/2 yrs, all natural conception. I have done med cycles before but to no avail I never got pregnant.
DrGrunfeld: Uterus malformations that effect the endometrial lining can effect implantaiton. Examples include uterine septum and T shaped uterus. It sounds to me that your defect is a cervix problem limiting the ability to perform a smooth embryo transfer. This effects IVF outcome as well.
William: Sher hi, here. Pam is the Exec Director of American Infertility Association, based in NYC. Her group has been doing a lot of the work behind the NY infertility mandate that I believe is still before the legislature in Albany.
DrGrunfeld: Metformin alone only achieves a 20% ovulation rate. It is most often combined with other ovulation inducing drugs if you are trying to conceive.
Pamela: By the way Bill. It was actually looking good for NY. We will know in two weeks. Kind of like an ivf cycle that never ends!
Emjay: Melissa, are your tubes still intact?
shelly: This is my situation. We have been trying for 3yrs,as of yesterday . I have had an HSG & Hysteroscopy & a couple of endo biopsies, everything on all those procedures looked good. We are currently waiting to find out if our 1st FET was a success or not!
We want to cover all of our bases & want to have a laporoscopy done. I have not had one & not been real pushed to, since all the procedures always looked good. Do you think we should have a lap done?
William: That's great news, last we spoke it sounded like the NY mandate effort was sorta dead in the water, definitely far along but an impasse. We should chat on the phone about this.
StacyD: Hi Dr Grunfeld thank you for being here. Can HCG make one trigger too early. When I did my last two IVF cycles I only had half the eggs that I had had one my last sono? I took my HGC shot 36 hours before rtvl.
Jennifer: I've just had a Lap and have been dx with Stage II Endo. Is this mild of endo enough to cause infertility? Since my RE said he removed all of the endo. what are our chances of conceiving naturally or with Clomid/IUI. OR should we go straight to injectibles. Up to now we've been unexplained.
laslanian: Hi- I never got a response to my question- is there something that I am not doing?
Sher: thanks william.....
DrGrunfeld: Nancy, Even though you are 22 there is no reason why your concerns should not be taken seriously. While there is no reason to actively intervene yet, it would be interesting to observe your ovulation cycles by some nonintrusive means (such as follicle sonograms and PCT test) to see if therapy is justified. If your cycles are clearly abnormal you don't need to wait a year to intervene. Your prolactin elevation is mild and should be repeated fasting.
lkp32: I have a question. I found out 2 days ago that I am pg. But now my doctor tells me k=not to get my hopes up since my progestrone levels are so low. Does this mean I am going to lose the pregnancy?

Pamela: laslanian..repost it...the questions can fly by Dr. Grunfeld while he is answering some one else's question, and you need to hit your refresh button to keep up!
Melissa: I only have my left tube intact. Ectopic in March of 99 ruptured my right tube. Heard babys heartbeat, before having emergency surgery. Then in August of 99 had 4th ectopic which happened to be in the left tube, did methotrexate. I have been on b.c. since then.
Emjay: laslanian, could you try asking it again? The volume is a little overwhelming :)
Sher: William....I will have to look into the legislation on this...,I also lobby for children's issues
Nancy: the prolactin was done after fasting 12 hours, and thank you. I live in NJ so maybe I will contact the St. Barbabas program and talk to someone about monitoring my ovulation/cycle. Thank you for taking me seriously it means alot!! What can I do about the prolactin if it is high again??
Nancy: the prolactin was done after fasting 12 hours, and thank you. I live in NJ so maybe I will contact the St. Barbabas program and talk to someone about monitoring my ovulation/cycle. Thank you for taking me seriously it means alot!! What can I do about the prolactin if it is high again??
jking2: I am using Donor egg. My donor had 2 small cysts drained today. She has been on lupron, hasn't started stim meds yet. Will this have any impact on this cycle?
DrGrunfeld: Shelly, there is no reason to have a laporscopy if you are using IVF to conceive (unless you have a hydrosalpinx). If you would like to try to conceive with non-IVF technology a laparoscopy can be useful to assure that you don't have endometriosis or peritubal adhesions.
StacyD: Can HCG make one trigger too early. The last two IVF cycles I did I only had half of the eggs that I had on the sono the day before. Could I have lost them before rtvl
DrGrunfeld: It is very rare for ovulation to occur prior to 36 hrs post hcg if you are taking lupron. It is more likely that your poor egg yield is due to immature eggs getting trapped inside the follicles.
Emjay: So Melissa's question is what is the success rate of her 1st IVF with one tube and history of ectopic
William: laslanian, I tried to scroll back but I didn't see your post; you may have accidentally hit the "log out" button rather than the send button. Please try again, sorry.
shelly: Dr.Grunfeld:
What do you mean by hydrosalpinx? & peritubal adhesions?
michele: Does anyone know the side effects of Prometrium and clomid?
lkp32: Can anyone tell me anything about progesterone levels at early pg?

William: Sher, there's info on the bill at Pam's website https://americaninfertility.org

Also, NY already has an infertility mandate, but it is fairly weak and doesn't require that insurers cover IVF. The mandate being considered at the current time is much more generous and requires coverage for the more effective treatments like IVF.
Nancy: hi julie...its nancy...getting some good help...finally someone wil listen to a 22 year old!!!
Lynn38: Dr.Grunfeld-I have been ttc for 31/2 years,so far unexplained.Husband's tests have all come back great and he has a son from previous.I have done the clomid,no pg.humegon/pergonal/hcg/iui-3x no pg.My RE says he wants to try one more round of pergonal/hcg/iui becuse he says I respond really well.I feel like due to my age-38-I should move onto IVF.What do you think????
Deb: Dr,

My husband has a count of about 50 million sperm/ml with 1% normal morph. Any chance this could work the old fashioned way? I've just been thru IVF, and I don't know if I could do it again.
Julie2: Hi Nancy! Yeah, it is hard to get some people to take us seriously! ((hugs))
jking2: I am starting to panic. My donor had 2 small cysts drained today. This is our last try at a family. Will this impact this cycle or can we continue on? She has been on lupron, no stim meds yet.
lkp32: Michele, I had a lot of headaches and weight gain while on clomid but I know other people have had other symptoms.
DrGrunfeld: Jennifer, Mild endo has been shown to achieve a 40 % cure rate following laparoscopy, but these rates often take up to 18 mos. to achieve. The need for aggressive ovulation induction is based primarily on your age. Remember that IVF can be performed, even if the endo recurrs. Generally, repeat laporoscopies are only performed for pain relief and not for infertility.
StacyD: We have done 6 IUI and 4 IVF and ICSI and have two sons from IVF one fron the third and one from the fourth we would like to try to have a third child. Am I putting my ovaries at risk from all the drugs. Becouse of my weight I have used 6 amps a day of stims each cycle
DrGrunfeld: Emjay, IVF success rates for tubal disease are excellent and are based upon your age. The success rates of every IVF program can be found at CDC.GOV
Julie2: DR Grunfeld, Hello. I was wondering if you could tell me the success rate of an follistim/hcg/iui cycle for a 22 year old with severe PCOS and insulin resistance.
Nancy: julie---doc says for me to test if there is any ? about af being implant...so will do that on Sat at 14 dpo. He works out of NYC and NJ so I might call his office and get some help!!!!
DrGrunfeld: Hydrosalpinx and tubal adhesions are the results of tubal infections, usually from chlamydia.
michele: ikp32 is it recommended not to take anything for the headaches and did you have a sustancial amt of weight gain?
Julie2: Nancy, good idea!
Nancy: julie---beginning to wonder if i might have pcos....i have low blood sugar....i see you have insukin resist.....any connection??
laslanian: My question concerns mild endo (and the relation to IVF- does it effect its effectiveness) and poor morphology- my husband has this- how exactly does it prevent fertility?
Jennifer: Thanks Dr. Grunfeld.
jking2: Can someone please help me with my question????? I am using a donor. She had 2 small cysts which were drained today. She has been on lupron for almost 2 weeks. Will this impact our cycle or should we even contine??
shelly: Could this have been seen from an HSG &or a hysteroscopy?
lkp32: michele, I just took tylenol for the headaches and I gain about 60 lbs in a 6 year period on clomid so no I guess the weight gain wasn't great considering I was on clomid about 5 years too long.
sheila: I am getting ready to do my first round of clomid 100 mg and my Re is saying I can do IUI too. Is this a better chance of conceving or is the old fashion way just as effective, so far my only dx is anmmenorrhea and no O according to my temps. It took me two years to conceive my first son wiht no fertility drugs
DrGrunfeld: Lynn38, I agree that at age 38 you could achieve better success rates with IVF than with prolonged HMG/IUI. I generally only recommend 1-2 cycles before IVF. Just make sure that the success rates in your program are reasonable.
michele: thanks ikp32 i was worried because I am just starting to loose the weight I gained while I was hypothyroid.
lkp32: Dr,
Can you tell me about low progesterone levels with an early pg. I conceived using repronex and no IUI. Now my doctor says to not get my hopes up???
Pamela: JKing2--hang in there, I promise we will get to you before the chat is over! As far as I know, cysts can affect stimulation. But Dr. Grunfeld should answer this!
Melissa: Can anyone make since of this. During med cycles the highest my e-2 ever was (1300) in know every follice doesn't contain an egg, but how much would my e-2 change taking lupron?
Emjay: Melissa, did you catch the dr's reply?
Julie2: Nancy, I am not sure about low blood sugar... with the insulin resistance my sugars and glucose are very high! or were high before the Actos I am taking... Metformin didnt help me at all
jking2: Thanks Pamela! It was hard enough going through my failed IVF cycles, but now to worry about a donor, it is almost scarier!
Lynn38: DR.What would you consider a reasonable success rate for 38 yr old unexplained?Are you familiar with Virginia Mason Clinic in Seattle??
DrGrunfeld: StacyD. The risk to your ovaries from repeated gonadotropin is exremely controversial. You have little to worry about since you have been succesful. The dose of gonadotropin is not important. It is the response of your ovary that is important. Refer to the ASRM.org web site for some interesting data on the subject.
Melissa: Yes, I did catch the drs reply, just posted another question. Thanks.
DrGrunfeld: Cyst puncture prior to IVF is not unusual and expedites getting the cycle started. This should not effect the development of new eggs as long as the stimulation is not begun before ovarian suppression has been achieved.
Nancy: Jul--blood sugar probs run in my family---many diabetics and doc says i will prob be diabetic one day too...had high sygar for 4 months (just slight so no meds) controleed by diet, then went for check up and 3 hour glucose tolerance test and found hypoglycemia....who nows....could be hugh again........havent checked in like 3 years!!! Just careful what i eat....if i feel good i don't worry!
jking2: thank you very much Dr Grunfeld! My mind is at ease again. . . .
Emjay: Melissa, our posts crossed, LOL!
Hi Julie2 - I missed saying hi!
Julie2: Nancy, well you should definitly keep an eye on it!

Hello Emjay! : )
Julie2: DR Grunfeld, Hello. I was wondering if you could tell me the success rate of an follistim/hcg/iui cycle for a 22 year old with severe PCOS and insulin resistance.

DrGrunfeld: ikp32. Low hormone levels can be predictive of miscarriage. If your progesterone is low you should take a progesterone supplement. Unless the BHCG fails to rise I do not recommend giving up hope until 6 weeks post ovulation when a heartbeat must be seen.
lkp32: Does anyone know anything about low progesterone levels? I am worried that after getting pg it just isn't going to work our afterall.
shelly: I meant to say thank you for answering my other question earlier in regards to whether or not to have a lap or not.Thanks!
lkp32: Dr,
Thanks, I have been taking progesterone supp. twice a day.so you are saying there is still hope?
Pamela: Ikp32--did you see Dr. Grunfeld's response to you???
DrGrunfeld: Lynn38 If your FSH is good you should get a live born rate of 30 40% per cycle depending on the clinic. Once again I refer you to CDC.GOV for the most recent success rates of each clinic (ie 1997)
lkp32: yes it posted at the same time i sent mine.
StacyD: Is Antagon being used yet. I responded poorly to Gonal f is there a better drug for me . I used Pergonal and Metrodin before and produced more eggs with them. What is the max amps per day one should be on.
rond: taking off... have a good night everyone!
Emjay: Night ronen
DrGrunfeld: Julie2, the success rate of ovulation induction in PCOS is mostly determined by your wilingness to accept ovarian hyperstimulation and multiple pregnancy. If you are a high responder IVF is often more controlled in that a high number of eggs can be induced, but embryo numbers can be controled.
William: I want to thank Dr. Grunwald for joining us tonight, sorry that I've been a bit disjointed here, system crash and kid tantrums sorta threw me off balance :o)
sonj: Hi Dr. Grunfeld, have ectopic pregnancies ever been treated vaginally?
Lynn38: Dr.Grunfeld,Thank you for your time and answers.One more question.Do you personnally think there is any connection between the flight attendants and infertility?
mia: hello all
Pamela: Note to All---If you did not get your question answered tonight or if you have further questions, please post your question on our physician moderated boards at https://americaninfertility.org
Dr. Grunfeld is one of our board experts, and the questions are answered everyday. Also, if you stop by, please request an information packet and we will send you a complimentary newsletter and information about membership in aia.
lee: Dr. Grunfeld, What are the ivf success rates for a 37 yr old woman with PCO and low progesterone? About how many ivf cycles are needed to get pregnant?
DrGrunfeld: Antagon is now available, but may not be the best choice for low responders because there is a drop in FSH level when the antagon is administered.
Beasley: How long does it take to thaw frozen embies?
Melissa: Dr. Grunfeld
In having a e2 level of 1300 during med cycles what should I expect during this ivf cycle? I know every follicle doesn't contain an egg what are my chances of having enough left over to cryo?

DrGrunfeld: I think I can take 3 more questions. All other questions can be referred to the gneral message board.
KENDRA: DOES HAVING ONE DOMINANT FOLLICLE AT 22mm. GIVE ME ANY CHANCE OF SUCCESS,IF SO HOW MUCH.I HAD ENDO REMOVED VIA LAP AND IT WAS MILD NO MALE FACTOR.
Julie2: Dr Grundfeld, I have hyperstimed before resulting in blood clots... So moving on to IVF if we have to will be quite scary for us... Thank you for answering my question
amita: Dr.Grunfeld, I am just starting a DE/IVF #2 the first DE/IVF failed due to the donors slow response to meds. I am concerned about my endometrium. My RE has me on up to 8mg of estrace to get my endometrium to a "9b with a halo" response. Should I be concerned "if" I get pregnant with birth defects from estrace?
DrGrunfeld: sonj, Ectopic pregnancies can be treated with vaginal methotrexate injections, if they are not ruptured.
William: Pam, can people leave an e-mail address on your board and then you reply to that and they send their snailmail address directly to your mailbox for privacy assurance?
Pamela: Reminder---general message board moderated by Dr. Grunfeld can be found at https://americaninfertility.org
It is past our bed time!
StacyD: Dr Grunfeld I don't respond to Lupron well and usually have to be on it longer to shut down ovaries before starting stims wouls the longer period of Lupron cause me to be poor responder to the stims
Beasley: Dr. Grunfeld: with a FET, how long does it take to "thaw" embryo's - I have some blasto and some at the 2pn stage... will the 2pn stage embryos need to grow more.?
DrGrunfeld: Lee, PCO usually carries normal IVF success rates based upon your age. Generally, high numbers of eggs are produced, but at least 3 good embryos for transfer can be replaced.
Pamela: When people request a packet it is through an email. They click on packet request and it send an email directly to my box. It is completely confidential and private. I am not suggesting that anyone leave their address on our message boards!
StacyD: Thank you Dr Gunfeld for being here and answering our questions
Pamela: Dr. Grunfeld, I want to thank you for coming tonight! We had a very very busy chat! You were wonderful! Again, you can find Dr. Grunfeld through our message board.
William: Pam, I need to log off and head to the office to get work done; gonna head out of town early tomorrow afternoon. I'll give you a call to discuss strategy on Sunday, ok?
Pamela: Good night Bill!
amita: Dr grunfeld, did you see my question about birth defects and estrace?
William: kewl, I figured that's what you meant, Pam, just wanted people to know they can leave e-mail addys :o)

Thanks again, Dr. G!
Pamela: Dr. Grunfeld, after you finish responding to your last question, it is time to say good night! Your fingers must be tired! Transcripts of tonight's chat can be found at https://americaninfertility.org under fact sheets and faq's.
DrGrunfeld: Last question for tonight.
StacyD, prolonged lupron can slow your response down, if you are a low responder. Good responders can tolerate this with no problem. If you have the tendency to low response, watch out for this. A flare cycle may be helpful.
amita: What about estrace and birth defects?
Nancy: pam--please type the last thing you wrote again....it was garbled on my screen....about the transcripts...please retype!!
StacyD: thank you Dr. Grunfeld
Pamela: Thanks again, Dr. Grunfeld! Reminder! You can leave a question for Dr. Grunfeld at https://americaninfertility.org on the message board. All questions will be answered there. Everyone is welcome to remain in this room and chat if you would like. It will remain open.
Pamela: Transcipts of tonight's talk and all previous chats can be found at https://americaninfertility.org under fact sheets and faqs.
DrGrunfeld: Thank you for joining me. I look forward to hearing from you on the general mesage board. Dr. B and I are happy to entertain your questions. Since I can respond slower, my fingers will be happier to.

Good night.
Pamela: Good night everyone!
Julie2: Thank you DR
Emjay: Good night everyone :)





dtredd: hi
dtredd: Hi Nancy
dtredd: Is anyone in here??
Marie: Hello

Tam: Hello, guess we missed the chat.
Anyone else around. I'm off to bed soon.
Tam: Hi Kristen.
kristin: hi
kristin: i guess the dr. left
Tam: Did you make it to the chat earlier?

I missed it. Shopping, getting my feet done. ;P
kristin: do you know any successful clomid stories? i am on my 3rd cycle.
kristin: no, i missed it. i've never had my feet done. i just started having my fingernails done.
Tam: Oh yeah. Me!

Well, let's just say I took clomid for 8 months and went as far up to 200 mgs and nothing hapened, then the month I went off it, BAM!! got pg on my own.

The Dr. is convinced the clomid sorted outmy wonky cycles and and corrected my prior luteal phase defect.Y
Tam: then, you have GOT to have a pedicure. I get paraffin wax treatments with it. It's heaven. :)
kristin: sounds good, tam. i will be on it for 6 months and then make a decision if we want to go farther.
Tam: Hi dawn!
kristin: do you have 1 child?
Tam: What is your dx Kristen? Are you seeing anRE or a gyn?
Tam: kristen, yup! One on the way too.
kristin: an obgyn who specializes in infertility. i guess you would say i am unexplained. i had endometriosis removed last summer and they said i should be pg in 6 months. well, that didn't happen,now we are trying the clomid.
Tam: AHHHHHH, dhis running me a bath.....We just installed a new bathroom this weekend.
kristin: did you get pg the 2nd time on your own? when are you due?
kristin: a pedicure and a bath-what a night!
kristin: hi shell
Tam: Kristen, I know of personally, so many women who got pg after ahving endo removed and a HSG too.

you have this sort of 'window of time' so to speak to get pg I think they give you up to a year.

one woman I know of in particular was told by her Dr. to eat right and try loosing some excess weight she ahd and it worked right after the surgery to treat endo..After the baby, she kept on the work out schedule, eating right and she wwent from stage 5 endo to stage 1.
Tam: Kristen, second time, it took us 5 months.
I am due this week.
kristin: wow tam! good luck. i better go.
Tam: my dx origionally was tubal blockage, Luteal phase defect, age factor and inconsistent AF.
Tam: kristen, 'K', see ya!