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Archive for February, 2014

The Nominee for Best Supporting Role is…

By David Kreiner MD

February 28th, 2014 at 4:21 pm


credit: Danilo Rizzuti/

In honor of the 2014 Academy Awards this weekend…and in the Long Island IVF tradition of posting something “Just for Guys” on the last day of the month…here’s the perfect post. Life is what you make it…and so is IVF, guys. You can be as involved or detached as you choose. So choose involved. Not just because it’s the right thing, but because if you choke at the big moment, you may just be forgiven.

Dr. Kreiner says:

Many husbands complain that they feel left out of the whole IVF process as all the attention and care is apparently directed towards the woman. If anything they may feel that at best they can show up for the retrieval at which time they are expected to donate their sperm on demand. If you should fail at this then all the money, time, hope and efforts were wasted all because you choked when you could not even perform this one “simple” step. I have not witnessed the terror and horrors of war but I have seen the devastation resulting from an IVF cycle failed as a result of a husband’s inability to collect a specimen. Relationships often do not survive in the wake of such a disappointment. Talk about performing under pressure, there is more at stake in the collection room than pitching in the World Series. Husbands and male partners view IVF from a different perspective than their wives. They are not the ones being injected with hormones; commuting to the physician’s office frequently over a two week span for blood tests and vaginal ultrasounds and undergoing a transvaginal needle aspiration procedure. At least women are involved in the entire process, speak with and see the IVF staff regularly and understand what they are doing and are deeply invested emotionally and physically in this experience. So what is a husband to do?


Get Involved 

Those couples that appear to deal best with the stress of IVF are ones that do it together. Many husbands learn to give their wives the injections. It helps involve them in the efforts and give them some degree of control over the process. They can relate better to what their wives are doing and take pride that they are contributing towards the common goal of achieving the baby. When possible, husbands should accompany their wives to the doctor visits. They can interact with the staff, get questions answered and obtain a better understanding of what is going on. This not only makes women feel like their husbands are supportive but is helpful in getting accurate information and directions. Both of these things are so important that in a husband’s absence I would recommend that a surrogate such as a friend, sister, or mother be there if he cannot be. Support from him and others help diminish the level of stress and especially if it comes from the husband helps to solidify their relationship. Husbands should accompany their wives to the embryo transfer. This can be a highly emotional procedure. Your embryo/s is being placed in the womb and at least in that moment many women feel as if they are pregnant. Life may be starting here and it is wonderful for a husband to share this moment with his wife. Perhaps he may keep the Petri dish as a keepsake as the “baby’s first crib”.  It is an experience a couple is not likely to forget as their first time together as a family. With regards to the pressure of performing to provide the specimen at the time of the retrieval, I would recommend that a husband freeze a specimen collected on a previous day when he does not have the intense pressure of having to produce at that moment or else. Having the insurance of a back-up frozen specimen takes much of the pressure off at the time of retrieval making it that much easier to produce a fresh specimen. There are strategies that can be planned for special circumstances including arranging for assistance from your wife and using collection condoms so that the specimen can be collected during intercourse. Depending on the program these alternatives may be available.

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Do you agree that the man should be more involved or would you prefer not to be? Why or why not?

photo credit: Danillo Rizzuti


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Infertility and the Only Child Syndrome

By Tracey Minella

February 24th, 2014 at 6:18 pm


photo credit: David Castillo Dominici/

The only thing as annoying as being nagged about when you are going to have a baby is…being nagged about when you are going to have another baby. This is a problem for both fertile and infertile folks.

Believe it or not, people will nag you about having a second child even when they know you had fertility treatments to have the first one. It happened to me. It’s as if having the first one resolved your underlying medically-based infertility issues (not so, in most cases). Or they’re clueless as to how expensive that first baby may have been to achieve. Or…brace yourself…they think only children are unhappy without a sibling.

There are two concepts of happiness to consider. The only child’s and the parents’.

I happen to be an only child and can offer my own experience to consider as merely one only child’s view. I never felt like a “lonely only” growing up, and if I was missing something, I didn’t know it. I had plenty of friends on the block, almost all who fought with their siblings and claimed to envy me having none.

Maybe I just focused on the positives of being the only one. My own room, my parents’ full attention, and at the risk of sounding spoiled, everything pretty much my way. Surely, having only one child eases the financial burden of braces, activities, college tuition, and wedding expenses. That’s a good thing. Of course I know now, from having two IVF children, that there is a special bond between siblings, but I didn’t know that as a kid, so I didn’t miss it. I was truly happy and so were my parents, who always convincingly claimed they only wanted one child.

But for every only child or its parents who are happy as a family of three, there are others who feel incomplete. We’ve all seen little ones begging for a little brother or sister, but it’s hard to tell if they really want one or they see that their friends have one. But when it’s parents who want… but can’t have…another child, it’s particularly heart-breaking. Sometimes the first child came naturally, but secondary infertility is preventing having another one. Other times, the firstborn came from assisted reproductive technologies like IVF or IUI.

Regardless, it is painful. And misunderstood.

Unfortunately, once you have one baby, any sympathy you might get from society in general over the fact that you can’t have another one basically vanishes. Even other infertile women may not support you once you become a mother. You don’t fit in with the IVF patients who are trying for their first baby. A stroller in the IVF clinic waiting room may draw a look by a childless patient that says “You’re not one of us. You have one. You’re so lucky. Be happy. Go away.”

In our hearts we know this reaction is wrong. Women should be able to have as many children as they wish and be encouraged to do so by others. But people…especially hormonal women longing for motherhood…are entitled to their feelings, too. And the IVF waiting room represents one of the few sanctuaries they can feel safe from encountering a newborn or toddler. Confronted by you and your adorable baby, irrational thoughts flood in: If you grab all that good “positive beta” karma, will my pregnancy test be the negative one? Yes, it’s irrational, but it’s very real in that moment.

Can you be happy with one child? That’s about as personal a question as there is.

Many bargain with the universe for just one baby and are truly happy with just one. Others may have one and be ecstatic, yet try for another as a welcome and “bonus” addition. For others, the longing for additional children is as strong as it was when trying for the first. The “right” way is whatever is right for you.

However you feel, it’s nice to know that research indicates that only children are, in fact, happy. Plus, they are becoming more common every day as women are having children later. For interesting stats and details, go to

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Do you feel strongly about how many children it would take to make you happy? Has that number changed as your infertility journey continued?


Photo credit: David Castillo Dominici








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Traditional Chinese Medicine (TCM) – Perspectives from a Western-Trained Physician-Part 2

By David Kreiner MD

February 18th, 2014 at 4:44 pm



I am now four tests deep into my TCM training and have experienced some of the typical Spleen disharmony that comes with anxiety over my performance on the exams.  It was not bad enough to cause a clinical spleen Qi deficiency but I did have some stomach upset from rebellious stomach Qi and occasional weak knees.

I wonder at times if I could explain TCM fundamentals in Western terms.  It would be very satisfying to put TCM physiology in a language and system that was consistent with the science that as a physician I have learned and lived with for the past 30 years.  I am used to a medical construct based on organs and structures I can see and feel and metabolic processes that I can measure. TCM affords us none of this.

Instead, the physiology of TCM to me is based on faith and experience.  Hmmm… if there is experience supporting successful therapeutics whether they be herbal medicines or acupuncture then why do I say that TCM is based on faith.  From a scientific perspective, we cannot explain TCM fundamentals such as Qi or Essence nor the channels they travel in.  There is nothing we are able to see or touch to prove to ourselves their actual existence.

I am not saying that it is necessary to have a blind faith in TCM in order to either practice it or submit oneself to its treatment.  Once again, there is the experience to justify its practice.  However, it does make a Western-trained physician perplexed.  Perhaps our science is not yet at a level to explain TCM.  Maybe…if we were able to measure extremely minute changes in electrical charges, or levels of energy radiated in the body at a frequency or amplitude that we are currently unable to document… then we might be able to witness and even measure TCM phenomena related to Qi deficiency and other clinical syndromes.

In the meantime, I study so that I may be able to someday offer the TCM as an adjunct to my fertility practice.

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Would you be open to combining TCM principles with Western medicine in your fertility treatment plan?

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A Valentine’s Day Exercise for Infertile Couples

By Tracey Minella

February 14th, 2014 at 3:19 pm


credit: feelart/

Most holidays are hard on the infertile, but Valentine’s Day doesn’t have to be one of them. It’s one of the few that isn’t centered on children. And it’s perfectly acceptable, even expected, that you will spend it alone as a couple…no family gatherings to endure.

I know a fancy dinner, candy, roses, or even diamonds can’t substitute for the gift you really want to give or receive from your partner today. And on this Hallmark holiday, I urge you to try not to focus on the baby quest for just this one day…or at least for a good part of it…and instead focus on your partner.

Battling infertility can make you lose sight of pretty much everything else. It can make you understandably cranky and depressed. And it can make you take your loved ones…especially your partner…for granted.

If you’ve fallen into that rut, today is the perfect day to change things. Start by stealing a moment and clearing your mind of everything else. Then, make a list of five things you love about your partner. If you need help getting started, think about how he/she is right beside you in this battle. What have you weathered together already? Remember how much he/she can make you laugh or the special inside jokes only you two share?(Consider telling your partner you’re doing this and ask them to do the same so you can exchange lists tonight or wait until you’re together tonight and make the lists together.)

Valentine’s Day doesn’t have to cost a lot, especially when financing infertility treatments. If you do want to go out, kick back and enjoy yourself knowing that most places will be child-free tonight.

Of course, a great Valentine’s Day doesn’t need to cost anything at all. A quiet and simple dinner at home may be all you need to spiritually reconnect. Candles and the right companion can make even mac and cheese incredibly romantic. And those lists of what you love about each other will be treasured keepsakes to look back on later. Trust me.

And having walked many miles in your shoes let me tell you a little secret…

Infertility can be a gift. A twisted kind of gift on nobody’s wish list, of course. But it’s a gift that is often not realized until after the battle is won. If it doesn’t break your marriage, infertility can make your love stronger than you ever imagined it could be. Every tear and painful loss or setback can be cement for your union. Many infertile couples look back and feel that if they got through infertility together, they can handle anything else the future may throw at them. What doesn’t kill you makes you stronger, as they say.

So this is a night to give thanks for…and celebrate… your soul mate and your union. Focus on that. Reconnect. It will strengthen you for when you resume the battle again tomorrow.

Now, pencils ready…


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How do you celebrate your love when battling infertility?

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Sunshine and Your Fertility

By Dr. David Kreiner and Brianna Rudick, MD

February 12th, 2014 at 4:34 pm


image courtesy of samarittiw/free

Vitamin D is a fat soluble vitamin that is present in a variety of forms but has recently been recognized as playing a critical role in reproduction.  It is essential in the production of sex hormones in the body.  It is thought that a deficiency of Vitamin D may lead among other things to ovulation disorders.

It has been demonstrated that Vitamin D deficient rats had a 75% reduced fertility and a 50% smaller litter size that was corrected with Vitamin D treatment.  In addition, sperm motility in males was reduced in the presence of a Vitamin D deficiency.

A recent study at the Yale University School of Medicine revealed that only 7% of 67 infertile women studied had normal Vitamin D levels and not a single woman with an ovulatory disorder had normal levels.  Nearly 40% of women with ovulatory dysfunction had a clinical deficiency of Vitamin D.

At the American Society of Reproductive Medicine conference last year, a study presented by Dr. Briana Rudick from USC showed that a deficiency of Vitamin D can also have a detrimental effect on pregnancy rates after IVF, possibly through an effect on the endometrial lining of the uterus.   In her study only 42% of the infertile women going through IVF had normal Vitamin D levels.  Vitamin D levels did not impact the number of ampules of gonadotropin utilized nor the number of eggs stimulated, embryos created or embryo quality.  However, Vitamin D levels did significantly affect pregnancy rates even when controlled for number of embryos transferred and embryo quality.  In this study the pregnancy rate dropped from 51% in Caucasian women undergoing IVF who had normal Vitamin D levels to 44% in those with insufficient levels and 19% in those that were deficient.

Vitamin D deficiency has also been associated with poor pregnancy outcomes including preeclampsia and gestational diabetes

Vitamin D can be obtained for free by sitting out in the sun and getting sun exposure on the arms and legs for 15-20 minutes per day during peak sunlight hours.  The sunlight helps the skin to create Vitamin D3 that is then transformed into the active form of Vitamin D by the kidneys and liver.   An oral supplement is available also in the form of Vitamin D3, with a minimum recommended amount of 1000 IU a day for women planning on becoming pregnant.  For those with clinical insufficiencies a higher dose may be administered by injection.

Our study and many others suggest that the effect is endometrial, but we don’t know for sure.

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Do you ever go out in the sun without sunscreen? If not, would this study change your mind about 15-20 minutes of free Vitamin D? (Of course, if you are particularly fair-skinned you should reduce your time or speak to your doctor for advice.)

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Infertility Olympics: 5 Things You Have In Common With the Olympians

By Tracey Minella

February 10th, 2014 at 1:47 pm


public domain image source:

Ever been mistaken for an Olympic athlete? You could be.

No, I’m not accusing you of wearing an ugly Christmas sweater that just happens to look like Team USA’s Opening Ceremonies uniform. And though you could be as ripped as a downhill skier or figure skater… chances are pretty good that you’re built kind of average.

So, you might be surprised to learn that you have five things in common with these elite athletes:

1.      Determination. You are determined to have a child. Not taking “no” for an answer. You know you want it desperately and are willing to sacrifice whatever it takes to get it. Financially, emotionally, physically.


2.      Focus. You have your eye on the prize. At all times. You know the steps you need to take each day, maybe each hour, and nothing will get in your way from taking them. Stay the course.


3.      Courage. You overcome the often overwhelming obstacles. You may have failed at some point along the road, but you got back up. No time for fear. Bring the next challenge. You are not backing down.


4.      Stamina. It’s been a long road. Harder than you originally thought. Maybe you’ve suffered setbacks or been broken.  You’ve been hurt or failed. You’ve taken breaks, but you re-grouped and came back stronger. The road bent but the journey continued. You brushed yourself off and got back on course. Even when no one would have thought less of you if you had quit.


5.      The Dream. You live it daily. It dictates all you do from the moment you wake until you go to bed. It manifests itself in tasks and thoughts woven into your daily schedule. It’s the routine you live by. The necessary grind. The pain required for the gain. The sacrifice you’re willing to make. You close your eyes and envision it coming true.


Are you really any different than an Olympic athlete? Sure, you don’t have the same arenas, anthems, or medals. Your arena is a hospital. Your national anthem is a lullaby. You’re striving for something far more valuable than gold–you’re going for the pink or the blue. And you’ve got heart.

No one has more heart, fights harder, or deserves to be on the cover of a Wheaties box more than you. So keep following that dream.

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Did your infertility journey take longer than you expected when it began? If so, how did you find the strength to continue and did you surprise yourself?





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Surviving The Two Week Wait for Your Pregnancy Result

By Bina Benisch, MS, RN

February 8th, 2014 at 10:28 pm


credit Petr Kratochvil/


It seems interminable. 


You’ve finally made it through your IVF stimulation. You’ve survived your injections and all those early morning monitoring visits…not to mention being poked and prodded for blood and vaginal ultrasounds. You’ve undergone your retrieval procedure, sweated out the fertilization results, and here it is – the day of your embryo transfer.  Or, if you’re doing IUI, you’ve made it through your insemination.


What a relief!  You can finally relax…. NOT so fast!


The next 10-14 days can seem like an eternity when you’re waiting for your pregnancy result.


Your emotions may ride that roller coaster … slow ascending hope, with glimmers of joy at the prospect that this time you actually may be pregnant … only to be violently interrupted by thunderous pangs of fear that this may not have worked, and then falling into despair.


How do you regulate your feelings and create a sense of balance so that you’re not held hostage by every emotion and negative thought that grips you?  Here is your mission for the next 10-14 days, should you choose to accept it:


·        Create a list of leisure activities that you and your partner have always enjoyed doing, and set a plan into action.  Yes, there are jobs and responsibilities, but schedule some “special” time together for these activities… whether it’s watching movies together, outdoor activities, date nights, music, or working together on a project that embodies a sense of satisfaction.  Not only does this help keep your relationship close – which in itself is emotionally enriching – but it may distract your attention and maintain some perspective on your life so that you are not feverishly focused on your fertility status.


·        Talk to your partner about your feelings.  There are no pat solutions which will stop your anxiety. However, making room for all feelings – even the darker ones – and knowing you will get through it as you ride this wave, will relieve the stress of suppressing these feelings. This will also keep the lines of communication open between you and your partner. 


·        Restructure your thoughts! This is not to advise Pollyanna or positive thinking.  Let’s face it, the last thing you need is to be told to “be positive” or “relax.” It’s extremely difficult to feel “positive” when you’re struggling with infertility.  However, take a moment to look at the thoughts you are telling yourself – the thoughts that are causing your fear and anxiety to escalate: “I know I’m not pregnant.”  “It probably didn’t work this time.” “What if it doesn’t work this time?” “What if I never become pregnant?”   These thoughts and statements are not etched in truth, and are only fear-based. Better thoughts… which may be equally true, but are not fear based…are: “I could very well be pregnant.” “The possibility that I will become pregnant is just as much a reality.”  Don’t fear that allowing yourself to entertain these hopeful thoughts will cause greater disappointment from a negative result. You will be disappointed or devastated either way, whether you’ve been fearful, anxious, and negative, or you’ve had the perspective that you may very well become pregnant.  Here is a mental framework that is absolutely realistic, true, and can go a long way to helping you maintain peace of mind:  “I am doing everything in my power to become pregnant, and therefore, I can emotionally let go for now, and leave this in the hands of (God, the universe, my doctors).” 


·        Selectively avoid situations that you know will trigger your fear or anxiety.   Learn to say “NO”.  People will forgive you for not attending a family function, social event, or any situation where you find pregnant people, or people with babies, or people who will ask you when you are going to have children.  YOU come first at this time in your life. YOUR emotional health takes precedence. 


·        Nurture yourself. Whatever that means for you. Massage, Reiki, reading, movies, shopping, yoga (not hot yoga), — what do you find to be a relaxing, self-nurturing activity?


·        Remember proper breathing. Slow, deep breathing will cause a physiological reversal of the body’s stress response.  This will reduce anxiety and stress.  Learn to practice breath work every day.


In essence, have compassion for yourself.  Talk about your feelings with your partner.  If you find it difficult to restructure your thoughts, practice the mantra that you have done everything in your power, and now it’s time to let go.  This takes practice, but you can do it if you take on this mission for self-balance, peace of mind, and equilibrium. 



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To Qi or not to Qi? That is the Question

By David Kreiner MD

February 1st, 2014 at 5:27 pm


credit: StuartMiles/freedigital

It has been a month since I started my studies in Traditional Chinese Medicine and Acupuncture at the New York College of Health Professions in Syosset, NY. 

Why does this 58 year old Reproductive Endocrinologist want to go back to school for an additional career after practicing for 27 years you may ask?  Is it because I am jealous of my younger daughter starting the University of Michigan this past fall and I want to enjoy the Greek life?  Eh…I cannot deny the coincidence is suspicious.

However, my interest in Traditional Chinese Medicine (TCM) dates back to my own college days. While I bought a copy of the “Barefoot Doctor’s Manual”, the thick red book sat on a shelf for years.  I never got past a few lines about “dampness in the lower burner” and treating “excess phlegm”.  After all, my goal was to become a physician and I liked wearing my clogs back then anyway.

TCM appears quite strange to a Western-trained physician.  The language is unique to TCM and bears little resemblance to the medical physiology that we are familiar with.  As I become more knowledgeable about the fundamentals of TCM, I am fascinated by the elaborate construct of ideas on which TCM is based. 

Unlike modern Western Medicine which is based on scientific study and experimentation, the wisdom of TCM was built upon hundreds of generations of experience by the wise healers of China.  Observations of thousands of cases led to the development of theories regarding disease, illness and healing.  To my physician friends who question the concept of treating pain and illness by impacting channels of Qi, a form of life energy, I ask them: Who are we to question the collective wisdom and experience of hundreds of generations of the wisest healers of China when Modern Medicine has been helping more people than it has been hurting only for the past 80 years or so?  I personally have seen many examples of accepted “Medical Truths” rejected and disproved since graduating medical school in 1981.

My goal is to help my patients any way I can.  Yes, I am a Western-trained physician but more than that I am my patients’ healer who is helping them in their journeys to build their families.  We have great tools in Western Medicine including gonadotropin medications, intrauterine insemination (IUI) and in particular In Vitro Fertilization.  But sometimes they may not be enough. 

I am reminded of the book and movie “Life of Pi”.  The protagonist, Piscine or Pi,tells his story about how he survived 227 days after a shipwreck while stranded on a lifeboat in the Pacific Ocean with a Bengal tiger named Richard Parker.  The official representatives investigating the incident reject his story as unbelievable and insist on hearing the “truth”.  Pi then offers them a second story in which he is adrift on a lifeboat not with zoo animals, but with the ship’s cook, a Taiwanese sailor with a broken leg, and his own mother. The cook amputates the sailor’s leg for use as fishing bait, then kills the sailor and Pi’s mother for food. Pi then kills the cook and dines on him. 

Pi points out that neither story can be proven and neither explains the cause of the shipwreck and in the end of each story the outcome is the same… that he still lost his family.  We are left without an answer as to which story is real. Why does it matter which story was true?  We are asked which story we preferred.

Similarly, with TCM, if we can achieve the desired outcome…in my specialty, the much sought after pregnancy and healthy baby, why does it matter if we do not fully understand the science or principles behind the therapy? The story we choose for that much desired baby…for our “journey to the crib”… can include TCM if it could help us to attain our goal. 


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Do you think the blending of TCM and Western medicine principles could benefit infertility patients? Have you ever used or considered using TCM in your own fertility journey?

Photo credit: Stuart Miles

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