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Archive for January, 2011

Infertility Dream Team: The GYNO and the RE

By Tracey Minella

January 31st, 2011 at 12:00 am


You’ve heard the guidelines on how long you should be trying to conceive before you see a gynecologist for help. One year if you’re under 35. Six months if you’re over.

Sure, those guidelines are fine for the fertile world, because contrary to what we were all scared into thinking as hormone-crazed teens, it’s not that easy to get pregnant each month. Doctors don’t want stampedes of patients seeking testing after TTC for only one or two months. It is perfectly normal for it to take a few months.

But to a thirty-something (or older) woman who continues to ache for a baby, those guidelines are just a freakin waste of time. Precious time. Just suffer through the disappointment of 12 negative pregnancy tests and unwanted periods before investigating the reason? Seriously?  I know tons of desperate women who lied about how long they’d been TTC so they’d fit into the guidelines and not get sent home to try some more. Hell, I was one of them.

So, now that you’re there, how long do you give the GYNO to diagnose and solve your problem? Where are those guidelines?

How many tests, procedures or surgeries should you let the GYNO perform before switching over to the stirrups of a RE? Do you trust him enough to decide when to refer you to an RE? Are you sure that her heartfelt desire to get you pregnant, or her ego, won’t delay her referring you on for advanced treatment? Those are loaded questions.

I’m a firm believer in listening to that voice in your head. If there are factors, suspicions, or nagging fears about something in your medical or social history…and your heart is telling you that you’re going to need special help to have a baby…listen to it and get specialized help earlier. Especially if your age is a factor.

Here’s how I see it. If your face lost a battle with a windshield, would you want the ER doctor to sew your face back together, or would you want a plastic surgeon? Both doctors can close you up just fine. But only one is a specialist in making you look good. One has different talents, special training, knowledge and skills that the other doesn’t… all of which are designed to give you a better chance at the best possible outcome. And you have to face the mirror and live with the consequences of that decision for the rest of your life. It’s sorta the same thing with your fertility.

I’m not saying to by-pass the GYNO, just to keep the communication lines open about any concerns and expectations you have about the cost, pace and scope of your treatment. Consider your age. Also, keep your finances and emotional strength in mind when deciding how long to wait before moving on to an RE. It’s hard to leave your comfort zone. But sometimes it’s necessary.

Don’t wait to switch over until you and your partner are so emotionally and financially drained that you don’t have anything left to put into the more intense assisted reproductive technologies, like IVF, if it’s needed.

Remember, you won’t be leaving your beloved GYNO forever. The RE specializes in getting you pregnant. After that, you’re referred back to the specialist best equipped to monitor your pregnancy and deliver the baby you’ve worked so hard to conceive…your beloved OB.

When you have the best of both specialties…an Infertility Dream Team… and they each work their magic, there’s no telling what they, or you, can deliver.

Do you think you waited too long before seeing a gynecologist about your inability to conceive? Did you stay too long with the gynecologist before moving on to a reproductive endocrinologist? Do you have a story to share?

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You’re So “Vein”, You Probably Think This Post is About You

By Tracey Minella

January 27th, 2011 at 12:00 am

Have you been told that your veins hide, roll, collapse, or basically run for the hills? Do the nurses scurry away like mice when they see you heading toward the blood-drawing chair? Does it take a few people a few tries to get blood out of you every day? Are you the poor schnook who walks out of the blood-drawing room with wads of gauze taped inside both elbows and on the back of a hand or two?

If so, then yes, this post is about you!

Well, if it’s any comfort, it’s about me too. As an IVF medical assistant, certified phlebotomist and seven time IVF cyclist with $hit for veins (sounds like I should get a medal or something) I am the resident expert on this subject!

I’ve got one vein that works. Sorta. You can’t see it. You have to be able to feel it. Of course, it’s been used and abused daily for years, so now it has a little track of scar tissue running along its length, which helps the lamer phlebotomists (a/k/a vampires in lab coats) to have a shot at hitting it. If you have only one vein that sorta works, too, don’t hesitate to point it out to whoever is coming towards you with a needle. They will appreciate the guidance.

No one wants to draw me. Not even the professor/hospital lab director of the phlebotomy course when I was a student. And when she missed my vein on that first night of class she pretty much gave my fellow clueless phlebotomist trainees a license to never get blood out of me either. It was a long and painful journey to certification!

Due to my own bad blood-drawing experiences, I was determined to be damn good at venipuncture. After certification, I worked in a hospital, drawing blood in the most challenging and stressful settings. Once, I even rode on an ICU patient’s gurney on the way to the O.R. surrounded by doctors expecting me to draw a vial of blood when the only vein available was a teeny tiny bluish thread on the patient’s index finger. Sweat was running into my eyes as everyone was watching me. I swear it was like something you’d see on “E.R.”!

When I came to work at the IVF office, I drew blood almost every day. I welcomed the challenge of the tough cases. It was my mission not to miss anyone’s vein. Ever.  Yeah, well, no one’s perfect. (Sorry, Janet!) The greatest compliment I could receive was when patients… surprised it was over already… would say they didn’t even feel it!

I wish I could draw your blood. Share IVF war stories. Feel that “high” when I get you on the first try. Start your day off on a better note than you were expecting.

As those of us with crappy veins know, it really is a special skill to be able to draw blood nearly painlessly. So, if a nurse or med tech does a good job, let them know. It’ll make their day.

Wondering about that O.R. patient? Yep. I got him.

I know… I’m so “vein”.

Do you have a story to share about an IVF blood-drawing experience? How about a “shout-out” to a nurse or med tech that always comes through for you when others fail? Now’s your chance.

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Is IVF Success Like Winning the Superbowl?

By admin

January 24th, 2011 at 2:26 am


What does an infertile woman have in common with a NFL professional athlete? Well, there’s the thrill of victory and the agony of defeat to begin with…

The agony part hit me last night as my husband and I watched his team go down in flames again, just a game shy of making it to the Superbowl. Again.

And it got me to thinking about how driven and relentless these professional athletes are in their quest for the ultimate trophy. And how hard it is to fulfill that dream. How for each one team that makes it to the pinnacle, there’s so many whose hopes are dashed. How hard it must be pick themselves up, brush themselves off, make a new plan, and continue to move forward. And how frustrating the wait for another chance at the trophy must be. How they feel defined by whether or not they can achieve that one all-important goal. How, with each season they fail to achieve it, they feel the pressure that they’re getting too old and the window of opportunity is closing.

Sound familiar?

Well, never mind seasons. My own infertility journey outlasted entire careers of some professional athletes! I’d be thinking “I need a new play book NOW” each time the negative test results came back on yet another failed IVF cycle. (Actually, I was thinking much nastier things and was really hoping for new tubes and an extra ovary instead of a play book, but you know what I mean.) My hopes were crushed as if one of those refrigerator-sized linebackers was sitting on my heart. Seems every time we changed things up, we got sacked. Why do I keep playing this game? I loathe games! How much longer can I go on?

Enter: The fan. Professional athletes are surrounded by adoring fans who live that dream along with them. Follow them anywhere. Stand by them in the good times and the bad with unwavering devotion. Who, before the news even breaks about the season-ending game, are already looking toward the future, hopeful for the next season. The believers.

Never forget your own fans.

You, too, are surrounded by supporters. Your friends and family, doctor and nurses, even people you meet on supportive blogs. They are all cheering for you. They are in this game with you and they are on your team. They stand by you in the tough times. They wait longingly… with all the faith in you that you sometimes lose in yourself… for you to achieve the dream. They’re the believers.

So, you have a lot in common with the NFL professional athlete. But there are differences.

As strong as the call of the Lombardi trophy may be, it pales in comparison to the deafening roar of a woman’s call to motherhood. At the end of the day, the athletes are grossly overpaid men playing a boy’s game, hoping to win the big, cold, hard, shiny trophy to stroke their big egos.

Infertile women don’t play games. And they don’t get paid. (In fact, they pay dearly.) They don’t have egos. They have a hole in their soul where a baby belongs.  But, the trophy…

Ah. The trophy. It’s small, and soft, and warm. And when you hug it, it hugs you back.

Now that’s the thrill of victory.

Tell us about how your fans keep you going, or how you manage to remain relentless on your journey.

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If You Hug Me While I Pee on That Stick, Will I Get Pregnant?

By Tracey Minella

January 21st, 2011 at 12:00 am


Maybe I was too focused during that sex education talk in school on whether you could get pregnant from a hot tub. But I know I never heard that you could get pregnant from hugging someone. So, what gives?

Well, it’s true that there needs to be a meeting of egg and sperm, of course. And that part may happen the natural way or with ART. But there just may be more to the story.

If you’re trying to conceive and are feeling depressed and frustrated at the lack of control you have over your own fertility, the extra stress is not going to help. But there is something that you can try that won’t interfere with any part of your treatment plan, is totally safe, non-controversial, and it’s free.

Hugs. Preferably many of them.

Today is National Hugging Day, created in 1986 by Rev. Kevin Zaborney, who is the founder and copyright owner of the National Hugging Day Club TM. It is celebrated annually on January 21st. Check with him if interested in finding or forming a local chapter!

First, I thought of all the times I really needed a hug during my IVF cycles. Sometimes I got one from the nurses. Oftentimes from my husband. And once or twice… in moments of extreme crisis… I got one from the doctor. I remember the amazing healing power of that particular hug as it was not something normally shared between doctor and patient. I just dissolved into it. It was like a lifeline thrown to me at my lowest low.

Then, I thought of all the times I didn’t want anyone near me during my IVF cycles. And sometimes I still got hugged. Hugs are like that. They just happen when someone wants to help and comfort you… especially when words are not enough.

Hugging is comforting. Common sense tells us that. But is there science behind the benefits of hugging or touching?

Yes, it comes within the realm of psychosomatic medicine, defined by Wikipedia as “the study of the relationship between social, psychological and behavioral functions on bodily processes.” It deals with the influence of your mind over your body’s processes.

Touch has been studied and found to have a “beneficial influence” over many bodily systems sensitive to stress. [See PsychoSom Med 70:976-985 (2008) Influence of ‘Warm Touch’ Support Enhancement Intervention Among Married Couples on Ambulatory Blood Pressure, Oxytocin, Alpha Amylase and Cortisol, Holt-Lunstad, Birmingham, and Light, for full article or abstract.]

But enough of all that scientific stuff! Go out and hug someone today. I dare you. Then do it again. Better yet, get a hug from the person you need one from most. Make it a habit. Then come back and tell me how you felt. 

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IVF and the Big Fat Birth Control Joke

By Tracey Minella

January 20th, 2011 at 12:00 am


The scene: Two teenagers tangled in various stages of undress in the backseat of a parent’s car. Steamy windows lend some privacy to the star-crossed lovers. Deserted dead end road, two hours past curfew. Someone’s gonna get grounded big time… but no one’s thinking of that right now.

Paradise by the dashboard light.

“What’s it gonna be boy, yes or no?” What’s it gonna be boy? Yes…or…no?

We’ve had that feeling come upon us like a tidal wave. We started swearing to our God and on our Mother’s grave, too.

Remember those reckless days of youth? Girls with their compact-sized disks of little pills. Boys toting Trojans stolen from an older brother’s stash. Hanging out blasting Billy Joel hits about “Cath-o-lic girls start much too late…”At least that’s how it was right before AIDS came on the scene.

I don’t know who planted the idea way back in the nether regions of my brain, but there would always be some level of consciousness in the back seat screaming out: “Don’t do it. You’re gonna get pregnant!”  (That thought eventually morphed into “Well, be really careful. You don’t want to get pregnant!”)

Fast forward to that monumental day, five years into the marriage, when the last pill of the last compact disk was swallowed. Finally. Grad school was done. House was bought. We’re ready to start our family. Well, almost. You see, we’d heard you should be off the pill for 3 months before trying to conceive.

So we naturally factored that in to our “plan”. That way, when we got pregnant on the very first month of trying (after being extra careful not to conceive during those first three months off the pill), we’d have our baby precisely in October, 1991.

Idiots.

It was so strange to be unprotected. To open yourself up to the universe in a way that was so totally opposite of all you ever knew before that moment. To wait anxiously for life to spring up inside you.

And wait. And wait.

If I could somehow have known that no baby would ever have come without IVF (and that even with IVF, she wouldn’t get here until 1998), I could have saved a ton of needless worrying over an unplanned pregnancy. Plus I’d have saved enough money in birth control alone to finance at least one of those IVF cycles! Oh, the irony!

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IVF and the Broken Friendship

By Tracey Minella

January 19th, 2011 at 12:00 am


My husband and I were friends with “Erica” and “Rob”, a couple we met through our mutual involvement with a charity. Despite a history of miscarriage and with some progesterone support, they had a toddler and had gotten pregnant with their second child about two years after we met. I was still plugging away at IVF. We became fast friends and spent lots of time at their house. We also became friendly with their best friends “Pam” and “Bill”, a childless couple.

When Erica was hospitalized for pre-term labor months before her baby was due, I happily pitched in with laundry duty, cooked meals, visited her almost daily, even painted a room in their home. All ended well.

Two years later, I had my daughter on my sixth IVF cycle. I was working for Dr. Kreiner as a medical assistant at the time, too. Erica asked me to talk to Pam and Bill about IVF. Bill was pretty against it, but Pam really wanted a baby. So, I talked to them and they decided to come in for a consultation.

Before the consultation, they’d already decided on doing only one cycle of IVF, which was no surprise and, of course, was totally fine. They pressured me (to the point where it was uncomfortable) to get them a break, though they were not unable to pay for it. It’s just that Bill didn’t really like the idea of charging it on their VISA. (Hey, I charged mine!)

I recall they’d gotten a break on their meds through some grant or study at the time. Were they happy? Nope. They called me at all hours at home. They called the office constantly, using my name to try to get preferential treatment from anyone they needed to talk to. They were a pain in the freakin A$$. They were even outright rude to the doctors.

So guess what happened?

Right. She didn’t get pregnant. And that’s when it really hit the fan.

Verbally abusive confrontations as the office. More phone calls. I’d never seen any patient act like this before. How’d they get past the psych screening? And here I stuck my neck out for them. Everyone bent over backwards for “my friends”. I was mortified at their behavior. Embarrassed and fuming. Thought I’d need a restraining order, for Pete’s sake.

Long story short: Whatever “friendship” I thought I had with Pam and Bill was shredded beyond repair. No big loss, really. But I also lost the friendship of Erica and Rob over this incident. That hurt more, but in time I realized that they had to choose their best friends over us, since Bill would never have apologized for his horrendous behavior. The awkwardness would never have faded, and seeing each other as often as we did would only have reminded us of the whole nasty scene.

For the first time in 12 years, I ran into Bill today. It was awkward and sad. He briefly spoke of Erica and Rob’s kids as if they were his own. I didn’t bother to speak of mine. It was a brief and cordial passing of ships in the night. He seemed old to me, which I attribute to the fact he’s lived a life without children to keep him young at heart. I couldn’t help but feel sad over being involved in the one shot they took at parenthood.

So, before you refer a friend (or a friend’s friend!) to your super-amazing, awesome, reproductive endocrinologist …who is right up there with God in your eyes …you need to have a heart-to-heart talk about how your friendship may be affected by the outcome. By all means, make the referral. But set the ground rules first.

Do you have a story about losing, or maintaining, a friendship as a result of a RE referral? If so, please share your story here.

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IVF, Sex on the Beach, and the Rectal Thermometer

By Tracey Minella

January 18th, 2011 at 12:00 am


I could have called this post “I’ll trade you my passport for your colicky snot-faced baby”, but would you have noticed it?

We’re talking about one thing nearly all “in the closet” infertile couples have endured. Vacation envy.

While the rest of the fertile world stays home with their kids because the kids are sick, or in school, or because their activities, braces, and college savings plans have depleted the family’s vacation fund, the “lucky” infertile couple seems to be jetting off to some place exotic every other month.  

The fertile world misses sleeping late, secluded beaches, and umbrella drinks they enjoyed before breast pumps and rectal thermometers came on the scene. So they envy the infertile couple.

Little do they know…

The infertile couple takes these vacations …until the cost of their IVF treatments kick in… simply to escape their day-to-day reality of still not having a baby. It’s no second honeymoon. No “mile high club” adventure. No sex on the beach…in a glass or otherwise. It’s a mental health break.

Face it. The romance was removed from sex back when the basal thermometer entered the picture. Sure there’s some reconnecting going on in Cancun, but there’s always that black funk of infertility hanging over it all.

“Honey, should you really be drinking that margarita?” he asks with a kill-joy tone.

“Babe, get your ‘guys’ out of that hot tub, right now!” she barks in return.

In fact, when you’re far along on your infertility journey, even “the happiest place on Earth” can be the saddest. My advice: Stick to couples only resorts.

The infertile couple longs to live on no sleep, join the PTA, change dirty diapers, and wipe snotty noses. They’re willing to trade in tailgates with the guys to be the soccer coach. Or lattes with the girls to throw a princess birthday party. They’d sell their soul to achieve their goal… if only they had a buyer.

Luckily, many infertile couples who seek medical treatment will eventually become parents. And when that call comes in and the doctor says “Congratulations! You’re pregnant! What are you going to do now?” you can happily exclaim: “We’re going to Disneyworld!”

Now, don’t forget to pack the rectal thermometer.

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Martin Luther King Inspires Infertile Women Today

By Tracey A. Minella

January 17th, 2011 at 12:00 am

We all know the great quotes. “Four score and seven years ago…” “The only thing we have to fear is fear itself.” “Ask not what your country can do for you. Ask what you can do for your country.”

Today, as Americans celebrate the late, great Dr. Martin Luther King, Jr., we usually remember the most famous quotation from his 1963 speech for racial equality.

“I Have a Dream…”

Those trying to conceive a baby live by these same words. They are the mantra of the suffering, infertile woman.

Let me be clear. I’m not implying that infertility is on the same “life-and-death” level as the civil rights movement.  However, there are some parallels between the passion MLK felt for his cause and the passion infertile women feel for their quest for motherhood.

When you are infertile, you are ever-aware of a different unfairness and inequality in the world. How fertile couples take their fertility for granted. How others have what you’ve been denied. You suffer unimaginable pain and despair at what is effectively a denial of your right to the pursuit of happiness. And you passionately dream your dream…of a day when you will hold a baby in your arms.

But for the infertile woman, there is no group to protest against to make that dream come true. Sure, there’s more the government can do to help, such as provide more comprehensive medical insurance for infertility treatment. And that’s certainly worth fighting for. But ultimately, your plight is based on individual circumstance, not oppression by others. New legislation won’t get you pregnant. So how do you deal with the frustration over the situation? How do you keep your dream alive?

People often forget that Dr. King…a spiritual man and motivational speaker…gave us more than that one famous quote. And this inspirational gem also speaks to the heart of the infertile woman:

“Faith is taking the first step, even when you don’t see the whole staircase.”

Keep the faith. Follow that dream.

Because big dreams do make little miracles…

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A Fertility To-Do List for All Those Trying to Conceive

By David Kreiner, MD

January 14th, 2011 at 12:00 am

Dr. David Kreiner of East Coast Fertility has put together a "To Do" list for hopeful wanna be parents – hoping to conceive. “Whether you are just starting to think about having a family, or if you’ve been struggling with infertility for some time, the following list can provide some helpful tips,” says Dr. Kreiner. Here are his top 10 suggestions for trying to conceive.

1. Get your health in order now. Before you get pregnant, get a checkup! Get your pap smear done – go to the dentist – have your blood pressure and lipids checked. If you are over 35, get that mammogram done. Go for preconception testing for infectious diseases and hereditary disorders that can affect a baby. Whatever has been on your list, check it off before you get pregnant.

2. Make sure your partner is in good health as well. Make sure your partner takes his health seriously as well. Get him to stop smoking since it affects quantity and quality of sperm. Encourage your partner to avoid tight pants and underwear, hot tubs and saunas. Excess heat in the testicular region affects sperm production.

3. Consult with your doctor about any medications you are taking. You never know what might get in the way of your fertility and hinder conception. Have your partner check with his doctor as well. Visit Dr. Kreiner’s blogs to find out more about how specific medications may affect fertility.

4. Pay attention to your nutrition and exercise regime. Your weight can affect ovulation and preparation of your uterine lining either because it is too high or too low. If you are overweight, get on a healthy diet and exercise. If you are underweight, try to increase your body weight. Some experts recommend eating more organic foods especially chicken, meat, eggs, fruit and vegetables. Others may tell you to limit your carbohydrate and caffeine intake. Consult with your doctor about what foods are best for you and if you should start taking prenatal vitamins.

5. You and your partner should stop smoking. Cigarettes can affect a woman’s ovarian hormone production and egg development. In males, they can affect the quantity and quality of sperm. Quit now to avoid harm to your reproductive health.

6. Find ways to diminish stress. Stress can affect your health and physiology in a negative way. Go for a massage, exercise regularly and communicate with your partner and your friends. Let them know how you are feeling. Go to a support group or mind and body program. Learn relaxation exercises. Try yoga or acupuncture.

7. Consult with your Ob/Gyn and see if you need a reproductive endocrinologist who specializes in infertility. It is recommended that you consult with a RE if you are under 35 and unsuccessful in getting pregnant after 1 year of trying, and if you are over 35 and have been unsuccessful after 6 months. Don’t wait.

8. Conduct research on fertility clinics and doctors in your area. Get references or check their history and success statistics. Find a reputable program where treatments are documented to be successful and affordable.

9. Research your health coverage carefully! Read your insurance policy to see what types of fertility treatments are covered if any, and what stipulations are placed on such treatments. Get the best insurance coverage for infertility that you can, and be prepared for what costs you may be responsible for.

10. Chart your cycle. Use ovulation kits or basal thermometers to learn about your menstrual cycle. Not only will it tell you a lot about your reproductive health, but it will help you best time intercourse to achieve pregnancy.

It is important to educate yourself and be prepared for what is involved in starting a family. Talk to your doctors, and communicate with your partner. Dr. Kreiner states, “Infertility can be extremely stressful on a couple’s relationship. It is especially important at this time to support each other and work through any problems together.”

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The IVF Virgin and the Old Bitches Club

By Tracey Minella

January 13th, 2011 at 9:18 am

You’ll never forget your first time…

Naked from the waist down. Trembling from nerves and feeling vulnerable. Trying to be casual and cool, like you had more experience. Waiting awkwardly in anticipation in the darkened room. So full of hope and expectation. From the shadows, a ten inch wand approaches…

We ARE talking about the first time you had IVF, right?

Phew. Then, I was 31.

So, I’m sitting in the IVF satellite office minding my own business, anxiously waiting my turn for blood and sono during my first…and what I firmly believed would be my only… IVF cycle.  

Ok. I just lied. I was actually secretly minding the business of these other two patients who were loudly trading IVF war stories, as if they were chatting about weather over coffee in Starbucks. With my head buried in a book, I listened intently, figuring I could pick up some pointers.

These ladies were much older than me. Neither one had any children yet, but they were IVF experts. One was on her fourth IVF cycle. The other was on her fifth. Fifth? Are you serious?  I remember thinking there is no freakin way I’d go through all this that many times! I thought they were crazy for continuing. And truth be told, I thought they were never going to get pregnant.

But I was fascinated by them and wished they’d include me in their conversation. When I looked up, one of them looked over at me and asked how many cycles I’d done. Here’s my chance to get “in” with them.

So, I said…full of hope and innocence… that this was my first IVF.  Then it happened. With no more than a snobbish “Oh.”, they actually dissed me. Like I wasn’t worthy of being in their “club”. Like I didn’t understand. Game over. They went back to their conversation.

Well, the hell with them, I thought. Rude old bitches. I’m going to get pregnant right now and be done with all this… and with people like them.

Long story, short: I became the president of the Old Bitches Club.

Actually, that’s another lie. I did hang around for six years and six IVF cycles before having my first child. And I did come to understand that IVF virgins, or first timers, are different from the veterans. Yes, with every failed IVF, comes knowledge and wisdom that newbies don’t yet have or understand. But there’s no reason to be an old bitch about it. I never talked down to or discouraged newbies and I only used my stories to encourage them not to give up. I even came to work for Dr. Kreiner so that I could help others.

Shame on you IVF veterans who don’t use your wisdom for good.

With IVF success rates so much higher now, I propose we abolish the Old Bitches Club. All in favor?

Have you been talked down to or blown off by another “more experienced” patient? Or has a veteran helped you?  Share your experience here.

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