images
Sponsors

Ferring Pharmaceuticals, Inc. is the Presenting Sponsor of the AFA Website

Ferring Pharmaceuticals

New Patient Treatment Options

May 27, 2008 - Tuesday
8:00 PM to 9:00 PM (EST)
Guest Speakers: Jacqueline Guttman, M.D., Northern Fertility and Reproductive Services

Categories


[Tue May 27 06:23:18 PDT 2008] abreeden joined.
[Tue May 27 06:23:59 PDT 2008] abreeden left.
[Tue May 27 08:25:58 PDT 2008] tara joined.
[Tue May 27 08:26:52 PDT 2008] tara left.
[Tue May 27 10:16:35 PDT 2008] falln_rayne joined.
[Tue May 27 10:16:43 PDT 2008] falln_rayne left.
[Tue May 27 13:36:35 PDT 2008] rme joined.
[Tue May 27 13:36:39 PDT 2008] rme left.
[Tue May 27 16:11:25 PDT 2008] jackie joined.
[Tue May 27 16:59:23 PDT 2008] Corey_Whelan joined.
[Tue May 27 16:59:23 PDT 2008] dianakeane joined.
[Tue May 27 16:59:24 PDT 2008] sb10847 joined.
[Tue May 27 17:00:30 PDT 2008] Corey_WhelanHi all, welcome to tonight's chat with Dr. Jackie Guttman on New Patient Treatment Options. I'm Corey Whelan, your chat moderator. I'm very happy to be here and welcome all of you.
[Tue May 27 17:00:42 PDT 2008] jackieThanks
[Tue May 27 17:01:16 PDT 2008] Corey_Whelan To[Private] jackieHi there. Are you Jackie Guttman?
[Tue May 27 17:01:26 PDT 2008] jackie To[Private] Corey_Whelanyup.
[Tue May 27 17:01:37 PDT 2008] Corey_Whelan To[Private] jackieok! We can get started then. I wasn't sure
[Tue May 27 17:01:47 PDT 2008] jackie To[Private] Corey_Whelani am ready.
[Tue May 27 17:03:09 PDT 2008] Corey_WhelanWelcome sb and diana. Dr. Jackie Guttman is here and ready to take your questions. Welcome, Dr. Guttman. Can I ask that you give us your web address?
[Tue May 27 17:03:46 PDT 2008] jackiewww.northernfertility.com
[Tue May 27 17:04:38 PDT 2008] Corey_Whelanthanks. Dr. Guttman, can you tell us a little bit about what to expect, as a new patient when entering an IVF center?
[Tue May 27 17:05:02 PDT 2008] Corey_WhelanDiana, please feel free to post.
[Tue May 27 17:06:02 PDT 2008] jackieAbsolutely. The vast majority (if not all) IVF centers also do "general infertility" (all the rest of the stuff that we do other than IVF).
[Tue May 27 17:06:43 PDT 2008] jugijules joined.
[Tue May 27 17:07:07 PDT 2008] dianakeaneThanks Corey. Dr. Guttman, i have a question regarding PCOs. Can you PCOs and not actually have a cyst?
[Tue May 27 17:07:09 PDT 2008] Corey_Whelanhi jugjiules. We are chatting with Dr. Jackie Guttman on New Patient Options
[Tue May 27 17:07:29 PDT 2008] jackieExactly what happens depends on the presenting situation. Irregular cycles trying to get pregnant, history of pelvic surgey and trying to conceive etc.
[Tue May 27 17:07:51 PDT 2008] jackiediana, yes!!!!!
[Tue May 27 17:08:52 PDT 2008] galo joined.
[Tue May 27 17:09:02 PDT 2008] jackiePCOS is the name given to the "syndrome" (thats the "S" in PCOS) that is characterized by too much male hormone and irregular cycles. The cysts do not have to be a part of it
[Tue May 27 17:09:53 PDT 2008] jackieWomen with PCOS often have many very small cysts almost looking like a strand of pearls in the ovary.
[Tue May 27 17:10:23 PDT 2008] Corey_WhelanHi galo, please feel free to jump in at any time
[Tue May 27 17:10:47 PDT 2008] galook
[Tue May 27 17:10:53 PDT 2008] galotanks
[Tue May 27 17:11:00 PDT 2008] Corey_Whelanthat's why we're here
[Tue May 27 17:11:08 PDT 2008] jackiesmile
[Tue May 27 17:12:17 PDT 2008] galoto do an IVF
[Tue May 27 17:14:08 PDT 2008] galo left.
[Tue May 27 17:14:11 PDT 2008] jackieGalo, do you have specific ??? about doing IVF or do you want a general sense of the process?
[Tue May 27 17:14:25 PDT 2008] dianakeaneI have always had regular peiods; but i have the rest of the symptoms - infertility and hirsutism. I have been struggling with my physician and gynecologist as well. The hormone levels seem to be ok except progesterone which has been fluctuating. It's frustrating as i know sth is wrong but i don't have a diagnosis yet.
[Tue May 27 17:14:48 PDT 2008] sb10847 left.
[Tue May 27 17:15:10 PDT 2008] jackieIn your case, the little cysts on the ovary would make the diagnosis.
[Tue May 27 17:15:51 PDT 2008] jackieBut you may have idiopathic hirsutism. Whisch really means that we are not sure why.
[Tue May 27 17:16:24 PDT 2008] jackieIt may be that your hair follicles are very sensitive to the male hormone.
[Tue May 27 17:16:44 PDT 2008] jackieAnd the infertility may or may not be rel;ated
[Tue May 27 17:17:15 PDT 2008] bookieboo joined.
[Tue May 27 17:17:34 PDT 2008] jackieHi bookieboo
[Tue May 27 17:17:38 PDT 2008] Corey_Whelan.Hi bookieboo. We are chatting with Dr. Guttman, please feel free to jump in at any time
[Tue May 27 17:17:55 PDT 2008] bookiebooThank you
[Tue May 27 17:18:21 PDT 2008] jackieCorey, while the others are typing..
[Tue May 27 17:18:29 PDT 2008] Corey_Whelanyes?
[Tue May 27 17:18:44 PDT 2008] dianakeaneDo you usually prescribe clomid to your patients with PCOS? I did 3 unsuccesful cycles of clomid and the endocrinologist recommended Femara with IUI.
[Tue May 27 17:18:50 PDT 2008] jackieAll new patients (at any office) ill have a consult with the RE
[Tue May 27 17:19:19 PDT 2008] jugijulesI have PCOS, Hirsutism, Endo, Crazy Hormone Levels, I had a Septum Resection..it seems like the only thing we have going for us is that my husbands tests come back normal
[Tue May 27 17:19:45 PDT 2008] jackieYes to the clomid. I typically move from clomid ti injectible medication if everything else is normal (including HSG)
[Tue May 27 17:20:14 PDT 2008] slspra joined.
[Tue May 27 17:20:15 PDT 2008] jackiejugijules, I am sure that there is a lot more going for you!
[Tue May 27 17:20:44 PDT 2008] jackiejugijules, did you have miscarriages
[Tue May 27 17:21:14 PDT 2008] jackieHi, slspra. Welcome
[Tue May 27 17:21:22 PDT 2008] jugijulesI had a Lap to correct all the problems they could. I had 9 cycles of failed clomid, we went through one cycle of Gonal-f with IUI and spent a small fortune. we now are going for acupunture and are now making slow progress
[Tue May 27 17:21:32 PDT 2008] jugijulesno never had a miscarriage
[Tue May 27 17:21:59 PDT 2008] Corey_WhelanHi sispra, please feel free to jump in at any time! We are chatting with Dr. Jackie Guttman.
[Tue May 27 17:22:08 PDT 2008] jugijulesi finally ovulated on my own for the first time
[Tue May 27 17:22:08 PDT 2008] teacher422 joined.
[Tue May 27 17:22:23 PDT 2008] jackieDid you have endo. Septum probably not a big part of process (really doesnt cause infertility) and now gone anyway!
[Tue May 27 17:22:27 PDT 2008] bookiebooWhat is the new patient treatment options
[Tue May 27 17:22:47 PDT 2008] slsprathanks. I've never joing one of these chats before. I happened to read the e-mail and thought I'd see what was going on.
[Tue May 27 17:23:04 PDT 2008] Corey_Whelangood! we're glad youre here
[Tue May 27 17:23:05 PDT 2008] jugijulesI did have it he said she got rid of it during the lap
[Tue May 27 17:23:05 PDT 2008] jackieBookieboo, a number of things depending on what area we are addressing
[Tue May 27 17:23:53 PDT 2008] Corey_WhelanHi teacher, nice to see you.
[Tue May 27 17:23:56 PDT 2008] jugijulesthey are now talking about doing a trigger and IUI along with acuptunture
[Tue May 27 17:24:18 PDT 2008] teacher422Thanks!! You too!
[Tue May 27 17:24:39 PDT 2008] jackiesounds good. How old are you (if its OK to ask)?
[Tue May 27 17:24:49 PDT 2008] jugijulesme??
[Tue May 27 17:25:02 PDT 2008] jackieyes jugijules
[Tue May 27 17:25:04 PDT 2008] jugijules27
[Tue May 27 17:25:14 PDT 2008] teacher422Anything new for high FSH patients who are over forty?
[Tue May 27 17:25:22 PDT 2008] jackieYou are young smile. This is good!@!!!!!
[Tue May 27 17:25:35 PDT 2008] Corey_Whelanhang on teacher, jugijules first and then you're up
[Tue May 27 17:26:16 PDT 2008] jackieThere are always things that people are talking about. Unfortunately, there is still no "magic bullet."
[Tue May 27 17:26:17 PDT 2008] jugijuleseveryone tells me that but it's so hard when its something you want so badly and trry so hard for
[Tue May 27 17:26:28 PDT 2008] bookiebooIs there anything new for PCOS since metformin, I have been on metformin for 8 years, it worked, however I have been ttc for 2 years now and cant seem to get pregnant, we did iui las month, had a follicle that measured 18.5 but when the 21 day progesterone test was done it was low only 7.1, what could be wrong. I am a little over weight bu have gotten pregnant at this weight, I am also 36 so I am confused
[Tue May 27 17:27:02 PDT 2008] jackieJugijules, absolutely agreed. But when its dark and you are alone hoprfully it helps a little to remember.
[Tue May 27 17:27:45 PDT 2008] jugijulesit does
[Tue May 27 17:28:05 PDT 2008] Corey_WhelanDr. Guttman, I think teacher has a question up, and then bookie
[Tue May 27 17:28:12 PDT 2008] jackieBookieboo, was the progesterone a week after ovulation? Did you get "trigger"? Wsa that your first month of treatment? Semen OK?
[Tue May 27 17:29:23 PDT 2008] jackieTeacher, unfortunately, though there are several things taht have tries for women over forty with high FSH none apppear to be a panacea.
[Tue May 27 17:29:33 PDT 2008] bookiebooit was on the 21st day of my cycle, not sure what trigger is but I did get OPK positive, oh I got the HSG shot, semen is ok, actually higher then normal (DH was proud LOl)
[Tue May 27 17:30:29 PDT 2008] jackieBookie (can I call you that ...), the hcg shot is the trigger! OPK positive on day 13??
[Tue May 27 17:30:41 PDT 2008] bookiebooyes
[Tue May 27 17:31:19 PDT 2008] jackieBookie, Was that your 1st IUI?
[Tue May 27 17:33:05 PDT 2008] slspra left.
[Tue May 27 17:33:08 PDT 2008] bookiebooDoc now has me on 150mg of clomid said hopefully that will raise the progesterone level, Yes i was my 1st, cant afford to do it again, I have never had this much trouble, usually my problem is carrying the baby, jus wondering if its my weight or my age, I have killed myself trying to lose weight, as usually this works but hasnt so far
[Tue May 27 17:33:12 PDT 2008] slspra joined.
[Tue May 27 17:33:54 PDT 2008] jackieHopefully the clomid with the HCG and maybe a little progesterone supplement may help.
[Tue May 27 17:34:19 PDT 2008] jackieBookie, does your insurance cover all but IUI?
[Tue May 27 17:34:22 PDT 2008] teacher422I find it extremely disheartening and unconscionable that some doctors basically REFUSE to help "over forties" mainly because they are trying to maintain a more positive success rate!...Where are the doctors who are truly trying to help women like me, instead portaying an image?....
[Tue May 27 17:34:27 PDT 2008] mscardwright joined.
[Tue May 27 17:34:55 PDT 2008] Corey_Whelanhi mscardwright. We're chatting with Dr Jackie Guttman; please feel free to jump in at any time
[Tue May 27 17:35:03 PDT 2008] mscardwrightGood Evening All
[Tue May 27 17:35:55 PDT 2008] Corey_Whelanteacher, what is your fsh?
[Tue May 27 17:36:14 PDT 2008] jackieteacher, our goal is to evaluate, counsel and treat. We do not refuse people treatment but I will sometimes tell people things that they dont want to hear (who would), but the choice to go ahead with treatment is upto the patient.
[Tue May 27 17:36:19 PDT 2008] teacher422it is 15.
[Tue May 27 17:36:40 PDT 2008] Corey_Whelanteacher, where do you live?
[Tue May 27 17:36:48 PDT 2008] jackieTeacher, have you taken meds before?
[Tue May 27 17:36:59 PDT 2008] Corey_Whelanwe may be able to help you with a referral. Some areas are better than others
[Tue May 27 17:37:01 PDT 2008] teacher422I'm in Connecticut.
[Tue May 27 17:37:28 PDT 2008] teacher422Thanks...I am not on meds...
[Tue May 27 17:37:38 PDT 2008] Corey_Whelanok. If you contact Lisa at our helpline number tomorrow she may be able to send you to an "older patient" low tech or high tech RE
[Tue May 27 17:38:00 PDT 2008] lisa_collins joined.
[Tue May 27 17:38:06 PDT 2008] teacher422I REALLY appreciate that Corey!
[Tue May 27 17:38:16 PDT 2008] Corey_WhelanHi Lisa. Welcome. Please feel free to jump in at any time.
[Tue May 27 17:38:30 PDT 2008] teacher422Is the phone number on the main page?
[Tue May 27 17:38:31 PDT 2008] Corey_Whelanteacher, of course. We wll do what we can to support you in any way that you deem appropriate
[Tue May 27 17:38:45 PDT 2008] Corey_Whelan888 917 3777
[Tue May 27 17:38:51 PDT 2008] bookieboomy insurance doesnt cover anything, I paid for the iui out of pocket
[Tue May 27 17:38:56 PDT 2008] Corey_Whelanand you can always reach me at corey@theafa.org
[Tue May 27 17:38:59 PDT 2008] Corey_Whelandon't hesitate ever
[Tue May 27 17:39:23 PDT 2008] jackie15 is not particularly high, and if you were up to it it would not be unreasonable to try though the statistical likelihood of success is prob less than 10%, but as I tell my patients, for any individual it is 100% or 0. And we hav no way to know who the lucky onesare
[Tue May 27 17:39:50 PDT 2008] jackieBookie, do you also pay for bloods, US?
[Tue May 27 17:39:51 PDT 2008] Corey_Whelanwhere is that crystal ball when you need it, huh.
[Tue May 27 17:39:56 PDT 2008] slspraWe have only been diagnosed with MFI, but bypassed that with ICSI. We have had a failed IVF and FET---both "perfect cycles" according to my RE. I'm looking into acu, but am not happy with one I went to see last week. There aren't many others in the area. Any suggestions?
[Tue May 27 17:40:05 PDT 2008] jackieyeah!!!
[Tue May 27 17:40:28 PDT 2008] bookieboolike what kind of test, it covered the 21 day progesterone test
[Tue May 27 17:40:28 PDT 2008] teacher422Thanks again...I wont, time-of course...or lack of it....is not on my side!
[Tue May 27 17:40:35 PDT 2008] Corey_Whelanslspra, you too. You can contact us for a referral to an acupuncturist in your area
[Tue May 27 17:40:53 PDT 2008] jugijules left.
[Tue May 27 17:41:06 PDT 2008] jackieIslspra it sounds as though not going with ICSI was OK (you had fresh and FET).
[Tue May 27 17:41:10 PDT 2008] jgwiggs joined.
[Tue May 27 17:41:15 PDT 2008] lisa_collins left.
[Tue May 27 17:41:16 PDT 2008] Corey_WhelanHi jgwiggs, welcome
[Tue May 27 17:41:32 PDT 2008] jgwiggsthank you corey
[Tue May 27 17:41:36 PDT 2008] mscardwrightAny suggestions for docs in Atlanta, GA? I have PCOS but tried metformin and clomid once.
[Tue May 27 17:41:48 PDT 2008] jackieslspra; sometimes it is a matter of trying again, Can you give me more info age etc?
[Tue May 27 17:42:02 PDT 2008] Corey_Whelanyes, but you'll need to contact us off screen mscard. 888 917 3777 and we can send you to a fedw
[Tue May 27 17:42:04 PDT 2008] jackieAndre Denis in atlanta
[Tue May 27 17:42:04 PDT 2008] Corey_Whelanfew
[Tue May 27 17:42:15 PDT 2008] jackieoops. An old friend!!!
[Tue May 27 17:42:17 PDT 2008] Corey_Whelanthere you go!
[Tue May 27 17:42:23 PDT 2008] Corey_Whelanoh that's ok,
[Tue May 27 17:42:31 PDT 2008] slsprawe did use ICSI. Sorry if I was confusing. It resulted in great fert. for us, but nothing wants to stick. I'm 32. With my fresh cycle I responded well--32 eggs, 25 mature, 19 fertilized.
[Tue May 27 17:42:39 PDT 2008] mscardwrightTHANKS! I am new at trying to figure out what's going on with me in terms of PCOS
[Tue May 27 17:43:30 PDT 2008] jackieBookie, it may make sense to do bloods (E2, LH, P) and US to monitor ovulation on the medsand hold on the IUI>
[Tue May 27 17:44:11 PDT 2008] jackieslspra: do you still have more cryod?
[Tue May 27 17:44:55 PDT 2008] slspraWhat is cryod?? frozen embies?? If so, we have 8 left.
[Tue May 27 17:45:34 PDT 2008] jackieslspra, yes. Another FET makes sense. Have you had a hysteroscopy to double check the uterus?
[Tue May 27 17:46:25 PDT 2008] slspraNo, I haven't had a lap either. I discussed the lap with my RE, but I have no symptoms of endo or anything else.
[Tue May 27 17:46:33 PDT 2008] bookiebooTHanks, I know its hard to say but more then likely with my progeserone being low, its prob the good ole pcos acting up right and that is prob why I show a positive opk but dont ge pregnant and can the higher dosage of clomid help this thanks, your awesome to be able to keep up with everyones questions
[Tue May 27 17:47:17 PDT 2008] jackieslspra, I would hold on lap, but would recommend hysteroscopy (to double check) and Corey can "hook you up" with aniother acu..
[Tue May 27 17:47:34 PDT 2008] slsprathanks, I will call about acu
[Tue May 27 17:47:49 PDT 2008] Corey_Whelanok
[Tue May 27 17:48:24 PDT 2008] jackiebookie, thanks. and yesthe higher dose of clomid can help and maybe a little progesterone supplementatoin too..
[Tue May 27 17:48:25 PDT 2008] mscardwrightI had a hsteroscopy. The results was that I had a mild left hydrosalpinx otherwise results OK. Could someone explain a little more about hydrosalpinx?
[Tue May 27 17:49:56 PDT 2008] jgwiggsi am 43, took clomid for six months , had i u i which failed. my insurance covers nothing. whats my best option next. i'm also running out of time.
[Tue May 27 17:49:59 PDT 2008] jackiemscardwright: hydro means water. salpinx means tube so literally it means water in the tube. what that really means is that the tube has sustained some sort of "injury" that will make it work less well.
[Tue May 27 17:50:13 PDT 2008] mscardwrightAlso thanks Dr. Jackie I found Andre Denis too and I believe he works near the hospital I will be working at shortly.
[Tue May 27 17:51:03 PDT 2008] mscardwrightOK Thats Dr. Jackie.
[Tue May 27 17:51:09 PDT 2008] jackiejgwiggs: thats hard. Because time is important, i would suggest moving on and being aggressive (injectible meds or IVF) but that also really increases the price tag!!!!
[Tue May 27 17:51:27 PDT 2008] jgwiggsokay thanks
[Tue May 27 17:51:45 PDT 2008] jgwiggsi figured that would be next, but thought i would ask anyway
[Tue May 27 17:51:56 PDT 2008] jackiejgwiggs: Is everything else OK? HSG? Semen?
[Tue May 27 17:52:43 PDT 2008] jgwiggssemen is low, but still capable. i can't remember my numbers now. but dr. says he doesn't see any reason why i s houldn't
[Tue May 27 17:53:57 PDT 2008] jackiejgwiggs: given that semen low IVF (as expensive as it is) may offer "best bang for the buck."
[Tue May 27 17:54:12 PDT 2008] jgwiggsokay thanks
[Tue May 27 17:54:17 PDT 2008] dianakeaneIs the doctor supposed to monitor the hormones and ovarian response during an IUI cycle?
[Tue May 27 17:55:02 PDT 2008] jgwiggs left.
[Tue May 27 17:55:34 PDT 2008] jackieSadly, there has been a common theme relating to expense and insurance coverage. We should all try to work with our legislators to get mandatory coverage. Its an uphill battle but...
[Tue May 27 17:56:17 PDT 2008] jackiediana, we do monitor to make sure that the follicles are growing well, the lining is developing etc.
[Tue May 27 17:56:42 PDT 2008] mscardwrightThere are so many women suffering from this type of issue. The help of insurance coverage would be great!
[Tue May 27 17:56:58 PDT 2008] Corey_Whelanguys we only have a minute or two left
[Tue May 27 17:57:13 PDT 2008] slsprainsurance coverage should be mandated in all states!!
[Tue May 27 17:57:20 PDT 2008] bookiebooThank you so much this was great
[Tue May 27 17:57:20 PDT 2008] Corey_Whelanamen to that!
[Tue May 27 17:57:27 PDT 2008] jackieHaving a baby and access to care to help acheive that end should not be restricted to tjose with $$$$
[Tue May 27 17:57:46 PDT 2008] Corey_WhelanDr. Guttman is very knowledgeable. We want her to come back here all the time!
[Tue May 27 17:57:57 PDT 2008] slsprathank you
[Tue May 27 17:58:00 PDT 2008] jackieThank you!
[Tue May 27 17:58:00 PDT 2008] teacher422 left.
[Tue May 27 17:58:09 PDT 2008] Corey_Whelanthanks everyone so much for being here. Thanks Jackie, it is always a pleasure to have you involved in AFA chats.
[Tue May 27 17:58:25 PDT 2008] mscardwrightThank you all for the information provided and great questions asked and answered
[Tue May 27 17:58:28 PDT 2008] jackieThanks for having me and good luck to all!!!!!!!!!
[Tue May 27 17:58:43 PDT 2008] dianakeaneThanks Dr. Guttman for answering our questions!
[Tue May 27 17:58:43 PDT 2008] Corey_Whelangood night and good luck all.
[Tue May 27 17:58:50 PDT 2008] slspra left.
[Tue May 27 17:58:51 PDT 2008] Corey_Whelan left.
[Tue May 27 17:58:57 PDT 2008] dianakeane left.
[Tue May 27 17:58:58 PDT 2008] bookieboo left.
[Tue May 27 17:59:03 PDT 2008] mscardwright left.
[Tue May 27 17:59:10 PDT 2008] jackie left.
[Tue May 27 18:06:12 PDT 2008] cheeboo joined.
[Tue May 27 18:06:41 PDT 2008] cheeboo left.
[Tue May 27 18:26:59 PDT 2008] aligator312 joined.
[Tue May 27 18:27:56 PDT 2008] aligator312 left.
[Tue May 27 18:28:50 PDT 2008] aligator312 joined.
[Tue May 27 18:28:56 PDT 2008] aligator312 left.
[Tue May 27 18:42:29 PDT 2008] jvalles joined.
[Tue May 27 18:44:21 PDT 2008] Crystal joined.
[Tue May 27 18:44:57 PDT 2008] CrystalHave I missed the chat?
[Tue May 27 18:45:47 PDT 2008] Crystal left.
[Tue May 27 18:48:05 PDT 2008] jvalles left.