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Archive for June, 2013

Fertile Food Friday- Avocado

By Tracey Minella

June 28th, 2013 at 3:29 pm


image courtesy of flikr

Did you know that some foods can potentially boost male and female fertility? Want to learn more? Check out Long Island IVF’s “Fertile Food Friday” posts. We’ll have some fun facts and a recipe or video for each food we focus on… for those who aren’t sensitive or allergic to the ingredients, of course.

The first fertile food will be avocado.

As you can see from the photo, avocados hail from what the Aztecs nicknamed Āhuacatl , short for āhuacacuahuitl, which means “testicle tree”.*

Avocados are thick-skinned, dark green/black, pear-shaped, bumpy fruits (about the size of your palm) with soft, pale yellow flesh and a large pit. They are rich in folate and Vitamin E, and are an excellent monounsaturated (good) fat which may benefit the reproductive health of both men and women and also help lower inflammation and insulin resistance (which could be particularly beneficial to many PCOS patients).

In fact, a recent study out of Harvard’s School of Public Health on the effects of dietary fats on IVF outcomes found that those who consumed the highest intake of monounsaturated (good) fats were 3.4 times more likely to have a baby after IVF than those who consumed the lowest amount. Lead researcher, Professor Jorge Chavarro, was quoted by the Daily Mail** as saying, “”The best kinds of food to eat are avocados, which have a lot of monounsaturated fat…” In addition, the women with the highest levels of monounsaturated fat consumption had higher live birth rates. Further, the women who ate mostly saturated (bad) fats had lower egg quality.

Ready for an avocado recipe recommendation?

image courtesy of Mister GC/

Perhaps the most popular use for avocados is in Guacamole, a Mexican dip often used for chips and nachos. It is the quintessential party food and a staple at many summer gatherings. But you may need to skip out on its partner…the Margarita… if you’re trying to conceive.

Chef Rick Bayless, author of Frontera: Margaritas, Guacamoles and Snacks and other cookbooks, is famous for guacamole, and often demonstrates his technique in short videos. His guacamole begins with avocados, salt, fresh white onion, fresh lime juice, and cilantro, but the remaining ingredients vary. Additions may include fresh or canned hot chiles, tomatoes or tomatillos, and crispy, crumbled bacon. Check out this video demonstration or one of his cookbooks (available on amazon) to learn how to make fresh guacamole in about 5 minutes. Add chips and a cold drink and you’re ready to go!

Don’t forget that you can also add avocado chunks to salads. And if you don’t care for the taste but still want the health benefits, I will share one of my biggest culinary secrets…you can add it to meatloaf. Cream it into the meat mixture. I promise no one will know.

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Did you make this guacamole? Have another avocado recipe to share? Please share. Let’s help each other feed ourselves fertile.




Guacamole photo credit: Grant Cohrane

Avocado Tree photo credit: Alpha/avlxyz





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“Windows of Implantation” and Recurrent IVF Implantation Failure

By Satu Kuokkanen, MD, PhD

June 27th, 2013 at 10:09 pm

Recurrent implantation failure is a devastating problem for infertile couples and a challenging clinical dilemma for physicians.  

It is hard for patients to accept an unsuccessful in vitro fertilization (IVF) cycle outcome and discontinue infertility therapy attempts when their physician reviews everything in their cycle as being fine… with normal follicle development, egg fertilization and embryo development as well as sonographically-appropriate endometrial thickness.  However, there are still factors beyond our visual scope that may not be quite perfect.

Human endometrium, which is the inner lining of the uterus, undergoes extensive changes under the influence of female hormones, estrogen and progesterone in each cycle.  These sequential endometrial events are critical in the preparation of the endometrium becoming receptive for a fertilized egg to implant.  Indeed, there is only a specific time during the cycle, called the “window of implantation”, when the endometrium is receptive for implantation.  

Extensive research has focused on identifying either morphological characteristics or molecular level markers of the endometrium to determine when the endometrium allows implantation of an embryo.  The hypothesis behind this research is that an endometrium lacking the required features and markers is considered abnormal and thus non-receptive for embryo implantation.  However, it has recently become clear that there are not only one or two such biological markers of endometrial receptivity, but instead a whole group (hundreds) of molecular signals that together describes receptive endometrium.

Interestingly, recent research has indicated that the window of implantation in some women with recurrent implantation failure has shifted from what has been traditionally considered the window of implantation.  

Dr. Carlos Simon (University of Valencia, Spain) presented his findings on this phenomenon at the Annual Meeting of the Society of Gynecological Investigation (SGI) in March this year. He described that the window of implantation for some women can be either earlier or later than the typical window of implantation.  Thus, if embryos are transferred when the endometrium is not fully prepared or when it has passed its peak receptivity, implantation cannot occur.  

When his research team determined the correct window of implantation for women with multiple past implantation failures and the embryo transfer was performed during their “personalized” window of implantation, these women had comparable pregnancy rates to the control women of their age group.  If these research results can be confirmed in larger patient groups, there will be therapeutic options available for some women with unexplained implantation failure. 

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Infertility Podcast Series: Journey to the Crib: Chapter 20: Co-Culture of Embryos

By David Kreiner, MD

June 24th, 2013 at 9:34 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: Co-culture of Embryos. You, the listener, are invited to ask questions and make comments.  You can access the podcast here:

Co-Culture of Embryos

Co-Culture is a procedure whereby “helper” cells are grown along with the developing embryo.  The most popular cell lines include endometrial cells (from the endometrium or uterine lining) and cumulus cells from a woman’s ovaries.  Both cell lines are derived from patients.  Endometrial cells are more difficult to obtain and process, while cumulus cells are routinely removed along with the oocytes during the IVF retrieval.

Cumulus cells play an important role on the maturation and development of oocytes.  They produce hyaluronan which is normally involved in cell adhesion, growth and development in the body and is found in the uterus during implantation.

Co-culture of cumulus cells provides an opportunity to detoxify the embryo’s culture medium that the embryos are grown in and produce growth factors important for cell development.

Performing co-culture of embryos has improved implantation and pregnancy rates as presented by us at the national meeting of the American Society of Reproductive Medicine in 2007.

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Was this helpful in answering your questions about co-culture of embryos?

Please share your thoughts about this podcast here. Ask any questions an Dr. Kreiner will answer.

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Summer Adventure: Infertility Action Plan or Antidote?

By Tracey Minella

June 23rd, 2013 at 10:42 pm


image courtesy of njaj/free digital

Ah, summertime. It’s finally here. So what are you going to do with yours?

On Long Island, the lure of the beach is hard for many to resist…even if indulging forces us to face throngs of little children that kick sand on our blankets as they rush for the waves. Parks and other hot spots for fun pose similar challenges.

So how do you have fun when there are children everywhere you look? How do you survive…and thrive…this summer?

Make a summer “bucket list”. A list of the things you want to accomplish, places to go, people or sights to see, before summer “kicks the bucket” and the weather cools.

Yes, some of the list items may still bring you in contact with families with children…a sore spot for many. But if you put it on your list anyway then it’s clearly very important to you. Infertility has stolen enough happiness. Don’t let it prevent you from doing the things you love best, even if there will be kids present. The simple act of putting it on the list can help you feel more in control and can give you permission to go enjoy it. Take back some happiness during a sad time.

Be sure to put some things on the list that will be fun and do not include families or children that allow you to reconnect with your partner. I call it “forced relaxation”. Travel as far as finances allow or find couples-only fun right in your neighborhood. Tour mansions and historical sites, dine in romantic restaurants (or try creating a special candlelit meal together!), consider a couples’ massage, check out the vineyards, escape for a night or weekend and stay in a bed and breakfast that doesn’t allow children. Maybe even do something really adventurous like skydiving or scuba diving! To coin a cliché: find yourselves again.

For some infertile folks, summer is a time for a vacation from the rigors of infertility treatment. It’s a time to take a well-earned break and rejuvenate doing those list items above. We all need a mental, emotional, and physical break now and then. So if summer is your time to recharge, enjoy it guilt-free. And unless your doctor has said otherwise, resist that whip-cracking voice in your head that screams “You can’t afford to take two months off.”

But if you are a teacher, or someone who has decided that this summer is the very best time for you to put your fertility action plan into high gear, then embrace it full force. Think positively. To the extent possible, don’t focus on the cost, the drugs, the needles, or any of the other negatives of treatment. Instead, keep the goal front and center. This is your chance. Positive thinking can’t hurt and may help reduce stress, which can play a part in a happier outcome. Participating in a cycle…whether it is IVF or IUI…means giving yourself a greater chance to conceive this month than if you were not cycling. Focus on that reality. And when you are not focused on treatment, sneak in some bucket list fun…but not the skydiving!

So whether this summer is your fertility action plan or the antidote, embrace it. It will be gone too soon.

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What are you doing this summer? Treatment or a break from it?


Photo credit njaj/

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No More Pencils, No More Books, No More Infertile Folks’ Dirty Looks

By Tracey Minella

June 20th, 2013 at 7:36 pm


Ready to trade in the twice daily yellow school buses for an overabundance of neighborhood children in your face 24/7 all summer?

Well, neither are their parents.

Starting this week in our neck of the woods, you can expect to dodge bikes overloaded with boys and baseball equipment heading to the park and little girls in wet bathing suits running back and forth between their houses, selling warm and weak lemonade on the driveway. And don’t forget the toddlers in blow-up turtle pools on the front lawns. Or the tons of teens hanging out at the mall or beach.

During the school year, you could possibly arrange to miss the crowded bus stops when going to and from work. But kids are simply unavoidable in summer.

Is it me or does Mr. Softee park smack in front of your house, too? Seems like every 15 minutes that tune… the one that could make war criminals confess… drones on as blue-tongued rugrats scrape Italian ices sitting on your curb. Sometimes, this sight hurts. Other times, it can set off a daydream of the day your own little one will be bolting out the door bellowing “Ice cream maaaan! STOP!”

That’s what seeing little kids does to infertile people. It makes us hurt and it makes us happy. We want the kid and the whole package. We want to buy Disney towels, Happy Meals, and cool bikes. We want to set up playdates… and pretend we like the mom of our kid’s best friend of the week. We want to plan outrageously-priced kiddie parties, complete with the annoying goody bags full of useless junk.

Just once, we want to make…not buy… that lousy, weak lemonade at the stand.

And not having any of this…or knowing when or if we ever will… is just devastating.

So, here’s a message to the fertile folks. First, stop offering us your poorly-behaved children as a substitute for the perfect baby of our dreams. And more importantly, stop complaining about how you can’t wait for them to go back to school.

You don’t know how lucky you are.

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What is the hardest thing about summer time when you’re facing infertility?

Photos credit: Maliz Ong/

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Infertility Podcast Series: Journey to the Crib: Chapter 19: Fertility Drugs Do Not Increase Risk for Ovarian Cancer

By David Kreiner MD

June 17th, 2013 at 10:22 pm


Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Nineteen: Fertility Drugs Do Not Increase Risk for Ovarian Cancer. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.long

Fertility Drugs Do Not Increase Risk for Ovarian Cancer

I am often asked whether the medications we use in our fertility treatments can cause ovarian cancer.  In 2009, the largest study to date concluded that they do not.  Instead the data suggests that factors related to the diagnosis of infertility such as genetic or biological factors and not the use of fertility medications can increase the overall risk of ovarian cancer.

The study was reported in the British Medical Journal online February 5, 2009.  These data are reassuring but cannot absolutely rule out a very small increase in ovarian cancer that could perhaps occur much later in life, at an age beyond that which was studied.

A review of the specifics are in the chapter but the bottom line appears to be that fertility medications either do not increase the risk whatsoever of ovarian cancer but if they do perhaps at a much later stage than was studied and/or the effect is so slight that it still has not been detected.  Now that these medications as they are currently given or in their earlier form have been used for 50 years it is reassuring that data fail to demonstrate an increased risk for ovarian cancer.

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Was this helpful in answering your questions about fertility medications and ovarian cancer?

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

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Infertile on Father’s Day

By Tracey Minella

June 16th, 2013 at 5:50 pm


image courtesy of free digital

So much focus and sympathy is put on infertile moms and Mother’s Day. And rightly so. There is no void worse than that of an empty womb. But infertile men hurt, too.

Especially on Father’s Day.

Men get a raw deal. Society expects them to be the strong ones. Tough it out. Support your wife. Hide your emotions. She can cry, but not you.

Men can carry the same guilt women do if they are the “cause” of the infertility diagnosis. Not being able to father a child is as painful to men as not being able to get pregnant is to a female diagnosed as the “cause” of the infertility. And men get ribbed by Neanderthal-minded friends’ cruel barbs about “shooting blanks” and crass offers to help get their wife pregnant.

Even hormonal wives… understandably stressed by the demands an IUI or IVF cycle puts on them… may unintentionally minimize their partner’s feelings or their contribution to the process. “I’ve been poked and prodded for weeks and am being wheeled off the O.R. and you’re complaining about your part?” But producing that specimen under enormous pressure is no small task. While it shouldn’t be, it often can be emasculating or uncomfortable for a man to go off to the collection room knowing that everyone knows what he is doing in there. And wondering why he’s taking so long. Which of course makes him take even longer.

So this post isn’t about how to get through Father’s Day when you are infertile…though you can take comfort in celebrating your own father today, if you’re lucky enough to still have your dad. And you can do something fun you enjoy with your partner…avoiding bowling alleys, min-golf, and the steakhouse chain restaurants.

No, this post is a salute to the dads… and dads yet-to-be… that have ached for fatherhood and loved their partners enough to have taken this challenging journey. Many men can father a child the old-fashioned way, but it takes a true hero to be a father when the odds are against you. And that door awaits.

So, Happy Father’s Day to my husband and all the other fathers that have emerged victorious from the collection room. And a big shout out to all the guys still on their quest that next year will be your year.

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If you have a guy you know does, or will, make a great father, give him a shout out now.


Photo credit: chanpipat and

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Infertility and the Cruelty of June

By Tracey Minella

June 14th, 2013 at 10:10 pm


image courtesy of free digital

June is such a busy month. And baby showers top most infertile women’s list of annoyances in June. Of course, Father’s Day is really awful, too. But there are other irritating celebrations as well this month.

Weddings can trigger flashbacks to our own “big day’…that happy time of promise, innocence, and planning out how our “happily ever after” would unfold. Before infertility…like a villain in a fairy tale… reared its ugly head and ruined it all.

And depending on how old you are, how long you’ve been on the journey, and how many losses you’ve suffered, there’s the annoyance of graduations.

They’d have been graduating high school this month. My twins.

I was sure that after two failed IVF cycles, the third time was the charm. I’d lost my mom that February and was sure that with her watching over me things would work out this time. It was the day after Christmas in 1994 and I was finally pregnant. Very pregnant, actually. The kind of super pregnant that you know even before your blood is drawn.

An astronomical second beta and crowded sonogram revealed three embryos had implanted from this GIFT/ET cycle in which four eggs and some sperm were placed into my open tube during a laparoscopic retrieval and an additional three embryos were transferred back a couple days later. [Remember protocols and success rates were very different back then!] One baby failed to develop a heartbeat, leaving me with twins.

But complications arose and I needed emergency surgery. I kept telling myself the pregnancy would be okay. Two weeks later, I lost the pregnancy. And all hope for quite some time. It took me three more IVFs before I finally had my daughter in 1998.

But I still remember them. My twins. With the 9-5-95 due date. I would have occasionally thought of their milestones even if I didn’t know a woman whose son was born that week. A boy, now 18, who I’ve watched like some sad, distant stalker as he lived a childhood my own twins never saw.

Perhaps you too have had an actual loss and mourn a kindergarten or middle school graduation. You may even grieve like this over a potential loss due to failed IUI or IVF cycles…since at some point during the two week wait we all calculate what our due date would be if the cycle worked. The negative beta merely starts the clock ticking for us to mark stolen milestones and mourn that potential life.

Can we just skip to July now?

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What do you think is the worst part of June?

Do you mourn an actual loss or a potential loss?

photo credit anekono and



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The Powerful Impact of PGD in Infertility Treatment

By Tracey Minella

June 13th, 2013 at 11:37 am

credit: Dream designs/

Preimplantation genetic diagnosis (or screening)…a/k/a PGD or PGS… is a process by which embryos created through in-vitro fertilization (IVF) are screened for various reasons prior to transferring them back into a woman’s uterus in the hope of implantation.
Why would a couple do this?
Well, most people think of infertility as being unable to get pregnant. While that is true, it is only one half of the definition. When you can conceive on your own but can’t maintain the pregnancy, as in the case of recurrent miscarriages, you are also considered clinically infertile.
PGD/PGS can help infertile couples in many ways:
• Improve IVF success rates by selecting for “chromosomally normal” embryos;
• Reduce the incidence of miscarriage;
• Reduce the risk of a live born child with a chromosome or genetic abnormality;
• Reduce cycle numbers to a live birth.


Simply put, screening embryos before transfer increases the chance of transferring embryos that are the most likely to implant. Screening may reduce miscarriage or a pregnancy at risk of a baby with a genetic condition.
PGD/PGS can be used to screen embryos for hereditary genetic diseases or conditions and gives couples the choice of transferring back only embryos that do not appear to carry the disease. For example, Spinal Muscular Atrophy (SMA) is a devastating, often fatal disease and is the leading genetic cause of death in infants. The carrier rate for someone to have the gene for SMA is only 1 in 50. Unfortunately, testing for such diseases is not performed prenatally so parents only learn they are carriers after they have a child affected. Other more commonly-known diseases that can be screened by PGD/PGS include Cystic Fibrosis, Tay Sachs, Muscular Dystrophy, and Huntington’s disease. In fact, there are literally hundreds of diseases we can test for with this technology.
PGD/PGS can also screen embryos for chromosomal abnormalities which may be the cause of recurrent miscarriages, enabling the couple to transfer back only viable, chromosomally-accurate embryos. It also can help in cases of repeated implantation failure.
In addition, PGD/PGS can be used for gender selection…choosing the sex of your baby. There are genetic diseases that run through offspring of only one sex, so by selecting to transfer only embryos of the opposite sex, couples can increase the odds of avoiding that disease in their children. However, gender selection can also be used for “family-balancing”, a sometimes controversial topic. Critics cite religious and moral objections to using PGD/PGS for the sole purpose of balancing out your family by choosing embryos of the sex opposite the child(ren) you already have.


It may be upsetting to infertile people who need IVF… and would be happy to have it produce a child of any sex… to hear that PGD/PGS can be used for gender selection by those who do not need IVF otherwise. However, others argue that anyone who undergoes the inconvenience and expense of IVF should be entitled to access any and all of the diagnostic tools available through today’s rapidly-developing assisted reproductive technology, including PGD/PGS for any purpose.
It is interesting to note that, although PGD/PGS is an additional out-of-pocket cost over and above traditional IVF, PGD/PGS may lower the overall total cost of IVF for those who produce an excess number of embryos. Since PGD/PGS seeks to select “chromosomally normal” embryos, patients can potentially avoid wasting money on thaw cycles for embryos that would likely not have the potential to develop into viable babies.
Long Island IVF is one of only five infertility practices in the country selected to participate in a recent PGD/PGS study by Reprogenetics. For more information on the study, including whether additional participants can be accommodated, please ask your Long Island IVF doctor, or contact Eva Schenkman, Senior Embryologist at
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How do you feel about PGD/PGS? Is it acceptable in any case, certain cases, or not at all?

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Infertility Podcast Series: Journey to the Crib: Chapter 16 Micro-IVF

By David Kreiner MD

June 10th, 2013 at 9:46 pm


Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Sixteen: Micro-IVF. You, the listener, are invited to ask questions and make comments.  Dr. Kreiner will answer them. You can access the podcast here:


Micro-IVF, also known as Mini-IVF, is a minimal stimulation IVF that differs from routine IVF only in the ovarian stimulation hormones that are used.  We typically stimulate with clomid 100mg for the first five days followed by 75 units of FSH hormones for two days.  We monitor, retrieve the eggs, fertilize the eggs in the lab and perform the embryo transfer in the same exact way as we do with all other IVF patients. 

In 2006, a friend and colleague of mine, Suheil Muasher, who completed the Jones Institute fellowship two years before me, introduced the idea of Micro-IVF to me.  My initial reaction was not unlike most other reproductive endocrinologists who question “Why offer an IVF alternative that has a lower success rate?”  Well, as they say, the proof is in the pudding. And it doesn’t hurt that the pudding costs less with ingredients that have less of an effect on the body.

Since October 2011, when East Coast Fertility merged with Long Island IVF, we have had a better than 50% pregnancy rate for our patients under 35 years of age utilizing Micro-IVF.  That the cost is $3900 and the exposure to fertility drugs is minimal makes this an astounding success rate.

Furthermore, our patients who transfer just one embryo with the fresh transfer qualify for the Long Island IVF Single Embryo Transfer program and as a result are entitled to cryopreserving and storing up to one year any excess embryos for free. 

With such great results, I recommend Micro-IVF as a safer and superior alternative to FSH/IUI and sometimes even Clomid/IUI cycles especially in our younger age patients.

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Was this helpful in answering your questions about Micro-IVF?

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

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