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Archive for September, 2012

Long Island IVF at the Z-P Health & Wellness Fair on Sunday!

By Tracey Minella

September 28th, 2012 at 12:29 pm

This is the perfect time of year to focus on your health and make some new goals…especially when there’s a free outdoor health and wellness fair to stroll through!

Long Island IVF will be one of over 50 vendors at the First Annual Zwanger-Pesiri Health and Wellness Fair. It’s this Sunday, September 30, 2012, between 1:00-5:00 pm, in the parking lot of Zwanger-Pesiri Radiology at 150 East Sunrise Highway, Lindenhurst, New York. Many vendors will be raffling off or giving away free items!

Don’t miss a chance to meet some of Long Island IVF doctors and staff. Our own Lindsay Montello is a fun-loving wealth of information, so be sure to swing by our booth where there’s always something interesting going on. Rumor has it that Dr. Kreiner will make an appearance as well.

So grab a light sweater or funky knit scarf…and a friend… and head out into the fresh fall air. Again, it’s FREE admission and FREE parking. And in addition to great health-related vendors and physician specialists, there will be live music, bouncy houses, great food and drinks, and cooking demos…just to name a few things! There’s also a blood drive going on. So there’s something for everyone. Check out the details on the different participating vendors here: http://www.zwangerpesiri.com/HealthFair

If you go, be sure to snap a picture by our booth and share it on LIIVF’s Facebook page at http://www.facebook.com/longislandivf , so everyone can see the fun they missed.

Please note the raindate is October 7, 2012.

Looking forward to seeing you there!

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Do you like to attend Health and Wellness Fairs? What kinds of booths and raffles interest you?

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Infertility Podcast Series: Journey to the Crib: Chapter 29: Why the Wyden Bill Does Not Support Fertility Patients

By David Kreiner, MD

September 28th, 2012 at 6:22 am

 Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twenty-Nine: Why the Wyden Bill Does Not Support Fertility Patients. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=138 

Why “The Wyden Bill” Does Not Support Infertility Patients 

IVF results subjected to government audit were mandated to be reported with the passage of the “Wyden bill”.   The intent of the CDC and national reproductive society (SART) was to assist infertility patients by informing them of the relative success of all IVF programs in the country.  

Unfortunately, what sometimes creates the best statistical results is not always in the best interest of the mother, child, family and society.  Now that prospective parents are comparing pregnancy rates between programs there is a competitive pressure on these programs to reports the best possible rates.   Sounds good…unfortunately it doesn’t always work out that way for the following reasons. 

Patients with diminished ovarian reserve, who are older or for any number of reasons have a reduced chance for success, have a hard time convincing some programs to let them go for a retrieval.  In 2008, we reported our success, 15% with patients who stimulated with three or fewer follicles.  Sounds low and in fact many of these patients were turned away by other IVF programs in our area.  However, for those families created as a result of their IVF, these “miracle” babies are a treasure that they otherwise… if not for our program giving them their chance… would never have been born. 

Another unfortunate circumstance of featuring live birth rate per transfer as the gold standard for comparison is that it pressures programs to transfer multiple embryos thereby increasing the number of high risk multiple pregnancies created.  This is not just a burden placed on the patient for their own medical and social reasons but these multiple pregnancies add additional financial costs that are covered by society by increasing costs of health insurance as well as the cost of raising an increased number of handicapped children. 

William Petok, the Chair of the American Fertility Association’s Education Committee reported on the alternative Single-Embryo Transfer (SET) “Single Embryo Transfer:  Why Not Put All of Your Eggs in One Basket?”.  He stated in November 2008, that although multiple rather than single-embryo transfer for IVF is less expensive in the short run, the risk of costly complications is much greater.  Universal adaptation of SET cost patients an extra $100 million to achieve the same pregnancy rates as multiple transfers, but this approach would save a total of $1 billion in healthcare costs.

We have offered SET since 2006 with the incentive of free cryopreservation, storage for a year and now a three for one deal for the frozen embryo transfers within the year in an effort to drive patients to the safer SET alternative.  

If we are going to report pregnancy rates with IVF as is required by the Wyden Bill, let us put all programs on the same playing field by enforcing the number of embryos to be transferred and even promoting minimal stimulation IVF for good prognosis patients.  The Wyden Bill without the teeth to regulate such things as the number of embryos transferred and reporting success per embryo transfer does more harm than good.  Let us promote safer alternatives and report in terms of live birth rate per stimulation and retrieval, including frozen embryo transfers, so that there is a better understanding of the success of a cycle without increasing risks and costs from multiples. 

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Was this helpful in answering your questions about the Wyden Bill, IVF success rates and reporting requirements, and SET?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

 

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Yom Kippur and Infertility

By Tracey Minella

September 25th, 2012 at 10:41 pm

image courtesy of photostock/free digitalphotos.net

The physicians and staff at Long Island IVF would like to acknowledge the significance of this day for our patients who celebrate this most solemn of Jewish holidays.

Yom Kippur is a day of atonement for Jews. Jews believe that God inscribes their fate for the next year in the Book of Life during Rosh Hashanah and that that fate is “sealed” on Yom Kippur. Jews spend the day praying and repenting. They may also give to charity. As part of this holiday of atonement, Jews fast from just before sundown to the following sundown. Most Jews who observe do not work or make profit on this day.

Not being Jewish myself, I only know of these rituals through my many Jewish friends. I’ve always enjoyed learning about other religions and the impact of those religious doctrines on infertile people who follow that faith.

So I wonder… since I have a friend going through a donor egg retrieval and transfer this week… how an infertility patient may be affected by this holiday. What decisions would the patient be faced with regarding religious tradition and medical protocol?

I imagine the idea of one’s fate being sealed for the upcoming year would be both exciting and possibly a bit frightening when going through IVF this very week. Has the outcome already been determined? Does that belief bring a sense of comfort or more anxiety?

And what about fasting? A generally healthy adult can get through such a sacrifice without much discomfort. But what if you are undergoing a retrieval or transfer today or this week? Is there stress and deprivation to the body you’re preparing for pregnancy? What do you do?

Many religions can present infertile followers with conflict… as well as comfort …along their infertility journeys. Good luck to my friend, Keiko, and to anyone else undergoing fertility treatment this week. You can check out Keiko’s donor egg adventure this week at her blog, The Infertility Voice.

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We invite your respectful and thoughtful responses. Would you fast? Would you be stressed or comforted by doing IVF on the day of Yom Kippur, when your fate is sealed for the year? If a friend was doing IVF today and asked you for input on these issues, what thoughtful words of advice would you give her?

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Uterus Transplants in the News

By Kathleen Droesch MD

September 24th, 2012 at 8:31 pm

credit: david castillo dominici/freedigitalphotos.net

Swedish doctors this week reported on two women who each received a donated uterus from her mother in the hope of one day being able to become pregnant, carry, and deliver their own children.*

Until recently, uterine transplants were only performed successfully in animal models.  After many years of research, a live-to-live donor uterus transplant has now been offered to two women.  One woman was born without a uterus while the other had a hysterectomy for cervical cancer. Previously, these women would have been unable to have a biological child unless they utilized a gestational carrier to carry the pregnancy to term.

Prior to the transplants, both patients underwent in vitro fertilization (IVF) procedures for the purpose of stimulating their ovaries to produce multiple follicles (eggs). The eggs were retrieved, combined with a semen specimen for fertilization to occur, and (because the women did not yet have a uterus to transfer the embryos back into) the resulting embryos were cryopreserved (frozen for future use).  The embryos will be transferred after waiting one year to allow for healing and confirmation of the viability of the transplanted uterus.

Certainly there are disadvantages and potential concerns regarding this procedure.  The recipients will need to take immunosuppressive medication to prevent rejection of their transplanted organs. Although, there are studies of women after kidney transplant that have had successful pregnancies while on immunosuppressive medications. It will also be more than a year before they will be able to attempt pregnancy and there are no guarantees that they will ever be successful. Even if the women achieve pregnancies, the ability of a transplanted uterus to function normally in pregnancy has not been studied.

Currently at Long Island IVF, we have patients using donated oocytes (eggs) or embryos. We also have a number of patients who’ve had their embryos transferred into the uterus of a gestational carrier.  Not only is this a complicated decision for a couple to make, but a carrier that the couple trusts may not be available.

It is exciting to see the ongoing research into fertility issues.  Although uterine transplants are currently considered experimental, one day they may take their place alongside kidney transplants for women who desire the ability to experience pregnancy after the loss of their uterus.

*For the full report, click here: http://www.cnn.com/2012/09/19/health/uterine-transplant/index.html

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What do you think of this breakthrough in technology?

 

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Lifestyle Changes and Infertility

By Tracey Minella

September 21st, 2012 at 11:42 am

image courtesy of Ambro/free digitalphotos.net

I’ve spent the better part of this morning contemplating the issue of infertile folks making lifestyle changes to improve their health in general, and specifically to potentially boost their fertility. My thinking was inspired by a discussion over at RESOLVE.

Because I was far from the perfect IVF patient myself, I don’t feel right getting on a soapbox and telling you that in order to conceive you must get 10 hours of sleep (when you may be working an extra job to finance your fertility treatments). Or that you have to exercise daily (when I was a “couch potato” during my own exhausting, long journey). Or that you have to shell out some serious cash to start eating organic and juicing nature’s bounty (when I had major Brussels Sprouts issues and inhaled my favorite comfort food…mac and cheese).

I am, however, okay with telling you flat out not to use recreational drugs. And you really aren’t helping anything by drinking alcohol… though an occasional glass of wine or a beer might be okay if you ask your doctor. Likewise, doctor-recommended exercise programs, supplements, vitamins, a reasonably healthy diet, and little or no caffeine, may only help your fertility. Maybe my own journey would have been shorter if I’d changed my lifestyle for the better.

It can be hard to change under the best circumstances. And infertility is certainly not the best of circumstances. In fact, it’s one of the worst. If you’re depressed about your struggle to conceive, it can be hard to find the strength to get out of bed every morning, much less mount some huge, draining lifestyle change. You already don’t have the baby yet. Now there are more things to give up? How much more deprivation can a person stand?

On the other hand, one of the worst things about infertility is the lack of control over the outcome. Making some positive lifestyle changes can help you feel more empowered. It can help you feel like you’re “doing something” …beyond going through the 24/7 motions of your treatment plan’s monitoring…to possibly better your odds of getting pregnant and having a healthier baby. And all of this can help combat that depression. Plus these changes can make you feel and look better, too. If these lifestyle changes are doctor-recommended, they certainly can’t hurt.

For me, I changed the things I was financially, emotionally, and physically able to change and forgave myself for the things I couldn’t. I weighed the deprivation of not having a baby against the deprivation of some harmless and occasional vices… so that I could function with some kind of a normal life during my 7 year journey. I paced myself.

However you choose to approach the issue boosting fertility through lifestyle changes, I hope you’ll remember to both forgive yourself and reward yourself along the way.

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What lifestyle changes, if any, have you made to increase your chance of conceiving? Do you see these lifestyle changes as burdens and deprivations or as empowering opportunities?

Photo credit: http://www.freedigitalphotos.net/images/search.php?search=exercise&cat=&page=6&gid_search=&photogid=0

 

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Infertility Podcast Series: Journey to the Crib: Chapter 28: No More “Jon and Kate” Casualties

By David Kreiner MD

September 20th, 2012 at 5:03 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twenty-Eight: No More “Jon and Kate” Casualties. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=136

 No More “Jon and Kate” Casualties

 Two years ago when I wrote this chapter, the Jon and Kate makes eight story was still hot in the press.  It brought to the national limelight the potentially tragic risk of the high order multiple pregnancy for women undergoing fertility therapy.  It is one I was all too familiar with from my early days in the field, during the mid-1980′s when the success with IVF was poor and we consequently ran into occasional high order multiple pregnancies with transfer of four or more embryos or with the alternative gonadotropin injection treatment with intrauterine insemination (IUI). 

Today, IVF is an efficient process that, combined with the ability to cryopreserve excess embryos, allows us to avoid almost all high order multiple pregnancies.  In fact the IVF triplet pregnancy rate for Long Island IVF docs has been under 1% for several years now.  There has not been a quadruplet pregnancy in over 20 years.  Such a claim cannot be made for gonadotropin injection/IUI therapy where as many eggs that ovulate may implant. 

You may ask then why would we provide a service that is both less successful and more risky and was the reason Jon and Kate made eight. 

Not surprisingly, the impetus for this unfortunate treatment choice is financial.  Insurance companies, looking to minimize their cost,  refuse to cover fertility treatment unless they are forced to do so.  In New York State, there is a law that requires insurance companies based in NY State that cover companies with over 50 employees that is not an HMO to cover IUI.  The insurance companies battled in Albany to prevent a mandate to cover IVF as has been passed in New Jersey, Massachusetts and Illinois among a few others.  As a result, many patients are covered for IUI but not IVF.  This short-sighted policy ignores the costs that the insurance companies, and ultimately society, incurs as a result of high order multiple pregnancies, hospital and long-term care for the babies. 

The answer is simple.  Encourage patients to practice safer more effective fertility.  This can be accomplished with insurance coverage for IVF, wider use of minimal stimulation IVF especially the younger patients who have had great success with it and minimizing the number of embryos transferred.  

At Long Island IVF we encourage single embryo transfer by eliminating the cost of cryopreservation and embryo storage for one year for patients who transfer one fresh embryo.  In addition, we offer those patients up to three frozen embryo transfers for the price of one within a year of their retrieval or until they have a live birth. 

It is my sincere wish that the government can step in to enforce a policy that will never again allow for the possibility of another Jon and Kate debacle. 

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Was this helpful in answering your questions about multiple pregnancies, IVF, IUI, and Micro-IVF?  Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

 

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Long Island IVF Seminar Thursday Night! Meet Our Team!

By Tracey Minella

September 18th, 2012 at 1:11 pm

Summer’s over. There’s a slight chill in the autumn night air. And you have no plans for Thursday night. That is until now. 

Grab a light sweatshirt and some comfy jeans… maybe even a festive scarf… and come on down to Long Island IVF and meet the team. 

We can really help you get your mind off all the worry that comes with trying to conceive and not succeeding yet. Is there a voice in your head saying there may be a reason why you haven’t gotten pregnant yet…but you keep ignoring it out of fear? 

Well, don’t miss this chance to meet and mingle with the Long Island IVF team this Thursday, September 20, 2012 at 6:30 pm and get all your questions answered! Think about that. Free access to privately pick the brain of a Reproductive Endocrinologist. No co-pay. No check. No cost. Just listen, learn, and then ask your questions in private. 

Spend some time with us learning all about IVF. After all, knowledge is power. We’re a very knowledgeable and approachable group. Still nervous? Bring a friend. 

In fact, we’ll sweeten the pot if you do just that! Grab a friend* and come down to meet some of our team… and we’ll give you a Starbucks card for yourself. 

Can’t get your friends to come with you? Well, you still have US…and we’re the best friends someone suffering from infertility could ask for…we understand AND can help! You’ll get riveting, cutting edge fertility information from some of the most respected doctors, embryologists, and staff members in the reproductive medicine business. You could even make a new friend. 

As if that’s not enough…we’ll have cookies. That’s right. We feed you snacks if you come out in the chilly night air. 

Remember, after you’ve learned everything there is to know about IVF, you can have all your personal questions answered privately right after the speakers wrap up their quick presentations. And the best part is that you don’t even have to be a current patient to come! Just come in off the street. Have an early dinner and come over afterwards. Or swing by after work. 

Have you been trying to conceive without success? Maybe suffered one or more miscarriages? Is your day 3 FSH in the stratosphere? Have other programs told you to give up?  Have they said you’re too heavy to conceive? Do you need info on grant programs and financing? Would you like to hear of contests where you could win great prizes like restaurant certificates and free or discounted infertility services? If so, you really need to come down and meet the some of our professional team. 

Don’t you owe it to yourself to just check it out? When was the last time you could corner a RE and ask all your questions without them politely dashing out? For free.

 Come on. We’re waiting for you. And your legitimately interested friend*…who, by the way, can’t be a spouse, partner, parent, child, pregnant neighbor, octogenarian, or octomom. (That would be cheating!) 

Seminar begins this Thursday, September 20th at 6:30 pm at: Long Island IVF, 245 Newtown Rd., Suite 300, PLAINVIEW, New York 11803 

We’ll be there ‘til the last question is asked and answered…or we run out of cookies…whichever comes first ;-) Be there. 

Photo credit: =http://www.publicdomainpictures.net/view-image.php?image=5684&picture=cup-of-coffee

 

 

 

 

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Can Fertility Medications Cause Ovarian Cancer?

By David Kreiner MD, and Tracey Minella

September 17th, 2012 at 7:49 pm

image courtesy of david castillo dominici/freedigitalphotos.net

September is National Gynecological Cancer Awareness Month.

Admit it. If you’ve done IVF or stimulated IUI cycles, or even Clomid, the thought has crossed your mind. Will fertility drugs cause ovarian cancer later? Am I doing all this to become a mother, but I won’t be around to see my baby grow up? And the more cycles you do, the more you start to worry.

It’s natural to worry.

I worry… even though I know better. But to help keep my fears in check, I remind myself that infertility itself is a risk factor for ovarian cancer, so by defying it and becoming pregnant I may be helping my odds. I am also vigilant with my annual exams and I get an annual ovarian sonogram as well. By spacing the regular annual and the sonogram 6 months apart, I am examined every 6 months and like to think I’m boosting my odds of catching any problems that may arise early. [Fertile folks think I’m nuts going twice a year, but as we infertiles know, stirrups twice a year is a welcome change from stirrups every… stinkin... day.] If you are freaked out about cancer, you can follow my neurotic lead or listen to Dr. Kreiner.

Fortunately, Dr. Kreiner of Long Island IVF can put the fears of rational ladies like you to rest. Read on for some peace of mind:

I am often asked whether the medications we use in our fertility treatments can cause ovarian cancer. In the past, conflicting stories have been published mainly in the newspapers and non medical magazines. A scientific forum, Medscape Medical News, reviewed research on this topic and the good news is summarized below.

OnFebruary 10, 2009— It was concluded in the largest study of the subject to date that Fertility drugs do not increase the risk for ovarian cancer. There was no convincing association with ovarian cancer for any of the 4 different types of drugs used to treat infertile women — gonadotrophins (Bravelle, Menopur, Gonal F, Follistim), clomiphene citrate (Clomid, Serophene), human chorionic gonadotrophin (HCG,Novadrel, Ovidrel) and gonadotropin releasing hormone agonist/antagonist (Lupron, Ganirelix, Cetrotide).

Instead, the data suggest that factors related to the diagnosis of infertility (for example, genetic or biological factors) — and not the use of fertility drugs — increase the overall risk for ovarian cancer.

However, they also point out that there is a major limitation to this study — many of the participants have not yet reached the age at which the incidence of ovarian cancer peaks (early 60s).

The study, headed by Allen Jensen, PhD, assistant professor of cancer epidemiology at the Danish Cancer Society’s Institute of Cancer Epidemiology, in Copenhagen, Denmark, is reported online February 5, 2009 in BMJ(British Medical Journal).

These data are reassuring but cannot absolutely rule out a very small increase in ovarian cancer or one that occurs much later in life.

Main Limitation Is Age of Participants
A link between fertility drugs and increased risk for ovarian cancer was suggested by several studies in the early 1990s, and this has created concern for patients undergoing infertility treatment. However, many of the studies over the past 8 to 10 years have been very small and none were able to reject or confirm the hypothesis.

This study was the largest because it included 156 women with ovarian cancer, more than 3 times as many as any previous cohort.

The main limitation of the study, however, is the age of the participants. These were young women; they were first evaluated for infertility at a median age of 30 years. Despite a long follow-up, the median age of these women at the end of the follow-up period was 47 years. This is below the usual age at which women are diagnosed with ovarian cancer, which reaches a peak incidence in women in their early 60s. So there is a possibility that there could still be a spate of ovarian cancers diagnosed as these women age, which could alter the conclusions.

This is a question that nobody can answer yet, we should say that the data so far are reassuring with this observation period, and with this age of the cohort, we cannot see any association with an increase in the risk of ovarian cancer.

The researchers intend to revisit the data at regular points in the future to check on the progress of the study cohort with “passive surveillance.” The Danish system of personal identification numbers and nationwide health and cancer registries will allow them to track any new diagnosis of ovarian cancer.

Cannot Exclude Small Possibility
The Danish study investigated the records of 54,362 women with infertility problems, and compared 156 women who developed invasive epithelial ovarian cancer with 1241 controls.
However, although this study was much larger than previous investigations, it still could not exclude the possibility of a small increase in the risk for ovarian cancer in users of fertility drugs, The rate ratio for use of any fertility drug was 1.03, but the upper bound of the 95% confidence interval was 1.47.

Larger numbers of women will need to be studied to answer this question, and these will come with further follow-up of the cohort as they enter the age range where ovarian cancer is most common. Some women who take fertility drugs will inevitably develop ovarian cancer by chance alone, but current evidence suggests that women who use these drugs do not have an increased risk.

Clinical Context
Infertility has previously been associated with an increased risk for ovarian cancer. In an epidemiologic study of 3837 women treated for infertility, Rossing and colleagues demonstrated that infertility increased the risk for malignant ovarian tumors by a factor of 2.5 vs. the overall community prevalence of ovarian cancer. This study, which was published in theSeptember 22, 1994, issue of the New England Journal of Medicine, also suggested that the use of clomiphene in particular could increase the risk for ovarian cancer, particularly in women who had used the medication for more than 1 year.

The current study uses a large cohort of women to examine the effects of different fertility medications on the risk for ovarian cancer.

Study Highlights
• The study cohort consisted of women referred to Danish hospitals or infertility clinics between 1963 and 1998. A total of 54,362 women had data available for analysis.
• Cases of ovarian cancer were documented with use of 2 national registries: 176 women were diagnosed with epithelial ovarian cancer during a median follow-up of 16 years, and 156 women had data for analysis.
• The main outcome of the study was the relationship between fertility drugs and the risk for ovarian cancer. The 156 women with ovarian cancer were compared vs 1241 women from the infertile cohort who did not have ovarian cancer.
• The median year for entry into the infertility clinics was 1989, and the median age at the first evaluation for infertility was 30 years.
• The median time from entry into the cohort until the diagnosis of ovarian cancer was 14.5 years.
• Overall, the use of fertility drugs did not significantly affect the incidence of ovarian cancer. Fertility drugs were used by 49% and 50% of women with and without ovarian cancer, respectively.
• Clomiphene was the most widely used fertility drug, followed closely by human chorionic gonadotropins. Other gonadotropins and gonadotropin-releasing hormones were used less frequently.
• Nulliparity (No births) conferred an especially high risk for ovarian cancer in these women with infertility. The risk for ovarian cancer decreased with a higher number of births.
• The use of oral contraceptives and the cause of infertility did not significantly affect the risk for ovarian cancer.
• After adjustment for parity (Births), none of the individual fertility drugs were associated with a significant effect on the risk for ovarian cancer. The number of cycles used or the number of years since first use did not affect this conclusion.
• Similarly, combination treatment with multiple fertility drugs did not appear to increase the risk for ovarian cancer.
• Serous tumors were the most common histological type of ovarian cancer. Clomiphene use was associated with a higher risk for serous tumor vs. no use of fertility drugs but only in women who used clomiphene at least 15 years before the diagnosis of ovarian cancer.
• Previous research has found that infertility is associated with an increased risk for ovarian cancer, particularly in women who used clomiphene for more than 12 months.
• The current study suggests that fertility drugs do not significantly increase the risk for ovarian cancer.

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Do you worry about getting ovarian cancer from fertility drugs? Do you trust the results of studies like the ones referred to above?

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Infertility in Stepfamilies

By Tracey Minella

September 16th, 2012 at 9:38 am

Not all couples struggling with infertility are childless. Sometimes there are children in their lives from a prior marriage or relationship. Maybe they have full custody. Maybe joint.

Today is National Stepfamily Day. Ever since the days of Cinderella, stepmothers have had an image to overcome. They’ve been portrayed as thoroughly wicked, evil, and ugly. However, over the past few decades, divorce has become more common and…like many things do over time… it’s become more accepted by society. Blended families are everywhere.

What better time to ask the question…

How does the existence of stepchildren affect an infertility journey?

Well, to start with the obvious: one partner has experienced parenthood, with its joys and challenges…and the other has not. So they are approaching the infertility challenge from different perspectives. How they navigate this journey together goes beyond their relationship as a couple. It may be influenced by whether their parenting (and step-parenting) experience has been mostly joyful or mostly challenging.

Does the partner who already has children feel the same burning desire for more children that the childless partner feels to have their first child? Do the financial obligations and time commitments regarding existing children affect how supportive the parent with kids will be along this journey? Maybe knowing the joys of parenthood would make one partner more determined than ever to help the other find that joy. Or maybe adding more children is not as high a priority for the one who has them.

And how does the childless parent feel in cases where their partner had previously undergone a vasectomy or tied their tubes? Was that action a “statement” that their partner doesn’t want more children…or merely that he/she didn’t want more children with their prior partner?

There are other factors that affect infertility journeys with stepfamilies beyond the couple itself. There are all the interwoven relationships of stepfamilies beyond the couple itself. The parent’s relationship with his/her kids. The parent’s relationship with the ex. The new partner’s relationship with the stepchildren. When these relationships are healthy and supportive, everyone benefits, but when there are problems, the stress can be unbearable. And added stress is never a good thing, especially to couples trying to conceive.

It’s hard enough to be in a childless relationship when each partner is striving to become a parent for the first time. Even then, some couples struggle with extra guilt if the diagnosis is “their fault”. (They shouldn’t feel that way, but many do.) Now imagine the added frustration some childless parents might feel in not being able to give their partner a child when the prior partner could.

Yet in other cases, the existence of stepchildren may lessen the stress of infertility. As much as the couple wants biological children from their union, they at least have children in their life. They have children to tuck in, PTA meetings to attend, birthday parties to plan, and ballgames or recitals to enjoy. If they are not successful in conceiving, they will not live a child-free life.

There are financial issues, too. Especially in a bad economy. If there are children to support from a prior relationship, that can be a strain on a couple’s ability to finance fertility treatment. And that strain can lead to some resentment. The partner with children may resent having to spend money to have a child…when he didn’t have to pay to get pregnant before. And the childless partner may be bitter that they can’t afford the IVF cycle she needs to get pregnant because her partner is supporting a prior family and there’s just not enough money left over for treatment.

It is important for any couple undergoing infertility treatments to support each other along the journey, and also to seek outside support when needed. Long Island IVF’s Mind-Body specialist and psychologist, Bina Benisch, M.S., R.N., offers group and individual therapy sessions for men and women facing the challenge of infertility.

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Are you struggling with infertility as part of a stepfamily? Do you have any advice for others in your position or just need to vent?

Photo credit (public domain):  http://vintageprintable.com/wordpress/vintage-printable-animal/animal-reptiles-and-related/medieval-mythology-baby-hercules-wrestling-serpents-thrown-in-his-crib-by-his-step-mother/

 

 

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Infertility Podcast Series: Journey to the Crib: Chapter 27: A Dozen Embryos, Who Will Stop This Madness?

By David Kreiner MD

September 13th, 2012 at 10:58 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twenty-Seven: A Dozen Embryos, Who Will Stop This Madness? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=133

A Dozen Embryos, Who Will Stop This Madness? 

When I wrote this chapter, the news of the day was that an IVF clinic had transferred 12 embryos.  In fact, it was learned weeks later that this was a hoax.  However, in the wake of Octomom, where 8 embryos were transferred, I felt there was still an important lesson to be learned especially since insurance companies often insist that a patient try multiple cycles of intrauterine insemination (IUI) before covering IVF… if they cover it at all. 

In fact, gonadotropin hormones in conjunction with IUI offers a 35% risk of multiple pregnancy including a 5% risk of triplets or more.  After obtaining six fetuses after one such cycle, I became very wary of offering gonadotropin IUI cycles to my patients. 

Yet, this is what our insurance companies are covering rather than the safer IVF where only 1 or 2 embryos can be transferred at a time. 

When we do an IUI, as many eggs that ovulate can implant resulting in a high risk multiple pregnancy.  I believe that it is not until we discourage the use of gonadotropins without IVF by offering a regulated covered alternative will we eliminate these risky multiples. 

Until then, all of us including society, the government, insurance companies and employers are to blame for letting these dangerous multiple pregnancies occur. 

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