By Tracey Minella
January 26th, 2015 at 3:58 pm
So, you went through all the blood work, sonograms, and injections for your IVF cycle and you wake up on the morning of your retrieval…if you even got any sleep the night before… ready for the big day.
Only problem is that blinding white glare streaming into the room.
“What the #@*%!” A snow storm hit overnight. Three feet down already and still falling fast. It’s gonna take all morning to dig out the car. Hey, where is the car?
Then your blood runs cold as you remember the biggest rule of all: “Don’t be late for your retrieval!”
Timing of the HcG shot and the subsequent retrieval is critical, so that the eggs are retrieved before they are ovulated. Then the next worry hits: “Even if I get there, will my doctors make it in?”
Fortunately, today’s meteorologists generally predict major storms enough in advance for patients and doctors to put contingency plans into place. Retrieval and transfer patients may be given special instructions and suggestions when a blizzard is expected.
If you anticipate a winter retrieval, in addition to allowing lots of extra time and filling the gas tank up, consider these 5 IVF Retrieval Blizzard Preparedness Tips:
- If there’s talk of snow, line up driveway plowing or shoveling extra early, or park the car down near the end of the driveway (but not in the street) so there’ll be less to shovel to get out. (Note: Ladies with swollen ovaries full of follicles should not shovel.)
- Call your town offices the day before, explain your medical situation, and beg them to have your road plowed early and often, if possible.
- If you don’t have one, line up borrowing an SUV or have a friend with an SUV drive you to the retrieval.
- Know the names of hotels near your clinic or hospital and consider staying in a hotel the night before retrieval if you live far away.
- Last resort: Call your local police department or fire department for help. Explain the situation and your need to get to the hospital or clinic immediately.
If despite the best planning, you’re running late on retrieval day, call your doctor’s office or service and tell them what’s going on and follow whatever instructions they give you.
There’s usually a small time window built into the schedule to accommodate for such an emergency, so don’t panic until you talk to them.
Because a retrieval can’t be postponed once the HcG shot has been given…even for a blizzard of potentially historic proportions… arrangements are made for Long Island IVF’s team of doctors, nurses and embryologists to stay local and to have reliable transportation so you can rest assured they will be there for your big day.
Remain positive and calm. And when it’s all over, you’ll have an interesting story to tell or excerpt to write in your fertility journal.
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Did you ever have a retrieval or transfer in a blizzard? How did it go and do you have any other tips to add?
Credit: Peter Griffin/http://www.publicdomainpictures.net/view-image.php?image=4893&picture=snowed-in&large=1
January 20th, 2015 at 2:28 pm
It is with humble yet excited hearts that we announce that Long Island IVF was voted the Best In Vitro Fertility Practice in the Best Of Long Island 2015 contest. Unlike prior years, for the 10th anniversary of the BOLI contest, there could only be one winner per category with no runners-up.
We just received word that we won. Thanks to all of you!
The doctors, nurses, embryologists, and the rest of the Long Island IVF staff are so proud of this honor and so thankful to each and every one of you who took the time to cast a vote in our favor. From the moms juggling LIIVF toddlers… to the dads coaching LIIVF teens…to the parents sending LIIVF adults off to college or down the aisles… to the LIIVF patients still on their journeys to parenthood who are confident in the care they’re receiving…we thank you all.
We love what we get to do every day…build families. And that’s all the thanks we really need. But your endorsement of us to your friends, families, and the public (by voting for us) means so much and will enable us to help even more infertile couples fulfill their dreams of building a family.
As we usher in 2015…our 27th year…we will continue to offer our unique blend of cutting-edge medical technologies and holistic, personal support… wrapped in the comfort of a private, non-hospital setting.
Thanks again. Happy New Year to all.
By Tracey A. Minella
January 11th, 2015 at 7:31 am
Chances are, if you are struggling with infertility, one of the biggest obstacles is the financial burden of the fertility treatments. A New Year often causes infertile couples without the benefit of infertility treatment insurance to revisit their family-building plans and reassess their options.
Some forgo the usual things like fine-dining, vacations, houses, new cars, and other luxuries of a typical life, putting the savings into their treatment. Many work over-time or take second jobs. Others max out credit cards, dip into retirement funds, or borrow from family. And some raise treatment money through on-line fundraising campaigns.
What if there was an easier way…a free way…to finance IVF (or fund an adoption)? You’d consider it, right?
Well, there is a grant opportunity you should consider pursuing that is offering grants of up to $10,000 to use toward your family-building goals. That’s money you don’t have to pay back. Enough to pay for all or a substantial portion of an IVF cycle or an adoption. But you need to act quickly because there is a February 1 deadline for the Spring Grant Cycle.
You may remember that Long Island IVF co-sponsored an exciting event last year…Dancing For the Family… with the Tinina Q. Cade Foundation. Not only did Long Island IVF donate a free IVF cycle as a door prize, but the event raised money that enables the Cade Foundation to fund these family-building grants. All you need to do now is apply.
Don’t like forms? Think you’ll never be chosen? Well, you’re in good company. Do you realize that so many people think like that, or are just beaten down by the stress of infertility, that there are often more funds than applicants for grants like these?! That’s right…grant money is often sitting there waiting for applicants to apply for it! And that’s a shame.
To apply, go here: http://www.cadefoundation.org/?page_id=10
And keep your eyes open for upcoming news of this year’s Long Island IVF and Cade Foundation new and exciting event.
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Are you going to apply? If not, why not?
By David Kreiner MD
January 10th, 2015 at 8:45 am
It’s a beautiful day in Boston today. I am here not because of the Red Sox playoffs or Sunday’s Patriots game but rather to attend our annual ASRM national fertility meeting.
I was delighted upon greeting some former colleagues of mine from my old stomping grounds, the Jones Institute, to hear compliments about how good I looked. (Well, if you lose 55 lbs. of “baby fat” people tend to notice.) I explained that my son, Dan, convinced me to try the Paleo Diet, modeled after the diet of Paleolithic man.
I am intrigued that so much is known about how man from the Paleolithic age ate. I guess he left menus and recipes on the walls of his man caves. Anyway, the focus… aside from elimination of dairy and gluten from his diet… is avoiding processed foods and chemical additives such as artificial sweeteners.
It was while eating my veggies and bun-less burger that I came upon one of the lead stories at the ASRM in the Wall Street Journal. The chemical BPA, or Bisphenol A, found in plastic is tied to the risk of miscarriage. BPAs can leach into the food that is heated on it such as in a microwave or in water stored in plastic and left out in the sun. Additionally, it was recommended to limit the use of canned foods and avoid handling cash register receipts, which often are coated with resins that contains BPA.
I’m not sure “Paleo” man extended his life, avoided disease or lived any healthier with his “natural only” diet but we have some evidence of some benefits by doing so today. Oh, and did I mention I can fit into those jeans from my college days?
For more information on the effects of BPAs on fertility as being discussed at the ASRM, see http://bit.ly/19Q28Bt
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Did you know that plastics and other items made from BPAs may be harmful to your fertility or contribute to miscarriage? Do you use these products and if so, will you consider stopping now?
Photo credit: Keattikorn/freedigitalphotos.net
By David Kreiner MD
January 2nd, 2015 at 9:01 am
The most shocking thing I’ve experienced in my 30+ year career in Reproductive Endocrinology has been the consistent “resistance” among specialists to treat women with obesity. This “resistance” has felt at times to both me and many patients to be more like a prejudice. I have heard other REI specialists say that it is harder for women to conceive until they shed their excess weight. “Come back to my office when you have lost 20, 30 or more pounds,” is a typical remark heard by many at their REI’s office. “It’s not healthy to be pregnant at your weight and you risk your health and the health of the baby.” Closing the door to fertility treatment is what most women in this condition experience.
An article in Medical News Today, “Obese Women Undergoing Infertility Treatment Advised Not To Attempt Rapid Weight Loss”, once suggested that weight loss just prior to conception may have adverse effects on the pregnancy, either by disrupting normal physiology or by releasing environmental pollutants stored in the fat. The article pointed out what is obvious to many who share the lifelong struggle to maintain a reasonable Body Mass Index (BMI): Weight loss is difficult to achieve. Few people adhere to lifestyle intervention and diets which may have no benefit in improving pregnancy in subfertile obese women.
The bias in the field is so strong that when I submitted a research paper demonstrating equivalent IVF pregnancy rates for women with excessive BMIs greater than 35 to the ASRM for presentation, it was rejected based on the notion that there was clear evidence to the contrary. Here’s the point I was trying to prove: IVF care must be customized to optimize the potential for this group.
Women with high BMI need a higher dose of medication. Those with PCOS benefit from treatment with Metformin. Their ultrasounds and retrievals need to be performed by the most experienced personnel. Often their follicles will be larger than in women of lower weight. Strategies to retrieve follicles in high BMI women include using a suture in the cervix to manipulate the uterus and an abdominal hand to push the ovaries into view.
Most importantly, a two-stage embryo transfer with the cervical suture can insure in utero placement of the transfer catheter and embryos without contamination caused by inadvertent touching of the catheter to the vaginal wall before insertion through the cervical canal. Visualization of the cervix is facilitated by pulling on the cervical suture, straightening the canal and allowing for easier passage of the catheter. The technique calls for placement of one catheter into the cervix through which a separate catheter, loaded with the patient’s embryo, is inserted.
Using this strategy, IVF with high BMI patients is extremely successful. With regard to the health of the high BMI woman and her fetus, it’s critical to counsel patients just as it is when dealing with women who live with diabetes or any other chronic situation that adds risk.
We refuse to share in the prejudice that is nearly universal in this field. It’s horrible and hypocritical to refuse these patients treatment. Clearly, with close attention to the needs of this population, their success is like any others.
Women who have time and motivation to lose significant weight prior to fertility therapy are encouraged to do so and I try to support their efforts. Unfortunately, many have tried and are unable to significantly reduce prior to conception.
What right do we have to deny these women the right to build their families?
It can be hard to deal with obesity and even more so when combined with infertility. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. I advise you to ask your doctor about support groups and for treatment that can help you including fertility treatment. Long Island IVF has a complete Mind-Body program with counselors for men and women suffering from infertility and we welcome those who are not yet our patients. See http://www.longislandivf.com/mind_body.cfm
Remember, though this condition can be annoying, aggravating and even depressing, seek an REI who is interested in supporting you and helping you build your family and reject those who simply tell you to return after you have lost sufficient weight.
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Have you been turned away from an RE because you’re overweight or obese? Do you think that’s fair?
Photo credit: Ohmega 1982 http://www.freedigitalphotos.net/images/agree-terms.php?id=10073481
By Tracey A. Minella
January 1st, 2015 at 9:32 am
“This could be the year.”
No matter how you spend your evening on New Year’s Eve…brave-facing it through a big party or sleeping through the ball-drop…there is still a new year to face this morning. How will you meet it?
If you’ve been saying “this could be the year” for more New Year’s than you care to remember, it gets harder to believe it will happen. It gets harder to think of anything except having a baby. Your mind is laser-focused on the baby goal, while the rest of your life, well, is sort of just out there passing by in the blur of your peripheral vision. And you’re missing or forgetting some good things while you wait.
I’ve been there. I suffered for more than 7 empty New Years. I let it make me miserable. But you don’t have to make the same mistake.
Sure I can tell you to have hope and to believe. But those words tend to ring hollow on pivotal days like New Year’s Day. So I’m going to give you one simple, but concrete job to do instead.
I’m challenging you to make a Gratitude Jar for 2015. I did this and promise it will be worth it. Get a mason jar from a craft, hardware, or grocery store. Decorate it (or not), depending on your mood and your talents. (I’m not crafty, so mine’s embarrassingly and totally plain as you can see).
Make a point to make a small note as good things happen throughout the year. Anything that makes you smile or laugh. Something nice someone did for or with you. Fun outings or events. Cherished notes or letters you receive. Basically, anything good. It’s so easy to forget. Toss those notes into the jar all year long.
Then, next New Year’s Eve or Day, (or any time you’re particularly hurting), you open the jar and read all the notes. It’s guaranteed to jog your memory and make you smile and focus on what you do have to be grateful for…at a time when it’s so hard to do so.
And who knows? Maybe you’ll be reading those little scraps to your newborn next year at this time…
Wishing you all a magical 2015 full of hope and dreams come true.
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What, if anything, do you do on New Year’s Day as far as your family-planning journey is concerned?
By Tracey A. Minella
December 31st, 2014 at 2:17 pm
I know exactly what you want to do with that noise maker.
No one would blame you either.
When you’re battling infertility, the last thing most people want to do is party. Unless you’re determined to forget reality for a few hours, who wants to spend money we don’t have dressing up for some rip-off celebration where you’re crowded into a ballroom full of strangers, with bad food, bargain booze, and loud tacky music while fertile friends complain about what the babysitter is costing them?
Truth is…I never liked New Year’s Eve. I hate high heels…and am not really fond of strangers either. My well-done steak never arrives until the ball is dropping. And the group rendition of Sweet Caroline just doesn’t have the same old lure. You may have your own reasons to hate big New Year’s Eve celebrations. Reasons in addition to the obvious one…
Facing the passing of time, coupled with infertility, is a mood killer.
Here’s the best advice I’ve got: Boycott it! Yes, treat New Year’s Eve like any other night. Be a rebel and go to bed at 10. Or maybe have a romantic dinner before turning in early. Unlike many of the recent holidays, this is one where you can actually avoid family. And you can avoid the holiday itself, too…as long as you turn over the calendar the next morning. This might be best if 2014 was a particularly rough year full of losses.
Want to see people? Keep it small…with only those who truly support you…so you don’t find yourself having to fake a fun time or dodging questions about finally having a baby in 2015. A few close friends, great food and drinks, some funny board games or a good movie. Low-key.
Of course, if you do go out big time and some drunk asks if that’s a noise maker in your pocket or you’re just happy to see them, you know what to do.
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How do you feel about New Year’s Eve? A time to celebrate wildly? A time for quiet, casual fun? A night to hide under the covers?
What do you plan to do?
By Tracey Minella
December 24th, 2014 at 4:37 pm
This time of year is the hardest on infertiles. With nativities and Menorahs everywhere, we’re reminded of the reason for the season for many. And there’s no shortage of reminders of the other reason for the season…children.
Christmas and Chanukah are the most difficult holidays to navigate when infertile because they are both family- and child-focused. Holiday photo cards of children dressed in fancy outfits in the mailbox. Social media hosts a continued onslaught of images. Breakfast with Santa. Wish lists and Toys R Us©. Elf on the Shelf shenanigans. Even the old TV Christmas classics like Rudolph and Frosty that brought such joy to us as kids don’t have enough magic in them to make the holidays happy now.
Infertility is so devastating, it can drive the non-religious to find religion or can give atheists an argument that a higher power would never allow such pain and suffering. It can deepen the faith of the faithful or cause others to stray from their faith. Whatever your faith, or lack of it, the holiday season can be a challenge.
How do you keep the faith that it will all work out? How do you remain hopeful?
Do you find comfort in the type of meditation that attending church or temple services can bring? Do religious stories of miraculous conceptions bring your hopeful comfort or just frustration? Does helping the needy through charity work or donations rejuvenate your faith this time of year? Do you have a particular tradition that helps you? (I used to go to St. Patrick’s Cathedral each year and it brought me much comfort).
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Though an intensely personal area, for those inclined to share it: How has your infertility journey affected your faith? (A friendly reminder not to judge each other and to be respectful of our differences in faith).
By David Kreiner MD
December 19th, 2014 at 8:01 pm
What Is Fertility Screening?
Fertility screening starts with a blood test to check the levels of FSH (follicle stimulating hormone), estradiol and AMH (antimullerian hormone). The FSH and estradiol must be measured on the second or third day of your period. The granulosa cells of the ovarian follicles produce estradiol and AMH. The fewer the follicles there are in the ovaries the lower the AMH level. It will also mean that less estradiol is produced as well as a protein called inhibin. Both inhibin and estradiol decrease FSH production. The lower the inhibin and estradiol the higher the FSH as is seen in diminished ovarian reserve. The higher the estradiol or inhibin levels are then the lower the FSH. Estradiol may be elevated especially in the presence of an ovarian cyst even with failing ovaries that are only able to produce minimal inhibin. However, the high estradiol reduces the FSH to deceptively normal appearing levels. If not for the cyst generating excess estradiol, the FSH would be high in failing ovaries due to low inhibin production. This is why it is important to get an estradiol level at the same time as the FSH and early in the cycle when it is likely that the estradiol level is low in order to get an accurate reading of FSH.
The next step is a vaginal ultrasound to count the number of antral follicles in both ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least a total of eight antral follicles for the two ovaries. Between nine and twelve might be considered a borderline antral follicle count.
As you start to screen annually for your fertility, what you and your doctor are looking for is a dramatic shift in values from one year to the next.
What Does the Screen Indicate?
A positive screen showing evidence of potentially diminishing fertility is an alarm that should produce a call to action. When a woman is aware that she may be running out of time to reproduce she can take the family-planning reins and make informed decisions. The goal of fertility screening is to help you and every woman of childbearing years make the choices that can help protect and optimize your fertility.
Although none of these tests is in and of themselves an absolute predictor of your ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny. That’s when it makes sense to have a discussion with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out. It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as a history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order.
Regardless of the nature or severity of the problems, today, with Assisted Reproductive Technology and the latest Egg-freezing technology, there is a highly effective treatment available for you.
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Have you had a fertility screening yet? Did you find it helpful? Do you have any questions for Dr. Kreiner?
By Tracey Minella
December 16th, 2014 at 3:56 pm
Many people suffering from infertility do so in silence. And this makes the struggle even harder. Did you just survive another holiday season dodging and lying to the baby-naggers and holding back tears as a mob of nieces and nephews opened presents? Are you wondering how you’ll face another New Year like this?
Despite the spike in infertility awareness and all the progress that’s made during April’s National Infertility Awareness Week (NIAW), by the time the holiday season approaches in December infertility awareness is off the public’s radar. With all the child-centered fun and the family gatherings where ignorant or insensitive baby pressure comments are made, December is particularly hard on the infertile. Especially the “closet” infertile who doesn’t have family support.
NIAW is specifically timed for late April, just before Mother’s Day…the indisputably most painful day of the year for infertile women. On the heels of NIAW is Advocacy Day in early May, when hundreds of infertiles and their supporters flock to Washington, D.C. to speak to elected officials about infertile-friendly issues and pending legislation. NIAW and Advocacy Day raise infertility awareness, educate the fertile public and legislators, and help reduce the ignorant and insensitive comments infertile couples are faced with. At least temporarily.
There is even a National Infertility Survival Day, on the first Sunday in May (also just before Mother’s Day) to “celebrate all the hard work and effort that infertile couples put towards trying to have a child. The day’s main emphasis is on self-care and celebration for what they do have. It’s also a day for friends and family to help lift the spirits of a loved one coping with infertility.” * This is a great idea for those who’ve already told their friends and families… or for couples to celebrate privately.
But wouldn’t it be wonderful if infertile people had a day…much like the GLBT community’s Coming-Out Day in October…when they could “come out” to their family and friends about their infertility? And wouldn’t it be great if that day was timed for right before Thanksgiving, the kick-off of the winter holiday season? I vote for November 11th. 11-11…easy to remember. Just like two lines on a test strip.
Participants in Infertility Coming-Out Day would release the burden of their silence, quiet the “baby-naggers”, and hopefully receive needed support and understanding. And even those who still remain silent might benefit from publicity surrounding such a day.
Who is with me?
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Do you think there should be such a day just before the winter holidays? If you are currently suffering in silence, would you find strength in numbers and find it easier to “come out” on such a day? If you’re struggling with wanting to tell, but not knowing how or when the time is right, would this help you?
If you have told your family, how and when did you do so…and how was the news received?
credit: stuart miles/freedigitalphotos.net Image ID: 10054806