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Archive for February, 2013

Infertility Podcast Series: Journey to the Crib: Chapter 3: What Are My Odds?

By David Kreiner MD

February 26th, 2013 at 4:59 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Three: What Are My Odds? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=24

 

What are my odds?

 

This chapter is dedicated to informing patients regarding the potential for success with fertility therapy.  Success, in particular with IVF has been increasing significantly over the years as physicians and embryologists became more experienced.   The tools we use are more accurate and effective today and the protocols, media and laboratory conditions are all far superior to that which was standard not so many years ago.

 

This improved efficiency of the process has allowed physicians to transfer fewer embryos thereby avoiding the higher risk multiple pregnancies that IVF was known for in the 1990’s.  Still pressure exists to transfer multiple embryos to minimize expenses for the patient and maximize success rates for the IVF programs.  I have instituted a single embryo transfer incentive (SET) program at Long Island IVF eliminating the cost of cryopreservation and storage for a year for patients transferring a single embryo.  These patients are also offered three frozen embryo transfers within a year of their retrieval for the cost of one in an effort to eliminate the financial motivation some patients express to put “all their eggs in one basket”.  Experience tells us that the take home baby rate for patients transferring a single embryo at the fresh transfer is equal to that for patients transferring multiple embryos when including the frozen embryo transfers. For information on the SET program, go to: http://bit.ly/WpzCvv

 

Since the merger of East Coast Fertility and Long Island IVF, we have seen clinical IVF pregnancy rates at 66% (35/53) for women <35, 60% (18/30) for women 35-37, 54.1% (20/37) for women 38-40 and 8/28 (28.6%) for women 41-42 from Oct 1- Dec 31, 2011.  MicroIVF has been running better than 40% for women <35.

 

Different factors are discussed that can affect pregnancy rates at different programs.  The use of Embryo Glue and co-culture at Long Island IVF are discussed as laboratory adjunctive treatments that appear to improve our success rates.

 

For the most recent success rates, speak to your Long Island IVF physician or visit our website at http://bit.ly/XYZrSC

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Please share your thoughts about this podcast or ask any questions of Dr. Kreiner here.

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Oscar’s Relationship with Infertility

By Tracey Minella

February 25th, 2013 at 8:12 pm

image courtesy of free digital photos.net

Last night was the 85th Annual Academy Awards celebration. As I watched the show, a small part of me…the cynic…couldn’t help but shake my head at the ridiculous amount of money entertainers make for what they do. (Was I the only one secretly wondering how many IVF cycles could have been funded by that gown Jennifer Lawrence tripped over?) But then, they only make it because we’re willing to pay it to see them. In fact, America loves Hollywood so much that millions of us watch not only their movies, but also shows where they give awards to each other!

Why are movies so important to infertile people? Well, they are still an affordable date for most folks. They’re a good choice for an outing when you have to socialize with those annoying friends that would otherwise talk your ear off about their children. But most importantly, movies are an escape from reality for the infertile couple. True, it’s a temporary one. But as anyone who’s walked a mile in our stirrups knows, we’ll take any escape we can get.

There are dramas that make you cry—a great release of all that pent up emotion and stress. Dramas also make us realize that others are suffering from their own burdens, which is something we may lose sight of when wallowing in our own sadness. Surely, misery loves company.

Then, there are comedies. Sometimes a great comedy is the only thing that can coax that true, long-forgotten belly-laugh out of an infertile person. Laughter really is the best medicine sometimes. (And it beats the heck out of Clomid.)

Of course, there are also animated films. These are tricky. They are usually made for a young audience and attract families, which may make viewing them anything from challenging to unbearable. But some infertile people like them…possibly viewed at home on DVD… because they think of bringing their future child to see such movies someday. I used to buy the Disney DVDs and put them away for my future child “before they went back in the vault for another 10 years”. Anyone else do that?

Then, on only two occasions I can remember, a movie will come along to deal with infertility head-on. This past year saw the release of the Disney movie, The Odd Life of Timothy Green. It was about an infertile couple at the end of their journey who, on the night they decide to give up trying to conceive, wrote down on paper scraps the qualities of the child they longed to have. Then, with heavy hearts, they buried the scraps in a box in their yard. A kick of wind, some Disney magic, and then the next morning, their son “grew” from the garden. The other film I remember starred Nicole Kidman doing IM fertility injections. Anyone remember the name of that one?

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What type of films do you escape with? Or do you escape another way? Did any of this year’s nominees’ or winners’ performances touch your heart?

 

Photo credit: http://www.freedigitalphotos.net/images/Movies_Theater_and_C_g202-Oscar_Su_Sfondo_Rosso_p12046.html

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Infertility: A Dozen Losses

By Tracey Minella

February 24th, 2013 at 12:27 pm

credit: david castillo dominici/freedigitalphotos.net

Infertility is responsible for so many different kinds of losses:

Loss of control because you can’t have a baby when you want to, and you can’t have a baby without someone else intervening, and you can’t have as many babies as you planned on.

Loss of the dream because you’ve always wanted to be a mother (or father) someday and now the dream is lost…at least temporarily but possibly permanently.

Loss of your sense of self because becoming a parent is such a big part of your identity…and when you can’t have a baby, nothing makes sense or matters any more.

Loss of job opportunity because you can’t rock the boat at work if medical benefits are at risk and you can’t take time off for treatment at a new job.

Loss of happiness because without the baby, there is always, always a black cloud overhead. Some moments are better than others, but none are truly happy. Even vacations, if you can afford to take them, are half-hearted.

Loss of relationships with friends and family because they either don’t know or don’t understand your situation. Because they have children and you don’t, your lives have taken different paths. Your interests are different. They’ve moved on to “family” activities while you remain in “couples” activities. And the pain to be around the children is sometimes unbearable. So you feel isolated.

Loss of people who die along the way, such as the parents you were hoping would live long enough for you to make them grandparents.

Loss of time because sometimes the infertility journey takes much longer than you thought and those years become a black hole…time that you can’t get back. And you become a parent at an older age than you’d planned. That lost time shows up when you find it a bit harder to keep up with your child and when you secretly worry whether you’ll live long enough to see your child settled or see your grandchildren.

Loss of love because infertility is a bitter test. And not every marriage or partnership can withstand the emotional, physical, and financial burdens of infertility.

Loss of dignity because not every woman wears a paper gown with confidence. And some tests, procedures, and losses… with their pain, poking and prodding…leave her physically and emotionally exposed, vulnerable and broken.

Loss of financial security because the aching heart and empty womb knows better than the brain. And before many people know it, the costs of multiple cycles of infertility treatment or an adoption can deplete savings and retirement accounts, cause credit card debt, and delay or prevent home ownership.

Loss of children because happy endings are not guaranteed and often don’t come without great sacrifices. From embryos transferred that didn’t implant to miscarriages, stillbirths, and infant deaths, there are unimaginably painful losses.

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Many of these losses are not erased even by the happy resolution of the infertility journey. We absorb them and live with them and their after effects as best we can for years to come. Obviously, it’s easier to cope if the outcome is a positive one.

And it is the hope for that positive outcome…for that miraculous gain amongst all the loss… that drives us all further than we ever thought we’d be able to go.

Don’t lose hope.

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Are there other losses? Are there any above that you relate to?

 

Photo credit: http://www.freedigitalphotos.net/images/CouplesPartners_g216-Man_Comforts_Woman_p56766.html /David Castillo Dominici

 

 

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Privately Ask Personal Infertility-Related Questions

By Tracey Minella

February 21st, 2013 at 6:33 pm

If you’re trying to conceive or suffering from infertility, you’ve got questions. Lots of them.

Sure there are plenty of busybodies willing to diagnose you with their unsolicited two cents. They “get it” because it took them a whole 3 months of trying before they “finally” got pregnant. And there are plenty of answers on the internet…if you can decipher their technical terminology or even trust their sources.

Wouldn’t it be great to hear the answers from the doctors you trust or to get the support from the patients who’ve walked…or are walking…in your shoes? Well, you can. Privately and for free.

If you ever have a question to pose to a Long Island IVF doctor, embryologist, or nurse, or if you are wondering if a fellow or former patient might have some encouraging words of support, you can send your question (or rant!) to us privately through Facebook’s private message feature. (Do not just post it to the general page, though, unless you want it to be seen publicly.)

Your private message will not be seen by the public or fans of the Long Island IVF Facebook page. Only by Long Island IVF staff.

If it is a question for staff, we will get the answer and post both the question (using only the first name of the asker) and the answer. If it is a question for the group of Facebook followers or a rant, we will post it (again, with only the name of the asker) and allow our community members (who are willing to publicly share their responses) to post helpful and respectful comments. Many of our Facebook fans are current and former patients, or experts, with big hearts and great advice to share.

This will enable us to turn Facebook into a more personal, forum-type experience for all of our followers, while still posting all the entertaining, educational, and inspirational things you’re used to seeing from Long Island IVF.

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So, my fellow infertile friends are you ready to help… and be helped by… others?

 

Photo credit: Stuart Miles http://www.freedigitalphotos.net/images/Computing_g368-Girl_Secretly_Looking_Behind_Laptop_p54818.html

 

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Infertility Podcast Series: Journey to the Crib: Chapter 2

By David Kreiner, MD

February 19th, 2013 at 4:50 pm

Welcome to the Journey to the Crib Podcast. We will have a blog discussion each week with each chapter.

This podcast covers Chapter Two: The Pregnancy Test is Negative Again-What Do I Do? You, the viewer, are invited to ask questions and make comments.  You can access the podcast here:  http://podcast.longislandivf.com/?p=20

A negative pregnancy test is a reminder of all the feelings of emptiness, sadness and grief over the void created by infertility.  This chapter was written to arm the reader with infertility with a strategy to fight off the potentially damaging effects that this condition can do to the afflicted individual.

The first step in dealing with the emotional onslaught that infertility brings includes focusing on breathing, meditation and seeking support from a partner or friend.  Perspective through knowledge in the fact that fertile couples only conceive every five months means that the infertile couple is in good company with many future moms and dads.

The next step is seeking help from a trained professional, a reproductive endocrinologist, whose focus is on helping infertility patients.  He/she works with infertile couples to develop a plan based on diagnosis, age, years of infertility, motivation as well as financial and emotional means to support that therapy.

Therapy may be surgical or medical.  They may include intrauterine inseminations or IVF with minimal or full stimulation.  There may be diagnostic tests, yet undone that may prove to be of value in ascertaining a cause for the problem and facilitate treatment.

Complementary and adjuvant therapies may offer additional success potential and emotional support by improving the health and wellness of an individual.  The mind body programs and acupuncture are the most popular of these.

A strategy for dealing with the negative pregnancy test is offered with the intent of helping patients take control of their lives, improve their health and well being and increase the likelihood that the next test will be a positive one.

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Please share your thoughts on the podcast and ask Dr. Kreiner any questions.

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Long Island IVF’s Personal Financial Counselor and Payment Options

By Tracey Minella

February 17th, 2013 at 4:45 pm

credit: stuart miles/freedigitalphotos.net

For many couples, understanding their infertility diagnosis and treatment options is challenging.  But that can pale in comparison to navigating the financial maze of infertility insurance and payment options for self-pay patients.

Imagine finding out on the day before your retrieval that the IVF cycle you thought was covered, actually isn’t? Fortunately, Long Island IVF can help you avoid such nightmares.

At Long Island IVF, every patient is assigned a “Personal Financial Counselor” that stays with you every step of the way… from the first day you walk through our doors until you’re returned to the care of your OB/GYN. This knowledgeable specialist is a valuable part of your personal treatment team during your time with us.

Your Personal Financial Counselor will act as the liaison between you and your insurance company and help ensure that you know the maximum benefits you may be entitled to for your infertility treatment. She can help explain your coverage, including pre-authorizations, co-pays, doctor referral requirements, and exclusions, if any, before your treatment begins.

Having a Personal Financial Counselor means there will be one specific and knowledgeable person who has your financial back on this journey…freeing you from the frustration of having to explain your whole situation over and over to whoever happens to pick up the phone whenever you call with a question.

Your Personal Financial Counselor can explain monetary or treatment-specific limitations in your policy right upfront when you become a new patient, so you can factor them in when discussing your treatment plan with your doctor. For example, if your plan covers IVF but has a monetary limit, it might affect how many IUIs you’ll want to do before moving on to IVF.

Your Personal Financial Counselor can also advise you about Long Island IVF’s many payment options. There are several different “Self Pay Case Rates” or programs offering bundled services for virtually every treatment protocol, http://bit.ly/Z2uTCj.

Long Island IVF also offers two different grant programs to help patients afford IVF treatment: the “IVF Grant” program http://bit.ly/YjVeKR and the New York State Department of Health, or “DOH Grant” program http://bit.ly/YjVnOD.  You can also reduce your costs if Micro-IVF is appropriate for you http://bit.ly/12ZjvaD.

Another financial option available to Long Island IVF patients is the “IVF Refund Program”. http://bit.ly/ZfqDmC. Also known as the “IVF Financial Share Program”, this program includes up to three (3) fresh IVF and up to three (3) Frozen Embryo Transfer cycles until a live birth is achieved. If you do not give birth, you receive 70% of your fees for the Program refunded to you. For more information about this program, which is administered through In Vitro Sciences, speak to your Personal Financial Counselor or call In Vitro Sciences directly at (877) 678-1999 to see if you meet the clinical and age criteria.

Don’t let your fear or confusion over the financial issues paralyze you from moving forward with your treatment. Let your Personal Financial Counselor explain and help you maximize any medical benefits, or direct you to the best available Long Island IVF  case rate program, grant, or financial refund program possible.

Having a Personal Financial Counselor will allow you to focus only on your medical treatment… and reducing stress can only benefit your treatment outcome.

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What is the single biggest obstacle impacting your infertility treatment plan?

Photo credit: http://www.freedigitalphotos.net/images/Other_Health_and_Bea_g278-Health_Insurance_Approved_Stamp_p96067.html

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Valentines, Infertility and Stupid Cupid

By Tracey Minella

February 14th, 2013 at 7:31 pm

image courtesy of AKARAKINGDOMS/free digital photos.net

Ah, Valentine’s Day is here again. Another holiday conjured up by Hallmark and Hershey…not to mention Jared and 1-800-Flowers.

There’s little consolation in the fact that singles hate this day which is focused on couples in love. But why is it hard for us infertiles? We have someone. We love someone. We’re not alone.

In fact, if we’re in infertility treatment, there’s a pretty good chance that our “someone” has proven their love to us daily by being there beside us on our infertility journey. There with us in the trenches. Comforting and reassuring us.

Joined at the heart and focused on the goal of creating or building a family together.

Yet, even if we are with our soul mates on Valentine’s Day, we may still feel down or empty. It’s hard to feel happy or focus on anything fun when you’re trying to conceive. No matter how much you love each other.

Yet the holiday and its pressure to buy gifts of diamonds, chocolates or flowers…not to mention the whole satin sheets thing…can make you want to call Cupid stupid.

Here are some tips for getting through tonight:

  • Unlike the other stressful family- or child-focused holidays, this one is just for couples. So take heart in the fact that you’re not expected to be with anyone else. If you want to be alone together, do it however you please.

 

  • If you can’t shake the blues, try writing a Valentine note to your future child. Date it and share how you’re feeling. Then put it away. Putting your feelings down on paper can make you feel a little better and may make a sentimental keepsake someday. After you’re done, you may even feel like doing a little something tonight.

 

  • If you go out, pick a place that won’t have children there. This is one of the few nights a year that most couples who go out for dinner will leave the little ones home with a sitter.

 

  • If you stay in and want to be romantic, that’s great, but don’t pressure yourself (unless of course, you’ve been advised that it’s “medically advisable” tonight). When was the last time you watched your wedding video or looked at your album?

 

  • Try something different tonight. Maybe a new restaurant or fun place. Ever been roller-skating? Taken in a show at a community theater? If you shake things up tonight, it may help brighten your mood and you’ll rediscover the reason you fell for each other in the first place.

 

  • Make a point to tell each other at least three reasons why you love each other. Real and specific reasons, with examples. Not the vague “fluff”…but the deep stuff that you each need to hear. It will be good for your marriage. I promise.

 

  • Have an injection to take tonight? Pretend for one evening that that IM syringe is Cupid’s arrow.

 

Hmmm. That just brings us back to Stupid Cupid…

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How are you getting through Valentine’s Day?

 

Photo credit: http://www.freedigitalphotos.net/images/search.php?search=cupid&cat=

 

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Long Island IVF Podcast: Journey to the Crib Ch.1: Welcome

By David Kreiner MD

February 11th, 2013 at 10:24 pm

Welcome to the Journey To the Crib Podcast.  We will have a blog discussion each week with each chapter.  You, the viewer, are invited to ask questions and make comments. You can access the podcast for this Chapter 1 here: http://podcast.longislandivf.com/?p=16

The first chapter introduces the reader to the writer, me, and my early experiences in the field of reproductive endocrinology, infertility and IVF.  This was during the early years of IVF and I was a new doctor driven by a passion for fertility; the science, the surgery and the new technology of in vitro fertilization.

I dedicated the book to my parents who were still alive when it was published.  They taught me the importance of family as it was the most precious commodity they owned.  My father recently passed but he was excited and proud of the work his son did even if he suggested making more revisions to my original drafts than I wanted to hear.  My mother, who suffered a ruptured cerebral aneurysm twenty five years ago and as a result has significant cognitive issues, remains my biggest fan.

It was with great anticipation that I sent to my mentor, Dr. Howard W. Jones Jr., this first chapter as much of it describes my impressions of him and his wife, Georgeanna Seegar Jones, the American pioneers in In vitro fertilization.  Today, he is 101 years old and remains the sharpest individual I have ever met.  I am proud to say that he was touched and impressed with my memories as I recorded them.

If you have not had the opportunity to hear him speak, please do yourself a favor and listen to any one of many videos recorded of him.  “Dr. Howard” describes how he initiated his efforts to develop the first IVF program in the U.S. on http://vimeo.com/asrm/howardjones .

I have a YouTube video discussing this pioneering couple at: http://www.youtube.com/watch?v=b790aiFLzJI&feature=related

If you have time, Dr. Howard gives an exceptional speech on the future of fertility on http://vimeo.com/17418251 .  He starts speaking about 19 minutes into the video.

The reproductive endocrinologist who had the greatest impact on my career was Dr. Zev Rosenwaks.  I unfortunately did not sufficiently credit him with the huge influence he had on my career and in shaping the physician that I have become.  As Zev was a fellow of both Joneses at Johns Hopkins and I was a fellow of his, it is this family of Reproductive Endocrinology from which my career was born.  There is not a thing that I do in practice today that cannot be traced back to Zev or Drs. Howard and Georgeanna or to any of the other fertility giants that were in Norfolk in those days including Suheil Muasher, Mason Andrews, Annibal Acosta, Gary Hodgen, Sergio Oehninger and Richard Scott.

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Do you have any questions about this podcast? Dr. Kreiner would be happy to answer them. Please tune in weekly as we continue to cover Dr. Kreiner’s  book, Journey to the Crib, chapter by chapter. Back by popular demand.

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Don’t Jostle Your Ovaries

By Tracey Minella

February 10th, 2013 at 12:58 pm

It takes a strong woman to go through infertility treatment. And sometimes, in our headstrong, full-speed-ahead-with-blinders-on mode, we feel we’re unstoppable. Invincible, even. But we are not.

With some areas of Long Island blanketed in over two feet of snow, there is a potential danger to infertile women in treatment… snow shoveling. You are not invincible. Do not shovel snow if you are currently in a treatment cycle, have just completed a cycle, are in the two-week waiting period for results, or are pregnant. You must be gentle to and mindful of your ovaries.

When you take injectable medications for IVF (or ovulation induction) to stimulate your ovaries to produce multiple follicles… instead of the single monthly follicle you may otherwise have produced… one of the reasons the doctors monitor you so closely with blood work and sonograms is to reduce the risk of ovarian hyper-stimulation syndrome, or “OHSS”.

When you stimulate the ovaries, they temporarily swell a bit in response, which is expected. OHSS in its mild form can be uncomfortable, but usually resolves on its own. Fortunately, severe OHSS cases are incredibly rare. But in the 1-2% of those cases, patients may experience symptoms including rapid weight gain, abdominal pain, vomiting, and shortness of breath. Pregnancy hormones can worsen OHSS. So, it is important to report any of the above symptoms to your RE as soon as possible, before or after your retrieval or transfer (or IUI). For more info on OHSS, see http://mayocl.in/Xv5NsP

Most women know not to do anything that could be harmful to a developing baby, but they don’t often realize the potential risk certain activities can pose to their stimulated, or recently retrieved, ovaries. Play it safe. Don’t jostle your ovaries.

So put the snow shovel down, ladies. And, leave the vacuum alone while you’re at it, too.

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Have you ever done anything strenuous while stimulating? Have you ever experienced OHSS?

 

Photo credit: Peter Griffin @ http://www.publicdomainpictures.net/view-image.php?image=29815&picture=shovel-snow

 

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Ten IVF Survival Tips for Blizzard Season

By Tracey Minella

February 8th, 2013 at 5:07 pm

So what do you do when….on top of all the rest of the stress of an IVF cycle… there’s a blizzard of record-breaking proportions on the day of your retrieval or transfer? Or on the day of your IUI?

Let’s imagine you had laser focus on all the details and instructions surrounding your procedure. And maybe you were into one of those “cut myself off from civilization” moods and didn’t hear about the approaching blizzard. Suddenly, there’s three feet down and no sign of it stopping.  It’ll take forever to dig out the car. Hey, where is the car?

“Are you kidding? Seriously?”

Here are 10 Tips for surviving your retrieval/transfer/IUI in a blizzard:

  • Touch base with the RE’s office, during regular hours if possible. Otherwise, do not hesitate to call the nurse on call or service. Be sure you understand your instructions, follow the instructions, and know what number you should call in an emergency or if there is a delay in getting to your procedure.
  • Be that geek who has their general storm preparedness kit together so all you need to focus on is your treatment preparedness plan. Water, food, batteries, cash, gas, charge your cell phone, etc. Have a casserole-type meal in the freezer, too, for when you come home from your procedure.
  • Pack a bag. (It’ll be good practice for when you are pregnant and ready to deliver.) Have copies of any important paperwork, insurance form, phone numbers for family and the doctor’s office, your cell phone, eyeglasses, and the comfy clothes you plan to wear to and from the procedure. If you’re able to bring a camera or camcorder, get that stuff ready and charged in advance.
  • Know where you are going and know at least one alternate route to get there in case roads are closed. Have the address ready to input in a GPS. Better yet, use an online service like Mapquest to print out at least two different routes to your destination. And put them in your packed bag. Then, gas up the car.
  • Have emergency phone numbers ready in case you are stranded at home or on the road so you can call your local police department or fire department for help…especially if you’ve taken a timed hCG injection for IVF. Though there may be a small window of flexibility, your retrieval timing is critical so that the eggs are retrieved before they are ovulated. Explain the situation and your need to get to the hospital or clinic immediately. (When I ran this scenario by my local precinct, they said they’d likely dispatch an ambulance.) After all, they are here to protect and serve.
  • Line up help in advance…reliable neighbors or a service…for plowing or shoveling the driveway and have them arrive well before you need to leave for the hospital or clinic.
  • Call your local village or town offices to explain your medical situation and beg them to have your road plowed early and often on the day in question.
  • Borrow an SUV from a friend, or, if you just aren’t a confident bad weather driver, ask them to drive you to the hospital or clinic.
  • Consider staying in a hotel very near the hospital or clinic if you live far away.
  • If you have young children at home already, have a babysitting plan (with a back-up) ready in the event of an unexpected illness or weather-related school closing on your big day.

So what do you do if you didn’t plan in advance of the blizzard?

First, stay calm and call the doctor’s office. Follow their instructions. Then plan how to get there safely and quickly. Remember, a woman with swollen ovaries full of follicles on the verge of ovulation should not be shoveling snow nor doing anything super strenuous or potentially dangerous. If others can’t get your car out, call a friend, neighbor, reliable taxi, or emergency services to get you to the hospital or clinic.

When it all works out fine and you can take a sigh of relief, be sure to commit this story to memory. Hopefully, the tale of the blizzard you faced in order to have your child can be held over his or her head for years to come…especially during those teenage years!

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Did you ever have a blizzard or other “natural disaster” that affected your treatment? Do you have any tips to add or advice to share?

 

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=4893&picture=snowed-in


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