TOPIC: LUCRIN DEPOT VS LUCRIN DAILY PACK
Q	What is the difference between the once off injection of Lucrin depot 3.75mg compared to the Lucrin patient pack daily injections?
A	The difference between the 2 is in how it is used. Depot Lucrin is convenient from a patient point of view as it boils down to only one injection. The feeling is however that suppression of the ovary is too much, meaning that it takes longer and a bigger effort to recruit subsequent oocytes. For this reason we feel that the daily preparation is more suitable. However, the depot preparation does have a place in the treatment in so far as the preparation of uteri in donor egg and surrogate cycles where the degree of ovarian suppression is not that important.
	TOPIC: LUCRIN POST EMBRYO TRANSFER
Q	Please ask a question regarding FET's for me. If they are not going to do the transfer by co-ordinating it with ovulation but rather suppressing you with lucrin and using progynova to thicken the lining - should one continue with lucrin until you do a pregnancy test? At which stage is lucrin discontinued?
A	The Lucrin is generally stopped on the day that the progesterone supplementation starts, which is 2 days before the embryo transfer is performed. However, this is one of the areas where we use the depot preparation in our clinic which means the Lucrin is already out of the system when the embryo transfer is done.
	TOPIC: 10 DPT VS 14DPT hCG
Q	I have family that emigrated to the USA. They have a friend that is undergoing IVF with ICSI at the moment. Her clinic told her to come in for a beta at 10DPT??!!! Why do clinics in SA only test 14DPT? It would really make it SO much easier if the 2WW were 4 days shorter!!
A	The reason is to confirm an ongoing pregnancy in a positive manner by having a proper level on day 14, and not having a very low level which ,in fact can mean anything, and giving the patient a false sense of security.
	TOPIC: FAT BURNING/TRAINING SUPPLEMENTS
Q	I can't seem to find the answer to this question. Is Dr V able to tell me if fat-burning/training supplements like USN Phedra-cut can influence male fertility negatively?
A	Fat burning supplements put the body in a state of increased metabolism and subsequently a state of tissue breakdown. This is not a normal physiological environment and theoretically not an ideal environment for normal physiological processes such as sperm production. This is only theoretical and there is no scientific evidence to support it at this stage – more deduction by common sense.
	TOPIC: MCDONALD STITCH
Q	a) Do you think all gynaes are equally good enough in placing the McDonald stitch, or should i question my Dr if he has had enough experience. My FS said its an insult to ask a gynae if he can place a stitch, its like asking him if he can perform a cecarean.
A	I agree with your gyne – placing a stitch is part of routine gynecology and obstetric training and should be in the scope of all gyne’s.
Q	b) What is the aftercare after the stitch is placed? Do you have to stay in bed for the remainder of the pregnancy? what may you and may not do? how often do you have to go to gynae?
A	Aftercare depends on the indication for the suture – elective or emergency. If it was an elective suture, the patient is kept overnight for observation and discharged the next morning with instructions re. “pelvic precautions” This means abstaining from intercourse and inserting objects into the vagina. Weekly follow up is indicated to evaluate the performance of the suture. Emergency sutures have a different aftercare course as these patients will stay in hospital longer for observation and suppression of contractions and signs of ascending infections etc.
	TOPIC: CHRONIC BACTERIAL PROSTATITIS(E.COLI).
Q	My husband suffers from chronic bacterial prostatitis(E.coli). He has been on 3 different antibiotic this months and has become resistant. I think i have contracted his infection during intercourse. I am currently being treated for the infection. Can i start IVF this month or will my success rate be better next month due to the infection and antibiotics
A	Before any attempt at IVF is made it should be documented that both partners are absolutely infection free. Documented means culturing of semen and taking a high vaginal swab to confirm that both are clear of the infection. If this is neglected, it can lead to the infection being transferred to the embryos which is lethal to the embryos. Theoretically it can also spread to other adjacent embryos in the incubator.
	TOPIC: IMPLANTATION
Q	What do we know about implantation and what factors influence it? Is there any assessment one can make of the embryos at transfer that gives an indication of chances of successful implantation? and what should one to do enhance chances of implantation?
A	The biggest factor playing a role during implantation is the quality of the embryo – about 75-80%. The rest is made up of uterine factors, such as the presence of submucosal and large intramural fibroids, adenomyosis etc. and immunological and thrombotic factors such as HLA incompatibility, thrombophylia’s, etc.
	TOPIC: CMA3 - FERTILISATION
Q	Can CMA3 count of 48% play a significant role in fertilization?
A	CMA3 is just another tool we use to try and predict the fertilization potential of the sperm.
	TOPIC: CMA3 – EMBRYO QUALITY
Q	Can CMA3 have an impact on the quality of the embryo's?
A	No – CMA is just a tool to try and predict the potential of the sperm to fertilize an oocyte and has nothing to do with embryo quality.
	TOPIC: CMA3 – 48% NATURAL CONCEPTION VS ART
Q	Can a man with 48% CMA3 still conceive naturally or would IVF with ICSI be a better alternative?
A	Yes, he will still be able to conceive naturally, as long as all the other parameters are within normal limits, such as count, morphology, motility, survival etc.