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Archive for May, 2013

A Heart-Stopping Tale: The Old Friend, A Fertility Doc, and The Subway Series

By David Kreiner MD

May 31st, 2013 at 9:05 pm

 

image courtesy of freedigital photos.net

“How do I feel?…The Mets won!” he exclaimed. And with those words exuding from his mouth, Marty’s whole face smiled from ear-to-ear.  “How do I feel?…Weak, but I don’t think I need a fertility doctor.”

Marty was on a roll, his joking relaxed me…his light-hearted mood and focus on his love for the Mets gladdened my heart as I was slowly realizing that Marty was back.

This 76 year-old semi-crippled athlete who loved to play tennis despite his obvious orthopedic infirmities of late struggled to walk, much less compete athletically, but clearly competitive sport was a great love of his.

This is how I knew Marty was back as he joked about his Mets winning the Subway Series.

His wife was now by his side, grasping for rational thought clouded by the sight of seeing her life’s soul mate lying apparently helpless on the floor, having just returned from a temporary state of cardiorespiratory arrest.  She was shaking, yet uncertain about Marty’s fate.

Karina, Dr. Karina I learned… our hero… was a 40-something gastroenterologist who initiated chest compressions moments before I arrived to the lobby of the restaurant but seconds after Marty was seen clutching at his chest, collapsing to the ground. He stopped breathing… his heart stopped beating…and he turned blue.

I confirmed there was no heartbeat nor respirations, as Dr. Karina continued chest compressions.  I looked at Marty and thought about all the fuss he had made over the years regarding road safety in our community…his involvement in tennis and the men’s club, as well attempts to bring others into the fold.

I respected Marty as a role model who I wished to emulate 19 years hence.  He was active, athletic, and responsible for the welfare of the community.

I was determined to breathe life back into this man who in my eyes had plenty more tennis matches to play, Mets games to cheer for, and kids to warn to slow down their cars.  With the will of God I exhaled my life’s breath, filling Marty’s lungs not once but twice.  In response to Dr. Karina’s chest compressions and my breaths, Marty started to perk up with a strong pulse.  His palms were now sweaty and his eyes were beginning to focus.

I dared to ask him, “Marty, do you know who I am”?

“Of course,” Marty said.  “You are the fertility doctor and the one who creates life”.

Later that evening, reflecting on the events at the restaurant, I finally felt that maybe there is some truth that Dr. Karina and I acted as agents of God and indeed did recreate life in the lobby of the restaurant that evening.

Photo credit: Victor Habbick/ http://www.freedigitalphotos.net/images/agree-terms.php?id=100100670

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When You Have Years to Choose a Baby Name

By Tracey Minella

May 28th, 2013 at 10:19 pm

 

image courtesy of stuart miles/free digital photos.net

I admit I never understood those couples who leave the hospital with their unnamed newborn. What’s up with that?

Assuming you never entertained the thought prior to conceiving, you’ve got nine months to come up with a name or two (or rarely three or four). Okay, let’s say you’re not an infertility patient who knew the precise moment of conception…and therefore may not have found out you were pregnant for a month or more. That’s still a good seven months to pick a name. And let’s even lop off another month for prematurity. Six months to pick a name. And if you find out what you’re having, then you only need to pick one name. Do-able, no?

Other than Theodore Winston Longfellow III, who’s always known his boy would be Teddy IV, most guys haven’t spent years dreaming about what their baby would be named. Unlike most of us ladies who have been naming our babies since we were tiny tots in pink tulle playing mommy to our dolls.

I remember one night on our honeymoon 25 years ago when the conversation drifted to where we saw ourselves in, wait for it…FIVE years. (Like it was an eternity away!) I still laugh when I recall how old we thought we’d be at that point. Ancient at 28.

We…meaning I…brought up potential baby names. It’s what we women do. And even if we don’t share it, we’re still thinking it, guys. (Of course, neither of us predicted we’d be on a seven year infertility journey when that 5th anniversary rolled around.)

Since we weren’t going for the “classics” or the “trendy”, the chosen names changed often during the long infertility journey. When my mom died, it automatically cemented her name as the girl’s middle name, if we were to be so blessed. But the first name options came and went.

For me, choosing the names (with middle names, too) was a major part of the two week wait following each IVF cycle. It gave me something fun to do. And for the heck of it, I’d put the top contenders in order for each sex, wondering if I’d have to narrow it down to one boy and girl, or two boys and two girls, or *gasp* even more than  that. (Remember I did IVF back in the days when 4 or more embryos were transferred routinely). The name game was a welcome distraction from  the insanity of trying to interpret what every twitch I felt might mean.

I won’t even get into how many times I shopped for a baby shower gift and chose my nursery colors…

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Do you have baby names picked out already or do you not let your mind go there for superstitious or other reasons? If you’ve been TTC for a long time, have those names changed?

Want to share them? And the significance behind the name(s), if any?

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

By David Kreiner, MD

May 27th, 2013 at 9:06 pm

 

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

 

Trying to Conceive with Clomid Therapy

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

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

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

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

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

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

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Was this helpful in answering your questions about Clomid therapy?  Please share your thoughts about this podcast here. And ask any questions.

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4 Tips to Avoid Being Grilled This Memorial Day

By Tracey Minella

May 26th, 2013 at 2:54 pm

 

image courtesy of free digital photos.net

You can’t hide in the mall any longer. The sun is out and the charcoal is waiting for fresh meat…

Don’t be the meat.

The first picnic of the summer season is starting and that means you may be thrust into big group social situations again, after a long winter of hibernating. Are you ready?

Here are 4 tips to help you dodge the “When are you gonna have a baby?” naggers:

Drink heavily. That doesn’t mean alcohol necessarily. But if you have a drink in your hand or a glass to your mouth, it can discourage conversation. Plus, you can down the contents and excuse yourself for a refill at the first hint of unpleasant conversation.

Stuff your face. Well, you don’t have to eat  non-stop, but keeping something  in your hand or on a plate that you can pop into your mouth when a nagger approaches could be key. You can’t be expected to answer an inappropriate… or any…question with your mouth full.

Have a Plan B. If a nagger is in the kitchen where you’re helping out, grab a tray of hors d’oeuvres and make a hasty exit to the yard. Or reverse.

Use the children as shields. Normally, the kind of people who nose in on your personal life aren’t the ones who play with the 100’s of kids at these gatherings. While being with others’ kids can be hard on your heart, it may still be better to jump into their game than face a nagger’s interrogation. No one’s gonna pry while you’re jumping rope or pitching a wiffle ball.

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So what are your plans? Do you have any other tips to add?

Photo credit: JackThumm  http://www.freedigitalphotos.net/images/agree-terms.php?id=10082780

 

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Babysitting and Infertility

By Tracey Minella

May 24th, 2013 at 10:11 pm

 

image courtesy of freedigital photos.net

There are several “hot topics” in the understandably over-sensitive world of the infertile couple. And babysitting is one of them. I was reminded of that when I saw a card on Facebook that said something like: “Of course, I’d be happy to babysit. As long as you never take me up on that offer.”

For me, and probably many of you, babysitting nieces, nephews and our friends’ kids was fun back in the beginning of our infertility journey. I mean way back. As in, back before we even realized we were on an infertility journey. Back when we’d first stopped trying not to get pregnant and were just sort of letting destiny happen. And when destiny didn’t happen, we started trying to get pregnant.

And still nothing happened.

And then babysitting got on our nerves.

In fact, somewhere along our seven year journey, the babysitting issue became just another complication of infertility. Another awkward, emotionally-charged relationship challenger.

In time, those early days of having fun “playing parents” while our friends or siblings had a night out or a weekend away morphed into something uglier. Resentment and jealousy…along with the torturous guilt for feeling that way…crept in. Sometimes, we’d make up excuses to avoid babysitting. We’d become secretly critical and judgmental over how others raised their kids and less tolerant over their bratty behavior. In reality, the parents’ decisions and the kids’ behavior were typical. But we weren’t typical…we were infertile. And that sad fact warped our perspective on these things and caused us to miss out on some times we can’t get back.

Turns out that babysitting… and the lost opportunities to do it…was just another happy part of life that infertility stole from us. More happy memories we could now look back on if the pain of prolonged infertility didn’t prevent them from happening.

Hindsight is always 20/20. I always say you need to do what you must to protect your heart while you are on your journey. Some can handle baby showers, birthday parties, and babysitting. Other can’t. There is no right or wrong.

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Do/did you babysit for others while on your infertility journey? Was it fun, or hard? Any tips for others who are struggling with babysitting?

 

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=10075943 /DavidCastillo Dominici

 

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Infertility Podcast Series: Journey to the Crib: Chapter 13 Sperm Meets Egg- Why Doesn’t It Work Every Time?

By David Kreiner, MD

May 20th, 2013 at 9:48 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirteen: Sperm Meets Egg-Why Doesn’t It Work Every Time? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=92

Sperm Meets Egg- Why Doesn’t It Work Every Time?

We live in a society where people grow up with certain entitlements.

We expect to complete a transatlantic flight within 6 hours without delay.  While 30,000 feet up in the air we get upset if our internet momentarily goes on the blink.  When normally menstruating women having regular intercourse cannot get pregnant it turns their lives upside down.  After all, we plan our lives, our careers and our families and there often is not time allowed for such difficulties.

When the source of the trouble is the Man, the impact on his ego, his mood and the couple’s relationship can be quite dramatic.  Men have a problem that contributes to the difficulty conceiving in 50-60% of cases.  Most of these cases can be picked up by a simple semen analysis. 

Unfortunately, even when the semen analysis screen is normal about 10% of the time when routine in vitro fertilization is attempted, the partner’s eggs fail to fertilize.  This is why we recommend that we perform ICSI, intracytoplasmic sperm injection, in cases of unexplained infertility, on half the eggs.  That allows us to test the fertilizability of the eggs and treat those with deficient fertilization in the same cycle.

There are numerous causes of male infertility discussed in the chapter.  Some are amenable to hormonal treatment, some could benefit from surgery, and nearly all may be overcome with IVF using ICSI. Other supplements, herbal medicine, and adjunctive therapy are mentioned.

Recently, it has been found that in cases of severe male infertility, though pregnancies may be achieved with ICSI, in those cases there appears to be a higher incidence of miscarriages and congenital anomalies and other problems in some babies born to such couples.

Still… for those couples who otherwise would never have previously been able to conceive without IVF… IVF with ICSI offers a significant possibility for them to build their own healthy families using their own eggs and sperm.

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Was this helpful in answering your questions about why it doesn’t work every time sperm meets egg?

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

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Long Island IVF’s 25th Anniversary Reunion Recap

By Tracey Minella

May 17th, 2013 at 9:14 pm

 

The only thing more perfect than the beautiful spring weather for Long Island IVF’s 25th Anniversary reunion party yesterday was the smiles on the faces of all of our babies and their grateful parents!

Every spring, Long Island IVF celebrates the births of our most recent IVF arrivals with a picnic for that year’s newborns and their parents. But this year…for our big anniversary…we opened it up to all 5,000+ couples whose families we’ve helped build over the past quarter century! Please “like” us on Facebook and check out some more reunion pictures there.

For those who don’t know, Long Island IVF was the practice to bring Long Island its first IVF baby, first FET/cryo baby, and first donor egg baby. The same doctors who co-founded Long Island IVF twenty-five years ago are still partners today.

We cherish every little life we’ve helped create, from the college grads to those being conceived today. But it was especially exciting to reunite with some of our oldest babies, now all grown-up, including the second baby born to Long Island IVF’s program, Alyssa.

Alyssa is the beautiful 24 year-old blonde in the picture with Dr. Kreiner. She and her mother came (her 21 year-old younger brother couldn’t make it) and they were instant “celebrities” as word spread throughout the crowd that Baby #2 was “in the house”. They each addressed the crowd, recalling how important Long Island IVF was in their lives, in a very emotional moment of the day that really helped bring home the magnitude of what Long Island IVF has meant to so many couples for 25 years and counting.

Other beautiful older babies were there. Some reiterated the same sentiment as they spoke about their lives…lives that would not have been possible without Long Island IVF. It was a humbling and gratifying experience for the whole Long Island IVF staff. As always, the fresh crop of adorable newborns and toddlers, decked out in their finest, were a joy to meet and gush over!

Everyone at Long Island IVF would like to thank all of the parents and children who came out to celebrate this very important milestone with us…and all those who were there in spirit, but were not able to come.

You and your families are beautiful. You all inspire us each day to do the work we love…building families. Thank you from the bottom of our hearts for allowing us the privilege of building yours.

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Were you at the party? Please share your thoughts and feel free to upload a photo on our Facebook page.

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Saying “Goodbye” to the Infertility Clinic

By Tracey Minella

May 14th, 2013 at 9:25 pm

 

image courtesy of free digital photos.net

Perhaps the only thing harder than walking in to the fertility clinic for the first time… is walking out of it for the last time. And while that’s obviously true when treatment is discontinued, it’s also true with a baby on the way.

It’s not easy to face infertility and the fact that neither your own best efforts as a couple nor the treatment of your trusted gynecologist are enough to get your pregnant. You may feel anything from concern, anger, fear, depression, denial, or even shame walking in for the first time. But in time, many people come to not only trust their fertility doctor and the staff, but to bond with them in a meaningful way.

And when the infertility treatment produces a positive pregnancy test result, especially if it’s been a long time in coming, many patients wish they could stay with their fertility clinic for the duration of the pregnancy. But just as there was a time when your gynecologist needed to refer you to a reproductive endocrinologist in order to get you pregnant…the time comes shortly after a heartbeat is confirmed when the RE will refer you back to the obstetrician, who is the expert at monitoring your pregnancy and delivering your baby.

So while one part of you is happy to skip off clutching your black and white sonogram, the other part of you tearfully watches the door close behind you. A chapter is over.

This place that you never wanted to have to come to…where countless mornings were spent being poked and prodded…where tears of all kinds were shed…where you never lost sight of the dream no matter how intense the hormonal havoc got…

This place that somehow…when you weren’t looking… became strangely comfortable and comforting.

Now just like that, with one final wave of the sono wand, you’re gone. Like baby dust and fairy tales.

Of course, at Long Island IVF, we expect you to come back and visit with the baby. And we look forward to all the holiday photo cards each year. And we really love it when you check in with a photo or an encouraging word on our Facebook page and let us know what the little miracle did today that took your breath away. But this year, we’re doing better than all that…

This Thursday, May 16th, we are inviting ALL of the Long Island IVF (and East Coast Fertility) IVF babies and their parents back for our 25th Anniversary Reunion celebration, from noon until 2:00 pm at the Mid-Island Y JCC, 45 Manetto Hill Rd., Plainview, N.Y. 11803.

Many of our babies will be driving their parents there! Please try to make it as we would really love to see you again and bring those old pictures with you from the early reunions. Email Lindsay at lmontello@liivf.com for more info and to tell her you’re coming. Many of the nurses and staff from the 90’s still work here and can’t wait to see you.

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Was it hard to say “goodbye”? Have you kept in touch by visiting or through Facebook?

Will you be coming on Thursday?

 

photo credit: Stuart Miles/http://www.freedigitalphotos.net/images/Other_Metaphors_and__g307-Time_For_Goodbyes_Message_Showing_Farewell_Or_Bye_p146553.html

 

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Infertility Podcast Series: Journey to the Crib: Chapter 12 What Do You Know About Your Fertility?

By David Kreiner MD

May 13th, 2013 at 8:16 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twelve: What Do You Know About Your Fertility? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=74

What do you know about your fertility?

Women have a biological clock.  Everyone knows that.  However, life seems to get in the way sometimes; whether it be school, career or failure to find Mr. Right.  Most people assume that if they are healthy then there should not be a problem conceiving.  Unfortunately, general health and fertility are not always related.

Women are born with their reproductive lifetime supply of eggs.  That means the body doesn’t produce new ones.  With each menstrual cycle one egg is released and an additional thousand eggs simply are lost in the body’s natural process of selecting one for ovulation.  As a woman approaches 50, she typically runs out of her store of eggs.

Additionally, there is the issue of the effect of aging on the eggs.  Older eggs are more likely to have chromosomal abnormalities making them unlikely to become viable embryos.  Fertilized eggs with abnormal chromosomes are the most common cause of miscarriages, running about 40% by age 40.

Furthermore, not everyone’s ovaries/eggs age at the same rate and again it is not necessarily reflective of how old you look either.  Often very young looking women have very old acting ovaries and eggs.  You can be screened to evaluate your fertility status with an ultrasound examination of your ovaries performed by an experienced reproductive endocrinologist as well as by blood hormone screening looking at your FSH, estradiol and AntiMullerian Hormone levels.

I urge every woman of reproductive age who has not completed her childbearing to be evaluated and make plans based on knowledge about her own fertility.  Aggressive fertility treatment might be needed depending on your age, how long you have been trying to conceive, and your fertility screening.  Women who do not have a partner should explore the possibility of freezing their eggs while the likelihood of them still being healthy is high.  Remember, fertility treatment has a high success rate that decreases significantly as time passes on the biological clock.

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Was this helpful in answering your questions about your fertility?

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

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Infertility, Mother’s Day, and Unfair Assumptions

By Tracey Minella

May 12th, 2013 at 9:17 pm

 

If I had a dollar for every post I’ve read about how Mother’s Day is the hardest, most dreaded day of the entire year for infertile women, well… I could probably pay for an IVF cycle.

I’ve written such posts myself over the years. The memories of my personal pain and frustration each Mother’s Day during my years of infertility have caused me to perhaps do some of you a disservice with my prior Mother’s Day posts of survival tips and quick verbal comebacks. In my need to help you through this day, I’ve assumed you are all inconsolably miserable and totally broken, as I had always been. And while many of you may well be, that assumption is unfair to those infertiles who may be able to find some measure of joy on this day.

I read something this past week that made me realize the unimaginable…that being infertile on Mother’s Day is not automatically the end of the world for every infertile woman. (It took a lot for me to let that sink in).

Who am I (or anyone else) to assume the day was going to be awful for you? Is it fair to set you up in advance to have a horrible day? What if you happened to wake up on Mother’s Day and, against all odds, actually didn’t fall apart as you thought you would…or as some well-meaning blogger predicted you would?

What if you were somehow stronger?

So while advice to sleep late, focus on your own mom, avoid places that mothers would be, and go to bed early may be helpful to many seeking to get through a day so painful they can hardly bear it, they are not hard and fast rules for every infertile woman.

Just as the causes of our infertility are different, so are the ways we handle it. Even on Mother’s Day. Forgive me if I underestimated you.

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Did anyone have a better day than they expected to have? If so, please share. And if it was as bad as you thought it’d be, feel free to vent.

 

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=497&picture=tulips

 

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