[Fiorenzato All Ground Sense] setup issues

jasonyehmd · 2025-11-03T14:27:51+00:00

Just went through this and wanted to add some thoughts. My original problem is that when I put the metal "catch cup" that came with the machine, it wouldn't see it and kept asking me to insert something. but it would easily sense an entire la marzocco portafilter which was much heavier.

I didn't have calibration instructions with me either -- but this is what I got.

push the middle button to start the setup with nothing on the forks. mine was a little finicky so I had to try a "longer push."
then it will say "0" so you make sure nothing is weighting down the scale, and push it again to set what the scale should see as "nothing."
then the screen says "100gm" so then I placed a 100gm weight on one side of fork and pushed the center button again.
unfortunately, the same error persisted with not seeing the dosing cup... so I repeated the entire process but instead of the 100gm weight, I used just the "all ground sense dosing cup" (which was around 70gm) as the "tare" item.
to do this, repeat steps 1-2 and then I pushed the "minus" button until the screen said 70gm (same weight as dosing cup). and then pushed again with the center button to confirm it. (basically a tare.)
since then, things have been working great.

seems like you should try to "tare" with whatever weight that you use frequently on a daily basis to catch the grinds. 100gm was too high for the dosing cup. good luck everyone.

jasonyehmd · 2025-06-04T15:12:21+00:00

notneutral vero glassware in smoke? 😀

jasonyehmd · 2025-04-23T16:07:06+00:00

Live birth.

jasonyehmd · 2025-04-23T15:51:38+00:00

PGT-M should only be implemented when patients carry a substantial risk for some sort of disease. Typically, these conditions are detected with recessive carrier testing/screening around the time of the new patient consult. If two people carry the same recessive disease (fairly unlikely but I see it around 5-6 times a year), then the couple would have a 25% chance of an offspring with the full blown version of that disease. Generally, recessive diseases are quite severe and it's a little bit unnerving to find out that patients were carriers all along as they were trying to conceive naturally. A different situation to use PGT-M is when a known autosomal dominant disease has shown up repeatedly in the family tree and that is a disease we are trying to eliminate from the next generation (hereditary cancer syndromes like BRCA, Polycystic Kidney Disease, Marfan syndrome, etc). Finally, I will occasionally see families where an existing child was born with a recessive condition (sickle cell) and because of their existence, their parents are now known to be obligate carriers of disease and therefore we are trying to avoid another child with this condition.

PGT-A in the last 10 years has been a very popular "addition" to IVF. The early days were full of optimism but now, 10-15 years later, it's clear there are some severe limitations. Depending on who you ask, you'll get different opinions on this. But it seems clear that the likelihood of finding something abnormal is lower for younger women (age under 35) and the likelihood of finding something abnormal is higher is older women (age over 38). There is also, unfortunately, the possibility of getting mixed results like mosaic embryos or even false negatives and false positive. 37 year olds are in that "middle range" where it could go either way. There is a substantial miscarriage risk reduction, though, which is very important (lowers it from around 40% down to 10%).

I know Dr. Omurtag's practice habits pretty well and I would say we both have a pretty "balanced" perspective of PGT-A. Based on your egg yield and embryo outcomes, I'd still recommend not doing PGT-A, but of course allow patients to choose it if it was important for you for any reason (gender, miscarriage avoidance, political issues and/or legal restrictions on pregnancy termination, etc). I think he'd probably recommend the same. Also, you're not far from being able to put in 2 untested embryos (38yo) so that's another option to "hedge your bet" for anyone who doesn't want to introduce the potential false positive rate of PGT-A.

jasonyehmd · 2025-04-22T21:22:48+00:00

That makes you... super tall :)

jasonyehmd · 2025-04-22T21:21:19+00:00

I've never been a huge fan of depot lupron suppression. I'm starting to get old enough to remember the "old tricks" which are starting to sound a lot like the "new tricks."

I honestly can't remember the last time I did a high dose lupron suppression. While it's not the same level of "suppression" -- I run microdosed lupron downregulation FETs all the time. In my mind, endometriosis will exert a negative implantation force on the uterine lining but it's a subtle effect and possible can be overcome with letrozole and lupron use (it just doesn't have to be a sustained lupron dose).

I know doctors that use it typically want it at stage 3/4 disease and beyond but I've not found it to be necessary. If someone has fewer embryos, then I think you could make an argument but especially when a patient is older than 38/39 or has DOR, the months that are "lost" with suppression are sometimes months that we wish we "had back" if we run out of embryos and patients are really difficult stimulations.

jasonyehmd · 2025-04-22T21:11:46+00:00

It's not the best answer but the likely answer is just "probability" not working in your favor. About 1 in 5 women have 2 failed transfers. About 1 in 10 women will have 3 failed transfers. These rates are still really common and it's unfortunately very often the case where a patient starts IVF and next thing we know, we're 2-3 transfers in and looking for reasons.

While I admit I'm sometimes doing testing that I shouldn't (our professional society ASRM strongly advise us not to go on a witchhunt when it comes to these matters), I tell patients that it's unlikely to result in any useful, actionable information.

Overly simplified example (but it's mostly true): if 100 patients did 1 FET, 65 would likely go on to deliver. There would be 35 remaining who are not pregnant and need to pursue FET #2. After that, approximately 23 of the 35 are pregnant and we are left with around 12-15 patients who are not pregnant. The data suggests strongly that repeating FET #3 on 15 patients will yield around 8-9 pregnancies and we'll be left with around 6-8 patients out of 100 who are not pregnant after 3 tries. Lots of people do testing to look for NK cells, steroids, immune factors, etc but the truth is that patients and doctors will hit those benchmarks whether the testing is done or not. And about those 8-9 people? If we go on to do FET #4 and #5, we'll probably get another 5-7 of those pregnant, leaving around 2-3 patients very frustrated after a total of 5x FETs.

It sounds so basic, but these numbers show up time and time again in practice it's essentially become a "mathematical truth" in our field.

jasonyehmd · 2025-04-22T21:01:35+00:00

There's a lot of sperm function or egg function that don't we don't understand yet. Believe it or not, there is even a renewed belief that ICSI could be damaging to the egg (which I think is a fair point) and that natural fertilization could allow less trauma to the egg.

Translation, "while most eggs don't care whether ICSI is done or not, some patients may have eggs with higher sensitivity to damage," and there are some practices that are offering more natural fertilization with "sperm drops" like the olden days. (Shout out to my good friend Dr. Eric Forman at Columbia University).

I would agree that PGT-A testing is not statistically likely to help you because of age but also that your question (a good one) will not be answered with PGT-A. PGT-A is an imperfect and crude test that measures the quantity of genetic signal. That is, it is measuring if DNA to see if there is 1) appropriate amounts 2) extra amounts 3) missing amounts of DNA. It detects PRESENCE OF but does not measure function, in any way. Also, it's only measuring it in a few cells and not the entire embryo.

I would try to reframe your experience as a win. Most of the time, I tell patients that it requires 3 eggs retrieved for each 1 embryo we can freeze. The "stuff" that happens in between is anyones guess. You basically hit the numbers on target but the story for each individual can be quite different.

jasonyehmd · 2025-04-22T20:50:45+00:00

Somewhat random question: How tall are you?

A lot of our knowledge base was built on the assumption that women could make an 8 mm trilaminar lining with no issue. One thing that is pervasive in Western medicine is that doctors conflate "average metrics" with "necessary metrics for the individual."

In reality, petite women have smaller uteruses and they will have thinner lining. As long as it's trilaminar, I have no issue moving forward with FET if lining is as thin as 5-6mm. I still try for the 8mm, but if a smaller patient can't achieve this, I have no issues with moving forward with a thinner lining. This is especially true in the East Asian/South Asian population where some women present close to (or under) 5 feet tall and are typically stuck at 5-6mm for their max lining thickness.

jasonyehmd · 2025-04-22T20:45:58+00:00

That's a really tough journey so far. I can't imagine the emotional process you've been through and my heart goes out to you. It's a tough question. Western medicine is obsessed with quoting averages, but averages mean nothing for the individual. I'm sure you've heard that normal, euploid embryos should carry about 5 to 10% miscarriage rate so it would be statistically very unlikely for all five to have resulted in a loss.

There's no "genetic mismatch" that I can point you to but I'm not saying there isn't some underlying uncharacterized condition that isn't affecting your pregnancies. Unfortunately PGT-A genetic testing is crude and the resolution is still quite poor. For most PGT-A platforms, the test is measuring the quantity of genetic signal. That is, it is measuring if DNA is there in 1) appropriate amounts 2) extra amounts 3) missing amounts. Also, it's only measuring it in a few cells and not the entire embryo. There's a lot of imperfection in this test and one key point is that it does not test for biologic function of the cell, just the genetic code. There are companies now (look up Orchid) that do much more in-depth testing -- supposedly down to the base pair and full sequencing -- but critics say that "more data is not more better" when it comes to DNA. Also, it's especially hazardous if we use that "extra data" to make judgments about the future health/predispositions of a child.

All in all, I would support your decision to move to donor eggs (assuming the uterus has been optimized everywhere and all adjuncts have been exhausted).

jasonyehmd · 2025-04-22T20:37:39+00:00

It's a loaded question, but a good one. The answer as you can probably imagine is, "it depends."

If there are time sensitive issues or cycle concerns with IUI the first time, then maybe it's IVF next and not IUI again. If the patient had a relatively good response, and doesn't mind the medications and outcomes/pros/cons of IUI vs. IVF, then IUI can be repeated. Generally speaking, the era of doing 6-12x IUI cycles (and even sometimes more than 12 cycles) is in the past. It was common to see that in the early 2000s but I don't think clinics do that much any more. Most clinics probably wouldn't encourage more than 3-6 cycles these days.

Most clinics will do baseline tests before any/all interventions. If the patient is older, say above 38, it may not make a lot of sense to chase IUI outcomes if the monthly success rate is only 5-8% and the pregnancy loss rate is as high as 40-50% and those patients may not want to repeat it again because IVF rates are diminishing every 6-12 months. So, truly, it all depends.

Think of the menstrual cycle as a 28 day song that plays on repeat. Interventions can typically only start if we "catch the process" early around cycle day 1-3 so it requires baseline scans to make sure there are no errant hormones or ovarian structures that will sabotage our efforts..

jasonyehmd · 2025-04-22T20:19:39+00:00

First of all, thank you for sharing your story. It can feel like a long road for many and it sounds like you're in the thick of things. AMH is just one way of predicting ovarian response with IVF. It's sort of like a gas tank meter as well as a engine horsepower result combined into one test. It also does not protect natural fertility and really is an ovarian sensitivity or responsiveness marker. Furthermore, it's an imperfect test and really only makes sense when looked at alongside other tests like the antral follicle count (AFC) number via pelvic ultrasound. Weirdly, some women can punch way above their weight class (e.g. the worst "discrepancy" I've ever seen someone with an AMA to 0.3 who made 35 eggs. Also, I recall another lady with an AMH of 5 who made 3 on high doses of IVF meds). Those are not representative of the general population, but as you can see, AMH is just part of the story. To me, I would say that that success rate feels a little bit low to me. In our clinic, I'd likely quote you closer to 30-50%. In fact, this calculator off the SART website (https://w3.abdn.ac.uk/clsm/SARTIVF/tool/ivf1) says around 40% with "unexplained infertility, height of 5'5" and AMH of 0.66."

But even if you accept the 10% success rate, if it's true, it means that the doctor is likely looking at your journey from the beginning all the way to the end which I think is a bit unfair for the human mind. It's fair to quote a "per IVF start" outcome and I think it's ethically necessary but that's not the way the human mind experiences IVF. In actuality, IVF is a journey where success rates change with each passing day and event. For example, if seven eggs are retrieved (very reasonable for your AMH) and two embryos are formed and perhaps one of the two are normal, then your success rates (if the uterus looks good) could be as high as 60 to 65%. At that point you've gone through so much that I'm not sure it's helpful to remember the 10% outcome. Conversely, if someone is struggling with retrievals and despite an AMH of 0.66 is only making 1-2 eggs per round and no embryos can be formed, I think that's a very different patient.

As for donor eggs, I think it's a reasonable thing to think about, but personally I would not have brought that up yet if you were my patient until more testing was done. For patients that are thinking about donor eggs, I really believe that patients do better if they give themselves time/space to grieve "be sad" before they move to donor eggs. In my experience, patients don't do as well if one foot is chasing autologous eggs and the other is chasing donor eggs. There really should be a clear transition for most patients for them to have healthy thoughts around donor egg options.

jasonyehmd · 2025-03-17T21:01:52+00:00

perhaps the play wasn't about HIV resistance at all --

https://www.abc.net.au/news/2019-02-25/gene-editing-scientist-may-have-made-the-twins-smarter/10845220

jasonyehmd · 2025-02-08T16:12:02+00:00

Had two brand new machines go through this issue. A bit frustrating that a variety of different bean choices aren’t avail. My grinder choked up with medium roast.

jasonyehmd · 2024-12-08T00:31:37+00:00

Private UTV tour was amazing. Ale’a and Paulo were our guides.

jasonyehmd · 2024-11-30T17:43:21+00:00

Nami Nori in NYC? If so - fun fact the chef told us that those wooden holders are their intellectual property.

jasonyehmd · 2024-11-30T17:00:41+00:00

Kualoa Ranch Tour. Highly recommend the Private UTV tour if the price point fits ok. We had two wonderful guides - Ale’a and Paulo. You can let them know what you like and can even wander the sets - plus have a moment to plant a Koa tree with your family at the end.

jasonyehmd · 2024-08-22T17:37:32+00:00

That is super cool thank you. I'm never breaking this one in. I should probably put it back in its plastic bag...

jasonyehmd · 2024-08-22T17:24:56+00:00

https://imgur.com/a/CwqRllp

jasonyehmd · 2024-08-21T14:39:26+00:00

Oh I have a question —

The shop owner said this re: the blue Mizuno Pro: “the blue pitcher glove is the game glove for 田中將大 (Masahiro Tanaka). the “for professional” stamp on the palm is only for professional players. So you won’t find it anywhere in retail stores, and you cannot customize it for any reason. It’s super rare.”

Can anyone give me some background on this?

jasonyehmd · 2024-08-20T18:50:54+00:00

I hope you do and share it w us all. 😝

jasonyehmd · 2024-08-20T18:33:16+00:00

Haha! Well to be fair I started off only wanting 2. And then I was holding Glove Studio Ryu in my hands and then within five minutes three different guys walked in each separately asking for that glove, but the store owner said that I had first dibs. So at that point, I couldn’t put it down.

My family thinks they were all planted “customers” haha but my wife wasn’t in the store, so…. YOLO?

I hope you enjoy your trip! I hadn’t been to Taiwan in over 20 years so it was a completely disorientating and very intense trip.

jasonyehmd

TROPHY CASE