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Archive for June, 2014

Infertility and TCM: Part 9: Tong Bing Yi Zhi.

By David Kreiner MD

June 29th, 2014 at 8:34 am

 

image courtesy of stuart miles/ freedigitalphotos.net

According to Western Medicine, a particular disease is caused by a specific pathogen and the Western Medicine treatment is directed at that pathogenic factor. However, Traditional Chinese Medicine (TCM) recognizes that two people may react differently to that same pathogen.  They refer to this as Tong Bing Yi Zhi.  For example, in one individual the symptoms may appear as Damp heat syndrome and in another as Yin deficiency with false heat syndrome. In TCM, despite the common pathogen, patients would be treated differently depending on the syndrome identified. Syndrome identification is based on 4 diagnostic methods: inquiring, palpation, inspection and listening/smelling. This information is gathered and analyzed to identify the syndrome that a patient is experiencing.

 

On the other hand, two people with two different Western diagnoses such as menopause and hyperthyroidism may experience the same TCM syndrome from their respective pathologic conditions, Yin deficiency with false heat. This is also referred to as Tong Bing Yi Zhi.  In this case it refers to treating different diseases the same because they result in the same TCM syndrome.  In the first case TCM treats the same disease differently because as a result of the varying natures and constitutions of patients the symptoms resulting from the same pathologic condition often varies. To clarify, we do not need to know in TCM what diseases the patients have. We treat them according to TCM by their syndrome diagnosis.

Syndromes are differentiated based on several different factors. There are eight principles of paired opposing conditions including; Exterior and Interior, Cold and Heat, Deficiency and Excess, and Yin and Yang. These general principles are the basis for categorizing all the syndromes. The other syndromes are differentiated according one of the following  theories such as; Qi, blood and body fluids, the theory of the Zang-Fu organs, the theory of the six channels or meridians of Qi, the four levels of heat invasion, and the three burners or sections of the body.

It is through the four diagnostic methods above that the practitioner identifies the syndrome affecting the patient. He/she will choose the particular treatment specific for the syndrome modified by the age and health of the patient. This can include Tui-Na massage, acupuncture, moxibustion, cupping, and herbal medicine all directed at specific points in the body depending on the syndrome.

To me, as a Western physician trained to direct treatment for a particular pathogen or disease, I am very attracted to differentiating treatment based on its specific effect on the individual patient. We know that the same disease can have different resulting effects on people and that different diseases can affect some individuals in the same way. Therefore, the concept of directing therapy based on the effect the pathogenic factor has on the individual appears to me to be an effective way to treat a patient. If a physician were to combine the Western pathogen-directed therapy with TCM treatment based on the syndrome affecting the individual then the East-West combination therapy I believe should be most ideal.

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Does the Western pathogen-based treatment plan seem sufficient or does the idea of blending it with Eastern principles of syndrome-based treatment seem like it’d be a complementary bonus?

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Long Island IVF “Dancing for the Family” Fundraiser with Free IVF Cycle Door Prize

By Tracey Minella

June 25th, 2014 at 5:48 pm


Remember date nights?

Infertility often wreaks havoc on a couple’s social life. Couples who were the life of the party before their diagnosis may start to withdraw from social situations for several reasons including depression, apathy, and financial restraint. If the journey is long, the couple can become virtual hermits.

Sound like you?

Well, we have a very special Saturday night planned with your name on it! Long Island IVF has partnered with the Tinina Q. Cade Foundation’s Dancing for the Family to bring you an event that is the first of its kind anywhere…and it’s coming this summer on August 23, 2014 at Dance with Me Studios Long Island, in Glen Head, N.Y.

Each attendee will have a chance to win a great door prize: A FREE IVF CYCLE donated by Long Island IVF*.

So whether you were party animals who loved to tear up the dance floor or just a couple of couch potatoes who watch Dancing With The Stars®, this event is for you. You will get to dance in the very studio where professional and DWTS dancers like Maksim and Val Chmerkovskiy and Tony Dovolani call home. You should be sashaying across the floor to order your tickets already, but if you need some persuading to fight that “hermit habit” just picture this…

The big night arrives. It’s date night. At least one of you is excited enough to have made these plans. You’ll get dressed up a bit, maybe for the first time in a while. Your eyes meet. The old spark ignites between you and any apprehension melts away. You’re on your way. The studio is abuzz with excitement. People are eating and enjoying the silent auction. You’ve got a drink in hand. Moods are relaxed, the music starts, and the professional dance instruction fun begins.

By the evening’s end, you’ve rediscovered each other or maybe met some new friends who share your challenge. Perhaps you even cut the rug with one of the LIIVF doctors. You’ve danced and laughed and possibly even won a silent auction prize. Or the free IVF cycle door prize. Someone will win it. And since attendance is limited, the odds are increased.

The coveted door prize is even transferable once*, so encourage your generous friends and family… who may not personally need the Free IVF cycle… to join you at this special event to help increase your odds of winning.

Go on, make it a party. Share this event with your friends and bring your own crowd!

You’ll leave feeling like a champion for being part of this ground-breaking event since all proceeds raised will enable the Tinina Q. Cade Foundation to offer education-based programming and Family-Building grants to help people overcome infertility.

Tickets are available at www.LIDanceForTheFamily.eventbrite.com. Admission tickets are only $65 (or $100 for V.I.P tickets). A portion of each ticket is tax deductible. See details on the eventbrite link. Don’t delay. Tickets are first-come, first-served. Click the link and reserve your spot today! Go on. Click. Now.

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Will you be coming to the event?

 

*See Long Island IVF website and eventbrite ticket purchase site for full details, rules, and restrictions.

 

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=100248739

 

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An Infertile Woman’s Advice to the New Grad

By Tracey A. Minella

June 21st, 2014 at 6:19 am

 

credit: david castillo dominici/freedigitalphotos.net

How innocent you look there in your cap and gown, your broad smile gleaming in the sun. Another educational milestone met. Another diploma for the wall.

You’ve got grand plans for your bright future. Another advanced degree, or maybe your first big job, waits. Visions of the good life fill your mind. Having it all. The career with its promotions, the marriage with romantic vacations. The first house. And then…eventually… the baby. The one you’ve decided will arrive in May of some yet undetermined year. Right on schedule. Exactly as planned.

Today, your foot is poised on the ladder to success.

And as I see you, my mind screams “Put it in the stirrups!”

I was you, long ago. Innocent, with no reason to suspect my life’s lofty goals would not turn out exactly as planned. And as it turns out, I’d trade all my degrees, romantic vacations and big empty house in a heartbeat just to have some of that time back. Just to have thought to start trying to conceive sooner. Or to have budgeted money better. And sadly, I’m in good company feeling this way.

I never thought I’d be married 13 years before I finally conceived. Or that my journey to the crib would take 6 years and 6 IVF cycles and then another IVF four years later. Or that the costs…financial and emotional… would be so great and still have an impact on my life for so many years.

There’s something about graduations that brings out the cynic in me.  It’s that innocent optimism of the grad and the sense that they have all the time in the world before having a family that makes me want warn them that a rude awakening may await them. But who am I to shatter their dreams?

So the best advice I can give new grads is to look ahead optimistically, but keep one eye on the mirror and keep your ear on the biological clock because time moves faster than you think. Whether you have a partner or not, see an RE periodically for a complete fertility evaluation as your eggs may be older than you think. Rule out or treat any issues found early…before you’re ready to conceive.  Consider egg freezing, if indicated. A simple semen analysis is an inexpensive test that yields a lot of information. These exams will let you know if you should consider changing your original family-building timing.

Being book smart is great, but there’s more. Be smart about your body and your fertility. Know your options because knowledge is power.

Now, go out and conquer the world.

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What, if anything, would you do differently in terms of timing your education, career, and family planning?

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Femvue: The HSG Alternative Test

By David Kreiner MD

June 18th, 2014 at 6:27 am

 

image courtesy of OhMega 1982/free digital photos.com


Fear can be an awesome motivator.

Unfortunately, when it leads to avoiding a vital medical test such as investigating the patency of fallopian tubes it can prevent a physician from discovering the cause of a couple’s infertility.

The hysterosalpingogram (HSG) is an x-ray of the fallopian tubes after radio-opaque contrast is injected transvaginally through the cervix.  Contrast can be visualized filling the fallopian tubes and spilling through patent fallopian tubes into the pelvis.

The HSG is performed using a metal instrument clamped on the lip of the cervix while a tube is placed through the cervix and contrast injected into the uterine cavity under pressure.  Patients have complained that this procedure is too painful for them to endure and either refuse to undergo the procedure or go for a surgical laparoscopy under general anesthesia.

Today, a new procedure, known as the Femvue, is available whereby a physician inserts a catheter similar to that used at insemination into the cervix.  The physician observes by transvaginal ultrasound the flow of air bubbles through the tubes and into the pelvis.  This can be accomplished in the office with typically minimal discomfort to the patient.

Sometimes, it may be difficult to get reliable results with Femvue in obese patients. In cases where the results of Femvue are abnormal, a traditional HSG may be done to confirm results.

With the Femvue, the fear of pain experienced by some patients from the HSG is no longer an obstacle to the infertility workup.

Femvue is currently being performed at Long Island IVF by Doctors Kreiner, Pena, and Zinger.

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If you have had an HSG, was it painful? If you’ve had Femvue, how did it go?

Have you avoided an HSG because of fear?

 

Photo credit: http://www.freedigitalphotos.net/images/Diseases_and_Other_M_g287-Woman_With_Abdominal_Pain_p76296.html

 

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7 Tips to Help Your Guy Survive Father’s Day When You’re Infertile

By Tracey Minella

June 14th, 2014 at 7:18 am

 

Credit: david castillo dominici/freedigitalphotos.net

 

Just as Mother’s Day is the hardest day of the year for infertile women, Father’s Day is roughest on the infertile men.  And society’s expectations of men make it even harder.

Men are “supposed” to be so many things. Tough guys. Knights in shining armor. Passionate lovers. Good providers.

And daddies.

But the harsh reality of infertility flies in the face of all that. Real men cry. Timed sex is no fun. (Ditto for specimen cups.) Ten thousand dollar bills don’t grow on trees. You can’t “just look at her” and get her pregnant. And this Sunday is yet another day…and another year… without a crayon-colored card and painted rock paperweight present.

Our guys are there to pick us up each month as we face another disappointment and to hold us after yet another a failed cycle. Some hold back their tears so we can let ours flow freely while others join in.  (Either way, they hurt, too.) They lose sleep worrying about how to finance the next fertility treatment. And if the cause is male factor, they often shoulder unbearable guilt as well, no matter how much we reassure them.

Face it. Society isn’t even sympathetic to us on Mother’s Day even though the depth of the maternal instinct is universally accepted. So the support, empathy, and understanding our men need needs to come from somewhere else.

It needs to come from us. So what can we do to help our partners this Sunday?

Here are 7 tips to help get him through Father’s Day:

Cater to him: Get inside his head and go for the best diversion for him. Do whatever it is he likes…preferably where there won’t be children (if being around them is hard). In fact, set up a whole day of his favorite things, starting with breakfast in bed.

 

Surprise him: Has he been begging you to share a new experience with him, like fishing or hiking…or any other positively mortifying thing? Has he hinted about a concert or sporting event that you would rather die than attend? Well…surprise him with those tickets or grab the tackle box and go for it with a smile on your face. That simple gesture will speak volumes. (Tomorrow you can tell him it was a one-day only thing!)

 

Solo time with Dad: Instead of having to endure a barbeque with the whole family…including the wise-cracking fertile siblings and the 22 grandchildren they’ve already provided…plan to spend solo time with Dad. Consider breakfast on Sunday morning or dinner on Saturday night instead.

 

 

Daddy-in-Waiting card: He’s already a father in his heart. He’s just waiting. Don’t make him wait to get a card (or a gift for that matter). Write him a heartfelt note telling him how much he means to you and how he’s helped you on this journey. Tell him what wonderful traits he has that you hope your children will one day have and why he’d make a great dad. (Then get the tissues ready.)

 

Adopt a kid: If you can handle it emotionally and you’re close to someone with a child who no longer has a father in the picture, consider doing something with that child on Sunday. Toss a ball in a park, see a movie, get an ice-cream. It may be an awkward or difficult day for the child and his mom, but you could make a difference… and do your heart some good, too.

 

Get physical: Relieve some of the stress of infertility with physical activity. Take a walk or run on the beach. Take a trip to the gym. Have a roll in the hay. Or not.

 

Sow your seed: There’s something cathartic about getting your hands dirty with nature. About sowing seed or planting a tree that will live for generations. About fertility and making something grow. So while you are waiting for that baby, consider planting a Father’s Day tree or garden…something to watch grow over the coming years. A tree next to which you might take annual photos with your future child every Father’s Day as they both grow.

 

Remind him that this journey will end someday and that IVF success rates and technology continue to improve daily so there’s no better time to be trying to conceive.

Hopefully, the reality of that painted rock paperweight is only a stone’s throw away.

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What are you planning to do on Father’s Day this year?

 

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Infertility and TCM (Part 8): The Promise of Blending Western and Eastern Medicine

By David Kreiner MD

June 10th, 2014 at 6:34 pm

 

 

image courtesy of stuart miles/freedigital photos.net

As I approach the midway point of my second semester of studying Traditional Chinese Medicine (TCM) I realize that I believe much more strongly in the effectiveness of these ancient healing arts.  I have begun to work on recharging the Qi in my body by performing Qigong exercises and improving my abdominal breathing.  I stimulate my Qi meridians throughout my body daily to improve the flow of Qi in my body.  I even have performed some acupuncture on myself that I am convinced has helped relieve some minor arthritic pain as well as other symptoms that I have developed over the years.

I foresee a time when many physicians will utilize acupuncture to fill some voids that I have witnessed in Western Medicine.  Patients with aches and pains, chronic cough, urinary complaints and other common health issues often are either overlooked by Western physicians or inadequately treated.  TCM treatments of acupuncture, moxibustion, cupping and herbal therapies may offer an effective alternative to pharmaceuticals and surgery with less risk and fewer side effects.  I have seen benefit from these “manipulations of Qi” and believe that as the Western public becomes more aware of TCM it will become a commonplace mode of therapy.

Perhaps, even more exciting to me is the use of TCM as an adjuvant to Western Medicine.  We know that sophisticated Western laboratory and diagnostic testing is very effective in establishing Western diagnoses that are amenable to pharmaceutical and surgical therapeutics.  TCM, used as an adjuvant to these treatments offers a unique opportunityto improve the constitution of individuals thereby increasing their natural abilityto fight disease.  Also, by working through a different pathway TCM holds promise to increase the effectiveness of the Western Medicine treatment. 

This is the reason TCM/acupuncture combined with Western Medicine provided by high quality IVF centers offers patients their optimal chance for pregnancy success. 

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Have you, or has anyone you know, used TCM/acupuncture as an adjuvant to IVF or another assisted reproductive technology? Did you feel it made a difference?




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Infertile Women Never Forget

By Tracey Minella

June 4th, 2014 at 3:55 pm

 

credit: idea go/freedigitalphotos.net


When it comes to remembering, elephants have nothing on infertile women.

Date of last menstrual period? Pshhh! Without even a glance at a calendar or app, we can tell you the date… plus the time it started, where we were, what we were wearing, who we were with, and how many pee sticks we went through thinking we were pregnant in the 5 days before it began.

And that’s just getting warmed up.

We know how many vacation days we’ve used and how many precious few remain because they’ve been mentally earmarked for upcoming cycles. We can recite the months, years, series numbers, and assigned nurses’ names of all our IVF cycles. We know how many embryos we transferred back and what grades they were. And we can tell you the number and grade of any frozen embryos faster than we can give you the current time.

We know the number of follicles we had on each ovary from our last sonogram and the sizes of the dominant ones. We may not know how much gas is in the car, but we know how thick our uterine lining measured. We know our last Day 3 FSH level and how many vials of medication are still in the fridge. And we definitely know what vein still works.

We know the dates of our retrievals, our transfers, and our pregnancy test dates. Some of us carry the painful details of unspeakable losses as well. And we know what we wore to each and what music was playing on the radio. We can detail how we fell apart, how we pulled it back together, and how we recalculated when we’d be trying again…and what the new due date might be. We’re always aware of the date we need to conceive by in order for a baby to be born before the year ends, or before our next birthday.

These incredible memory skills build up gradually along the course of the infertility journey, starting with the innocent basal body temperature charts used for tracking ovulation patterns. As the journey progresses, more tests and procedures follow. Results come in and a treatment plan is made. The brain absorbs all this additional information… because there is simply nothing else on our minds as important as our goal of getting pregnant.

And in the end, all these dates…these often-frustrating dates…become your history. They make up the story of your journey to parenthood. And you will never forget them.

I know this because today I celebrate the 17th anniversary of the day of my first positive pregnancy test from my 6th fresh IVF cycle which resulted in the birth of my first IVF baby. It was also coincidentally the first day I started working at LIIVF as a medical assistant and I was wearing scrubs when Dr. Kreiner called me into his office to tell me the good news at the end of that nerve-wracking first day. After so many result calls that began with “I’m so sorry…” it was a moment that will live forever.

Your moment will, too.

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What has been your most memorable moment of the journey? What details do you remember that others would be impressed or amazed by?

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Forget the Beach Body! Are You in Reproductive Shape?

By David Kreiner MD

June 3rd, 2014 at 5:41 am

 

 

image courtesy of stock images/freedigitalphotos.net


How do you get started building your family when it isn’t happening on its own?

First, if you are thinking about getting pregnant get a check up! Get your pap done – go to the dentist – have your blood pressure and lipids checked. I’m not an expert on the art of motorcycle maintenance, but our bodies, like machines, go through wear and tear and, as a result, occasionally are not operating at optimum capacity.

Here’s what needs to happen for a life to be created. Millions of sperm need to traverse the cervix (which needs to have adequate watery mucus for the sperm to swim through to get to the uterus) and, from there, to the fallopian tubes where, en masse, the sperm gang release digestive enzymes that help bore a hole through the egg membrane. Your egg needs to be healthy and mature, picked up by the fimbria, the fingerlike projections of the fallopian tube and swept along the length of the tube by microscopic hairs within the tube. The environment of the tube needs to allow for fertilization with penetration by only one of the sperm, followed by division of the fertilized egg into a multi-cellular embryo. While the embryo continues to grow and cleave and develop ultimately into a blastocyst containing the future fetus (inner cell mass) and placenta (trophoblast) the tubal micro-hairs continue to sweep the embryo ultimately into the uterine cavity.

The lining of the uterus, the endometrium, must be prepared with adequate glandular development to allow the now hatched embryo to implant. Yes, there is a shell surrounding the embryo that must break in order for the embryo to implant into the uterine lining. Inflammatory fluid, polyps, fibroids or scar tissue may all play a role in preventing implantation.

Oy, it’s amazing this ever works!

In fertile bodies of good working order, this all works an average of 20% of the time!

So . . . how do we get our bodies in optimal shape to maximize our chance of conception?

Check on medications that you may be on. Can you stay on them while trying to conceive? Guys need to do this too! Some medications may affect ovulation or implantation. Prostaglandin inhibitors found in common pain relievers can affect both ovulation and implantation. Calcium channel blockers commonly used to control high blood pressure may affect your partner’s sperm’s ability to penetrate and fertilize an egg.

How is your diet? Is your weight affecting ovulation and preparation of your uterine lining either because it is too high or too low? Do you have glucose intolerance that is leading to high levels of insulin in the blood that affects your hormones and ovarian follicular and egg development? Perhaps you would benefit from a regimen including a carbohydrate restricted diet, exercise and medication to improve glucose metabolism.

Make love. Sex is critical to reproduction, obviously but I am often asked how often and how to time as if it need be a schedule chore. This is a bit tricky as it is vital that while we reproductive endocrinologists are assisting our patients to conceive we want to preserve the relationship that provides the foundation on which we want to build their family. I try not to give patients a schedule until they are in an insemination cycle where we actually identify the precise day of ovulation. I recommend spontaneous lovemaking that in cases of normal sperm counts (which should be analyzed as part of that check up) should average at least every other day in the middle of a woman’s menstrual cycle. Ovulation typically occurs 14 days prior to the onset of her menses. Sperm survive anywhere from 1 day to 7 days in a woman’s cervical mucus varying both on the sperm and the quality of her mucus which for some women is optimal for only hours if at all. Eggs survive 6-8 hours. Therefore, when we perform insemination it is better if we inseminate prior to ovulation rather than after as the sperm have more time to sit around and wait for the egg than visa versa.

See an RE. When all else fails, it is recommended that you consult with a reproductive endocrinologist if you have not conceived after one year before age 35 and six months if you are 35 or older. The treatments available to the specialist are extraordinarily successful today and should ensure that for the great majority of you, you may happily retire that teeny weenie bikini for a maternity swimsuit.

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What items on this list have you intentionally or innocently neglected? Did you find this information helpful?

 

 

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