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Dr. Richard Grazi, of Genesis Fertility

April 15, 2008 - Tuesday
8:00 PM to 9:00 PM (EST)
Guest Speakers: Dr. Richard Grazi, of Genesis Fertility

Categories

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[Tue Apr 15 16:46:28 PDT 2008]	Corey_Whelan	hi everyone. Welcome early birds. I'm Corey Whelan, The AFA's chat moderator. We're glad you're here.
[Tue Apr 15 16:47:02 PDT 2008]	Corey_Whelan	Dr. Richard Grazi, of Genesis Fertility, will be joining us in about ten minutes and we can get started then. How is everyone tonight?
[Tue Apr 15 16:47:40 PDT 2008]	strmgirl97	doing well, thank you.
[Tue Apr 15 16:48:29 PDT 2008]	Corey_Whelan	anyone currently in treatment? Dealing with pcos? I'm a pcoser myself
[Tue Apr 15 16:48:57 PDT 2008]	amanda112903	I am in treatment
[Tue Apr 15 16:49:05 PDT 2008]	amanda112903	clomid
[Tue Apr 15 16:49:11 PDT 2008]	strmgirl97	yes, kind of in treatment... but definitely dealing
[Tue Apr 15 16:49:17 PDT 2008]	strmgirl97	same with me... clomid
[Tue Apr 15 16:49:37 PDT 2008]	Corey_Whelan	got it. Hope you've all gotten the low carb message. It's the key
[Tue Apr 15 16:50:15 PDT 2008]	amanda112903	yeah, my RE said that that is why the glucophage was making me sooo sick
[Tue Apr 15 16:50:50 PDT 2008]	Corey_Whelan	Do it without medication. Just go low carb in your eating.
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[Tue Apr 15 16:51:12 PDT 2008]	Corey_Whelan	Hi jg. We're chatting while we wait for Dr. Grazi
[Tue Apr 15 16:51:31 PDT 2008]	jgottwald	Hi. chatting is fine with me.
[Tue Apr 15 16:51:43 PDT 2008]	Corey_Whelan	then you're in the right place!
[Tue Apr 15 16:51:58 PDT 2008]	jgottwald	so what are we chatting about
[Tue Apr 15 16:52:10 PDT 2008]	Corey_Whelan	PCOS, and eating healthy
[Tue Apr 15 16:52:15 PDT 2008]	strmgirl97	my doc really hasn't talked to me about any of that kind of stuff. it was a very quick meeting about my diagnosis. she just handed me the clomid prescription, and that was about all. i think i'll be able to ask a lot more questions next time i talked to her...
[Tue Apr 15 16:52:48 PDT 2008]	amanda112903	strmgirl- are you seeing an OBGYN?
[Tue Apr 15 16:52:54 PDT 2008]	jgottwald	I had my doctor write a referral to a nutritionist. It was a great experience.
[Tue Apr 15 16:53:06 PDT 2008]	Corey_Whelan	carbohydrates are poison for a woman with pcos. I suggest that you go to www.atkinscenter.com and learn more. I started ovulating on my own when I lowered my carb intake and started excercising
[Tue Apr 15 16:53:09 PDT 2008]	strmgirl97	yeah, i live in a very small town
[Tue Apr 15 16:53:22 PDT 2008]	Corey_Whelan	where are you str?
[Tue Apr 15 16:53:33 PDT 2008]	amanda112903	yeah, I know how small towns can be...
[Tue Apr 15 16:53:42 PDT 2008]	jgottwald	strmgirl - I would definitely ask more questions. As for carbs - I eat the carbs that are better for you
[Tue Apr 15 16:53:48 PDT 2008]	strmgirl97	central wyoming - about 10k people here at most
[Tue Apr 15 16:54:15 PDT 2008]	Corey_Whelan	ok. we do have some RE's in that state though. Please just don't do clomid for more than a few months, ok?
[Tue Apr 15 16:54:31 PDT 2008]	strmgirl97	hopefully i won't have to
[Tue Apr 15 16:54:54 PDT 2008]	Corey_Whelan	If you need a referral, call the AFA's helpline. A good doctor can often work with you even if you are right next door. And yes, I hope everything happens for you VEry FAST!!!!!!
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[Tue Apr 15 16:55:21 PDT 2008]	Corey_Whelan	Hi rickets, we're chatting while we wait for Dr. Grazi. WELCOME
[Tue Apr 15 16:55:40 PDT 2008]	Corey_Whelan	jgottwald, you can still go overboard on good carbs - make sure you have a plan
[Tue Apr 15 16:56:09 PDT 2008]	strmgirl97	are the carbs only a concern for lack of ovulation?
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[Tue Apr 15 16:56:23 PDT 2008]	strmgirl97	(aside from the obvious weight gain issues)
[Tue Apr 15 16:56:27 PDT 2008]	jgottwald	I do - I learned a plan for eating from my nutritionist. something must have worked. I went on a cruise and stayed my same weight.
[Tue Apr 15 16:56:32 PDT 2008]	Corey_Whelan	no. carbs and insulin resistance actually increase your testosterone output
[Tue Apr 15 16:57:07 PDT 2008]	Corey_Whelan	Hi Symharmony. Welcome
[Tue Apr 15 16:58:15 PDT 2008]	Corey_Whelan	guys, give me a few minutes, I'm going to try to get Dr. Grazi on the phone
[Tue Apr 15 16:58:15 PDT 2008]	Symharmony	Hi everybody...Thanks
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[Tue Apr 15 16:59:19 PDT 2008]	Corey_Whelan	feel free to chat guys, I'll be right back
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[Tue Apr 15 16:59:54 PDT 2008]	Corey_Whelan	Hi Squishy, welcome back
[Tue Apr 15 17:00:05 PDT 2008]	rivergonzos	Hi, How long has everyone been trying?
[Tue Apr 15 17:00:17 PDT 2008]	jgottwald	strmgirl - don't lose hope - I went to a few doctors before I found one that was willing to work with me and help me find answers. It is a great feeling when you find the right doctor.
[Tue Apr 15 17:00:19 PDT 2008]	Squishy	Oh, thanks, I'm new and wasn't sure I was connected.
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[Tue Apr 15 17:00:30 PDT 2008]	jgottwald	We have been trying for over 2.5 years
[Tue Apr 15 17:00:32 PDT 2008]	strmgirl97	trying since feb '07
[Tue Apr 15 17:00:58 PDT 2008]	amanda112903	I, too, have been trying for a little over 2.5 years
[Tue Apr 15 17:01:04 PDT 2008]	auntheatty	same here
[Tue Apr 15 17:01:14 PDT 2008]	strmgirl97	i feel kind of bad because i'm not sure my doc is bad... i just don't think i really understood how serious this was, so i downplayed it a bit, and so did she
[Tue Apr 15 17:01:36 PDT 2008]	Squishy	We've been trying for about 5 years. We did 6 IUIs and 1 IVF, where I got pregnant and then miscarried, and then got pregnant on my own but lost the baby at 24 weeks.
[Tue Apr 15 17:01:50 PDT 2008]	jgottwald	it isn't "bad" your doctor could just not understand. Not everyone does
[Tue Apr 15 17:01:54 PDT 2008]	rivergonzos	wow, sorry to hear
[Tue Apr 15 17:01:58 PDT 2008]	amanda112903	I'm so sorry squishy
[Tue Apr 15 17:02:05 PDT 2008]	rickels	sorry
[Tue Apr 15 17:02:11 PDT 2008]	strmgirl97	def sorry to hear squishy... that stinks
[Tue Apr 15 17:02:13 PDT 2008]	jgottwald	I am sorry squishy
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[Tue Apr 15 17:02:32 PDT 2008]	Corey_Whelan	hi all, welcome. we're waiting for Dr. Grazi to join us.
[Tue Apr 15 17:02:34 PDT 2008]	Symharmony	So sorry Squishy
[Tue Apr 15 17:02:40 PDT 2008]	jgottwald	With IVF and PCOS are there tips that are helpful?
[Tue Apr 15 17:02:43 PDT 2008]	rivergonzos	has anyone else tried iui? i've tried a few times but only seem to get 1 or 2 eggs with clomid?
[Tue Apr 15 17:02:55 PDT 2008]	Squishy	Thanks
[Tue Apr 15 17:02:57 PDT 2008]	auntheatty	Yes, once
[Tue Apr 15 17:03:05 PDT 2008]	Corey_Whelan	IUI's didn't work for me.
[Tue Apr 15 17:03:17 PDT 2008]	rivergonzos	how many eggs did anyone get with iui & clomid
[Tue Apr 15 17:03:52 PDT 2008]	Squishy	Yeah, the only time I had multiple follicales develop while doing IUIs was when Femara was used in conjunction with Clomid.
[Tue Apr 15 17:03:52 PDT 2008]	jgottwald	Clomid worked better for me. I got one or two. I did another drug that didn't work at all - I can't remember the name.
[Tue Apr 15 17:03:54 PDT 2008]	auntheatty	have you all been told that if you have PCOS and your overweight that if you lose weight it will go away?
[Tue Apr 15 17:03:56 PDT 2008]	Corey_Whelan	IVF is a great option for women with pcos. You have to be careful that hyperstimulations doesn't occur but with a good doctor that can be avoided 90% of the time.
[Tue Apr 15 17:04:05 PDT 2008]	amanda112903	i'm doing an IUI with clomid and cd 13 I had 3 but they were only 11mm
[Tue Apr 15 17:04:34 PDT 2008]	rivergonzos	what is femara?
[Tue Apr 15 17:04:35 PDT 2008]	Squishy	auntheatty, Oh My GOD! I can't tell you the number of times I've heard that, even from specialists!
[Tue Apr 15 17:04:46 PDT 2008]	jgottwald	I had one doctor tell me that. She pretty much blew me off. I found another that has helped me since then
[Tue Apr 15 17:04:49 PDT 2008]	Corey_Whelan	auntheatyy, it can go into remission but you still have it. If you go low carb you will most likely start to ovulate on your own. That is NOT the same as being thin. You can be thin and be high carb, you won't ovulate that way
[Tue Apr 15 17:05:36 PDT 2008]	Squishy	I know women with PCOS and they're not overweight.
[Tue Apr 15 17:05:36 PDT 2008]	auntheatty	I am overweight, but I know of alot of heavier people that have gotten pg with no problem. it's very frustrating.
[Tue Apr 15 17:05:41 PDT 2008]	rickels	i ovulate on my own and have pcos
[Tue Apr 15 17:05:43 PDT 2008]	jgottwald	My current doctor has said that IVF is my only solution
[Tue Apr 15 17:05:55 PDT 2008]	jgottwald	auntheatty - I totally agree
[Tue Apr 15 17:06:08 PDT 2008]	rivergonzos	i ovulate most of the time and I have pcos
[Tue Apr 15 17:06:12 PDT 2008]	strmgirl97	rickels... i do too i think. but i'm not sure i completely understand my diagnosis since doc put me on clomid??
[Tue Apr 15 17:06:26 PDT 2008]	strmgirl97	but my ovu tests are positive every month
[Tue Apr 15 17:06:34 PDT 2008]	Squishy	ovu tests?
[Tue Apr 15 17:06:52 PDT 2008]	rivergonzos	squishy what is femara?
[Tue Apr 15 17:06:54 PDT 2008]	strmgirl97	ovulation tests... you know, hooray two dark blue lines...
[Tue Apr 15 17:07:23 PDT 2008]	rickels	i was also put on clomid by my regular OBGYN till everyone told me i was doing it wrong
[Tue Apr 15 17:07:23 PDT 2008]	jgottwald	I ovulated on clomid, but it ended up that my husband has issues as well. So we both have issues. Has your husband been tested?
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[Tue Apr 15 17:07:36 PDT 2008]	strmgirl97	no
[Tue Apr 15 17:07:44 PDT 2008]	Corey_Whelan	Guys I have Dr. Grazi on the line, we will have him here shortly
[Tue Apr 15 17:07:47 PDT 2008]	jgottwald	clomid isn't wrong. It is just usually the first thing that they do
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[Tue Apr 15 17:08:33 PDT 2008]	Squishy	Ohhh! Femara is a drug that is used for some cancer patients I think. There were preliminary tests that showed it could help in stimulating the ovaries to give up more than one egg, but the Femara people found out it was being used for fertility and have since stopped that... at least that's what the doctor told me.
[Tue Apr 15 17:08:41 PDT 2008]	Corey_Whelan	Hi guys, welcome. Dr. Grazi will be here in a few minutes
[Tue Apr 15 17:09:12 PDT 2008]	Corey_Whelan	Femara is used for endo
[Tue Apr 15 17:09:18 PDT 2008]	jgottwald	That is what I found on line about femara. that was the last thing on the FDA website
[Tue Apr 15 17:09:39 PDT 2008]	rivergonzos	thanks Corey
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[Tue Apr 15 17:10:13 PDT 2008]	Squishy	strmgirl97, I think the ovu tests just measure hcg levels in the body that spike at ovulation. I don't know that it means you're actually having an egg come out of the follicle, which I think might be my issue.
[Tue Apr 15 17:10:31 PDT 2008]	Corey_Whelan	Welcome.Dr. Grazi!
[Tue Apr 15 17:10:36 PDT 2008]	drgrazi	My sincere apologies for being late, but... better late than never. Thanks for waiting.
[Tue Apr 15 17:10:45 PDT 2008]	auntheatty	Is there an official test that can be performed to see if you have pcos, or is it based upon symptoms?
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[Tue Apr 15 17:11:03 PDT 2008]	Corey_Whelan	OK, we'll start with auntheatty's question
[Tue Apr 15 17:11:12 PDT 2008]	Corey_Whelan	hi dogwood, welcome.
[Tue Apr 15 17:11:29 PDT 2008]	drgrazi	PCOS is considered a clinical diagnosis, meaning that the diagnosis is usually made by history and physical examination alone
[Tue Apr 15 17:11:50 PDT 2008]	drgrazi	there are, however, several tests that MUST be done when considering the diagnosis.
[Tue Apr 15 17:12:31 PDT 2008]	drgrazi	It must be said, first off, that the clinical signs of PCOS are lack of ovulation causing irregular cycles, and also some element of excess male hormones.
[Tue Apr 15 17:13:05 PDT 2008]	moaicha	can you please define it
[Tue Apr 15 17:13:18 PDT 2008]	drgrazi	One can measure hormones such as testosterone or androstenedione, for example, and often find inappropriate elevations.
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[Tue Apr 15 17:13:34 PDT 2008]	Corey_Whelan	Hi cheeboo
[Tue Apr 15 17:13:52 PDT 2008]	drgrazi	I am sending my answers in small bits so that it does not take too long for you to start thinking about questions. I hope that is OK
[Tue Apr 15 17:13:59 PDT 2008]	jgottwald	Drgrazi - If I do PCOS, are there any tips that would help me during the process? Things to do or not do?
[Tue Apr 15 17:14:09 PDT 2008]	Squishy	That explains excess hair?
[Tue Apr 15 17:14:32 PDT 2008]	auntheatty	can an ultrasound or your pap smear tell if you have pcos?
[Tue Apr 15 17:14:39 PDT 2008]	dogwood7	I hate the hair the most it makes me feel like a man
[Tue Apr 15 17:14:46 PDT 2008]	jgottwald	Sorry, I meant to say IVF process
[Tue Apr 15 17:14:46 PDT 2008]	rivergonzos	what are the ways to treat pcos that have the highest success rate?
[Tue Apr 15 17:14:53 PDT 2008]	drgrazi	I think it also bears saying that PCOS is exrtremely common, affecting 5-10% of women. It is easily the most common problem that brings a woman to a practice like ours, or any other RE specialist, for that matter.
[Tue Apr 15 17:15:07 PDT 2008]	Squishy	Isn't the only thing that can definitevly tell is while doing an egg retrieval to see if there are empty follicales?
[Tue Apr 15 17:15:31 PDT 2008]	drgrazi	OK. let's slow down, because the questions are going all over the place.
[Tue Apr 15 17:15:56 PDT 2008]	Corey_Whelan	guys, let's take it one at a time, ok?
[Tue Apr 15 17:16:25 PDT 2008]	auntheatty	ok
[Tue Apr 15 17:16:25 PDT 2008]	drgrazi	The hair is caused by excess male hormone, and can be extremely troubling. But, unfortunately, it is not possible to address this problem therapeutically while at the same time trying to conceive.
[Tue Apr 15 17:16:51 PDT 2008]	moaicha	what's PCOS definition please
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[Tue Apr 15 17:17:04 PDT 2008]	Corey_Whelan	When you are ready, laser hair removal really works. But your hormones have to be under control for it to work
[Tue Apr 15 17:17:13 PDT 2008]	drgrazi	And, if the hirsutism is really severe, you should have a specific test to make sure that the PCOS is not actually stemming from a primary problem in the adrenal gland.
[Tue Apr 15 17:17:15 PDT 2008]	Corey_Whelan	Hi hoping
[Tue Apr 15 17:17:52 PDT 2008]	dogwood7	I had my adrenal level checked and they were in line
[Tue Apr 15 17:18:00 PDT 2008]	drgrazi	Any REI will be able to steer you to the proper tests for ruling out adrenal dysfunction, which actually accounts for ~ 10% of all PCOS [AND THE TREATMENT IS DIFFERENT]
[Tue Apr 15 17:18:23 PDT 2008]	drgrazi	Now let's talk about the role of ultrasound (U/S)
[Tue Apr 15 17:18:33 PDT 2008]	hoping	hi everyone!
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[Tue Apr 15 17:18:41 PDT 2008]	flo	FSH 7.4 E2 43 TSH 2.103 PRL 6.1 does that mean pcos
[Tue Apr 15 17:18:41 PDT 2008]	drgrazi	U/S is extremely useful both in diagnosing and managing PCOS.
[Tue Apr 15 17:18:59 PDT 2008]	Corey_Whelan	flo, hold back a few seconds please
[Tue Apr 15 17:19:10 PDT 2008]	Corey_Whelan	hi teacher, welcome
[Tue Apr 15 17:19:35 PDT 2008]	Squishy	How do I "manage" PCOS?
[Tue Apr 15 17:19:39 PDT 2008]	drgrazi	U/S shows a particular pattern of egg follicles in the polycystic ovary. In this country, although it has not yet been accepted as part and parcel of diagnosing PCOS, most physicians use it anyway. Esp since it's so easy to do.
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[Tue Apr 15 17:20:25 PDT 2008]	drgrazi	In addition, since most women who have been diagnosed with PCOS are trying to conceive, U/S is useful in following the response to ovulation inducing agents.
[Tue Apr 15 17:20:50 PDT 2008]	drgrazi	It is not possible to diagnose PCOS by pap smear!
[Tue Apr 15 17:21:20 PDT 2008]	drgrazi	History, physical exam, hormononal tests, ultrasound. The diagnosis is usually easily achieved. Then the question is... what to do?
[Tue Apr 15 17:21:34 PDT 2008]	drgrazi	The answer, of course, depends on what the goal is
[Tue Apr 15 17:21:35 PDT 2008]	jgottwald	what pattern does the egg follicles follow
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[Tue Apr 15 17:21:57 PDT 2008]	drgrazi	The best form of cycle control, and of managing hirsutism, is the birth control pill.
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[Tue Apr 15 17:22:27 PDT 2008]	drgrazi	So if that's the desired outcome, unless there is some contraindication, the BCP is the way to go.
[Tue Apr 15 17:22:55 PDT 2008]	hoping	does PCOS influence response to meds, and amount of follicles?
[Tue Apr 15 17:23:30 PDT 2008]	drgrazi	It also bears mentioning, for those who have had side effects with BCP, that this is often a trial and error process. Eventually, the right formulation is found. And, BTW, ALL BCPs help with the cycle and the hirsutism.
[Tue Apr 15 17:23:49 PDT 2008]	drgrazi	Trying to conceive with PCOS is a different story.
[Tue Apr 15 17:24:24 PDT 2008]	dogwood7	you can say that again, going on 5 yrs
[Tue Apr 15 17:24:32 PDT 2008]	drgrazi	In terms ot the pattern of egg development, basically there are lots of egg follicles - each with an egg - but they become arresteed along the developmental track, and do not mature sufficiently to ovulate
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[Tue Apr 15 17:25:09 PDT 2008]	jgottwald	That is what happened with me on femara
[Tue Apr 15 17:25:19 PDT 2008]	Squishy	How does Metformin help?
[Tue Apr 15 17:25:19 PDT 2008]	Corey_Whelan	Hi jmorgan
[Tue Apr 15 17:25:26 PDT 2008]	ljmorgan84	hello
[Tue Apr 15 17:25:30 PDT 2008]	rivergonzos	what is the best way to fix that so they do develope because with clomid I might have 1 or 2 devolpe
[Tue Apr 15 17:25:34 PDT 2008]	drgrazi	All of the ovulation agents that we use are designed to push 1 or 2 egg follicles (preferably one) towards maturing and ovulating. They just all work in different ways.
[Tue Apr 15 17:26:22 PDT 2008]	drgrazi	So now 2 different drugs have been mentioned: clomid and femara. I will say a few things about them if you want.
[Tue Apr 15 17:26:32 PDT 2008]	rickels	is it common to have PCOS and ovulate monthly ?
[Tue Apr 15 17:26:35 PDT 2008]	Corey_Whelan	please do
[Tue Apr 15 17:26:49 PDT 2008]	rivergonzos	what are the different agents that can be used?
[Tue Apr 15 17:26:58 PDT 2008]	rivergonzos	sorry, beat me too it
[Tue Apr 15 17:27:04 PDT 2008]	Corey_Whelan	first rickets, then riverg
[Tue Apr 15 17:27:40 PDT 2008]	drgrazi	If you ovulate every month, you do not have PCOS. Your ovaries may look polycystic - what we call PCO-like - but you do not have the SYNDROME. But let's talk about the meds for a minute.
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[Tue Apr 15 17:28:06 PDT 2008]	drgrazi	Clomid has been around for > 40 years, is very safe and has few serious side effects.
[Tue Apr 15 17:28:34 PDT 2008]	Corey_Whelan	howdy fracnes. we're discussing meds and pco
[Tue Apr 15 17:28:41 PDT 2008]	rivergonzos	i have side affects with clomid
[Tue Apr 15 17:28:44 PDT 2008]	drgrazi	It works by blocking the effect of estrogen on the pituitary gland, and therefore stimulating that gland to make more FSH. FS H is what makes eggs mature.
[Tue Apr 15 17:29:00 PDT 2008]	drgrazi	The desired effect is to get ONE egg to ovulate.
[Tue Apr 15 17:29:15 PDT 2008]	drgrazi	Unfortunately, many women are resistant to clomid.
[Tue Apr 15 17:29:21 PDT 2008]	dogwood7	I do not understand the answer reagrding the difference of PCOS to PCO, can you explain more?
[Tue Apr 15 17:30:05 PDT 2008]	drgrazi	Resistance is often caused by excessive body weight - i hope i don't touch a nerve with that comment (we can talk about that later) .- which necessitates either higher doses or a change in the med.
[Tue Apr 15 17:31:00 PDT 2008]	drgrazi	The problem with clomid is that because it works as an antiestrogen, it can other, undesirable effects on the reproducitve tract. This is the reason why clomid therapy must be MONITORED>
[Tue Apr 15 17:31:15 PDT 2008]	drgrazi	I will get to your question, dogwood
[Tue Apr 15 17:31:21 PDT 2008]	dogwood7	THANKS
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[Tue Apr 15 17:31:37 PDT 2008]	Symharmony	If your ovaries are polycystic, can you still have excess facial hair but have no other symptoms?
[Tue Apr 15 17:31:57 PDT 2008]	Corey_Whelan	Hi Koolaid
[Tue Apr 15 17:32:13 PDT 2008]	drgrazi	Femara, or letrazole, does not block estrogen receptors the way clomid does. Rather, it blocks the conversion of estrogen precursors to estrogen. This also causes the pituitary to make more FSH, but without the undesirable side effects of clomid
[Tue Apr 15 17:32:18 PDT 2008]	koolaid85	hi
[Tue Apr 15 17:32:38 PDT 2008]	drgrazi	Which is why it has become fashionable to use femara instead of clomid.
[Tue Apr 15 17:32:44 PDT 2008]	rivergonzos	how else does fem & letra help? success rates?
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[Tue Apr 15 17:33:00 PDT 2008]	drgrazi	Finally, the PREGNANCY rate is not as high as the OVULATION rate with any of these medications.
[Tue Apr 15 17:33:00 PDT 2008]	Squishy	Other than thinning of the lining, what other undesirable side effects are there with Clomid?
[Tue Apr 15 17:33:45 PDT 2008]	drgrazi	But, it is important to keep in mind that getting pregnant is a PROCESS, so if you are ovulating with clomid or femara and everything else looks right, you must give it time to work.
[Tue Apr 15 17:34:08 PDT 2008]	drgrazi	I will get to gonadotropins after i answer dogwood, because she asked a really important question
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[Tue Apr 15 17:35:20 PDT 2008]	drgrazi	Many women who have some degree of hirsutism and possibly irregular cycles have what looks like polycystic ovaries on sonography. But if they are having OVULATORY cycles, they do not have PCOS, because not ovulating is one of the defining features of PCOS.
[Tue Apr 15 17:35:36 PDT 2008]	drgrazi	SO they may have polycystic ovaries, but they do not have the SYNDROME
[Tue Apr 15 17:35:37 PDT 2008]	ljmorgan84	If you don't respond to Clomid what are the chances that insemination will work?
[Tue Apr 15 17:35:55 PDT 2008]	drgrazi	In such cases, it is important to explore for other sources of infertility.
[Tue Apr 15 17:36:17 PDT 2008]	rivergonzos	how do you know if you are ovulatory or anovulatory?
[Tue Apr 15 17:36:24 PDT 2008]	drgrazi	if you do not respond to cloimid, meaning you do not ovulate, there is ZERO chance insemination will help
[Tue Apr 15 17:37:00 PDT 2008]	drgrazi	there are several ways to track ovulation. many websites can assist in the time-honored method of tracking basal body temperature, or BBT
[Tue Apr 15 17:37:24 PDT 2008]	drgrazi	I prefer ovulation predictor kits, because the BBT only tells you've ovulated AFTER it's occurred
[Tue Apr 15 17:37:39 PDT 2008]	auntheatty	is your pituitary gland responsible for your hormones and in turn whether you ovulate or not?
[Tue Apr 15 17:37:44 PDT 2008]	drgrazi	having said that, the BEST way is to have your cycle monitored with ultrasound and possibly blood testing
[Tue Apr 15 17:38:15 PDT 2008]	frances1	i have very long menstrual cycles (8+ days), very heavy bleeding, pain, excess facial hair, 2 pregnancies both ended in miscarriage...could these be signs
[Tue Apr 15 17:38:28 PDT 2008]	Squishy	But is it possible to not have an egg in a follicle, so still have a bleed?
[Tue Apr 15 17:38:28 PDT 2008]	drgrazi	the reason for this is that these meds may give you regular cycles and ovulation, but have other side effects that can prevent pregnancy from occurring, such as drying up the cervical mucus, or interfering with proper development of the uterine lining
[Tue Apr 15 17:39:06 PDT 2008]	dogwood7	I have the syndrome and ovulate every month, What would that mean? I am more adrenal possibly?
[Tue Apr 15 17:39:11 PDT 2008]	rivergonzos	how can you counter those side affects?
[Tue Apr 15 17:39:20 PDT 2008]	drgrazi	some follicles do not have eggs in them, but this is an exotic cause of infertility. if your doctor is monitoring your cycle and tells you you are ovulating, you likely are
[Tue Apr 15 17:39:58 PDT 2008]	drgrazi	ok. lots of questions again. i am trying hard. cannot type any faster. am i losing anyone's attention?
[Tue Apr 15 17:40:13 PDT 2008]	rivergonzos	not mine
[Tue Apr 15 17:40:15 PDT 2008]	dogwood7	im good
[Tue Apr 15 17:40:15 PDT 2008]	strmgirl97	no
[Tue Apr 15 17:40:19 PDT 2008]	ljmorgan84	no
[Tue Apr 15 17:40:19 PDT 2008]	rickels	im good
[Tue Apr 15 17:40:29 PDT 2008]	flo	no
[Tue Apr 15 17:40:55 PDT 2008]	drgrazi	if you ovulate every month, you must look for another cause of infertiliity. if everything else comes up normal, then EMPIRICAL ovulation induction would be the way to go. i am going to write some more about that
[Tue Apr 15 17:41:17 PDT 2008]	drgrazi	because you asked me what to do if the medications are having undesirable side effects
[Tue Apr 15 17:41:28 PDT 2008]	drgrazi	and the answer to that is gonadotropins or ivf. let's start with gonadotropins
[Tue Apr 15 17:41:36 PDT 2008]	drgrazi	still all on the same page?
[Tue Apr 15 17:41:43 PDT 2008]	amanda112903	yep
[Tue Apr 15 17:41:44 PDT 2008]	rivergonzos	yes, thanks
[Tue Apr 15 17:41:45 PDT 2008]	ljmorgan84	yep
[Tue Apr 15 17:41:49 PDT 2008]	strmgirl97	yep
[Tue Apr 15 17:41:52 PDT 2008]	Corey_Whelan	everyone's doing great!
[Tue Apr 15 17:42:02 PDT 2008]	drgrazi	because - here's the good news - everyone with PCOS (virtually) will ovulate with gonadotropins
[Tue Apr 15 17:42:32 PDT 2008]	drgrazi	and we are talking here about NATURAL FSH or a combination of FSH and LH, commonly called hMG
[Tue Apr 15 17:42:47 PDT 2008]	drgrazi	The downside of these medications is that they must be injected
[Tue Apr 15 17:43:24 PDT 2008]	drgrazi	however, they are particularly useful if your weight is too high (i guess we should talk about that at some point) or if you just don't respond to anything else
[Tue Apr 15 17:44:01 PDT 2008]	drgrazi	another potential issue is multifetal pregnancy and something called ovarian hyperstimulation (OHSS). i would like to explain more if you are interested.
[Tue Apr 15 17:44:13 PDT 2008]	Symharmony	If your ovaries are polycystic, can you still have excess facial hair but have no other symptoms?
[Tue Apr 15 17:44:20 PDT 2008]	drgrazi	MFP is very problematic
[Tue Apr 15 17:44:25 PDT 2008]	dogwood7	i have been there 2x's, not fun
[Tue Apr 15 17:44:42 PDT 2008]	drgrazi	the answer to that question is yes.
[Tue Apr 15 17:44:45 PDT 2008]	rivergonzos	what is empirical ovulation induction?
[Tue Apr 15 17:44:56 PDT 2008]	Symharmony	thanks
[Tue Apr 15 17:45:10 PDT 2008]	drgrazi	also, that women with PCOS are partiuclarly prone to both MFP and OHSS. However, they are AVOIDABLE complicatons, mainly
[Tue Apr 15 17:45:44 PDT 2008]	ljmorgan84	ohss...is this when the cysts form while taking clomid? or similar?
[Tue Apr 15 17:45:52 PDT 2008]	drgrazi	(EMPIRICAL ovulation induction means that it is being used not to make you ovulate, but to ENHANCE your chances of conceiving with each cycle. It is usually combined with intrauterine insemination)
[Tue Apr 15 17:46:14 PDT 2008]	drgrazi	Similar and different. OHSS from clomid is extremely rare
[Tue Apr 15 17:46:36 PDT 2008]	dogwood7	2x during IVF we were were trying to avoid OHSS, happend anyway
[Tue Apr 15 17:46:51 PDT 2008]	ljmorgan84	Every time I take Clomid the cysts and pain are horrible to the point
[Tue Apr 15 17:47:01 PDT 2008]	dogwood7	I will be doing IUI at some point
[Tue Apr 15 17:47:08 PDT 2008]	drgrazi	the "cysts" you are talking about are basically small follicles that were too immature to ovulate at the time that ovulation actually occurred, and they can show up during the following period as cysts. they are benign and usually not felt
[Tue Apr 15 17:47:13 PDT 2008]	ljmorgan84	to the point I'm really sick
[Tue Apr 15 17:47:36 PDT 2008]	drgrazi	if you are having pain from clomid, something is not right. you should not take it
[Tue Apr 15 17:47:42 PDT 2008]	rivergonzos	i'm sure I ovulate about 9 months a year but I know I don't about 3 months a year would you consider that PCOS or PCO?
[Tue Apr 15 17:48:08 PDT 2008]	drgrazi	here is another good segue. it is true that IVF is often used to prevent OHSS. it is not infallible, however
[Tue Apr 15 17:49:07 PDT 2008]	drgrazi	but, what it is PERFECT for, if your ovaries are not behaving well, and insist on either not responding or over-responding, is to prevent MFP. With IVF, we have perfect control over how many embryos will reach your uterus. the right number is always ONE!
[Tue Apr 15 17:49:43 PDT 2008]	drgrazi	Rivergonzos is really giving me a hard test. i don't know what to call that: it is very unusual,however
[Tue Apr 15 17:49:55 PDT 2008]	Squishy	But the process getting to that one embryo can be difficult for some
[Tue Apr 15 17:50:03 PDT 2008]		dogwood7 left.
[Tue Apr 15 17:50:36 PDT 2008]	drgrazi	IVF is always a difficult process. From physical stress, emotional overlay, etc. it must be approached with lost of preparation from every end
[Tue Apr 15 17:51:15 PDT 2008]	auntheatty	and I don't know about all you guys, but who can afford it??? certainly not me
[Tue Apr 15 17:51:30 PDT 2008]	rivergonzos	i will miss periods where I have one every couple months, i've charted and used ovu tests and have been trying for about 10 years, using most treatments except a few hear mentioned, i can also feel the twinge when i ovulate just from getting to know my body so well
[Tue Apr 15 17:51:31 PDT 2008]	amanda112903	me either AH
[Tue Apr 15 17:51:33 PDT 2008]	drgrazi	I was thinking about saying something about weight. after all, we are talking about PCOS here. And 2/3 of all women with pcos are overweight or obese
[Tue Apr 15 17:51:55 PDT 2008]	flo	im with you auntheatty
[Tue Apr 15 17:52:02 PDT 2008]	rivergonzos	unless the egg just attached to my ovary as a cysts?
[Tue Apr 15 17:52:15 PDT 2008]	drgrazi	with regard to financial aspects of ivf, it all depends where you live and who insures you. in New York, although it is not mandatory to do so, MOST insurers covere IVF
[Tue Apr 15 17:52:26 PDT 2008]	drgrazi	and there are also other options for those who are not covered
[Tue Apr 15 17:52:31 PDT 2008]		frances1 left.
[Tue Apr 15 17:52:43 PDT 2008]	rivergonzos	i am and my weight has varied but no matter what my weight the results are the same, although my periods are more regular when i weigh less
[Tue Apr 15 17:52:56 PDT 2008]	hoping	can you say more about other options for those not covered?
[Tue Apr 15 17:53:14 PDT 2008]	drgrazi	thank you rivergonzos. it's a very important part of treating ivf - wt loss1
[Tue Apr 15 17:53:20 PDT 2008]	Corey_Whelan	Guys, I think we should talk about weight issues if you're alll up for it. We will also go ten minutes over tonight since we started late
[Tue Apr 15 17:53:31 PDT 2008]	ljmorgan84	I weigh 115 and I still don't have normal cycles.
[Tue Apr 15 17:53:33 PDT 2008]	flo	i live in New York its not cover
[Tue Apr 15 17:53:33 PDT 2008]	strmgirl97	yes please on the weight issues
[Tue Apr 15 17:53:46 PDT 2008]	Corey_Whelan	also, you are always free to stay in the chat room as long as you like after the chat has officially ended so please do so if you would like
[Tue Apr 15 17:53:51 PDT 2008]		christalp joined.
[Tue Apr 15 17:53:51 PDT 2008]	drgrazi	but it's not magic. remember also that 1/3 of women with PCOS are quite thin. Their physiology is different and my approach to ovulation induction with them is different
[Tue Apr 15 17:54:55 PDT 2008]	drgrazi	A lot has been bantered about metformin. i have found that most women with PCOS who are lean WILL respond to it, while weight is an obstacle to its working
[Tue Apr 15 17:55:40 PDT 2008]	drgrazi	So it is worth bearing in mind that if you weigh 115 lbs and have PCOS, metformin is the easiest (and least expensive!) way to start therapy
[Tue Apr 15 17:55:53 PDT 2008]	drgrazi	It also has no risk of MFP.
[Tue Apr 15 17:56:20 PDT 2008]	rickels	what does MFP stand for again?
[Tue Apr 15 17:56:36 PDT 2008]	drgrazi	On the other hand, if you are overweight, and especially if your BMI - body mass index - is over 35, it is really much better to lose wt before any treatment is begun
[Tue Apr 15 17:56:41 PDT 2008]	drgrazi	multifetal pregnancy
[Tue Apr 15 17:56:53 PDT 2008]	ljmorgan84	I was on Metformin a year ago (it made me sick) but i did get pregnant...miscarried at 9wks. Do you recommend women stay on metformin for the first trimester?
[Tue Apr 15 17:56:55 PDT 2008]	rickels	thank you
[Tue Apr 15 17:56:56 PDT 2008]	flo	i weigh 150 normal period and i took clomid and metformin for 6mos i still didn't ge pregnant
[Tue Apr 15 17:56:57 PDT 2008]	rivergonzos	my highest weight 270, my lowest 150, i currently weigh 230 after losing 25lbs, south beach & exercise work best for me, i'm 5'2. I don't eat junk food & soda, just gain weight for no reason
[Tue Apr 15 17:57:20 PDT 2008]	ljmorgan84	Just recently stopped clomid...I'm with you flo.
[Tue Apr 15 17:57:22 PDT 2008]	drgrazi	I usually take women off metformin at around 9-10 weeks
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[Tue Apr 15 17:57:57 PDT 2008]	Squishy	I think the reason you gain weight, rivergonzo, is because of PCOS
[Tue Apr 15 17:58:03 PDT 2008]	rivergonzos	i am guilty for not staying on the diet as a lifestyle change and exercise
[Tue Apr 15 17:58:04 PDT 2008]	amanda112903	what are the benefits of baby asprin with metformin and clomid?
[Tue Apr 15 17:58:05 PDT 2008]	Corey_Whelan	Hi jug, we're going to run late tonight so you're in luck
[Tue Apr 15 17:58:10 PDT 2008]	drgrazi	sorry about the stomach upset - that is certainly the most common side effect with metformin and if it's really bad you need to stop. The important thing is to start slowly and work your way up to a therapeutic dose
[Tue Apr 15 17:58:11 PDT 2008]	Symharmony	Why do women have miscarriages with PCOS?
[Tue Apr 15 17:58:27 PDT 2008]	jugijules	hi, ok
[Tue Apr 15 17:58:39 PDT 2008]	Corey_Whelan	amanda and symharmony have good questions up
[Tue Apr 15 17:59:06 PDT 2008]	drgrazi	All good stuff coming up. Yes, it's harder to lose weight if you have PCOS. But it's a matter of eliminating the carbs AND exercising. one without the other just will not work!
[Tue Apr 15 17:59:35 PDT 2008]	drgrazi	amanda: there is no place for baby ASA in the treatment of PCOS.It is used for other indications
[Tue Apr 15 17:59:41 PDT 2008]	Corey_Whelan	and remember guys, a potato can be just as bad for you as a cupcake.
[Tue Apr 15 17:59:49 PDT 2008]	drgrazi	symharmony: excellent question
[Tue Apr 15 18:00:09 PDT 2008]	drgrazi	we believe that the chronically high LH levels that accompany PCOS may be the culprit
[Tue Apr 15 18:00:16 PDT 2008]	rivergonzos	yeah i stay away from potatoes & pepsi, they are my weakness
[Tue Apr 15 18:00:24 PDT 2008]		hoping left.
[Tue Apr 15 18:00:31 PDT 2008]	drgrazi	there may be other reasons that have to do with egg quality and also functioning of the corpus luteum after ovulation
[Tue Apr 15 18:01:02 PDT 2008]	drgrazi	But, if you are getting pregnant from your treatment of PCOS, you are eventually going to be successful
[Tue Apr 15 18:01:29 PDT 2008]	drgrazi	no room for weakness, here, folks.
[Tue Apr 15 18:01:46 PDT 2008]	drgrazi	i know it's easy for me to say. i am, at the end of the day, a guy at home in pajamas
[Tue Apr 15 18:01:49 PDT 2008]	rickels	easier said then done
[Tue Apr 15 18:01:51 PDT 2008]	rivergonzos	thats why i stay away from them altogther, learned the hardway
[Tue Apr 15 18:02:24 PDT 2008]	rivergonzos	shop at meat market and veggie market instead of the grocery store
[Tue Apr 15 18:02:24 PDT 2008]	Corey_Whelan	well river, you're on the right track. Carbs really can be considered a kind of addiction. Eliminate them completely and you often eliminate the craving for them.
[Tue Apr 15 18:02:49 PDT 2008]	drgrazi	but, the truth is, the quest for pregnancy is a fabulous motivator. i have seen women lose many lbs once they full digested (pardon the pun) the importance of doing so and toxic that weight was to their achievement of pregnancy
[Tue Apr 15 18:02:50 PDT 2008]	Symharmony	Don't you need a LH surge to indicate ovulation? You mentioned the high LH levels
[Tue Apr 15 18:02:55 PDT 2008]	flo	i was pregrant 2yrs ago baby heart stop beating since i been trying no luck so far
[Tue Apr 15 18:03:00 PDT 2008]	rivergonzos	i heard metformin gives sweat cravings?
[Tue Apr 15 18:03:16 PDT 2008]	Corey_Whelan	so sorry, flo
[Tue Apr 15 18:03:36 PDT 2008]	drgrazi	Sym.. LH should be detectable only preceding ovulation. Women with PCOS tend to have chronically elevated levels of LH
[Tue Apr 15 18:03:38 PDT 2008]	Squishy	Sorry flo
[Tue Apr 15 18:03:39 PDT 2008]	rivergonzos	sorry to hear flo
[Tue Apr 15 18:04:07 PDT 2008]	Symharmony	Thanks
[Tue Apr 15 18:04:11 PDT 2008]	strmgirl97	so, an ovulation test like Clearblue can really be a false positive for PCOS people?
[Tue Apr 15 18:04:18 PDT 2008]	flo	thank you
[Tue Apr 15 18:04:24 PDT 2008]	drgrazi	sorry, flo. i am sure this is devastating. are you doing something different that you had been? was there a known cause for the miscarriage?
[Tue Apr 15 18:04:47 PDT 2008]	drgrazi	Don't forget that miscarriage is a risk that every woman takes when trying to conceive.
[Tue Apr 15 18:04:52 PDT 2008]	flo	no
[Tue Apr 15 18:05:13 PDT 2008]	drgrazi	This is a risk that cannot be eliminated. It is the topic of a completely different discussion, of course
[Tue Apr 15 18:05:35 PDT 2008]	drgrazi	flo: you need to talk to your RE. Two years is too long to not be looking at other things
[Tue Apr 15 18:05:46 PDT 2008]	rivergonzos	what is different with emperical? diff drugs?
[Tue Apr 15 18:06:03 PDT 2008]	Symharmony	Can a Lap help with removal of the cysts on the ovaries?
[Tue Apr 15 18:06:06 PDT 2008]	drgrazi	No. Same drugs, somewhat different approach
[Tue Apr 15 18:06:19 PDT 2008]	rivergonzos	how so? if you don't mind
[Tue Apr 15 18:06:25 PDT 2008]	flo	can you recommed one in New York
[Tue Apr 15 18:06:28 PDT 2008]	Squishy	I've heard that a benefit with PCOS is that the "age 35" factor is sort of extended.
[Tue Apr 15 18:06:28 PDT 2008]	drgrazi	But now i have to answer Symharmony. Pardon me while i address my pet peave
[Tue Apr 15 18:06:44 PDT 2008]	drgrazi	PCOS has nothing to do with ovarian cysts!
[Tue Apr 15 18:06:51 PDT 2008]	jugijules	i had a lap to remove cysts
[Tue Apr 15 18:06:59 PDT 2008]	drgrazi	There is no place for surgical removal, because there are no CYSTS.
[Tue Apr 15 18:07:22 PDT 2008]	Corey_Whelan	flo, if you are looking for a physician referral, please call the AFA helpline, Lisa will give you tons. And of course, Dr. Grazi has offices in Bklyn and SI
[Tue Apr 15 18:07:35 PDT 2008]	Corey_Whelan	toll free 888 917 3777
[Tue Apr 15 18:07:37 PDT 2008]	Symharmony	Some doctors make it sound like that is a way they can help you but it is good to know that they are wrong
[Tue Apr 15 18:07:44 PDT 2008]	drgrazi	Remember that the CYST in polyCYSTic ovary syndrome is about eggs. There are no cysts, as in "i had to h ave a cyst removed from my ovary"
[Tue Apr 15 18:07:54 PDT 2008]	Corey_Whelan	and all of you know you can always reach me, please don't hesitate corey@theafa.org
[Tue Apr 15 18:08:10 PDT 2008]	rivergonzos	i thought the eggs turned into cysts and attached to your ovaries?
[Tue Apr 15 18:08:24 PDT 2008]	drgrazi	Having said that, there is sometimes an indication for cautery or laser ablation of the follicles by laparoscopy. But indications for it are few and far between]
[Tue Apr 15 18:08:41 PDT 2008]	drgrazi	no no no no no!
[Tue Apr 15 18:08:49 PDT 2008]	drgrazi	This has nothing to do with cysts
[Tue Apr 15 18:09:01 PDT 2008]	drgrazi	The so called "cysts" are just egg follicles
[Tue Apr 15 18:09:08 PDT 2008]	rivergonzos	what happens to the polycystic eggs?
[Tue Apr 15 18:09:14 PDT 2008]	Corey_Whelan	Guys, it's up to Dr. Grazi how late he wants to stay but I know he has been typing very fast and working very hard! I think we need to let him go in a few minutes
[Tue Apr 15 18:09:26 PDT 2008]	drgrazi	Though it is true that if you cut up the ovary and put it under the microscope the follicles look like cysts.
[Tue Apr 15 18:09:48 PDT 2008]	drgrazi	But they are not cysts. You want them there! They are your eggs (and your future progeny, we hope)
[Tue Apr 15 18:10:17 PDT 2008]	drgrazi	Many women who have exhausted their egg supply and therefore have no hope of conceiving wish they were in your shoes!
[Tue Apr 15 18:10:32 PDT 2008]	drgrazi	All you need to do is get those lazy eggs to ovulate
[Tue Apr 15 18:10:42 PDT 2008]	drgrazi	This is a treatable condition.
[Tue Apr 15 18:11:16 PDT 2008]	drgrazi	As we wind it down, here is something to remember about what happens to those "cysts"
[Tue Apr 15 18:11:24 PDT 2008]	drgrazi	You keep losing them
[Tue Apr 15 18:11:29 PDT 2008]	drgrazi	And growing new ones
[Tue Apr 15 18:11:34 PDT 2008]	drgrazi	all the time!
[Tue Apr 15 18:11:34 PDT 2008]	rivergonzos	can i produce enough eggs to participate in shareivf? because I have a coworker with low quality eggs who is 39?
[Tue Apr 15 18:11:45 PDT 2008]	drgrazi	That is the way the system works in every woman
[Tue Apr 15 18:12:18 PDT 2008]	rivergonzos	sorry for all the questions, I really appreciate all your help
[Tue Apr 15 18:12:26 PDT 2008]	drgrazi	Women with PCOS are the highest responders - one of the problems with them using gonadotropins is MFP, as we spoke about
[Tue Apr 15 18:12:32 PDT 2008]	Corey_Whelan	river, don't apologize. that is why we are here!
[Tue Apr 15 18:12:39 PDT 2008]	drgrazi	But in IVF, this can be somewhat of an advantage
[Tue Apr 15 18:12:42 PDT 2008]	drgrazi	Somewhat
[Tue Apr 15 18:13:03 PDT 2008]	drgrazi	Because you do't want to over-respond and get OHSS from your IVF treatment
[Tue Apr 15 18:13:16 PDT 2008]	flo	Thank you Dr. Grazi i'll be intouch
[Tue Apr 15 18:13:19 PDT 2008]	ljmorgan84	thanks for all of your help!
[Tue Apr 15 18:13:23 PDT 2008]	Corey_Whelan	what a great chat everyone. I really want to thank you all for asking such great questions! And thanks of course to Dr. Grazi for his participation tonight. Terrific job! I learned a lot.
[Tue Apr 15 18:13:43 PDT 2008]	Corey_Whelan	Dr. Grazi, thank you SO MUCH. Please feel free to share your website address with us
[Tue Apr 15 18:13:44 PDT 2008]	drgrazi	But, ultimately, between Clomid, Letrozole, Gonadotropins, IVF -- nearly everyone gets pregnant
[Tue Apr 15 18:13:54 PDT 2008]	drgrazi	Just keep that weight down (sorry)
[Tue Apr 15 18:14:04 PDT 2008]	rivergonzos	Definately agree, I can't wait to get started trying again, took a little time off to recoup, lol
[Tue Apr 15 18:14:12 PDT 2008]	drgrazi	www.genesisfertility.com
[Tue Apr 15 18:14:17 PDT 2008]	Corey_Whelan	yes, please! It's the quality of your life and health too, not just your conception potential.
[Tue Apr 15 18:14:50 PDT 2008]	drgrazi	Good luck everyone. And, during this important quest,
[Tue Apr 15 18:14:53 PDT 2008]	Corey_Whelan	thank you all so much. Please jot down the date of SUnday, Oct 5th in your calendars for the next Family Matters conference, to be held in Bklyn NY
[Tue Apr 15 18:14:58 PDT 2008]	drgrazi	don't forget to live your lives.
[Tue Apr 15 18:15:08 PDT 2008]	amanda112903	Thank You!
[Tue Apr 15 18:15:11 PDT 2008]	rivergonzos	Thanks
[Tue Apr 15 18:15:14 PDT 2008]	strmgirl97	thank you
[Tue Apr 15 18:15:22 PDT 2008]	Squishy	Thanks very much!
[Tue Apr 15 18:15:23 PDT 2008]	Corey_Whelan	amen to that. You all deserve joy. You know I wish you so much luck. Guys, please log off with a state roll call, if you don't mind.
[Tue Apr 15 18:15:29 PDT 2008]	Corey_Whelan	xo to you all and sweet baby dreams
[Tue Apr 15 18:15:57 PDT 2008]	drgrazi	Thanks. I had fun.
[Tue Apr 15 18:16:02 PDT 2008]	drgrazi	Best of luck to all of you.
[Tue Apr 15 18:16:03 PDT 2008]	auntheatty	what's a state roll call?
[Tue Apr 15 18:16:05 PDT 2008]	Corey_Whelan	I could tell!
[Tue Apr 15 18:16:06 PDT 2008]	rivergonzos	Florida
[Tue Apr 15 18:16:08 PDT 2008]	amanda112903	Ohio (cincinatti)
[Tue Apr 15 18:16:10 PDT 2008]	strmgirl97	wyoming here
[Tue Apr 15 18:16:14 PDT 2008]	ljmorgan84	Virginia
[Tue Apr 15 18:16:14 PDT 2008]	Corey_Whelan	Like the state you live in. I'm in NY
[Tue Apr 15 18:16:16 PDT 2008]	auntheatty	oh, michigan
[Tue Apr 15 18:16:21 PDT 2008]	jugijules	florida
[Tue Apr 15 18:16:24 PDT 2008]	rickels	NY
[Tue Apr 15 18:16:25 PDT 2008]	flo	Bronx, New york
[Tue Apr 15 18:16:29 PDT 2008]	sweetsunny	minnesota
[Tue Apr 15 18:16:33 PDT 2008]	Squishy	Toronto, Canada
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[Tue Apr 15 18:17:39 PDT 2008]	christalp	NC
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[Tue Apr 15 18:42:21 PDT 2008]	christinaadepoju	weres the doctor?
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[Tue Apr 15 18:43:38 PDT 2008]	christinaadepoju	ok what r we talking about?
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Dr. Richard Grazi, of Genesis Fertility

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