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Archive for May, 2014

Sunshine, Vitamin D, and Your Fertility

By Dr. David Kreiner and Brianna Rudick, MD

May 27th, 2014 at 3:02 pm

 

 

image courtesy of victor Habbick/freedigitalphotos.net

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 an American Society of Reproductive Medicine conference, 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 embro 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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Did you know that Vitamin D deficiency can affect your fertility? Do you know if you are deficient?  

*****Note that if you’re thinking of sitting outside without sunscreen now that the sun is scorching hot, please check with your doctor first for guidelines on how much time, if any, he or she recommends you spending outside with minimal or no sunscreen. It is not for everyone. And you can burn even when it’s cloudy.

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Long Island IVF Doctors Named to “Super Doctors” List

By Tracey Minella

May 23rd, 2014 at 12:52 pm

 

Dr. Pena

Did you catch the big news in Sunday’s New York Times Magazine?

Long Island IVF doctors, Dr. Joseph Pena and Dr. Michael Zinger, have been named as New York “Super Doctors” in the field of Reproductive Endocrinology, securing two of just 6 spots on the elite list for the combined Long Island and Brooklyn area.

What makes this exciting and humbling is that “Super Docs” honorees are chosen by their peers. You can’t buy your way onto the list through paid advertising (at least LIIVF’s doctors didn’t pay for advertising!), or get on it by generating the most “likes” in a social media campaign (but feel free to come over and “like” us on Facebook anyway at http://www.facebook.com/longislandivf! It is doctors recognizing other doctors’ talent and ability.

For a complete list of the SuperDoctors in Reproductive Endocrinology, click here: http://bit.ly/1hglvmu

Dr. Zinger

We know of many other top notch doctors…both on the Long Island IVF team and in other fields who are not included on the Super Doctors list… and are humbled by this recognition. Thanks to all the physicians who voted for Drs. Pena and Zinger for this honor.

And of course, we’d like to thank our wonderful patients, who so often sing the praises of their LIIVF doctors… because it’s possible many of the doctors who nominate our physicians for these honors may have first heard about them from you! You are the reason we all love what we do every day.

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Have you ever told another doctor about your LIIVF experience or recommended your LIIVF doctor?

 

 

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Sacked by Clomid

By Tracey Minella

May 21st, 2014 at 5:50 pm

 

credit: wiki

What do you get when you mix Clomid and a professional male football player? Apparently, a four game suspension. At least that’s what happened to Robert Mathis, an outside linebacker on the Indianapolis Colts football team.

News that a professional athlete has been suspended for using performance-enhancing drugs rarely raises an eyebrow anymore. Many automatically assume it was steroids taken to enhance performance on the playing field. Such news often makes people feel angry, disgusted, and unsympathetic.

But what if the drug taken was meant to boost a man’s performance on a different field? A private field. What if the drug the athlete took was related to fertility treatments? Does that change anything? Should it? Does it still make you feel angry, disgusted, and unsympathetic?

Should an athlete be entitled to, well, a “pass” when it comes to fertility-enhancing drugs like Clomid? Is the issue about its alleged “off-label” use for fertility treatment in males (though it’s FDA-approved for females)? Is the problem one of failing to ask the NFL’s permission first? Should he have been allowed to keep his diagnosis confidential? Was he misled to believe Clomid was not an NFL banned substance? Or does none of that matter because NFL policies hold players responsible for anything they put in their bodies and “rules are rules”?

Initial reactions, not surprisingly, are largely sympathetic.

NFL suspension aside, there’s no sign of a lynch mob of men with pitchforks and torches. Yet, unlike a steroid case, there are no incendiaries around trying to bring down someone attempting to cheat his way into the Hall of Fame. Clomid is getting a different reception. It apparently doesn’t incite a mob to go after a football player who “came out” about taking a well-known female fertility drug to help his wife get pregnant. Why is that? No doubt many men today are more enlightened, sympathetic, and believing of Mathis’ claimed noble intentions. Others may simply believe this is not a big story, “rules are rules”, and the punishment here was just. Either of these positions is fine.

But the troubling thing is that there are also the less-enlightened… in locker rooms as well as living rooms… that may ignorantly consider Mathis’ now-public Clomid use to be somehow emasculating and the embarrassment and imposed suspension to be punishment enough. If Mathis took Clomid solely to get his wife pregnant and not to enhance his performance on the playing field, there is no place for shame in this story. Infertility awareness must address and eradicate the shame felt by those trying to conceive. And this is an opportunity, though sadly at the personal expense of Robert Mathis to increase awareness and remove the shame.

Many women would consider a man willing to take Clomid to enhance his wife’s chances of conceiving to be a hero…especially those who have taken the drug themselves. Woman may also warm up to reports claiming Mathis’ mother’s alleged cancer diagnosis brought a sense of urgency to conceive another grandchild.* The infertility social media world is abuzz with almost universal sympathy and is happy to hear they are now expecting a baby. How do you feel?

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Hero or Zero? What do you think about the NFL’s punishment here? Is it as simple as “rules are rules”? Or should he have been given a more lenient punishment or been able to pay a fine and not divulge his diagnosis? If it was you, would you “clear” your name by coming out about the Clomid use, or try to keep quiet about the specific drug and let the public draw its own…and likely wrong… conclusion about you?

And here is a bonus question for sports fans: This isn’t the first time a professional male athlete has been in the news and suspended for allegedly using a female fertility medication. Anyone remember the professional baseball player accused of taking HCG? If so, let us know!

*Here are two links used for this blog, one citing the NFL’s position and the other citing the player’s agent’s position: http://es.pn/1o8Hwc6 and http://on.nfl.com/1n3PSEB

Photo Credit: Wiki at http://www.wiki-culturismo.com/index.php/Clomid

 

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BFN! Negative Pregnancy Test Again! Now What?

By David Kreiner MD

May 16th, 2014 at 11:55 am

 

credit: david castillo/freedigitalphotos.net

Women confronted with a negative result from a pregnancy test are always disappointed, sometimes devastated. Many admit to becoming depressed and finding it hard to associate with people and go places where there are pregnant women or babies, making social situations extremely uncomfortable. A negative test is a reminder of all those feelings of emptiness, sadness and grief over the void infertility creates.

We don’t have control over these feelings and emotions. They affect our whole being and, unchecked, will continue until they have caused a complete state of depression. This article can arm you with a strategy to fight the potentially damaging effects that infertility threatens to do to you and your life.

First, upon seeing or hearing that gut-wrenching news, breathe.
Meditation — by controlling and focusing on your breathing — can help you gain control of your emotions and calm your body, slow down your heart rate and let you focus rationally on the issues. It’s best to have your partner or a special someone by your side that can help you to calm down and regain control.

Second, put this trauma into perspective.
It doesn’t always help to hear that someone else is suffering worse — whether it’s earthquake or cancer victims — but knowledge that fertile couples only conceive 20% of the time every month means that you are in good company with plenty of future moms and dads.

Third, seek help from a specialist, a reproductive endocrinologist (RE).
An RE has seven years of post-graduate training with much of it spent helping patients with the same problem you have. An RE will seek to establish a diagnosis and offer you an option of treatments. He will work with you to develop a plan to support your therapy based on your diagnosis, age, years of infertility, motivation, as well your financial and emotional means. If you are already under an RE’s care, the third step becomes developing a plan with your RE or evaluating your current plan.

Understand your odds of success per cycle are important for your treatment regimen. You want to establish why a past cycle may not have worked. It is the RE’s job to offer recommendations either for continuing the present course of therapy — explaining the odds of success, cost and risks — or for alternative more aggressive and successful treatments (again offering his opinion regarding the success, costs and risks of the other therapies).

Therapies may be surgical, such as laparoscopy or hysteroscopy to remove endometriosis, scar tissue, repair fallopian tubes or remove fibroids. They may be medical, such as using ovulation inducing agents like clomid or gonadotropin injections. They may include intrauterine insemination (IUI) with or without medications. They also may include minimal stimulation IVF or full-stimulated IVF. Age, duration of infertility, your diagnosis, ovarian condition, and financial and emotional means play a large role in determining this plan that the RE must make with your input.

There may be further diagnostic tests that may prove value in ascertaining your diagnosis and facilitate your treatment. These include a hysteroscopy or hydrosonogram to evaluate the uterine cavity, as well as the HSG (hysterosalpingogram) to evaluate the patency of the fallopian tubes as well as the uterine cavity.

Complementary therapies offer additional success potential by improving the health and wellness of an individual and, therefore, her fertility as well. These therapies — acupuncture, massage, nutrition, psychological mind and body programs, hypnotherapy –
have been associated with improved pregnancy rates seen when used as an adjunct to assisted reproductive technologies.

A negative pregnancy test can throw you off balance, out of your routine and depress you. Use my plan here to take control and not just improve your mood and life but increase the likelihood that your next test will be a positive one.

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What have you done…or what tips can you add… to get through the disappointment?

Photo credit: http://www.freedigitalphotos.net/images/Gestures_g185-Depressed_Woman_Sitting_On_Floor__p99322.html

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Mother’s Day: 5 Tips on Surviving The Hardest Day of the Year

By Tracey Minella

May 10th, 2014 at 8:00 pm

 

credit: david castillo/freedigitalphotos.net


Infertile women face plenty of rough days each year… Halloween, New Year’s Day, baby showers, and our birthdays. But, without question Mother’s Day is, well, the mother of them all.

It is the day the whole world dotes on moms…and assumes that any woman of a certain age is one. That assumption, when verbalized, can make you feel like crawling away and crying. And it is even worse for those who have lost babies along the journey. Everyone from store clerks to the whole congregation will unwittingly wish you a Happy Mother’s Day. So, what can you do?

Here are five tips for managing on Mother’s Day:

·         Focus on your own mom. It doesn’t help completely, but it can be a good distraction. You don’t have a child yet, but you do have a mom. If it’s too hard to be with her for a dinner that includes your pregnant siblings and their 37 kids, then make separate plans to see her for brunch instead. If she’s far away, schedule a nice, long call. If your mom is gone, consider visiting the cemetery with a note or flowers, or doing something that reminds you of good times with her. Yes, it may make you cry, but it’s a great place to vent. (Can you tell I’ve done this?) You will cry on this day anyway. Go for happier tears.

 

·         Call your church or temple in advance. If you’re dreading how all the mothers are asked to stand up and be recognized at your place of worship… something that would be particularly hard for those who have suffered miscarriages or lost babies or infants…why not call ahead and ask the priests or rabbis to recognize and include those who’ve lost children in that definition. Or ask when that moment of recognition will happen and plan to arrive before or after that point in the services.

 

 

·         Make yourself a Mother-in-Waiting’s Day Card. You are a mother. A mother-in-waiting. Believe your day will come. But why should your card wait? You should sit down and list all the reasons you are going to be a great mom. Things like, When I’m a mom, I’m going to let my kid have ice cream for dinner sometimes. While you’re at it, buy yourself a gift, too.

 

·         Make a garden. It’s a great way to connect with nature and spend some quiet, reflective time alone or with your partner on Mother’s Day and for many days to come. Plant pretty flowers or maybe some healthy, fertility-enhancing vegetables. Populate it with little gnomes, wind chimes, or cherub statues. It could become your sanctuary.

 

·         Get a dog. Or a cat. If you’ve been seriously thinking about getting a pet, this may be the time to act on it. “Furbabies” love unconditionally and fill a special spot in the infertile heart. Is there room in your life for one?

These are just a few tips to manage the day, not to enjoy it. The fact is that it won’t really be enjoyable until you are a mom. So, do whatever you want or need to do to get through this day. Treat yourself well. Spend time with your partner. Hiberate. And stay far, far away from Chuck E. Cheese.

As a mother-in-waiting, it’s your day, too. Take it one hour at a time.

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What are your Mother’s Day plans? Any tips to help others get through it?

 

 

 

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The ABCs of IVF

By David Kreiner MD

May 9th, 2014 at 9:15 am

 

credit: digitalart/freedigitalphotos.net

If you’re not pregnant yet and you’re wondering what to do, this post may shed some light on infertility diagnoses and treatments. Yes, there’s a lot to learn. Yes, it can be overwhelming. But the good news is that you can go to the head of the class by the time you finish reading this post.

Dr. David Kreiner of Long Island IVF gives you the low-down and the lingo. It’s everything you need to know, from A to… well… P. And what better letter to stop at? “P” is for pregnant:

“Why me? My wife never had any infections, surgery or any other problem? I have no difficulty ejaculating and there’s plenty to work with so why can my friends and neighbors and coworkers get pregnant and we can’t?”

I hear these questions daily and understand the frustrations, anger and stress felt by my patients expressing these feelings through such questions. There are many reasons why couples do not conceive. An infertility workup will identify some of these. A semen analysis will pick up a male factor in 50-60% of cases. A hysterosalpingogram will locate tubal disease in about 20% of cases. Another 20-30% of women do not ovulate or ovulate dysfunctionally. A post coital test may identify that the problem is that the sperm is not reaching the egg. It may not be able to swim up the cervical canal into the womb and up the tubes where it should normally find an egg to fertilize. When these tests are normal a laparoscopy may be performed to identify the 20-25% of infertile women with endometriosis. However, even when this is normal and there is no test that logically explains the lack of success in achieving a pregnancy; an IVF procedure may both identify the cause and treat it successfully.

What is IVF?

In Vitro Fertilization, IVF, is the process of fertilizing a woman’s eggs outside the body in a Petri dish. Typically, a woman’s ovaries are stimulated to superovulate multiple eggs with gonadotropin hormones, the same hormones that normally make a woman ovulate every month. Injections of these hormones are usually performed by either the husband or wife subcutaneously in the skin of the lower belly with a very tiny needle. It takes 9-14 days for the eggs to mature. She will then take an HCG injection which triggers the final stage of maturation 35-36 hours prior to the egg retrieval. This is performed in an operating room, usually with some anesthetic. The eggs are inseminated in the lab and 3-5 days later, embryos are transferred into the uterus with a catheter placed transvaginally through the cervix into the womb.

What is ICSI?

Some times even in the presence of a normal semen analysis, and normal results on all the infertility tests, fertilization may not occur without microsurgically injecting the sperm directly into the egg. This procedure is called Intracytoplasmic Sperm Injection or ICSI and may achieve fertilization in almost all circumstances where there is otherwise a sperm cause for lack of fertilization.

If it looks like a sperm and swims like a sperm, why doesn’t it work like a sperm?

A South African gynecologist, Thinus Kruger, discovered that small differences in the appearance of sperm affected the sperm’s ability to fertilize an egg. In 1987, Thinus demonstrated that when we used the very strict Kruger criteria for identifying a normal sperm, we were able to identify most men who had normal semen analyses and were yet unable to fertilize their wife’s eggs. Most of these couples suffered from unexplained infertility except now utilizing the Kruger criteria for sperm morphology we were able to identify the problem. Today, these couples are successfully treated with the ICSI procedure.

Old eggs?

As women age, the percentage of genetically abnormal eggs increases. These older eggs are less likely to fertilize, divide normally into healthy embryos or result in a pregnancy. When older women do conceive they are more likely to miscarry then when they were younger. Aging of eggs begins in the 20’s but accelerates after age 35. This is why a woman’s fertility drops as she gets older. The age at which it becomes significant for a woman varies. Some women in their 30’s have significant aging of their egg. Others less so and may have a good number of healthy eggs into their 40’s.

ABC’s of IVF

Assisted Hatching is when the embryologist makes a hole in the shell around the embryo called the zona pellucidum. This is performed minutes prior to embryo transfer and may be performed chemically with acid tyrodes, mechanically with a micropipette or with a laser. It is commonly believed that older eggs may lead to embryos with a thicker or harder shell that may prevent the natural hatching of an embryo that must occur prior to the embryo implanting into a woman’s lining of her womb.

Blastocyt embryo transfers occur on day 5 or 6 after the egg retrieval. This is the embryonic stage when an embryo normally implants into the womb. These embryos have been selected to be healthier by virtue of the fact that they have made it to this stage. Statistically, the pregnancy rates for women who have had blastocysts transferred is higher than when the same number is transferred on day 3 using “cleaved” embryos of 4-10 cells. As the advantage of the blastocyst transfer may be only a matter of selection, it is thought that there may be no advantage if the embryologist is able to select just as well the best embryos to transfer on day 3 which is typically the case when there are not excess numbers of high quality embryos which will vary according to the patient and be dependent on the age of the patient.

Bravelle – Brand of FSH, follicle stimulating hormone which is a gonadotropin used to stimulate a woman’s ovaries to superovulate and make multiple eggs mature during the IVF cycle.

Cetrotide – Brand of Gonadotropin Releasing Hormone Antagonist that prevents a woman’s pituitary gland from producing LH, luteinizing hormone. LH increases can trigger premature ovulation and stimulate testosterone and progesterone production which can be harmful to a woman’s egg production and prematurely mature the lining of womb potentially affecting implantation.

Co-culture of a woman’s endometrial cells from the uterine lining or granulosa cells from aspirated ovarian follicles along with the embryos in the same culture dish is thought to provide growth factors for the embryos which may improve the health and growth of the embryos.

Cleavage Stage Embryos are 2-10 cell embryos transferred on day 2 or 3. They are often graded by their lack of fragmentation and granularity of the inside of the cell cytoplasm; A to D or 1to 5 with A or 1 being the best grade.

Cryopreservation or freezing can be performed on individual eggs where it may serve as a way to preserve a woman’s fertility either due to aging or in preparation for surgery, chemotherapy or radiation which may affect future access to a woman’s eggs.  It may be performed on cleaved embryos or blastocyst embryos that are already fertilized either because they are in excess of the desired number of embryos to be transferred fresh or to bank for a future PGS/PGD or to improve implantation by delaying transfer to a subsequent unstimulated cycle.

Embryo Glue is a protein supplement to the transfer media prepared minutes prior to transfer to make the embryo more likely to stick to the lining of the womb. It is believed that some embryos may not implant since they are not adhering to the lining and do not get an opportunity to burrow into the endometrium.

Estradiol is produced by the granulosa cells of the follicle which surround the egg in the ovary. As follicles are stimulated and grow they produce more estradiol. We measure estradiol to monitor development of the follicles. It also helps to prepare the lining of the womb for implantation.

Follistim – Brand of FSH, follicle stimulating hormone which is a gonadotropin used to stimulate a woman’s ovaries to superovulate and make multiple eggs mature during the IVF cycle.

Ganirelix – Brand of Gonadotropin Releasing Hormone Antagonist that prevents a woman’s pituitary gland from producing LH, luteinizing hormone. LH increases can trigger premature ovulation and stimulate testosterone and progesterone production which can be harmful to a woman’s egg production and prematurely mature the lining of womb potentially affecting implantation

Gonal F – Brand of FSH, follicle stimulating hormone which is a gonadotropin used to stimulate a woman’s ovaries to superovulate and make multiple eggs mature during the IVF cycle.

Gonadotropins – FSH, follicle stimulating hormone and LH, luteinizing hormone stimulate the follicles in the ovary to mature and produce ovarian hormones, estradiol, testosterone and progesterone. It also is used to stimulate a woman’s ovaries to superovulate and make multiple eggs mature during the IVF cycle. We adjust the ratio of FSH and LH to achieve goals of optimal follicular development and maturation while trying to minimize the risk of hyperstimulation. Typically we administer the gonadotropins to the woman for 8-14 days before giving her HCG 35-36 hours prior to the egg retrieval

HCG is human chorionic gonadotropin, the pregnancy hormone we measure to see if your wife is pregnant. We follow the numbers to monitor the growth and health of the pregnancy. HCG has the same biological effect as LH and therefore can be used to mature the egg in the same way as if it were getting ready to ovulate. We therefore administer HCG to women 35-36 hours prior to the egg retrieval. Brand names for HCG include Pregnyl and Ovidrel.  HCG is occasionally used in place of HMG (Menopur, see below) with similar effects.

HMG – Human Menopausal Gonadotropins are purified from the urine of menopausal women since they have high levels of FSH and LH. Menopur is the brand of HMG used in IVF stimulations containing a 1:1 ratio of FSH to LH. We adjust the ratio of FSH and LH to achieve goals of optimal follicular development and maturation while trying to minimize the risk of hyperstimulation. Adding pure FSH, i.e. Bravelle, Follistim or Gonal F will increase the ratio of FSH to LH which may be desirable especially early in a stimulation. Some patients may not need any supplemental LH and are stimulated with FSH only. HMG is sometimes added towards the end of a stimulation to minimize the risk of hyperstimulation syndrome.

Hyperstimulation syndrome is a condition which occurs approximately 3% of the time as a result of superovulation of a woman’s ovaries with gonadotropins. A woman’s ovaries become enlarged and cystic, fluid accumulates in her belly, and occasionally around her lungs. When it becomes excessive, it may make it uncomfortable to breathe. We remove this excess fluid with a needle. Women can also become dehydrated and put them at risk of developing blood clots. We therefore recommend fluids high in salt content like V 8 and Campbell’s chicken soup. We give patients baby aspirin to prevent clot formation and a medication called cabergoline which helps prevent the development of Hyperstimulation.  It may also be recommended to freeze all the embryos and postpone the transfer to a later cycle as pregnancy can significantly exacerbate Hyperstimulation syndrome as well as potentially be more likely to implant in a subsequent cycle.

ICSI – Some times even in the presence of a normal semen analysis, and normal results on all the infertility tests, fertilization may not occur without microsurgically injecting the sperm directly into the egg. This procedure is called Intracytoplasmic Sperm Injection or ICSI and may achieve fertilization in almost all circumstances where there is otherwise a sperm cause for lack of fertilization

Lupron is a Gonadotropin Releasing Hormone Agonist that must be administered after a woman ovulates or concurrent with progesterone or oral contraceptive pills to effectively suppress gonadotropins. Lupron prevents a woman’s pituitary gland from producing LH, luteinizing hormone. LH increases can trigger premature ovulation and stimulate testosterone and progesterone production which can be harmful to a woman’s egg production and prematurely mature the lining of womb potentially affecting implantation

Monitoring of a woman’s stimulation with gonadotropins is performed by transvaginal ultrasound examination of her ovarian follicles and blood hormone levels. The gonadotropin doses can be adjusted according to the results of the monitoring. The timing of the HCG and subsequent egg retrieval are likewise based on the monitoring. Typically, a woman need not be monitored more frequent than every 3 days initially but may need daily monitoring as she approaches follicular maturation to determine timing of the HCG injection and retrieval.

Morula is the stage between the cleavage stage embryo and blastocyst. It is when the embryo is a ball of cells and is usually achieved by the 4th day after insemination.

Oral contraceptive pills are often given prior to the stimulation to help time stimulation starts and bring a woman’s reproductive system to a baseline state from which the stimulation may be initiated.

PGD/PGS is preembryo genetic diagnosis and screening.  PGD refers to diagnosing the presence of a single gene disorder in the embryo.  Typically, patients with a prior history of producing a child with this disorder or where both partners are known carriers for a genetic disease are candidates for PGD.  Alternatively, patients could make the diagnosis in pregnancy by chorionic villus sampling or amnioscentesis.  PGS is screening for chromosomal abnormalities and has been used to improve success after embryo banking, to prevent chromosomally caused recurrent miscarriages, to improve success with older patients’ IVF cycles and for family balancing/gender selection.  Embryos are biopsied 3 days after retrieval in the cleaved state or 5 or 6 days after retrieval in the blastocyst state. 

Progesterone is an ovarian hormone that prepares the lining of the womb for implantation. We measure it during stimulation to check if the lining is getting prematurely stimulated. We add it to the woman after the retrieval to better prepare the lining and continue it as needed to help sustain the implanted embryo until the placenta takes over production of its own progesterone.  It may be administered as an intramuscular injection in which it is placed in various oil media to facilitate absorption.  It may also be administered as vaginal suppositories or tablets either as compounded micronized progesterone or in the commercially prepared brands; Endometrin and Crinone.

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Fighting Infertility with Your Voice

By Tracey Minella

May 7th, 2014 at 10:42 am

credit: adamr/free digital photos.net

 

What would you do if I told you your voice mattered? If I said that you could make a difference. If I said that you could help yourself and others get financial support to defray the costs of infertility treatment and/or adoption?

What if I said today is the day?

Well, you can. And it is.

Today is National Advocacy Day and right now, women (and men) from all over the country are converging on Capitol Hill and taking a stand on behalf of all those who are struggling with infertility. They are meeting with their senators and representatives and asking them to support three bills, each aimed at assisting couples with their family-building.

The first bill is The Family Act. S 881/H.R. 1851: If passed it will provide a substantial tax credit for the out-of-pocket expenses associated with in vitro fertilization or IVF. It could be the difference between having a family… or not… for many people.

The second bill is the Adoption Tax Credit Refundability Act of 2013, S 1056/H.R. 2144: Although the adoption tax credit is permanent, if passed, this bill will add back in the refundable provision that was in place in 2010 and 2011 and help more children, especially those in foster care, find permanent homes.                     

The last bill is the Women Veterans and Other Healthcare Improvement Act of 2013, S 131/ H. R. 958: If passed, this bill will require the Veterans Administration to provide family building options (i.e. IVF and adoption assistance) to veterans who are now infertile as a result of being wounded while in service to our country.

You don’t have to be in Washington to be heard!

RESOLVE, the National Infertility Association has made it easy for your voice to be heard. For simple instructions with the links you need to make a quick phone call to each of your local representatives…and a simple script you can read from so you don’t even have to think at all or be nervous… just click here: http://bit.ly/1mChEUe

C’mon and pick up that phone. The only way things will ever change is if we take action. Our representatives need to hear that we can’t start our families without this support. They need to know that we support these bills and that they should support them, too. Do it for yourself. And if you’ve already built your family, do it for those who are still struggling to build theirs. Do it so change will happen and so your own children or grandchildren won’t have to struggle if they are faced with infertility someday.

It will be the most important call you make today. Be heard. Make a difference.

Make the call.

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Did you call your representatives today? How did it go? Please share your experience.

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Long Island IVF’s Complete Mind Body Program

By Bina Benisch, MS, RN

May 2nd, 2014 at 7:29 am

 

credit: david castillo/freedigitalphotos.net

With Mother’s Day around the bend, and Bereaved Mother’s Day coming this Sunday (for those who have suffered baby or child loss), it’s a good time to remind you of Long Island IVF’s many supportive counselors on staff, and to call your attention to the Mind Body Program and its benefits.

Bina Benisch is a Registered Professional Nurse and a psychotherapist with an M.S. in Mental Health Counseling. She did her Mind Body Medicine training at the Benson-Henry Institute for Mind Body Medicine, Harvard Medical School.

Bina is the support group coordinator, patient advocate, and stress management psychotherapist for Long Island IVF, working with both female and male patients. Her groups are wildly popular, and she always has room for more.

Bina explains the Long Island IVF Mind Body Program and its benefits for those couples trying to conceive:

 

Life changes.  You’ve had your intentions, your hopes, and your dreams of where life would take you.  What you may not have envisioned is suddenly being a member of the population that struggles with infertility.  Being diagnosed with infertility – for any reason – “unexplained,” male factor, or female factor, can feel like a lonely, isolating experience for many reasons.  The fact is that most women never expected to be in this position, and this is often one of the most stressful times in a woman’s life.  Feelings of anxiety, depression, isolation, and anger can be overwhelming during infertility.  Often, anger masks the feelings of loss experienced month after month of trying to conceive without success. Infertility impacts on one’s marriage, self-esteem, sexual relationship, family, friends, job, and financial security. 

Our Mind Body Program provides a space where you can relax, a place where you are free to express whatever it is you are feeling … a sacred circle of connection and support.  I have been told by women who have participated in the Mind Body Support Group that they experience a huge relief by connecting with other women who really “get it,” who understand these unique feelings. During the sessions, I take part of the time to teach Mind Body methods to elicit the relaxation response (emotional and physiological relaxation).  In this way, you can learn to practice these methods on your own on a daily basis

 

 

In our Mind Body support group, patients experience the opportunity to share information, feelings, or their own personal stories. You may be surprised to see how your support can help others or you may be relieved to hear others experiencing the same type of thoughts and feelings as you experience. Often, the supportive nature of this group, and the connection that develops between members, fosters a healing process.
Feelings of isolation, anger, and stress are slowly relieved. Our Mind Body program focuses on symptom reduction and developing a sense of control over one’s life by utilizing Mind Body strategies and interventions which elicit the relaxation response. The relaxation response is actually a physical state that counteracts the stress response. You can think of it as the physiological opposite of the body’s stress response. We cannot be stressed and relaxed at the same time.

Therefore when a person elicits the relaxation response, the body’s stress response is halted, stress hormones diminish.  It is important to understand fertility holistically. Your mind and body work together, not separately. Therefore your thoughts have a direct effect on your physiology. When you are experiencing stress, your brain releases stress hormones. These stress hormones function in many ways. One of the stress hormones, cortisol, has been documented to interfere with the release of the reproductive hormones, GnRH (gonadatropin releasing hormone), LH (luteinizing hormone), FSH (follicle stimulating hormone), estrogen, and progesterone. In fact, severe enough stress can completely inhibit the reproductive system. Cortisol levels have also been linked to very early pregnancy loss. For this reason, it has been found extremely helpful when treating infertility, to include mind body strategies which help to alleviate the stress responses which may inhibit fertility.

All mind body methods ultimately cause the breathing to become deeper and slower. This causes stress responses such as heart rate, metabolic rate, and blood pressure to decrease. The way in which you are taught to elicit the relaxation response is through methods such as: breath focus, guided visual imagery, muscle relaxation and learned mindfulness, and meditation. Awareness of the mind body connection allows us to use our minds to make changes in our physiology. This holistic treatment – combining bio-medical science with mind body medicine deals with the treatment of the whole individual rather than looking only at the physical aspect.  The fact is, body and mind work together.

Let’s not forget the men. Men often feel uncertain about the ‘right’ way to support their partners, and don’t realize how they themselves are affected. We now offer our “Just For Guys Group.” In sharing how infertility affects the men, their relationships, and each man’s deepest sense of self, these men gain insight, and experience support during what can be an isolating and difficult time.

We invite and encourage you to take advantage of this unique area of support provided by The Mind Body Program at Long Island IVF. Learn more here: http://bit.ly/1bGAvNb

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If you have ever met Bina or been part of one of her groups and would like to share your experience, please do so.

Photo credit: David Castillo http://www.freedigitalphotos.net/images/agree-terms.php

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