Q&A Sessions:

	-	Most Recent
	-	Age and Fertility
	-	Egg/Embryo Donation
	-	Follicle-stimulating Hormone (FSH)
	-	In Vitro Fertilization (IVF)
	-	Male Infertility
	-	Other Fertility Issues
	-	Polycystic Ovary Syndrome (PCOS)
	-	Tubal/Vasectomy Reversal
	-	Unidentified Infertility

Candice asks:
After having your tubes tied, can an egg be harvested for use in the procedure that is used to implant it in another woman?

Samantha Butts, MD responds:
Having had your tubes tied does not mean you stop producing eggs and these can be harvested by means of in vitro fertilization (IVF). Getting a tubal ligation (tying your tubes) for the purposes of birth control prevents pregnancy by blocking the ability of an egg and sperm to meet in the tube where normal fertilization happens.

We actually treat many women who have had their tubes tied and want to have children again using IVF which allows us to harvest eggs from a woman and have them fertilize with her partners sperm outside the body (as opposed to inside the body where it happens naturally).

To directly answer your question, yes, we can get eggs from women who have had their tubes tied but the number eggs depends on age and other medical factors.

Jeanne asks:
I no longer have a uterus but would like to know if my eggs could still be harvested and used in a possible surrogate pregnancy.

Steven Sondheimer, MD responds:
Yes, one of the wonderful modern successes of assisted reproductive technologies (ART) and in vitro fertilization (IVF) is the ability to fertilize your eggs and transfer the embryo to another women who will carry the pregnancy. The most important factors will be your age and the degree of ovarian ageing. Unfortunately, occasionally the ovaries stop normal functioning earlier after hysterectomy.

Another concern will be to check the location of your ovaries to determine the ease of transvaginal ultrasound guided retrieval. You will need to see a reproductive endocrinologist (fertility specialist) who can review your case in greater detail and obtain the proper screening of you and the gestational carrier.

Terry asks:
I am 41 with FSH 22, right tube blocked, left tube has some
adhesions because of endometriosis. My doctor wants to proceed straight to donor egg/IVF. Is there any other option? tube repair? herbs? acupuncture?

Clarisa Gracia, MD responds:
Your physician's approach is definitely the most efficient way to get pregnant. Tubal repair does not usually work well - especially in older women since it can take a long time to become pregnant. I wish that I had an easier solution - but acupuncture and herbs have not been proven effective for the treatment of infertility.

If you would like to see a Penn Ob/Gyn Care physician, please call 1-800-789-PENN (7366) or request an appointment online.

Luz asks:
I recently had a failed IVF cycle. I'm considering a frozen embryo transfer (FET). What are the chances of success? I have one blastocyst and nine embryos.

Samantha Butts, MD MSCE responds:
Your odds of success depends on your age and the experience of the practice where you are having your FET. In other words, the younger you are the better chance of pregnancy. In addition, you should ask your practice what their FET success rates are (which are generally lower than fresh cycle pregnancy rates) to get a better sense of what your chances are.

Jody asks:
I am 32 years old. I have been married and trying to conceive for four years now. I have endometriosis which has been removed to the best of the physicians' ability along with one of my tubes. I have recently done an in vitro cycle and was told that I have poor egg qualilty.

Is there anything that can be done to improve my egg quality? Should I try another cycle of IVF to see if there is a difference in the egg quality? Am I just wasting my money trying another cycle? Is it time to move on to a donor egg?

Response:
I am sorry to hear about your difficulties. Poor egg quality is often very difficult to diagnose. Often, it can be improved by changing your stimulation protocol. However, if you really do have "poor quality," then donor egg is a very good option. I would suggest a more formal consultation; these complex issues are best discussed in person.

We at Penn Fertility Care would be happy to take the time to go over these issues with you. If you would like to schedule an appointment, please call 800-789-PENN (7366) or visit pennhealth.com to schedule an appointment online.

Nicole asks:
What are your sucess rates with PDG? What is your sucess with working with people with a balanced translocation? Do you suggest egg retrieval or egg donation?

Response:
A direct answer to your question requires more information. It depends on who has the translocation. If it is you (the potential mother), a donor egg has a very good chance of working (50- 60 percent fresh cycle success and 80 - 90 percent with the additional of frozen transfer). PDG (with egg retrieval) has similar success assuming all other factors are okay.

The caveat is working with someone who is experienced in PDG for that abnormality. The choice between them is complex and best discussed in person. If you would like to make an appointment with a specialist at Penn Fertility Care, please call 1-800-789-PENN (7366) or visit pennhealth.com to schedule an appointment online.

Allison asks:
Is Penn doing research or considering offering cytoplasmic transfer using the woman's own eggs (not a donor egg) — sacrificing one of the woman's own eggs to inject the cytoplasma into the remaining eggs. I have been told using a donor egg is banned by the FDA but not if the woman is using her own eggs. Do you see any potential benefits to this procedure?

Christos Coutifaris, MD, PhD responds:
This answer may sound technical but I would like to answer it in detail. If the theoretical problem being corrected by the cytoplasmic transfer is to introduce factors in the recipient's egg that are suboptimal or lacking, then using the same woman's eggs for the source of the cytoplasm does not make physiological sense.

One theoretical exception could be if it is a matter of quantity of a particular factor, then such a procedure may have some benefit. I stress though that this is theoretical. At present, no such experimental protocol is being used at Penn. One point of caution: Any such experimental protocols should be approved by an Institutional Review Board and should be offerred to patients free of charge until they are proven effective.

Terri asks:
I am concidering getting a donor egg to get pregnant. I have
issues and don't want to risk an unhealthy baby. I am 43. How well do they screen donors for health and family health.

Kurt Barnhart, MD, MSCE responds:
Donor egg is an excellent option for many couples who are unable to conceive with out assistance. The process involves using a young healthy donor. She is screened thoroughly. She is screened psychologically, medically and genetically. Additionally, once she is "matched" she undergoes a battery of tests to ensure she does not have anything that can be transmitted to a potential baby.

While no screening process can be 100% perfect, the health of the baby through donor egg is often better (because the risk of a miscarriage or down's syndrome is actually lower)than a baby conceived without assistance by a women in her 40's. We have an excellent donor egg program at Penn Fertility Care. If you would like to find out more information or make an appointment call 1-800-789-PENN (7366).

Elena asks:
How do I become a donor and where can I go to donate?

Penn Fertility Care asks:
Thank you for your interest in becoming an egg donor. There are a few ways to get in touch with the program. You can simply call 800.789.PENN (7366) or you can also visit the donor egg program portion of our website. If you are interested in becoming a donor, please fill out the egg donation screening form (PDF) and either fax or mail to:

Penn Fertility Care
Attn: Donor Egg Program - Kelly Alexander
3701 Market Street, Suite 810
Philadelphia, PA 19104
Fax number: 215-615-4200

Zoe asks:
I was an egg donor four times in two years, back when I was 28 to 29 years old. I blew all the records away, as they retrieved 55 eggs the first time, lowered the stimulation meds and then retreived 45 the next time, then 38 the next time, then 45 the last time.

Now I'm 42 and trying to conceive for the first time. Do you think those donations will have any effect on our chances? Certainly my age does, but wanted to know specifically about the donation and if I might have "given all my good eggs away," so to speak. Thank you!

Kurt Barnhart, MD, MSCE responds:
I am sorry if you are having trouble getting pregnant at this time. However, I am confident when I say it was not related to your past egg donation. What you did then was a wonderful gift. You basically donated eggs that would never have ovulated, and would have been resorbed by your body.

Each month your body is ready to mature a number of eggs. The group that was to go to maturation in your 40's has had a significant amount of time to deplete itself. The eggs you donated were from a group that would have been used long ago. Specifically when you were a donor, that group started to grow.

If left to your body's own account, one egg out of the group would have ovulated (none if you where on the pill), and the others would have been resorbed. Thus, you gave donated eggs that would have otherwise just never had a chance. Those eggs were not taken from future groups, such as the one you are using now.

Hamptonsgirl asks:
I have been curious about egg donation, but I have been told that it is or can be a painful process for the donor. Is this true?

Kurt Barnhart, MD, MSCE responds:
Penn Fertility Care has about 40 women ready to donate eggs to those in need at any time. The women who donate have all gone through an extensive screening process and are fully consulted on all of the steps involved. The process is anonymous.

The process is, however, a complex one, with a few visits to discuss the process, including some blood tests. We will walk you through every step. However, there should not be one step that is very difficult or painful. If you are interested in learning more, please call 800-789-PENN (7366) or request an appointment online. We would be happy to discuss the process in detail. Donating eggs is a wonderful gift.

Marie asks:
I have known a couple for about two years now, and they have two children already. However, they are wanting another child and she cannot carry another child. I am interested in helping them have a child, using his sperm and her egg. Is this possible and how do I go about it?

Steven Sondheimer, MD responds:
It is wonderful that you want to be helpful. Nonetheless without more information I cannot fully answer your questions. If as I understand she has had a hysterectomy or for some other reason can not carry a pregnancy, but has healthy eggs, then you could be a gestational carrier.

In vitro fertilization (IVF) is performed and then the embryo is transferred to your womb to carry the pregnancy for the nine months. You will most likely need to be on hormonal medication to prepare your uterine lining to accept the embryo and to help during the first three months or so of pregnancy.

Often when a physician helps patients with this process, they try to meet with all of the individuals separately and then together so that they he/she can assess your health and to help you to understand in detail the health issues and risks involved. I wish you the best with your decision!

Kristin asks:
I would like to become an egg donor. What is involved and would I get paid to do so?

Kurt Barnhart, MD responds:
Thank you for your interest in egg donation. Penn Fertility care has and active program. We have been able to help many couples thanks to generous women like yourself.

Please reference our egg donation information. If you have further questions, call 1-800-789-PENN (7366) and ask to be connected to Penn Fertility Care.

You can also download and complete a donor egg application form. Women are generously reimbursed for their time and effort as egg donors.

Tanya asks:
I am considering becoming a egg donor, but wanted to know the following. Is it possible to be an egg donor if I had a tubal ligation five years ago?

Kurt Barnhart, MD responds:
Thank you for considering becoming an egg donor. That is a wonderful and noble gift that you may be able to give to someone. A tubal ligation will not be an issue for you to donate your eggs.

Please reference our egg donation information. If you have further questions, please call 1-800-789-PENN (7366) and ask to be connected to Penn Fertility Care.

You can also download and complete a donor egg application form. Women are generously reimbursed for their time and effort as egg donors.

Jess asks:
I am interested in the egg donor program. I was told about five years ago that I have genital herpes, but was also told that it would only be a factor if I had natural childbirth at the time of an outbreak. I have had one child by c-section and she is fine. Will I be denied as an egg donor due to this virus?

Kurt Barnhart, MD responds:
Thank you for your inertest in our donor egg program. The health history that you mentioned will not be a factor. We would be happy to provide you with more information about the program.

If you would like to pursue egg donation we would be happy to work with you. To make an appointment, call 1-800-789-PENN (7366) or you can also request an appointment online.

Lucia asks:
I had in vitro fertilization (IVF) in April 1999. It didn't take. Now, six years later, I have my own healthy younger egg donor of 35 years old. I need to know how are donor and receiver (I) coordinated? Regarding egg transfers based around both our period cycles, how does that work?

Kurt Barnhart, MD responds:
Thank you for your interest. We at Penn Fertility Care have an active egg donor program. We can work with your own donor, or if need be, you can choose from our large number of anonymous donors. At this time we have more than 20 potential donors.

The process of egg donation is complex, but easily coordinated. There is a link on our web site to a radio program in which I describe the process thoroughly. In addition, you will find further information about egg donation on our web site. In summary, both the cycles of you and your donor are synchronized with a series of hormonal treatments so that your donor can go through a "standard" IVF cycle while your uterus is prepared with oral hormones.

Donna asks:
I am currently 46 years old. I got pregnant at age 40 while using Lupron in advance of an intrauterine insemination (IUI). My pregnancy was normal in every way. My daughter is now five. I've since had multiple IUIs with no success. What would my chances be of conceiving now using donated embryo?

Clarisa Gracia, MD, MSCE responds:
The pregnancy rates using donor embryo depend primarily on the age of the woman at the time her egg was retrieved and fertilized. The livebirth rates per embryo transfer of women less than 35 years of age are 35 to 40 percent at our program. We wish you the best and please feel free to contact us if you are interested in our program.

Colleen asks:
I am 35 years old, and my husband and I underwent several unsuccessful infertility treatments (with another practice). In brief, we underwent IVF with ICSI, approximately four to five IUIs with donor sperm and two IVFs with donor sperm. We stopped treatment about two years ago and were blessed with a son through adoption. Now, we are questioning whether the donor embryo program may be the best way to grow our family. We have a few questions that I hope you can help us to answer.

(1)At what stage (or cell number) are the average embryos stored? (2) Are there various grades or qualities of the embryos in storage? (3) What is the average maternal age of stored embryos? (4) Is there a waiting list / time for embryos to become available, and if so, what is that average wait? Any information you could provide will be appreciated.

Kurt Barnhart, MD responds:
The gift of embryo donation is a very special one for some couples. I am happy to give you some information. At Penn Fertility Care we have embryos cryopreserved at a variety of stages. We have some at the 2 pronuclear stage, some at the cleavage stage (4-10 cells), and a few at the blastocyst stage.

The average age of women at the time of cryopreservation is about 35. However there is great variation in the profiles that you are able to look at and choose from. Currently there is a short wait list. The wait depends on when profiles become available. That varies quite a bit.

The best option is to call 1-800-789-PENN (7366) and get some more details about the program. We would be happy to work with you. You can also request an appointment online.

Greg asks:
I am a single male interested in having a friend carry a child for me. Is this possible through Penn Fertility Care?

Kurt Barnhart, MD, MSCE responds:
Yes, it is possible. This could be accomplished with insemination of the carrier (the sperm from the man is inseminated into the women who then carries the pregnancy), in vitro fertilization (IVF) with the eggs of the carrier (the eggs are taken out of the friend and mixed with your sperm to increase the chance of getting pregnant, or donor egg (the carrier would be the surrogate, your egg and a donor's egg would fertilize and the carrier would not contribute any genetic information to the child).

Phyllis asks:
I am 43 years old. I have never been pregnant. I have been undergoing fertility treatments for the past six months. No pregnancies. I have been on injectibles (Bravelle and Repronex) as well as Clomid. I have a fibroid. My physician is now recommending to have the fibroid surgically removed and then try an egg donor.

What are your suggestions? My husband (age 43) has had normal semen analysis and each of my 4 IUI his counts were good. Is there another cobination of medications which might help? Is the surgery necessary, or if I must go egg donor can I do so without the surgery?

Samantha Butts, MD responds:
If you are going to proceed with IVF (with or without egg donation) and the fibroid that you have impinges on the cavity of your uterus, this is a good reason to have it removed. Surgery for fibroids that are not in the uterine cavity or don't impinge on it is a little less certain in its benefits. It's possible that it might improve your chances but the research is not entirely clear cut.

The decision to procede with donor egg versus conventional IVF should be made between you and your physician and is based on many factors including age, response to prior medications and hormone tests that determine your ovarian reserve. All of these factors influence your odds of conceiving with your own eggs and with these infertility treatments.

Wendy asks:
My dear friend has asked me to donate eggs, as she has been unable to produce enough of her own, even through many different drugs and procedures. I had a bout with ovarian cancer many years ago (I am 38 now) and have been healthy for over 10 years. Can I donate eggs to her?

Steven J. Sondheimer, MD responds:
It is wonderful that you are doing so well after the diagnosis and treatment of ovarian cancer. Most ovarian cancer treatments include the loss of both ovaries. Since you are still considering egg donation, I assume you still have at least one ovary present.

Without an ovary you would not have eggs (oocytes), so you would have no eggs to donate. Still, because of your age, you would not be the best person to donate eggs to your friend. With egg donation, in vitro fertilization (IVF) is needed, and success with IVF decreases as a woman gets older. In addition, there is greater chance of miscarriage and chromosomal abnormalities using your eggs in this situation.

Cassie asks:
I am 44 and recently had a failed donor cycle. The donor was 25 and produced eight eggs, but only two embryos of poor quality came out of it. My lining was good and everything looked fine on my part. I was on progesterone injections. Do you think it's worth it for me to try again? We saved for so long to get that money and for this to happen we don't know where to turn next.

Clarisa Gracia, MD, MSCE responds:
That is incredibly frustrating! Of course trying with another donor would give you roughly a 50 percent chance of having a baby, but a lot goes into that decision, including finances. Donor embryo and adoption are also options that you should consider. If you do go for donor egg again, I would recommend using a donor who has helped another couple conceive to maximize your chances of success.

Mikki asks:
I am 47 and have had five in vitro fertilizations (IVF) with my own eggs and one IVF with donor eggs, and I'm not pregnant yet. What can be wrong? Why won't the eggs implant?

Kurt Barnhart, MD, MSCE responds:
I am sorry to hear about your difficult course. It is easy to blame yourself, or your uterus, for the failure to be able to start a family. I think you should look at the IVF and the donor egg cycle as two completely different procedures. Donor egg is the correct treatment for you at this stage. However, even in the best hands, there is no guarantee of success with one cycle.

At Penn Fertility Care, the chance of getting pregnant is about 50-75 percent with donated eggs. The range depends on if you have cyropreserved (frozen) embryos for a second chance. I hope you consider trying again. Approximately three out of four couples who proceed with a donor egg cycle at Penn Fertility Care have a baby.

Lisa asks:
What is the "true" cost of the egg recipent program? I am 44 and my husband and I have been through five in vitros and are considering egg donor. Please tell me the cost.

Linda Donoho, Chief Administrative Director, HUP-RSF, responds:
I am sorry to hear that you have been through so much. The cost of egg donation varies. At Penn Fertility Care, we provide financial counseling services. Our financial counselor can meet with you and your physician to discuss your individual situation.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please call 800-789-PENN (7366). You can also request an appointment online.

GEM asks:
I had my tubes tied several months ago, and I was wondering if I would be able to donate eggs yet?

Samantha Butts, MD, MSCE responds:
To be eligible to be an egg donor, a rigorous screening process is involved. Your medical history will be obtained, you will be evaluated by physicians and have laboratory tests performed. It is important to alert the egg donor team of your medical history, but it is certainly not too soon investigate the possibility of becoming a donor and what is involved in the screening process.

Joy asks:
I understand you have a donor egg program. Can you please tell me if you have a pool of donors or if I would need to find a donor from an outside agency? If you do have a pool of donors, what is the average wait time to be matched and what information do you provide to the recipient about the donor? Thank you.

Kelly Timbers, MSN, CRNP, CCRC:
We have a pool of donors for recipient couples to choose from when they come in for consult. We provide brief one page profiles consisting of age, ethnic background, eye and hair color, height and weight, education level, medical and surgical history and family health history. When a couple decides they are interested in a specific donor they can then view the questionnaire the donor has provided. It contains a more detailed assessment than the brief profile and information about what they were like as a child, favorite subjects, special talents etc.

When a couple chooses one of the donors the cycle mapping process can begin as soon as all involved are ready. If the donor is currently matched and in a donation cycle it would require a two month wait post cycle for her to start again.

Previous patient asks:
Three years ago my husband and I were patients at Penn Fertility Care. With your help (due to a balanced translocation of the 13 & 14 chromosome, my husband has very low sperm count) and the IVF & ISCI procedure we were able to have a baby.

Now we would like to try again, however, feel we would be more successful with donor sperm. I am 40 years old and responded well to the IVF meds for our first pregnancy. Could we be successful with donor sperm or should we consider donor egg too? Can you help us?

Kurt Barnhart, MD, MSCE responds:
You are correct in all of your concerns. Both a sperm donor and an egg donor may increase your chances or conceiving (just for different reasons). These are complex questions and are better addressed in person.

We do have a donor egg program (all services are conveniently performed in our offices) if that is the direction you would like to pursue. I would suggest you make an appointment with either me or another of our experienced physicians and I would be happy to talk to you about the benefits and potential drawbacks of each option. You can make an appointment by calling 1-800-789-PENN (7366).