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Archive for November, 2011

Has Infertility Affected Your Black Friday Shopping?

By Tracey Minella

November 25th, 2011 at 12:00 am


The true die-hard Black Friday shoppers will likely miss this post until tomorrow. They will be camping out in parking lots all night after stuffing their faces on Thanksgiving, waiting for the pre-dawn opening of stores for the Christmas shopping season’s official commencement.

I wish all of you good luck…and safety… as you brave the frenzied crowds and potentially deadly stampedes of bargain hunters in the excited challenge of power shopping.

So on the biggest shopping day of the year, where are you headed and why?

Has infertility affected your holiday shopping? Can you enjoy Black Friday when you’re in the red?

Do you do the Black Friday thing because the cost of infertility treatment requires you to take advantage of those holiday shopping bargains? Are you cutting back or cutting out gifts because of treatment costs? Do you avoid toy stores because it’s too hard? Or are you out there enjoying it all?

Do you have any tips for others on getting through their holiday shopping?

What Black Friday bargain was your proudest" score" of the day today?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=4793&picture=woman-enjoying-sales

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Thanksgiving Infertility Patient “Open Venting” Session

By Tracey Minella

November 24th, 2011 at 12:00 am

It’s Turkey Day. And today I am giving you permission to vent. (Actually, you can vent anytime in here, but today you are formally invited to let loose if you need to, as the stressful holiday season has commenced.)

Is it early in the day and you’re checking in for your Fertility Daily “fix” before bravely facing the holiday and all the relatives and their nosy questions, unwanted advice, and insensitive comments? (C’mon, humor me!) If so, why not tell me what you’re dreading about today? Who is the big mouth that could wind up with a fork in her neck if she so much as looks at you funny?

Or is it after the festivities and you are emotionally wiped out by, well, all the relatives and their nosy questions, unwanted advice, and insensitive comments? How about sharing whatever upset you? It’ll make you feel better to vent. And besides, who doesn’t love a good fork-in-the-neck story?

Sometimes it’s hard to feel thankful. Especially when you don’t have the family you expected to have by now.

Truth be told, I had my doubts about the response we’d get for our Thankfulness Contest. I remember feeling very depressed and resentful during the holidays when I was doing my seven IVF cycles. Year after miserable year.

I was pretty bitter and completely overlooked anything good in my life…unable to focus on anything at all other than my infertility struggle. My mind was jam-packed with cycle info, drug inventories, numbers of follicles or embryos, hormone levels, and the ever present mental calculation of “if I get pregnant this cycle, the baby will be born in [insert month] and I will be [insert age]”. There was nothing else that mattered. Nothing.

I was concerned that those of you still on your journeys would be unable to look past your own own anger or sadness…your emptiness…and be able to focus on something positive that came out of your infertility journey. I totally understand that feeling. But if you can look deep inside and find something positive among the negative, please enter the contest for a chance to win a romantic dinner.

And if you’re not feeling thankful, then how about sharing right now what it is that you are feeling? Go on. Vent. You will feel better. And everyone here understands.

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=15403&picture=woman-on-fire

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Washing Your Sheets May Help You Conceive

By Tracey Minella and David Kreiner MD

November 22nd, 2011 at 4:26 pm


No, not the laundry, silly. I’m talking about your sheets of cumulus cells. If you want to improve your chances for pregnancy, washing and separating these sheets of cells at the time of your IVF retrieval, and placing them in the dish with your embryos, may be just what the doctor ordered to get your pee stick to come back positive.

This revolutionary procedure is known as co-culture. Unfortunately, many IVF programs do not offer this pregnancy rate-boosting option. Fortunately for you, Long Island IVF and East Coast Fertility do offer co-culture.

Dr. David Kreiner explains the benefits of this exciting and promising weapon in the IVF arsenal:

Successful IVF is dependent on many factors.  The quality of the egg and embryo, the placement of the embryo into the uterus and the environment surrounding implantation are all paramount to the ultimate goal of creating a pregnancy that leads to a live baby.

Typically, patients present with their own gametes so the genetics and pregnancy potential of the eggs and sperm is usually predetermined when patients first present to an IVF program.  As a specialist in REI and IVF, I have dedicated my career to optimizing those other factors that we may influence.

In the late 1990’s I recorded data on all my embryo transfers including distance the catheter tip was placed into the uterine cavity, number of cells and grade of the embryos, difficulty of the transfer, use of tenaculum etc.  I presented my results at the ASRM in 2000 that highlighted the two step transfer to the middle of the uterine cavity and replaced the tenaculum with a cervical suture when needed and this radically improved pregnancy rates.

The uterine environment has been optimized through screening for anatomic issues in the uterine cavity with a hydrosonogram to identify polyps, fibroids and scar tissue that may impede implantation.  Hormonally, we have supplemented patient’s cycles with progesterone through both vaginal and parenteral (intramuscular) administration as well as estrogen that we monitor closely after embryo transfer and make adjustments when deemed helpful.

The greatest improvement in pregnancy rates for the past several years however has been due to a “Culture Revolution” in IVF that is the media environment bathing and feeding the embryos.  All these advances have had a great impact on IVF success rates to the point that 50% of retrievals will result in a pregnancy.  Unfortunately, older patients and some younger ones have yet to share in this success.

Many IVF programs have reintroduced the concept of utilizing a co-culture medium to improve the quality and implantation of embryos. Co-culture is a procedure whereby “helper” cells are grown along with the developing embryo. Today, the most popular cell lines include endometrial cells (from the endometrium, or uterine lining) and cumulus cells from women’s ovaries.  Both cell lines are derived from the patient, thereby eliminating any concerns regarding transmission of viruses. Endometrial cells are much more difficult to obtain and process, while cumulus cells are routinely removed along with the oocytes during IVF retrieval.

Cumulus cells play an important role in the maturation and development of oocytes.  After ovulation cumulus cells normally produce a chemical called Hyaluronan.   Hyaluronan is secreted by many cells of the body and is involved in regulating cell adhesion, growth and development. Recent evidence has shown that Hyaluronan is found normally in the uterus at the time of implantation.

Co-culture of cumulus cells provides an opportunity to detoxify the culture medium that the embryos are growing in and produce growth factors important for cell development.  This may explain why some human embryos can experience improved development with the use of co-culture.

Preparation of co-culture cells starts with separation of the cumulus cells from the oocytes after aspiration of the follicles. These sheets of cells are washed thoroughly and then placed in a solution that permits the sheets to separate into individual cells.  The cells are then washed again and transferred to a culture dish with medium and incubated overnight. During this time individual cells will attach to the culture dish and create junctions between adjoining cells. This communication is important for normal development. The following morning, cells are washed again and all normally fertilized oocytes (embryos) are added to the dish. Embryos are grown with the cumulus cells for a period of three days to achieve maximum benefit.

Performing co-culture of embryos has improved implantation and pregnancy rates above and beyond those seen with the IVF advances previously described. More importantly, it promises to offer advantages for those patients whose previous IVF cycles were unsuccessful.

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Have you tried this yet?

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How Do You Define “Family”?

By Tracey Minella

November 21st, 2011 at 11:05 am

Since we build families every day, it feels right to note that today marks the beginning of National Family Week. It is fittingly placed right around the holiday most closely associated with family…Thanksgiving.

I love Thanksgiving. I love that it is about food, family, and friends. Football featuring the Cowboys and Lions. The Macy’s parade. March of the Wooden Soldiers. No presents or commercialization. No overcrowded places of worship.

Did I mention food and family?

But what is a "family"?

Now I don’t want to give the impression that my holiday is like a Norman Rockwell painting or that my family is like the Cunninghams from Happy Days. We have good times and laughter. And arguments around the table…sometimes started by an insensitive remark by a blow-hard to a hormonal infertile woman.

Every family has a big mouth.

I remember one gathering when we were knowingly TTC and had failed at IVF, and a cousin walked in with her new IVF twins. “The Mouth” remarked: “I’d NEVER spend $10,000.00 to have a baby!” Way to offend two couples at once, loser! She is always good for a jaw dropper. Spending Thanksgiving…or any holiday… with her is as enjoyable as sitting with a wishbone wedged in your throat all night.

I also remember feeling like we weren’t really a “family” because we didn’t have children yet. We were a “couple”. I made a distinction when I shouldn’t have. And in retrospect, that feeling made Thanksgiving harder each year.

I wish someone pointed out to me back then that a couple is a family. I may have rolled my eyes at them, but if they persisted I may have felt better.

So I am telling you now that when a couple comes together to fight infertility, they get a benefit they don’t usually recognize until after their infertility journey is over. They find they’ve built a rock solid foundation upon which to build… as their family grows from a couple to something larger than that. Trust me on that one.

 

Please enter our Thankfulness Contest. Take some time to reflect on what you have to be thankful for as a result of taking this infertility journey…even if you are still waiting. What have you discovered about yourself, your spouse, your inner strength? We’d love to send you and your spouse out for a $100.00 romantic dinner at Scotto’s Restaurant.

Just you two…no big mouths.

Enter today right here: http://www.eastcoastfertility.com/about/blog/blog-entry/archive/2011/november/article/thankfulness-contest-kicks-off-today/?tx_ttnews%5Bday%5D=07&cHash=70e74b10d49a039bfdb5b684dcde9084

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So how do you define “family”?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=9638&picture=late-19th-century-family

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7 Survival Tips for Holiday Shopping for Others’ Kids

By Tracey Minella

November 18th, 2011 at 2:57 pm

Well, the stores are already decorated for the holidays, it’s only days before we carve the turkeys, and we’re moments away from the annual onslaught of 24/7 Christmas music on the radio.

Do you see visions of sugar plums? Or are you a Bah-Freakin Humbug kind of person? Maybe a little of both?

There’s no right answer to that one, by the way.

The infertility years were so hard for us.  It took real effort sometimes to be the favorite aunt and uncle. But seriously, Christmas lists for the nieces and nephews brought an almost bi-polar response.

On the one hand, we were like two kids ourselves, tackling Toys R Us with reckless abandon… excited to buy these adorable kids the biggest and most wanted toys on their lists. Then the next hormonal minute, I’d dissolve into tears, cursing the long-listed, greedy brats and reaching for whatever toy had the most pieces and would take the longest time to assemble…as if to punish their fertile parents. Talk about Scrooge.

I’d keep telling myself our day would come to buy toys for our own kids as my heart broke over the Easy Bake Oven and Lego set that would not be under our tree. Again.

Here’s Seven Tips to get through the shopping:

  1. Order toys through online shopping sources instead of going into the stores. Most offer free shipping and some even gift wrap for a fee.

  1. Consider a gift card to a favorite store if the child is older and would appreciate one.

  1. If it’s okay with the parent, and would be enjoyable for the child, consider a gift that involves an outing instead of a toy. Maybe you and the child could share a day at a concert, movie, play, circus, or other event? It may be just the “parenting fix” your heart needs. (Of course, if the kid’s a brat, let the mom take him!)

  1. If you are not superstitious, buy a little something to put away for your future baby. Maybe a small stuffed animal, basic baby toy or rattle, or a book. No one says you have to wait until it gets here to start to spoil it. It may make you feel better.

  1. Buy yourself (or your spouse) a little gift. Reward yourself for braving the toy store crowd with your heavy heart. Try a massage for the added benefit of stress reduction.

  1. Donate a toy to a needy child. Toys for Tots and similar programs are all over during the holiday season. Or check with your local place of worship for suggestions.

  1. Blow off the shopping and enter one or more of our contests!!! (Okay, that was cheap of me, but you really should enter our Thankfulness Contest at   http://www.eastcoastfertility.com/about/blog/blog-entry/archive/2011/november/article/thankfulness-contest-kicks-off-today/?tx_ttnews%5Bday%5D=07&cHash=70e74b10d49a039bfdb5b684dcde9084 OR our Nearly Wordless Wednesday photo caption Contest at  http://www.eastcoastfertility.com/about/blog/blog-entry/archive/2011/november/article/nearly-wordless-wednesday-photo-caption-contest-3/?tx_ttnews%5Bday%5D=16&cHash=36a40ab5dbe8a79061d473968ec1dbbe

And remember, and believe, that your day will come. Here’s hoping that Easy Bake Oven will be under the tree in 2012.

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How do you get through it? Do you have any tips for holiday shopping for other people’s children? Will you try any of the above tips this year?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=10175&picture=christmas-bag

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Embryo Screening for Genetic Defects is Available

By Tracey Minella and David Kreiner MD

November 17th, 2011 at 4:15 pm

When IVF first hit the news with the birth of the first “test tube baby” in 1978, people were amazed, but also skeptical, and even a bit frightened. Conservatives and religious objectors went nuts over the idea of creating life outside the womb.

Today, IVF is almost as common as root canal. It’s not science fiction anymore. In fact, at least 4 of the 29 kids in my daughter’s class are IVF babies. There are still opponents, for sure, but the “shock value” of plain ol’ IVF has passed to a great extent.

Yet, scientific advances in the field of reproductive endocrinology and genetics have brought technology and tools to the table that continues to amaze, and sometimes frighten the general public.

Now, pre-implantation screening exists that may dramatically improve IVF success rates in several different patient scenarios.

Dr. David Kreiner, of Long Island IVF and East Coast Fertility, describes this latest amazing development and how it may help IVF success rates soar. And it is now available to Long Island IVF and ECF’s IVF patients! Read on to see if it could benefit you!

As Dr. Kreiner explains:

Pre-embryo genetic screening (PGS) was developed to help weed out embryos containing inherited metabolic disorders and genetic abnormalities prior to implantation. It was thought that PGS could be used to minimize the risk of miscarriage and perhaps even increase live birth rates in older women undergoing IVF .

We have thus far been disappointed in our results obtained using the FISH technique, the procedure performed for PGS for the past decade and a half. But an alternative new technology that was recently developed makes me very excited about PGS once again: Array Comparative Genomic Hybridization (aCGH).

ACGH is a technique actually applied to detect deficiencies and excesses of genetic material in the chromosomes. DNA from a test sample and a normal reference sample are labeled using colored fluorophores that hybridize to several thousand probes. These probes are created from most of the known genes of the genome and placed on a glass slide.

The differential color of the test compared to the normal sample DNA reflects the amount of DNA in the test specimen. It can pick up monosomies, trisomies or significant deletions on an embryo’s chromosomes.

The first baby born from this procedure was in September 2009 to a 41-year old woman. When aCGH is performed on a Blastocyst biopsy, it is effective in screening out mosaicism (mixed cell lines in the same organism). ACGH is 20 percent more sensitive than the best FISH assays with an error rate of two to four percent. Fifty percent of the embryos tested were normal with pregnancy rates exceeding Blast transfers without aCGH screening.

So, who could benefit from using this new technology?

1. Patients with repeat miscarriages can eliminate up to 90 percent of their miscarriages.

2. Older patients who naturally have a higher percentage of genetically abnormal embryos may now screen for and only transfer their normal embryos.

3. Patients who want to maximize their success with a single embryo transfer.

4. Patients who have experienced repeat implantation failure can be screened for genetically abnormal embryos.

This technology is available for about the same cost as the FISH procedure yet, since it is performed on a Blastocyst, it is safer with less effect on the integrity of the embryo and without significant risk of wrongly identifying abnormal embryos. A concern with FISH is that embryos identified as abnormal can actually result in a normal fetus. This risk is practically eliminated with aCGH and is another reason making it more successful.

I expect PGS will now become a commonly-used addition to standard IVF to promote more successful single embryo transfers, improve success in older patients, eliminate miscarriages, and treat patients with repeat implantation failure.

We are approaching a new era in IVF. Brace yourselves for a thrilling ride into IVF’s future.

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What do you think about PGS?

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Nearly Wordless Wednesday Photo Caption Contest

By Tracey Minella

November 16th, 2011 at 10:08 am

Hooray for Wednesday! It’s photo caption time, folks! But first we have to name last week’s winner.

The winner of last week’s photo caption contest is Erintobe! Congrats!

Remember the baby and stuffed ducky duct taped to the wall? Well, Erintobe’s comment “What, I gave the baby her favorite duck!” was just the short, sarcastic remark we thought would be a great caption. So Erintobe, this week, the Starbucks is on us. Please email your address and the words “11-9-11 Duct taped kid caption” to Lindsay at lmontello@eastcoastfertility.com to claim your gift card.

Ready for this week’s challenge?

Give this photo a caption either below on this blog or on our Facebook page. I picked it because Black Friday will be here before we know it.

Best entry winner gets Starbucks on us! It’s a fast, fun and free contest open to anyone, whether infertile or not, and whether a patient of our practice or not.

Either provide your email address with your entry or check back to see if you won and we’ll tell you how to email us so we can mail you your gift card.

Plus, if you “LIKE” us on Facebook at https://www.facebook.com/ecfertility#!/ecfertility, we can send you the prize as a Starbuck’s Card e-gift right through Facebook, so you could be sipping your winnings as early as on the day we choose the winner! (And as much as we’d love you to like us on Facebook, it is absolutely not required to either enter or win our contests!)

Enter today!

Photo credit: http://www.killmydaynow.com/2011/03/funny-pictures-of-bad-parenting-part-3-58-pics.html/

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The Duggars Do it Again…Baby #20

By Tracey Minella

November 15th, 2011 at 12:00 am

Oh, the range of emotions. Not sure what to do first: close my dropped jaw or stop shaking my head?

Baby #20 is on the way for the Duggars, that famous reality show Christian family.

Part of me’s thinking this is surely a sign of the apocalypse coming. Well, it feels that way to me when I consider how many loving, deserving couples are out there mortgaging their lives away trying to conceive just one baby. It just doesn’t seem fair. It doesn’t seem right. And that’s just my opinion, of course. I’m sure there are tons of folks out there who’d be happy to have 20 kids.

I can’t say what I think constitutes a reasonable, manageable number of children these days, but it just feels to me like 20 is beyond reasonable. Beyond manageable. Especially when they’re being home-schooled. Consider that reality for just a moment. Talk about an overcrowded classroom.

In any event, 20 kids is not anywhere near the “norm”, that’s for sure. That’s why they are newsworthy, reality TV stars. And people can (and do) argue that it’s nobody’s business how many children someone else has.

Still, I’m thinking “Why couldn’t a force in the universe give the Duggars a generous allotment of, say, four kids…and then distribute the remaining baby dust for the other 16 over some other couples who need help?” That has a ring of fairness to it.

But, of course, all is NOT fair in love and fertility.

It brings interesting questions to mind, like:

How can the parents have enough time and love to go around for 20 children?

Is it safe for the mom and baby to keep conceiving at the age of 45 with a uterus that’s been through the ringer after carrying 19 babies?

Is it fair to the older kids to have to care for so many younger ones?

Is having 20 children over time as offensive as the octomom having 8 at once?

Why would someone whose 19th and last baby was born three months prematurely chance another pregnancy?

Are they just following God and are merely devout, loving parents doing things differently than the rest?

Or are they building their family so the ratings don’t drop and so they have fresh content on their promotional website?

Is it okay to profit from having so many children?

And perhaps the biggest question of all:

How do they find the time and energy and desire… with 19 home-schooled kids under foot 24/7… to have sex?

There goes my jaw dropping again…

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What do you think?

Photo credit: http://blogs.scientificamerican.com/context-and-variation/2011/11/11/the-duggars-demonstrate-life-history-trade-offs-around-quality-versus-quantity-of-offspring/

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A Winning Combination of Two IVF Practices!

By Tracey A. Minella

November 11th, 2011 at 1:28 am

We have BIG NEWS! East Coast Fertility and Long Island IVF have recently combined practices to serve their patients even better than before! This is good news for our patients.

We understand that you may have concerns, especially during the initial adjustment phase. Please ask whatever questions you have. Most people don’t like change. But rest assured, this blending of two of Long Island’s most successful fertility practices will give the patients of both practices everything they love about their chosen practice…plus access to all of the complementary services of the other practice. It’s a blending of “high tech” and “high touch”…where sleek, state-of-the-art clinical practice meets accessibility, hand-holding, holistic, cutting-edge/alternative medicine. Now you can have it all.

Bet you didn’t know that the directors of both practices founded Long Island IVF…together…nearly a quarter century ago. They were Long Island’s IVF pioneers! But after ten years apart building separate yet somewhat different practices, they’ve realized they’re better together!

Take it from me (who was a patient and worked as a medical assistant for them when they were originally together), this is really wonderful news for today’s infertility patients. You couldn’t ask for a better combination!

Click here for the initial website announcement: http://www.eastcoastfertility.com/?id=213

Some of the physicians of the combined practices are pictured above (l to r): Steven Brenner, MD, Joseph Pena, MD, Daniel Kenigsberg, MD, and David Kreiner MD.

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We want to know what you think of this blending of practices and what questions or concerns you may have. Please ask us, so we can put you at ease. Whether you comment here or speak to us in person, we look forward to addressing any concerns.

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ASRM 2011 and IVF’s “Magic Bullet”

By David Kreiner, MD

November 10th, 2011 at 1:52 am


This past October, reproductive endocrinologists from around the globe gathered for the annual scientific meeting of the American Society for Reproductive Medicine (“ASRM”).  It is an opportunity for us to share experiences and learn from each other.  

I had lunch with a colleague practicing IVF in Mumbai, India and was fascinated with how similar our practices felt despite the huge geographic and cultural differences.  The human interactions and emotional and social issues of infertility afflict our apparently disparate populations of patients in very similar ways.

There were a few presentations during the five day conference worth noting.  

Regarding ovulation induction for patients unable to ovulate on their own: Metformin, in combination with clomid appears to be slightly more effective than clomid alone or letrizole which may have a lower risk of multiples.  Ovarian drilling (a surgical procedure involving cauterizing small craters in the ovaries) is equally effective and was suggested for clomid/letrizole failures.

The best presentation according to many attendees was on surgery to enhance IVF success.  Data was presented documenting the huge benefit of eliminating hydrosalpinges (fluid filled fallopian tubes) prior to embryo transfer.  It is thought that the inflammatory fluid in these tubes bathes the uterine cavity… creating a hostile environment for the embryos.  It appears that salpingectomy (removal of the tubes), or tubal ligation laparoscopically or by one of the less invasive hysteroscopic procedures (such as Essure) appear to be equally effective.

Cysts of endometriosis do not affect the number or quality of a patient’s embryos. Because of the risk of removing normal ovarian tissue (and thereby reducing the ovarian reserve), it is not generally recommended that patients undergo endometriosis surgery to improve IVF outcome.

Routine hysteroscopy (visualization of interior of uterus through a scope) on asymptomatic patients found abnormalities in 11-12% of cases.  Removing polyps significantly improved pregnancy rates.  It was recommended that patients undergo a hysteroscopy after one failed IVF, if not done sooner.

Fibroids that were partially in the uterine cavity affected pregnancy rates and should be removed.  Likewise, fibroids that are intramural (in the muscle of the uterus) and distort or increase the size of the uterine cavity should be removed to increase the IVF pregnancy rate.  

It was also suggested that resection of the uterine septum increases the IVF pregnancy rate.

There were several interesting presentations about IVF over the course of the five day conference. But the one that stimulated the most conversation on the trip home was a study from Egypt.  

This program injected (through a catheter placed vaginally through the cervix) 500 units of HCG into the uterine cavity just before performing the embryo transfer.  They found higher pregnancy rates in women who were injected with this "magic bullet".  It inspired enough interest that I expect a year from now, we will learn if the intrauterine HCG is in fact the IVF magic bullet.

Certainly, we will endeavor to utilize the worthwhile studies presented at this year’s ASRM to continue to improve the outcomes for our patients.

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Did you learn anything new from this post? What is the most interesting thing? If the “magic bullet” was available to you, do you think you’d be interested in it? How important is it to you that your RE attends the annual ASRM conference?

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