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September is PCOS Awareness Month

By David Kreiner MD

September 12th, 2014 at 2:30 pm

 

credit: free digital photos.net


PCOS is the most common hormonal disorder of reproductive age women, occurring in over 7% of women at some point in their lifetime.  It usually develops during the teen years.  Treatment can assist women attempting to conceive, help control the symptoms and prevent long term health problems.

The most common cause of PCOS is glucose intolerance resulting in abnormally high insulin levels.  If a woman does not respond normally to insulin her blood sugar levels rise, triggering the body to produce more insulin.  The insulin stimulates your ovaries to produce male sex hormones called androgens.  Testosterone is a common androgen and is often elevated in women with PCOS.  These androgens block the development and maturation of a woman’s ovarian follicles, preventing ovulation resulting in irregular menses and infertility.  Androgens may also trigger development of acne and extra facial and body hair.  It will increase lipids in the blood.  The elevated blood sugar from insulin resistance can develop into diabetes.

Symptoms may vary but the most common are acne, weight gain, extra hair on the face and body, thinning of hair on the scalp, irregular periods and infertility.

Ovaries develop numerous small follicles that look like cysts hence the name polycystic ovary syndrome.  These cysts themselves are not harmful but in response to fertility treatment can result in a condition known as Ovarian Hyperstimulation syndrome, or OHSS.

Hyperstimulation syndrome involves ovarian swelling, fluid accumulating in the belly and occasionally around the lungs.  A woman with Hyperstimulation syndrome may become dehydrated increasing her risk of developing blood clots.  Becoming pregnant adds to the stimulation and exacerbates the condition leading many specialists to cancel cycles in which a woman is at high risk of developing Hyperstimulation.  They may also prescribe aspirin to prevent clot formation.

These cysts may lead to many eggs maturing in response to fertility treatment also placing patients at a high risk of developing a high order multiple pregnancy.  Due to this unique risk it may be advantageous to avoid aggressive stimulation of the ovaries unless the eggs are removed as part of an in vitro fertilization procedure.

A diagnosis of PCOS may be made by history and physical examination including an ultrasound of the ovaries.  A glucose tolerance test is most useful to determine the presence of glucose intolerance and diabetes.  Hormone assays will also be helpful in making a differential diagnosis.

Treatment starts with regular exercise and a diet including healthy foods with a controlled carbohydrate intake.  This can help lower blood pressure and cholesterol and reduce the risk of diabetes.  It can also help you lose weight if you need to.

Quitting smoking will help reduce androgen levels and reduce the risk for heart disease.  Birth control pills help regulate periods and reduce excess facial hair and acne.  Laser hair removal has also been used successfully to reduce excess hair.

A diabetes medicine called metformin can help control insulin and blood sugar levels.  This can help lower androgen levels, regulate menstrual cycles and improve fertility.  Fertility medications, in particular clomiphene are often needed in addition to metformin to get a woman to ovulate and will assist many women to conceive.

The use of gonadotropin hormone injections without egg removal as performed as part of an IVF procedure may result in Hyperstimulation syndrome and/or multiple pregnancies and therefore one must be extremely cautious in its use.  In vitro fertilization has been very successful and offers a means for a woman with PCOS to conceive without a significant risk for developing a multiple pregnancy especially when associated with a single embryo transfer.   Since IVF is much more successful than insemination or intercourse with gonadotropin stimulation, IVF will reduce the number of potential exposures a patient must have to Hyperstimulation syndrome before conceiving.

It can be hard to deal with having PCOS.  If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition.  Ask your doctor about support groups and for treatment that can help you with your symptoms.  Remember, PCOS can be annoying, aggravating even depressing but it is fortunately a very treatable disorder.

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Do you suffer from PCOS? Do you have any advice to share for other “cysters”?

 

 

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Remembering 9/11 Thirteen Years Later

By Tracey Minella

September 11th, 2014 at 1:40 pm

You will always remember where you were that fateful day. And so will I.

I was working as a medical assistant for Long Island IVF. I was also a patient there…and about 9 weeks pregnant with my son. Could life be any happier on a blindingly clear, crisp September morning?

It started out as a typical day, with the usual morning rush. Lots of busy women…many trying to get their blood and sono done so they cold hurry off to work. A few rushing to catch a train to the city. Men dropping off specimens on their way to the office. Some trying to catch a train to the city.

A train to the city.

By the time news of the second plane crash hit, most of the morning’s patients had already been seen and were gone. Disbelief was quickly followed by panic as we and the rest of the nation scrambled to figure out if our friends and family who worked in NYC were ok.  And what about our patients?

Doesn’t “So-and-So” work downtown? Isn’t “Mr. X” a trader on Wall Street? We spent the morning pouring over the employer info in the patients’ charts, making calls on jammed phone lines, and accounting for everyone’s whereabouts.  We went through the motions of the day on auto-pilot, glued to a 13” black and white TV in the nurse’s station, watching the horror unfold. What kind of world was I bringing this baby into?

But just as there were stories of heroism, good deeds, and miracles amid the atrocity of the attacks, there was something positive that day in the IVF office.

A patient learned that, despite the chaos unfolding around her, it was indeed going to be her insemination day. When it’s your day, it’s your day. Not even an act of war will intervene. And 9/11 was to be her only day. One insemination. That afternoon. Amid the sadness and silence and muffled sobs of the patient and everyone in the office.

And we came to learn a couple weeks later, that on the day the Twin Towers and the lives of so many innocent people were lost, we had participated in one ironically beautiful beginning. That patient got pregnant and had…twins.

Usually, it’s the patient who is thankful to the doctor and staff. But I will always be grateful to that patient for giving us one little happy something…well, actually two…to remember from that fateful day. And for being a sign to me that the world would go on, that we’d keep making babies, and that maybe it was going to be alright.

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Where were you?

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Infertility and TCM: Part 11: The Answer My Friend Is Blowin’ in the Wind

By David Kreiner MD

September 8th, 2014 at 5:49 pm

 

credit: freedigitalphotos.net


According to the ancient Chinese text, “The Yellow Emperor’s Inner Classic (Huangdi Neijing, 黃帝內經) “, written about two thousand years ago, the emperor Han asked his physician minister why his people in one town were all sick with colds but not elsewhere in the empire.  The wise minister, credited for accumulating and developing much of what is considered Traditional Chinese Medicine (TCM), answered almost in song…”the answer my friend is blowin’ in the wind…the answer is blowin’ in the wind”.

The common cold as we know it in Western Medicine is caused by viruses of a variety of types and species.  Today in Western Medicine, we have the capability of identifying the specific affecting virus.  TCM focuses on the syndrome of symptoms the patient exhibits from his/her illness.  The “common cold” typically causes fever and chills, headache, perhaps body aches, nasal congestion and mucus and avoidance of cold.  TCM since the time of Emperor Han and before has classified this set of symptoms as the Wind Cold… caused by “bugs” carried by the wind… which attacks the exterior of the body through the nose and the skin.  The wind pathogen invades the body surface which is blocked by the defending Wei Qi that as a result of the attack stagnates causing the fever.  The Wei Qi is also responsible to warm the body so as it is weakened by the pathogens it will induce chills in the affected individual.

Over the course of hundreds of generations, various herbs… which may include parts of a variety of plant species, animal species and minerals… have been observed to diminish the course of the illness as well as ameliorate the symptoms.  These herbs are prepared in numerous different ways depending on the illness and symptoms being treated, but often include cooking and drinking the finished product as a type of tea.  In the case of the Wind Cold, a feature of the herbal decoction, Ma huang tang, is to induce sweating in an effort to expel the affecting pathogen through the skin pores.  Acupuncture applied to specific points of the body can also induce sweating and “release of the exterior” pathogen so that it is eliminated from the infected superficial layers of the body.

In TCM, a variation of the common cold that is notable for inducing more fever than chills, a sore throat, and sweating is referred to as the Wind Heat.  Treatment, like for the Wind Cold, includes “releasing the exterior” as the pathogens are attacking the superficial layers much like they do with the Wind Cold.  However, therapy utilizes cooling herbs rather than warming herbs.  In TCM, the nature of a syndrome was established in conjunction with the development of an effective treatment.  Since, the “cooling” herbs were noted to benefit patients beset with the Wind Heat, not only did the treatment become standard, but it helped define the syndrome itself.  This is the way syndromes and treatments become established in TCM over the course of generations of experience.

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Do you use herbal teas or other herbal treatments to help prevent or recover from colds and flu? What do you use and has it helped?

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Ready, Set, Save On IVF!

By David Kreiner MD

September 3rd, 2014 at 7:46 am

 

credit: stuart miles


A pharmaceutical company started a new program designed to attract a larger market share by discounting its fertility medications by 50%.  What a novel idea!

Who would not choose to save over a $1000 if given the choice?  It got me thinking…

Do patients know about the many discounts offered by Long Island IVF?  

Here at Long Island IVF, a full stimulation IVF cycle is offered to qualifying patients earning under $100,000 per year at $7,500 and somewhat higher to those earning up to $200,000 per year.  Anesthesia is an additional $525 and medications… including the savings through the new Ferring® rebate program… would range in cost from $1500- $3500 depending on the needs of the patient.  For example, an “average” patient receiving 20 amps of Bravelle® (FSH) and 10 amps of Menopur® would pay about $1,050 for these medications and hundreds more for Novidrel® (hCG)  and Endometrin® (progesterone).  Of course, those requiring more medication would have proportionally higher costs for their medications.

We offer other cost-savings programs at Long Island IVF including up to three frozen embryo transfers for the cost of one and free cryopreservation to patients electively transferring a single embryo in their fresh cycle.  More details on our Single Embryo Transfer (SET) Program and its financial incentives are available here: http://bit.ly/WpzCvv

 

We also offer a minimal stimulation IVF, also known as Micro IVF, at $3900. Because patients using this treatment protocol use less fertility medication to achieve their minimal stimulation than is used in in a full stimulation IVF cycle, there are significant savings on medication costs as well. Patients are encouraged to ask their doctors if they are candidates for Micro-IVF. More details on our Micro IVF Program are available here: http://bit.ly/12ZjvaD

 

Most importantly, these cost savings programs are available with the same high level of service and comparable success that Long Island IVF is famous for where we offer patients as good a chance of achieving a pregnancy as nearly anywhere in the nation.

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Have you researched the many grants and other cost-savings programs available at Long Island IVF?

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Infertility and the Back-to-School Blues

By Tracey Minella

September 2nd, 2014 at 10:51 am

 

credit: vectorolie


 

It’s right up there with Christmas morning and Mother’s Day. The first day of school.

Today, many area school children go back to school. They’re out there in droves on the street corners, decked out in the latest trendy clothes, complete with cool backpacks. Suddenly, navigating the neighborhood can feel like some twisted horror movie for many infertile folks longing for a child of their own.

If you’ve ever gotten stuck behind a big yellow bus, you know the special pain of driving about 3 miles per hour and stopping at every other corner to allow yet another pack of 15 kids on board.

Am I really the only one in the neighborhood without a kid on that bus?

And what’s the etiquette on waving back? When following the bus, do you avoid eye contact and pretend you don’t notice the 4 little monsters waving their arms at you madly from the back seat? Or do you muster the courage and quickly wave or smile…only to find your acknowledgement has fueled their relentless and continued arm-flailing! Have you ever *gasp* made an ugly face back at them in a weak moment?

And you’re not off the hook once you get off the road. Beware the Facebook assault as every fertile person you’ve ever known floods your newsfeed with pictures of their children and grandchildren getting on the bus this morning. And just to twist that knife, they’ll throw in a complaint about having to wake up early.

The first day of school is a lousy day for infertiles. Alter your routine… if you can… to minimize the exposure. Tweak your travel time or route. Stay off social media. And treat yourself well today.

If you have room in the budget, consider something many moms burdened with back-to-school expenses may not indulge in often…like a nice massage, a romantic dinner, or buying that new bag you’ve wanted. Or commit to something new that could impact your fertility plan…like exercise, healthy eating, acupuncture, or a mind-body program. For info on Long Island IVF’s recommended acupuncture and mind-body counseling programs click here: http://bit.ly/16Kn5go

And remember, next year you may be looking at things differently. That long ride behind the bus isn’t so bad when there’s a sleeping newborn in your car seat. You may even find yourself smiling and flailing…

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What do/did you do to get through the first day of school?

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Where Were YOU When We Gave Away a Free IVF Cycle?

By Tracey Minella

August 27th, 2014 at 5:45 pm

 

credit: J.Upham


On Saturday night, Long Island IVF and the Cade Foundation hosted a fabulous infertility fundraiser…Dancing for the Family… at the breathtaking Dance With Me studio in Glen Head, NY—home of Dancing with the Stars® champion dancers.

There was music and dancing with all attendees enjoying professional dance lessons. Food and drinks and desserts for all. A silent auction. All for only $65. And perhaps the best part: a fabulous door prize of a free IVF cycle, valued at approximately $10,000 to help one infertile couple start or build their family. To have a baby through a treatment they otherwise may not be able to afford.

This free IVF cycle was transferable, meaning that someone could win it for someone else. So friends and family could come down and not only have a fun night, but could possibly become some couple’s hero by winning the prize for them. So many people who are open about their infertility struggle have loved ones who want to help them and this was the perfect opportunity.

And that’s what happened on Saturday night. Someone won it for her friend. What a gift! Can you imagine what happened between them when she shared the news?

Plenty of folks were out there on the dance floor, taking advantage of this fabulous opportunity to win the chance for themselves or their friends to have a baby. They all enjoyed a fun evening while also raising money for the Cade Foundation to continue to fund infertility and adoption grants and educational programs in our area and throughout the country. But…there was room for more. The night had it all: music, dance lessons, food, drinks, dessert and the best door prize imaginable. And everyone who came felt the magic in the air.

So…where were you?

Seriously, we want to know what kept those of you we missed from attending. Because we want you there the next time. Would you take a moment to let us know?

Did you not hear about the event in time? Was the ticket too costly? Did you stay away for privacy concerns? Was the location inconvenient? Was the dance night theme unappealing? Was the date inconvenient or did it conflict with other vacation plans? Was it something else?

Help us help you. Let us know what kept you and your friends from being part of this fabulous event. Your suggestions may help us plan our next amazing event.

And for those who were there…thank you for making it such a special night. We know that not winning the door prize hurts. A lot. That’s the hard part for us, too. But we encourage you all to research the grant options available through Long Island IVF and the Cade Foundation on our respective websites. And keep following us for any future special events.

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What did you think of the event if you went? And if you missed it, let us know why.

 

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Be a Hero: Win a Free IVF Cycle for Someone You Love

By Tracey Minella

August 21st, 2014 at 7:23 am

Everyone knows someone who is suffering from infertility. And you wish you could do something to help.

Now you can.

Some infertile people suffer in silence and unnecessary shame. Others are open about the devastation of wanting a baby but not being able to have one without medical intervention. And sadly, not being able to afford costly medical treatments like in vitro fertilization (IVF) is the number one reason some people will never become parents.

Who do you know that is suffering? Is it you? Your best friend? A sibling or co-worker? Maybe your own grown child or grandchild? What about that wonderful, child-loving person…that favorite “aunt” to everyone else’s kids… who would make the perfect mom but, oddly, hasn’t had a child of her own yet?

These people need you. Now.

It is time for a random act of kindness. Now.

Here is how you can be a hero today. Buy a ticket to our Dancing for the Family event this Saturday August 23, 2014. Long Island IVF is donating a Free IVF cycle as a door prize at the event. The value of this prize is approximately $10,000 in monetary terms. But for a couple who needs to win it in order to build a family…it’s priceless. How to you put a value on a family?

The Free IVF cycle is TRANSFERABLE*. This is HUGE. It means you can win it for someone you love…or even someone you just like a lot. If you can use it yourself, you’ve likely dreamt of how it would feel to win it. But for those who don’t need it for themselves, just picture how overwhelmed your suffering friend or family member would be if you presented them with this opportunity to get pregnant? Can you even imagine that moment?

How often do we get a chance to make a real difference in someone’s world on a large scale? Like an entrepreneur or charitable organization can? Wouldn’t we all love to have $10,000 or more to help someone in need? Well, here is that chance. It’s not cash, but it’s a potentially life-changing opportunity which may literally deliver a priceless gift.

$65.

An evening of music, professional dance lessons, food, drink, desserts, a silent auction…all in the breath-taking home dance studio of Dancing With the Stars® champions! So order your ticket today and we’ll be seeing you at Dance With Me Studios in Glen Head, NY on Saturday night from 6-9 pm. Tickets are limited. Get your friends together and come out for a good time and a good cause.

For details* about the event, including the Free IVF door prize, and to order tickets click here: http://bit.ly/1p8hDZ9

Someone needs you to take this chance. Will you?

 

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If you’re coming already, that’s great! And if not…Why haven’t you ordered your tickets yet?!

 

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Score a Free Ticket to Our Free IVF Door Prize Event

By David Kreiner MD

August 15th, 2014 at 9:35 pm

There are two separate events next Saturday, August 23 and while they are both being hosted by Long Island IVF and the Tinina Q. Cade Foundation, they are very different.

The first is a free public educational forum at the Jericho Public Library called “Different Pathways Toward Parenthood”. The second event, “Dancing for the Family” begins later that evening at Dance With Me Long Island studios in Glen Head, and it requires a ticket.

Here’s how you might score a free general admission ticket (valued at $65) to the Dancing for the Family event.

Show up at 1pm on August 23rd at the Jericho Public Library for The Cade Foundation and Long Island IVF’s free seminar on fertility and adoption including medical, legal, psychological, donor and acupuncture services.

As a teaser I am showing you the medical version. Watch this video carefully before the seminar. http://youtu.be/BCOuAPckKVI

I will ask a question at the seminar that comes from this video.

The first individual who answers correctly wins a free ticket to our fabulous event…“Dancing for the Family”… later that same evening. This infertility benefit is being held at Maks, Val and Tony’s (from Dancing with the Stars®) Dance With Me Studio in Glen Head, Long Island from  6- 9 pm. It includes dance lessons, drinks, hors d’oeuvres, desserts, and a silent auction. One attendee will win a free IVF cycle door prize donated by Long Island IVF.

For more information or to purchase tickets in advance, go here: http://bit.ly/1p8hDZ9

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Will we see you at our events next weekend?

 

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Long Island IVF Presents at Free Public Family-Building Forum

By Tracey Minella

August 13th, 2014 at 10:04 am

Long Island IVF is excited to be part of The Tinina Q. Cade Foundation’s free public event on the afternoon of August 23, 2014 at the Jericho Public Library entitled:

Different Pathways Toward Parenthood: An Educational Panel on Overcoming Infertility

This educational event… designed to further the Cade Foundation’s mission of helping families overcome infertility… will feature a panel of five experts in various fields related to family-building, including:

David Kreiner, MD:  Fertility specialist and Reproductive Endocrinologist, Long Island IVF

Carolyn Berger, LCSW: Mental Health Care Provider

Amy Demma, Esq.: Attorney and expert in third party fertility contracts

Jim Vitale, Suffolk County Acupuncture

Timothy Sutfin, New Beginnings Adoption Agency

 

There are many ways to build a family and if you or someone you know would like to know more, you will want to register for and attend this free event to be held at the Jericho Public Library, located at 1 Merry Lane Jericho, NY from 1:00-3:00 pm on Saturday August 23, 2014. And after learning so much about family-building, you may want to kick back and enjoy a fun night out… so be sure to read the bold message at the bottom of this post!

To register for this free educational afternoon event, visit: https://cadelongislandoutreach.eventbrite.com Questions may be directed to the Cade Foundation at (443)896-6504.

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The fun continues…

In addition, those interested in winning a free IVF cycle from Long Island IVF might want to attend a very special infertility fundraiser that same evening, from 6:00-9:00 pm. Long Island IVF and Cade host “Dancing for the Family” at the beautiful Dance With Me Long Island® studio that is home to Dancing with the Stars® champion dancers, in Glen Head, NY. Have a professional dance lesson and dance the night away, enjoying drinks, hors d’oeuvres, desserts and a silent auction for only $65 (or $100 VIP). One lucky attendee will win a Free IVF cycle, valued at approximately $10,000. The cycle is transferable once (subject to certain restrictions), so bring all your friends and family to increase your odds of winning. Tickets are limited so buy yours today. For details and to purchase your tickets to the evening’s dance event, click here: http://bit.ly/1p8hDZ9

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Will we see you at the free event? Do you have any questions you’d like Dr. Kreiner to answer?

 

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Baby Picture Walls Opinion Survey

By Tracey Minella

August 12th, 2014 at 8:55 am

There was an interesting piece in the New York Times Sunday about “Baby Pictures at the Doctor’s office” and the potential privacy issues surrounding them.  http://nyti.ms/1ovHH3h

Often, patients send their doctors holiday photo cards. You may have seen them at your family physician’s office. Or at the dentist or orthodontist. Or the OBGYN or infertility clinic’s office. And, for step-parents or those suffering from secondary infertility, you’ve certainly seen them at the pediatrician’s office.

Many doctor’s offices innocently display these photos where they can be seen by anyone, especially the sender who shared the picture. If so, they may question whether to continue that practice after this article…at least not without the sender having signed a written photo release.

So, as offices all over the country are either removing the baby picture walls entirely or are moving them to more private areas of the practice, it’s a perfect time to ask how these photo displays made you feel?

When I was undergoing infertility treatment, before privacy regulations became so stringent, I had mixed feelings. While they certainly stung on one level, they also gave me hope and something to strive for… they fueled my determination to “make it to that wall”. Come hell or high water (as my mom used to say) I was going to have a baby to schlep to the mall and wait 2 hours with in a stiff holiday outfit for a screaming photo with Santa that would be sent to everyone… including the doctors in our life… with the specific intention of it being publicly displayed. Heck, I imagined waving that photo in the face of every passing stranger I met. Yes, the light at the end of my infertility tunnel was going to involve a flashbulb.

I was so consumed with this idea of sharing our happiness and gratitude that… after 6 fresh IVF cycles…when my IVF baby finally arrived 2 days after New Year’s (can you believe the nerve of that kid?) I switched gears and did the more emotionally-scarring Easter Bunny photo just so I didn’t have to wait another year. After all the years of waiting, “making the wall” seemed like busting through the tape at the end of a marathon. But maybe some folks just want… and expect… their doctors to tuck photos shared away in the desk drawer or chart.

I do see the other side. Seeing pictures of babies and children can be another nuisance to encounter in a world already full of pregnant women on every corner. Especially at the holidays when our hearts hurt most. Is seeing these photos more or less offensive in certain doctor’s offices than in others? Does it hurt more at the OBGYN’s than at the dentist’s office?

Though it’s not a guarantee that any doctor’s office will display baby wall photos going forward, you can make it possible for those who want to do so by remembering to include a written and signed photo release giving the office the permission to publicly display the photo when you it in (this includes holiday cards). Check with the office for their guidelines. You may have to specify, among other things, where it can be displayed (i.e. public areas of office or on the website/social media, etc.); whether your names (first, last, both, or neither) can be used, and the duration of how long it can be displayed (an expiration date or no expiration) in addition to signing and dating it.

Some doctors will continue to display the photos. Others may require the release now. Still others won’t display them in public areas at all. Regardless, most doctors love to see pictures.

Please keep sending the photos. And stop by with the babies, too! The doctors, nurses, and the entire staff at Long Island IVF love to see you and your miracles. Our doctors keep patients’ babies’ photos and letters in their desk drawers to pull out when they need a lift. In fact, both Dr. Pena and Dr. Droesch even mention this practice in their personal videos on our website at http://www.longislandivf.com/our_staff.cfm

 

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So here’s the Baby Pictures Wall Survey:

  1. How do baby picture walls make you feel?
  2. When you send a baby photo to a doctor’s office, do you expect and intend for it to be displayed publicly or do you expect it to be kept hidden?
  3. Does it bother you to see baby photo walls at doctors’ offices and, if so, are there some offices that are more offensive than others?

In an effort to give back to the Long Island community, Long Island IVF has donated a free IVF cycle as a door prize for its very special infertility fundraiser on August 23, 2014 from 6:00-9:00 pm. Long Island IVF and The Tininia Q. Cade Foundation host “Dancing for the Family” at the beautiful Dance With Me Long Island® studio that is home to Dancing with the Stars® champion dancers, in Glen Head, NY. Attendees will enjoy a professional dance lesson, drinks, hors d’oeuvres, desserts and a silent auction for only $65 (or $100 VIP). One lucky attendee will win a Free IVF cycle, valued at approximately $10,000. The cycle is transferable once (subject to certain restrictions), so bring all your friends and family to increase your odds of winning. Tickets are limited so buy yours today. For details and to purchase your tickets to the evening’s dance event, click here: http://bit.ly/1p8hDZ9

 

photo reprinted with the enthusiastic permission of  author T. Minella

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