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Archive for May, 2012

Ethical, Moral and Legal IVF Factors

By David Kreiner MD, Tracey Minella

May 29th, 2012 at 9:35 pm

 

If you think that all fertility patients look like your average young urban professional neighbors with the SUV, think again. They are as diverse as the general population.

Actually, anyone can be infertile. There could be a reality show called “The Real Infertile Housewives of Long Island”. When the door swings open and a potential new patient walks in, infertility doctors never know what they’re gonna get. Often, it’s a so-called “traditional” married couple using their own eggs and sperm or those of a donor. It could also be an equally welcome gay couple or single woman using donor eggs and or sperm. But often enough… it’s not. And sometimes, it’s downright ugly and complicated.

Must he treat them? Should he treat them? Often, the legal system muddies the waters.

Dr. Kreiner of Long Island IVF gives us a glimpse of what it’s like to be on his side of the desk at a new patient appointment. Here’s a post he wrote prior to New York’s  legalization of same sex marriages:

Those of us who work in the infertility field are often presented with situations that make us ponder whether we should assist in endeavors that make us feel a bit, well, uncomfortable. I suppose it’s common to have these experiences in our field as family building is a cornerstone of our society. But manipulating a family affects not just the people directly involved, but all of us.

There are the straightforward illegal and unethical cases: The married woman who presents with a proposal to conceive with a man other than her husband (without the husband’s consent) or the married man “donating” his sperm to a “friend” other than his wife (without his wife’s knowledge). These are the easy ones that don’t even make me pause.

I come across more difficult questions, however, that require much more intense contemplation and research. On a daily basis, the way most of us professionals try to deal with ethical and legal dilemmas is to resort to an evaluation of the “yuk factor.” It’s an internal cliff notes version of societal morality and law that many of us professionals rely on to make daily decisions when we can’t read the whole book on an issue. Sure, there’s a potential downside of going down the slippery “yuk” slope, but when was the last time the approach “if you’d be ashamed to see it on the front page of the New York Times, then don’t do it” led you down the wrong path?

Yet, I still have difficulty understanding what’s ethically and/or legally right in some situations. The go-ahead is clear to me if an unmarried man and woman present as a couple, each using their own gametes, and both sign consent acknowledging their rights and responsibilities to the future child. Less obvious is the case of the unmarried lesbian couple who present with only one partner participating biologically. They live as a couple, but the law doesn’t necessarily recognize the partner who isn’t participating biologically as having parental rights. Should they be signing as a couple for use of donor sperm to create a baby and, if so, what –if any– are the ramifications? Is this situation different if the unmarried-yet-cohabiting partner who is not participating is a male? Does the unmarried lesbian partner have the right to adopt the baby? Does this change if the partner is a transsexual?

It would seem to me that if the couple decides that they will have a baby together, despite the fact that only one is contributing biologically, that there should be parity recognized legally based on the emotional and financial contributions the other partner makes, especially if she were willing to adopt the child and legally take on parental rights. For me the “yuk” factor becomes the legal system if that unmarried partner who is unable to contribute biologically is unable to retain parental rights in a split.

So now I’m off to the clinic to see what murky issues the day will present.

Every day is different.

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Do you think there are situations where a doctor can, should, or must refuse treatment? If so, when?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=10714&picture=halloween-wedding

 

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Find Gratitude and Hope on Memorial Day

By Tracey Minella

May 28th, 2012 at 8:12 am

 

Finally, a holiday that doesn’t absolutely require your presence at a family event. Just a day off to relax…something we all need.

Sure you may be invited to a barbeque, but bailing on it is more acceptable than, say, ditching Christmas Day. So, feel free to bail on it if you don’t want to be grilled. You come first. The family will simply have to live without your fabulous 7 layer dip.

After all, today is really about taking time to remember those heroes who’ve made the ultimate sacrifice so that we can live in and enjoy the freedom we do. And when you focus on the idea that people have given their lives for us…really focus on it… it can free you from feeling sorry for yourself for just one day.  It can bring out feelings of gratitude and hope…feelings that can be very hard to find on an infertility journey.

Think about that. A stranger – countless strangers, actually — gave his life for you. His mother, wife and children will never see or hold him again. Think of the female soldiers, too, many who died before becoming mothers. Whatever dreams they may have had for their future will not come true.

I’m not trying to make you cry here. Just trying to get in touch with your inner gratitude and hope. You have family and friends who love you (even if they seem to do or say the wrong things lately). And you have hope for the future. Hope to realize that dream of the family you’ve always wanted.

Whatever you do today, please take a moment to remember what you DO have, and why you have it. And be grateful that the dream that brings you to this page is something that is not only possible in this country, but grows more reachable each day due to advances in ART technology.

But most of all take care of yourself… and your heart… today. Because there is hope for tomorrow.

And to our patients, past and present, who are or who love someone in the military, Long Island IVF thanks you from the bottom of our hearts for your sacrifices and courage.

Don’t forget to enter your essay or video in our Extreme Family Building Makeover Contest. See the April 23, 2012 blog post for entry details.

YOU COULD WIN A FREE MICRO-IVF CYCLE VALUED AT $ 3,900.00!!!

And check back later this week as we announce the winners of the first early bird entry for May!! There’s still time to get your entry in for May early bird consideration.

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What are you doing for Memorial Day? And if you are going to be around people who “grill” you about having a baby, what’s your comeback strategy?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=21971&picture=national-cemetery

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Cryopreservation: A Look into the IVF Freezer

By Tracey Minella and David Kreiner MD

May 22nd, 2012 at 5:00 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 has a magic freezer, too. Full of dreams. Full of potential. Full of embryos that may one day turn out to be sweaty maniacs 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 very 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 [now merged with Long Island IVF], we are realizing the Joneses’ 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 Long Island IVF, the 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.

As recently 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,SahlgrenskaAcademy(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 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 Dr. Kreiner and Dr. Kenigsberg co-founded Long Island IVF  way back in 1988–back when most of you reading this were very little kids or teens?

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Long Island IVF’s “Every Baby’s Beautiful Pageant Parade”-MOVED TO RAINDATE!!

By Tracey Minella

May 21st, 2012 at 1:58 pm

 

At Long Island IVF, we love reunions. We love seeing the most recent batch of our beautiful babies every year at this time. But we’re not fond of the rain…

IN LIGHT OF THE FORECAST, WE’VE ALREADY DECIDED TO MOVE THE REUNION AND PAGEANT PARADE TO THIS WEDNESDAY, MAY 23, 2012.  PLEASE HELP US SPREAD THE WORD BY SHARING THIS ON YOUR FACEBOOK.

We wish we could have a reunion with ALL of our babies at once. But when you think of the sheer volume of children …many young adults now… conceived since we brought Long Island its first IVF baby shortly after our founding in 1988, well we’d need a super big place! And the Nassau Coliseum is probably taken!

So, since every baby’s beautiful at Long Island IVF, we decided it’d be fun to hold our first “Every Baby’s Beautiful Pageant Parade” for the boys and girls born through IVF in 2011. That is, of course, as long as it doesn’t rain on our parade! None of the Toddlers and Tiaras competitive nonsense here! Just a fun little stroll…or roll…down the red carpet! Every baby’s a winner!

Please come down with your little miracles and show off! This is what it’s all about…celebrating the life of your little miracle and your dream come true.

And be sure to check in on the Long Island Facebook page at http://www.facebook.com/longislandivf before you head on over on Wednesday if the weather looks bad. Updated information will be there if it gets postponed again. And while you’re at it, why not just “LIKE” our Facebook page if you haven’t already?!

Here’s the scoop:

What: LIIVF’s “Every Baby’s Beautiful” Luncheon and Pageant
Where: Syosset-Woodbury Community Park, Area “B,” Jericho Turnpike, Woodbury, NY 11797 (Across from the Fox Hollow Inn)
When: Tuesday, May 22,  Wednesday, May 23, noon to 2 p.m.

All family members of LIIVF babies born in 2011 are welcome at the reunion and pageant parade.

For more information or to RSVP, contact: Lindsay Montello at lmontello(at)liivf(dot)com or 516-939-BABY (2229).

Hope to see you all there!

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=18939&picture=driving-away

 

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Spending a Beautiful Weekend at the Fertility Clinic

By Tracey Minella

May 20th, 2012 at 12:13 am

 

Finally, the warm weather has arrived. The bulky sweaters have been shed (we won’t mention winter’s added pounds that need to go with them!)

And where are you on this sunny Sunday morning?

Stuck in the R.E.’s office being, well…stuck.

Stuck with a sono wand. Stuck with a needle. Stuck listening to the cries of another woman’s child as she sits in the waiting room trying to complete her family.

Well, how can we put a positive spin on this?

First, tell yourself that there is nothing… nothing… more important to be doing than what you are doing right now. Seriously, creating a baby trumps a barbeque any day. Tap into the hope that is around you. The promise of potential success. Embrace it.

Then, remind yourself that while it’s unfair that you have to go through all of this to have a child (when others can flirt and get pregnant), that you are luckier than those who need the same treatment but either have no insurance coverage or cannot afford it. Yes, it’s a small consolation, and it’s still a huge financial sacrifice, but it’s an opportunity that some don’t have. If you try to look at it that way, it may take some of the sting off.

Now, plan to make the most of the remainder of the day. Get out and do something in the sun. Vitamin D from the sun can even give your fertility a boost! Maybe do some planting or gardening. Some people love growing things and getting in touch with nature. (Plus digging is a great stress release!)

Maybe something more relaxing is more your speed? Read a book outside, walk on the beach. Get those toes in the sand. Consider a pampering pedicure. Go wild with a toe ring. Even something as small as that can give you a boost.

The point is to take some time for yourself. Do some positive visualization. Maybe even enter our Extreme Family-Building Makeover Contest and try to win the Grand Prize of a free micro-IVF cycle valued at $3,900.00! See entry details on the April 23, 2012 blog post! 

And remember…there are worse places to be spending a few hours on a Sunday afternoon…you could be stuck at a baby shower.

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What do you do on the weekends during treatment? Any rewards? Any tips on how to get through weekends at the doctor’s office?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=2071&picture=toes-in-the-sand

 

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Another Way to Get a Child Into Your Home

By Tracey Minella

May 14th, 2012 at 2:49 pm


Of course, I’m not talking about anything underhanded…
Well, Mother’s Day is finally past. Another day filled with thoughts of “Why me?” and “Why do those awful neglectful parents in the news get pregnant when I can’t?”
There’s another option for those still TTC who are frustrated and heartbroken over how long it’s taking to begin your life as parents…
Foster parenting. Even if temporarily.
Many people want to exhaust all efforts to have their own biological child before considering options like donor egg/sperm/embryos, surrogacy, or adoption. And that’s totally understandable. Everyone is entitled to build their families their own way and in their own time. But you rarely hear people mention foster parenting as a permanent or temporary answer.
May is National Foster Care Month.
Does the thought of the criminal parents in the news make you angry and ill? Does your heart break for the babies born sick? Or the children nearly murdered by abusive parents? Do you long to make a difference in the life of a suffering child?
If you answered yes, maybe becoming a temporary or permanent foster parent may be for you. Of course, it isn’t easy. There are qualification processes and red tape to go through. But for some people, having a child to start loving, even while you continue your infertility journey, can take off some of the stress. A win-win in some cases.
Sometimes you can foster a newborn; other times an older child. Sometimes the child becomes available for adoption; other times not. Sometimes it’s a short-term situation; other times it’s longer term. Maybe your needs will match those of a child awaiting a foster family.
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Did you ever consider foster parenting?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=19826&picture=sad-child-portrait

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Mother’s Day: The Hardest Day of the Year for Those TTC

By Tracey Minella

May 13th, 2012 at 1:10 pm


Some of you are suffering from secondary infertility. You have a child, but can’t complete the family you envisioned without medical assistance. Maybe the child you do have was a result of medical assistance, so you understand the pain of those still on their infertility journeys. For those of you who are already mothers, Long Island IVF wishes you the happiest of Mother’s Days with your miracles.
But for those who are childless and TTC, Mother’s Day is the toughest day of the year to get through. It’s worse than the winter holidays, New Year’s Day, and your birthday. And if your own Mom is gone or if you lost a baby along the way, it’s unbearable.
Not having your family built yet can make you feel like you don’t fit in at whatever gathering you may have to attend today. It’s hard not to be bitter. It’s hard to bite your tongue at the insensitive comments.
It’s hard to know what’s worse…the moms who complain about the gift they got today, always criticize their kids, or (*gasp*) say they wish they didn’t have (so many) children. Or the women who nag you with nosy, personal questions about when are you finally going to have a baby? And let’s not even talk about those who complain about their “accidental” conceptions!
Today or tomorrow (or really any day), if you find yourself here, please feel free to vent.
If you bit your tongue today, please tell us what was said and what you wish you would have said in response.
If you didn’t bite your tongue, please, please, please share what your comeback was! Was it a cold glance, a look to kill, words of venom? Any furniture go flying? Hospital visits?
Or if you have any tips on how you got through the day, or interesting ideas on spending the day, please share those as well.
We’ll choose one comment to win a little gift card to help take away the sting a bit. Post your comments by Thursday night.
Here’s a tip from me for today: Tell yourself that this will be the last Mother’s Day you go through without a baby in your arms or on the way. (It may or may not be true, but you will feel better for today if you allow yourself to envision that is true.)
Thinking of you all today, mothers of the present and especially those wonderful mothers-to-be in waiting.

 

photo credit: http://www.publicdomainpictures.net/view-image.php?image=22120&picture=mothers-day

 

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Do You Appreciate Your Nurse?

By admin

May 11th, 2012 at 10:54 pm

credit: wpclipart.com

Have you hugged your favorite nurse today?
When you’re TTC and seeing a Reproductive Endocrinologist, nurses take on a whole new importance in your life. Especially if you’re doing IVF or IUIs and are in the doctor’s office all the time.
Except for maybe an ICU nurse… perched beside your bed monitoring the bells and whistles that are keeping you alive from moment to moment… your IVF nurse is probably the most important nurse you’ll ever have a relationship with.
The nurse does so much to make your cycle run smoothly, and much of it is behind the scenes stuff you don’t even know about. She works weekends and holidays. If it’s your day to be inseminated on Christmas, she’ll be there by your side. I was lucky enough to have some great IVF nurses when I was a patient, and also to work beside them for years as a medical assistant. Many of them are still working at Long Island IVF, helping create today’s families.
Is there a special nurse in YOUR life? Do you have a special story to share about her? Or maybe you just want to make her day and give her a “shout out’ right here. Go on and do it. You‘ll both feel good about it!
Fine, I’ll start.
Thanks to the best IVF nurses around: Joey, Denise, Maryann, Sue, Patty, Dotty, and Karen. Also a shout out to my buddy Dina who started working at Long Island IVF as a medical assistant on the same day I did and went on to become a nurse. And to my favorite OR nurses Judy and Eileen.
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Now, whose hand did you squeeze to death or whose shoulder did you cry a river on?

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Today is Bereaved Mother’s Day and National Infertility Survival Day

By Tracey Minella

May 6th, 2012 at 4:44 pm

Early May is tough. And Mother’s Day is probably the hardest day of the year when you’re childless and TTC.
But for those who have lost a child, it must be unbearable.
If you or someone you know has experienced this unimaginable pain and loss, today is dedicated to supporting you and to acknowledging and remembering your child. It is National Bereaved Mother’s Day, the first Sunday in May.
I spent some time on a beautiful site owned by CarlyMarie, the woman behind the creation of Bereaved Mother’s Day. It’s a beautiful, supportive, calming place where extraordinary women can go to attempt to heal from extraordinary pain.
Check it out here: http://carlymarieprojectheal.com/2012/05/international-bereaved-mothers-day.html
So whether you are coping with infertility or with the devastation of infant or child loss, please know that there is support out there, in blogs, forums, and counseling support groups, to help you when you are ready to seek it. Please ask.
Blessings to you and your angels.

And for those still trying to build their families who need financial assistance to do so, please consider entering Long Island IVF’s “Extreme Family-Buiding Make-Over ” Contest, where the Grand Prize will be a FREE basic Micro-IVF cycle, valued at $3,900.00. Go to the April 23, 2012 blog post herein to enter, or check out the rules on our Facebook page at http://www.facebook.com/longislandivf?ref=tn_tnmn
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What have you done to help yourself through the pain? What memorial or tribute comforted you? Do you know of any other good support services? Let us know.
Photo credit: carly marie @ http://internationalbabylostmothersday.blogspot.com/

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How Fertility Issues Might Play Out for William and Kate

By Tracey Minella

May 1st, 2012 at 5:09 pm

 

It’s been one year since the royal wedding and no signs of a baby bump for the new, young Dutchess. Of course, inquiring minds want to know…

My mind is not inquiring. I don’t want to know.  Is yours? I positively loathed all the nagging during my own fertility journey.

Imagine how stressful it must be to be public figures like them, pestered by paparazzi and press who say the worst, hurtful, personal things. And what about the outright lies?

But unlike your average young celebrity couple, poor William and Kate’s royalty status adds a whole other level of stress and spotlight to their life when it comes to the meddling fertility questions. No one with a brain truly cared if J-Lo and Marc, or Mariah and Nick, or any other celebrity couple had children. They could choose not to.

That is not an option exercised by royals. Especially by the future King of England.

Imagine being a royal in line for the throne? Producing an heir is a job requirement! Whether they have a child or not impacts a nation. Which is why there’s such speculation on the subject. That, and the fact that they are an almost universally-loved couple. 

Although I don’t obsess with their family-planning efforts (or lack thereof), I’ve read many blogs speculating on whether Kate was put through any fertility screening prior to the marriage. How awful if that’s the case. If so, it makes me wonder if William was similarly screened. What if  he had issues?

One thing I haven’t seen in these blogs or articles…which struck me right away…was not “What if they do need IVF?”, but rather, “If they do need IVF, would they do sex selection to have a male heir?”

Sex selection, especially when used for gender preference rather than to screen for genetic abnormalities, has been a controversial topic  ever since it became available. Many infertile, childless couples are frustrated or even angered by its use by parents who simply want another child of the opposite sex.

I hope William and Kate (and all couples) will be able to  build their families the natural way when they are ready to do so, and will not be burdened with infertility. Though it would be interesting to see how they’d choose to handle it if IVF ever became necessary. Would they be open about this personal issue and help raise public awareness? Surely they are entitled to the same level of privacy as any couple. Just because you are a celebrity, doesn’t mean you have to make your personal issues public. But imagine what an impact they could have on how the world views infertility if they ended up with fertility issues and chose to go public. (Gee, I hope that didn’t just sound like I wished it on them just so they could champion the cause…I’d never wish infertility on my worst enemy.)

To me the real story, if there is ever one to consider, is in the impact of IVF on the royal world. The basis for the succession of the British monarchy for centuries can now be manipulated and turned on its ear not only by IVF, but by other advances in assisted reproductive technology, like sex selection. Couples who may never have been able to conceive naturally can now not only have a baby, but can take advantage of the heir-producing technology to assure that the throne travels continually down their branch of the family tree. Now you can have an heir with (or without) a spare. 

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What do you think?

 

Photo credit: (public domain): http://fundraisingcoach.com/2011/04/29/3-ways-that-fundraising-is-like-the-royal-wedding/

 

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