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Archive for June, 2012

Infertility Podcast Series: Journey to the Crib: Chapter 15 Intrauterine Insemination

By David Kreiner MD

June 29th, 2012 at 9:33 am

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Fifteen: Intrauterine Insemination. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.eastcoastfertility.com/?p=98 

Intrauterine Insemination 

Intrauterine Insemination or IUI involves preparing the sperm usually by a washing procedure removing prostaglandins and debris that would otherwise cause severe cramping when the sperm is introduced into the uterine cavity.  Since clomid, an anti-estrogen, can thicken the cervical mucus and create a cervical barrier to the sperm, IUI is a valuable adjuvant to clomid therapy. 

The disadvantage of IUI is that as many eggs as you ovulate can fertilize and implant.  In cases where multiple eggs are developed in ovarian hyperstimulation therapy like clomid and FSH (bravelle, menopur, gonal F, Follistim) the risk of multiple pregnancy occurring is enhanced.  The increase in pregnancy rate from this therapy as well as the increased risks associated with IUIs needs to be compared with the relatively superior success rate from In Vitro Fertilization where a single embryo transfer may be performed and excess embryos cryopreserved for a subsequent cycle.  If costs of the treatments are a consideration, such reduced-cost procedures like Minimal Stimulation IVF or Micro-IVF may prove to be a cost effective alternative to IUI when insurance does not cover the IUIs. 

Interestingly, not all insurance companies have caught on to this issue of a higher risk of multiple pregnancy with IUI associated with clomid or FSH.  Some require patients to go through a minimum number of IUIs prior to covering the more effective and safer IVF.

Ironically, a multiple pregnancy will cost the insurance company far more than if they had covered IVF. 

Worth repeating from the last podcast on clomid therapy: For those patients without insurance coverage, Micro-IVF, minimal stimulation IVF (utilizing Clomid), costs approximately the same as three Clomid/IUI cycles but offers women under 35 years of age a better than 40% pregnancy rate and as such may be a more cost effective alternative. 

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Was this helpful in answering your questions about Intauterine Insemination? 

Are you aware that Long Island IVF is giving away a free basic Micro-IVF cycle, valued at $3,900.00? Check out the contest here: http://bit.ly/LHbmQR

 Please share your thoughts about this podcast here. And ask any questions.

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Your Wildest Dreams Can Come True

By Tracey Minella

June 28th, 2012 at 9:00 am

Some ladies have crushes on their RE. Do you ever dream about your IVF doctor?

Ever fantasize that he comes to you in the wee hours of the morning, a hulking presence walking through the misty fog just past dawn? You feel the excitement in the thick air as he moves toward you with hurried anticipation. He meets your gaze and whispers “Let’s make a baby…”

Phew, is it getting hot in here or is it just me?

Well, for one lucky woman, this dream will come true on September 4, 2012! That woman would be the winner of Long Island IVF’s “Extreme Family-Building Makeover” Contest. She will receive a Free basic Micro-IVF cycle, valued at 3,900.00! And if she happens to come from the Long Island or Brooklyn area, she may get the good news by a personal visit from one of our doctors on the day after Labor Day!

The annual contest launched during National Infertility Awareness Week in April and runs through August 26, 2012. You can enter by essay or video. Please see full rules here:

http://blog.longislandivf.com/2012/win-a-free-basic-micro-ivf-cycle-in-long-island-ivfs-extreme-family-building-makeover-contest/

You can also get to the rules via Long Island IVF’s Facebook Page at: http://www.facebook.com/longislandivf and clicking on the “Contest” tab.

 In addition to the awesome Grand Prize of a Free basic Micro-IVF cycle, there are early incentive prizes awarded each month of the contest, so get those entries in, ladies.

A prior Micro-IVF winner tucks her baby boy in each night in Georgia. Will you be next?

 

 

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Behind the Curtain Antics in the IVF Clinic

By Tracey Minella

June 26th, 2012 at 10:06 pm

Okay ladies, I’m about to encroach on your personal space. (Guys, conservatives, prudes, or easily embarrassed types should bail now.) You may laugh or be a little uncomfortable. But, I just gotta ask:

What’s going on with you behind that exam room curtain?

We’ve all been there. Blood work and sonograms each morning. Sent to the bathroom to pee. Then to the exam room. Drop the panties. Fashionably wrap that paper sheet around as much of you as it covers and hop on the crinkly paper-covered table to await the invasion of the wand.

Some of us may be so overwhelmed and depressed by the infertility experience that we just plod through this routine on auto-pilot, maybe even unwittingly “letting ourselves go” in the hygiene department. Others have a morning grooming routine that takes on almost OCD-like attention to detail.

Where do you fit in?

Okay, so the ladies who painstakingly hide their holey granny panties under their pile of clothes are turning scarlet about now. But don’t be. Where else you gonna wear those big ol’ comfy panties? There is no place for Victoria’s Secret in the IVF office anyway. Or is there? Any zebra thong-wearing patients out there? Well, you go girl!

And how about those women who twist themselves like contortionists just to pick every last microscopic piece of Charmin off. I hear you laughing. What? You never even thought of that? Well, um, awkward.

It’s not over once you emerge from the curtain…

Then, there’s the placement of the paper napkin. Sure, they call it a drape but we know better. You’re lucky if it fits all the way around you. Most of us are left to close the gap with a strategically-placed arm behind our awkwardly-twisted torso. Or by assuming the laying-back-in-a-hammock pose, with hands behind the head.

And what the heck do you do with your feet? Put ‘em both in the stirrups early and skootch down? Let them dangle? Sit Indian-style as if you were playing cards? Hey, did you ever put just one foot in a stirrup and cross the other leg over it, like you’re casually hanging out? Yeah, well it doesn’t work.

Maybe you avoid all this by being the snoop…the one who boldly stands there (with her crack away from the door) peering over her open chart until the nurse or doctor walks in.

I could go on…about things like toting a hair pic or the wisdom of waxing…but you get the idea. We all have our ways.

Now I don’t expect any of you will have the nerve to confess your own “behind the curtain” antics, but I hope the next time you’re in there doing your thing, you’ll think of this post and smile. Or laugh out loud…just to keep ‘em guessing.

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So, are YOU on auto-pilot or from the contortionist camp? Too shy to answer with specifics? Then just say  “guilty” if you’ve ever done ANYTHING mentioned here. I dare you.

Photo credit: http://www.publicdomainpictures.net/hledej.php?hleda=curtain

 

 

 

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Sunshine and Your Fertility

By Dr. David Kreiner and Brianna Rudick, MD

June 25th, 2012 at 1:58 pm

Vitamin D is a fat soluble vitamin that is present in a variety of forms but has recently been recognized as playing a critical role in reproduction.  It is essential in the production of sex hormones in the body.  It is thought that a deficiency of Vitamin D may lead among other things to ovulation disorders.

It has been demonstrated that Vitamin D deficient rats had a 75% reduced fertility and a 50% smaller litter size that was corrected with Vitamin D treatment.  In addition, sperm motility in males was reduced in the presence of a Vitamin D deficiency.

A recent study at the Yale University School of Medicine revealed that only 7% of 67 infertile women studied had normal Vitamin D levels and not a single woman with an ovulatory disorder had normal levels.  Nearly 40% of women with ovulatory dysfunction had a clinical deficiency of Vitamin D.

At the American Society of Reproductive Medicine conference last year, a study presented by Dr. Briana Rudick from USC showed that a deficiency of Vitamin D can also have a detrimental effect on pregnancy rates after IVF, possibly through an effect on the endometrial lining of the uterus.   In her study only 42% of the infertile women going through IVF had normal Vitamin D levels.  Vitamin D levels did not impact the number of ampules of gonadotropin utilized nor the number of eggs stimulated, embryos created or embryo quality.  However, Vitamin D levels did significantly affect pregnancy rates even when controlled for number of embryos transferred and embryo quality.  In this study the pregnancy rate dropped from 51% in Caucasian women undergoing IVF who had normal Vitamin D levels to 44% in those with insufficient levels and 19% in those that were deficient.

Vitamin D deficiency has also been associated with poor pregnancy outcomes including preeclampsia and gestational diabetes

Vitamin D can be obtained for free by sitting out in the sun and getting sun exposure on the arms and legs for 15-20 minutes per day during peak sunlight hours.  The sunlight helps the skin to create Vitamin D3 that is then transformed into the active form of Vitamin D by the kidneys and liver.   An oral supplement is available also in the form of Vitamin D3, with a minimum recommended amount of 1000 IU a day for women planning on becoming pregnant.  For those with clinical insufficiencies a higher dose may be administered by injection. 

Our study and many others suggest that the effect is endometrial, but we don’t know for sure.

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Do you ever go out in the sun without sunscreen? If not, would this study change your mind about 15-20 minutes of free Vitamin D? (Of course, if you are particularly fair-skinned you should reduce your time or speak to your doctor for advice.)

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=7273&picture=girl-sunbathing

 

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Surviving the Two Week Wait for Your Pregnancy Result

By Bina Benisch, MS, RN

June 22nd, 2012 at 9:26 pm

It seems interminable. 

You’ve finally made it through your IVF stimulation. You’ve survived your injections and all those early morning monitoring visits…not to mention being poked and prodded for blood and vaginal ultrasounds. You’ve undergone your retrieval procedure, sweated out the fertilization results, and here it is – the day of your embryo transfer.  Or, if you’re doing IUI, you’ve made it through your insemination. 

What a relief!  You can finally relax…. NOT so fast!

The next 10-14 days can seem like an eternity when you’re waiting for your pregnancy result. 

Your emotions may ride that roller coaster … slow ascending hope, with glimmers of joy at the prospect that this time you actually may be pregnant … only to be violently interrupted by thunderous pangs of fear that this may not have worked, and then falling into despair. 

How do you regulate your feelings and create a sense of balance so that you’re not held hostage by every emotion and negative thought that grips you?  Here is your mission for the next 10-14 days, should you choose to accept it: 

1.  Create a list of leisure activities that you and your partner have always enjoyed doing, and set a plan into action.  Yes, there are jobs and responsibilities, but schedule some “special” time together for these activities… whether it’s watching movies together, outdoor activities, date nights, music, or working together on a project that embodies a sense of satisfaction.  Not only does this help keep your relationship close – which in itself is emotionally enriching – but it may distract your attention and maintain some perspective on your life so that you are not feverishly focused on your fertility status.

2.  Talk to your partner about your feelings.  There are no pat solutions which will stop your anxiety. However, making room for all feelings – even the darker ones – and knowing you will get through it as you ride this wave, will relieve the stress of suppressing these feelings. This will also keep the lines of communication open between you and your partner. 

3.  Restructure your thoughts! This is not to advise Pollyanna or positive thinking.  Let’s face it, the last thing you need is to be told to “be positive” or “relax.” It’s extremely difficult to feel “positive” when you’re struggling with infertility.  However, take a moment to look at the thoughts you are telling yourself – the thoughts that are causing your fear and anxiety to escalate: “I know I’m not pregnant.”  “It probably didn’t work this time.” “What if it doesn’t work this time?” “What if I never become pregnant?”   These thoughts and statements are not etched in truth, and are only fear-based. Better thoughts… which may be equally true, but are not fear based…are: “I could very well be pregnant.” “The possibility that I will become pregnant is just as much a reality.”  Don’t fear that allowing yourself to entertain these hopeful thoughts will cause greater disappointment from a negative result. You will be disappointed or devastated either way, whether you’ve been fearful, anxious, and negative, or you’ve had the perspective that you may very well become pregnant.  Here is a mental framework that is absolutely realistic, true, and can go a long way to helping you maintain peace of mind:  “I am doing everything in my power to become pregnant, and therefore, I can emotionally let go for now, and leave this in the hands of (God, the universe, my doctors).”

4.  Selectively avoid situations that you know will trigger your fear or anxiety.   Learn to say “NO”.  People will forgive you for not attending a family function, social event, or any situation where you find pregnant people, or people with babies, or people who will ask you when you are going to have children.  YOU come first at this time in your life. YOUR emotional health takes precedence. 

5.  Nurture yourself. Whatever that means for you. Massage, Reiki, reading, movies, shopping, yoga (not hot yoga), — what do you find to be a relaxing, self-nurturing activity?

6.  Remember proper breathing. Slow, deep breathing will cause a physiological reversal of the body’s stress response.  This will reduce anxiety and stress.  Learn to practice breath work every day. 

In essence, have compassion for yourself.  Talk about your feelings with your partner.  If you find it difficult to restructure your thoughts, practice the mantra that you have done everything in your power, and now it’s time to let go.  This takes practice, but you can do it if you take on this mission for self-balance, peace of mind, and equilibrium.

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Let me know if you’ve tried any of these tips…or if you have others to add. 

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=14919&picture=your-are-late

 

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Infertility Podcast Series: Journey to the Crib: Chapter 14 Trying to Conceive with Clomid Therapy

By David Kreiner MD

June 21st, 2012 at 8:43 pm

 

Welcome to the Journey to the CribPodcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Fourteen: Trying to Conceive with Clomid Therapy. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.eastcoastfertility.com/?p=95

Trying to Conceive with Clomid Therapy

Clomid, the best known brand of the fertility pill clomiphene citrate, is the therapy most commonly prescribed for patients suffering from infertility.  It is often prescribed by a patient’s primary gynecologist, sometimes with no diagnostic testing performed. 

Clomid is an antiestrogen and works by decreasing the effective negative feedback of estrogen on the pituitary gland resulting in a rise in gonadotropins, Follicle Stimulating Hormone(FSH) and Luteinizing Hormone (LH).  These in turn stimulate the ovaries usually resulting in the maturation and development of one or more eggs.  For couples whose only problem is ovulation, this offers a 20% chance of pregnancy each month.  Ovulatory patients and those with other infertility issues have a lesser chance for success with the drug.  

Since Clomid has anti-estrogenic properties, it may cause a thickening or drying up of the cervical mucus which may prevent sperm from penetrating the cervical canal and reaching the ovulated egg in the fallopian tube as it needs to do to fertilize it.  This is why we recommend performing intrauterine inseminations (IUI) concurrent with Clomid therapy. 

Additionally, the Clomid may thin out the endometrial lining so this should be monitored.  Since the egg does not typically last more than 8-12 hours, we monitor patients with hormone blood tests and ultrasound and then trigger ovulation with Human Chorionic Gonadotropin (HCG) to ensure that the sperm will reach the egg in the fallopian tube.  We will test women to ensure that their tubes are open and check the sperm to make sure that it is adequate as well for fertilization. 

As Clomid offers– at best– a 50% pregnancy rate for women who do not ovulate and less for those who do, we do not recommend persevering with Clomid therapy too long, especially for our women over 35 years of age or those couples with other associated fertility factors. Fortunately, we have more successful, aggressive treatment available that may be recommended depending on age, duration and causes of infertility.  

For those patients without insurance coverage, Micro-IVF, minimal stimulation IVF (utilizing Clomid), costs approximately the same as three Clomid/IUI cycles but offers women under 35 years of age a better than 40% pregnancy rate and as such may be a more cost effective alternative. 

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Was this helpful in answering your questions about Clomid therapy? Are you aware that Long Island IVF is giving away a free basic Micro-IVF cycle? Check out the contest here: http://bit.ly/LHbmQR 

Please share your thoughts about this podcast here. And ask any questions.

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NWW Photo Caption Contest No.25

By Tracey Minella

June 20th, 2012 at 7:26 pm

Well, it’s Wednesday again! It’s NWW time! That stands for Nearly Wordless Wednesday… our weekly wacky photo caption contest where anyone anywhere can enter to win by submitting a clever caption for the photo of the week. And what infertile couple, or generally stressed out person, can’t use a fun distraction once a week? Come on and play!

Each week, the winner gets a gift card. It’s our little thank you for playing our game.

This week’s contest winner will get a Starbucks gift card. Come on and play. Need a jolt of their famous java to get you going? Maybe a think and frosty Frappuccino? What is your favorite thing to drink there?  Win the contest and the gift card is yours to choose your favorite!

Now, on to this week’s challenge.

But first let’s announce last week’s winner: Maureen! Congrats!

Remember the group gathered outside the building and the mischievous other group on the roof dumping buckets of water on them? Well, we liked Maureen’s: “This is a test to see who qualifies for IVF. Remember, this is only a test!” caption.

Maureen, please email your address and the words “NWW Contest #24-Starbucks” to Lindsay at lmontello@liivf.com to claim your gift card.

Give this photo a caption on the blog. With summer finally hitting the area with blistering heat today, this one seemed perfect.

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

Bookmark our blog or like us on Facebook and check back next week to see if you won and we’ll mail you your gift card.

Plus, if you “LIKE” us on Facebook at https://www.facebook.com/longislandivf , we may be able to send you the prize as an e-gift right through Facebook, depending on what this week’s prize is, so you could be enjoying your winnings as early as on the day we choose the winner! (And as much as we’d love you to “LIKE” us on Facebook, it is absolutely not required to either enter or win our contests! But did I mention we’d love it if you did ;-)

Enter today! Or at least before next Tuesday!

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Why not bookmark us so you remember to check back often…at least every Wednesday…so you don’t miss our NWW contests. And we also run bigger contests, too. Please feel free to suggest other fun places we could get gift cards from that you’d like to win as prizes for these fun contests or topics you’d like to see discussed on the blog. Now go enter the contest!

Photo credit: source unknown

 

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LIIVF’s “Every Baby’ s Beautiful” Pageant Parade Video

By Tracey Minella

June 19th, 2012 at 10:08 pm

When I was doing IVF, one of the things I focused on when I’d get discouraged was the annual Long Island IVF reunion. It was my dream to get to that picnic with my little miracle. Some day, I vowed, I’m gonna get there.

In the summer of 1998, I got my chance and it was every bit as exciting as I’d imagined it’d be. Back then, all babies were still invited. It was a barely manageable crowd due to the years of successful baby-making. They used to bring in a crane or cherry-picker fire truck just to be able to get a photo of the crowd of families.

These days, they unfortunately have to limit the reunion to the most recent “class” of babies born through the program. So they decided to make it an exciting outing for the little attendees.

Check out the footage of LIIVF’s littlest wonders and their beaming parents at the recent reunion luncheon: http://www.youtube.com/watch?v=4ODaCHJsypk&feature=youtu.be

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Have you been to a reunion yet? If so, how was it? If not, does the thought of it keep you going in rough times?

Photo credit: http://www.publicdomainpictures.net/hledej.php?hleda=driving+away

 

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The Hole

By Tracey Minella

June 18th, 2012 at 9:23 pm

 

I’m emotional today. I got to relive my personal IVF experience today during a video shoot for an upcoming LIIVF video. The highs and lows of several years.

Maybe you are emotional, too.

You may be emotional from medications, from opening a baby shower invitation, from an insensitive comment, or from yet another negative pregnancy test. I’ve been there. I spent years there.

I call those years “The Hole”.

I didn’t realize at the time… as I was living the day to day, minute to minute hell of infertility…that it was the hole that it in fact became. I was too busy surviving it all.

It’s a survivor’s thing, I guess. When a major life crisis like cancer or autism or infertility hits, it plucks you out of the regular world and dumps you into another place. A dark and scary place full of uncertainty and fear and broken dreams.

A hole.

I wish I could spare you. I wish I could guarantee that happy ending, that light at the end of the tunnel. But I can only hope that the hole is not too deep. That it doesn’t steal too much of your life, as it did mine. That another hole won’t follow.

Fortunately, we all will see an end to our infertility journeys. Some journeys are long, others short. But they all do end. You won’t be in treatment TTC for 20 years (though it may feel that way). It may end with a baby that’s genetically connected, or not, or, in some cases it may end without a baby. Happily, advances in assisted reproductive technology make the last scenario less likely.

My point is that there are things you are not doing, not enjoying right now because your happiness…or unhappiness…is controlled by your infertility. It’s understandable to tell yourself you’ll do those things soon… right after you get pregnant. And to protect your heart by thinking this will be the month it happens. But when it doesn’t (again), you can lose sight of the time that is actually passing. You’re putting the rest of your life on hold. And life is passing you by like the blur in your peripheral vision.

Reclaim it. It takes effort not to allow infertility to pull you into the hole. Herculean effort, at times. I didn’t have the insight. I didn’t have someone who’d walked in my shoes to tell me about the hole. But I’m telling you, though.

Because whenever… and however… it is that you do eventually get out of the hole, you will look back and wonder where those months or years went. And no matter how happy you are to have that miracle baby, and how worthwhile you feel the whole journey was, you can’t get that time back. Trust me… it’s no fun to admit I can’t remember anything fun between 1992- 1998.

It’s summer and social calendars are active. Please resist the urge to say “no” to all of the social outings and events. Skip those that are too difficult, of course, but don’t deny or isolate yourself so much that you slip away completely. Make memories you can share with your future children.

Defy the hole.

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Has your journey been a hole? When did you realize that?  If you were able to defy the hole, how did you do it?

 

Photo credit: http://www.publicdomainpictures.net/hledej.php?hleda=black+hole

 

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Infertile Men are Fathers, Too

By Tracey Minella

June 17th, 2012 at 8:56 am

If you are a man who wants to be a father, but infertility is standing in the way, I don’t have to tell you how tough it is getting through today. If male factor infertility is all or part of the problem, there’s often an added level of misplaced guilt as well. And if you’ve lost your own dad along the way, the day is even worse.

I could tell you to take care of yourself today, but you’re probably more concerned about your wife or partner. How she wants the baby, the card and the homemade clay presents that Father’s Day is supposed to be about.

If you’re seeing your own dad… and siblings with children will be there… there can be guilt about not making grandchildren yet and the sense of urgency to do so while he’s still alive. But you will manage, despite the ache in your heart, to smile for your dad today and to play a little catch with those nephews.

And you may have to endure the insensitive and hurtful comments…sometimes directly targeted at your manhood… by ignorant brothers or in-laws. You know the ones. I won’t repeat them. But you’ll laugh it off to keep the peace and pretend it’s the barbeque smoke stinging your eyes.

Today I want you to know that you are a dad. You’re a father “in-the-making”.

Good dads are selfless. They put everyone else’s needs before their own. They take care of their wives and their parents. They often hide their pain. Without realizing it, some practice their “dad skills” on nieces and nephews. They get stronger by facing and overcoming adversity. Their commitment to their wife deepens by battling this challenge together.

All this crap you are going through… this journey… has either given you or fine-tuned all the traits you need to be a great dad someday.

So, Happy Father’s Day to a great dad-to-be. And I hope that next year will be the year of the baby to complete the deal.

To our patients who have already become fathers, Happy Father’s Day. Enjoy those miracles… and their homemade clay presents!

Happy Father’s Day to the wonderful doctor dads of Long Island IVF…great men and loving fathers/grandfathers who use their gifts every day to help build our families.

And finally, Happy Father’s Day to my husband Adam, not just for being the wonderful father I knew he’d be, but for hanging in there during the many years of our own 7 fresh IVF cycles journey to parenthood.

If winning a free Micro-IVF cycle (valued at $3,900.00) would assist you on your infertility journey, please enter Long Island IVF’s “Extreme Family-Building Makeover” Contest. Details are on the April 23, 2012 blog post or click here: http://blog.longislandivf.com/2012/win-a-free-basic-micro-ivf-cycle-in-long-island-ivfs-extreme-family-building-makeover-contest/

 

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Tell us how you get through days like this. Did anyone say something hurtful? How did you respond?

Photo credit: http://www.wpclipart.com/holiday/fathers_day/index.html

 

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