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Archive for February, 2011

“Your Ovaries Don’t Look a Day Over 34”

By Tracey Minella

February 28th, 2011 at 12:00 am

Ten years ago yesterday, on the day before she turned 40, I dragged a close friend into the stirrups for a consultation with Dr. Kreiner. She conceived on her own but miscarried, and on the eve of the big 4-0, she was concerned her time was running out. So was I.

A medical assistant at the time, I’d drag my friends and family into the office whenever they were careless enough to casually mention they were trying to conceive and thought they might have “issues”. To my delight, they’d often ask me to stay in the room so I could check out their ultrasound. I think they thought I’d tell them something Dr. Kreiner was holding back from them. Which “A” he wouldn’t do, and “B” I wouldn’t have a clue about anyway.

So here’s my friend on the exam table… a bona fide weakling normally… crushing the hand I offered in support, as I’m struggling to write notes in the dark with the other working hand. No worry, I thought. I would get even when it was time to draw her blood later with my mangled digits. The silence was broken and I was snapped back to reality by Dr. Kreiner’s announcement:

“Your ovaries don’t look a day over 34.”

Now, there’s a compliment you don’t hear every day. We exchanged glances as the news sank in.

Well, I guess it’s a compliment, right? It’s the fertility equivalent of the usual age-related compliment: “You don’t look a day over ‘X’”, where you tell someone they look ten years younger than they actually are.

I have to admit I was shocked. I was guilty of wrongly assuming (and you know what they say about that!) that if she had a history of miscarriage and was now 40, that the sonogram would show a bleak picture.

I offer this story not to encourage similarly-situated women to further delay their own fertility evaluation in the hope that their ovaries are looking younger than their years, too, but instead to approach the evaluation with some measure of hope and cautious optimism, because you never know what the doctor is going to find.

So, with those eight words, Dr. Kreiner delivered the best birthday present my friend could have gotten. She took her 34 year old ovaries home and now tucks her eight year old into bed every night.

I know you don’t want to hear this number my friend, but here is a special Happy 50th Birthday to you. Your story will make the day of many older women still TTC.

And if it’s any consolation, I’m sure your ovaries don’t look a day over 43!

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And the Academy Award Winner is…Nicole Kidman?

By Tracey Minella

February 25th, 2011 at 12:00 am

No, I don’t have secret insider info on who’s taking home the Oscar for Best Actress this Sunday night. But I bet many women suffering from infertility are rooting for her.

Over the past two decades, she has had her private journey made public due to her celebrity. She has suffered miscarriages and finally become a mom to four children through a combo of adoption, her own pregnancy, and, just announced this week… a pregnancy carried by a gestational carrier. Her first two children, with ex-husband Tom Cruise, were adopted and are teens now. Her second two children are with her current husband, Keith Urban.

She recently told several news outlets, including Fox News, all about her fertility “roller coaster” and that becoming a mother helped her portray a woman who loses her child in Rabbit Hole, the movie for which she is up for a Best Actress Academy Award.

You gotta love a woman who managed to marry both the hottest guy in Hollywood and the hottest guy in Nashville. One who, not too far into her second marriage and her forties, finally conceived (along with about a half dozen other women) reportedly after swimming in Australian waterfalls which folklore claims have fertility power.

Was I the only one who thought of making a pilgrimage there? If you told me I only had to wade in a river on the other side of the world in order to conceive, I’d have grabbed the passport, ditched the needles, and eased my pin-cushion butt into Shrek’s swamp ages ago. But I digress…

Whether the waterfall wasn’t tried again or merely wasn’t a fountain of youth, Kidman and Urban were unable to conceive on their own again. So they used a gestational carrier to carry their second biological child for them. Another little miracle, genetically theirs, at age 43.

But Kidman’s connection to infertility is not merely personal. It also spills over to her professional life on the screen.

I first fell in love with Nicole when I saw her in the 1993 movie, Malice, with Alec Baldwin and Bill Pullman. We’d gone to the movies one night to try to forget about our latest IVF failure for just two hours. We didn’t plan it in advance and hadn’t known anything more than that Malice was a thriller. To our surprise, there was Nicole on the big screen doing injectable fertility drugs…my drugs! Are you friggin serious? Can’t we even get away from this at the movies? It was a cinematic first. And it made me feel less alone. And for the final clincher…her character’s name was Tracey! (Of course, she’s a lunatic, but that’s beside the point.)

So, why not do something different this weekend? Instead of trying to catch one of the nominated movies you haven’t seen, why not rent Malice? It may make you root for Nicole Kidman to win the Oscar…if not for her role in Rabbit Hole, then for her inspirational 20 year “career” as an infertile woman who would not be denied her diverse and beautiful family.

What do you think about Nicole Kidman’s recent baby via a gestational carrier, or how she built her blended family? And, if you do see (or remember) Malice, please let me know what you thought about it!

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Does Your Man Know His Place?

By David Kreiner MD, and Tracey Minella

February 24th, 2011 at 12:00 am

Even when babies are conceived the way nature intended, the man’s role is small in comparison to the woman’s share of the, well, labor. He has his moment of fun…and I’m not saying his contribution isn’t significant… but afterwards he’s basically a spectator for the rest of the nine month journey. The woman, simply because it is her womb, is in charge of the pregnancy.

Conceiving with IVF doesn’t level the playing field, but does offer the man more of role in this alternative pregnancy plan. True, his “moment of fun” loses something in the collection room alone. However, IVF gives the man a way to make more than that one obvious significant contribution.

Dr. David Kreiner of East Coast Fertility offers great suggestions on ways men can find their place in IVF and support their wives and partners in the process:

A husband’s experience when going through an IVF cycle varies depending in large part on how involved he gets. When a husband participates actively with the IVF process it helps to relieve much of the stress on the wife and on the relationship. The more involved he is, the more invested he will feel in the entire experience, and the more control he’ll feel over the outcome.

Many husbands pride themselves in their new found skills of mixing medications and administering injections for their wives. It helps many men who are used to caring for their wives to be in control of administering the medication for them. Successful IVF then becomes something he played a very active role in, and he’ll relate better to the experience, his wife and the resulting baby.

Despite a lack of prior experience, most people can learn to prepare and administer the medication. Whether it is the feeling of “playing doctor” or the knowledge that he is contributing significantly in the process and supporting his wife, most men relate that giving their wives the injections was a positive experience for them and for their relationship.

Along the same line of thinking, accompanying your wife at the time of embryo transfer can be most rewarding. This can be a highly emotional procedure. Your embryo/s is being placed in the womb and at least in that moment many women feel as if they are pregnant. Life may be starting here and it is wonderful to share this moment with your wife. Perhaps you may keep the Petri dish as a keepsake as the “baby’s first crib”. It is an experience a husband and wife are not likely to forget as their first time together as a family. I strongly recommend that men don those scrubs, hats and booties and join their wives and partners as the physician transfers the embryos from the dish into her womb. Nine months later, do the same at delivery for memories that last a lifetime.

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Fertility-Saving Options for Breast Cancer Patients

By Tracey Minella

February 23rd, 2011 at 12:00 am

When you’re trying to conceive and you can’t, and then you go to a fertility specialist for help, and it still doesn’t happen, some women might think their life is over. That nothing could be worse. That no one has it harder than they do. That there’s no reason to live.

Sure that sounds melodramatic to anyone who hasn’t faced down infertility… who hasn’t faced the possibility that the most maternal of our instincts and desires and needs could be denied. But while the infertile woman is absolutely justified in feeling the whole range of emotions that accompany her diagnosis, things could actually be worse.

“What could possibly be worse than being infertile?” you ask.

You could have breast cancer.

It wasn’t too long ago that a breast cancer diagnosis, with its accompanying chemotherapy and/or radiation, and/or removal of the ovaries, meant the end of a woman’s dream of having a biological child. The focus…and rightly so…was on saving her life, not her breast, not her fertility.

Fortunately, women have more options today. Advances in reproductive technology can now offer women the chance to freeze their eggs or embryos prior to undergoing chemo or radiation or prior to surgically removing her ovaries. That way, women can preserve their fertility for a future time when their breast cancer is no longer their primary focus.

Some breast cancer survivors, like Christina Applegate, are lucky. They do not do chemo or radiation so their fertility is not compromised by their cancer treatment. She gave birth to a beautiful baby girl last month. But thanks to egg and embryo freezing now, and IVF later, more breast cancer survivors will be able to enjoy that same miracle.

One would like to think that oncologists and primary care doctors would routinely refer young cancer patients who have yet to start or complete their families to a reproductive endocrinologist for a consultation prior to chemo or radiation or oophorectomy. Many do, but for those that don’t, it’s an omission that can’t be remedied later.

Even if the referral is recommended, when faced with the diagnosis of cancer, can a patient even wrap her mind around saving her fertility when she fears mortality? And if so, does her cancer allow her the time to explore this option? And what about the very young patients, whose health care is effectively still in the hands of their parents? Will they even think about their “baby’s” future plans to have a baby when overwhelmed by a parent’s worst nightmare? That’s why we all need to help increase public awareness of fertility-saving options.

So file this bit of information away and hope you never need to use it:

If any female you know (except post menopausal women)…especially the youngest of girls… is ever diagnosed with breast cancer, tell her or her spouse or parent to see a reproductive endocrinologist before having chemo or radiation or before removing her ovaries, if her cancer treatment protocol can accommodate the delay. You just might save her fertility.

Can your friends and family count on you to share this information if need be?


Should Embryos Have Constitutional Rights?

By David Kreiner Md

February 22nd, 2011 at 12:43 am

The United States of America is the most amazing nation in the world. It was the birthplace for modern political freedoms and democracy. We have been on the forefront of individual rights and have the Constitution and Bill of Rights to protect us. So, it should not be too surprising when groups of Americans who believe that life begins long before birth and immediately after conception attempt to impose these same rights on embryos.

An Iowa House Subcommittee has advanced a bill, HF 153, which would give constitutional rights to embryos. The bill is being presented to the Human Resources Committee, and then very likely to the full GOP-controlled House, where it stands a good chance of being approved.

Those of us who work with in vitro fertilization (IVF) have enormous respect for the special status of the human embryo. Like the acorn from the oak tree, a human embryo has the potential to become a human life some day. But, let us be clear. I am not speaking of a fetus that resembles an immature developing baby — I am referring to a group of cells, in some cases undifferentiated, prior to the initiation of organ development.

This bill not only threatens the reproductive rights of women, it prevents those who suffer from infertility to seek treatment for their disease. It would take away the rights of an infertile patient to make decisions about embryos created as part of IVF. Excess embryos that otherwise are developed to improve a patient’s chances of having a baby would either not be allowed or would accumulate in a clinic without limit. Embryos with abnormal chromosomes could not be discarded and would be forced to be transferred, giving potential to an abnormal fetus.

Embryos are created for the sole purpose of creating a much-desired human being for those otherwise unable to build a family without the help of assisted reproduction. However, it is a basic American right backed by the courts that the responsibility for determining what happens to an embryo belongs to the progenitors of the embryos. Since most fertilized eggs fail to implant in the uterus, it is unreasonable to assume that an embryo will develop into a person — and, therefore, it is inappropriate to offer it the same constitutional rights as a live human being.

Passage of this bill would result in a ruling that all embryos either be transferred back into a woman’s uterus, which would result in many tragic, unhealthy multiple pregnancies, or that they be kept frozen forever.

This would truly be un-American.

What are your thoughts on this issue? How would passage of this bill affect your infertility treatment plans? If you are against this proposed legislation and its affect on your right to determine the disposition of your embryos, please write to your elected representatives.

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Trying to Conceive, Trying to Grieve

By Tracey Minella

February 21st, 2011 at 12:00 am

The only thing worse than being infertile and childless, is also being motherless and fatherless.

Seventeen years ago today, also on President’s Day, I lost my mother unexpectedly. Nineteen months later, I lost my dad. Between the two, I lost a long-awaited twin IVF pregnancy.

I am an only child. And despite having a great and supportive husband and loving in-laws, I was lost… living with no significant blood connection in this world.

No parents, no siblings, no children.

I felt like an astronaut lost in space, floating alone in the blackness, with no tether line to anchor me. Can you imagine that? My whole identity was shaken. The desire to have a child became a need to have one. I plunged even further into depression. I left my job.

Losing the daily calls was probably the hardest thing. I kept reaching for the phone to call Mom. And I kept expecting her voice on the other end if it rang. I kicked myself for all the time I kept my infertility a secret from my parents. Part of me was embarrassed; another part didn’t want them to worry. All that time I could have had their support to dry my tears. And now they were gone.

I had no one to reminisce with about childhood memories and no one to understand my loss. After all, I was the only one at the dinner table each night or opening gifts under the tree. No one else called them Mom or Dad, except me. They were mine and mine alone. Mine to grieve for and mine to keep alive in memory.

And, with no child to pass my family history and those memories along to, I felt like some eraser was wiping away a little of us with every passing day. Almost like in Back to the Future, when the people slowly faded away from the family photos.

The guilt was unbearable, too. It was up to me to make them grandparents… and I failed. Could I ever get past that? They’d have been wonderful grandparents, and they never had the chance. Not even for a day. Mom never saw me get pregnant. Dad lived through the miscarriage but died before I got pregnant again.

Since the IVF success rates were only about 17% back then, it took us several years of IVF before we had our daughter on our sixth cycle. And then our son on the next try. It is amazing the way our daughter looks like my mom and our son looks like my dad. I like to think they had something to do with that.

If you’re trying to conceive and haven’t told your parents, I urge you to reconsider that decision. I kept thinking I’d get pregnant the next time and then I could just share the happy news, and spare all this heartache. But I never got that chance to share the good news and I lost out on their support in many of the bad times.

Deep in your heart you know that you’re going to be the best parent in the whole damn world when this journey is done and that you’re going to love this child to the moon and back. You’re going to be there for your child in good times and bad and will smother it with affection ‘til it begs for mercy. Right?

Until that day comes, please allow your own parents the opportunity to be there for you. Embrace their special love for you while you can. Pick up that phone. Do it now. Because they love you to the moon and back, too.

Miss you and love you today and every day, Mom. <3

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Stop the Infertility Insanity!

By Tracey Minella

February 17th, 2011 at 12:00 am

The definition of insanity is doing the same thing over and over and expecting a different result. Are you doing that with your infertility treatment? Are you gearing up for your 15th IUI?  If so, maybe it’s time to shake things up a bit. Maybe move on to a new approach or technique. Time to stop the insanity.

Listen, if any one is entitled to be crazy, it’s a woman struggling with infertility. The fear of possibly not being able to have a biological child and the frustration over the lack of control and the costs associated with infertility treatment is maddening. And let’s not even talk about the havoc the friggin drugs wreak…

Your infertility journey is a series of steps, each one moving you further along to the goal of a healthy pregnancy. The key is not to spend too much time on one level if you are not successful. Be willing to move forward. You must face that at some point, the basal thermometer and ovulation kit goes in the drawer. Clomid may give way to injectables. Repeated IUIs without success should lead to IVF. And repeated IVF failures should lead to changes in the IVF protocol. Stop doing the same thing over and over.

So, how do you know when to move on?

First, you need to educate yourself on the medical aspects of your infertility treatment. Listen to and understand your diagnosis. Ask questions and do some research. Know your options and your odds for success doing each type of possible procedure. Don’t be afraid to talk to your fertility doctor. I can’t tell you how many times I’ve heard patients say they freeze up or forget to ask their questions. Or that they just blindly do as they are told. You won’t offend the doctor by asking questions. And if you do, he’s the wrong doctor. Think things out, write down questions, and take notes when you meet with the doctor. Remember, you are a team.

Second, you should understand the financial aspects of infertility treatment. Learn about what your insurance plan will or will not cover as far as medication and treatment options. Ask your clinic about grants to help off-set expenses. Do this early as there may be a waiting list. Reputable clinics will have billing and grant specialists who can help you navigate this frustrating and stressful part of the process. And less stress is best. You don’t want to waste your entire infertility budget on 12 IUI’s and have nothing left for IVF, with its higher cost, but higher success rates. It’s easy to say “just one more cycle” and then lose track of how fast time and money has flown.

Next, have a heart to heart talk with your partner. Better yet, have many. Keep the communication lines open about what you both want as a couple. One of you may want to move at a faster pace than the other or may be against even doing certain procedures. Plus, feelings change from cycle to cycle, so keep talking to each other. The last thing you need is for you to run out of the emotional or financial stamina before even getting to IVF. Take advantage of your practice’s support groups.

Finally, you need decide if you’re even in the right infertility practice. That’s a tough one because it’s unbearably hard to face the fact that you may’ve chosen the wrong clinic to begin with. And to admit that you wasted precious time and money. But if you don’t face that hard truth, and you stay there, things will likely only get worse.

(Next week, I will address the things to consider when choosing the right infertility practice, so be sure to check back!)

Are you an active partner in your infertility plan? Do you have tips to share for fellow patients who are reluctant to speak up? Or do you think the doctor knows best and the patient should just listen?

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Are Secondary Infertility Patients Like Second Class Citizens?

By Tracey Minella and David Kreiner MD

February 16th, 2011 at 12:42 am

It’s always been us against them. Fertile vs. infertile. They can have kids the natural way. We can’t. So, we hate them. They don’t understand us. We hate them more. They always say the wrong things to us. Still hating. Their kids are adorable. We loathe them.

Okay, so I exaggerated a bit. But you get the picture, right? Actually, it really isn’t all that simple. There is division in our infertile army and the rift has caused a civil war of sorts.

It’s primary infertile vs. secondary infertile. The primary group has not had a child yet. The secondary group already has given birth but has come back for another.

And if you thought that emotions run high between fertile and infertile, wait until you read this insightful post on Secondary Infertility by East Coast Fertility’s Dr. David Kreiner (The Fertility Doc):

Secondary Infertility, by Dr. David Kreiner:

Sometimes my patients who have difficulty conceiving their second child feel like second class citizens in the infertility world. Unlike their infertile peers without a child they perceive that friends, family and even their doctor’s offices do not have the same sympathy and concern for them as they observe others without a child receive. I have had patients express guilt and anger in addition to the routine sadness often associated with the inability to conceive.

Those of you with secondary infertility need to know that you are not alone in feeling this way. My patients all express this alienation which exacerbates the depressing effects of infertility universally experienced among those affected. You have as much a right to fertility care as anyone else as well as the respect and care.

There are some unique characteristics to patients with secondary infertility that are worth discussion. Those of you who have had a caesarian section, ectopic pregnancy or abdominal surgery are more likely to have a tubal factor causing your infertility. Scar tissue can form that can obstruct, or displace a fallopian tube making it more difficult for the tube to pick up an ovulating egg or the fertilized egg to make it to the uterus.

Borderline sperm counts and endometriosis typically make it more difficult to conceive so that it is not unusual that it took longer than expected to conceive the first time and now you are not experiencing any success at all.

We perform a semen analysis and hysterosalpingogram and consider the potential benefit of laparoscopic investigation. Alternatively, if the semen analysis is not too bad and the HSG is normal, patients may benefit from insemination with hormonal stimulation. Otherwise, in vitro fertilization either with minimal or full stimulation will offer significantly superior success rates.

Facing secondary infertility may be as difficult emotionally as infertility for those without prior pregnancies. However, treatment options are available that are highly successful in delivering you the family of your dreams.

So what do you think about this? Does the sight of another patient’s stroller make you cringe? Or smile?

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Please Join Us Tonight: East Meets West Free Seminar!

By Tracey Minella

February 15th, 2011 at 12:00 am

There is something really radical going on in Plainview, New York tonight. It is called a free face-to-face, real live informational seminar on infertility. That’s right.   We’re talking personal connections here. Not a webinar. For free. (Did I mention the munchies?)

Tonight’s discussion is about combining Western and Eastern approaches in treating infertility. Like a one-two punch. Have you been trying to conceive without success? Maybe suffered one or more miscarriages? Is your day 3 FSH in the stratosphere? Have other programs told you to give up? Then this unique approach designed to increase pregnancy rates and possibly reduce miscarriage rates could be your answer. Imagine that!

The expert speakers are Dr. David Kreiner of East Coast Fertility and Acupuncturist Mike Berkley of the Berkley Center for Reproductive Wellness. Don’t you owe it to yourself to just check it out? When was the last time you could corner a RE or an acupuncturist and grill him ‘til you were satisfied? For free.

Still hesitant? Consider this scenario.

Picture two infertile friends and co-workers talking at the water cooler. One can’t get pregnant. The other can’t stay pregnant. One invites the other to a free seminar after work. It goes like this:

“But, I’m too tired after work. I just wanna go home.”

“Oh, c’mon. There’ll be munchies. It’s just two hours and maybe we’ll find the answers we’ve been looking for.”

“But, I hate those things. A conference room full of strangers. It’s probably just a big sales pitch about the same old, same old.”

“What if it’s not, though? I’ve never seen a seminar about combining these two approaches. I wouldn’t even know where else to look for an acupuncturist to talk to.  Maybe, just maybe, it can help us. It’s free. If I could avoid another failed IVF, it’s worth checking it out. Besides, we’ll be together.”

“Nah. I’m gonna pass, but you have fun. Sounds kinda hokey to me. Anyway, it’s freezing outside…”

Now let me ask you something. If you are the one left alone at the water cooler because your friend is on maternity leave, how are you going to feel about doing the easier thing tonight?

There will always be plenty of excuses not to go. Apathy, cold, tired, and depressed are powerful feelings to overcome. But remember, cutting edge opportunities in infertility treatment don’t present themselves every day. I promise you won’t have any regrets if you do go. Bring a friend.

Go on. Step away from your laptop. We’re waiting for you. (Hey, did I mention the munchies?)

Seminar begins tonight at 6:30 pm, until 8:30 pm, at:

East Coast Fertility, 245 Newtown Rd., Suite 300, Plainview, New York 11803

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When Cupid’s Arrow is an IM Syringe

By Tracey Minella

February 14th, 2011 at 12:20 am

Is that a syringe in your pocket, or are you just happy to see me? 

Let’s face it, there’s just no easy way to candy coat the reality of being infertile on Valentine’s Day.

If you are a rose-colored glasses kind of person and can enjoy any of the traditional festivities of chocolates and roses and red satin sheets, my hat’s off to you. But if your infertility journey has you so down that even diamonds won’t cheer you up today…you’re not alone.

Usually, the ones who are down today are the ones without partners. And the stigma associated with being alone on Valentine’s Day has pretty much given way to society applauding singledom. Like the whole Beyonce movement that screams it’s ok to be single, with in your face lyrics like Single Ladies’ “If you liked it then you should have put a ring on it” to Irreplaceable’s “I can have another you in a minute. Matter fact, he’ll be here in a minute.”

But being married and in love and miserable on Valentine’s Day is something society doesn’t know how to handle. And neither do our friends or family. Even we don’t know how to handle it. There’s no anthem for lovers and infertility. We’re just misfits today. Nobody feels our pain unless they, too, are living it.

Foreplay left the building with the basal thermometer. And all the naughty, sexy words we used to describe spontaneous, carefree love-making endeavors quickly followed, only to be replaced with the ever-romantic and snippy come-on, “Just friggin roll over! We have to do it. Now!” Or even worse than that: the specimen cup.

While the fertile couples swap chocolates, cards, flowers this morning, we’re dealing with blood work and sonos. Instead of laughing over champagne, candlelight and pearl necklaces tonight, the only action we’re getting is a one-handed grope on the ass as he slides in that big two inch needle for a “quickie” of the unkindest kind.

So, I’m not here to tell you to have fun today if you don’t feel like it. Why should you? The only gift you both want to give or receive is the baby you can’t have yet. You absolutely don’t have to buy into this Hallmark holiday.

But I will ask you to remember at some point today the top three reasons why you love your partner. Write them down. I will even give you the first one. 1. Because he loves you enough to be by right by your side on this journey that has tested the strength of your love for each other.

So why not reconnect and show your partner your love tonight? A heartfelt talk. A long walk holding hands. A quiet dinner. Maybe even some long-forgotten naughtiness. Whatever feels right after you look at that list you created. Break the choke-hold infertility has had on your love life.

And if he comes at you with that big two inch tonight, take a deep breath, bend over, and accept it as a sign of his love and commitment to you and the dream you have together. Just for tonight, think of it as Cupid’s arrow.

If you have any stories or tips to share about how you get through Valentine’s Day, please share them here.

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