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Archive for October, 2010

Understanding Fibroids

By David Kreiner, Md

October 29th, 2010 at 2:11 am

Fertility is dependent upon so many things!

We must have healthy gametes (eggs and sperm) capable of fertilizing and implanting in a uterus with a normal endometrial lining unimpeded by any uterine or endometrial pathology. The sperm need be in sufficient number and capable of swimming up through a cervix which is not inflamed and provides a mucous medium that promotes sperm motility. The eggs need to ovulate and be picked up by normal healthy fimbriated ends (finger like projections) of the fallopian tubes. The tubes need to be covered with normal micro hairs called cilia that help transport the egg one third of the way down the tube where one of the sperm will fertilize it.

The united egg and sperm (the “conceptus”) then needs to undergo cell division, growth and development as it traverses the tube and makes its way to the uterine cavity by the embryo’s fifth day of life at which point it is a blastocyst. The blastocyst hatches out of its shell (“zona pellucidum”) and implants into the endometrial lining requiring adequate blood flow.

And you wonder why getting pregnant is so hard?

All too often patients, in some groups as many as 30% of women, are told that they have fibroids that may be contributing to their infertility. Fibroids or leiomyomata are non malignant smooth muscle tumors of the uterus. They can vary in number, size and location in the uterus including; the outside facing the pelvic cavity (subserosal), the inside facing the uterine cavity (submucosal) and in between inside the uterine wall (intramural). Fortunately, most fibroids have minimal or no effect on fertility and may be ignored.

The subserosal myoma will rarely cause fertility issues. If it were distorting the tubo- ovarian anatomy so that eggs could not get picked up by the fimbria then it can cause infertility. Otherwise, the subserosal fibroid does not cause problems conceiving.

Occasionally, an intramural myoma may obstruct adequate blood flow to the endometrial lining. The likelihood of this being significant increases with the number and size of the fibroids. The more space occupied by the fibroids, the greater the likelihood of intruding on blood vessels traveling to the endometrium. Diminished blood flow to the uterine lining can prevent implantation or increase the risk of miscarriage. Surgery may be recommended when it is feared that the number and size of fibroids is great enough to have such an impact.
However, it is the submucosal myoma, inside the uterine cavity, that can irritate the endometrium and have the greatest effect on the implanting embryo.

To determine if your fertility is being hindered by these growths you may have a hydrosonogram. A hydrosonogram is a procedure where your doctor or a radiologist injects water through your cervix while performing a transvaginal ultrasound of your uterus. On the ultrasound, the water shows up as black against a white endometrial border. A defect in the smooth edges of the uterine cavity caused by an endometrial polyp or fibroid may be easily seen.

Submucosal as well as intramural myomata can also cause abnormal vaginal bleeding and occasionally cramping. Intramural myomata will usually cause heavy but regular menses that can create fairly severe anemias. Submucosal myomata can cause bleeding throughout the cycle.

Though these submucosal fibroids are almost always benign they need to be removed to allow implantation. A submucosal myoma may be removed by hysteroscopy through cutting, chopping or vaporizing the tissue. A hysteroscopy is performed vaginally, while a patient is asleep under anesthesia. A scope is placed through the cervix into the uterus in order to look inside the uterine cavity. This procedure can be performed as an outpatient in an ambulatory or office based surgery unit. The risk of bleeding, infection or injury to the uterus or pelvic organs is small.

Resection of the submucosal myoma can be difficult especially when the fibroid is large and can sometimes take longer than is safe to be performed in a single procedure. It is not uncommon that when the fibroid is large, it will take multiple procedures in order to remove the fibroid in its entirety. It will be necessary to repeat the hydrosonogram after the fibroid resection to make sure the cavity is satisfactory for implantation.

The good news is, when no other causes of infertility are found, removal of a submucosal fibroid is often successful in allowing conception to occur naturally or at least with assisted reproduction.

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Kosher IVF

By Eli Rybak, Md

October 28th, 2010 at 5:48 am

Everybody knows a thing or two about kosher food:  Meat and milk, for example, just don’t go together; although that wouldn’t stop a creative kosher food vendor from selling a kosher “cheeseburger” provided, of course, that the burger portion derives from soy, or equivalent, not meat.  Additionally, only certain kinds of meat and fish are kosher.  So, why are symbols of kosher supervision required on many food items (for example, pretzels or cookies) that appear to be “intrinsically kosher”? 

There are two important answers: One, the kosher label on the bag, box, or wrapper of food affirms that a competent supervisor ensured that the processing and packaging of the food item was done using instrumentation dedicated for kosher purposes.  Kosher food cannot be produced in the same factory or kitchen, on the same equipment, used to serve or manufacture non-kosher food.  Two, supervision aims to ensure that honest mistakes are quickly identified and rectified, and to deter foul-play.  Ideally, 24-hour-a-day supervision would be desirable.  However, owing to logistic considerations, several alternative arrangements exist; commonly, the kosher supervisor promotes kosher practice and integrity by making frequent, randomly scheduled, unannounced, and unrestricted visits to the kitchen or factory.

So, who can be a kosher supervisor?  The answer is simple: it can be any reliable individual with integrity, man or woman.  There is but one requirement: competence.  The supervisor must be versed in the relevant religious laws as well as in the relevant technology and logistics of the food production he/she is supervising.  After all, in Judaism, just one witness – male or female – is required to vouch for issues of prohibition / permissibility.  Accordingly, a woman knowledgeable in the laws of kosher food or family purity is given absolute credence to affirm that her cooking is kosher, or that she is permitted / prohibited to her husband based on her menstrual status.  The overriding concept: a competent and knowledgeable observer is needed to verify the integrity of a process involving religious prohibition.

Judaism has a well-known embrace of assisted reproduction.  The Biblical mandate to procreate and the perspective that infertility is a disease deserving of medical intervention underpin the widespread Rabbinic and communal support for A.R.T.  But there are important considerations for Orthodox patients.  And one of them is that their gametes and embryos must be supervised in the embryology laboratory – as an added layer of protection to ensure that a mix-up, albeit rare, does not occur.  Strict protocols involving acquisition, labeling, processing and storage do exist at East Coast Fertility and other large and busy A.R.T. centers to ensure that eggs, embryos, and sperm from different couples are not inadvertently confused.  Indeed, all patients require and deserve absolute reassurance that their gametes and embryos are closely guarded to avoid the rare, but devastating, repercussions when there is a mix-up.  However, akin to the laws of kosher-food supervision, many Orthodox patients will not undergo A.R.T., nor will they obtain Rabbinic permission, unless a mechanism of supervision is instituted.  And, again, the goal is not to prevent the sensationalized possibility of foul-play.  Rather, by having an observer knowledgeable in the relevant basics of Jewish law and assisted reproduction, an extra layer of protection against inadvertent error is achieved.  The stakes can be high:  many Rabbinic authorities categorically prohibit donor sperm or eggs – and inadvertent use can and will have unavoidable repercussions on the offspring.  In the spirit of the Talmudic dictum that stringencies are to be applied in matters of lineage (“Ma’aleh Assu B’Yuchsin”), many Rabbis specifically condition approval for IUI or IVF on the provision of a supervision protocol.

The embryology lab in a busy A.R.T. center is a confusing place.  Different organizations (A Time, Bonei Olam, and Machon Pu’ah) train men and women to function as supervisors protecting the “identity” of gametes in the lab.  At East Coast Fertility, patients interested in religious supervision (Hashgacha) are encouraged to contact their Rabbonim and these organizations.  East Coast Fertility works closely and cooperatively with the Rabbinic supervisor to ensure the continued attainment of the highest levels of success – both spiritually and medically!

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DR. GREGORY ZAPANTIS OF EAST COAST FERTILITY PRESENTS RESEARCH AT ANNUAL MEETING OF LEADING FERTILITY ORGANIZATION

By Gregory Zapantis, Md

October 27th, 2010 at 7:17 am

Today, Gregory Zapantis, MD, a reproductive endocrinologist and infertility specialist at East Coast Fertility (ECF) in Plainview, NY, presented the results of his new research study—which aims to advance treatments for infertile women undergoing assisted reproductive technology (ART) such as in vitro fertilization (IVF)—to an international audience at the Annual Meeting of the American Society for Reproductive Medicine (ASRM), an organization renowned worldwide as the leader in reproductive medicine.  The 66th annual meeting was held in Denver, October 23-27.  The study was supported by Ferring Pharmaceuticals Inc. and the March of Dimes Foundation.

            “This research was inspired in large part by the many hopeful patients who arrive at our busy infertility practice yearning for a child.  My colleagues and I are determined to offer the latest treatment advances to our patients.  While we strive to provide individualized care and emotional support, we also know the importance of conducting research to optimize our patients’ outcomes,” said Dr. Zapantis.  “We hope our results will lead eventually to more successful pregnancies, not only for our patients but for all women undergoing IVF treatment.” Dr. Zapantis joined East Coast Fertility in 2005 after completing his fellowship at Albert Einstein College of Medicine, where he is currently Assistant Clinical Professor of Obstetrics and Gynecology.

            The new study continues Dr. Zapantis’ investigation of embryo implantation markers in the endometrium as part of an ART treatment.  The study evaluated the transient appearance of nucleolar channel systems (NCSs) in the endometrium before and after ovarian hyperstimulation, with and without vaginal progesterone (Endometrin®*).  Vaginal progesterone supports the implantation of the embryo and early pregnancy in ART.  The results showed that in healthy oocyte donors, NCSs appear earlier than expected following ovarian hyperstimulation, which might be responsible for a reduced implantation on cycle day 21 following embryo transfer in IVF.  This may indicate when the endometrium is receptive to the implantation of a fertilized egg, which could lead to a higher rate of successful pregnancy.

About East Coast Fertility

East Coast Fertility is one of the premier centers for infertility care on Long Island.  Established in 2002 by Dr. David Kreiner, the program at ECF is designed to utilize the most recent developments in reproductive technology while minimizing risks to the patient.  The Single Embryo Transfer program, which helps minimize multiple births, is evidence of ECF’s

commitment to reducing risks to the patient.   The team at ECF is known for delivering high quality care with a personal touch.  This combined with the most competitive pregnancy success rates in the country, and programs available to make fertility care affordable, help distinguish ECF as a center of excellence.   ECF has offices conveniently located throughout Long Island and New York City.  For more information about East Coast Fertility, visit eastcoastfertility.com.

*Endometrin® (progesterone) Vaginal Insert is manufactured by Ferring Pharmaceuticals Inc.

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East Coast Fertility Leads the Way With Few Premature Births

By East Coast Fertility

October 26th, 2010 at 8:51 am

With all of the negative publicity surrounding the fertility industry in the wake of "octomom" and other sensational news stories, it is no wonder public opinion has turned sour towards the doctors and clinics that perform the services. Society now questions the safety, practicality and costs of aggressive treatments that often result in multiple births.

The topic made front page news in the New York Times a few months ago with its article "The Gift of Life and Its Price." So how do infertile couples pursue a more conservative route to parenthood – one that’s safer for them and their baby, still offers high success rates, yet is affordable? Dr. David Kreiner of East Coast Fertility is using his conscience and his expertise to provide a solution. He is the first in the country to offer an In-Vitro Fertilization (IVF) package using Single Embryo Transfers (SET) at one set price to patients.

In a typical IVF cycle, a doctor will transfer two, three and sometimes more embryos back into the uterus, depending on many factors, in order to achieve the highest chance of success. However, this protocol lends itself to a high risk of multiples, making risky pregnancies, long NICU stays, babies with developmental problems and handicaps, and thus extremely high healthcare costs.

With a Single Embryo Transfer, just one embryo is placed back into the woman’s uterus, nearly eliminating the chance of achieving multiples. The remaining embryos are frozen and can be transferred to the woman in future cycles.

While SET is the optimal choice for many women, the current cost structure favors transferring multiple embryos over this method. Because transferring a single embryo has a lower success rate than transferring multiple embryos, a patient may have to undergo several SET cycles before achieving a successful pregnancy. Clinics charge for each additional procedure. The patients are expected to absorb what could add up to $100 million per year in extra costs. Thus, patients and programs are pressured to transfer dangerously high numbers of embryos. The real irony lies in the fact that research has shown that universal adoption of single embryo transfers could save the healthcare system a total of $1 billion in healthcare costs. Yet, the patients who choose SET are expected to foot the bill.

That’s all changing at East Coast Fertility. Their Single Embryo Transfer Program attempts to take the financial incentive out of this push to put "all your eggs in one basket." Dr. Kreiner and his staff are making it cost neutral to transfer only one embryo at a time by offering free cryopreservation, free embryo storage and free embryo transfers until a patient achieves a live birth, all for the cost of a single IVF cycle. ECF absorbs the extra costs in cases where successive transfers are needed. So, the patient can choose the more conservative route without having to worry about the financial implications. Dr. Kreiner believes the benefits to the patient and society are obvious, and he doesn’t feel he is sacrificing the success of his practice. "It is with confidence in our highly successful embryo cryopreservation program that we are able to limit the number of embryos transferred without decreasing the number of births that result from IVF cycles at ECF. We are willing to sacrifice some margin in those cases where patients need successive transfers."

It remains to be seen if other clinics will follow ECF’s lead. Perhaps society should demand that fertility doctors start doing what is best for the patient even if it means having to cut into their profits on occasion. "Hopefully talking about these issues will highlight some of the negative incentives that exist in the world of Reproductive Endocrinology, and bring about change in the industry," says Pamela Madsen, fertility blogger (www.thefertilityadvocate.com) and founder of The American Fertility Association. She continues, "It is refreshing to see Dr. Kreiner as an ethical standout in the fertility world – a patient activist who is not letting greed get in the way of practicing good medicine."

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Managing PCOS By Combining East Meets West Treatments

By Mike Berkley

October 25th, 2010 at 8:32 am

Polycystic Ovary Syndrome (PCOS) is a condition in which a woman’s hormones are out of balance.   It can cause problems with your periods and make it difficult to get pregnant.  PCOS may affect the way you look and can be associated with a variety of health problems including diabetes, hyperlipidemia and hypertension.  In addition to occasional acne and hirsutism (excess hair on the face or other areas of the body such as the abdomen or chest), patients typically have ultrasound findings of polycystic ovaries.  Fifty-percent of women with PCOS are considered obese.

The inability to conceive in the PCOS patient stems from several factors: 1) the follicles typically don’t mature and only develop to between 10 and 12 mm. A mature follicle grows to approximately 20mm;

2) The eggs contained within the follicles are usually not of the best quality. This is often why, even when women with PCOS use medication and IUI or IVF to conceive there may be a greater rate of miscarriage than experienced by women in the general population.

 3) There is an inappropriate hormonal milieu: the FSH, LH, Estrogen, Androgen and Progesterone levels are typically at either inappropriate levels or have inappropriate quantitative relationships between them.

One of the mainstays of acupuncture and herbal medicine is to improve hemodynamics or blood flow to the ovaries and uterine lining. This is important because blood carries hormones, electrolytes, oxygen and nutrients to target tissue and upon its return, takes debris or dead cells away from the target tissue. Thus, an increase in the patency of blood flow to any tissue means a healthier tissue and a better performing organ system.

From the perspective of traditional Chinese medicine, PCOS represents a disease that is caused by what we call ‘phlegm’.  This phlegm is not the typical phlegm that you think of, but represents rather a sticky, viscous substance that is inert, still, clogging and blocking. This type of presentation as you can imagine is not very amenable to being nurtured by blood and enjoying the benefits that blood has to offer. One may think of a polycystic ovary in traditional Chinese medicine terms as a big bruise that won’t go away.

Imagine if you will, strongly improving blood flow to and through that bruise: it is then that the healing process begins. This is exactly the case with the polycystic ovary.  Acupuncture and herbal medicine cannot cure PCOS, but when combined, they can help to improve follicle quality and egg quality.  This is why the East meets West approach to infertility makes sense. When a patient undergoes an IUI or IVF procedure, the reproductive endocrinologist fertilizes an egg with sperm and transfers the embryo back to the uterus. Or, as in the case with an IUI, the doctor will facilitate the growth and development of more than one follicle and have those follicles meet with more sperm than that which occurs with sexual intercourse thereby improving the chances of a fertilized ovum.

The problem with these methods is that the treating physician can only work with the eggs and sperm that the patient presents with. If either egg or sperm is qualitatively deficient, either a pregnancy will not occur, or a miscarriage will prevail.

By including acupuncture and herbal medicine in the mix, there is a good chance, based upon 3000 years of clinical history, and volumes of classical literature on gynecology and infertility, and modern day clinical experience, that pregnancy rates will increase and miscarriage rates will decrease. This is because egg quality and lining is improved.

Lining quality is an often overlooked problem in the PCOS patient. The health of the endometrium is dependent upon the proper circulating amounts of estrogen and progesterone. In the PCOS patient the estrogen levels are abnormal as are the progesterone levels. So, even when a doctor states that “you have a beautiful 10mm lining” this is not necessarily so. The shape or morphology of the uterine lining is no more an indication of its health that the shape of a person’s body.  For example, you can look at a male model who is tan, handsome and muscled up and appears to be at the height of health but in fact,  is HIV +. 

Again, as acupuncture and herbal medicine can stimulate blood flow to the lining of the uterus; it too will improve in quality, thereby increasing the chances of a successful implantation.

Herbal medicine and acupuncture, when provided by a licensed professional are safe.  Remember the statistics: there are over one million hospitalizations per year in America as a result of reactions to prescription medications. When is the last time that you heard about a death or severe illness occurring as a result of herbal medicine? Does it happen? Can it happen? Yes. But it is extremely rare.

When seeking the care of an acupuncturist and herbalist, look for two things: 1) experience in the field of reproductive disorders and 2) licensure and board certification.

East Coast Fertility is now very excited to be able to offer these services through The Berkeley Center for Reproductive Medicine at East Coast Fertility in Plainview, Long Island.

Mike Berkley, the center’s founder is a Licensed Acupuncturist and Board Certified Herbalist has been treating infertility cases for thirteen years. He is the first acupuncturist in the United States to specialize in this field.  For more on traditional Chinese medicine and infertility please see www.berkleycenter.com o

Or call 516-204-7149 to set up an appointment!

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When Periods Come and Go

By Dr. Eli Rybak

October 22nd, 2010 at 8:24 am

Recently a patient asked me:

“I don’t get my period regularly – and I am thinking about trying to get pregnant.  Should I be worried about infertility? Is there anything I should do now?"

This is an excellent question – and one that arises frequently in reproductive medicine.

I will address it both with a brief response below, and then with a longer explanation.

The Bottom Line:

Having irregular periods is a common challenge among women of reproductive age.  Thankfully, it is one that can be overcome – via lifestyle modification and/or medication / hormonal therapy.  Occasionally, assisted reproductive technology is warranted – and proves highly successful in inducing ovulation among women with irregular periods.  And, yes – a woman who does not get her period regularly should see her gynecologist even if she is not thinking about pregnancy in the short-term.  If she desires a pregnancy, she should see a reproductive endocrinologist (“fertility specialist”) for a specific diagnosis regarding her irregular periods and for a treatment plan.

The Big Picture:

A normal menstrual cycle should be approximately 25 – 35 days, with ovulation occurring approximately 14 days prior to a woman’s (next) period.  When the hormonal pathways between the brain and ovary are functioning properly, a follicle (usually a single follicle, 1% of the time – 2 follicles, reflecting the 1% incidence of twins in the absence of assisted reproduction) grows during the follicular phase (first-half of the menstrual cycle) and produces increasing amounts of estradiol.  At a certain point, this heightened level of estradiol produces a massive surge of LH (a hormone from the pituitary gland) that triggers ovulation – release of an egg from the grown follicle.  Whether or not the egg is fertilized, the empty follicle – now called a corpus luteum – begins to secrete progesterone, which transforms the uterine lining (thickened already from its exposure to rising estradiol in the first-half of the menstrual cycle) to prepare for a possible pregnancy.  The corpus luteum survives in the absence of pregnancy for 14 days.  During this time (the luteal phase), the pituitary secretes pulses of LH to maintain the corpus luteum, which, in turn, produces progesterone.  By 14 days after ovulation, these LH pulses attenuate, the corpus luteum regresses, progesterone production ceases, and the uterine lining begins to bleed – menses has arrived.  If, however, a fertilized egg (now embryo) implants into the uterine lining and secretes HCG (the “pregnancy hormone” detected in the home urinary pregnancy test or in blood tests) to “rescue” the corpus luteum, then the corpus luteum resumes progesterone production – to support the uterine lining and pregnancy – until about the tenth week of pregnancy, when the placenta takes over this role.

A woman who never has a period should see her physician ASAP.  First, of course, she needs a pregnancy test!  Second, her diagnostic workup will depend upon whether she never had a period in her life (primary amenorrhea) or whether she has had periods in the past, but no longer (secondary amenorrhea).  I mention this, only because some of the conditions that cause irregular periods might, in more severe circumstances, cause amenorrhea – i.e. secondary amenorrhea, or the total cessation of menses.

Back to our scenario, having irregular periods means that a woman is not ovulating regularly.  She is not releasing an egg, nor does her uterine lining experience progesterone from the corpus luteum.  Instead, her uterine lining remains exposed only to estrogen – a dangerous phenomenon if this occurs (i.e. if a woman has no period) for many months at a time.  Why?  Because the uterine lining thickens under estrogen influence, and after a prolonged “unopposed” exposure to estrogen there is the long-term (thus, do NOT panic) increased risk of endometrial cancer.  In the short-term, this “anovulatory” woman will experience irregular bouts of breakthrough bleeding, possibly combined with occasionally ovulatory cycles followed by menses.  The nature of these bleeding episodes may be similar, and the woman will not be able to distinguish whether or not she has ovulated – other than to rely on the rule (not-absolute) that cycles more than 35 days apart are unlikely to be ovulatory.

So, if a woman has irregular periods, she should see her doctor for a work-up.  Irregular periods can result from lifestyle factors.  These might include: stress, eating disorders, or an intensive exercise regimen that affect the brain’s regulation of female reproductive hormones.  Indeed, for normal menses and ovulation to occur, a woman must maintain a body weight within a certain window – thankfully this “window” is lenient.  But should her weight sink too low (anorexia, training for the marathon) or climb too high – and each person has a different threshold – then periods may become irregular.

A physician will also investigate other causes for irregular periods:  Does the patient have excess hair growth or acne suggestive of elevated levels of androgens (“male” hormones)?  Does the patient have galactorrhea (milky secretions from the breasts) occasionally seen with hyperprolactinemia?  Are there symptoms including fatigue or cold intolerance suggestive of hypothyroidism?

Among patients I see, The Polycystic Ovarian Syndrome (PCOS) is the most common cause of irregular periods.  But it is important to remember that PCOS is a diagnosis of exclusion.  Other causes of anovulation / irregular periods must be specifically excluded prior to labeling a person as having “PCOS”.  Specifically, thyroid and prolactin function must be assessed.  Additionally, an appropriate array of blood tests should be ordered to ensure that hyperandrogenism is not caused by an adrenal or ovarian tumor (rare) or by late-onset congenital adrenal hyperplasia (more common in the Hispanic and Ashkenazi Jewish Populations).

Treatment for these endocrine disorders is fairly straightforward.  Hence, I repeat my encouragement to such individuals: Do NOT stress or worry about irregular periods.  Rather, proactively pursue medical intervention.  Prolactin or Thyroid dysfunction may warrant some more tests but, ultimately, the vast majority of such patients can be treated with medication that will treat both the underlying disorder, and promptly restore normal menstrual function.  PCOS patients seeking to conceive will benefit from a variety of ovulation induction agents as needed.  Should imminent fertility not be desired, then a physician could prescribe an oral contraceptive or variation thereof to enable the uterine lining to “experience” both estrogen and progesterone.  This will avoid long-term risks of unopposed estrogen and short-term risks of irregular, breakthrough bleeding episodes. 

Bottom Line: Irregular periods warrant a visit to a gynecologist or reproductive endocrinologist.  If a woman is seeking to conceive, she should not wait 12 months (or less, if she is in her thirties) if she has irregular periods.  The “12-month” rule applies to couples without any known disorders.  Having irregular periods is a disorder, but one that, thankfully, is very amenable to hormonal treatment!

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Eggsploitation: So Very Far From The Truth

By Amy Demma, Esq

October 21st, 2010 at 7:12 am

Last Thursday evening, I attended, along with some colleagues, an event hosted by Harvard Law School. The event was a screening of the documentary entitled: Eggsploitation: The Infertility Industry Has a Dirty Little Secret, the guest speaker was the producer of the film, Jennifer Lahl, Founder and National Director of the Center for Bioethics and Culture Network. After the screening, Ms. Lahl asked of the audience “Don’t you feel better informed?”. I am writing to you this morning to tell you that watching this documentary not only leaves the viewer uninformed but dangerously misinformed. As I viewed the documentary and listened to its allegations of coercion, abuse, human trafficking, egg selling, pillage, walking egg factories (these are all words lifted straight from the film), my worry went quickly from those in the HLS audience to those prospective parents who may be considering egg donation, are currently in an egg donation cycle or who have been blessed with a donor conceived family. My message to you is simple: if you have made the decision that third-party or collaborative reproduction is the right alternative family building effort for you and if you feel confident about your clinic selection as well as the other donor egg professionals you have retained (perhaps you are using an  agency, hopefully you have retained legal counsel for the drafting of your Egg Donor Agreement) then please go into this process with trust, hope and good-faith.

Back in the summer, I wrote an article for Fertility Authority on Eggsploitation. I began the article as follows: “I am writing today to prospective parents considering egg donation, to the parents of donor conceived children and to donor candidates.” I ended the article with: “See the film if you must (and as a side-note, consider the agenda of the organization releasing it) but please do not regard Eggsploitation as authoritative; do not let this documentary dissuade you from a process you otherwise thought might be right for you.” (to read the entire article, visit: http://www.fertilityauthority.com/blogger/amy-demma/2010/08/30)

Frankly, I thought the release of the documentary, earlier this year, was but a blip on my radar. I figured there would be some industry buzz, some of us who were inspired to do so might write or do some public speaking. I assumed it would be reviewed as the vehicle it is intended to be for conservative, faith-based groups to target and ultimately restrict ART.

(Last week The Boston Globe ran an article on Jennifer Lahl. The Globe wrote: “Lahl has become a lone voice for a message that many of her fellow evangelicals are uncomfortable hearing: If embryos are human lives, she argues, then it is time for Christians to be consistent about their moral objections and unite against IVF.”)

Well, Lahl and Eggsploitation are still going…the documentary was recently screened on Capitol Hill and the producer is taking it on the road and  touring the country. And so, here I am, again, writing to prospective parents. I am sending you my empathy, my compassion but also my determination that you should know that egg donation is not as depicted by Lahl and her group, that there are good, passionate, caring professionals from all disciplines (physicians, nurses, attorneys, mental health pros) who will embrace the donor you are intending to cycle with, will care for her as they do you and that collectively, all parties will work in a careful, thoughtful and considerate way so that you may experience the joy of parenting and move forward with your family with good thoughts about your egg donation experience.

 To Learn More About Amy Demma, Esq please visit:

http://www.lawofficesofamydemma.com

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Corporate Denial of Right To Watch Favorite TV Show

By David Kreiner, MD

October 20th, 2010 at 5:13 am

Tagged with , ,

It’s now official. News Corp. has pulled the plug on Cablevision customers by turned off the signal of FOX and My Nine affecting 3 million viewers in the New York Metropolitan area. My wife and daughters are distraught. Their favorite television show; Glee, not to mention critical sports shows and others are no longer viewable on our TV sets. They like so many others are frustrated and depressed at the prospect that they will be denied those pleasures that we have grown accustomed to expect.

My wife and I never truly experienced infertility. We had a workup for recurrent miscarriages and it took us over a year to conceive a healthy pregnancy in between our two boys and two girls. We were quite fortunate that we were not denied the joy of building our family that we had learned to expect while growing up, observing our own as well as our friends’ and neighbors’ families. It is a way of life that we understand as well as anything else that we experience throughout our lives.

When a couple experiences infertility, this expected right to the pursuit of happiness by creating one’s own family is denied. It is not deserved; the affected are innocent bystanders of a tragedy not of their own making. Someone afflicted with infertility might have just as randomly caught a cold or some other disease or condition. The difference is that if you unfortunately have any other condition or disease requiring medical treatment, the odds are excellent that you have insurance coverage for it. Infertility is not covered by most providers not because of ethical or religious reasons or even lack of sympathy, but instead because it costs money to the providers.

Cablevision and Fox TV are battling over millions of dollars. How I wish they would use the argument that they have increased costs to cover safe, cost effective fertility care like IVF; that they wish to provide for the right for their employees to have a family like they grew up seeing on Fox and My Nine movies and on Cablevision. Senator Kerry, former presidential candidate interceded in the past to try to negotiate a settlement between Disney and Cablevision so that my wife and others would not be denied their TV shows. Why can’t we get a similar hero to negotiate a settlement for coverage so that the infertile couple can get the treatment they need so they are not denied their families?

IVF is now cost effective and safe when used conservatively especially with our single embryo transfer program. We have a greater than 60% live birth rate per retrieval in women under 35. We can avoid multiple pregnancies by transferring one embryo at a time rather than expose a woman to a 35% multiple rate with ovulation induction and intercourse or insemination. Minimal stimulation IVF is a low cost alternative, $3900 at ECF that avoids hyperstimulation and allows for single embryo transfer. Why do politicians ignore the millions of infertile individuals and couples in this country and deny them the right to have their family that they grew up expecting as naturally as tuning into Fox and My Nine and watching a favorite TV show?


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Why Join A Mind/Body Support Group at East Coast Fertility?

By Bina Benisch, Ms, Rn

October 19th, 2010 at 6:57 am

Why join the Mind/Body support group at East Coast Fertility?  How can this group support you through your journey on your path to conception? Our Mind/Body Group is a safe haven, a place where you can relax, a place where you are free to express whatever it is you are feeling … a sacred circle of connection and support. Whatever you bring into it is respected, whether expressions of your thoughts and feelings, questions and concerns, or simply your attentive silent presence as you listen.

What impresses me most about these sessions is the warm acceptance and offering of support by group members. In addition to being in a place where your insights, concerns, and tears are always welcome and treated with respect, laughter is sometimes the natural byproduct of sharing our own personal stories, and I’ve seen this phenomenon foster much closeness among members.  Meditations are focused on eliciting the Relaxation Response as described in mind body medicine, quieting the mind and decreasing stress hormone levels. Meditations are soothing, relaxing, and anyone can do it!

I am often told by group members that the sharing of information has been enormously helpful to them.  One reason this information is so appreciated is that often when patients are given instructions or information by their doctors or office staff, something may get lost in translation. We know that when so much information is being transmitted under stress, we often have “mental blockages” due to our anxiety.  However, in this relaxed atmosphere of our sessions, among women sharing a common undertaking, they can absorb information so much more easily! They are then more aware of what questions they actually need to ask their doctors to make themselves more comfortable with their knowledge.

New members are always welcome and invited. 

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How Einstein Would Get Pregnant

By admin

October 18th, 2010 at 7:22 am

Circle + Bloom has started a fantastic new blog series called How Einstein Would Get Pregnant to highlight ways we can creatively use our brains, minds and body to influence our fertility and ability to become pregnant.  They have created this as a podcast as well which you can find on iTunes.  Special Thanks to Circle + Bloom for sharing their series with East Coast Fertility!

Welcome to Week 1 of our new series of How Einstein Would Get Pregnant.  This week we would like to cover the basics of our existence – our cells. We have between 50 – 75 trillion cells that make up our bodies and shouldn’t we know more about how they work? I promise not to take you back to high school biology! What Cellular Biology is covering lately is how our thoughts, emotions, experiences create change on a cellular level.  Sound interesting?  Let us start with some basic foundation of how our cells look and work:

  • Each cell at its basic level contains proteins, nucleus – and within the nucleus has DNA – all which is surrounded by a membrane;
  • Each cell is constantly working, breathing, digesting and reproducing to support our entire existence;
  • A key component of the cell are the proteins that provide direction to how the cell should operate and change; and
  • The cell membrane, and its millions of receptor sites, decides what information (ligands) enter the cell to change the proteins and hence change the cell.

Dr. Bruce Lipton in his book Biology of Belief discusses his work in uncovering how our cells are manipulated and changed as we go about our daily lives.  He covers the fact that the Human Genome Project has essentially debunked the theory that whatever is in your DNA dictates the expression of your cells.   In summary, there are about 120,000 different types of proteins responsible for what makes a cell do what it needs to do.  DNA theory would suggest then that there should be the same amount of DNA instructions or coding to create these proteins.  The Human Genome Project found only about 30,000 different types of DNA, leaving the question of how exactly our proteins become the various types of proteins that make our cells accomplish the things they need to accomplish.

So no longer can we sit back and credit (or blame!) our genes.   The book Genius in All of Us by David Shenk shows us “why everything you’ve been told about genetics, talent, and IQ is wrong.”  Genes are not a “blueprint” that bless some with greatness and doom most of us to mediocrity or worse. Rather our individual destinies are a product of the complex interplay between genes and outside stimuli-a dynamic that we can influence. 

It is now believed that there are signals and packets of information that are sent from our senses, which are then put into our subconscious and sent to the cells.  The packets of information attach themselves to the cell membrane – and it’s actually the membrane that accepts those messages to be let in and subsequently change our cells.

And here is the power  – if your senses and subconscious have a direct effect on the messages that are sent to the cells, then who is in “control?”  Let’s explore this a bit more and explain how we can begin to influence positive change for our reproductive health.

To try and keep this as simple as possible – think about a messenger, the person on the bike that races around NYC to deliver packages – well there are millions of messengers in your body delivering packages to your cells – constantly 24X7 – no overtime pay required.

And these packages are filled with energy and information from our sensory input (what we are seeing, felling, hearing, etc).   These packages originate from our sense and feelings, interact with our subconscious and then brought to the cells.  This is why visualization works. When we are “seeing” – in this case using our imagination – our subconscious mind does not know the difference between what we are imagining (which is why our perception or beliefs make such a huge difference in our health – look no further than the Placebo effect) and what we are physically seeing with our two eyes. Through our subconscious, signals from those visualizations are sent to our cells. The cellular membrane lets in those signals, and viola, we change our cells. This is why being relaxed, being fully present when visualizing, which is what our programs help you to accomplish is so important. It’s the power of your subconscious that does the work!

Candace Pert, Ph.D, in her book Molecules of Emotion expands on this in her ground-breaking work that uncovered the opiate receptor, proving that emotions which create opiates or the “feel good hormones” have a physical interaction with the cell and change teh cell.  Happening both within the body and brain, our cells are constantly talking to each other back and forth, and our feelings and emotions literally leave physical imprints of this detailed and complex inner communication. 

Pert believes that the nervous, endocrine, and immune systems are interlocked in a body-wide system where each part can communicate with every other part. According to Pert, “emotions are the nexus between mind and matter, going back and forth between the two and influencing both.”

This explains studies showing severe stunted growth of children who are not held or shown any kind of love or attention. It also makes sense when you hear that monks meditating in sub-zero temperatures with wet robes can make their bodies steam from heat generated within. It makes sense when you hear of the miraculous stories of self-healing from cancer survivors who make an enormous empowering decision to take control of their lives and change their thoughts.

The subconscious mind is the part of the brain that directs physical function. It also our conscious attention to focus on the tasks in front of us and allows our bodies to function seemingly on their own. The problem with this, however, is that the subconscious is also where we hold our deep-seated beliefs about our bodies, our lives, our abilities, etc., etc. The subconscious has been effectively “programmed” mainly when we were young children – some even say it starts in-utero. The subconscious creates our “filter” in terms of how we view the world. The filter changes our perception of our existence, and then leads to physical changes in the body by way of signals and changes in our cells.

In summary, we’ve got a lot of information now that points to a new way of being and how we can directly impact our health, reproductive cycles and lack of disease through an understanding of how our cells are given instruction. It’s empowering to know that we are not at the “mercy” of our genes! Our environment – and more importantly, the perception of our environment – is hugely influential and one that we can control.

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