Pamela: Hello all. Feel free to chat among yourselves...Dr. Kligman will be here in ten minutes and we will start then. Welcome!
Pamela: Hi Tarney,
How did you find out about the chat?
Pamela: Hi Dr. Kligman! You made it here a little early! Welcome!
Pamela: You have to hit refresh constantly in this chat room to keep up with the conversation.
Pamela: Your Back! Are you having trouble Dr. Kligman...Can you talk to me??? : )
Merrill: Hello?
Pamela: Hi Merrill, I am here. We are a bit early for the chat, but Dr. Kligman is here, and this is his first time doing a chat. It looks like he may be having a little trouble getting used to it!
Pamela: Dr. Kligman are you on board???
kligman: hi pam, i am just getting used to this system
Merrill: Hello Pamela.
Pamela: He Speaks!!!! Welcome again! I am glad that you are figuring this out. Just keep hitting refresh after you send a message or while you are reading so that you are able to keep up with the conversation.
Pamela: Hi Merrill. Where did you hear about the chat?
kligman: i am ready
Pamela: We have a few early birds. Merrill or Christina do you want to take advantage of being first in and ask Dr. Kligman a question?
Merrill: The aia homepage and someone mentioned it online.
Pamela: We have Dr. Isaac Kligman here tonight from The Center For Reproductive Medicine. The chat topic tonight is infertility over 40, but Dr. Kligman can take any general questions as well.
Pamela: Any questions for Dr. Kligman???
Christina: When do I get my period back after a D & C?
Pamela: Welcome Lily!
Pamela: Dr. Kligman?
theresa: Hi Dr K I'm at Cornell and just got a low positive beta of 11.5. I am very unsure what this means and nurse didn't sound very encouraging any advice??
kligman: it depend how advanced the pregnancy was. sometimes it may take up to 6 weeks. after that time you can go to your doctor to run certain tests to assess where you are in your cycle.
Pamela: Dr. Kligman is here tonight answering questions...the topic is over 40, but Dr. Kligman will take general questions as well.
laika: Hi Dr K: I am a 40 year old woman who wants to be aggressive as possible with my treatment. I am seeing a RE at UCLA. The only tests I have done our: (1) FSH - 11 (my RE says up to 15 is normal in the lab UCLA uses), (2) progesterone - 9.5 (3) post-coital - decreased CM. The RE recommended IUI with Clomid. Is this aggressive enough? What are my chances? And when should I move on to IVF? Thanks!
Pamela: If Dr. Kligman does not get to you right away, please repost your question...
karyn: Hi, is this chat working?
Pamela: Yes, Karyn. We are just a little slow tonight. This is Dr. Kligman's first time doing an on line chat. Just post your questions...Also in this format you have to hit refresh often to follow the flow of the conversation.
theresa: Dr. Kligman -- thanks for responding - that low beta (11.6) was on day 28. So is it more important to have doubling than initial level and is there a possible ectopic issue?
Christina: Hello Dr. Kligman! I am Dr. Spandorfer's patient. I just turned 41. I started for the first time with Gonal-F and a IUI. I worked immediately but I had a misscarriage after 6 1/2 weeks. Can I still be hopeful for another healthy pregnancy?
karyn: Dr. Kligman: Does Cornell have a preferred protocol for women over 40?
Long lupron vs.flare? Pure FSH vs FSH+LH combo? BCPs before flares?
karyn: That is, for IVF?
kligman: Dear laika. in spite of your fsh levels within normal limits, i would suggest to be a little bit more aggressive than clomid. The quoted rsates for success with clomid are around 10-13% for your age. with ivf the rates vary according to the center. In ours for instance those are in the order of 34 % (That is delivery rate per transfer). altough i do not think that you should go directly into ivf, with the limited information that i have of your case i would suggest to start with gonadotropin injections which provide you with a greater chance for success than Clomid, especially if combined with IUI. if you are not succesful after a couple of cycles, then i would say that it is time to proceed with IVF
Pamela: Dr. Kligman is welcoming questions....
laika: Thank you!
kligman: Teresa: a Beta of 11 on day 28 is unfortunately a low level. you should follow it very closesly
laika: How many cycles should one do of IVF before they should probably call it quits?
kligman: karyn: it depends on age, fsh level and previous response to other protocols
lilly: Hi Dr Kligman. Do you know if gum disease can cause m/c?
Merrill: Dr Kligman, can extreme stress cause IVF not to work?
kligman: laika: if you have a good respose to the meds and a good number and embryo quality, there is room for repeated cycles . however if there is poor response even with the aggresive protocols, other options such as donor egg should be considered.
kligman: lilly: i have never seen a study in the literature linking both of these conditions.
jg: Hello Dr Kligman. I have a history of fast response to injectables/IUI I ovulate b/t CD7-9 with usually a dominate follicle on low doeses of medicine (1-2 amps). Does this give me a bad prognosis for IVF? Will lupron help?
Previous FSH 8
Age 39 1/2
Deedee: Dr.Kligman, I am 43.1, just came out of a cancelled IVF (4amps GonalF75IU) ttc#1, had 1 m/c last year.. fsh 11, then 9.. any recommendations?
laika: Speaking of donor eggs, is anyone doing that research in the US of transferring the DNA of the woman into the Donor egg?
Pamela: Laika,
They were doing nuclear transfer studies are NYU, but they stopped due to government pressure. I don't if anyone is doing this research in the United States anymore.
kligman: Merrill. In general for extreme stress to cause infertility there needs to be a profound alteration in the woman's menstrualk cycle frequently resulting in absolut lack of periods. even under extreme circumstances, women achieve pregnancies. altough of course a stress free life helps for your general well being it is hard to prove that the contrary has an impact in a cycle outcome. has an impact
lilly: Dr Kligman I am 42 and had 1 m/c from d/e at 7 weeks. I am doing a FET with blasts. Should I stop all caffeine and alchol before transfer?
Merrill: Thank you Dr. Kligman
kligman: jg. not necesarily. in a lupron cycle, the response could be totally different.
karyn: Dr. Kligman: what would you classify as "poor responder" to meds?
Would 4 good eggs at age 43, with max IVF stimulation, considered a poor,normal, or good response?
Deedee: How good an indicator is FSH? for response to meds?
kligman: lilly: i would decrease the caffeine intake, and definetely limit the alcohol consumption, especially if a pregnancy results
jg: Thank you Dr
kligman: Karyn: The issue with the number of eggs is that at 43 you prefer to transfer 5 or 6 embryos to get an approximately 16% delivery rate /transfer. having 4 eggs may result obviously in 4 orless that embryos which would considerably decrease your chances
kligman: deedee: it is an indicator of response, number and quality of eggs retrieved and ultimately of ivf success.
theresa: Dr. Kligman thank you for your response.
Deedee: thanks Dr.Kligman, how is it that FSH tends to vary so much between labs?
Christina: Hello Dr. Kligman? I am Dr. Spandorfer's patient. I just turned 41. I started Gonal-F with IUI and it worked after the first try, so I was thrilled, but I had a misscarriage after 6 1/2 weeks. Can I still be hopeful for a healthy pregnancy?
jg: Dr how do you feel about taking herbs while on stims for IVF?
kligman: Christina: as you know the risk for miscarriage increases with age. however the fact that you got a pregnancy on your first try should be encouraging.
karyn: Dr. Kligman: Are you saying Cornell's delivery rate/transfer for 43 y/o is 16%?
mskvetche: Can I find out if there are any specialist in Ft. Lauderdale?
kligman: jg some herbs contain estrogen and may produce misleading results on baseline levels-like showing a low fsh - when it really is high. Other than for that fact i do not have any comment
Rebecca: Dr. Kligman: This question is not really age related, but I'll give it a try. I am currently preparing to start an IVF cycle soon. The last time my prog. was tested it was 8.5 and I was told to start Lupron in 2 days. At what point of my menstraul cycle would my prog. be 8.5? How many days after that can I except my period? Thank you
Rebecca: I mean expect my period.
Christina: Dr. Kligman: Can the doctor find out about other medical conditions during a D& C?
lilly: Dr Kligman The embryos were frozen at 2 days. RE is going take them to blastocyte. Do I have a good chance of success with this?
kligman: karyn:Last report for /99 of 43+ 15.2 ( check our website and choose statistics)
Merrill: Dr Kligman, do you know what causes identical twinning in IVF done without assisted hatching?
kligman: christina: The embryo can be tested for chromosomal anomalies
Rebecca: Mskvetche- that's a cute name!
lilly: Dr Kligman On my last FET 1 embryo split in two in the petridish. Is this very unusual?
kligman: merrilapproximately one in 600 embryos can result in identical twins . hatching has been attributed as a cause. the other genetic conditions that cause twinning in nature still operate in an IVF transfer as well!
Christina: Dr. Kligman: I meant medical conditions on the uterus, not the embryo. I my case there was chromosomal abnormalties.Can next pregnancy have better eggs?
mskvetche: Is the Dr still taking questions or is he gone already
Pamela: Dr. Kligman is still taking questions.
Deedee: Dr.Kligman: I'm 43, had 2 pg (1 m/c and 1 abortion) is pg a positive indication to still be able to conceive? ttc#1
karyn: Dr. Kligman: Is advanced maternal age >40 with multiple failed IVF's an indication for co-culture at Cornell? How effective is it in these cases?
KT: Dr. Kligman: I am 44 and will be starting an injectable protocal next month. I jog 4 miles 3 days a wk. My heartrate is always under 140. should I not run during treatment?
kligman: christina: uterine anomalies are usually diagnosed with either an ultrasound, saline ultrasound, hsg or hysteroscopy. durying a D&C if your doctor suspects any of these abnormalities, he will proceed with the other tests that i mentioned. next pregnancy can ceratainly - and hopefully- have a better outcome.
Merrill: Dr Kligman, in August at age 40 I became pg from my only ivf with identical twin boys. My perfect boys were stillborn on 3/2 because of a knot in their cords. I am in a state of extreme grief. Because I am 41 I have to start again right away. My day 3 bloodwork is all normal. Is there any reason I would not get pg again?
kligman: karyn: multiple failed ivf cycles after age 40 for poor response and low number of eggs is not an indication for co culture. co culture helps improve embryo qality but ovarian reserve plays definetely a very important role
Pamela: Merrill,
I am so so sorry.
Deedee: Dr.Kligman, according to Cornell, what is a decent FSH?
kligman: merryl i am deeply sorry to read your note. again, the fact that you got pregnant on your first try should be a good prognosticator for your upcomming cycle. good luck!!
Merrill: Thank you Pam. I came very, very close to my dreams of a family.
lilly: Merrill,
I am very sorry.
Marla2: Dr. Kligman, Is there any indication that the longer the time spent on suppression drugs (Synarel) before starting stims, the fewer eggs will be retrieved?
kligman: deedee; in our center a fsh below 20 is considered normal to respond to a previous question ech lab has its assay and its experience in terms of outcome with specific results. that is why each center requires the day 3 fsh levels be done in their lab
Christina: Merryl: I am so sorry for you and wish you the best next time.
Rebecca: Dr. Kligman: This question is not a related, but I'll try my luck. I am going to be starting an IVF cycle soon. The last time my prog. was checked it was 8.5. I was told to start Lupron two days later. At what point of my cycle should my prog. be 8.5? Hos soon after that result should I expect my period? Thank you
Merrill: Thank you for your response Dr Kligman
kligman: It was a pleasure. i am sorry that my typing is not as fast as i would like, i hope i clarify some of the many issues and hope to do this again soon.
Deedee: thank you Dr.Kligman, I am at Cornell now and will test FSH on D2
lilly: Thank you Dr Kligman
Merrill: Thank you Lily and Christina
Pamela: Dr. Kligman, Thank you for coming...if anyone has anymore questions, please post it on our physician moderated message boards at
You are also welcome to remain in this room and chat among yourselves!!! Good night everyone!!!
Christina: Thank you Dr. Kligman for all your information.