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Archive for March, 2013

4 Tips for Being Infertile on Easter

By Tracey Minella

March 31st, 2013 at 9:14 am

credit: larisa Koshkina/publicdomainpictures.net

Being infertile on Easter stinks like that one rotten egg from the hunt that never got found.

Every holiday is hard when you’re longing for a child. Each holiday brings its own unique challenge and twists the gut in a special way. Easter is no different. And the hardest part about it for me isn’t the spongy pink marshmallow peeps. It’s the spongy pink hair curlers, and more importantly…

It’s the little girly outfits.

The little white gloves and matching spring bonnets. Miles of pastel satin and tulle. Patent leather Mary Janes and tiny pocket books. Even the little boys’ suits are tough to take.

Easter fashion is a killer. I mean, who hasn’t dreamed of stuffing a hot, sweaty baby into some stiff, itchy Easter outfit…complete with pinching shoes (and annoying hat and tights for girls)?

So, how are you going to get through this one?

Well, if you attend religious services, you will no doubt be bombarded by babies in bonnets. Many will be wailing. If it’s too hard on your heart to take it all in, then take advantage of the prayerful atmosphere and close your eyes. Use the time to reflect, meditate, contemplate, or whatever comforts you.

Is there an egg hunt in your plans? Well, if you can’t help the littlest tike without tearing up, help out in the kitchen while it’s going on. The frazzled hostess will likely welcome the extra sets of hands.

Are you lucky enough to still have your parents? If so, instead of focusing on not being a parent just yet, why not make a point of reminiscing with your folks about your childhood memories of Easter? You can do this in person or on the phone. Tell them how they made it special for you. It will make you all feel better.

Don’t look at eggs as symbolic of the Easter egg hunt that you don’t have a child participating in. Instead, try to remember that the egg is a symbol of fertility.

And believe that next year, that sweaty, itchy, wailing baby in the bonnet may be yours.

Happy Easter to all our patients, friends, and families who celebrate  it.

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Would you (or did you) dress your baby up in stiff, fancy holiday outfits?

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Finding (or Keeping) the Faith During Infertility

By Tracey Minella

March 28th, 2013 at 10:57 am

image courtesy of david castillo dominici/free digital photos.net

Perhaps the only topic more potentially explosive than infertility itself is infertility and religion.

In this holy week, where the Jewish and Catholic holidays of Passover and Easter coincide…and where families blessed with little children jet off to Disney for Spring break… infertile couples are practically forced to examine their faith, or lack of it, whichever the case may be.

For some patients, their religious faith during their infertility journey is comforting, steadfast and strong. It’s an intangible bonus whose value can’t be measured. It may offer some patients an additional measure of hope or patience coming from a belief that there may be a “higher” plan at work. If a couple is open about their infertility and is active in their temple or parish, their religious community may even be a source of great support. Of course, some communities may be judgmental.

But a diagnosis of infertility is hard to accept graciously, whether you are among the faithful or not. And it is so devastating that it has caused many suffering couples to occasionally question their faith. Or abandon it.

“Why us?”

I don’t think there is an infertile couple out there that hasn’t looked up and shouted that question at some point. I sure did. Often. And not very politely, as long as we’re being honest here.

For me, it wasn’t too difficult to reconcile my faith’s position on IVF and my need to use IVF to have children. I’m a pretty good negotiator. I am a good, moral, and charitable person. I concluded that reproductive endocrinologists and assisted reproductive technology was created for a reason. That’s just me. But I understand how others would be more conflicted and how such stress could further exacerbate the stress of infertility.

There is nothing so personal as one’s infertility journey and its affect on their relationship with God. And, of course, one’s right not to believe at all.  In a forum like this, comments are encouraged with the gentle reminder not to let passion override respect of others’ different positions.

So regardless of your religion, I wish you all a journey smooth enough that it doesn’t shake your faith in God or the universe, a journey short enough that it doesn’t shake your faith in your doctor, and a journey full of peace and hope that ends with the realization that faith in yourself is as important as anything else.

This post is strictly the author’s perspective and does not necessarily reflect the views of Long Island IVF or its physicians or staff.

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Has your relationship with your faith changed, been strengthened, or been challenged as a result of your infertility journey?

 

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=10095434

 

 

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Infertility Podcast Series: Journey to the Crib: Chapter 7 Are Fibroids and Polyps Preventing You From Getting Pregnant?

By David Kreiner, MD

March 26th, 2013 at 6:35 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Seven: Are Fibroids and Polyps Preventing You From Getting Pregnant? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=52

 

Are Fibroids And Polyps Preventing You From Getting Pregnant?

Fibroids, also known as myomata, are benign smooth muscle tumors of the uterus.   Most are located in the muscle wall and become clinically significant if they invade the uterine cavity or take up so much space in the uterine wall that they may distort the uterine cavity, obstruct the blood vessels serving the endometrial lining or even block the fallopian tubes.   Fibroids may also extend outside the uterine surface, subserosal or pedunculated when connected to the uterus by a stalk.  These tend to be clinically significant only when they affect the fallopian tubes from picking up the eggs.  Fibroids growing into the uterine cavity are called submucosal myomata and these have the greatest impact on implantation and fertility.

The diagnosis of fibroids may be suspected at a bimanual examination of the uterus or a hysterosalpingogram but ultrasound and MRI are the best diagnostic modalities to evaluate the extent of the fibroids.  A hydrosonogram where water is injected into the uterine cavity allows delineation of the myoma or, for that matter, polyps (endometrial growths).  Further examination of the uterine cavity is performed at a hysteroscopy when the myoma or polyp may be excised.

There remains controversy regarding the indication to surgically remove intramural fibroids or those that reside within the uterine wall and not significantly affecting the uterine cavity.   Some specialists believe that intramural fibroids greater than 3 cm are more likely to affect fertility and recommend surgery for these.  Others have a larger threshold or smaller if there are numerous myomata or they cause tubal obstruction.

Polyps like submucosal fibroids are thought to effect implantation and it is therefore recommended they be removed when trying to conceive.  Patients with a history of anovulation and unopposed estrogen are more likely to have hyperplastic endometrium which can include polyps.  Rarely, in these cases they can be neoplastic and need to be removed and examined by a pathologist.

Examination of the uterine cavity is essential prior to performing an IVF procedure to ensure the optimal result for patients.

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Was this helpful in answering your questions about the effects of fibroids and polyps on TTC?

 

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

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Infertility Insensitivity

By Tracey Minella

March 22nd, 2013 at 5:40 pm

image courtesy of david castillo dominici/free digital photos.net

It’s both well-known and completely understandable that couples suffering from infertility can be very sensitive to the pregnancies of others. Emotions can range from mild jealousy to down-right anger and resentment. If the infertility journey lingers on, it can get harder and harder to overlook deliberate and innocent comments. It can even be hard to see a pregnant woman. (And they are everywhere). Attending baby showers or kiddie birthday parties can be torture.

And when a pregnant woman complains about anything related to being pregnant, it can take everything an infertile woman has within her to maintain her composure. We don’t want to hear that it took you a whole 3 months to conceive, that your hemorrhoids hurt, you hate the added weight, or you’re annoyed that you’re due on Christmas Day. And we really won’t be held responsible for our reaction if you say this fifth baby was an accident and you wish you weren’t pregnant.

Infertility is something you can only understand if you’ve experienced it. And if you haven’t, you can’t console us. Don’t try because regardless of your intentions, you will only make it worse. Just say you’re sorry if you have to speak at all.

Thankfully, there are blogs, like this one, which provide a forum for the infertile to vent to people who understand infertility, to get accurate and helpful information and support, or even to have an occasional laugh. The blogs and Facebook pages http://on.fb.me/Zi22aL are a safe haven where infertile women can retreat to escape the fertile world’s insensitive comments and baby/pregnancy visual overload.

But the question is: How sensitive do these blogs and Facebook pages need to be?

Must there never be a mention of anything baby-related? Must we never share anything related to life after a positive pregnancy test? Does supporting the infertile require a total ban on baby talk… or is an occasional reference acceptable?

Is there room in an infertility forum for references of IVF success? Can the shared experience of those who’ve walked the path before us bring us hope and wisdom? Can something like a unique baby keepsake project occasionally be shared for the immediate use of those who completed their journeys and the hopeful future use of those still on the path?

Or would that unintentionally break some unwritten infertile code?

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What do you think is appropriate…or inappropriate… for an infertility blog or forum?

Photo credit: http://www.freedigitalphotos.net/images/Emotions_g96-Woman_With_Sad_Expression_p137117.html

 

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Infertile in Springtime

By Tracey Minella

March 19th, 2013 at 5:36 pm

image courtesy of Ambro/free digital photos.net

Worn down by winter and overwhelmed by infertility’s challenges? You’re not alone. But spring is coming tomorrow…at least on the calendar if not by the forecast. It’s time to change things up a bit.

When I ask other infertile couples what the most frustrating thing about infertility is, lack of control is one of the most popular answers. Lack of control over your dreams, your life, and your body. The longer you live under this frustration, the greater the chance you’ll feel stressed or depressed. Your “fuse” gets shorter and the littlest thing that upsets your routine can…understandably…throw you off. Even last week’s time change—one hour lost— may’ve affected your routine and added to your exhaustion and crankiness for days!

Why not turn it all back around to your benefit?

Take control over a small block of time. Make a change for the better and take back some control this spring. Just a bit.

Imagine committing to even one small change in your day…one that you choose. One that you want. One that you… control.

No need to be drastic or crazy or set a lofty goal you can’t reach (which will defeat the purpose here). Pick something do-able and fun that is just for you. If it happens to have an added fertility-boosting benefit, all the better. But the main goal is that you feel better, either physically or emotionally, or both. And that you feel more in control of your life.

Here are a few examples of little things you can consider:

  • Drink more water. You will feel and look better and the health benefits are countless.
  • Reduce stress and get organized with a “To Do” list before bed. You’ll sleep better knowing your next day is planned out and you haven’t forgotten something. Then, spend 15 minutes on your most important task first thing in the morning if you can, so you start off feeling more in control.
  • Exercise for just 10 minutes each day. If that seems like root canal, just pick something fun that makes you move. Anything. Dance like Elaine from Seinfeld (just close the blinds first)!
  • Take 10 minutes to keep a daily gratitude journal or… if you’re feeling particularly peeved…then make it a venting journal. Either way, you will have an outlet for your feelings and you’ll feel better afterwards.
  • Sleep more. Take a power nap at lunchtime of you’re feeling tired or treat yourself to an early turn-in at bedtime. Even 30 minutes would feel indulgent. Trust me.
  • Meditate. It could be in a fertile yoga class or just grabbing 15 minutes of quiet, uninterrupted “you” time on your den floor (or outside if it ever warms up again).

What kind of big impact could these small changes make for you?

How about committing to one of them…or some other change that works for you? Want accountability? Post your commitment right here if that’ll help you keep it. Just say the word and I’ll crack that whip to keep you motivated…and I’ll be your biggest cheerleader when you stick with it. Let’s see what a difference a small change that you control can make in your life in 30 days.

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You in?

 

Photo credit: http://www.freedigitalphotos.net/images/Dancing_g399-Dancing_Youngwoman_p44076.html

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Infertility Podcast Series: Journey to the Crib: Chapter 6 Have You Had A Fertility Workup?

By David Kreiner MD

March 18th, 2013 at 7:33 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Six: Have You Had a Fertility Workup? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=43

Have You Had A Fertility Workup?

A fertility specialist called a Reproductive Endocrinologist, who has performed a three year fellowship training in IVF and infertility after an Obstetrics and Gynecology residency, will initiate the fertility workup by conducting a history and physical examination.  The exam includes a pelvic ultrasound of a woman’s uterus and ovaries to determine if there are any abnormalities that may affect implantation or pregnancy, as well as assess ovarian activity and the presence of endometriosis.

Different causes of infertility will be tested.  The most common factor, that affecting the male, is easily tested with a semen analysis.  Tubal obstruction preventing a woman’s eggs from reaching the sperm can be ascertained by a hysterosalpingogram, a radiograph of the uterus and fallopian tubes performed after injecting radio-opaque contrast through the cervix.

Other tests to better delineate problems in the uterine cavity may be performed such as a hydrosonogram, where water is injected through the cervix and the cavity inspected by vaginal sonography or with hysteroscopy, where a scope is placed through the cervix to directly inspect the uterine cavity.

Blood tests may be performed to assess ovarian activity, in particular day 3 FSH and estradiol levels and AntiMullerian Hormone.  Prolactin and TSH levels are checked to rule out other hormonal disorders that may affect ovulation and fertility.

Treatment can be directed at the cause of infertility, such as ovulation induction for women with ovulatory disorders or surgery to remove uterine polyps or it may be independent of the cause such as with ovarian stimulation and intrauterine insemination or IVF which will improve success rates regardless of the cause of infertility with some exceptions.  IUI will have limited success for tubal factor, male factor infertility and endometriosis.  IVF will have limited success in women who have diminished ovarian reserve or abnormal eggs unless they use eggs donated by young fertile women.  Today, there is a highly successful treatment available for all.

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Was this helpful in answering your questions about what to expect from a fertility workup?

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

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Infertility and Lucky Charms

By Tracey Minella

March 16th, 2013 at 9:18 pm

Another holiday to negotiate this weekend: St. Patrick’s Day.

Well, it’s a festive party day that you don’t have to celebrate or spend with family… a big plus for some folks. And it certainly, refreshingly doesn’t have a kiddie theme… though checking out a local parade is bound to overwhelm you with little girl and boy scouts. Heck, it’s a night where a good part of the country…Irish or wannabes…gets downright hammered.

So what are you going to do? If you’re a cycling infertility patient, you’ll likely resist the urge to drown your TTC sorrows in a pint of green beer, sacrificing the party for the benefit of the potential life you’re trying to create. There’s no shame in being sober on St. Patrick’s Day. In fact, think of being the designated driver as the most responsible thing you can do. Great training for all the parental responsibility and sacrifice that’s hopefully coming your way soon.

So what about all that “luck o’ the Irish” stuff? As a half-Irish lass myself, and one who did my share of IVFs before having success, I thought it was a farce. A scam. If I was really lucky, I wouldn’t have needed IVF to conceive. I wouldn’t have needed any help at all. And, might I add, I would have had a pot o’ gold to finance it all. But no…

Are there lucky charms for fertility? Google that phrase and you’ll find more symbols associated with good luck and fertility than you can shake a shillelagh at! There are frogs, acorns, and of course, eggs. You can buy statues and jewelry of these and other symbols. I once bought a cheap pewter Chinese fertility symbol on a thin black leather necklace. Couldn’t hurt, right? Today, there are fertility jewelry sites that make beautiful handmade items, like Hoping Waiting Believing.

I actually did have a lucky charm. It was a gift from a casual friend from work who was moving out of state and knew of my infertility secret. She gave me a pretty mirrored compact with a little cameo angel on top…for luck. I had it with me when I finally had my IVF success. After my angel was born, I tucked it away, figuring I’d give it to her one day and tell her its special story.

But a few years later, I had a co-worker who was TTC and moving to Florida. I thought of my lucky compact and everything suddenly became clear. I told her the story and gave it to her on the following condition: She was to use it as long as she needed it and then pass it along to someone else who was TTC, with the same instructions.

This compact is making its way all over America, leaving little angels in its wake.

Now that’s worth doing a jig over.

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Have you given or received a lucky charm? What is it and what is the story behind it?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=25389&picture=lucky-clover

 

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Infertility Podcast Series: Journey to the Crib: Chapter 5

By David Kreiner, MD

March 12th, 2013 at 8:39 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Five. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=39

Meet the Doctor

A woman’s desire to have children can be colossal, yet many are unable to take that first step to overcoming the impediments to their fertility.  Seeking assistance from a qualified reproductive endocrinologist whose sole focus and practice is on such issues will put affected individuals on the right path to achieving motherhood.

I have now, over my twenty seven years of infertility practice, experienced thousands of first encounters with infertility patients.  I know that those coming to see me have various degrees of past disappointments and frustrations and have suffered depression, anxiety and relationship problems because of it.  This presents quite a challenge to me as the physician encountering a patient in need for the first time.

I have several goals that I strive to achieve in this first visit.  First, and perhaps most important is to get to know my patients and form a bond.  This would assist us as we work through our plan of treatment.  Email is a wonderful way for patients to communicate with their physicians and I encourage patients to ask questions and vent frustrations before they become a problem.

As it may be difficult to hear everything a physician says during this appointment, I recommend that patients bring with them their partner or some supportive individual who can serve as a second set of ears.  Since no patient will retain everything that is said to them, we hand patients a written treatment plan, offer information on our website and blog, and repeat information at subsequent visits.  Again, email is always available for questions.

This first visit is a critical step for a woman to take when she encounters difficulty conceiving.  Choosing the right doctor for you will set you on the right path.  It is essential that you select a fellowship trained Reproductive endocrinologist with whom you can communicate your problems.

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If you’ve gone, what was YOUR first visit to the Reproductive Endocrinologist like? If not, what’s holding you back?

 

Please share your thoughts about this podcast here.

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Can Napping Help Your Fertility?

By Tracey Minella

March 11th, 2013 at 7:47 pm

image courtesy of David Castillo Dominici/freedigital photos.net

Sleep deprivation is the theme of the day!

Today is National Napping Day. Yesterday was Daylight Savings Time, where we all sprung forward…and lost a precious hour of sleep. And the effect of sleep deprivation on your fertility is also in the news today. http://huff.to/WEbF93

I was already dragging, but now I’m exhausted just trying to keep up with everything that could impact a woman’s fertility. There should be a law against turning the clock ahead on a Sunday. But in all seriousness, it’s one thing to adjust to an hour of lost sleep once a year and another thing to consistently be cheating your body of a good night’s sleep.

With all the multi-tasking and demands of multiple jobs or longer work days, it seems like no one I’ve talked to is getting 8 or 9 hours of sleep anymore. The tough economy is causing people not only to work longer and harder, but to worry about keeping their jobs since new ones are not easy to find lately. Major stress.

Now add the stress of infertility and you have a vicious cycle:

Stress>Lack of Sleep>Infertility. Repeat.

It’s hard to know which came first.

Your endocrine system, and the hormones it produces and regulates, is responsible for conception and it may not function well without adequate sleep. Poor sleep has been tied to low leptin levels, which has been linked to irregular ovulation and decreased or irregular periods. In addition, adrenal hormones are increased in stress and can cause a hormonal imbalance which may also impact fertility. http://exm.nr/ZDKNCB

So while you still may need something more than 40 winks nightly in order to conceive, turning in early each night is an easy first step for any woman wanting a baby. Sweet dreams.

And may all your dreams come true.

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Did you know that sleep may impact your fertility? How many hours of sleep do you get?

 

Photo credit: http://www.freedigitalphotos.net/images/Gestures_g185-Young_Woman_Yawning_p95461.html

 

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Spring Forward and Infertility

By Tracey Minella

March 10th, 2013 at 6:27 pm

image courtesy of digital art/free digital photos.net

After what feels like a whole year of lousy weather…starting with Hurricane Sandy and ending with a couple of Super snowstorms, including the blizzard named Nemo… it looks like we can finally breathe a sigh of relief. Sandy stole the fall and Nemo knocked us down, but it’s time to set the clocks ahead and look forward to spring.

Spring ahead.

Doesn’t that sound so cheery? So hopeful? The season of rebirth is on the way.

Or are you like me and only see it as an hour of lost sleep? And the start of the baby shower season?

Do you feel hopeful as spring comes in? Or will you miss the comforting, socially-acceptable isolation of a long, cold winter… as spring forces you back outside and into social situations again?

Well, here is a thought to brighten …or further brighten…your mood.

According to the Wall Street Journal, a study in Brazil involving ICSI (intra-cytoplasmic sperm injection) found that spring was the season with the highest fertilization rates. http://online.wsj.com/article/SB10001424052702303644004577524824251585782.html

“The rate of fertilization was 73.5% in spring, 68.7% in summer, 67.9% in winter and 69% in autumn.”

It should be noted however that the study found the season had no effect on pregnancy rates and it did not explore the role of sperm in seasonal fertilization rates.

It was also theorized that natural fertilization rates may be higher in springtime, possibly due to temperature changes and days of increased sunlight.

So whether you are going the natural fertilization route, or IVF with ICSI, spring certainly can’t be a bad thing. And maybe…just maybe…it’ll turn out to be your favorite season ever!

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How do you feel about spring? Renewed hope or kind of down?

 

Photo credit: http://www.freedigitalphotos.net/images/Spring_g102-Types_Of_Season_p61769.html

 

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