Archive for September, 2011
By Tracey Minella
September 30th, 2011 at 6:25 pm
It’s the last day of the blogging month, so this one’s for the boys. However, it’s a great read for the ladies, too.
I am going to share a link to a moving story about a man and his love for a little girl. It’s about a love so strong that it literally became this man’s life force.
Here’s a teaser: Church-going Vietnam vet and his wife end up taking in the baby girl of a young stranger who showed up in church one day, completely overwhelmed by trying to parent this baby. It was supposed to be for one night. The man falls in love with the baby and they want to adopt her. But the man is dying. Soon. He wants to adopt her so she can have his survivor benefits after he dies. Can this small town make this all happen before the man dies?
Before you click on the llink to the story, you must promise to come back and weigh in on whether you cried. Also there will be a question at the end of this post.
Here’s the link to the story: http://www.msnbc.msn.com/id/44597789/ns/health-health_care/#.ToP3uOxiYfU
Cue the Jeopardy music while we wait for you to read and return…
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Was this a beautiful story of love and community?
Or does anyone have any concerns about any of the following issues:
The birth father’s consent
A man on death’s door adopting a baby
Pushing an adoption for survivor benefits
What would you guys have done in this man’s shoes?
By Tracey Minella and David Kreiner MD
September 29th, 2011 at 12:00 am
It’s not working. It’s not working.
Why isn’t it freakin’ working?!
Feel like a slave to the calendar and temperature chart? Spending a king’s ransom on those damn ovulation kits? Constant sex causing you to walk like you just got off a horse?
Is a voice telling you that you may need something more in order to get pregnant…but you’re scared to face that possibility?
Well, clomid is that first step for many women.
Dr. David Kreiner of East Coast Fertility answers all your questions about Clomid therapy:
It has become commonplace for women who have been frustrated with repeated unsuccessful attempts to conceive naturally on their own to see their gynecologist who often times will try clomid therapy on them. Clomid, the traditional brand name for clomiphene citrate, is a competitive inhibitor of estrogen. It stimulates the pituitary gland to produce follicle stimulating hormone (FSH) which in turn will stimulate the ovaries to mature follicle(s) containing eggs. Estrogen normally has a negative effect on the pituitary: Clomid blocks estrogen and leads to pituitary FSH production and ovarian stimulation.
Infertility patients — those under 35 having one year and of unprotected intercourse without a resulting pregnancy and those over 35 having six months without pregnancy — have a two to five percent pregnancy rate each month trying on their own without treatment. Clomid therapy increases a couple’s fertility by increasing the number of eggs matured in a cycle and by producing a healthier egg and follicle. The pregnancy rate with clomid therapy alone is approximately ten percent per cycle and 12 -15 percent when combined with intrauterine insemination (IUI). Women who are unable to ovulate on their own experience a 20 percent pregnancy rate per cycle with clomid, the equivalent to that of a fertile couple trying on their own.
Clomid and Your Cervical Mucus
Women who are likely to conceive with clomid usually do so in the first three months of therapy, with very few conceiving after six months. As clomid has an anti-estrogen effect, the cervical mucus and endometrial lining may be adversely affected.
Cervical mucus is normally produced just prior to ovulation and may be noticed as a stringy egg white like discharge unique to the middle of a woman’s cycle just prior to and during ovulation. It provides the perfect environment for the sperm to swim through to gain access to a woman’s reproductive tract and find her egg. Unfortunately, clomid may thin out her cervical mucus, preventing the sperm’s entrance into her womb. IUI overcomes this issue through bypassing the cervical barrier and depositing the sperm directly into the uterus.
However, when the uterine lining or endometrium is affected by the anti-estrogic properties of clomid, an egg may be fertilized but implantation is unsuccessful due to the lack of secretory gland development in the uterus. The lining does not thicken as it normally would during the cycle. Attempts to overcome this problem with estrogen therapy are rarely successful.
Many women who take clomid experience no side effects. Others have complained of headache, mood changes, spots in front of their eyes, blurry vision, hot flashes and occasional cyst development (which normally resolves on its own). Most of these effects last no longer than the five or seven days that you take the clomid and have no permanent side effect. The incidence of twins is eight to ten percent with a one percent risk of triplet development.
Limit Your Clomid Cycles
Yet another deterrent to clomid use was a study performed years ago that suggested that women who used clomid for more than twelve cycles developed an increased incidence of ovarian tumors. It is therefore recommended by the American Society of Reproductive Medicine as well as the manufacturer of clomiphene that clomid be used for no more than six months after which it is recommended by both groups that patients proceed with treatment including gonadotropins (injectable hormones containing FSH and LH) to stimulate the ovaries in combination with intrauterine insemination or in vitro fertilization.
For patients who fail to ovulate, clomid is successful in achieving a pregnancy in nearly 70 percent of cases. All other patients average close to a 50 percent pregnancy rate if they attempt six cycles with clomid, especially when they combine it with IUI. After six months, the success is less than five percent per month.
In vitro fertilization (IVF) is a successful alternative therapy when other pelvic factors such as tubal disease, tubal ligation, adhesions or scar tissue and endometriosis exist or there is a deficient number, volume or motility of sperm. Success rates with IVF are age, exam and history dependent. The average pregnancy rate with a single fresh IVF cycle is greater than 50 percent. For women under 35, the pregnancy rate for women after a single stimulation and retrieval is greater than 70 percent with a greater than 60 percent live birth rate at East Coast Fertility.
Young patients sometimes choose a minimal stimulation IVF or MicroIVF as an alternative to clomid/IUI cycles as a more successful and cost effective option as many of these patients experience a 40 percent pregnancy rate per retrieval at a cost today of about $3,900.
Today, with all these options available to patients, a woman desiring to build her family will usually succeed in becoming a mom.
By Tracey Minella
September 28th, 2011 at 9:03 pm
All the best from ECF…
May your year be as sweet as apples and honey.
By David Kreiner MD
September 27th, 2011 at 9:15 pm
One of the most distressing things I face in practice is when I get negative feedback from a referring physician. Fortunately, it happens rarely but recently I was shocked about the complaint. Apparently, his patient was offended that I discussed the finances involved with her treatment. Her Ob Gyn agreed with her that it was inappropriate for me to discuss the cost of her options. He told me, “I like you and think East Coast Fertility is an excellent program but I never talk about money directly to patients! It’s not – I don’t know…seemly!” “Money issues are discussed with the business office, the doctor only discusses the medicine”.
Perhaps it’s unfortunate that fertility doctors have to be so concerned about their patient’s pocket books unlike other fields of medicine that are usually covered by some measure of insurance. But in the case of infertility with only a handful of states having some kind of mandated coverage – not everybody in the United States - mandate or no mandate for infertility -even has health insurance! Many fertility patients are in some form or another “cash pay” patients. One of the most popular places that patients visit when they go to any fertility clinic’s website is the finance page. This is simply a fact of life.
For this reason I have developed many programs that will create access to fertility care for as many people as possible. But here is the catch! One program does not fit all. These are simply not over sized tee shirts – each of these programs represent a certain course of medical care – and each individual and couple needs the assistance of a caring doctor to help them choose the right program that will fit their own particular medical history.
The most effective treatment and the most efficient is always a full stimulation IVF. However, if someone has insurance coverage for IUI and meds but not IVF then they may prefer to do IUI. If they do not have coverage for IUI either then it may be more cost effective to do the Micro-IVF Program or minimal stimulation IVF at 2-3 x the success of IUI with less risk than gonadotropin IUI and less cost per pregnancy. Yet at a price of $3900 it may be more attractive than a full stimulated IVF.
There is also The Single Embryo Transfer Program where we reward patients transferring one embryo at a time by making their cryo, embryo storage and unlimited frozen embryo transfers for free.
Others prefer the insurance of The Money Back Guarantee Program where patients are offered six IVF retrievals and frozen embryo transfers for a fixed fee that is refunded if they do not result in a live birth. In order to inform patients about our success and programs that make IVF more available to them we offer free consultations.
And now we have the brand new ECF Miracle Plan. We are always working to offer the most competitive and comprehensive financial plans possible to assist in your family building efforts. Plus we offer contests through this blog, our website, and in the office and recently awarded one lucky patient a free Micro-IVF cycle. Check out the video where we surprised the winner with an in-person visit announcing her as the winner. http://vimeo.com/28993272.
In today’s world of fertility care – a good doctor will help a patient find not only the right treatment but how to access that care. In order to do that – a doctor may have to do what some may think is unseemly – and that is to talk about money.
By Tracey Minella
September 26th, 2011 at 6:20 pm
With the holiday season approaching, and the fall festivals in full swing, the thought of family traditions comes to mind.
While you’re waiting to start or expand your family, have you imagined how your baby will fit in to your family’s traditions? Have you thought of any new traditions you’d like to begin when you have children?
For over twenty years, I’ve been entering fairs in the fall. I compete in baking and canning (yes, me and the little blue-haired eighty year-old ladies). I’ve won hundreds of ribbons in New York, Connecticut, and even Nevada.
For years while I was TTC, I imagined having a daughter who would grow up baking beside me, learning to make jams and pickles, and eventually be old enough to enter the fairs, too.
It took some time, and a few IVFs, but my dream came true.
I’ve been blessed to make my tradition of entering fairs into my family tradition. We added apple picking to the fun as well. Both my daughter and son enter the junior divisions of the fairs and love winning ribbons.
Sometimes it can seem like those dreams will never come true, but you need to believe. In the meantime, it can help to write down your ideas on traditions you’d like to start with your family.
We buy ornaments from each vacation, even if it’s a mini “day-cation” and date them. We make a family photo ornament each year, too. We have Chinese food with the whole extended family every New Years Day and make zillions of honey struffoli every Christmas together. We pick berries and make jam. And the list goes on…
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What traditions do you do now? What traditions would you like to start when you start or expand your family?
By David Kreiner, MD
September 23rd, 2011 at 8:45 pm
I was at a college graduation party for Rebeka, one of the first IVF babies I ever helped create. Her parents and grandparents beamed with pride, bragging about Rebeka’s achievements and plans while passing the hot wings and beers. I shared in this proud moment, feeling as if I bore some responsibility, since were it not for IVF, the party itself would never have happened.
Among the guests was a family friend, Conrad, who talked about the old neighborhood. He grew up in Kew Gardens and I was from Queens Village and Floral Park. Conrad asked me if I remembered playing handball and what would happen when the ball hit a crack on the floor and took an awkward bounce away from its original path, preventing a player from returning the ball cleanly. “It was called a Hindu and you got to do the point over.” Yes, I remembered “Hindus” and “do overs” and thought to myself that it would be an ingenious concept if we could extend the “do over” beyond the game to life in general.
Who hasn’t come across some crack in their path that causes an unexpected detour? My patients grow up expecting that they, like everyone else, can create their own family when they reach a stage in their lives, perhaps married and financially and emotionally secure. When a woman does not get pregnant as expected, it’s as if she hits that crack in her path — just like the handball — and her life gets thrown off track. If only she could get that “do over” and set her life back on its rightful path.
We also see these “Hindus” in our IVF cycles especially when a patient develops an LH surge and her ovulation is accelerated so that her eggs and ovulation are affected prior to retrieval.
Perhaps we need to consider the “do over” rule. IVF is a great way to give a couple a second chance to replay their errant family building when a “crack” in their fertility prevents successful procreation.
Fortunately, Rebeka’s parents got a “do over” and now, 22 years later, are celebrating their baby’s college graduation.
Life can throw a lot of cracks in our path that will detour us along our way. We should help each other by offering “do overs” whenever we have the opportunity.
By David Kreiner, MD
September 22nd, 2011 at 3:25 pm
Tagged with AMA, celebrity infertility, celebrity IVF, donor egg, DOR, East Coast Fertility, fertility news, IVF, IVF Long island, IVF over 45, jon and kate plus 8, kate plus 8, Micro-IVF, Nadia Suleman, octomom, Single Embryo Transfer
The Fertility news is constantly highlighted in sensational headlines, such as “49 year old woman conceives with own egg through IVF”. In the past, readers have been entertained with “Octomom”, “a woman pregnant with a supposed dozen”, “Jon and Kate plus eight” and “a 62 year old mother through IVF” not to mention the numerous over 45 and sometimes over 50 year old celebrities having babies supposedly with their own eggs.
Reading these “news” stories one may get the impression that Fertility is a thriving business bearing little resemblance to the medical specialty of reproductive endocrinology requiring seven years of post medical school training.
The medical pioneers Drs. Steptoe and Edwards in the UK and Drs. Howard and Georgeanna Jones Jr. in the US envisioned a world in which couples inflicted with the curse of an inability to procreate, would, with the benefit of this technology that they developed, give these couples the ability to build their own families.
They were excited that as the technology improved and became more efficient and the cryopreservation of embryos became routinely available that risky multiple pregnancies could be eliminated. They believed that insurance companies would pay for an IVF benefit that had a high success rate and could deliver healthy singleton pregnancies with far greater confidence than any alternative treatment especially intrauterine inseminations (IUI).
They were unhappy that in the early years when IVF was inefficient, many embryos needed to be transferred in order to give a patient a reasonable chance for success. This resulted in multiple pregnancies, many of which delivered prematurely requiring expensive neonatal intensive care and unfortunately many did not end well. Today, we have control over this with IVF by transferring one embryo at a time but not with IUI.
They also did not believe that women should be subjected to the medications, blood work and retrieval process without a fair chance for a successful outcome.
The idea of subjecting a 49 year old woman to IVF for what may be a 1% chance of conception with a greater than 50% chance of miscarriage is not medically reasonable. Women of this age have a 70 to 80% chance for conception through egg donation.
This is how the 50 something celebrities are getting pregnant.
They are not using their own eggs. Misleading the public with news stories that feature these older pregnant celebrities gives patients the misconception that they too can create their families at the same age using their own eggs.
We have recently performed IVF on two perimenopausal patients with FSH levels over 50 at age 45 after days of counseling regarding the extreme low odds of pregnancy and a live birth. In both cases, they felt they needed to give it one shot before moving on to egg donation.
They had one follicle each and both resulted in pregnancies with a gestational sac seen on ultrasound. One has since miscarried and will now move on to egg donation where her odds of having a live baby jump from less than 5% to 60% per attempt. The other remains pregnant and is miraculously the exception to the rule.
IVF is a medical procedure that is part of a proud tradition of reproductive endocrinology. It is a medical treatment that can cure one of the cruelest maladies known to man, the inability to have a child.
This problem is featured in the bible with several references including from the woman’s perspective with Hanna weeping for a baby of her own. The Old Testament proclaims the commandment to procreate. This is part of the human condition.
Does it not make sense then that insurance companies provide the financial coverage to allow IVF, a treatment that can be controlled by transferring one embryo at a time to result in a singleton pregnancy? Regulations to prevent costly dangerous multiple pregnancies and the performance of IVF in patients with unreasonably low odds of success need to be instituted.
Financial programs that make it no more expensive to patients to transfer one embryo at a time such as our Single Embryo Transfer program at East Coast Fertility need to be the news highlight of the day not the 49 year old who conceived on her sixth try.
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Do YOU think any of the older celebrity moms… who claim or imply that their children are not conceived through donor egg programs… are being untruthful?
Do you think their right to privacy is more important than the disservice such lies do to the public’s misconception about how old women can be and still conceive with their own eggs?
By Tracey Minella
September 21st, 2011 at 11:52 am
Here’s something new and fun at ECF’s The Fertility Daily blog…nearly Wordless Wednesdays!
On occasional Wednesdays, we’re going to post a photo…with few if any words…and either look for your comments and reactions to it, or ask you to come up with a creative caption for it. Maybe even both.
If we do a caption contest, we’ll reward the best submission with a gift card.
If you really like Wordless Wednesdays, we may do it more often, so let us know.
If you have a photo that you’d like to submit for inclusion in a future Wordless Wednesdays post, email it to me at email@example.com. If we choose your photo, you’ll get a gift card, too.
Today’s photo, credited to Lauren Greenfield, comes from this week’s People Magazine.com and its feature story on baby beauty pageants. Read all about the Toddlers and Tiaras at: http://www.people.com/people/gallery/0,,20529092,00.html#21054987
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CAPTION CONTEST: GIVE US THE BEGINNING OF THIS GIRL’S ACCEPTANCE SPEECH.
Or weigh in….what do you think about Toddlers and Tiaras? To each his own or is there something worrisome with this behavior?
By Tracey Minella, The Wench
September 20th, 2011 at 3:09 pm
Ahoy, me hearties! Today be International “Talk Like a Pirate” Day!
If infertility be makin’ yer feel like a scurvy bilge rat, come out of yer gung hole and take this challenge. Sure to cure what be troublin ya:
Funniest scallywag to post yer comment…in pirate language… wins a Starbucks card.
To inspire yer, here be a treasure of pirate pick up lines:
Top Ten Pickup lines for use on International Talk Like a Pirate Day*
10 . Avast, me proud beauty! Wanna know why my Roger is so Jolly?
9. Have ya ever met a man with a real yardarm?
8. Come on up and see me urchins.
7. Yes, that is a hornpipe in my pocket and I am happy to see you.
6. I’d love to drop anchor in your lagoon.
5. Pardon me, but would ya mind if I fired me cannon through your porthole?
4. How’d you like to scrape the barnacles off of me rudder?
3. Ya know, darlin’, I’m 97 percent chum free.
2. Well blow me down?
And the number one pickup line for use on International Talk Like a Pirate Day is …
1. Prepare to be boarded.
Here’s hopin yer got a laugh from me post today. Lest ye think, this list be mine, avast, this booty be swindled from Mark “Cap’n Slappy” Summers and John “Ol’ Chumbucket” Baur of www.talklikeapirate.com. Check out thar site and be finding yer inner pirate or wench today!!!
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Weigh in now, ye salty dogs and wenches…
By Tracey Minella
September 19th, 2011 at 12:00 am
Tagged with best comedy, best drama, coping with infertility, East Coast Fertility, Emmy Awards 2011, Emmys results poll, IVF, IVF Long island, Modern Family, stress of IVf, TTC, TV to cope with infertility
2011 Emmy Awards: Did your favorites win?
They’re already nicknaming last night’s Emmy Awards, “The Modern Family” Awards. And rumor has it the cast and creators needed a U-haul to truck their many trophies away.
I love the Emmy’s.
Television can be your best friend when you’re TTC.
It can be your escape. You can just get lost in the story…drama or comedy…and get away from the stress and pain of infertility.
You can use it to avoid talking on the phone or going out with people you really don’t want to see. Its also a great excuse for eating a pint of Ben & Jerry’s with a spoon…alone.
So what shows are your favorites?
What comedies make you laugh when you want to cry? What dramas make you cry when you need to cry?
At the risk of sounding like I’m 72, my infertility years spanned great comedies like Mad About You, Frazier, Everybody Loves Raymond and Seinfeld. (In fact, Seinfeld was on in the delivery room when I gave birth to my son…though it wasn’t particularly funny at that moment!) NYPD Blue and E.R. were my favorite dramas of the time.
Enjoy the TV while you can. Soon enough, you will lose control of the remote.
And no amount of Chunky Monkey will make you feel better when Yo Gabba Gabba comes on.
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Did your favorites win last night? What shows take you away from it all?