Tracy:
I'm an 41 yr old married woman of 10 yrs and me and my husband thought long and hard over the yrs to have a baby , my tubes are tied and want to know if there is an alternative to conceiving

Dr. Christos Coutifaris:
Although success rates decrease with age, certainly at age 41 it is worth pursuing in vitro fertilization as the best option to achieve pregnancy. A key screening test would be a Day Three FSH. You can call 1-800-789-PENN if you would like to schedule an appointment for a consultation to review all of the issues related to age and success rates.

Anne L.:
What would you recommend for a woman with high FSH?

Dr. Pasquale Patrizio:
It depends on the level and on your age. If the level is extremely high, one option is egg donation. If you would like to arrange an appointment at Penn Fertility Care, feel free to call 1-800-789-PENN.

Lisa:
Is this only for fertility questions?

Moderator:
Yes, Lisa

Sheila:
Hi Dr. Coutifaris! I am one of your IVF success stories having delivered boy/girl twins in December 2000. The children are wonderful and Steve and I enjoy parenthood. I just wanted to say how happy I am that this program is being aired to educate all about infertility about the fabulous program you have at University of Pennsylvania. We will send updated pictures of the twins to you soon. Say hello to Dr. Patrizio for us!

Dr. Pasquale Patrizio:
Thank you! Dr. Coutifaris and I are happy to hear things are going well.

Judy:
I am a 41 year old woman that has gone through 7 cycles of IUI 4 clomid and 4 various injecables -- and just yesterday underwent laparoscopy. Laparascopy showed no endrometreosis, no adhesions, clear tubes and normal looking ovaries. How shall I proceed?

Moderator:
Hi Judy, please see answer 2

Nola:
I have seen Dr. Samantha Pfeifer @ Penn @ Radnor for a consultation for infertility. I had a HSG done which revealed my tubes are closed. I had a procedure to open my tubes about 10 years ago and no pregnancy resulted in that. I am 37 now. What are my chances of actually becoming pregnant?

Dr. Christos Coutifaris:
Women younger than 38 years of age have the best success through IVF. That is probably your best choice of treatment.

Florence:
I'm 25 and married for 3 years. I was told that I'm unable to conceive due to swollen tubes. Would IVF work for me. If so what's the cost and success rate.

Dr. Pasquale Patrizio:
Yes, Florence, you are a great candidate for in vitro fertilization because of your young age and the problem has been identified.

Karan:
Dear Drs, I'm 38 years old and I would like to conceive. What immunization shots must I be current with and how long should I wait to try to conceive after getting these shots. I'm also a recovering hyperthyroid patient. Will I have problems with trying to have children? And finally will my age be an issue? Thank You!

Dr. Christos Coutifaris:
You should be immune to German measles and chicken pox. If you are not and you need a vaccine then you should delay conception for 2 to 3 months. As a rule, thyroid problems do not cause major fertility issues, however it is critical for you to have a normal thyroid at the time of conception. This should be easy to achieve. 38 is a good age to proceed with fairly intensive treatment, such as IVF. Fertility rates decrease further after age 40.

Jeannie:
I'm 38yrs. old. I've been through every test to try to get pregnant.We never tryed invetro. I never got a answer on what the main problem was. I've been to three doctors in the past.
Is there any hope at my age? We never tryed invetro because of the high price & risk.

Dr. Pasquale Patrizio:
You need to be reevaluated to identify the reason behind your infertility. We will be happy to review your case. Yes, at age 38, if your hormones are normal, you have a good chance of pregnancy if we have to perform IVF.

Karen:
Why is IVF so expensive? How do people pay for this when insurance does not cover it?

Dr. Christos Coutifari:
At Penn Fertility Care, we try to work with you to arrange for payment plans. However, the important issue is to have mandated coverage for infertility procedures, including IVF, which many states in the Northeast have, such as New Jersey. It is critical to lobby your representative.

Alex and Diana:
My Husband and I are in your program. We tried once for IVF but was not successfull. We are making our second attempt right now as we type this message.

One question we have is: Being I am taking all the medication/shots, etc., we know the problem lies within my husband. A question has come to us and we were wondering why my husband is not taking any medication to help boost his sperm count? Any advice would be greatly appreciated.

Thank You,
Alex and Diana

Dr. Pasquale Patrizio::
Since all the analysis to detect possible sperm problem gave normal results, there is no documented benefit to starting any medications.

Marta:
Dear Doctors I am hoping that it is not too late for me. Is thare any hope at age 49 to conceive?

Dr. Christos Coutifaris:
In our program, the oldest patient to have a successful pregnancy with her own eggs was 46 years old. At 49, the most realistic option is achieving a pregnancy through egg donation.

John A:
We have been visiting an infertility doctor for about 1 year. We have tried clomid for 6 cycles. Only during one cycle (cycle 5) were we able to see positive results, however hormone levels were unable to sustain. Our doctor has now recommended either injection, IVF or endometriosis. What advice can you provide or suggest.

Dr. Pasquale Patrizio::
From the information provided, it is difficult to answer completely. However, after 6 months of Clomid, I would certainly encourage you to step-up your efforts by considering the use of injectables. We will be more than happy to review your case. Our call center is now open by calling 1-800-789-PENN.

Tracy:
can you tell me what is "day three fsh" and can i or we (me and my husband) be a canidate for invitro even with my tubes being tied i have heard of it being possible

Dr. Christos Coutifaris:
Day Three FSH is a blood test which determines the number of eggs remaining in a woman's ovary. In vitro fertilization doesn't require open tubes, therefore your tubal ligation is not an issue.

Elva:
I live in NJ and am currently on my 2nd cycle of DIUI using clomid. My husband has azoospermia and as far as we know I do not have any fertility problems. How many times is average to try IUI before considering IVF? My insurance co. (Cigna) is NOT covering most of the costs we are incurring with DIUI even though NJ has a state mandate. Would it make a difference if I went to HUP in PA? Thanks for your advice.

Dr. Pasquale Patrizio:
Usually, 4 cycles of DIUI with Clomid should be sufficient before switching to a different medication. It is also important to consider your age, when deciding how many cycles of DIUI to perform before IVF. I hope your husband medical condition has been fully evaluated. If you would like an evaluation with our fertility team, call 1-800-789-PENN.

Tracy:
do you know of any doctors in the new jersey or south jersey area who would perform the ivf?

Dr. Christos Coutifaris:
We are opening an office in Cherry Hill, NJ this Spring. In the meantime, we will be able to see you for consultation at the University of Pennsylvania Medical Center. Please call 1-800-789-PENN if you would like to make an appointment.

Mike:
What steps can be taken when the male is the infertility issue, are there medications that help sperm count and motility which is the issue i am currently dealing with. After one unsuccessful IUI with injectibles, should we consider a second try or are we needing to move on ti IVF?

Dr. Pasquale Patrizio:
Mike, Your question is very appropriate. There are a series of tests that can help detect the reason behind your infertility. These tests can help also in the planning of treatment. One IUI is not enough, you should consider at least four cycles before IVF.

Kelli-Jo:
i was on clomed for about 1 year then concieved my son. we are now trying again i have been on clomed and then changed to tamoxifen. this has been going on for about 2 yrs. being on these meds for so long, can i develop any kind of cancer or any other health problems?

Dr. Christos Coutifaris:
There is some concern that patients who take fertility drugs may have an increased chance of developing ovarian cancer. However, studies indicate that women who have been pregnant before or get pregnant through the treatments are not at increased risk. We shouldn't forget that the attempts at pregnancy with these medications should be limited. With current success through IVF, it is rare that a patient needs more than three cycles of treatment.

Melissa:
My husband has a low sperm count and slow swimmers he also has a enlarged prostate and I have severe endometreosis what are our chances and which is the best way to go?

Dr. Pasquale Patrizio:
Your husband needs an evaluation. We need more information about your endometriosis and your age before advising you on the best way to go.

Sue:
What help can be given to a couple when the man is diagnosed with sertoli cell only syndrome?

Dr. Pasquale Patrizio:
The first thing is to be 100% sure that your husband is diagnosed with Sertoli cell only (perhaps we could review the pathology slide). If the diagnosis is confirmed on the slide, there is still 25% chance that your husband may have some sperm in the testes. This will require another biopsy. Donor sperm inseminations are the only options if the diagnosis is confirmed.

Barbara:
I have recently been through two IVF cycles, with no success. The first one began the end of June, the second mid september, each time I was told I had over ten eggs retrieved. All through the cycle every blood test result was great, after tranfer and pregnancy test no baby because for some reason it just did not stick. I am 35 years old could there be a clear reason for no sucess. Please advise.

Dr. Christos Coutifaris:
Generally speaking, the first three attempts at IVF have a similar success. Usually, some modifications can be implemented which possibly improve embryo quality and hence pregnancy. You are in the best age group of patients and you should definitely proceed with a third IVF attempt.

Aviva:
what would you anticipate the likely success rate to be for IUI with gonadotropins or IVF in a 43 yo woman with a normal day 3 FSH and one open tube.

Dr. Pasquale Patrizio:
The success rate for IUI for 43 years old and only one tube open is about 1-3%. IVF is less than 10%.

TT:
Is it true that women start lose their ability to conceive at age 27? -Thanks

Dr. Christos Coutifaris:
There is no question that there is slow decrease in chances of achieving a pregnancy with increasing age. However, 38 is the age after which there is a more substantial decrease and certainly after age 40. Even though you are still young, it is a good idea to think ahead in planning your family.

Alex:
Question for Dr. Pasquale, my wife who just turned 42, and I will be 41 next week do not have any children. We have never attempted to get any help and now we feel as if we wait any longer it wont never happen. Will you consider seeing us and if yes how do we go about setting it up? By the way, we have been together fot 21 years

Dr. Pasquale Patrizio:
Alex, I strongly recommend both of you be evaluated soon. You can reach an operater now by calling 1-800-789-PENN until 9pm tonight and Monday-Friday 8:30-5pm.

Kate:
How many embryos need to be implanted during IVF as a minimum or is it up to the patient? What is normally done?

Dr. Christos Coutifaris:
It depends on the age of the patient. The goal is to maximize success and minimize triplets or other higher order multiples. Generally, the guidelines we follow are two embryos in women less than 35, two or three in women 35 to 37 and four to five in women over 38. This is always discussed with

VIKKI:
DEAR DR. PATRIZIO,
I AM A 44YR OLD FEMALE, WHO HAS BEEN DEALING WITH INFERTILITY FOR THE PAST 8 YEARS. I HAVE BEEN THROUGH SEVERAL CYCLES OF IUI AND AM PRESENTLY SEEING A REPRODUCTIVE ENDOCRINOLOGIST WHO CAN FIND NOTHING WRONG WITH MY HUSBAND WHO IS 49 YRS OF AGE OR MYSELF. WHAT ARE MY CHANCES OF BECOMING PREGNANT?

Dr. Pasquale Patrizio:
Vikki, At age 44, unfortunately, your chances of success are greatly reduced butI would consider IVF instead of IUI.

DENISE:
WE HAVE DONE 5 MONTHS OF CLOMID AND HCG SHOTS WITH IUI ALSO. WHAT ARE YOUR SUGGESTIONS?

Dr. Christos Coutifaris:
Denise, We would need to know your age before recommending the next step

Becky & Chris:
Thank you for a wonderful show...we are so happy for the other couples and wish you much success in helping other couples achieve their dream, as you did ours.

Jennifer:
Is it possible to still be a viable candidate for IVF even though my husband had a vasectomy.

Dr. Pasquale Patrizio:
Jennifer you are a great couple for IVF and sperm retrieval, thus avoiding the need for a vasectomy reversal. One of my oldest patients had a successful sperm retrieval after 27 years of vasectomy.

Julie:
I am a 29 year old female. We have been trying for 3 years. I have undergone a lap. that found mild to moderate endometriosis. All other tests have found my husband and I to be "normal". We have tried 5 clomid cycles, 2 with IUI in the past. We did 2 cycles of Repronex, following three months of Depo-lupron. We are going to try one more round of injectables. Should we continue with meds or try IVF?

Dr. Christos Coutifaris:
At your age, this is your choice. There is no question that the most efficient way to achieve a pregnancy is IVF. But at age 29, a less aggressive approach may be better for you before moving on to IVF. 3-4 cycles of superovulation with gonadotropins with IUI may be considered an intermediate step before IVF.

DENISE:
I AM 39 YEARS OLD

Dr. Christos Coutifaris:
Generally speaking, I recommend IVF in women over 38 even before doing Clomid/IUI. Therefore, I would not delay proceeding with IVF.

Alex:
Dr Pasquale I tried to call the 1800 789-Penn as you suggested however the operated states that this number cannot go through in this calling area (I tried with my home phone and my mobile no luck) is ther another number for me to call now before 9PM

Dr. Pasquale Patrizio:
Alex, call 215-662-7366. I am not sure why the 1-800-789-PENN number was not working. Ask for an appointment with Dr. Patrizio

Josh:
The doctors also said she has female testicular ferminization whatever that is.They did karotyping and said it is XXY.We have been married 6 yrs

JLu:
I missed most of tonight's program on IVF. Will it air again?

Dr. Christos Coutifaris:
Penn Vital Signs will air again tomorrow at 1 pm on Channel 6 WPVI.

Lisa:
I am a 30 year old former patient of your practice. I was diagnosed with Unexplained IF. After a year and a half of treatments I became pregnant naturally. My son is now 10 months old. My husband and I have been trying to get pregnant again for over 6 months with no success. Is it too soon to begin treatments again? What would my next step be?

Dr. Pasquale Patrizio:
Josh, This is very complex question and we would need more information. If you would like to make an appointment for a consultation, call 1-800-789-PENN.

Dr. Christos Coutifaris:
Lisa, Obviously, there is a sub-fertlity problem, but we are really happy that it worked out for you. Given that you are experiencing problems again, it may be a good idea to have a repeat evaluation within the next four to six months and proceed from there. We would be happy to see you again if you don't acheive a pregnancy in the next few months.

Kim:
My husband has a low sperm morphology count, what are the causes for this?

Dr. Pasquale Patrizio:
Kim, There are many possible causes for the problems that you posted. He needs a complete evaluation, feel free to call 1-800-789-PENN.

Krista B.:
I am a former patient of Dr. Coutifaris who was fortunate to have a successful IVF on the third cycle. I came to Dr. Coutafaris after having 3 unsuccessful cycles with another physician and I just wanted to say that he is an unforgettable person. The gift he offers to couples is beyond words. We have a beautiful 20 month old daughter and I am 30 weeks pregnant with my second daughter (so they tell me). If it wasn't for his dedication and perseverence I wouldn't be living the "fairytale" life. This message is for all those couples wondering if Penn is the right practice for them to go to. Take advise from someone who has experienced both Penn's center as well as another; if you choose Penn, you are making the right choice. Thanks again Dr. Coutifaris.

Dr. Christos Coutifaris:
Thank you, Krista.

Melissa:
I am a 45 year old male and my wife is 25 we have been trying to conceive for the past 5 years. I have had a scope done and they found a large prostate gland but nothing was determined. I went on anti-inflamitory and antibiotics. My wife has had 2 laps. done and there was to much to scrape or laser the severe endometreosis. My wife preduced 2 fertile eggs but once again I had slow swimmers and low sperm count. What is your suggestion?

Dr. Pasquale Patrizio:
Melissa, I would like to know the day 3 FSH level and we need to review your medical records before giving you the best suggestion.

Lisa:
Dr. Coutifaris, what do you mean by sub-fertility problem?

Dr. Christos Coutifaris:
Lisa, If it takes more than one year to acheive a pregnancy then by definition a patient has an infertility problem. Since you have been able to achieve a pregnancy, however, it appears to happen after significant time and effort, that is why I used the word "sub-fertility."

ANNE:
My husband was diagnosed with oligospermia and viracocele and IVF was recommended.Are there other less agreesive treatments that we can look into? We are both 35 years old.

Dr. Pasquale Patrizio:
Anne, We need to know sperm count, motility and morphology before giving you our advice. If the varicocele is large I would advise to have it corrected.

Alex:
DR. Pasquale, I got through with the number and I gave my infor. they said someone will call me and I thank you

DENISE:
YOU HAD SAID TO GO WITH IVF BUT DO YOU SUGGEST I GO WITH MY OWN EGGS OR WITH A DONOR?

Melissa:
Thanks for all your help and we will be setting up an appt. ASAP thanks again!!

Dr. Christos Coutifaris:
Denise, If your Day 3 FSH is normal, definitely with your own eggs.

Jennifer:
Is it possible to have the sperm retrieval performed at Penn but the implantation done at another facility(our insurance will only cover Cooper Hospital)?

Dr. Pasquale Patrizio:
Jennifer, It is possible to have a sperm retrieval at Penn. We can work with you to arrange to have the sperm delivered.

Kim:
In cases where there are conflicting semen analyses (morphology - both normal and abnormal) and with a blocked fallopian tube, would it be most appropriate to 1. Go directly to IVF or 2. Get the tube unblocked and attempt to conceive normally?

Dr. Pasquale Patrizio:
Kim, Depending on your age, if you are older than 35, I would go directly to IVF. If you are younger than 35, you can try to unblock the tube.

Dana:
Hi Drs. Here are a couple of questions for you. I am 28 & have a 2 yr old after undergoing 6 IUI. We have had just as many IUI & 2 IVF since she has been born (one with co-culture). We did try 1 frozen transfer but the 2 eggs I had did not survive the thaw. I have been told I do not ovulate & have polycystic ovaries, but I was negative for PCOS. I can't get past the fact that I got pregnant w/ IUI after 9mos of being with an RE. I want to know what your thoughts are with going back to IUI. Also, I heard you say in previous messages that you recommend 3 IVF's. After that do my chances decrease. Last question, I live about 1 hr from Penn. If I transferred care, would I be required to come in to the city or do you have a satellite office for bloods, US, etc. (It is hard with the 2 yr) Thanks for your time.

Dr. Christos Coutifaris:
Dana, We are establishing a network of multiple sites around Phila. to make it convenient for our patients so they don't need to come to the city. Currently, our Radnor site is fully operational and our site at Limerick accepts consultations, but will be a 5-day-a-week operation in the next few months. With respect to your specific questions, proceeding with a third IVF cycle is probably optimal. Generally speaking, the success decreases after 3 cycles at the same program. I think I would be able to give you better answer if I could review in detail your history and IVF outcomes. Please call 1-800-789-PENN if you would like to make an appointment and you don't mind coming to the city for that initial visit. Thank you for your inquiry.

Dr. Pasquale Patrizio:
Denise, Without knowing your age, I cannot give you an accurate answer. In general, for women younger than 37, we recommend 4-6 cycles of IUI with Clomid before going to injectibles.

Denise:
How many attempts of IUI with clomid would you try before going to injectables?

Dr. Pasquale Patrizio:
Denise, Without knowing your age, I cannot give you an accurate answer. In general, for women younger than 37, we recommend 4-6 cycles of IUI with Clomid before going to injectibles.

ANNE:
MY HUSBAND HAS A LOW SPERM COUNT,WOULD YOU RECOMMEND IVF

Dr. Pasquale Patrizio:
Anne, it depends how low is the sperm count? If there are less than 5 million of motil sperm in the sample, I would certainly recommend IVF.

Dana:
Thank you Dr. I am sure you'll be hearing from us!

Christine M:
CAN YOU PLEASE TELL ME IF I COULD GET PREGNANT I AM 43YRS OLD . I 'VE DONE THREE TESTS . I WAS TOLD THAT FSH IS TO HIGHT IT, 17 . IS IT POSSABLE TO GET PREGNAT. THE LAST TIME I GOT PREGNAT I WAS 37YRS OLD AT THAT TIME I WAS NOT READY.

Dr. Christos Coutifaris:
With a high FSH and your age, the option we would recommend is egg donation.

Chris:
This a follow up question regarding my azospermia diagnosis question earlier. I am a 30 year old, and my hormone levels for FSH and LH were high and my Testosterone level was low. How do these conditions limit my chances of for providing enough sperm for conception via IVF?

Dr. Pasquale Patrizio:
Chris, To answer your question we need to perform a testicular biopsy. Contact us if you need more information, 1-800-789-PENN.

Angie:
I am 28 and have had 3IUI's with Clomid and no response, I then had a Lap and was told I had a mild case of endometrosis, so I tried 3 more IUI's with Clomid and Injectables got pg on the second and missed AB, then was told my FSH level is 9 so I tried one round of IVF and that didn't work I am now starting my second IVF cycle do you feel this is worth trying again.

Dr. Christos Coutifaris:
Angie, If you feel comfortable with your physicians and the quality of the program is good, you should definitely proceed with another IVF cycle.

Rose:
where is your office

Dr. Christos Coutifaris:
We see patients at the University of Pennsylvania Medical Center at 34th and Spruce Sts. in the city, as well as at our satellite sites in Radnor, Limerick and Chesnut Hill. We are also opening a site in Cherry Hill, NJ this Spring.

Angie:
Could you please tell me your success rates for IVF programs!

Dr. Christos Coutifaris:
Since many of you have asked where to see, please call 1-800-789-PENN. We see patients at the University of Pennsylvania Medical Center at 34th and Spruce Sts. in the city, as well as at our satellite sites in Radnor, Limerick and Chesnut Hill. We are also opening a site in Cherry Hill, NJ this Spring.

Question:
Dr. Patrizio, my husband was diagnosed with oligspermia of 50,000 count, his motility level was normal, not sure of morphology, and gus variacocele is not large. IVF was recommended and I do not have any infertility issues. Are there other treatment options we should consider that would be less expensive and agressive? Thanks for airing that show.

Dr. Patrizio responds:
If the sperm count is truly 50,000, the best option is to do ICSI, i.e. insertion of a single sperm into each of your eggs. However, before ICSI your husband should receive genetic screening to try to identify the source of the problem.

Question:
My son has a varicocele; he is 20 yrs old. He's going to have a varicelcolectomy on Friday. Will this procedure increase his chances for future fertility? Do the procedure risks outweigh any possible benefits?

Dr. Patrizio responds:
Yes, if your son has an obvious varicocele it is better to fix it now.

Question:
Should I consider laparascopy, or should I try injectable first? If I should try injectable, how many times should I try before considering another option? (additional information, diagnosed with hsg, fallopian tubes open, uterus normal, age 27. )

Dr. Patrizio responds:
I would consider laparoscopy first.

Question:
We went through 1 insemination with clomid and my husband had an enlarged prostate which has been evaluated and low sperm count plus slow swimmers. What are our chances for insemination now or is it best to just go IVF?

Dr. Patrizio responds:
It really depends on sperm count/motility. Without knowing these numbers, I cannot formulate a proper answer.

Question:
My husband had a vasectomy over 10 years ago - we recently went through surgery to reverse it - but is was unsuccessful. We have been told there is no sperm in the samples provided. Is it possible to go through IVF succesfully if there is no sperm in the ejaculate? Is the success rate different than with normal IVF?

Dr. Patrizio responds:
Your case is ideal for the procedure of 1) sperm aspiration; 2) ICSI, i.e. insertion of single sperm into each of the eggs that you will produce. There are very good chances of finding sperm without doing an extensive surgery on your husband, but simply using a butterfly needle. Your chance of having a baby is dependant mainly on your age. If you are younger than 35 you have 40-50% chance of getting pregnant.

Question:
My wife and I just happen to catch some of the information on channel 6 tonight. We are 17 years in marriage and have no children. We desire to so bad but we always have given up without ever seeing some one. How can we reach you?

Dr. Patrizio responds:
Please call Penn Fertility Care at 1-800-789-PENN to make an appointment.

Question:
My husband had testicular cancer when he was 21 and he had 1 testicle removed. We haven't used any birth control for the last 2 years. Can you please tell me what my first steps should be to begin the pregnancy process?

Dr. Patrizio responds:
He should have a semen analysis. Call Penn Fertility Care at 1-800-789-PENN and make an appointment to have the sample checked and to see me.

Question:
I have been recently diagnosed/tested as having zero sperm count (a second specimen analysis showed fructose was present), with the probable cause being end organ failure. What options exist for my wife and I?

Dr. Patrizio responds:
In your case, the only sure way to know if some sperm are produced is to do a testicular biopsy. Please call Penn Fertility Care at 1-800-789-PENN to make an appointment or if you need more information.

Question:
I am 34 (35 in March) and my husband is 37...we've done 2 IVF's (positive, m/c at 5 weeks and m/c again at 10 weeks. Our dx is male factor and high FSH (11.5) as well as poor responder. The fetus is having tissue biopsy done and my husband and I recently had karyotyping done, waiting results...what do you suggest we try next?

Dr. Patrizio responds:
Let's first see the results of your (and your husband) karyotype and then decide the best course of action.

Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.

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