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May 29, 2009

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Your Patient

Hi Dr. Zhang,
I'm a patient of yours and just had my fresh transfer from mini-ivf last week. You have me on oral estrace and a progesterone suppository. I feel the only way to get a solid answer on my questions is to try and contact you directly.

QUESTION:
1) I am concerned about taking drugs for so long (1st trimester if I'm pregnant). These drugs are not supposed be taken "if" pregnant (according to the pamphlets that came with them). I realize my body isn't naturally producing these to the level needed to support pregnancy and that's why I'm on them. But, shouldn't we be testing my blood every few days to indeed test those levels and see if the drugs are needed or are they needed in those doses? Might they need to be altered?

2) I'm suddenly discharging a LOT of clumpy dry white stuff. I suspect it's the progesterone cream. Why is it suddenly doing this? Is this an indication that it's not working or I'm not using it correctly? After my procedure last week, the nurse told me to take the oral pill and vaginal suppository at dinner time if I wanted. When I called the clinic today to inquire about the discharge, the nurse told me I should be doing this stuff in the morning so I'm walking around during the day, helping it get absorbed. NOW I'M CONCERNED that I wasn't directed properly and might have jeopardized my fresh transfer.

Thanks,
Your patient

Dr. Zhang

Please contact our clinic directly to discuss these issues.

GPS

Hello Dr. Zhang,

My wife is about to turn 40 this month. She was diagnosed as pre-menopausal and with a diminished ovarian reserve. We have not undergone any IVF cycles at our current fertility clinic because we were rejected at the clomid challenge test phase. Her day 3 FSH before the clomid challenge was 33 and subsequently jumped to 49 after the clomid treatment. This information alone was enough to prompt our doctor to suggest that we move straight to a donor egg program. His opinion is that her eggs are of very poor quality and that we only have a 5% to 10% chance of success using her eggs in IVF. We are of course looking for other opinions. Having read some of your materials on newhopefertility.com, it seems that you believe that high FSH levels do not necessarily mean poor oocyte quality.

Given this information, would you recommend that we contact you to discuss a Mini-IVF treatment or do you think that this treatment might not be right for us (given that you use clomid in the first place)?

Best Regards

Jane

Can I do several Mini-IVF cycles to bank the embryos, and then do one time PGD (sex selection) for all of the banked embryos? Or is it better to do "Sperm Sex Selection"?

"Sperm Gender Selection

Over the last decade, the dominant technique used to determine gender prior to conception has always been preimplantation genetic diagnosis, or PGD. The newest alternative, sperm gender selection, is a technique designed to separate and sort X (female) or Y (male) chromosomal sperm. This sorted sperm can then be fertilized with an egg via intrauterine insemination (IUI) or in vitro fertilization to produce a child of the desired gender. "

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