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Archive for October, 2011

Male Fertility Home Test? Move over Pee Stick!

By Tracey Minella

October 31st, 2011 at 11:59 pm

Knock knock.

Who’s there?

Thermos.

Thermos who?

Thermos be a better knock knock joke than this.

Well, I couldn’t just let Knock Knock Joke Day go by without recognizing it somehow. But it’s the last day of the month, so today’s post is all about the guys. So let’s move on to something really interesting.

Dueling pee sticks? Well, not exactly. But one day soon you could conceivably (get it?)  see a man and woman battling each other for bathroom space to take… and await the results of…their own stick-like fertility tests.

We’ve already got ovulation and pregnancy test kits for the ladies. But the latest thing to come down the pregnancy quest pike will be the male “fertility chip”.

Researchers are developing, with the intention of mass-marketing, a male fertility chip which is like a lab on a stick. A drop of male ejaculate onto this chip could test male sperm concentration (count) and sperm movement (motility)…reliably and in the comfort of your own home.

Imagine that, guys? No more embarrassing collection rooms. No more hurried home collections, messy cups, and quick deliveries to labs. Good-bye hand-off of awkward brown lunch bag to smirking nurse.

Now this is still in the early stages, so don’t run out to Walgreen’s just yet for your own kit. And the report did not mention that the test could determine the sperm’s size and shape (morphology), so a standard lab analysis, at least initially, may still be necessary. But 2 out of 3 ain’t bad. What a great development in the field of infertility!

Here’s the link for the details:   http://www.sciencedaily.com/releases/2011/10/111028103306.htm

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If a home kit did become available to test male fertility as indicated above, would you trust it or would you stick to today’s lab testing? Would the convenience of a home test trump the embarrassment of a lab test?

Anyone want to share a funny (but printable) collection story? (Well, it is knock, knock joke day…) Yeah, I didn’t think so…

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=2783&picture=toothbrushes

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6 Halloween Survival Tips for Infertile Folks

By Tracey Minella

October 28th, 2011 at 3:27 pm

Face it. Halloween without kids…well, bites. And I don’t mean in the neck.

Most of the fertile world misses the boat completely when it comes to sensitivity to our feelings on the holidays.

If we’re really lucky, we get some compassion for Mother’s and Father’s Days…sometimes for Christmas. Thanksgiving and New Year’s? Not really.

Halloween? Fuggedaboutit!

If you’re dreading facing Halloween without a baby dressed like a pea pod, here are some tips to get through the haunted happenings:

  1. Give yourself permission to be depressed, mad, or whatever it is you’re feeling. You don’t have to fake it for anyone. If you are open about your infertility journey, let people know it’s a hard day for you. This is one of those holidays fertile folks are usually clueless about when it comes to how bad we feel.

  1. If 85 bags of candy are not in the budget because you’re saving for fertility treatments, don’t sweat it. Turn the lights down low and pretend you’re not home. What you do in the dark is your business!

  1. If you want to give out treats, but can’t take the heartbreak each time a pack of princesses or ninjas come knocking, leave a big bowl with a “Please Take One” sign outside your door and let them help themselves.

  1. You want children and are still waiting. Why not spend the holiday brightening the day of children who are waiting for parents, or who can’t afford to celebrate Halloween? Contact your local social services department or place of worship and see if there is an orphanage or homeless shelter that could use some candy.

  1. Attend…or host…a “grownups only” Halloween party or dinner. Nothing will cheer you up faster than mummy dogs (hot dogs wrapped and baked in breadstick dough) and jello molds of brains and hearts. (Don’t forget the spiked witch’s brew!) Or go to a spooky play or movie.

  1. If you feel too guilty to do any of the above and are determined to face the parade of masked cherubs, then remember this… your day of ringing doorbells with Buzz Lightyear or Belle in tow is coming.

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How do you get through Halloween? Any tips or traditions?

For those who finally did have their babies….please share your best Halloween pics with us on our Facebook page at https://www.facebook.com/#!/ecfertility. (Feel free to LIKE our page while you’re there, and then tell all your friends and family to come see your baby’s picture on our Facebook page!)

Or, you can email them to tracey@eastcoastfertility.com. Your success may encourage others.

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TTC with Fibroids

By David Kreiner MD

October 27th, 2011 at 9:39 pm

As many as three out of ten women have fibroids, or uterine muscle tumors. Don’t get nervous about the word “tumor”. Often, they are not malignant. Sometimes they don’t need to be removed.

Everything you ever wanted to know about fibroids and your fertility is right here.

Dr. David Kreiner of East Coast Fertility gives you the facts about fibroids and how they may…or may not…be a factor in your fertility.

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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Anyone have a fibroid story to share?

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Stuck at the Fork of IUI Road and IVF Blvd.?

By Tracey Minella and David Kreiner MD

October 21st, 2011 at 12:00 am


You may not know where you went wrong, but most infertile couples feel lost at some point along their infertility journey. And the longer the trail of treatment gets, the more it can feel like you’re on a road trip from hell without a map…and with a partner who won’t stop for directions.

If your own journey has got you stuck at the corner of IUI Rd. and IVF Blvd… wondering whether to continue with more IUIs or to move in a different direction like IVF or micro-IVF…East Coast Fertility’s Dr. David Kreiner may be the infertility GPS system you’re looking for.

Dr. Kreiner gives valuable insight on how to handle this tough question if you find yourself at that particular crossroads:

Wantababy asked: iui versus micro ivf versus IVF:

I had three negative IUI cycles. I was on clomid and ovidril which produced ample follicles. IVF is not covered under our insurance and 12,000.00 with no guarantee is very expensive. Is micro-ivf advisable? Is it advisable to do a fourth IUI which is covered under insurance? i had been going for acupuncture which I didn’t do for the first three IUI cycles.

Dr. Kreiner (The FertilityDoc) replied:

I prefer to have entire history which would influence my decision. Issues such as your age, duration of infertility, cause of infertility, your antral follicles count, AMH, day 3 E2, FSH all play a role. Personally, I weigh heavily a covered cycle vs. having to pay for uncovered cycle but at some point it does make sense to move to more aggressive treatment.

MicroIVF in general has about 3 times the success of an IUI and costs $3,900. Some groups, age, diagnosis do better with MicroIVF than others.

In addition, we do have income based grants and often studies which will significantly lessen the cost of a full stimulation IVF. If you prefer to discuss your personal situation directly email me at dkreiner@eastcoastfertility.com or call 516-939-2229 for a consultation. Free consultations are available if you are not covered by insurance.

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How many IUIs did you have before moving on to IVF? What factors went into your decision to do more IUIs or to move on to IVF?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=1666&picture=signpost

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Do I Need a Pre-IVF Mammogram?

By Tracey Minella

October 20th, 2011 at 11:51 am

It’s hard not to jump on the bandwagon and flat out say “Yes!” after hearing the news this week that reality TV star, Guiliana Rancic, 36, was recently diagnosed with breast cancer after her new RE insisted she have a mammogram before going forward with her third IVF cycle.

But even though many of us have been routing for her and her husband, Bill Rancic (of “The Apprentice”) since they courageously made their infertility battle public…and even though it happens to be breast cancer awareness month… we should be wary of getting swept up in our collective heartbreak for Mrs. Rancic and demanding pre-IVF mammograms for all patients.

Should the accepted standards of medicine regarding mammograms be modified because of her rare case? Is the exposure to radiation a risk worth taking in light of the slim chance of detecting cancer in younger patients without known risk factors?

In the general population, mammograms are not recommended by either the National Cancer Institute or the American Cancer Society for women under 40.

Further, with respect to women about to undergo IVF, neither the American College of Obstetricians and Gynecologists, nor the American Society for Reproductive Medicine (ASRM) recommends mammograms before age 40. Just a pap and breast exam.

Of course, if there is a family history or a patient has tested positive for the breast cancer gene mutation, screening may be indicated earlier.

Despite the continued lack of evidence after many studies, of a causal connection between IVF and cancer, there remains a skepticism or fear among some of the public. And it rears its ugly head in cases like these. For right on the heels of Monday’s announcement, the Today show had to do a follow up interview due to “hormone phobia”. Did Rancic’s first two IVF’s cause the breast cancer?

I wince when I see this because I see IVF taking an undeserved step backwards in the public eye. I can only hope people look past the sympathetic face of the beloved celebrity and really hear the answer from Dr. Nancy Snyderman: “Take this as a stand alone case.” 

People have been taking IVF meds and birth control meds…both of which are hormones…for decades. Women tend to seek IVF when they are older. Women tend to get breast cancer when they are older. “There is an age relation, not a hormonal relation” between IVF and breast cancer, Dr. Snyderman reassured.

Rancic, who is recovering from Tuesday’s lumpectomies and will need radiation treatments, had been stimulating at the time of her diagnosis and underwent the retrieval, but no transfer. We wish her only the best in her recovery and in her future family-building efforts.

I loved her closing remarks in her interview on Today when she confirmed her plans to get pregnant through IVF after her cancer treatment. “I’m not going to give up. I want that baby. What’s amazing is… that baby will have saved my life.”

You can see both interviews…Guiliana’s announcement and Dr. Snyderman’s interview …here: http://vitals.msnbc.msn.com/_news/2011/10/17/8368474-doctors-ivf-not-to-blame-for-rancics-breast-cancer.

The bottom line is that you as the patient need to be comfortable. Please speak to your OB/GYN and your RE about your concerns and questions so they can help you determine if a mammogram is called for in your particular case.

Good luck, Guiliana and Bill. And good luck to everyone on their family-building journey.

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Do you think all IVF patients should get pre-IVF mammograms regardless of age? Do you worry about having or getting breast cancer as a result of IVF? Have you spoken to your RE about your concerns?

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Infertility and the Man’s Part

By Tracey Minella and David Kreiner MD

October 18th, 2011 at 6:10 pm


IVF is hard on us women. After all, we’re the ones whose hormones have gone wild, whose butts have swollen bulls-eyes, whose wombs are empty.

But our guys have it hard, too. If it’s male factor, they have misplaced guilt.  They have their own pain, but probably hide it so as not to further burden their partner. And in any case they likely have depression and frustration over not being able to fix the situation for their suffering partner. Their wives are in pain. Don’t most guys want to be their wife’s hero? The knight who rides in to save the day?

IVF is a team effort which extends beyond the man’s obvious contribution in the collection room.

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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Guys: Would you (or have you) been present during the transfer? What was it like?

Girls: Would you want (or did you have) your husband present during the transfer? What was it like?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=2163&picture=young-love

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Are Secondary Infertility Patients Less Sympathetic?

By Tracey Minella and David Kreiner MD

October 14th, 2011 at 5:51 pm

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.

Is the case of the secondary infertility patient less sympathetic? Do you think there’s a bias…if not in society, then in the IVF office… against them? Are people really thinking that they may be “greedy” to come back for another? If so, isn’t that unfair? Why should someone have to settle for one child simply because they’re infertile and their presence in the waiting room might upset those who are still waiting for one baby?

There’s tension between fertile and infertile, for sure. But what about tension among the ranks of  the infertiles? Dr. Kreiner shares an insightful post on Secondary Infertility:

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.

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Do you feel tension in the waiting room if there’s a baby there? Or do you feel hope?

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Channel Your Inner Columbus

By Tracey Minella

October 10th, 2011 at 9:38 am

TTC?

Bet you never realized how much you have in common with Christopher Columbus.

Think about it. You’re hanging out, having a good life. But something is missing. You’re different from the rest. You’ve got a yearning that won’t go away. People are talking about you.

You believe in your dream.

You need to take this long and scary journey. You don’t know where it will lead, but your dream is at the other end. Can you feel it?

It is going to be costly… draining you emotionally, physically and financially. But not going forward is simply not an option.

And finally, after struggling and holding on to hope for longer than you ever imagined you could, the dream appears over the next horizon.

Today, as we celebrate Columbus Day, I wish you a safe and speedy journey to the new land of parenthood. And I promise, when you finally arrive, it will be all you ever dreamed it would be.

And for those of you who don’t happen to have a King Ferdinand and Queen Isabella to finance your voyage, check out ECF’s grant programs and innovative package discount plans… and our fun contests as well.

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Has your infertility journey been longer than you thought it’d be? What has been the hardest part of it? What has been the greatest lesson from it?

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Yom Kippur, Infertility, and the Wrong Path Taken

By Tracey Minella and David Kreiner MD

October 7th, 2011 at 9:25 pm

Today is Yom Kippur, the holiest day of the year in the Jewish faith. It’s a day of atonement for Jews. A day when they look back on the choices they’ve made and the goals they’ve set and ponder things like what mistakes or wrong decisions they may have made that have led them down a path they did not intend to take.

Sometimes, mistakes may have landed patients on the path of infertility.

Dr. Kreiner, of East Coast Fertility examines a common situation he encounters where poor decisions…or indecision…on behalf of patients and their GYNs leads them down a path they certainly did not intend:

A friend of mine was complaining to me about the trouble he got into with his homeowner’s association because he did not hide his empty garbage cans in his garage but left them behind his cars in front of his house.  It was 20 feet from the curb, he claimed, still distraught that he should have been scolded for breaking the rule.  “I didn’t know”.  That phrase, “I didn’t know” clicked in my brain as a recurrent declaration from the frustrated patients who I see every day.

My infertility practice is filled with patients who spent years of their lives all the time assuming that their fertility would be there when they were ready.  Some even mentioned their failed attempts at conceiving to their gynecologist who may have reassured them or if it were a more aggressive clinician, he may have put them on clomid for 3 to 6 months.  Meanwhile these women got older, many over 40 not realizing that time was chipping away at their fertility.  “They didn’t know”.

A fertility screen is a good way to assess annually what is happening to your fertility independent of your age.  This is accomplished by getting day 2 or 3 FSH and estradiol levels as well as an ultrasonographic antral follicle count.  An AntiMullerian Hormone level can be checked at any point in the cycle and likewise reflect the relative number of eggs left giving some reassurance about a person’s remaining fertility.

What do I as a reproductive endocrinologist who sees the damage done by this benign neglect on a daily basis do to wake people up to the fact that fertility is a temporary state that needs to be taken advantage of when the time is right?  Recently there was a report of doctors taking ovarian tissue/eggs from a child to preserve her fertility.  It’s hard for me to imagine that this is the future solution for the masses.  However, egg freezing technology is shortly becoming acceptable therapy with ever increasing success and lack of problems being noted.

Patients who are not in a position to execute their reproductive rights while they are still fertile should consider egg freezing when they do not have a partner to share in conception.  With a willing and available partner, freezing embryos is the most viable option.

But without question, couples who are ready to start a family, should seek assistance from a reproductive endocrinologist who specializes in helping those such as yourselves build your families.  Even when not covered by insurance, there are affordable options such as minimal stimulation IVF ($3900 at East Coast Fertility), grants and studies that make the process within reach of most people in need.   So do not become another victim to “I didn’t know”.  Take action, see a reproductive endocrinologist and get on the right path to building that family of your dreams.

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Did YOU Cause Your Infertility?

By Tracey Minella

October 6th, 2011 at 1:34 am

First, there’s the expectation of getting pregnant. Then there’s the worry that you might need help conceiving. And when you do need help, there’s the initial anger and sometimes self-pity. Why me?

Are you asking “Why me?” when you really just mean “Why not somebody else?”

Or are you really asking “Why me? Did I do something to cause this?”

The issue of which partner’s “fault” it is, and the guilt-filled arguments surrounding that topic have been around forever. It’s a tough burden to be the one with the problem, even when your partner is wonderful about it. But “Why me?” goes beyond just knowing which partner has the diagnosis, it asks why that partner has the diagnosis.

Did something you did…or did not do…cause your infertility?

That question makes people squirm. I often wonder if I was born with a blocked tube or if it developed later. And if later, was it from something I did? Did I not recognize and get treatment for some infection? How did it happen? Could I have prevented it?

This deep question came to me late last night as I sat in the ER waiting to find out if the red hot poker sensation in my right calf was from a blood clot waiting to do me in. I knew that if it was a clot, I’d likely be admitted and put on blood thinners and my life would be turned upside down for a couple days.

I started cursing myself for stupidly spending up to 12 hours per day at the computer writing over the past 6 weeks…and not getting up to stretch my legs. How easy it could have been to prevent this condition, I thought. Like my chiropractor’s mantra goes: It’s better to prevent disease than treat to it.

What about you?

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 Do you think your drinking, smoking, hygiene, drug-taking, sexual history, medications, vaccinations, work environment, birth control method, environmental toxins, accident or any other factor caused your infertility? What advice do you have for others to help them avoid the same pitfalls?

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