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Archive for July, 2012

Garlic and Male Fertility

By Tracey Minella

July 31st, 2012 at 10:31 am

free image courtesy of Michelle Meiklejohn/ FreeDigitalPhotos.net

It’s National Garlic Month. It’s also the last blogging day of the month…which means it’s “Just for Guys” day, too.

So, how can I do garlic and the guys justice in one post? Easy. I’ll tell you how garlic can affect male fertility.

For thousands of years, garlic has long been widely regarded as one of the top natural fertility enhancers for men. It’s also an aphrodisiac. Sound like a win-win, guys? Well, I’m not sure your lady will see your garlic-chomping bedtime routine in the quite the same light.

True it has selenium, which is an antioxidant mineral that’s necessary for properly-shaped sperm and to maintain sperm count. And it has Vitamin B6, which (along with zinc) fortifies the immune system and is responsible for formation of the male sex hormones.

A compound in garlic has even recently been shown to be 100x more effective than traditional antibiotics in fighting the intestinal bacteria that causes food poisoning. http://bit.ly/KFGhzo. Its benefits for lowering cholesterol and blood pressure, helping diabetes, clearing blood vessels, and thinning blood are well-known.

However, a report in the journal, Reproductive Biology and Endocrinology, published on June 24, 2009 cautioned that excessive use of crude garlic may negatively impact spermatogenesis (sperm production) by causing the death of the germ cells which develop into sperm cells. The study was conducted using rats given higher concentrations of crude garlic than humans typically consume. However, it was noted that human spermatogenesis is more sensitive to stress than rat spermatogenesis, and that human spermatogenesis could therefore still be negatively impacted by excessive crude garlic consumption, even at a lower concentration. In fact, the study suggested the possibility of crude garlic consumption inducing azoospermia (lack of sperm) in men with low sperm counts. See the abstract here: http://bit.ly/R1Vw95

So while many naturalists and homeopaths (and your great grandma) may encourage the mass consumption of garlic as a cure for male infertility, there are two important take-aways here. First, do everything in moderation. Something between a garlic knot and eating a garlic bulb like it’s an apple may be in order. Unless, of course, you know you have a low sperm count. This brings me to the second point…

Second, nothing is a substitute for a thorough male fertility evaluation by a medical professional, preferably a urologist who specializes in male infertility. Few things are sadder than seeing patients who wasted valuable time exploring unproven natural alternatives which did not address or correct an underlying problem that required medical intervention. Also, if you are taking a garlic supplement, or any herbal/holistic supplements, be sure to let your R.E. know.

Long Island IVF has renowned urologist and male infertility specialist, Dr. Yefim Sheynkin, on staff for anyone in need of an evaluation.

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Love garlic? What’s your favorite garlic-laden food? A favorite pizza, or a dip on game day? Please share the recipe and give props to its creator!

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R-E-S-P-E-C-T is More Than a Song Title

By David Kreiner MD, and Tracey Minella

July 30th, 2012 at 7:28 pm

Free Image courtesy of FreeDigitalPhotos.Net /Danilo Rizutti

Here’s an oldie of Dr. Kreiner’s. I’ve dusted it off as a farewell to Jennifer Lopez as she leaves American Idol. Her position on IVF may be upsetting to many patients who need help conceiving…especially since she has been blessed with twins.

Interestingly, Mariah Carey, the newly-signed Idol judge, is also a celebrity mom of twins. But she has a different view on getting medical help when trying to conceive or maintain a pregnancy. After the birth of her twins, Mariah (who’d suffered a previous miscarriage) told Barbara Walters that she used progesterone each month while TTC and then for 10 weeks after becoming pregnant.

Like it or not, many people view celebrities as role models. So it’s nice to see a celebrity who is respectful of the feelings of those who need medical assistance to conceive or maintain a pregnancy.

Here’s Dr. Kreiner’s thought-provoking post:

Back in 1985 when I started my fellowship at the pioneering mecca of IVF, the Jones Institute for Reproductive Medicine, there were still many people and religious leaders who objected passionately with the use of Assisted Reproductive Technology to help people in need conceive.  Arguments ranged from accusing IVF of being immoral to the potential dangers of playing God.

Physician defenders of this nascent technology offered comparisons to other medical problems that have been helped by technology, such as immunizations to prevent infectious diseases like polio, chemotherapy to cure cancers like lymphoma, kidney transplants, etc.  To them, a world unwilling to use technology to aid the suffering is unethical.  They see it as criminal to stand by and ignore the cries for help.  To have infertility, is to be cursed with an inability to satisfy that basic human need, sited in the bible as a commandment to “go forth and multiply”, to procreate and build a family.  How, in God’s name can a physician with the technology and know how, ignore such pleas from the suffering?

Yet, Jennifer Lopez feels it appropriate to speak up in 2010 against IVF saying, “I…believe in God and I have a lot of faith, so I just felt like you don’t mess with things like that”…”And if it is (meant to be), it will.  And if it’s not, it’s not going to”.

I wonder if she would feel the same without the ability to cradle her babies in her arms.  Or for that matter, if she developed a disease that required the use of some other “God-like” technology would she let herself suffer rather than take advantage of a potential cure.

I respect others’ opinions and beliefs and would never tell them they were wrong in following their faith.  I wish that people like Jennifer Lopez would share the same respect for suffering infertile couples who think that IVF is an ethical treatment offering these patients their only chance at building their families.

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Post your gut reaction now.

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Connecting with Your Olympic Spirit

By Tracey Minella

July 27th, 2012 at 10:55 am

Swept up in the excitement of the 2012 Summer Olympics in London?

Imagine being an Olympian. One of the “chosen” ones. Different from all the rest. The one everyone is rooting for. The one with the big dream that sometimes feels out of reach.

Come to think of it, it’s not that hard to imagine living as a member of a select group, focused on a single goal, different from others, and complete with your own cheering section. Chasing the dream.

Basically, you are an athlete in the Fertility Olympics. And unfortunately, our team uniform is a paper gown.

When you embarked on your fertility journey, you probably never imagined it’d be like this. Not this hard. Not this long. You’ve had all the tests and preliminary procedures. You’ve set and met goals for good general health. You’ve sacrificed more than you ever thought possible. You focus on your goal every minute of every day… like tunnel vision. In fact, everything you do is connected with making that dream come true. With getting your one moment in time…

Of course, there is a difference between you and an Olympic athlete in an individual sport. (And it’s not just that no one’s approaching you from Nike or Wheaties.) Whether they win a medal or not is entirely in their own hands. It’s their moment to succeed or fail. But your outcome is not entirely in your hands. And that can be frustrating to say the least. You are not ultimately in control of your dream coming true. A doctor, nurse, and maybe even an embryologist are the ones in control.

You are more like the Olympic team athlete. Your success depends, in part, on your teammates’ performance. So be sure you choose the right team. Find the right Reproductive Endocrinologist. Check out the success rates, including the live birth rates. Because the right team will be your dream team.

Now, bring home the gold.

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How did you find your fertility dream team? The internet? A friend’s recommendation? An ad?

 

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=23151&picture=london-2012-olympic-torch

 

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Should Parents Have to Take a Parenting Course?

By Tracey Minella

July 23rd, 2012 at 12:42 am

Ever want to tell the fertile folks: Just because you CAN procreate, doesn’t always mean you SHOULD!

I’m sure this has happened to you. You’re out and about doing errands or something and suddenly you see it. In the interest of decorum, I’ll call it “parental incompetence”.

Now maybe we’re just so good at spotting it because we’re acutely aware that we’ll be better parents someday than most of the people for whom parenthood came easy. Or because part of our coping mechanism involves zeroing in on morons whose actions announce to the world that they clearly don’t deserve to be parents.

In today’s episode of The Young and the Ridiculous, I was driving on the LIE when I spied one of those popular Jeep Wranglers ahead of me. You know the ones where all the doors and windows and roof come off, leaving you tooling around in a death trap with a roll-bar…

Well there are two young guys in the front and a young woman in the back with her long, loose hair whipping around in a frenzy in the 70 mph winds. The woman put her arm around the seat next to her and leans over. But there’s no one sitting there.

Then I see it.

A car seat.

“Are you *#%&* kidding me???!!!” I hear my mind scream. So, I pull up beside them because I cannot imagine they’d actually have a baby in that thing, doing 70+mph on the LIE.

Sure enough, this little baby with its short blonde hair whipping all around was noticeably distressed and uncomfortable, with its head turned toward the idiot woman. OMG, I think, as the “What ifs” start to flood in.

What if it can’t breathe with the force of the 70+ mph winds in its little face? What if the wind rushing into its ears causes an infection, or worse? What if something blows into its eye? And then I looked at the roll-bar. What if, heaven forbid 1000x, there was an accident?

In this day and age, it can be dangerous to confront a stranger…especially a stupid one. You just never know who’s armed and dangerous. Yet it’s hard to live with yourself if you don’t speak up.

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What would you do? Have you ever confronted someone about their questionable parenting? Do you think you have a shorter fuse for these things because of your infertility?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=15127&picture=baby

 

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Does the Colorado Movie Theater Shooting Make You Question TTC?

By Tracey Minella

July 20th, 2012 at 3:21 pm

Another senseless mass murder. Not Columbine or Virginia Tech. Not a school. But just as senseless.

More than fifty unsuspecting movie-goers at a Batman midnight premiere were injured. Twelve are dead. Reportedly, one of the victims was only three months old. A baby. It could have been any of us at any theater in any state.

Sadly, while this is tragic, it is no longer shocking. No doubt movie theaters will now enhance their security measures, joining airports and schools in the metal detector line-up. And it shouldn’t take long before a politician backs a bill to ban midnight premieres. But it’s too late to help today’s victims. And the sickos will find another way.

I was newly pregnant on Sept 11, 2001, my seventh IVF. And for a split second… no, a nanosecond…  the thought actually crossed my mind that day “Should I be bringing a defenseless baby into this world?” Of course, I squashed it immediately and hoped no one actually heard me think it, for I knew how truly lucky I was.

But that day was a day like no other.

Until Columbine, or Virgina Tech, or today.

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Anyone pregnant or TTC out there willing to admit they’ve thought the same thing when these tragedies occur?

 

Photo credit: http://www.wpclipart.com/cartoon/people/comic_situations/irate_at_the_theater.jpg

 

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Does Having a Baby After a Loss Heal the Pain?

By Tracey Minella

July 19th, 2012 at 5:44 pm

No one should ever have to experience the loss of a child. Ever. It’s quite simply not the natural order of life.

Whether through a miscarriage, still birth, or after birth, the pain is unspeakable, unbearable. And so personal.

When comforting someone who has suffered this loss, please choose your words wisely…if you even use words at all. Sometimes a look, a squeeze of the hand, or a hug is all that’s in order…or welcome.

Sometimes just doing a task that needs doing speaks volumes more than the well-meaning but awkward chatter. Bring a casserole, do an errand. Offer to listen over a cup of coffee. You don’t understand the loss. Even if you suffered a similar loss yourself, everyone’s experience is different.

Which brings me to the question: Does having a baby after losing a baby heal the pain?

Some people hold their grief close and never let go, even after the blessing of another child… for one cannot replace another. Others manage to let go of the loss, almost completely, in their joy over a new beginning, a new life… for what’s the use of looking back.

For me, a twin loss at 9 weeks, on my third IVF attempt, coming two weeks after an emergency surgery, was a tough loss to process. The surgery left me in a state that would further handicap my chances of conceiving again. I was devastated.

But after three more IVFs, I had my little girl. At that moment, all was made right in my world. I was healed. And part of me feels guilty about that.

But I look back now that I do have two children and find comfort in the idea that it is these two children, not the earlier two, that I was supposed to have. Sure, I think about what age those angels would be and what they’d be doing sometimes, but if I’d had them, then I would not have these exact children that I do have now. And that thought is also unbearable.

Without in any way minimizing a loss by early miscarriage, I wonder if grief is generally harder to bear the longer you’ve loved the child, the longer the attachment. Or whether grief subsides faster for those who do experience a subsequent birth than for those whose arms remain empty. Sure, it sounds logical. Except there’s no place for logic here.

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What do you think?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=1463&picture=mother-and-baby

 

 

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Micro-IVF Can Further Reduce Rare Risk of Ovarian Hyperstimulation Syndrome

By David Kreiner MD

July 17th, 2012 at 6:29 pm

Recent media attention* regarding the risk of ovarian hyperstimulation syndrome (OHSS) in in-vitro fertilization (IVF) cases– estimated by most sources at three percent (3%) for patients undergoing traditional IVF — has increased interest in minimal stimulation IVF, also known as Micro-IVF or Mini-IVF.  

Long Island IVF’s Micro-IVF program is five (5) years old and is registered with the Society of Assisted Reproductive Technology separately as East Coast Fertility under the medical directorship of Dr. David Kreiner and embryology directorship of Dr. John Moschella, who have a combined fifty years of IVF experience.

Since the merger of East Coast Fertility with Long Island IVF in October, 2011, the pregnancy rate for women under 35 years of age exceeds 50% per transfer with MicroIVF.  

Using clomid and two days of lowest dose gonadotropin hormones, this minimal stimulation has a 0% incidence of OHSS at Long Island IVF.  

Furthermore, a Micro-IVF procedure costs $3,900.00 plus the cost of the medications, and $500.00 for optional anesthesia.  

In tune with the safer minimal stimulation IVF, Long Island IVF also offers their Single Embryo Transfer (SET) Program to motivate patients to select the very safest procedure by avoiding the increased risk of multiple pregnancyassociated with a multiple embryo transfer.  Patients electing SET for traditional IVF or Micro-IVF pay nothing to freeze excess embryos and store them up to a year.

Certainly those concerned about OHSS, or those looking for a less costly alternative to traditional IVF should inquire about whether Micro-IVF–successfully performed by Long Island IVF’s doctors for five years—might be for them.

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Long Island IVF is holding its annual “Extreme Family-Building Makeover” contest to award a Free basic Micro-IVF cycle, valued at $3,900.00, to a woman without (or who has exhausted) infertility insurance coverage. You do not have to be a LIIVF patient or even a New York resident. Contest ends August 26, 2012. For details, rules, and to enter, click here: http://bit.ly/LHbmQR

Have you experienced severe OHSS during traditional IVF that required hospitalization? If so, did it stop you from pursuing traditional IVF again? Would you consider Micro-IVF?

*This letter was prompted in response to today’s New York Times article, entitled “High Doses of Hormones Faulted in Fertility Care”, by Jacqueline Mroz. See the full article here: http://nyti.ms/OJT4yu

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Is Multi-Tasking or Sleep Deprivation Affecting Your Fertility Efforts?

By Tracey Minella

July 16th, 2012 at 12:03 pm

If you are TTC, especially with medical intervention, chances are you’re totally overwhelmed. You may be struggling emotionally. Or juggling extra jobs to finance your treatments. Or both.

Maybe you keep extra busy to avoid focusing on the baby you don’t yet have or to avoid having to say “Yes” to another baby shower invitation. Maybe you don’t know how to say “No”, so you are beyond depressed by attending an endless string of baby-centered affairs for everyone else but you. Maybe you stay in simply because there’s no room for a vacation when there’s an IUI or IVF cycle draining your finances.

Those with secondary infertility are trying not to neglect the needs of one child as they focus on expanding their family, all while living in fertility limbo. Often unsupported by friends after having had baby success… and shunned by jealous primary infertility patients who may see their quest for a second child as greedy…secondary infertility patients may find themselves thrust into “justification mode” at any moment. Why should they have to explain that as much as they are grateful for one child, that they would love another one?

Well, banging at this keyboard on only two hours sleep (and having pulled an all-nighter two nights ago for the first time since my college days in the old millennium), I am acutely aware of the toll thatmy style of “extreme multi-tasking” takes on the body. Especially as we age. I’d need an IV of caffeine to make a difference today.

This is really not good. There are so many bodily functions that you mess with when you deprive yourself of sleep. I was a maniac back when I was TTC. Worked like a dog at three different jobs and only had 2 days off per month, every other Sunday. Obviously I was escaping from something. Or trying to. Looking back now, I wonder what role that crazy schedule may have had in the length of my journey.

How many of you are out there TTC, but doing too many tasks in your day?  

Maybe a good guideline to follow is to ask yourself: “Would I be doing all this stuff at this pace if I were pregnant?”

Hey Superwoman! I urge you to STOP and re-evaluate your to-do list. Now. Please knock-off whatever tasks you can afford to for the benefit of your health and conception efforts. Get some rest. Maybe do some meditation. Better yet, give Long Island IVF’s Bina Benisch a call to learn about how the Mind/Body Program and therapy sessions may help you through this difficult time http://www.longislandivf.com/mind_body.cfm.

Do not make me come after you with a block of Kryptonite!

If you never sleep, you’ll never dream. And if you don’t dream, how can your dreams come true? 

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Confession time: Name one (or 10) things you did this week that you know you shouldn’t have done because it pushed you too far mentally, emotionally, physically or financially?  Fess up. Did you forget, lose, or break something because you were rushing or too tired and not “on your game”? And let us know how many hours you sleep each night and if you feel it’s enough, too little, or too much.

 

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=15614&picture=headache

 

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Dr. Kreiner’s Letter to the Editor of Newsday

By David Kreiner, MD

July 12th, 2012 at 3:29 pm

credit: wpclipart.com

 

Long Island IVF’s co-founder, Dr. David Kreiner responds to the assertion that in-vitro fertilization, or IVF as it’s known, is a treatment of “last resort”. Here is his letter to the Editor of Newsday published on July 8, 2012:

“ Adrian Peracchio wrote an interesting account of in vitro fertilization, a technology that is now 34 years old ["The future is now," Opinion, July 1]. As stated in the article, IVF is a procedure that was born in a hailstorm of controversy and remains today accountable for 3 percent of all births in the developed nations.

A reason for IVF’s rise in popularity is a tremendous improvement in success rates. As reported in the June 28 issue of the New England Journal of Medicine, live birthrates with IVF approximate natural conception in fertile couples. Also, IVF reaches success rates as high as 80.7 percent for couples using donor eggs after three cycles.

Peracchio points out that the cost of IVF, as much as $15,000 in many centers, is often not covered by health insurance, and that IVF was intended as a “last resort” treatment.

This is a misunderstanding of IVF as an alternative only after the failure of less aggressive treatments — such as inseminations with fertility drugs. Insurance providers cover the drug treatment, which is ironically more expensive. Fertility drug treatments can lead to multiple pregnancies and premature deliveries. According to the Centers for Disease Control and Prevention, we could save $1.1 billion a year if single embryo transfers with IVF were performed instead.

It is a shame that the technology developed by Robert G. Edwards for which he was awarded the Nobel Prize for Medicine remains available only to a minority of couples and is still not recognized by insurance companies.”

Dr. David Kreiner, Plainview

Editor’s note: The writer is the co-founder of Long Island IVF, an infertility care center.

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We’d love your thoughts here on the blog.

But if you’d like to respond to this article on Newsday.com and reply to the thread of unsympathetic comments, the link to the letter is here: http://bit.ly/NcuEwn (I’m guessing a stress-busting vent session will result for anyone willling to take up the cause!)

 

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Forget the Bikini! Are You in Reproductive Shape?

By David Kreiner MD, and Tracey Minella

July 10th, 2012 at 9:00 am

It’s that time of year when your unused gym membership begs for renewal. I used to fall for that. Now I just scope out someone who looks worse than me to sit near on the beach. So lame, I know.

Alas…the trim, fit body of my youth is but a memory. I remember summers on the beach sporting the darkest tan and the smallest bikini I could get away with wearing when sneaking out to the ocean. I had no body issues back then. Way back then.

Then came the “freshman 15” from eating dorm food and doing midnight pizza runs. A pre-wedding diet wiped them away, only to find the same fifteen pounds creeping back during law school. Add a few more the summer of the bar exam. And BINGO… I was not in the best physical shape when we started TTC. Then, throw some more junk in my trunk from fertility meds and depression bingeing as each cycle failed. Suffice it to say, I didn’t give myself the best chance for fertility success.

You can learn from my mistakes.

Sure, being reasonably physically fit is important, but there’s so much more to making your baby dreams come true than being able to fit into that itsy bitsy teeny weenie yellow polka dot bikini.

Dr. Kreiner of Long Island IVF shares his tips for getting in fighting reproductive shape below:

How do you get started building your family when it isn’t happening on its own?

First, if you are thinking about getting pregnant get a check up! Get your pap done – go to the dentist – have your blood pressure and lipids checked. I’m not an expert on the art of motorcycle maintenance, but our bodies, like machines, go through wear and tear and, as a result, occasionally are not operating at optimum capacity.

Here’s what needs to happen for a life to be created. Millions of sperm need to traverse the cervix (which needs to have adequate watery mucus for the sperm to swim through to get to the uterus) and, from there, to the fallopian tubes where, en masse, the sperm gang release digestive enzymes that help bore a hole through the egg membrane. Your egg needs to be healthy and mature, picked up by the fimbria, the fingerlike projections of the fallopian tube and swept along the length of the tube by microscopic hairs within the tube. The environment of the tube needs to allow for fertilization with penetration by only one of the sperm, followed by division of the fertilized egg into a multi-cellular embryo. While the embryo continues to grow and cleave and develop ultimately into a blastocyst containing the future fetus (inner cell mass) and placenta (trophoblast) the tubal micro-hairs continue to sweep the embryo ultimately into the uterine cavity.

The lining of the uterus, the endometrium, must be prepared with adequate glandular development to allow the now hatched embryo to implant. Yes, there is a shell surrounding the embryo that must break in order for the embryo to implant into the uterine lining. Inflammatory fluid, polyps, fibroids or scar tissue may all play a role in preventing implantation.

Oy, it’s amazing this ever works!

In fertile bodies of good working order, this all works an average of 20% of the time!

So . . . how do we get our bodies in optimal shape to maximize our chance of conception?

Check on medications that you may be on. Can you stay on them while trying to conceive? Guys need to do this too! Some medications may affect ovulation or implantation. Prostaglandin inhibitors found in common pain relievers can affect both ovulation and implantation. Calcium channel blockers commonly used to control high blood pressure may affect your partner’s sperm’s ability to penetrate and fertilize an egg.

How is your diet? Is your weight affecting ovulation and preparation of your uterine lining either because it is too high or too low? Do you have glucose intolerance that is leading to high levels of insulin in the blood that affects your hormones and ovarian follicular and egg development? Perhaps you would benefit from a regimen including a carbohydrate restricted diet, exercise and medication to improve glucose metabolism.

Make love. Sex is critical to reproduction, obviously but I am often asked how often and how to time as if it need be a schedule chore. This is a bit tricky as it is vital that while we reproductive endocrinologists are assisting our patients to conceive we want to preserve the relationship that provides the foundation on which we want to build their family. I try not to give patients a schedule until they are in an insemination cycle where we actually identify the precise day of ovulation. I recommend spontaneous lovemaking that in cases of normal sperm counts (which should be analyzed as part of that check up) should average at least every other day in the middle of a woman’s menstrual cycle. Ovulation typically occurs 14 days prior to the onset of her menses. Sperm survive anywhere from 1 day to 7 days in a woman’s cervical mucus varying both on the sperm and the quality of her mucus which for some women is optimal for only hours if at all. Eggs survive 6-8 hours. Therefore, when we perform insemination it is better if we inseminate prior to ovulation rather than after as the sperm have more time to sit around and wait for the egg than visa versa.

See an RE. When all else fails, it is recommended that you consult with a reproductive endocrinologist if you have not conceived after one year before age 35 and six months if you are 35 or older. The treatments available to the specialist are extraordinarily successful today and should ensure that for the great majority of you, you may happily retire that teeny weenie bikini for a maternity swimsuit.

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So…are you in fighting reproductive shape? If not, what’s on your list to take care of next?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=16221&picture=girl-in-swimsuit

 

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