Chat Transcript for 3/23/2010

ivfmoderator(P)	Hi everyone and welcome to Boston IVF's Fertility Chat. If you have questions don't hesitate to submit them now.
ivfmoderator(P)	Today we are joined by Carol Lesser, NP, a nurse practitioner at Boston IVF's Brookline Center. For more than 25 years Carol has provided fertility treatment to individuals and couples. She is NAACOG certified as an OB/GYN Nurse Practitioner and NCC certified in Reproductive Endocrinology and Infertility.
ivfmoderator(P)	We'll get started at about 4:00 PM so submit your questions now!
Carol-Bostonivf(P)	Hi everyone let's get started!
Carol-Bostonivf(P)	Hi Jess, it's Carol :)
Kim(C)	Hi - I am doing IVF at a fertility center in Vermont. I had my 5 day embryo transfer on 3/15. I don't go for a blood test until tomorrow. But I used 2 home pregnancy tests on Sunday and one today and all 3 came up postiive! I'm dying to know if it could be a false postive caused by Ovidrel (my dose was 250)... do you think it's accurate to use a home test before the blood test?
Carol-Bostonivf(P)	While it is always safer to wait for your blood test, I would suspect with three positive home tests that you will most likely see another positive result. I am guardedly optimistic for you!! :)
jess(C)	Hi Carol, So to start, My fiance and I desperately want to have a baby. Unfortunetley he had a vasectomy 8 years ago :( We are looking for the best and most inexpensive way to go. I am 23 and have been checked by my GYN and I am fertile. Advice?
Carol-Bostonivf(P)	Hi Jess! My best advice to you is to speak with one of our insurance coordinators to find out how much it would cost for an IVF cycle out of pocket and then compare this to the cost of a vasectomy reversal. Both can be quite successful considering your relative youth. The prognosis for a successful vasectomy reversal can only be explained properly by a urologist, who knows your case. You have two very good options here. If we can guarantee that IVF would work on the first try and let you freeze extra good quality embryos for future use, this would be the best way to proceeed. However there are no gauarantees and reversals can fail over time. It's also important to have the surgeon extract sperm in case the reversal fails over time. that sperm can also be used for IVF in the future. I would suggest speaking with our Patient Liaison Rhonda Gannon, who can walk you through how you wanted to proceed. She can be reached at 781-434-6554
Beth(C)	I am considering IVF, but am worried because I've heard that it increases the chances of miscarriage. What is your view? If you need to know -- I am 27 -- and pretty healthy. I need the fertility treatments because of PCOS.
ivfmoderator(P)	Hi Beth. I'm not sure where you rec'd that information but it is NOT true that IVF increases miscarriage. There is a SLIGHT risk of miscarriage with PCOS, so perhaps that is what you were told? If other methods have not worked in the treatment of your PCOS, then IVF is the perfect way for a successful pregnancy while controlling for the risk of multiple births. Miscarriages are always a risk and are generally corrolated with a woman's age. Our physicians here at Boston IVF are very familiar with PCOS and take every precaution to facilitate a healthy pregnancy.
jess(C)	Whats the price range usually for both? i know it varies but do you have a guess?
ivfmoderator(P)	I would suggest speaking first with an insurance coordinator -- Diane DeRosa -- to help you help walk you through the costs as I'd hate to misspeak. She can be reached at 781-434-6500. "Clinically" speaking, treatment-wise, Rhonda Gannon is a great liaison to run your thoughts by.
abc123(C)	Considering a frozen cycle, can you explain the process? I understand its much less invasive than a fresh cycle, but what's the typical time frame from start to finish?
ivfmoderator(P)	Hi ABC, you are correct -- thaw cycles are much easier to complete. The approach can be medicated or non-medicated -- depending on physician and patient preference. In the case of medicated cycles, generally it takes about two weeks of oral pills and/or patches. At Boston IVF, we use a vaginal progesterone preparation that prepares the uterine lining for implantation. Embryo transfer is carefully timed and if pregnancy occurs, women stay on the medications until the 10th week of pregnancy. In the non-medicated scenario, which works best for women with regular menstral cycles, they are instructed to use a home-ovulation kits and embryo transfer is timed according to the LH surge and rise in progesterone detected by a blood test. Both ways work -- so it's the patient and MD who decide together which is best.
Beth(C)	ok thanks for clarifying for me! do you know what % of ivf cycles produce a pregnancy for someone in my situation?
ivfmoderator(P)	Beth -- IVF rates would be in the 40-50% rang per cycle. These rates might be slightly lower considering your PCOS and other factors I do not have access to.
jess(C)	Thank You!
ivfmoderator(P)	You are welcome!
valerie(C)	Hi - is the success rate lower for a frozen embryo transfer than it is for a fresh ivf cycle? If so, is it because some of the embryos don't thaw or because they are less likely to implant after they've been frozen?
ivfmoderator(P)	Hi Valerie -- success rates at Boston IVF are comparable between fresh and frozen embryos. This is largely due to the fact that at Boston IVF we freeze only high quality embryos. In other programs, if all embryos are frozen, success rates may be much lower, because they are including embryos of varying quality.
ivfmoderator(P)	Valerie, if you have more questions regarding this, don't hesitate to contact our patient liaison -- Rhonda Gannon -- at 781-434-6544
ivfmoderator(P)	Thanks everyone -- it looks like we're out of time for today. If you have any additional questions don't hesitate to contact our patient liaison Rhonda Gannon at (781)434-6554. She is happy to answer any of your specific questions.

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Chat Transcript for 3/16/2010

ivfmoderator(P)	Today we are joined by Carol Lesser, NP, a nurse practitioner at Boston IVF's Brookline Center. For more than 25 years Carol has provided fertility treatment to individuals and couples. She is NAACOG certified as an OB/GYN Nurse Practitioner and NCC certified in Reproductive Endocrinology and Infertility.
susiew(C)	We are searching for reputable egg donor clinics/agencies in the north east, perhaps connected to universities. Are there any you recommend or does Boston IVF have a donor database ? If so, we would like access. Thank you
Carol-BostonIVF(P)	We have an active donor egg program. I will suggest you call our team for their best resource suggestions. I know that many of our pts use an agency called donor Source. You can call our DE team 781 434-6500. Best of luck.
nt(C)	Can women 45 years old and older get IVF services with Boston IVF?
Carol-BostonIVF(P)	While we strongly discourage IVF with one's own eggs at age 45 and insurance generally will not cover IVF at your age, there have been occasional exceptions made. It all depends if there is a compelling reason to offer IVF to a particular 45 yo patient . We offer donor egg treatment here until age 50 which is generally the recommendation that most MD's would make at 45. it is not that occasionally 45 year olds never get pregnant but that IVF services have not been found to raise the chances of success beyond trying naturally. This is because success is primarily based on egg quality which IVF cannot control. There are occasional exceptions made when women have above average egg reserve and another reason like blocked tubes where IVF is the ONLY way to be able to try. We always recommend a consult so one of our MD's can explain your options face to face as this can be difficult for some women to accept.he bottom line is that if you are ovulating at age 45, your chances of success with your own eggs will be the same with and without treatment if your tubes are open and if there are no other problems beyond age. good luck figuring this out.
nt(C)	Are there any IVF centers in or close to Chelsea?
Carol-BostonIVF(P)	Yes, our Boston Center location is near Chelsea -- about 7 miles distance.
nt(C)	What is the age limit on IVF services?
Carol-BostonIVF(P)	Generally IVF is offered until the age of 43-44 -- depending on several factors.
nt(C)	Is the process Boston IVF uses the same as other fertility centers?
Carol-BostonIVF(P)	Yes, Boston IVF is a full service fertility center. We offer a variety of cutting-edge reproductive technology treatments as well as a in-house mind/body program for support that many find beneficial....including acupunture, mind/body groups, yoga and counseling.
Kim(C)	Hi - I am going through an IVF cycle with another clinic out of your area.. I am concerned because I was taking the wrong dose of progesterone suppository after egg retrieval -- I just realized / fixed the mistake the day of my blastocyst transfer... Did I totally ruin this cycle by not using enough progesterone after egg retrieval?
ivfmoderator(P)	Because you are not our patient, it is VERY important for your to review this with your current physician. HOWEVER...generally a temporary error in progesterone dose should not be a problem. Without exact information it is impossible to completely reassure you but hopefully your team can. On a positive note, there are many different doses prescribed routinely, so perhaps it may not be as big a mistake as originally perceived.
nt(C)	Thank you for the information on age; my cycle for March is late right now so I'm worried that maybe I would not be able to have a pregnancy on my own and was hoping IVF would be helpful in this case. (I did the pregnancy test ($1 test) and it was negative. How do I know if my body is done being able to reproduce?
Carol-BostonIVF(P)	Hi and thanks for your question. i would suggest making an appointment with your gynecologist and request an FSH level at the very least. When FSH levels are elevated it suggests that a woman is moving into menopause. While this may not absolutely indicate the end of reproductive capabilities, it strongly suggests that a woman must consider alternative ways to start a family.
nt(C)	How does weight affect not getting pregnant? I am about 50 lbs overweight?
Carol-BostonIVF(P)	Generally 50 lbs. will not have a "make or break" effect unless it affects your ovulation. We offer nutrition services via our Domar Center for Mind/Body Health to help patients achieve and maintain their optimal weight.
trish(C)	Is there anything that can be done for increasing sperm motility?
Carol-BostonIVF(P)	It is important for your husband to see a urologist who specializes in fertility. Slight decreases in motility are generally not a problem if everything else is normal. For some couples, IUI, IVF, etc can be very helpful so it's good to be under the care of a reproductive endocrinologist. Via our Male Infertility Clinic we offer these services with Dr. Steven Lazarou and other affiliating urologists.
nt(C)	Thank you, does this have to be with an OB/GYN or can it be with my primary care physician?
Carol-BostonIVF(P)	This can done by any physician.
trish(C)	We have just had our 2nd failed IUI. How many times is it reasonable to try until we think of IVF?
Carol-BostonIVF(P)	If your physician is recommending IVF then it is generally recommended over IUI because of its higher success rate and better control over the potential of multiples. Of course, this is a bit more tricky to advise without knowing the specifics of your situation. If you have more specific questions please call our Patient Liaison Rhonda Gannon who will be more than happy to discuss your specifics :) She can be reached at 781-434-6554.
nt(C)	Is there a rating of reproductive centers and how the rank?
Carol-BostonIVF(P)	Yes, you can go to the SART website but please remember the specific info they report is several years behind current rates. www.sart.org.
nt(C)	Is there such a thing as IVF services in a doctors office vs a big reproductive center? Or is it not the way to go?
Carol-BostonIVF(P)	The collective experience and wealth of services offered at Boston IVF cannot be matched and are not available in a regular physicians office. Even though we are one of the larger clinics, we pride ourselves on individualized, patient friendly approach. And with our MD's on staff at Harvard Medical School you can be assured you're receiving the highest quality of care.
nt(C)	Also, not so much a reproductive question but is a $1 test just as good as a $10 test?
Carol-BostonIVF(P)	Unfortunately unless we know the name of the test we cannot know which is better than others. Some patients say cost doesn't matter while others do. I would suggest contacting our Patient Liaison Rhonda Gannon at 781-434-6554 to discuss the test you are using.
ivfmoderator(P)	Thanks everyone -- it looks like we're out of time for today. If you have any additional questions don't hesitate to contact our patient liaison Rhonda Gannon at (781)434-6554. She is happy to answer any of your specific questions.