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Archive for November, 2013

Kennedy Assassination: 50 Years Later: One Story Untold

By Tracey Minella

November 26th, 2013 at 1:27 pm

 

credit: wiki free public domain

Last weekend marked the 50th anniversary of President Kennedy’s assassination. Like most of the nation, I read and watched with renewed interest all the stories and theories about that fateful day. Only an infant myself when it happened,  I don’t have an independent recollection of the moment, but as an American History major, it’s always been a fascination of mine.

Believe it or not, in all the coverage, there remains a story untold. After 50 years, there is an angle largely unexplored. It struck me for the first time as I read over the issue of The Daily News from 50 years ago which was re-published Sunday. Then I did more research, driven not by the historian in me, but by the infertile woman I am.

The Kennedy’s struggled with fertility issues.

Not the kind involving secret injections or specimen cups, of course. But problems staying pregnant, and devastating losses at and shortly after birth. Did you know that Jack and Jackie Kennedy experienced a miscarriage, a stillbirth, and an infant death?

They were married in 1953 when she was 24. Jackie suffered a miscarriage in 1955. Then, in 1956 she suffered the tragedy of the stillborn birth of her first child, a daughter to be named Arabella. The following year, Caroline was born.  

Shortly after JFK announced his bid for the presidency in January, 1960, Jackie got pregnant with John, Jr. and was not able to play as large a role in his presidential campaigning. John, Jr. was born only two weeks after his father was elected President. Can you imagine the stress of that pregnancy on Jackie? But there was more to come.

There… in the footnotes of the recent coverage of the assassination…it was: the story that would resonate with any infertile woman or any woman who suffered a miscarriage, stillbirth, or infant loss. The Daily News reported that that fateful trip to Dallas marked the return of Jackie to public touring after the sudden death of her newborn son Patrick in August.

Can we let that sink in for a moment?

It’s only three months after her latest baby died.  This time, she was already First Lady when she conceived, delivered, and then lost her baby boy. She was recovering from her third Caesarian section, back in a time when they were not at all common. How could she still be standing, let alone be performing her duties as First Lady?  And in a horrific moment, her husband is murdered at her side.

In a whirlwind of two hours, her world exploded. She went from First Lady waving in a presidential motorcade to widow of the slain president, standing beside Vice-president Lyndon Johnson in her blood-stained pink suit as he is hastily sworn-in as President in the cabin of the aircraft carrying her husband’s body below. Ready to return to Washington with news that would shatter her children’s worlds as well. How she maintained her composure is beyond comprehension.

I’m fascinated by imagining Jackie’s fertility journey. To walk along the public timeframe of history as she tried to build her family, and embellish it with imagined personal stresses she may have felt. The world felt close to her by watching her publicly grieve her husband’s death. To learn of her family-building struggle makes me feel somehow closer to her. As if there is a new connection beyond what the public already feels toward her…one that only women who have suffered such losses understand.

Did she feel pressure over not being able to give Jack the large family he wanted…the one that other Kennedy women effortlessly had? Did she feel inadequate or threatened or trapped when rumors of her husband’s love affairs surfaced? Did the stress of the First Lady duties impact her fertility? Did her smoking (in the days when its dangers were not known) somehow cause her son Patrick to be born prematurely and die from a respiratory illness? How on earth did she handle losing two babies, especially in the public eye?

She was an icon. Imagine what she could have done for American women suffering the same kinds of losses if she could have spoken out. Of course, it wasn’t socially acceptable then to talk publicly of such intimate matters. And in fairness, she shouldn’t have to just because she was famous. She had certainly shouldered her share of grief in the public eye.

“What is my proudest accomplishment? I went through some pretty difficult times, and I kept my sanity.”*~ Jacqueline Kennedy Onassis.

Sometimes, keeping our sanity is the best we can do. Remember this as you approach the family table this Thanksgiving.

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If you could’ve asked Jackie one thing about her family-building journey, what would it be?

 

Source of all facts for this story: Wikipedia.org

*IMBD.com

Photo credit: Toni Frissell/ public domain photo http://en.wikipedia.org/wiki/File:Jacqueline_Bouvier_Kennedy_Onassis2.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

November 24th, 2013 at 9:44 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-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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Finding Gratitude During Infertility

By Tracey Minella

November 23rd, 2013 at 9:48 pm

 

photo credit: Felixco, Inc./freedigitalphotos.net

For many, battling infertility is the hardest and most devastating fight they’ve yet to face. It may rear its ugly head in relative youth on the heels of a fairytale wedding… or it may step up and mock the carefully laid life plans of those who delayed family building for education, career, or other reasons.

Whenever it hits, it is simply devastating. It throws every aspect of your life into chaos. It affects your relationship with your partner and with fertile friends and family. It challenges your career in terms of job performance, health insurance issues, and juggling a morning treatment schedule which requires flexibility. Your emotional and physical health can be taxed. Your financial situation may dictate whether you can access the treatment you need in order to conceive. You live with the ever-present question of “Will I ever be a parent?” And the 24/7 frustration over not being in control of the answer to that question.

Why can’t I just have one healthy baby?

It can be hard to be happy…much less thankful… when you’re battling infertility. And that can make Thanksgiving time even harder than it is. So, here’s an experiment for the days between now and Thanksgiving that might help you feel just a little bit better. And every step away from the sadness helps.

A Gratitude Experiment.

Each day, simply list one thing that you are thankful for. Just one. You can share it here on the blog, or post it on our Facebook page, or simply write it down privately. Think about it and do write it down. It may come easily or may take a while, but it will come to you. And you will be forced to focus on something positive…if only for a little while each day.

I admit that I always found this hard to do during my own journey and I think it’s human nature for most of us to take the things we do have for granted and focus only on the things we don’t have…especially when they are as important as a baby. But there is truth to the saying that “You don’t know what you’ve got ‘til it’s gone”. So stop and acknowledge the blessings in your life this week. And remember that it’s possible that by next Thanksgiving you may have something truly spectacular to be thankful for.

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What are you thankful for?

 

Photo Credit: Felixco, Inc. / http://www.freedigitalphotos.net/images/Reading_and_Writing_g344-Thank_You_p12922.html

 

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Infertility and National Prematurity Awareness Month

By Tracey Minella

November 19th, 2013 at 10:53 am

 

photo credit: praisaeng/freedigitalphotos.net

Infertility is a disease. Its course often follows a common progression. It often starts with the abandonment of what turns out to have been unnecessary birth control. It then progresses through a repeated series of monthly disappointments until charts, thermometers, and the “chore-mentality” move into the bedroom. ObGyn intervention becomes an RE referral. A battery of tests and invasive procedures follow. Sometimes there’s Clomid. Maybe even ovulation induction with IUIs. Possibly, there’s IVF.

It’s no wonder that most infertility patients are so caught up in the all-consuming grind of simply trying to get pregnant, that they don’t think past getting that positive pregnancy test. They don’t think that…after all that time and sacrifice…something could threaten that hard-earned pregnancy.

It’s National Prematurity Awareness Month. And there is no better time to focus on what you can do to reduce your chances of having a premature baby than before you become pregnant.

It’s not always known why babies are born prematurely, but according to the Mayo Clinic*, some risk factors can include:

  • Pregnancy with twins, triplets or other multiples
  • Problems with the uterus, cervix or placenta
  • Smoking cigarettes, drinking alcohol or using illicit drugs
  • Poor nutrition
  • Some infections, particularly of the amniotic fluid and lower genital tract
  • Some chronic conditions, such as high blood pressure and diabetes
  • Being underweight or overweight before pregnancy.

 

According to the CDC**, some of the symptoms or warning signs of pre-term labor include:

  • Contractions (the abdomen tightens like a fist) every 10 minutes or more often.
  • Change in vaginal discharge (leaking fluid or bleeding from the vagina).
  • Pelvic pressure—the feeling that the baby is pushing down.
  • Low, dull backache.
  • Cramps that feel like a menstrual period.

If you are doing IVF, one of the things you may want to consider to reduce your chances of prematurity is having a single embryo transfer (“SET”), if your doctor feels you are a good candidate. Doing so virtually eliminates your chance of a multiple pregnancy. In addition to the safety considerations for mother and baby, SET at Long Island IVF offers financial incentives, including free cryopreservation and reduced rates for subsequent frozen embryo transfers. Click here for more information about Long Island IVF’s Single Embryo Transfer Program. http://bit.ly/WpzCvv

As an IVF mom of two preemies myself, let me acknowledge that very often, babies arrive early for reasons beyond our control. Sadly, the outcomes are not always happy. But knowledge is power, so control what you can, watch for the signs, and listen to that little voice if you feel something is amiss. And remember that the vast majority of these hard-earned pregnancies do turn out just fine.

*http://mayocl.in/HWaNGz

** http://1.usa.gov/IdCytZ

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Do you worry about prematurity? If so, would you consider SET to reduce the chance of a multiple pregnancy?

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=100141619 /praisaeng

 

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Long Island IVF Now Recruiting Patients for Exciting Research Study

By admin

November 14th, 2013 at 11:01 pm

 

 

The MultiCenter Registry with Eeva (MERGE) Research Study is currently recruiting patients at Long Island IVF.

Eeva: The Early Embryo Viability Assessment Test is a test to be used by IVF laboratories to analyze early embryo development and to aid in the selection of the best embryo for transfer. At the heart of Eeva is software that was designed to assess critical difference in early embryo growth and determine an embryo’s viability and the potential for further development.

The Eeva Test was developed based on landmark research conducted at Stanford University[1] which discovered that early embryo growth events can predict embryo development and reflect the underlying health of the embryo.

Auxogyn Inc. recently completed a multi-center clinical trial using Eeva with 54 patients and 758 embryos. The results from the trial supported that when embryologists used Eeva in conjunction with their traditional techniques they were able to correctly identify non-viable embryos 86% of the time vs. only 58% of the time without using Eeva[2].

The goal of the MERGE study is to record and evaluate the use of traditional embryo grading techniques combined with Eeva in the treatment of in vitro fertilization.

If you are interested in participating in this research, please contact Long Island IVF at 631-752-0606 or info@longislandivf.com and ask for the Auxogyn study coordinator for more information.

_______________________________________________________________________

1. Wong et al. in Nature Biotechnology, 2010.

2 Conaghan et al. Fertility & Sterility, May 2013.

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

By David Kreiner MD

November 9th, 2013 at 11:56 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: 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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The Baby Sprinkle: Hell Revisited for Infertile Women

By Tracey Minella

November 7th, 2013 at 10:40 am

 

credit: stuart miles/freedigitalphotos.net

 

Infertility robs us of many joys in life. And if the infertility journey is long, it twists our hearts and causes a pain that can rob us of the ability to celebrate the blessings of even our closest friends and family. People we truly love and want to be happy for. If only we weren’t so down.

Infertile women, in general, hate baby showers. Make that loathe.

It’s such a well-known fact that even my mailman leaves rubber when delivering one of those invitations stuffed with pink and blue confetti. May as well pull the dagger out of the heart and use it as a letter-opener.

Some women get to a point where they simply cannot, for their own heart’s protection, attend a baby shower. Others steel their minds and go, gritting their teeth through the 4 hour assault of nosy questions. But whether you go or not, there was at least some consolation in mentally checking off one more name on the dreaded “friends-who-are-fertile” upcoming baby shower list.

Fertile. Pregnant. Baby shower. Done. A one-shot deal. You load the lucky lady up with everything she needs for baby and then you are done, because everyone knows you only get one baby shower. Phew.

But just when you thought it was safe to go back to the mailbox…

Enter the Baby Sprinkle. If you haven’t heard of it yet, it’s merely a cute term for what amounts to a second baby shower. That’s right. Double their pleasure and double your pain. Only this time you get to not only buy another present, but also pay for your own meal and pay your share of the guest of honor’s meal.

I got my first Sprinkle invitation last month and must have been a sight as I stood there… mouth agape… trying to comprehend it. Baby number one is only 18 months old. I remember the conflicting emotions. Confusion. Shock. And, truth be told, some resentment. My abundant love for the pregnant woman was momentarily suffocated by these ugly feelings. Of course, that added some guilt…which then added even more resentment at being put in this spot in the first place. And because of my own long journey, the very first thing I thought of was that a Sprinkle is hell revisited for infertile women.

If you can disguise a second baby shower as a “Sprinkle”, can a third baby shower be far behind? And what, pray tell, will we call that…a “Drip”?

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What do you think about the new Baby Sprinkle trend? Is it just a harmless celebration of new life is it just a move in a tacky direction? Whatever you answer, do you think your response was affected by infertility?

Photo credit: Stuart Miles/

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Infertility Podcast Series: Journey to the Crib: Chapter 29: Why the Wyden Bill Does Not Support Fertility Patients

By David Kreiner MD

November 3rd, 2013 at 11:20 am

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twenty-Nine: Why the Wyden Bill Does Not Support Fertility Patients. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=138

Why “The Wyden Bill” Does Not Support Infertility Patients

 

IVF results subjected to government audit were mandated to be reported with the passage of the “Wyden bill”.   The intent of the CDC and national reproductive society (SART) was to assist infertility patients by informing them of the relative success of all IVF programs in the country. 

 

Unfortunately, what sometimes creates the best statistical results is not always in the best interest of the mother, child, family and society.  Now that prospective parents are comparing pregnancy rates between programs there is a competitive pressure on these programs to reports the best possible rates.   Sounds good…unfortunately it doesn’t always work out that way for the following reasons.

 

Patients with diminished ovarian reserve, who are older or for any number of reasons have a reduced chance for success, have a hard time convincing some programs to let them go for a retrieval.  In 2008, we reported our success, 15% with patients who stimulated with three or fewer follicles.  Sounds low and in fact many of these patients were turned away by other IVF programs in our area.  However, for those families created as a result of their IVF, these “miracle” babies are a treasure that they otherwise… if not for our program giving them their chance… would never have been born.

 

Another unfortunate circumstance of featuring live birth rate per transfer as the gold standard for comparison is that it pressures programs to transfer multiple embryos thereby increasing the number of high risk multiple pregnancies created.  This is not just a burden placed on the patient for their own medical and social reasons but these multiple pregnancies add additional financial costs that are covered by society by increasing costs of health insurance as well as the cost of raising an increased number of handicapped children.

 

William Petok, the Chair of the American Fertility Association’s Education Committee reported on the alternative Single-Embryo Transfer (SET) “Single Embryo Transfer:  Why Not Put All of Your Eggs in One Basket?”.  He stated in November 2008, that although multiple rather than single-embryo transfer for IVF is less expensive in the short run, the risk of costly complications is much greater.  Universal adaptation of SET cost patients an extra $100 million to achieve the same pregnancy rates as multiple transfers, but this approach would save a total of $1 billion in healthcare costs.

 

We have offered SET since 2006 with the incentive of free cryopreservation, storage for a year and now a three for one deal for the frozen embryo transfers within the year in an effort to drive patients to the safer SET alternative. 

 

If we are going to report pregnancy rates with IVF as is required by the Wyden Bill, let us put all programs on the same playing field by enforcing the number of embryos to be transferred and even promoting minimal stimulation IVF for good prognosis patients.  The Wyden Bill without the teeth to regulate such things as the number of embryos transferred and reporting success per embryo transfer does more harm than good.  Let us promote safer alternatives and report in terms of live birth rate per stimulation and retrieval, including frozen embryo transfers, so that there is a better understanding of the success of a cycle without increasing risks and costs from multiples.

 

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Was this helpful in answering your questions about the Wyden Bill, IVF success rates and reporting requirements, and SET?

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

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