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Archive for September, 2013

Thanks, Mariano, for the “Mo”-ments You Gave Us (and the Journey We Shared)

By Tracey Minella

September 30th, 2013 at 6:48 pm

 

credit: wiki free public domain

 

You don’t have to be a sports fan to appreciate what’s been going on in major league baseball this week. The regular baseball season just ended amidst a host of emotional moments surrounding the retirement of long-time superstar Yankees relief pitcher, Mariano “Mo” Rivera, who made his major league debut in May, 1995. It’s been a while since I penned a “Just for Guys” post at the end of the month, and this “Mo”-ment demands attention.

Married to a diehard Yankees fan and unable to escape the Mariano frenzy even if I wanted to, I watched in awe as Rivera’s personal life and professional stats were highlighted. An extremely poor boy who first played baseball using a milk carton for a glove, Mariano has quietly invested tons of his own money in a namesake foundation that’s building schools and starting programs designed to improve life back in his native Panama and elsewhere. He is a humble man and still married to his childhood sweetheart. And as the All-Time Saves record holder he is a pitching legend, destined for first ballot induction into the Baseball Hall of Fame.

Of all the stats and milestones that were rattled off, one leaped out at me. Although he didn’t start a major league game until 1995, he signed as a free amateur agent with the Yankees in 1990. That’s when I started trying to conceive. He’s been in baseball all the years I’ve been infertile…and for as long as you’ve been trying to conceive, too. In fact, today’s youngest infertility patients probably can’t remember a time when Mariano wasn’t pitching for the Yankees. So I’m joining in the farewell tributes with this light-hearted comparison of our respective “careers”.

Mariano’s journey with the Yankees, like my infertility journey, officially started years before anyone knew about it. He spent the 5 years after signing in relative obscurity; I spent a few years trying to conceive without medical intervention and unbeknownst to anyone else. His big league career began as a starter. Mine as an IUIer.

He moved on to relief pitching in 1996 and I moved on to IVF in 1993 and over our long careers we both racked up impressive records:

His all-time post-season ERA of 0.70 over a 19 year career is legendary. But my 7 fresh IVFs over 9 years and my all-time ECA (Earned Cryo Average) of 0.028 is nothing to sneeze at. His “most strikeouts by a Yankee reliever in a single season” record of 130 is impressive, but doesn’t hold a candle to the number of my follicles that struck out. He never got to play center field. I never got to have a FET (frozen embryo transfer). He emerged from the bullpen to Metallica’s “Enter the Sandman”. I emerged from my retrievals to Garth Brook’s “Two of a Kind, Workin’ on a Full House”.

He had 18 consecutive seasons with at least one save. I had 7 consecutive cycles with at least one embryo. His pitching talent was a “gift from God”. My third cycle was a G.I.F.T from Dr. Kreiner. He never hit a triple. I had one double that was almost a triple. We were both MVPs …him the “Most Valuable Player” and me the “Most Victorious Patient”. And we were both on the disabled list with a groin strain in 1998 and 2002… though mine was due to childbirth. He was the three time “Delivery Man of the Year”. I was a two time “Delivery Woman of the Year”. We both received rocking chairs at the end of our careers, but his…made from broken bats…was much cooler.

He had longevity and consistency. So did I.

We’ll never see another Mariano, much less one with a two decade career. And fortunately, advances in reproductive technology have made long infertility journeys like mine just as rare. So, Mo and I will quietly take our respective places in the records books and watch as the next generation takes the field. And we will cheer you all on.

May your journey be a quick one. And may you bring home as many championship rings as you’ve been dreaming of.

Congratulations, Mariano on your retirement. Thanks for providing many in the infertility community some much-needed “Mo-ments” of entertainment…and distraction… during some difficult times over the past 19 years.

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How long have you been on your infertility journey? Do sports help distract from or relieve the stress of infertility for you or your partner?

 

Stat Sources:

http://en.wikipedia.org/wiki/Mariano_Rivera

http://www.northjersey.com/sports/196249831_Mariano_Rivera_s_career_highlights.html?page=all

Photo credit: Public Domain Orig released by BuickCenturyDriver http://commons.wikimedia.org/wiki/File:New_Yankee_Stadium.JPG

 

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Infertility Podcast Series: Journey to the Crib: Chapter 31: When Are You Too Old to be a Mother?

By David Kreiner, MD

September 24th, 2013 at 11:08 am

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirty-One: When Are You Too Old to be a Mother? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=143

When Are You Too Old to be a Mother?

Over the years, there have been reports of women as old as in their 70′s having babies as a result of In Vitro Fertilization (IVF) performed using donated eggs from a young fertile donor.  Immediately after these reports appear, I am bombarded with questions and criticisms about how wrong it is that we (somehow I am included as part of the responsible party as an IVF practitioner) allow women to have children beyond that which is not just natural but also reasonable. Those of us in IVF have had many experiences with making the news as this medical technology pushes to the edges of what society views as acceptable.

We are often put in the position of making decisions with our patients that have even larger implications to society than the individual patient.  I do my best to look at each patient and each situation as unique and treat them accordingly.  Regarding the age of a prospective egg recipient however we are dependent on the patient’s honestly reporting such to us.  Unfortunately, there are circumstances where patients have misled their doctors and in the case of one 70 year old mother, she had reported to the clinic that she was in fact 53.

Even so, it is the responsibility of the IVF provider to ensure that a woman is healthy and capable of bearing the pregnancy, giving birth and being a mother.  There is not an absolute age cutoff at which point a woman is universally unfit to undergo IVF and become pregnant.

My personal oldest woman I helped achieve a pregnancy was a 53 year old who delivered at age 54.  She had a normal stress test, EKG and was cleared by an internist, perinatologist and psychologist.

Some point out that beyond a certain age, it is unnatural to become a mother and that it puts the family at risk that she may not be around to help raise the child or that perhaps the woman lacks the energy and stamina to raise the child properly.  I personally struggle to separate my own feelings about the proper age to have a child which may be inappropriate for others who have a different perspective.  My responsibility as the physician is to the health of my patients, the well-being of the child and for the good of society.

Many women in their 50′s have the health and energy to carry a pregnancy and bear a child with no more risk than many women 10-20 years younger.  That being said, what about the risk that the mother may not be around to raise the child to maturity?   There is no question that a young healthy couple with sufficient financial support and emotional maturity is ideal to raise a family.  But, happy, successful families can take on many different faces.  Single parent families exist, survive and often thrive.  One can never be certain that the condition of the couple at the time of conception will continue through the child’s birth or for that matter until the child has reached maturity.  In addition, at least 50% of couples in the U.S. become divorced.  One can argue that couples at risk of divorce should not get pregnant.

I apologize that I cannot offer an answer to this question, when are you too old to be a mother.  For me personally, it is more a question of health …for the mother and baby… which needs to be evaluated individually for each case utilizing testing and experts to make the best assessment.  Otherwise, I feel it is an individual’s right to choose as long as society is unaffected or supports the individual in those cases where the pregnancy has a significant impact beyond the immediate family.

 

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Was this helpful in answering your questions about what fertility doctors might consider when questioning if an older woman may be able to conceive and carry a pregnancy?

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

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September is National Gynecological Cancer Awareness Month

By Tracey Minella

September 22nd, 2013 at 11:00 am

 

image courtesy of stuart miles/free digital photos.net

When hot in pursuit of parenthood, especially if you are doing IVF or IUIs, it is easy to lose track of everything else. The laser focus on your fertility treatment can easily force other important things onto the back burner.

Things like maintaining the house or car. Social plans. Or more importantly…regular annual doctor visits to the gynecologist.

If you’re waving me off with your hand right now, I urge you to listen up. I’ve been in your stirrups and know what you’re thinking. You figure delaying your annual visit is only temporary and that you will be back to the OBGYN real soon…finally pregnant. Deep down you don’t want to go back until you have that baby sonogram photo in hand. Well, maybe next month will be the lucky one. Or the month after that.

But sometimes, success doesn’t happen as fast as we want. Any number of setbacks can delay the process. And the gap between when you were due for your annual exam and today grows uncomfortably large. I know the last thing you want right now is a ride in yet another doctor’s stirrups, but your RE is not looking for gynecological cancers…your gynecologist does that.

September is Gynecological Cancer, Ovarian Cancer, and Prostate Cancer Awareness Months. And next month will be Breast Cancer Awareness Month.  So this serves as a reminder to stay up-to-date on your annual gynecologist exam…and to get checked sooner if anything else seems amiss. And make sure your partner gets checked as well.

The last thing you’d ever want after battling infertility is to finally get back to the OBGYN with that baby sonogram photo and find out you have another battle ahead.

Please make that appointment today if you are overdue.

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Are you overdue for your annual appointment? Did it slip your mind or are you purposely avoiding it?

 

Photo credit: Stuart Miles http://www.freedigitalphotos.net/images/agree-terms.php?id=10087391/

 

 

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September is PCOS Awareness Month

By David Kreiner, MD

September 19th, 2013 at 8:10 pm

image courtesy of arztsamui/free digital photos.com

 

PCOS is the most common hormonal disorder of reproductive age women, occurring in over 7% of women at some point in their lifetime.  It usually develops during the teen years.  Treatment can assist women attempting to conceive, help control the symptoms and prevent long term health problems.

The most common cause of PCOS is glucose intolerance resulting in abnormally high insulin levels.  If a woman does not respond normally to insulin her blood sugar levels rise, triggering the body to produce more insulin.  The insulin stimulates your ovaries to produce male sex hormones called androgens.  Testosterone is a common androgen and is often elevated in women with PCOS.  These androgens block the development and maturation of a woman’s ovarian follicles, preventing ovulation resulting in irregular menses and infertility.  Androgens may also trigger development of acne and extra facial and body hair.  It will increase lipids in the blood.  The elevated blood sugar from insulin resistance can develop into diabetes.

Symptoms may vary but the most common are acne, weight gain, extra hair on the face and body, thinning of hair on the scalp, irregular periods and infertility.

Ovaries develop numerous small follicles that look like cysts hence the name polycystic ovary syndrome.  These cysts themselves are not harmful but in response to fertility treatment can result in a condition known as Ovarian Hyperstimulation syndrome, or OHSS.

Hyperstimulation syndrome involves ovarian swelling, fluid accumulating in the belly and occasionally around the lungs.  A woman with Hyperstimulation syndrome may become dehydrated increasing her risk of developing blood clots.  Becoming pregnant adds to the stimulation and exacerbates the condition leading many specialists to cancel cycles in which a woman is at high risk of developing Hyperstimulation.  They may also prescribe aspirin to prevent clot formation.

These cysts may lead to many eggs maturing in response to fertility treatment also placing patients at a high risk of developing a high order multiple pregnancy.  Due to this unique risk it may be advantageous to avoid aggressive stimulation of the ovaries unless the eggs are removed as part of an in vitro fertilization procedure.

A diagnosis of PCOS may be made by history and physical examination including an ultrasound of the ovaries.  A glucose tolerance test is most useful to determine the presence of glucose intolerance and diabetes.  Hormone assays will also be helpful in making a differential diagnosis.

Treatment starts with regular exercise and a diet including healthy foods with a controlled carbohydrate intake.  This can help lower blood pressure and cholesterol and reduce the risk of diabetes.  It can also help you lose weight if you need to.

Quitting smoking will help reduce androgen levels and reduce the risk for heart disease.  Birth control pills help regulate periods and reduce excess facial hair and acne.  Laser hair removal has also been used successfully to reduce excess hair.

A diabetes medicine called metformin can help control insulin and blood sugar levels.  This can help lower androgen levels, regulate menstrual cycles and improve fertility.  Fertility medications, in particular clomiphene are often needed in addition to metformin to get a woman to ovulate and will assist many women to conceive.

The use of gonadotropin hormone injections without egg removal as performed as part of an IVF procedure may result in Hyperstimulation syndrome and/or multiple pregnancies and therefore one must be extremely cautious in its use.  In vitro fertilization has been very successful and offers a means for a woman with PCOS to conceive without a significant risk for developing a multiple pregnancy especially when associated with a single embryo transfer.   Since IVF is much more successful than insemination or intercourse with gonadotropin stimulation, IVF will reduce the number of potential exposures a patient must have to Hyperstimulation syndrome before conceiving.

It can be hard to deal with having PCOS.  If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition.  Ask your doctor about support groups and for treatment that can help you with your symptoms.  Remember, PCOS can be annoying, aggravating even depressing but it is fortunately a very treatable disorder.

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Do you suffer from PCOS? Do you have any advice to share for other “cysters”?

 

photo credit: artzsamui/http://www.freedigitalphotos.net/images/agree-terms.php?id=100156295

 

 

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Long Island IVF Patient Satisfaction Survey and Extended Hours Program

By Tracey Minella

September 17th, 2013 at 7:57 am

While Long Island IVF routinely conducts patient satisfaction surveys, earlier this year we undertook a major, multifaceted patient satisfaction review process. As this is the 25th anniversary of our bringing Long Island its first IVF baby, we felt it was the perfect time to reach out and confirm that we were still giving today’s infertile patients everything they want and need in their journey to parenthood.

This review included surveying current patients, former patients, and prospective patients who’d expressed an interest in our practice. It included in-office surveys, online surveys, mailings, and phone calls. It was structured to encourage both positive and negative feedback so we could really get an honest look at what we’re doing right and where we might do even better.

We weren’t just looking for a sugar-coated, love-fest from the many patients who we’d fast-tracked to parenthood. No, we wanted to hear from everyone: those whose success took longer, those still trying, those who came to us from other practices, and those who connected with us but didn’t follow through. This was a huge undertaking.

The results were well worth the effort. And we learned a lot.

Today’s patients are doing their homework. They are educated consumers who often come to Long Island IVF researching our success rates and comparing them to other clinics, nationally and regionally. We strongly encourage patients to do this and we take pride in our success rates, which far exceed the national averages.This information is available on our website http://www.longislandivf.com/  and is also explained simply in this recent blog: http://bit.ly/199We8L

Today’s patients appreciate a blend of high-tech and high-touch. They want the benefits of a stellar clinical program with great success rates, but they want the human touch. They want the best of a shiny state-of-the-art facility, but they want their hands held. They want the cutting edge technology of traditional IVF but they often want to blend it with other complimentary offerings like our unique Mind-Body program’s stress-reduction techniques, counseling, and acupuncture. http://www.longislandivf.com/mind_body.cfm. Our warm, private, non-institutional environment offers all these things.

But today’s patients have a real dilemma. The extended economic downturn has driven many infertile patients to work longer hours, sometimes at more than one job, in order to afford their treatments. Sadly, the days of 9-5 are history.

Even though we’ve long offered early morning hours for patients so they could get to work on time, many patients need or want to come to the office in the evening when possible. This request frequently came up in our survey.

We want you to know…we listened.

Long Island IVF is pleased to announce the following extended evening office hours and locations. Doctors will see patients until 8:00 pm, with the last appointment starting at 7:00 pm.

Monday: Dr. Brenner will see patients in Lake Success.

Monday: Dr. Zinger will see patients in Brooklyn.

Tuesday: Dr. Kenigsberg will see patients in Melville.

Wednesday: Dr. Kreiner will see patients in Melville.

Thursday: Dr. Zinger will see patients in Brooklyn.

Patient satisfaction has always been a priority at Long Island IVF and it’s something we will continue to assess frequently as we enter our next 25 years of family-building. Thanks to all those who took the time to share your thoughts and ideas. And thanks for continuing to refer us to your friends and family.

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We’re always looking for your input and suggestions. Feel free to weigh in on anything right here.

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Choosing a Fertility Clinic: The Importance of Being an Educated Consumer

By David Kreiner MD and Eva Schenkman MS CLT TS

September 9th, 2013 at 9:16 am

 

image courtesy of Ambro/free digital photos.net

In-Vitro Fertilization (“IVF”) offers the highest chance for success of any fertility treatment.

Pregnancy rates for IVF have improved dramatically over the years. In 1989, the national delivery rate was only 14%… by 2011, it had increased to 30%. To put this in perspective, the pregnancy rate of couples with proven fertility is approximately 20% per cycle. So while 30% nationally may sound low, it is greater than the average fertile couple will have in any given cycle.

In 2011, Long Island IVF had a 40% live birth rate per retrieval for the 303 patients under 43 years of age.

There have been many advances in IVF technologies over the years, including embryo culture media and environment, improved laboratory air quality, improvements in embryo transfer technique and ultrasound visualization of transfer catheter placement, and advances in fertility medication.  The skills and experience of reproductive endocrinologists and their cycle management, coupled with the highly-skilled and experienced embryologists, have improved IVF success rates significantly.

When investigating prospective IVF clinics, the delivery rate or “take home baby” rate as it is known, is really the only true measure of success. As a patient, you should be aware that many clinics define success in different ways. This may include defining success as a positive pregnancy test or any pregnancy, even miscarriages and ectopic pregnancies. While to a clinic, these numbers may serve as important quality indicators to the patient desiring a baby these successes are irrelevant.

Pregnancy and birth rates from IVF procedures are subject to influences that may vary significantly from clinic to clinic, making success rate comparisons between clinics very troublesome for consumers. These differences between clinics may be explained by a variety of factors that impact a patient’s fertility potential.  Such variables as infertility diagnosis, age of patients, rejecting patients with prior failed cycles and a program’s threshold for performing IVF on patients with diminished ovarian reserve will impact reported success rates..  Cycle cancellation policies and the number of embryos the clinic is willing to transfer likewise will significantly affect reported success rates.

In most cases, these differences reflect the philosophies and clinical practices of the physicians, and are not sinister or purposefully deceptive manipulations. Nonetheless, consumers need to be aware of these differences when comparing success rates, and also, put success rates in perspective when choosing a clinic. Success rates among clinics can vary greatly, so consumers must be careful when investigating prospective programs. Even the Society for Assisted Reproductive Technologies (“SART”), the organization to which IVF practices report their pregnancy rates, cautions consumers that IVF success rate data should “not be used for comparing clinics.”

Given this complexity to interpreting pregnancy rates, how should patients choose a clinic?  Most important, and potentially evident to the prospective patient, is the level of experience and expertise of the physicians and embryologists in the program.  Furthermore, IVF labs that rely on per diem staff that is unable to monitor and manage the embryology laboratory on a daily basis may lead to deficiencies in quality and consistency which may be another potential cause of lower success rates.  

It is important to look at several years’ worth of data rather than just how a clinic performed in one year. If a clinic consistently under- performs, patients need to think strongly before entrusting their eggs in its care.

While IVF success can vary with many factors, the biggest determining factor of success is maternal age. Success rates will decline with a woman’s age, and they drop off dramatically after about age 37. Age can affect both egg quantity and egg quality. While there is no test to assess egg quality, there are tests that can be performed to assess egg quantity. These include:

·                     Day 3 FSH testing

·                     AMH Levels

·                     Antral follicle counts.

The following table shows pregnancy rate, live birth and singleton rates nationally for 2010. This data clearly shows the impact of advancing maternal age on IVF success. As you can see, the curve starts to drop about age 28. It drops faster at about age 34 and even more startling drop after age 38.


*   The dark blue line (triangles) shows pregnancy rates per cycle by age

*   The red line (circles) shows live birth rates per cycle by age

*   The rate of singleton live births per cycle is shown by the green line
*   The difference between “pregnancy” rate and “live birth” rate is due to miscarriages

In this table, the IVF live birth rates per cycle started for different age groups (circled in red). Percent of IVF cycles resulting in egg retrieval, an embryo transfer & a pregnancy are also shown.

              At Long Island IVF, the total combined years of experience of our Senior Embryology team is over 100 years. Most of our Senior Embryologists hold advanced degrees in their field. Our Laboratory Director holds a PhD degree and is certified by both NYS and the American Board of Bioanalysts as a High Complexity Laboratory Director.

             Long Island IVF achieved Long Island’s first successful IVF leading to the birth of a baby in 1988.  Since then, with advances in technology and experience, success rates have skyrocketed.

            At Long Island IVF, from the most recent birth rates available (IVF performed in 2011), patients under 35 had a 51% live birth rate (59 live births/116 retrievals).  As of the summer of 2013 an additional 20 patients achieved live births as a result of 50 transfers from embryos frozen at the time of their 2011 retrieval (40%).  This cumulative success rate from 2011 retrievals as of August 2011 was 68.1% (79 live births/116 retrievals).           

            Not all clinics are created equal and as the consumer you really need to do your homework to find the clinic with excellent success rates that offers the expertise needed to give you the best chance of achieving your dream and bringing that baby home. Do not be too shy to ask the tough questions about not only the physician but the lab.

            The message here is to do your research on all clinics in your area, schedule a consult with several different clinics, and pick the clinic that best fits your needs.

 

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What is/was the most important factor to you when choosing a fertility clinic?

 

Photos credit: Ambro http://www.freedigitalphotos.net/images/agree-terms.php?id=10029569

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Infertility: 4 Tips for Surviving the Back-to-School Blues

By Tracey Minella

September 7th, 2013 at 9:20 pm

 

 

image courtesy of anankkml/free digital photos.com

When you’re trying to conceive, it seems that everywhere you look, everyone is pregnant. Except you.

This week and next across Long Island, this emotional overload worsens as children return to school. After three months away in summer camps or out of sight in backyard pools, the little monsters come screeching out to the curb in full force.

Millions of them…or so it seems. They’re on every corner. Giggling at the bus-stop with their new outfits and backpacks full of crayons and glue sticks while their moms chat over morning coffee. Yellow buses seem to outnumber regular cars. It’s almost too much to bear.

Here are 4 tips on how to get through this transition:

1. Avoidance. If it’s possible, don’t go out for the half-hour or so that kids are waiting at the bus-stop. Leave a little earlier or later.

2. Treat yourself to something special. Whatever your budget, there is surely something that would brighten your day. Some trinket, manicure, massage, coffee on the beach? Infertility has deprived you. So indulge.

3. Do something to enhance your health or your odds of conceiving. It could be anything from re-committing to that gym membership now that summer’s over, taking yoga or doing something meditative, clearing your mind with a daily walk, sleeping longer, eating better, quitting a bad habit. Check out Long Island IVF’s Mind-Body Program offerings to get support and relieve the stress of infertility http://www.longislandivf.com/mind_body.cfm

4. Turn a negative into a positive. If you are tired of having to wait for your day to finally buy a child back-to-school clothes and school supplies…don’t. Gather your courage, walk into the nearest Walmart or Target and open your heart to a child that can’t afford such necessities. Your local social services department or school district would gladly accept donations of loaded backpacks, lunch boxes, and new clothes on behalf of needy children. Be an angel. It’ll make you feel better.

With any luck, you’ll be an overprotective parent secretly following your precious cargo’s school bus to school very soon.

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How do you get through the back-to-school blues? Any tips to share?

 

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=10047172 anankkmi

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Infertility Podcast Series: Journey to the Crib: Chapter 30: The Gift of Life and Its Price

By David Kreiner, MD

September 3rd, 2013 at 7:41 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirty: The Gift of Life and Its Price. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=141

The Gift of Life and Its Price

 

IVF has been responsible for over 1 million babies born worldwide who otherwise without the benefit of IVF may never have been.  This gift of life comes with a steep price tag that according to a newspaper article in the New York Times in 2009 was $1 Billion per year for the cost of premature IVF babies.

 

According to the CDC reported in the same NY Times issue, thousands of premature babies would be prevented resulting in a $1.1 Billion savings if elective single embryo transfer (SET) was performed on good prognosis patients. 

 

The argument often given by a patient who wants to transfer multiple embryos is that to do SET would lessen their chances and to go for additional frozen embryo transfers is costly.

 

In fact, if one considers the combined success rate of the fresh and frozen embryo transfers that are available from a single stimulation and retrieval, the success rate is at least as high if not higher in the cases of fresh single embryo transfers. 

 

At Long Island IVF, in an effort to eliminate the financial motivation for multiple embryo transfers, we offer free cryopreservation and embryo storage for a year to our single embryo transfer patients.  In addition, we offer them three (3) frozen embryo transfers for the price of one for up to a year after their retrieval.

 

IVF offered with single embryo transfer is safer, less costly and probably the most effective fertility treatment available for good prognosis patients.                     

 

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Was this helpful in answering your questions about single embryo transfers?

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

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