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Archive for January, 2012

Putting All Your …Sperm in One Basket

By Tracey Minella

January 31st, 2012 at 10:05 am

It’s the last day of the month and that means it’s “Just for Guys” day here at the Fertility Daily blog! For those who don’t know it, I always post something of particular interest to the boys on the last blogging day of the month. You know, just to remind them where their place is…Oh, just kidding! (Where would we be without them?)

So, today I’m sharing a true miracle story especially to inspire the guys with male factor infertility (and their loving wives).

The man was tested. No sperm. Not low motility or low count.


But thanks to advancements in assisted reproductive technology, he underwent a testicular biopsy…a procedure to search tissue for sperm, one at a time. A team of three scientists spent 9 hours searching his tissue for sperm.

They found one. A single sperm. And they froze it.

The wife underwent IVF and wasn’t a super egg producer herself, according to the article. But, with ICSI (intracytoplasmic sperm injection), they fertilized one of her eggs with that single sperm cell.

And she conceived. Against the odds.

They have a little girl now. To read the whole story, click here:

Fortunately, Long Island IVF patients have easy access to our on-staff male reproductive specialist, Dr. Yefim Sheynkin. His unique experience and many years of expertise in reproductive medicine, microsurgical treatment of male infertility, and sperm retrieval techniques for in vitro fertilization are unparalled.

If you have male factor infertility, please ask your RE about all of your options. Get evaluated by their on-staff reproductive urologist. The best centers will have one. You may have more options than you think.

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Do you find stories like this inspiring? If you were diagnosed with severe male factor infertility and were a candidate for a procedure like the couple in this article had, would you consider it?

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Will You Have a Dragon Baby?

By Tracey Minella

January 23rd, 2012 at 4:53 pm

You don’t have to be Chinese to appreciate the richness of that culture’s traditions and the mystique of the Chinese methods of enhancing fertility.

Today is the celebration of Chinese New Year. Out with the Year of the Rabbit. Welcome the Year of the Dragon.

The rabbit was to be a peaceful year. Children born in the Year of the Rabbit are said to be among other things sweet, sensitive, obedient, observant, clever, resilient and well-liked. How wonderful! Why would it be nice to see that year end?

Because the Year of the Dragon…well, that’s the biggest deal of all. It is considered to be THE luckiest year of the entire Chinese Zodiac and the most coveted year to have a child! And it only comes around every 12 years, so it’s a pretty big deal.

If you’d like to read about the extremes some people are going to just to ensure they conceive a dragon baby, check out this link:

But be forewarned, it could upset you, especially if you believe that having a baby any day of any year is all that really matters.

The Chinese zodiac consists of a cycle of 12 years, with each year being named for a different animal, and supposedly bestowing upon those born in that year certain characteristics which are similar to the traits of the featured animal.

In the early years of my own fertility battle, I worked with Mai, a friendly Chinese girl, in law firm near Chinatown. Whenever she spoke of her family’s traditions, I listened in fascination…especially whenever anything related to good luck or fertility came up. I figured so what if I’m Italian and Irish. I want a baby and I’ll try anything!

So now I can share some of Mai’s wisdom with all those trying to conceive at this enchanting time in the Chinese calendar.

On New Year’s Eve, the Chinese often celebrate by eating dumplings called “jiaozi”, which translates literally to “sleep together and have sons” according to Mai was adept at making these challenging dumplings. I, however, was inept.  So, I’d improvise and order wonton soup instead. (No wonder it took me so long to conceive…)

Then, sweep out the house from top to bottom with a broom and give it a good cleaning. It symbolizes the sweeping away of all the bad luck of the past year so the good luck can enter. I do this religiously every single year. It feels authentic. You must try it.

On New Year’s Day, wear something red. It’s the color of good luck and symbolic of wealth. Mai’s older relatives used to give her and her siblings red envelopes with money inside on Chinese New Year. Maybe you can break out a red envelope, start a new tradition, and get your relatives to contribute to the IVF fund. Wish I’d thought of that one sooner.

Put away the knives…this is good advice for hormonal women anyway. Using knives and scissors at this time symbolizes the “cutting off” of the good luck and is an omen of bad luck in the year to come. Remember this one at mealtime.

My point is that you don’t have to be Chinese to embrace some of the Chinese culture

and have some fun. Wear red. If you’re feeling adventurous, try making a batch of jiaozi from an internet recipe. Or do the wonton soup thing. (I still do to this day!) Try your hand at chopsticks. Surround yourself with the richness of red and gold. Sweep out that old bad luck and embrace the peaceful year that waits.

Do you celebrate Chinese New Year or follow any other cultural traditions with fertility-related traditions? What do you think about the actions of those in the article?

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Can Twins Be Born Years Apart?

By Tracey Minella

January 19th, 2012 at 2:14 pm

Unless you’re the Octomom, chances are that if you’ve done IVF, you may have frozen…or cryopreserved… a number of embryos above and beyond the number you elected to transfer back on your fresh IVF cycle. If you were lucky enough to have an excess, that is. (Alas, my first few IVFs back in the dark ages, never produced enough for cryo. But later cycles did.)

So, let’s assume you had a baby from that fresh cycle. You breathe a sigh of relief at your motherhood dream coming true and proceed to enjoy a few years of normalcy with your little miracle. So you’re out there doing the play date thing, having great birthday parties, doing Disney. Not to mention suffering–happily–  through Yo Gabba Gabba  as you catch yourself singing things like “Don’t bite your friends”…

All the while in the back of your brain there’s some security  knowing you’ve got “potential” children…literally frozen in time from when your eggs were younger than they are today. No guarantee, but some level of security nonetheless. They do cross your mind at times.

So the time comes to revisit the clinic with the hope of a successful cryo transfer. Imagine it works again.

The question: Are your two children “twins”?

Well, they were conceived at the same time, as fraternal twins would be. But one has been out living its life for a few years. A big head start. The other was tossed in the freezer. (Oh, I’m just kidding…) But the reality is that one… merely through the judgment call of an embryologist … was ever so carefully placed in a frozen state of existence. It’s potential for life on hold. For years.

So are they “twins”?

Is it defined at conception? Is it occupying the same uterus at the same time?

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What do you think?

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“I Have a Dream”: MLK Inspires Infertile Women

By Tracey Minella

January 16th, 2012 at 3:32 pm

Today, as Americans celebrate the late, great Dr. Martin Luther King, Jr., we usually remember his most famous quotation from his 1963 speech for racial equality.

“I Have a Dream…”

These words are also the mantra of the suffering, infertile woman.  Without suggesting the causes are equal in terms of life and death, there are some parallels between the passion MLK felt for his cause and the passion infertile women feel for their quest for motherhood.

When you are infertile, you are ever-aware of a different unfairness and inequality in the world. How fertile couples take their fertility for granted. How others have what you’ve been denied. You suffer unimaginable pain and despair at what is effectively a denial of your right to the pursuit of your happiness. And you passionately dream your dream…of a day when you will hold a baby in your arms.

But for the infertile woman, there is no group to protest against to make that dream come true. Your plight is based on individual circumstance, not oppression by others. New legislation won’t get you pregnant. So how do you deal with the frustration over the situation? How do you keep your dream alive?

People often forget that Dr. King…a spiritual man and motivational speaker…gave us more than that one famous quote. And this inspirational gem also speaks to the heart of the infertile woman:

“Faith is taking the first step, even when you don’t see the whole staircase.”

Keep the faith. Follow that dream.

Thank you, Dr. King, for not only inspiring today’s infertile women to have faith and follow their dreams, in spite of seemingly insurmountable obstacles in their way, but for also beginning the movement that has resulted in today’s opportunities for… and the acceptance of… inter-racial adoption and blended families.

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IVF and Superstitions

By Tracey Minella

January 13th, 2012 at 12:00 am

Anyone out there ever have a transfer or retrieval or IUI or pregnancy test on a Friday the 13th? I did.

How did you feel about that? Defeated and doomed from the start? Steadfast and set to defy the day? Or was it just another day?

Do you do anything special on such days for good luck?

When I was doing IVF, I used to wear this fertility amulet. It was a pewter fertility symbol hanging on a long, thin, black leather cord around my neck. I also carried a mirrored compact with an angel on it given to me by a friend who was moving away who said I would get pregnant. (After I finally did, I passed that compact along to another friend TTC).

And I also always wore this one particular pair of jeans to my retrievals and transfers. It was the pair I wore on my first consultation appointment with Dr. Kreiner. Of course, as the years wore on, those jeans wore out. But I kept wearing them anyway. The bottoms were frayed, the knees were both shot, and the back end offered less coverage than the hospital gown I traded them in for. But I wore them to both successful retrievals and transfers.

And now they have been saved in a special drawer along with other mementos of “the infertility years”, like all of my hospital bracelets, slipper socks, souvenir unused syringes and needles, pharmacy and insurance bills, and other trinkets to remind me of the journey. Ready to pull out when I’m feeling nostalgic… or when the kids grow up and I want to make them feel guilty about misbehavin’ (“Ya see all these bracelets, Missy? Do you know I had general anesthesia 10 times to have you…?”).

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 Do you have any routines, traditions, or superstitions regarding your treatment…on Friday the 13th or any other day? If so, please share.

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IVF and Cloning

By David Kreiner MD, and Tracey Minella

January 10th, 2012 at 12:45 pm

We’ve all jokingly commented at one time or other how we’d love to clone ourselves, so we could accomplish more things in less time. But as progress in technology continues to advance, we find ourselves on the brink of a potentially dark place. Cloning technology is no longer science fiction. It is here. It is controversial. Now what?

Dr. Kreiner takes a look at the possible implications of cloning to the field of ART:

First Octomom. Then a fertility doctor is denounced for claims of human cloning*. I get the impression there are fertility specialists out to ruin the reputation of IVF for the rest of us.

In the case of Octomom, there is some question as to how the patient was counseled. We focus on high success with least risk as possible. It is unfortunate that a few others aspire to something other than their patient’s best interests. It is very difficulty for a fertility specialist to deal with patients who insist on using up all their embryos in one attempt. We share with the patient a desire not to discard embryos but retain responsibility for not allowing for potentially dangerous outcomes.

Cloning is an ethical dilemma yet to be solved by society. Until then we do not participate in cloning since we are unsure whether to do so is ethically sound. Benefits of modified forms of cloning have been proposed. Multiplying high quality embryos in patients would theoretically increase their success rates. Women who had poor quality eggs (cytoplasm) could have their nuclei transplanted into the egg of a healthy young woman. Again, theoretically, this can improve success rates. Another proposed clinical use is to produce tissue for transplantation say in a child with cancer who requires chemotherapy.

The form of cloning that usually comes to mind however, is the creation of an identical being whether it be to replace a loved lost child or in our common vernacular a “mini-me”. It is this possible use of the technology that causes almost universal disdain in our society. We have yet to figure out whether there is a place for any of the aforementioned forms of cloning that is potentially more palatable.

IVF is a clinically useful form of technology that is allowing for greater than 40,000 more babies to be born each year who may otherwise never have been given life. But, as with all technology there are risks and potential downsides that need to be considered. Today, cloning as well as high ordered multiple embryo transfers moves the IVF technology beyond our comfort zone with our assessment of the potential risks and downsides. Let us not distort the relative benefit vs. risk of IVF technology by wrongfully applying it to cloning or high order multiple embryo transfer.


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Do you think cloning should be available, and if so, in what circumstances?

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Is Your Biological Clock Running Out?

By Tracey Minella and David Kreiner MD

January 6th, 2012 at 12:00 am

So, we just counted down the minutes on the regular clock, ringing in a brand new year. Did that remind you of anything? Maybe some other clock that is ticking down and causing you to fidget a bit?

You know which clock I mean: THE BLASTED BIOLOGICAL CLOCK!

I’ve always hated this term. Probably because I used to hit its SNOOZE button for years. It used to nag at me in the back of my mind as I pursued my education and got settled in my career…especially since I married young. And when it wasn’t in the back of my mind, it was being shoved smack in my face by the rude comments of nosy jerks, collectively known as “the masses of asses”. We’ve all got ‘em.

If you’re wondering whether your biological clock is really running out, this post by Dr. David Kreiner may be enlightening:

Tears start to course down the cheeks of my patient, her immediate response to the message I just conveyed to her. Minutes before, with great angst anticipating the depressing effect my words will have on her, I proceeded to explain how her FSH was slightly elevated and her antral follicle count was a disappointing 3-6 follicles. I was careful to say that though this is a screen that correlates with a woman’s fertility, sometimes a woman may be more fertile than suspected based on the hormone tests and ovarian ultrasound. I also said that even when the tests accurately show diminishing ovarian reserve (follicle number), we are often successful in achieving a pregnancy and obtaining a baby through in vitro fertilization especially when age is not a significant factor.

These encounters I have with patients are more frequent than they should be. Unfortunately, many women delay seeking help in their efforts to conceive until their age has become significant both because they have fewer healthy genetically normal eggs and because their ability to respond to fertility drugs with numerous mature eggs is depressed. Women often do not realize that fertility drops as they age starting in their 20s but at an increasing rate in their 30s and to a point that may often be barely treatable in their 40s.

A common reason women delay seeking help is the trend in society to have children at an older age. In the 1960’s it was much less common that women would go to college and seek a career as is typical of women today. The delayed childbearing increases the exposure of women to more sexual partners and a consequent increased risk of developing pelvic inflammatory disease with resulting fallopian tube adhesions.

When patients have endometriosis, delaying pregnancy allows the endometriosis to develop further and cause damage to a woman’s ovaries and fallopian tubes. They are more likely to develop diminished ovarian reserve at a younger age due to the destruction of normal ovarian tissue by the endometriosis.

Even more important is that aging results in natural depletion of the number of follicles and eggs with an increase in the percentage of these residual eggs that are unhealthy and/or genetically abnormal.

Diminished ovarian reserve is associated with decreased inhibin levels which decreases the negative feedback on the pituitary gland. FSH produced by the pituitary is elevated in response to the diminished ovarian reserve and inhibin levels unless a woman has a cyst producing high estradiol levels which also lowers FSH. This is why we assess estradiol levels at the same time as FSH. Anti-Mullerian Hormone (AMH) can be tested throughout a woman’s menstrual cycle and levels correlate with ovarian reserve. Early follicular ultrasound can be performed to evaluate a woman’s antral follicle count. The antral follicle count also correlates with ovarian reserve.

By screening women annually with hormone tests and ultrasounds a physician may assess whether a woman is at high risk of developing diminished ovarian reserve in the subsequent year. Alerting a woman to her individual fertility status would allow women to adjust their family planning to fit their individual needs.

Aggressive fertility therapy may be the best option when it appears that one is running out of time. Ovulation induction with intrauterine insemination, MicroIVF and IVF are all considerations that speed up the process and allow a patient to take advantage of her residual fertility.

With fertility screening of day 3 estradiol and FSH, AMH and early follicular ultrasound antral follicle counts, the biological clock may still be ticking but at least one may keep an eye on it and know what time it is and act accordingly.

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Did you realize that aging is not the only factor in the biological clock race? Did you know that certain conditions, like endometriosis, can play a part, too?

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“Yo Mama’s So Fat…” and Other Reasons Infertile, Overweight Women Kill

By Tracey Minella and David Kreiner MD

January 5th, 2012 at 6:21 pm

Didn’t these jeans fit me three weeks ago?


Raise your hand if you made a resolution to lose weight this year…again. Or were you like me and just thought it but didn’t say it out loud… to avoid the snickering? C’mon, get that hand up, sister.

Tell me I’m not the only one out there who chomped down too many Christmas cookies, finished off too many fried latkes and zeppoles, and got hammered on gallons of eggnog. Really, I’m not the only one pulling out the “fat” clothes again, am I?

To a woman TTC, nothing is worse than being told you can’t have a baby without medical intervention…unless you’re then told you’re too overweight to have the treatments. That can hurt even more than those terrible fat jokes.

For me, depression and overeating Oreos went hand in…well… mouth. And the longer my infertility journey took… with the sorrows of miscarriage, failed IVFs, and an ovarian torsion to drown… the bigger the gap got in the back of my hospital gowns.

In a perfect world, we’d all be a healthy weight. None of us would be infertile, or have thyroid issues or diabetes, or PCOS, or just plain-old, depression-induced obesity to fill the void where our baby is supposed to be.

But the world is not perfect.

Fortunately, there are compassionate RE’s out there who are willing to give overweight patients the respect and the treatment they deserve. They’re just not easy to find. Maybe they even felt the sting of the public’s disdain for the obese on a personal level. Whatever their motivation, it’s worth the extra effort to find this kind of support on your infertility journey.

You need a doctor who is willing to potentially sacrifice his program’s IVF stats to make you a mom, because he believes he can do it…today…not after sending you home to lose those 20-30 pounds of extra weight first. Today.

Even if you are morbidly obese or have other health issues related to morbid obesity… and your treatment needs to be deferred for safety reasons until some of that weight is taken off…  there’s no reason to have to scale down to Cover Girl stickness in order to be treated. You can get a bun in your oven… and have some junk in your trunk!

Dr. Kreiner brings this prejudice and injustice to the forefront in his thoughtful, compassionate post:

The most shocking thing I’ve experienced in my 30 year career in Reproductive Endocrinology has been the consistent “resistance” among specialists to treat women with obesity. This “resistance” has felt at times to both me and many patients to be more like a prejudice. I have heard other REI specialists say that it is harder for women to conceive until they shed their excess weight. “Come back to my office when you have lost 20, 30 or more pounds,” is a typical remark heard by many at their REI’s office. “It’s not healthy to be pregnant at your weight and you risk your health and the health of the baby.” Closing the door to fertility treatment is what most women in this condition experience.

An article in Medical News Today, “Obese Women Undergoing Infertility Treatment Advised Not To Attempt Rapid Weight Loss”, suggested that weight loss just prior to conception may have adverse effects on the pregnancy, either by disrupting normal physiology or by releasing environmental pollutants stored in the fat. The article points out what is obvious to many who share the lifelong struggle to maintain a reasonable Body Mass Index (BMI): Weight loss is difficult to achieve. Few people adhere to lifestyle intervention and diets which may have no benefit in improving pregnancy in subfertile obese women.

The bias in the field is so strong that when I submitted a research paper demonstrating equivalent IVF pregnancy rates for women with excessive BMIs greater than 35 to the ASRM for presentation, it was rejected based on the notion that there was clear evidence to the contrary. Here’s the point I was trying to prove: IVF care must be customized to optimize the potential for this group.

Women with high BMI need a higher dose of medication. Those with PCOS benefit from treatment with Metformin. Their ultrasounds and retrievals need to be performed by the most experienced personnel. Often their follicles will be larger than in women of lower weight. Strategies to retrieve follicles in high BMI women include using a suture in the cervix to manipulate the uterus and an abdominal hand to push the ovaries into view.

Most importantly, a two-stage embryo transfer with the cervical suture can insure in utero placement of the transfer catheter and embryos without contamination caused by inadvertent touching of the catheter to the vaginal wall before insertion through the cervical canal. Visualization of the cervix is facilitated by pulling on the cervical suture, straightening the canal and allowing for easier passage of the catheter. The technique calls for placement of one catheter into the cervix through which a separate catheter, loaded with the patient’s embryo, is inserted.

Using this strategy, IVF with high BMI patients is extremely successful. With regard to the health of the high BMI woman and her fetus, it’s critical to counsel patients just as it is when dealing with women who live with diabetes or any other chronic situation that adds risk.

We refuse to share in the prejudice that is nearly universal in this field. It’s horrible and hypocritical to refuse these patients treatment. Clearly, with close attention to the needs of this population, their success is like any others.

Women who have time and motivation to lose significant weight prior to fertility therapy are encouraged to do so and I try to support their efforts. Unfortunately, many have tried and are unable to significantly reduce prior to conception.

What right do we have to deny these women the right to build their families?

It can be hard to deal with obesity and even more so when combined with infertility. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. I advise you to ask your doctor about support groups and for treatment that can help you including fertility treatment.

Remember, though this condition can be annoying, aggravating and even depressing, seek an REI who is interested in supporting you and helping you build your family and reject those who simply tell you to return after you have lost sufficient weight.

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Have you been turned away from an RE because you’re overweight or obese? Do you think that’s fair?

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What a Difference a Year Can Make

By Tracey Minella

January 3rd, 2012 at 12:00 am

Today’s is not a post about losing weight, stopping smoking, or any other traditional New Year’s resolutions that we actually have control over keeping or not.

Today’s post is meant to take a burden off of you.

If you even celebrated New Year’s Eve this year, and raised a glass somewhere at midnight, you may have also made a resolution to get pregnant in the 2012. Bad idea.

Resolutions should be something that you can control. And if you are suffering from infertility and undergoing treatment…especially if you’ve suffered losses or have had failed cycles along the way so far…you know that building your family this way is largely out of your control.

Sure, you can get in shape, eat well, sleep more, kick bad habits, get a fertility workup by an excellent RE and have any recommended tests done, and take care of dental work so you don’t have problems once you’re pregnant. Those are all great, actionable, controllable resolutions.

But once you’re in treatment, conceiving a baby is no longer something for a resolution list. And to put it there is not being fair to yourself. It is putting more pressure on yourself to have a baby when you’ve handed control of that outcome to somebody else.

If you’re in treatment, whether you have a baby is not within your control. So having a baby should be your dream, not your resolution.

It took me seven miserable New Year’s Eves to realize this nuance when I did my many IVF cycles back in the dark ages when success rates were only 17%.

But on one of those miserable New Year’s Eves, my husband and I were snuggled in a local Bed and Breakfast, weary from yet another year of failed IVF attempts and lamenting our fate… as we gazed into the orange light bulb that was “burning” in our bedroom’s “fireplace”. Par for the course of our year.

The following New Year’s was different. We were as happy that year as we’d been miserable the previous six. Forty hours into 1998, and 6 weeks early, my water broke. I finally became a mother… after six years and six IVF cycles…on this day, 14 years ago. But I will never, ever forget the heartache that only one who has suffered on this journey really knows.

Be good to yourself this year. Resolve only to do what is in your control. Surround yourself with the best people to help you achieve what is not in your control.

And dream. Big dreams.

Because one year can make a big difference.

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Do you feel out of control of your family planning? How do you cope with those feelings?

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Long Island IVF: Back to the Future 2012

By Tracey Minella

January 2nd, 2012 at 7:54 pm

Happy New Year to all of the friends and patients of Long Island IVF and East Coast Fertility.

As you probably know, these two powerhouse infertility practices have recently merged, and will now be known as Long Island IVF.

People by nature don’t like change. And when it happens to something as important as one’s chosen fertility practice, it’s bound to make some of you uncomfortable or nervous. Add the raging hormones, and you may be ready to kill…

Well, I have something very important to share that should make you all not only comfortable, but excited about this change. It is a short history lesson. Don’t you dare click away.

Back in the 80’s when IVF was pretty new, East Coast Fertility’s Dr. Kreiner and Long Island IVF’s Drs. Kenigsberg, Brenner, and Droesch were practicing together as Long Island IVF. These IVF pioneers were the first to bring IVF success to Long Island.

Long Island IVF has bragging rights to:

Long Island’s First IVF baby…

Long Island’s First Cryo baby…

Long Island’s First Donor Egg baby!

Now here’s the exciting part: After 10 years of growing as two separate practices, they are finally all back together again. This is not an experiment between strangers…these guys couldn’t know each other better! It’s the perfect union of high-tech and high-touch. So it’s wonderful for their patients.

And I should know. I was a patient when they were originally together. I also worked as a medical assistant beside all of those doctors (and many of the nurses). So you’ll have to trust me that I am doing a happy dance jig right now that they are back together again!

Everything a patient could want in an infertility practice is now available in one unified practice, including but not limited to:

·         Impressive success rates;

·         Center of Excellence distinction;

·         Payment options, grant, and refund programs;

·         Mind/Body, Acupuncture, Patient counseling, and Patient support programs;

·         Outstanding Donor Egg Program;

·         Single Embryo Transfer Program (w/free cryo, free storage, and free cryo transfers*);

·         Micro-IVF Program ($3,900 mini-IVF program*);

·         Experienced and compassionate medical staffs;

·         Locations all over Long Island, and Brooklyn.

So I ask you to think back to 1988. How old were you? Elementary school, maybe? Still playing with dolls? Well, these doctors were already together making babies by then.

When I needed them in 1992, they already had the reputation as the best on Long Island. I worked for them for six years back then. Dr. Kenigsberg did my transfer when I got pregnant with my daughter and Dr. Kreiner did the transfer with my son. I can’t say enough about the individual genius of these two doctors, and the collective genius of all of LI-IVF’s doctors. There is certainly a doctor with a style and personality that will suit yours.

I’m telling you as a grateful IVF mother and former patient and medical assistant, that you could not be in better hands. The doctors, nurses, and embryologists who created my family are together again to help you build yours. I am so happy for all of you and hope that 2012 will be the year all your dreams come true.

You can start doing YOUR happy dance jig now!

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Do you have any questions or concerns about the merger of the practices? Please ask.

*please see  website for further details on these programs

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