Ivy: after being diagnosed with endometriosis what should be the next step?
Ivy: Is the larascopy enough to clean away the endometriosis?
massimo: is the genetic male infertility today
most frequent?
sallysandra: Hi
pamela: Hello. We will be starting the chat as soon as Dr. Bar-Chama gets here! The clock on the room is off. He will be here at 8:00.
sallysandra: I have never been in one of these bofore
sallysandra: ok
pamela: The clock is fifteen minutes fast!
pamela: When Dr. Bar-Chama gets here, you just ask your questions! Hit the refresh button often to keep up with the chat.
jj: How many people usally participate in these chats?
pamela: The size varies. Anywhere from ten people to seventy! We have seen the number of participates go down in the summer. I guess people may be doing other things like traveling or actually taking a break!! The size also depends on the subject. The general chats gets the highest attendance.
pamela: Are you AIA members, or did you just wander in???? From where????
jj: I am not a member...just happened across your website. My husband and I have been trying to get pregnant for about 6 months now. My OBGYN has so far not been interested in doing any testing. I am hoping to start gathering info...
pamela: This is a good place to begin. There is a lot of information on the site and if you send me your name and address via the form on the homepage, we will send you a newsletter.
pamela: Hi Bill!
William: hiya Pam, how's life?
pamela: Call me after the chat and I will tell you ALL about it ; )
pamela: We are still waiting for Dr. Bar-Chama, and then we will begin the chat!!
greenacres: Pamela, it is a priveledge to be here with you today. I am Sandra Green.
William: okeydokey..*smile*
greenacres: I believe we had spoken by e-mail a few times regarding infertility insurance legislation in WI.
pamela: Hi Sandra! It's a privledge to meet you too!
greenacres: My husband and I have just decided on Donor Insemination. We have been through a lot.
William: Btw, I'm working on a project here so am just lurking about, but I'll give you a call at a little after 9
pamela: Dr. Bar-Chama is coming! I am helping him right now!!!
chris: what is the success rate for pregnancy - icsi with sperm aspiration
pamela: Dr. Bar-Chama is having trouble folks! I will be right back!!!!! Bill make chit chat!!!
sallysandra: It seems to me that i am hearing a lot of stories lately about poeple with MF infertility who try treatments for years with no success and then suprisingly get PG on their own.
greenacres: Chris, from what I read, there's about a 20-30% success rate with each egg implanted back into the uterus.
greenacres: Sally, that does happen but not to everyone obviously. I'm hoping that after we get PG with Donor, that 1-2 yrs. down the road that happens to us. The chance is there for us. I wish it were for everyone going through MF.
pamela: Welcome Dr. Bar-Chama! Isn't technology wonderful!!!
William: OK, here's a topic, discuss among yourselves...
sallysandra: I am hoping the same thing
greenacres: WELCOME Dr. Bar-Chama !!
William: oh, looks like the server clock is 20 minutes fast again
pamela: Dr. Bar-Chama is ready to take your questions!
sallysandra: I keep having to hit my refresh button to get the messages rolling
drbarchama: HELLO This is Dr Bar-Chama From Mount Sinai Looking forward to answering your questions
greenacres: Whom should go first ?
sallysandra: What do you think of people getting PG on their own with a count of 4 mill
greenacres: Yes Sally, that's the way these Chatrooms work. It's kind of strange.
pamela: Greenacres---just jump in!!!
sallysandra: ok
drbarchama: Sally Sandra
A count of 4 muillion can mean a total count of 4 million ot a count of 4 million per ml if the latter is accurate the total count an be obtained by multiplying by the volume
The motility is critical as well In summary for a n IUI to be effective a total motile count of greater than 5 million is recommended and that is also reommended for attempting naturally
greenacres: Ok here goes. I hope you are ready. Long story short. DH had bilateral microsurgical vasoepididymostomy because of complete azoospermia in June of 99. We NOW have 30 million TOTAL sperm with a motility of 1-5%. Dr. Silber says "wait 6 more months", we have decided on DONOR insemination starting in October. What do youthink? Do we REALLY have a chance of conceiving naturally after a surgery like that or should we not waste anymore time and move on?
sallysandra: My hubbie had a varicolel repair, on the report it read spermatic vien ligation..could this be our problem?
greenacres: that is 30 million TOTAL sperm. So, that's 7.5 per ML.
pamela: Dr. Bar-Chama is working folks! This is his first time, and his typing is a little slow!
drbarchama: Chris
success raes with ISI and testicular sperm retrieval depends primarly on the womans age as well as the cause of the need for testicular retrieval. In cases of obstruction (CAV or vasectomy) success rates should be equal to the general population 25%-40% depending on the lab used
chris: but, once the fertilization takes place thro ICSI, the chances should be similar to that of IVF without icsi.
cnr: My husband has a varicocele and we are wondering what the chances of getting pregnant will be if we go through surgery. Anyone know?
greenacres: Pamela, just a suggestion. What you can do is if someone wants to ask a question they type in a "?", you write down their names in order and ask them to submit their question when the Dr. has finished answering the last one. That's the way I do my chat rooms. It keeps it in a lot more order. Just a suggestion though, you can ignore me if you like :)
drbarchama: Green acres
the motility of 1-5% is suitable for IVF/ICSI and is certainly an option available at present using your husbands sperm otherwise natural pregnancy is unlikely but not impossible good luck
pamela: Good suggestion! I will try that next time. We are hoping to get some technology soon! Right Bill??? ; )
Lkp: My husbands count has varied from a low of 3 mil to a high of 80 mil pre wash, with varied motility as well. We never know what we are going to get for iui. What are some of the reasons for this? He does not have any variacocele as per his urologist and we were told even if he did it would not pay to have surgery due to my infertility problems as well.
greenacres: Thank you Dr. That is what I thought. IVF/ICSI isn ot an option for us due to money. DI is acceptable for the both ofus. Thanks again.
drbarchama: CNR
success rates following varicocele repair are dependant on the initial semen analysis your age hormonal profile all these should be conidered in the equation
sallysandra: Can cardizem cause problems with sperm?
greenacres: Dr. ....what do you think of the nutritional supplement "Proxeed" ? Do you suggest this to your male patients?
William: greenacres, that's a good suggestion, we're actually working on a chatroom program that will do that online!
sallysandra: We are bombarding this poor guy with questions LOL
chris: cornell or st.barnabas which one is better for male factor ivf.
cnr: the initial semem analysis was not good and the Dr. said IVF with ICSI would be our only option and we are not willing to do that. I am 25 hubby is 27 and hormaonal profile is normal, what do you think, will varicocele repair work. It is a normal size varicocele, they could not feel it but found it on ultrasound.
Thanks for your answer
drbarchama: Chris
once fertilization occurs with ICSI it is important to assess embryo quality to give an accurate sense of pregnancy success if embryo qalit is good success rats should be comprable
Stacy: Lets give the Dr. a chance
greenacres: Cool WILLIAM. That is so nice. Sometimes these chatrooms just get bombarded and the person that is visiting can't even keep up LOL !!
nancy: In general, what are the odds for a pregnancy after bilateral microsurgical
vasoepididymostomy because of complete azoospermia? Can you also comment specifically to a current SA where the counts were 23mil per cc(4.5 cc) and 7% motility, where 37% of non-motile cells are viable. Thank you Dr. Bar Chama
drbarchama: sally sandra
a varicocele repair technically described is a spermatic vein ligation
sallysandra: Thank you, this has always bothered me!
greenacres: NANCY, we have EXACT same male factor diagnosis!!
drbarchama: green acres
nutritional supplements can be beneficial for sperm function
especially in patients following an evaluation who have been recommended to attempt naturally or IUI
I recommend antioxidant therapy as well as proxeed Proxeed is L-carnitine and may improve sperm motility
greenacres: Dr. What causes HIGH VISCOSITY and is there any "nutritional supplement" or anything we can do to reduce or thin the fluids so the sperm have better motility?
greenacres: Thank you. What is involved with "antioxidant therapy involve"?
drbarchama: LKP
It is normal to have fluctuations in sperm count although what you are describing is slightly more than expected
Try alternating abstinence periods as well as if on that day the count is very low produce asecond sample and combine
chris: which inst would you suggest for male factor ivf.
Lkp: Thank you Dr. Barchama
drbarchama: nancy
following Vasovasostomy pregnacy rates are 50-60% however following vasoepidiymostomy the take home pregnancy rate is much lower and is bout 20-30%
drbarchama: greenacres
antioxidants used include vitamin e andc zinc glutathione
greenacres: Can the zinc glutathione be purchased at ahealth food store?
drbarchama: chris
where do you live
drbarchama: green acres
these antioxidants are available at the health food stores
camille: what procedure do you recommend for a count of 8 million with low motility but normal morphology? everything w/me is ok and i ovulate monthly.
greenacres: In what dosages and quantities should these be taken?
pamela: Chris,
The programs in the NY metro area are all very very good. It is really your choice. Cornell, NYU, Saint Barney, Richard Scott in Morristown, Mount Sinai cycles with NYU...there are others...but those have the highest numbers.
drbarchama: camille
resulats will depend on your age as well
is this 8 million per ml and what is the total count
this certainly sounds sufficient for initiating IUI's as oppoed to jumping directly to iVF/ICSI
chris: washington dc
camille: i am 32, dh 37. volume was 5 ml and it is total count pre wash. not sure of count after wash. would meds help us at all since i do ovulate on my own and really want children but have low desire for multiples.
drbarchama: Green acres
exact dosing has not been determined
would recomend standard supplements
vit e 400IU glutathione 400mg ect
drbarchama: camille
I would use 3 attempts at a specific therapy prior to moving forward ( 3 natural and then 3 IUI's prior to considering IVF
chris: we failed 2 cycles with ivf / icsi despite transferring 10 embryos.
My wife hyperstimulated both times.
camille: thanks doctor, gotta go and will let you take care of everyone else. thanks again for the info.
pamela: any other questions????
maria: my husband has low morphology and motility. At what point is ICSI suggested.
greenacres: Yes, what causes HIGH Viscosity ?
drbarchama: Maria
low motility is more mportant than low morphlogy
try to calculate the total motile sperm count and if this is above 5 million IUI and natural can be offered prior to ICSI
also your age is important
rvl: I guess i just want to know your advice on sertoli cell only syndrome. I guess its unlikely but is there any reversing of this condition? should DH consider genetic testing to find out more, even if we won't attempt IVF/ICSI. thanks
drbarchama: Green acres
high viscosity is primarily a prostate abnormality and can be due to inection antibodies nutrional deficiency and needs to be worked up
IUI's where sperm is processed is extremly effective
drbarchama: RUL
even if the pathology reads sertoli only testicular sperm may be present and used for ICSI
genetic testing is highly recommended (CF profile , Y deletion and Karyotype)
It may explain the etilology and many patients find that important for their relationship
greenacres: Dr...what would cause "thickening of the seminiferous tubules". This is what was found on my Dh's testicular biopsy.
greenacres: Sorry I have so many questions, but it's GREAT to get another Dr's point of view !! Thanks Pamela and Dr. Barchama.
drbarchama: green acres
thickening of the semineforous tubules on pathology is nonspecific more important is the level of germ cell concentration and maturation
maria: Have any studies been done on the children conceived using ICSI
drbarchama: hi corey
thanks for joining in
pamela: Dr. Bar-Chama you are doing Great!!!! If Patients want to find you, could you please give your phone number???
greenacres: Do you consider "pathological obstructive azoospermia with epididymitis" a MEDICAL CONDITION" that required treatment? (this is an "insurance" thing :) LOL !!
drbarchama: Pamela

The Mount Sinai Hospital
greenacres: Are we done now with the chat ?
pamela: Greenacres..we have ten more minutes...the good doctor is now answering Maria's questions...can't you hear him typing??? LOL
greenacres: LOL, you are too funny !!
drbarchama: maria
the genetic abnormality rate in children concieved fromICSI have for the most part not revealed any incresed incidence rate of abnormalities
thousands of ICSI chldren have been and will continue to be closely followed
rvl: i don't know if i sound paranoid but is genetic analysis ever used against people, i mean does it stay in your medical files for insurance companies to look at and is it just specific to infertility aspects or is it comprehensive? thanks
maria: thanks, I heard the rate is the same as when conceived naturally.
drbarchama: rvl
male infertility genetic tessting does not reflect life expectancy or disease risk prognosis
pamela: To The Folks Who Haven't Asked A Question Yet.....Ask Now...the clock is ticking and Dr. Bar-Chama's fingers are starting to get sore!!!!
greenacres: Dr. Do you think "pathological obstructive azoospermia with epididymitis" is considered a medical condition needing treatment ?
rvl: thank you for your time and answers
pamela: If there aren't any more questions, I will thank Dr. Bar-Chama!!!! Any last dibs?????
maria: Thanks doctor for your time. I've enjoyed sitting in on this chat. Gotta go now! Good night all.
William: Thanks for joining us this evening, Dr. Bar-Chama!
Pam, thanks again for arranging the chat, I'll be calling in a few minutes!
pamela: Thanks Dr. Bar-Chama!!! Please come again!!!!
greenacres: Thank you Dr. ..it was great to get another doctor's point of view. Pamela, thank you and again, it was very nice to "meet" you. Have a good night.
*****POOF**** LOL !!
drbarchama: good night and I hope things work out for all of you
greenacres: GOD SPEED !!
greenacres: Pamela, do you have bulletin boards to post on at AIA ?
greenacres: I'll go check it out.