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Archive for October, 2013

Nightmare on Infertility Street: 3 Halloween Survival Tips

By Tracey Minella

October 31st, 2013 at 6:48 am


photo: debspoons/

Forget Nightmare on Elm Street. It’s nightmare on every street today.

Halloween isn’t one of those holidays that force you to put on a happy face at the dinner table while a dozen nagging and insensitive extended family members drone on and on with their basically useless advice on how you can conceive. Oh, no. Halloween is not like that at all. It’s so much worse.

When you are infertile, Halloween can be your worst nightmare. Literally. Instead of the handful of adorable children you might encounter on a regular day, each tugging at your heartstrings, Halloween multiplies that heartache about 300 times. Til your heart bleeds.

It’s like living in a horror movie. There is no escape from the onslaught as the doorbell rings. And rings. And rings. Each time you open it, your shaky psyche is confronted by scores of goblins and princesses yelling “trick or treat”. Two conflicting… and equally inappropriate… impulses may surface as you’re torn between wanting to snatch up a cutie for yourself and wanting to slam the door in their little faces. And then just as you turn away having resisted those impulses, you spy another pack of children at the mailbox.

If you’re in the majority and are having a hard time on Halloween, consider these three survival tips.

1. Go out. Get dinner in a restaurant and go to an R-rated movie. Great way to avoid kids. But be sure to leave a bowl of candy out so the little monsters don’t egg your house.

2. Hide inside. Leave the candy bowl outside with a “Take One” sign so they won’t ring the bell. Keep the lights off and watch TV… or whatever… in the dark.

3. Indulge your mean side. Hide in a bush after dark and scare the living daylights out of them! But then you’ve really got to give them some candy. Unless you’re really mean…

Of course, some of you can emotionally handle Halloween. Maybe even enjoy it. And that’s great. While you’re happily dolling out the Snickers and imagining what costume your future baby will wear, the rest of us will be silently judging the lamest costumes, scarfing down Twix, and leaving out a bowl of the ever-popular Mary Janes.

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How do you handle Halloween?


Photo credit: debspoons /


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Did IVF on Live TV Help or Hurt the Cause?

By Tracey Minella

October 23rd, 2013 at 8:23 pm


credit: Dream designs/

In vitro fertilization, or IVF, went mainstream media recently with the ground-breaking, first ever televised account of human fertilization taking place on the Today show.

A young couple, who were undergoing IVF for the first time, agreed to show the world …on live TV… the moment her eggs were fertilized with his sperm using intracytoplasmic sperm injection, or ICSI, a technique whereby an embryologist isolates and injects a single sperm into a newly-retrieved egg. The resulting embryos were then left to develop for a few days in the embryology lab before being transferred back into the woman’s uterus or being cryopreserved (frozen and stored) for later use.

When I first saw the story, I thought it was both courageous and incredibly cool. I could have seen myself doing it. But it also struck me that the IVF newbies seemed more caught up in the probability of a positive outcome than I thought they should have been. Even their excited doctor stopped just short of guaranteeing success. The guards were down. But maybe that was just my IVF veteran heart worrying on their behalf that they’d suffer a devastating disappointment…also on national TV…if the result was negative. A result I and many, many couples have gotten even though today’s IVF success rates are better than ever.

Happily, they received positive pregnancy results… also live on the air. Like so many infertile couples watching their journey, I sent out a virtual fist-pump to the lucky couple, who are already speculating on whether they’re having twins. I didn’t sense in their reactions any visible worry about the potential risks or added costs of a multiple pregnancy or, dare I speak it, of a miscarriage or other complication. And many who haven’t seen or experienced what I have may rightly argue to let them have their moment. If things go awry, they will deal with it then. Fast forward to the assumption of a fairy tale happy ending with boy/girl twins.

Do we ignore the elephant in the room?

If things go wrong, will that be news, too? Should it be news? Or will we only be invited to the post-birth experience where they exit the hospital with their bundle(s) of joy? Is society really ready to see the ugly side of infertility if at any point it, God forbid, came to be? Were we ready to see them fail to get pregnant? Are we ready to see anything go wrong? To share in what would normally be complete and private devastation and heartbreak?

As much as this televised IVF cycle has given infertility awareness a major boost on a national scale, it has also on one level painted an unbalanced or unrealistic picture of IVF. Many couples do not get pregnant on the first try… as many infertile couples already know. They may be older, have greater obstacles, or may simply not have had first-round IVF success despite what all the factors seemed to indicate would be the case. Sadly, others get pregnant, but don’t end up with a baby, which is why it is important to inquire about birth rates, not just pregnancy rates when choosing an IVF center.

But now the public (or at least those who remember the story)…through this positive experience…may think IVF is always an easy fix. So, this experience may in fact result in increased awareness, but not necessarily increased sympathy for infertile couples. I can hear the public now: “Oh just do IVF. It always works, right?”

And then there’s the rest of the public…those who have already forgotten this couple as yesterday’s news. What a luxury to be them. I haven’t forgotten the couple. I can’t forget them. I’m worrying on their behalf and will keep worrying until I see them on the news holding a bundle of joy on those hospital steps in eight months.

Please, I don’t want to see them on the news a moment sooner.

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Do you think the story helped or hurt infertility awareness? Do you think their experience is typical?


Photo credit: dream designs /





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Infertility and ObamaCare

By David Kreiner MD

October 21st, 2013 at 7:07 pm



photo credit: David Wagner/

Have no fear ObamaCare is here!

For those of us hoping to increase accessibility to health care for the uninsured, the passage of ObamaCare…the administration’s own term for the Affordable Care Act… provides us with hope that this much sought after right to obtain health care for all Americans might soon become a reality.

Well, unfortunately, we are not quite there yet especially as it relates to fertility care. There still remains concern about the out-of-pocket expenses for fertility medications and treatments.

Apparently, on January 1, 2016, the federal government is withdrawing support for mandated fertility coverage in the six states where such coverage does exist… including in New York.  That day, Uncle Sam says “you’re on your own” to those mandated states.  It will be up to the states to foot the bill or else eliminate the mandated coverage.  I think we know how that will go.

On other fronts, we have more bad news.  Medications covered by the new state- supported exchanges require much higher co-pays.  Fertility medications are estimated by some to cost as much as $1,300 per covered cycle under these exchanges.   Considering the goal of ObamaCare was to make health care more accessible, I understand why the administration has stopped referring to the new law as the Affordable Care Act.

The exchanges can be purchased at different levels with increasing cost correlating with a lower percentage of out-of-pocket expense.  Those interested in fertility treatment (or for that matter anyone with a preexisting condition) should and presumably will purchase the better coverage, if able. If one can afford the coverage of the Gold plan, the 10% co-payment, and the enormous co-pay for the medications, then IVF will be a possible option.  Unfortunately, these costs may be prohibitive for many who otherwise, under the current insurance system, are financially able to afford IVF.

So you may ask what the ramifications of ObamaCare are to the infertile seeking treatment.   As it stands now, for most it will prove to be the Unaffordable Care Act which will prevent access to care which could otherwise allow them to build their family; a right that is denied them due to their infertile medical condition and ObamaCare.


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What impact, if any, do you think ObamaCare will have on your fertility insurance and care?


Photo credit: David Wagner/

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ASRM Retrospective 30 Years Later

By David Kreiner MD

October 17th, 2013 at 1:48 pm

image courtesy of renjith krishnan/freedigital


Flying into Boston this week it occurred to me that this was the 30 year anniversary of the first ASRM meeting I ever attended.  In 1983, the American Fertility Society “AFS” meeting (as it was called then) was held in San Francisco and I attended as a third year ob-gyn resident. I was in awe attending this huge conference of about 3-5,000 held at the Hyatt Hotel as I recall.

Though I was required to man the Ovcon 35 birth control pill exhibit (since Ovcon’s manufacturer was paying my way), I was drawn to the microsurgery and in vitro fertilization exhibits and presentations.  

In the ballroom, the presenters presided over a few thousand of us eager to hear about the most recent successes in IVF.  Already, Norfolk had achieved dozens of births through this new scientific process which brought gynecological surgeons (laparoscopists) together with embryo biologists, endocrinologists, andrologists and numerous nurses, technicians and office staff.  For me, hearing Dr. Howard Jones, American IVF pioneer, and others speak about their experiences with this life creating technique was exhilarating.

Years later, as a Jones Institute reproductive endocrinology fellow, I would hear Dr. Howard proclaim that a chain is only as strong as its weakest link.  IVF required every link to maintain its integrity for the process to work.

In 1985, I presented my own paper at the AFS meeting in Phoenix, Arizona.  My wife and two sons joined me.  My presentation on endometrial immunofluorescence in front of hundreds of experts and specialists in the field remains one of the strongest memories in my life.

Today, the ASRM must be held in mega convention centers like the one in Boston where it could accommodate tens of thousands of attendees.  One presentation estimated the number of IVF births worldwide at over five million. Interestingly, per capita, the US performs one fifth the number of IVFs as Europe–where IVF is much more accessible and typically covered by government insurance.

Today, success in the US is better than fifty per cent for most people, thereby making single embryo transfer (“SET”) for good prognosis patients a viable option to avoid the risk of multiple pregnancy. Minimal stimulation IVF (“Micro-IVF”) is a viable alternative for many patients, offering a lower cost and lower risk option.  Egg freezing offers a means of fertility preservation, especially valuable to women anticipating cancer therapy.  Pre-embryo genetic screening (“PGS”) is an option that allows patients to screen for and eliminate genetically undesirable embryos that may otherwise lead to miscarriage or termination.

Looking back at the past thirty years, I am amazed at the progress and achievements made by my colleagues in IVF and happy that I was able to participate in this most rewarding field that has brought so much joy to millions of people.

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photo credit: renjith krishnan


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6 Helpful Resources for Pregnancy and Infant Loss

By Tracey Minella

October 16th, 2013 at 12:10 pm


image courtesy of small bird studio

Infertility is hell. Everyone on this journey knows that. And we all know that unless you are experiencing infertility yourself, you can’t possibly understand our pain. No matter how much your heart breaks for us. You have to live it to relate to it.

Unfortunately, the journey is longer and harder for some of us. And sometimes, just as you think you can finally glimpse the sun peeking through the darkest forest, you lose your footing and tumble into the blackest hole. To a special section of hell so awful that it forces you to redefine the term.

Ectopic pregnancy. Miscarriage. Stillbirth. SIDS or other infancy loss. Whatever the cause…your baby is gone. How do you go on?

October is National Pregnancy and Infant Loss Awareness Month and since many infertility patients suffer these unimaginable losses along their journeys, it’s important to acknowledge the pain and provide some resources to help cope. Like infertility itself, unless you’ve lived it, you can’t relate to baby loss.

Here are some places where those who have suffered a loss, and those who love them, can start:

Project Heal I cannot say enough about this Baby Loss Community support group, available online and through Facebook. The moderator, Carlymarie, suffered the loss of her son, Christian. She helps people cope (and they help her in return) through photography, writing, beach art, short films, and many other therapeutic ways. She is hosting a month-long “Capture Your Grief” photography event in honor of National Pregnancy and Infant Loss Awareness Month. Her site, which provides all the details, is a “must visit” for anyone who knows someone or who has themselves suffered a loss.

In addition, please visit Small Bird Studio on Facebook at  where another artist and bereaved mother, Franchesca Cox, offers support and beautiful artwork. She and Carlymarie teamed up to create the “Lost for Words” 2014 calendar from heartbreakingly poignant quotes contributed by grieving moms.

Still Standing Magazine This online magazine is exclusively related to “Surviving Child Loss and Infertility”. You can navigate your way through subjects like:  Grief, Infertility, Parenting after Loss, Faith, Siblings’ Grief, Pregnancy after Loss, and more. Everything is written by someone who has somehow survived and is “still standing”.

A Heart to Hold  This website and Facebook community’s mission is to “offer comfort to families who have experienced pregnancy and infant loss by creating and sharing the gift of a weighted handmade heart.” Recipients of these hand-sewn keepsakes may find some measure of comfort in having something soft to hold which are made to order at the weight of the infant that was “born sleeping” or who passed shortly after birth. Loved ones who are looking to do something for a grieving couple to acknowledge their loss and pain can inquire about a hand-sewn heart. This non-profit charitable organization was started by a woman who was given a hand-sewn heart by her midwife after her son was stillborn at full-term. Mamas who receive these hearts often want to pay it forward by volunteering to make one for another mom. For more information on volunteering, donating, or ordering see the site above.

Infertility/Infant Loss Jewelry*: There are several sites that offer  handmade and/or customized jewelry especially for those who are suffering infertility or from pregnancy or infant loss. Some people who have suffered a loss may find comfort in wearing a piece of jewelry that commemorates or acknowledges that lost life. Here is a sampling of such sites:


Professional Counseling Sometimes, a professional therapist is the best option to help you after such an unbearable loss. Long Island IVF offers several professional counselors uniquely-qualified to handle supporting you through infertility and pregnancy and infant loss.

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If you have suffered from pregnancy or infant loss, do you have any advice to share or any resources to recommend to help others?

* Long Island IVF has no affiliation with any of these jewelry or other merchandise sites and offers them for informational purposes only. Use your own discretion when considering making any purchase.


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Plastics, Infertility, Paleo and the ASRM 2013

By David Kreiner, MD

October 15th, 2013 at 4:01 pm


credit: stuart miles/

It’s a beautiful day in Boston today.  I am here not because of the Red Sox playoffs or Sunday’s Patriots game but rather to attend our annual ASRM national fertility meeting. 

I was delighted upon greeting some former colleagues of mine from my old stomping grounds, the Jones Institute, to hear compliments about how good I looked.  (Well, if you lose 55 lbs. of “baby fat” people tend to notice.)  I explained that my son, Dan, convinced me to try the Paleo Diet, modeled after the diet of Paleolithic man.

I am intrigued that so much is known about how man from the Paleolithic age ate.  I guess he left menus and recipes on the walls of his man caves.  Anyway, the focus… aside from elimination of dairy and gluten from his diet… is avoiding processed foods and chemical additives such as artificial sweeteners.

It was while eating my veggies and bun-less burger that I came upon one of the lead stories at the ASRM in the Wall Street Journal.  The chemical BPA, or Bisphenol A, found in plastic is tied to the risk of miscarriage.  BPAs can leach into the food that is heated on it such as in a microwave or in water stored in plastic and left out in the sun.  Additionally, it was recommended to limit the use of canned foods and avoid handling cash register receipts, which often are coated with resins that contains BPA.

I’m not sure “Paleo” man extended his life, avoided disease or lived any healthier with his “natural only” diet but we have some evidence of some benefits by doing so today.  Oh, and did I mention I can fit into those jeans from my college days?

For more information on the effects of BPAs on fertility as being discussed at the ASRM, see

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Did you know that plastics and other items made from BPAs may be harmful to your fertility or contribute to miscarriage? Do you use these products and if so, will you consider stopping now?

Photo credit: Stuart Miles



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Three Reasons to Keep an Infertility Journal

By Tracey Minella

October 13th, 2013 at 12:39 pm


credit: Simon Howden/

The ASRM …the biggest annual medical conference of infertility professionals…is happening right now in beautiful Boston, Massachusetts. History is being made and discoveries shared in one of the country’s most historic towns.

Imagine the ASRM of bygone days. When decades ago, procedures which are routine today… like embryo cryopreservation and ICSI…were first being studied and proposed. How exciting that the brightest minds in assisted reproductive technology are gathering as we speak and crafting another chapter in the history of IVF.

Which begs the question: What chapter are you on in your personal infertility journey and have you been keeping your own historical journal?

The deafening sound of your collective “no” isn’t surprising. I know why most of you don’t keep the journal. I missed out on the very beginning of my own story for the same reason… because you wish, hope, believe, or pray…that it won’t really become “a journey”. You assume it’ll be resolved fast… that next month will be the lucky one… and you will just get on with your life. That infertility will be just a little speed bump… instead of a potentially long and bumpy road. So you don’t write about it.

Here are 3 reasons to keep and infertility journal:

1. Memory Fades: Even though you have committed every little detail about your failed cycles and the numbers and grades of frozen embryos to memory, those memories are going to fade.  Especially if the journey lingers on… and the details about cycle 2 and 4 start to blend. Trust me on that one. You should have a one place to look back on it all someday. And you will want to look back. Trust me on that, too. While you are living it, you can’t appreciate how strong you are. That only comes from hindsight.

2. It is Therapeutic: It’s another place to vent, and for those who hold it all in, it may be the only place to vent. And venting helps reduce stress. Reducing stress may help you conceive. It’s a good cycle.

3. It is Part of History: Your infertility journey, however long it is or may be, is taking place alongside history itself. Keeping a journal forces you to connect with today’s important news and events, when everything else about battling infertility could otherwise send you into self-imposed isolation. I’ll explain:

My own infertility journal chronicles what is arguably the most important day in U.S. history during my adult lifetime…September 11, 2011. I was newly-pregnant with my son, barely pregnant actually, after IVF cycle #7. And I was working as a medical assistant at Long Island IVF. I wrote about how we frantically tried to reach our patients that worked in NYC, how we inseminated a tearful woman who went on to conceive twins on that day, and how I worried about the world I was bring this baby into. I love that I have that story to share with my kids.

Maybe your story would be woven into events like the election of President Obama, the Boston Marathon bombing, or other historical events, good and bad, yet to unfold. Those events that people look back on and ask: “Where were you when…..happened?”

I know it’s hard to write it down. It’s hard enough to just live it. But do it. The babies you’re working on having will consider it a gift someday.

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Do you keep a journal? Do you have any stories to share about what you were doing…infertility-wise…on historically significant dates?


Photo credit: Simon Howden /




Is Your Reproductive Endocrinologist or Fertility Practice On Top of Their Game?

By Tracey Minella

October 10th, 2013 at 7:22 pm


photo credit: jscreationzs/

Did you research your reproductive endocrinologist’s background before your initial appointment or did you just trust the recommendation of a friend who had success with him? Has your investigation gone no further than a quick glance at those diplomas on the office wall?

Does it matter that your doctor graduated first in his class at Harvard Medical School in 1980 if he hasn’t kept abreast of the rapidly changing advances in the assisted reproductive technology (ART) field, or hasn’t surrounded himself with a team of top-rate embryologists? Or hasn’t conducted any research studies?

Certainly, education matters. But so does something else…continuing education.

Is your doctor on top of his or her game? Is he involved in ground-breaking research? Is she recognized as a leader in the field?

The biggest annual conference on Assisted Reproductive Technology is the Conjoint Meeting of the International Federation of Fertility Societies and the American Society for Reproductive Medicine…more simply referred to as the ASRM… and it kicks off in Boston this Saturday. Fertility doctors, embryologists, IVF nurses, and others working in the field come from all over the world to attend the 5 day conference to learn the latest, cutting edge developments in reproductive technology.

The information to be presented at the ASRM each year is chosen by the committee based on research studies and abstracts submitted by fertility professionals across the globe. Having an abstract chosen for presentation at the ASRM is a great honor to a fertility practice.

Although Long Island IVF always sends several doctors and key support staff, this year is extra special… 

This year, not only one… but two… abstracts from Long Island IVF have been accepted for presentation at the ASRM.

The first abstract is titled: “Minimal Stimulation (Micro-IVF) Achieves Similar Clinical Outcomes in Patients Under 35 years of age compared to those undergoing conventional controlled ovarian hyperstimulation.” For more information about the Long Island IVF Micro-IVF Program see or speak to your Long Island IVF doctor.

The second abstract is titled:  “eSET vs DET: Its Clinical Effectiveness in the Real World”. This abstract compared the effectiveness of Single Embryo Transfers (SET) against that of Double Embryo Transfers (DET). For more information about the Long Island IVF Single Embryo Transfer Program, including the financial incentives offered to SET program patients, see or speak to your Long Island IVF doctor.

Through these two ground-breaking studies, Long Island IVF has addressed two important issues for today’s infertility patients… lowering the costs of treatment and minimizing the chance of potentially risky multiple pregnancies…all while maintaining competitive pregnancy success rates.

If you have any questions, including whether you might be a candidate for either of these well-established Long Island IVF programs, please contact your Long Island IVF doctor.

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Have you participated in (or would you consider) the SET or Micro-IVF program? What would your primary reason be for doing so, or not doing so?


Photos credit: jscreationzs/


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IVF (and Life) Do-Overs

By David Kreiner, MD

October 8th, 2013 at 9:09 pm


credit: feelart/

I was at a college graduation party for Rebeka, one of the first IVF babies I ever helped create. Her parents and grandparents beamed with pride, bragging about Rebeka’s achievements and plans while passing the hot wings and beers. I shared in this proud moment, feeling as if I bore some responsibility, since were it not for IVF, the party itself would never have happened.

Among the guests was a family friend, Conrad, who talked about the old neighborhood. He grew up in Kew Gardens and I was from Queens Village and Floral Park. Conrad asked me if I remembered playing handball and what would happen when the ball hit a crack on the floor and took an awkward bounce away from its original path, preventing a player from returning the ball cleanly. “It was called a Hindu and you got to do the point over.” Yes, I remembered “Hindus” and “do overs” and thought to myself that it would be an ingenious concept if we could extend the “do over” beyond the game to life in general.

Who hasn’t come across some crack in their path that causes an unexpected detour? My patients grow up expecting that they, like everyone else, can create their own family when they reach a stage in their lives, perhaps married and financially and emotionally secure. When a woman does not get pregnant as expected, it’s as if she hits that crack in her path — just like the handball — and her life gets thrown off track. If only she could get that “do over” and set her life back on its rightful path.

We also see these “Hindus” in our IVF cycles especially when a patient develops an LH surge and her ovulation is accelerated so that her eggs and ovulation are affected prior to retrieval.

Perhaps we need to consider the “do over” rule. IVF is a great way to give a couple a second chance to replay their errant family building when a “crack” in their fertility prevents successful procreation.

Fortunately, Rebeka’s parents got a “do over” and now, 22 years later, are celebrating their baby’s college graduation.

Life can throw a lot of cracks in our path that will detour us along our way. We should help each other by offering “do overs” whenever we have the opportunity.


Photo credit: Feelart/

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Infertility Podcast Series: Journey to the Crib: Chapter 32: Octomom

By David Kreiner, MD

October 3rd, 2013 at 6:57 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-Two: Octomom. You, the listener, are invited to ask questions and make comments.  You can access the podcast here:



A year ago, the Medical Board of California revoked the license of Dr. Michael Kamrava, finding he “did not exercise sound judgment” in transferring 12 embryos to Nadya Suleman, who already had six children at home. The ruling, while not surprising, was illuminating, and it’s worth reflecting on the five things we learned from Octomom:


1.      Know How to Say “No”: There is a point where physicians have to make a judgment call. Pregnancies with triplets – let alone eight infants – put the mother at high risk of serious medical complications and put unborn children at risk for developmental disabilities. Physicians need to rely on their professional expertise and experience to know when to turn down a patient request no matter how vehemently it is made.


2.      Beware the Patient with Tunnel Vision: Often when a patient comes to a fertility doctor, unsuccessful pregnancy attempts have made her anxious and determined. She might want to get pregnant regardless of the risks that pregnancy may present.

3.      Less is More: In 1999, 35 percent of all transfers involved four or more embryos. In 2009, only 10 percent had four or more. And those high-number transfers are generally reserved for patients with significant fertility challenges. In contrast, Octomom already underwent multiple successful IVF (in vitro fertilization) procedures and had given birth to six children when she had her 12-embryo transfer.


4.      Know When to Deviate: While Dr. Kamrava’s deviation from guidelines was an extreme departure, deviations do occur for specific reasons, such as repeated IVF failure, age-related infertility and poor egg quality. It is important to know when implanting several embryos is appropriate.

5.      “Reduce” Risk: Dr. Kamrava complained that Octomom refused to undergo “selective reduction,” which would have reduced the number of embryos she carried to term. Here, again, is an argument for fewer transfers. Had he transferred fewer embryos, Octomom would not have had to face such a difficult decision.


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Was this helpful in answering your questions about what could have been done differently to prevent the Octomom case? How much weight do you give your doctor’s recommendation on the number of embryos to transfer?

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

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