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Archive for December, 2011

What the #@WI-FI&* Happened to Your Sperm?!

By Tracey Minella

December 30th, 2011 at 6:50 pm

Last post of the month… so it’s one for the guys as usual.

We all know the things the ladies are doing (or should be doing) to increase their chances of conceiving a healthy baby. Tests taken, prenatal vitamins, dental work, healthy diet and exercise, etc. And you both should be avoiding excessive caffeine, alcohol, and tobacco, of course.

But if you think sportin’ those loose boxers is all you need to do to maximize the potential of “your boys”, think again!

High tech breakthroughs have advanced the fields of assisted reproductive technologies, like IVF. But not all things “high-tech” are beneficial. Some things can potentially do harm.

Like Wi-Fi. (a/k/a wireless internet connections.)

We already know that a laptop on your lap for extended periods of time can cause scrotal hyperthermia, or increased testicular temperature. But great balls o’ fire, there’s another sperm quality killer to worry about!

It’s possible that laptop of yours, with its Wi-Fi could be messing with your sperm’s motility (ability to move) and quality. It could be fragmenting your sperm’s very DNA!

Now don’t try this at home…yes, I went there… but when semen samples were placed under a laptop for four hours, one group with the Wi-Fi on and the other with the Wi-Fi off, there were noticeable differences in the quality of the sperm.

The Wi-Fi sperm sample showed 25% lost motility and 9% suffered DNA fragmentation, compared to the non-Wi-Fi sperm sample which showed 14% lost motility and 3% suffered DNA fragmentation. Scientists theorized that the electromagnetic radiation emitted from the Wi-Fi may be the reason for the results. For more information, click here: http://www.medicalnewstoday.com/articles/238455.php

So fellas, be careful what you allow on your lap!

Which brings me to a potentially-related closing comment, depending on how wild your plans are tomorrow night: Have a safe and healthy New Year’s Eve. I hope all your dreams come true in 2012.

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How do you plan to spend New Year’s Eve? Do you put infertility aside and have fun out with a crowd or have a romantic dinner for two? Do you stay in with a small group or alone and watch the ball drop on TV? Or do you treat it like any other night and go to bed early?

 

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Hormones, Stress, and…Murder?

By Tracey Minella and David Kreiner MD

December 29th, 2011 at 10:37 pm

We’ve all got ‘em. Stories of when we blew up at our guys. I don’t mean just normal arguing. I’m talking about ripping him a new one. And he may not even have deserved it this time. But it was those damn hormones…

Dr. Kreiner shares a husband’s tale:

I’m racing a 40 foot sailboat in 25 to 30 NNW winds yesterday out of Manhasset Bay. Gear was breaking, sails ripping, we broached twice….nearly did a “death roll” (when the boat gets knocked down and the tip of the mast nearly hits the water). A competitor had a man overboard; the USCG and NCPD were involved with another boat in distress. It was insane. The adrenaline is pumping, the testosterone is flowing and I walk in the door 12 hours after I left and there is Gina.

She is sitting on the couch watching reruns of 90210. I just spent 10 hours engaged in manly man activity in conditions that no one intentionally goes out in and I am hyped to share it with my wife. But nooooo she is on the edge of her seat fully engrossed in a show that went off the air 12 freaking years ago….she knows what happens. Her man just returns from the sea and she cant be bothered, I lose it….I get nuts….she yells back and then without notice gets all weepy.

Suddenly, as quickly as the tears came, they are gone and she is glaring at me with a look that bores right through me and in a voice similar to Linda Blair’s (just as her head does a 360 in The Exorcist) says, “I took 15 *&% &^%$ pills today and 12 of them went in my @#&! vagina, where they still are and I feel like a G*D damn gumball machine….let me put just one in your *@#!% penis.

Man, I spun on my heels thinking, “Why couldn’t that have been me who went overboard?”

This is one husband’s story about living with a woman on hormones. It is not always this dramatic but the stress can be very difficult for a couple and many relationships benefit from professional support when going through fertility treatments.

Imagine dealing with the stress, frustrations and cyclic disappointment couples feel when trying unsuccessfully to start a family. Add to this that your wife is being pumped up with hormones that have the potential to lower her threshold of rationality and sanity. Outbursts of anger directed at especially those closest to them are very common.

Under normal circumstances most of us can control our reactions without letting our emotions get in the way. Hormones can greatly diminish our ability to control our behavior when circumstances become tense and stressful. Hormones have even been used as a defense in murder cases.

My recommendation is to get rid of any guns in the house and not respond to apparent emotional outbursts. This should pass when the cycle is completed and the hormones have faded from the system.

If not…?

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So, what’s YOUR best “blow-up” story? Come on. Confess.

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The Miracle of Birth

By Tracey Minella

December 27th, 2011 at 12:39 pm

Less than an hour ago, a long-awaited miracle baby was born on Long Island.

My beautiful niece didn’t want to know the sex of her first child. So much of the spontaneity of family-building had been taken away when infertility treatment crept into their life.

My husband and I (IVF vets who made the same choice) were big supporters of that decision, often telling them of the indescribable magic of the moment of birth, when they’d first learn what kind of child they’d had. And how much more interesting things would be for everyone to be kept guessing.

We were all together on Christmas night. It was a bit sad as we’d lost several close family members in 2011, but we had the baby to look forward to in January.

Imagine our surprise to learn that, less than 24 hours after we said goodnight on Christmas, her water broke and she was in labor. Preemies at this age are generally fine, but still…

The extended family gathered in the waiting room to await the birth, as we’ve done for every baby born for the last 34 years… including the little girl who, when we weren’t watching, somehow grew up to become a mommy today.

Suddenly, lullaby music began to play over the loud speaker in the waiting room. As if to answer the perplexed faces of the crowd, the nurse announced that the music meant a baby had just been born. Moments later, my nephew the daddy came through the door beaming with pride to spread the news.

Welcome, Kane Alexander.

You were sent down with love by a team of angels and arrived just when we needed you most.

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If you’ve had a baby, did you find out the sex in advance? If you haven’t had a baby yet, will you want to know?

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IVF, Christmas, Santa, and Faith

By Tracey Minella

December 23rd, 2011 at 7:40 pm

There’s the religious side and the commercial side to Christmas. But when you’re facing the holiday without kids, there’s not much comfort in either side, if you ask me. (And I know you didn’t, but work with me here.)

As for the commercial side: Anyone undergoing infertility treatment automatically makes it onto Santa’s “nice” list. Yep. It’s a rule, you know. I don’t care how many times you’ve ripped someone a new one this year when they overstepped in the none-of-your-business-baby-making-questions department. There’s no hunk of coal with your name on it. But it’s little consolation when what you want most in the world can’t be found under a tree.

An exemption from the naughty list will hardly make your spirits bright this weekend. Especially if this isn’t the first Christmas you’ve been trying to conceive. Or the second. Or the third…

I went through seven miserable Christmases. Seven.

I “get it”. And I also will never forget it. There’s nothing I can say to make it better, but I will offer the fact that the success rates for IVF today are astronomically higher than they were when I conceived my kids. So most of you won’t have as many miserable Christmases, or at least you will have me for company.

As for the religious side of Christmas: That topic is so personal and such a hot potato. Some lean on their faith to get through the journey. Others may be questioning or turning their backs on their faith. After all, isn’t it natural to ask why this is happening? Not conceiving is awful. Miscarriage is awful. A loss after birth is unspeakable, I imagine.

I used to take the subway from my job over to St. Patrick’s Cathedral in NYC every year on the last work night before Christmas. I’d just stand there and soak it all in, trying to draw some strength to make it through the holiday with the family. I lit enough candles to power a village. Year after year. For seven years.

Again, I “get it”. I’ve felt the full range of religious emotions. I’ve made my own bargains with God. And all I will offer is that when the prayer that seemed like it’d never be answered got answered, I felt all the awful waiting time melt away. And I couldn’t imagine having any other baby than the one in my arms at that moment.

For those who believe in the miracle of the Immaculate Conception and the birth of Christ, I hope your faith remains strong even through the challenges, and I wish you your own little miracle in the New Year.

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In your opinion, what is the hardest part of Christmas when you’re infertile? The commercial or the religious part, and why?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=4807&picture=nativity-scene

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Miracle on Old Country Road

By David Kreiner MD

December 22nd, 2011 at 11:09 pm

In this season of miracles, I decided to pull out my very favorite old post of Dr. Kreiner’s, edited for the current holiday. Any infertility patient fortunate enough to conceive will be jealous of this patient’s luck.

Here’s Dr. Kreiner’s story:

I was feeling depressed the other day.  It seemed that we had insurmountable computer issues, staff morale was down and my family was acting rebellious.  My kids were arguing with each other, with me and I found myself mindlessly walking out of my office down Old Country Road.

I came to a busy intersection and just stood there as cars sped by me.  Honestly, at that moment in time I was thinking, why am I here?  Why put up with all the hard work at the office trying to make the practice viable despite the pressures of the recession?  Insurance companies were denying claims and when they were paying claims, it was at lower reimbursements that threatened to not compensate for our expenses.  The government was planning to lower reimbursements even more.  Patients, also experiencing financial difficulties were either asking for more breaks in the fees or not paying.  I have to admit I gave thought to giving it all up as the pain and aggravations were not worth the efforts.

Suddenly, a white Audi convertible came to a screeching stop right next to me.  It was one of my patients in the passenger seat sporting a very pregnant belly and apparently blowing through what I assumed was a labor pain.  Her husband spoke.  “Dr. Kreiner, Lara went into labor early this morning and we are on our way to the hospital to have the baby…can you come with us?”  Speechless and shocked, I let myself into the cramped backseat and tried to comprehend what was happening as Lara’s husband took off.

We pulled into the emergency room five minutes later.  Lara and I were taken to the labor floor while her husband dealt with the paperwork at the desk.  Nurse’s barked orders, the doctor was called, and Lara started screaming during her pains and in this laboring frenzy I was awakened from my funk.  It has been awhile since I was involved in a delivery but this baby was not waiting for the doctor and I got back into obstetrical mode, checking the baby’s position and heart rate and getting the anesthesiologist to administer the epidural.  Lara’s husband was now at her side assisting her with her breathing.

“Push Lara, push”, I yelled as I saw the baby’s head crowning.  She and her husband acted as if they had trained all pregnancy for this moment, working together as a team, his arm around her shoulders, breathing with her and supporting her back as she pushed.

Well, the doctor got there just before the baby was delivering.  I stood on the side watching this miraculous event…Lara and her husband together pushing the baby out of the same womb that I had implanted nine months earlier.  I remembered the image of showing Lara and her husband the photograph of the embryo and then watching on ultrasound as I injected the drop of media and air bubble containing the microscopic embryo into her uterus.  I thought how sweet life was and I smiled.

Moments later, Lara put baby Adam to breast, her husband a proud new father was beaming as he gave out chocolate cigars to the doctor and nurses and then came to me with tears in his eyes and said, “thank you, so much Dr. Kreiner.  We could never have done this without you.”

What can I say?  It was as if my problems never existed.  I thought the only thing missing for me was to be with my family and appreciate what I have.  And what my wife and I have is truly amazing.  We have my two lovely daughters and two sons, one a newlywed with a fantastic wife and another son who has the best wife and most gorgeous three children one can ever wish for.  Playing with them, having brunch and dinner with the family I love, I enjoyed a very Happy Hanukkah.

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How do you feel about having to leave your fertility doctor once you get pregnant to go back to your OB/GYN? Do you wish your RE could deliver the baby?

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Happy Hannukkah From Long Island IVF & ECF

By Tracey Minella

December 20th, 2011 at 10:31 pm

Here’s wishing you and yours a wonderful Hanukkah. (I thought it’d never get here!)

Spinning dreidels, collecting gelt, and eating latkes are all rich Hanukkah traditions that many of you are anxiously waiting to pass on to your own children some day.

For those who are frustrated or losing faith due to the delay in your family-building plan, I hope you’ll draw strength from the Hanukkah story.

When you feel you have only enough left in you to go on for one more day, you will somehow, inexplicably, go on for much longer. You will keep the faith.

And for many, you will witness a miracle.

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Do you believe in miracles?

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Is Micro-IVF the Answer?

By David Kreiner MD

December 19th, 2011 at 9:08 pm


You’ve already crossed the bridge from “We’re going to get pregnant!” to “We need help…” But this other side looks filled with more obstacles, including expensive and risky fertility medications.

How far do you have to go just to have a baby?

Micro IVF (sometimes called MiniIVF) may be your answer.

The primary point of MicroIVF: fewer fertility drugs, less cost.

Plus you get additional benefits: decreased chances of ovarian hyperstimulation syndrome and of multiple pregnancy.

Additionally, East Coast Fertility and Long Island IVF patients who choose MicroIVF can increase their savings if they also use our Single Embryo Transfer Program — embryo freezing, storage, and future frozen embryo transfers are free.

Why go Micro?

I learned long ago that pregnancies of twins, triplets, and more can bring heartache to what should be a joyous journey for fertility patients. So the ECF team has dedicated our practice to the achievement of safe, healthy pregnancies.

IUI or IVF?

Intrauterine insemination (IUI) is often considered the first order of business for many infertility patients.

Sometimes called “artificial insemination,” the usual protocol — oral and injectable fertility medications to induce superovulation (of more than one egg in a cycle), followed by insemination via exam room procedure — is believed to be simpler and, therefore, less costly than IVF.

That’s just not true any longer.

The facts now are that success rates can be far better for IVF than for IUI, depending on the individual’s or couple’s cause of infertility. Many women undergo several IUIs before achieving conception.

Some infertility causes — pelvic adhesions/scarring, blocked fallopian tubes, endometriosis, and severe male factor issues — will not respond to IUI but are treatable with IVF.

Even patients who would otherwise try IUI to get pregnant will find that choosing MicroIVF can result in cost savings and greater safety:

Micro IVF fee (current as of Dec 2011): $3900

ICSI (if required): $1000

Anesthesia (as requested): $550

IUI with hormone injections: $3500 to $4500

Is MicroIVF right for you?

Each patient’s case is considered carefully and individually. The following are conditions that might respond best to MicroIVF:

Young healthy women with PCOS or who otherwise produce many follicles

Women with pelvic adhesions or scarring, blocked fallopian tubes, or endometriosis

Couples with severe male factor infertility

MicroIVF really is a case of a little treatment going a long way! With it, you can access the world’s most successful assisted reproductive technology at far less cost.

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Has this blog post changed your mind about the course of treatment you are taking (or planned to take)? Did you know about Micro-IVF and Single Embryo transfers prior to this post?

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Get Your Mind Off Your Infertility This Holiday Season

By Tracey Minella

December 16th, 2011 at 9:45 pm

I know you can’t really do that…or at least not for long. It’s all-consuming. Others are counting the days until Christmas or New Year’s…you’re counting the days of your cycle.

It’s maddening.

Emotions can range from frustrated and sad to pissed and downright suicidal. Add the holiday stress of everything you see this month being centered on children and it’s like salt in the gaping wound.

Many of you may be saving for your uncovered treatment costs…another major stress in itself! (I didn’t eat Kraft macaroni and cheese and ramen noodles for 6 years because I loved them either!)

However, if you are fortunate enough to have medical coverage or otherwise be able to afford your infertility treatment…and have a bit extra to spare this holiday season…you might be inspired to action by what I’m about to share. And if you can’t take action, you will still want to read this.

So, here is a feel good story that is so…well…feel good…that it will make you smile for real. (Not one of those “faking it” smiles you’ve been gallantly wearing all month at office parties and cookie swaps.)

A woman who lost her husband this year decided to secretly pay for the layaway Christmas gifts of struggling families with young children. This trend is popping up in Kmart stores across the country this season. Apparently, a significant number of shoppers who use this layaway service end up losing the layaway because they can’t keep up with the payments. That means the gifts get re-shelved and their kids have no Christmas. For the poorest people, the layaway wasn’t even toys, but essentials like clothes.

Please read this story. It will make your heart feel good. It’s about generosity and kindness and Christmas spirit.

It’s about all the things we forget because we are stressed about our infertility and the people and situations that make us crazy this time of year. Here’s the link: http://finance.yahoo.com/news/anonymous-donors-pay-off-kmart-222535611.html

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If anyone is inspired to do this (or has already done it), please come back and share your story of what you did and how it made you feel.

Photo credit:  http://www.publicdomainpictures.net/view-image.php?image=13064&picture=christmas-shop

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Five Facts About Embryo Transfers

By Tracey Minella and David Kreiner MD

December 15th, 2011 at 4:07 pm

One is the loneliest number. Eight makes you an Octomom. But there’s more to Embryo Transfers than just those extremes.

And the standards regarding how many embryos to transfer back to a woman’s uterus have changed as the assisted reproductive technology improves and IVF success rates continue to rise.

Two decades ago, it was standard to transfer up to four embryos per fresh IVF cycle. Even more if you were older or had prior failed IVF cycles. Today, cutting edge clinics like Long Island IVF and East Coast Fertility have success rates so high that Single Embryo Transfers (SETs) are often highly encouraged. And transferring more than two embryos is generally discouraged in most cases.

So, nowadays, one is no longer the loneliest number…it’s often the luckiest number!

Below, Dr. Kreiner shares five facts about embryo transfers that curious patients need to know:

  • After a few days of development, the best appearing embryos are selected for transfer
  • The number chosen influences the pregnancy rate and the multiple pregnancy rate
  • A woman’s age and the appearance of the developing embryo have the greatest influences on pregnancy outcome
  • Embryos are placed in the uterine cavity with a thin tube
  • Excess embryos of sufficient quality that are not transferred can be frozen

After a few days of development, one or more embryos are selected for transfer to the uterine cavity.  Embryos are placed in the uterine cavity with a thin tube (catheter).  Ultrasound guidance may be used to help guide the catheter or confirm placement through the cervix and into the uterine cavity. Although the possibility of a complication from the embryo transfer is very rare, risks include infection and loss of, or damage to the embryos. 

The number of embryos transferred influences the pregnancy rate and the multiple pregnancy rate. The age of the woman and the appearance of the developing embryo have the greatest influence on pregnancy outcome and the chance for multiple pregnancy.  While it is possible, it is unusual to develop more fetuses than the number of embryos transferred. It is critical to discuss with your doctor the number to be transferred before the transfer is done.

In an effort to help curtail the problem of multiple pregnancies (see multiple pregnancies), national guidelines published in 2006 recommend limits on the number of embryos to transfer (see Tables below). These limits should not be viewed as a recommendation on the number of embryos to transfer. These limits differ depending on the developmental stage of the embryos and the quality of the embryos and take into account the patient’s personal history.  

Recommended limits on number of 2-3 day old embryos to transfer

Embryos

age <35

age 35-37

age 38-40

age >40

favorable

1 or 2

2

3

5

unfavorable

2

3

4

5

Recommended limits on number of 5-6 day old embryos to transfer

Embryo Prognosis

age <35

age 35-37

age 38-40

age >40

favorable

1

2

2

3

unfavorable

2

2

3

3

In some cases, there will be additional embryos remaining in the lab after the transfer is completed.  Depending on their pregnancy potential, it may be possible to freeze them for possible use in a subsequent cycle. 

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How many embryos have you had transferred at one time? What was the hardest thing about your decision on the number?

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Cryopreservation: A Look into the IVF Freezer

By Tracey Minella and David Kreiner MD

December 13th, 2011 at 2:41 pm

Remember the Good Humor man? You’d hear that sound from blocks away and bolt out the door barefoot, shrieking “STAAAPPP!” arms flailing, and being joined by the rest of the block like rats to the Pied Piper.

Remember the way the white square door with the chunky silver hinge on the back swung open and all that cold, smoky fog billowed out into the humid air?

Remember the frozen magic inside?

Well, Long Island IVF and East Coast Fertility have magic freezers, too. Full of dreams. Full of potential. Full of embryos that may one day turn out to be rugrats running after the ice cream man.

In fact, Long Island IVF’s freezer once held the frozen embryo that turned out to be Long Island’s first cryo baby! Let’s revisit an earlier post by Dr. Kreiner which lets us take a peek inside the freezer of Long Island’s first successful cryopreservation program:

In 1985, my mentors, Drs. Howard W. Jones Jr. and his wife Georgeanna Seegar Jones, the two pioneers of in-vitro fertilization in the USA and the entire western hemisphere, proposed the potential benefits of cryopreserving or freezing embryos following an IVF cycle. They predicted that cryopreserving embryos for future transfers would increase the overall success rate of IVF and make the procedure more efficient and cost effective. They also suggested that it would reduce the overall risks of IVF. For example, one fresh IVF cycle might yield many embryos which can be used in future frozen embryo transfer cycles, if necessary. This helps to limit the exposure to certain risks confronted only in a fresh IVF cycle such as the use of injectable stimulation hormones, the egg retrieval operation, and general anesthesia.

At East Coast Fertility, we are realizing the Jones’ dream of safer, more efficient and cost effective IVF. By utilizing the ability to cryopreserve embryos in 2007, 61.5% (118/192) of patients under 35 were successful in having a live birth as a result of only one egg stimulation and retrieval cycle! In addition, because of our outstanding Embryology Laboratory, we are usually able to transfer as few as 1 or 2 high quality embryos per cycle and avoid risky triplet pregnancies. In fact, since 2002, the only triplet pregnancies we have experienced have resulted from the successful implantation of two embryos, one of which goes on to split into identical twins (this is rare!). By cryopreserving embryos in certain high-risk circumstances, we are able to vastly reduce the risk of ovarian hyperstimulation syndrome requiring hospitalization. At East Coast Fertility, safety of our patients comes first. Fortunately, our success with frozen embryo transfers is equivalent to that of fresh embryo transfers, so that pregnancy rates are not compromised in the name of safety, nor are the babies.

Today, as reported in the Daily Science: “The results are good news as an increasing number of children, estimated to be 25% of assisted reproductive technology (ART) babies worldwide, are now born after freezing or vitrification” (a process similar to freezing that prevents the formation of ice crystals).

The study, led by Dr Ulla-Britt Wennerholm, an obstetrician at the Institute for Clinical Sciences, Sahlgrenska Academy (Goteborg, Sweden), reviewed the evidence from 21 controlled studies that reported on prenatal or child outcomes after freezing or vitrification.

She found that embryos that had been frozen shortly after they started to divide (early stage cleavage embryos) had a better, or at least as good, obstetric outcome (measured as preterm birth and low birth weight) as children born from fresh cycles of IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection). There were comparable malformation rates between the fresh and frozen cycles. There were limited data available for freezing of blastocysts (embryos that have developed for about five days) and for vitrification of early cleavage stage embryos, blastocysts and eggs.

Slow freezing of embryos has been used for 25 years and data concerning infant outcome seems reassuring with even higher birthweights and lower rates of preterm and low birthweights than children born after fresh IVF/ICSI. For the newly introduced technique of vitrification of blastocysts and oocytes, very limited data have been reported on obstetric and neonatal outcomes. This emphasises the urgent need for properly controlled follow-up studies of neonatal outcomes and a careful assessment of evidence currently available before these techniques are added to daily routines. In addition, long-term follow-up studies are needed for all cryopreservation techniques,’ concluded Dr Wennerholm.

The use of frozen embryos has become a common standard of care in most IVF Programs. At East Coast Fertility, [now merging with Long Island IVF], we are able to keep multiple pregnancy rates down – by only transferring one or two embryos at a time – while allowing patients to hold on to the additional embryos that they may have created during the fresh cycle. It is like creating an insurance plan for patients. We developed a unique financial incentive program using the technology of cryopreservation to encourage patients to transfer only one healthy embryo at a time.

In order to ensure the best outcome for mother and child – these special pricing plans take the burden off the patient to pay for the additional transfers and the cryopreservation process. We have eliminated the cost of cryopreservation, storage and embryo transfer for patients in the single embryo transfer program. Thus, patients no longer have that financial pressure to put all their eggs in one basket! We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

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Did you know before today that Long Island IVF is the home of Long Island’s first cryo baby?

Or that East Coast Fertility’s Director, Dr. Kreiner, and Long Island IVF’s Co-Directors, Drs. Kenigsberg and Brenner were running the show together at Long Island IVF way back then when cryo first came to Long Island…back when most of you reading this were very little kids?

Stay tuned as we bring you more interesting history about these IVF pioneers now that they’re all together again.

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