Archive for December, 2014
By Tracey A. Minella
December 31st, 2014 at 2:17 pm
Tagged with coping with infertility, Infertility, infertility and New Year's Eve, Infertility Support, Long Island IVF, stress of infertility, surviving infertility, Tracey Minella, Trying to Conceive, TTC
I know exactly what you want to do with that noise maker.
No one would blame you either.
When you’re battling infertility, the last thing most people want to do is party. Unless you’re determined to forget reality for a few hours, who wants to spend money we don’t have dressing up for some rip-off celebration where you’re crowded into a ballroom full of strangers, with bad food, bargain booze, and loud tacky music while fertile friends complain about what the babysitter is costing them?
Truth is…I never liked New Year’s Eve. I hate high heels…and am not really fond of strangers either. My well-done steak never arrives until the ball is dropping. And the group rendition of Sweet Caroline just doesn’t have the same old lure. You may have your own reasons to hate big New Year’s Eve celebrations. Reasons in addition to the obvious one…
Facing the passing of time, coupled with infertility, is a mood killer.
Here’s the best advice I’ve got: Boycott it! Yes, treat New Year’s Eve like any other night. Be a rebel and go to bed at 10. Or maybe have a romantic dinner before turning in early. Unlike many of the recent holidays, this is one where you can actually avoid family. And you can avoid the holiday itself, too…as long as you turn over the calendar the next morning. This might be best if 2014 was a particularly rough year full of losses.
Want to see people? Keep it small…with only those who truly support you…so you don’t find yourself having to fake a fun time or dodging questions about finally having a baby in 2015. A few close friends, great food and drinks, some funny board games or a good movie. Low-key.
Of course, if you do go out big time and some drunk asks if that’s a noise maker in your pocket or you’re just happy to see them, you know what to do.
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How do you feel about New Year’s Eve? A time to celebrate wildly? A time for quiet, casual fun? A night to hide under the covers?
What do you plan to do?
By Tracey Minella
December 24th, 2014 at 4:37 pm
This time of year is the hardest on infertiles. With nativities and Menorahs everywhere, we’re reminded of the reason for the season for many. And there’s no shortage of reminders of the other reason for the season…children.
Christmas and Chanukah are the most difficult holidays to navigate when infertile because they are both family- and child-focused. Holiday photo cards of children dressed in fancy outfits in the mailbox. Social media hosts a continued onslaught of images. Breakfast with Santa. Wish lists and Toys R Us©. Elf on the Shelf shenanigans. Even the old TV Christmas classics like Rudolph and Frosty that brought such joy to us as kids don’t have enough magic in them to make the holidays happy now.
Infertility is so devastating, it can drive the non-religious to find religion or can give atheists an argument that a higher power would never allow such pain and suffering. It can deepen the faith of the faithful or cause others to stray from their faith. Whatever your faith, or lack of it, the holiday season can be a challenge.
How do you keep the faith that it will all work out? How do you remain hopeful?
Do you find comfort in the type of meditation that attending church or temple services can bring? Do religious stories of miraculous conceptions bring your hopeful comfort or just frustration? Does helping the needy through charity work or donations rejuvenate your faith this time of year? Do you have a particular tradition that helps you? (I used to go to St. Patrick’s Cathedral each year and it brought me much comfort).
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Though an intensely personal area, for those inclined to share it: How has your infertility journey affected your faith? (A friendly reminder not to judge each other and to be respectful of our differences in faith).
By David Kreiner MD
December 19th, 2014 at 8:01 pm
Tagged with AMH, David Kreiner MD, diminished ovarian reserve, egg freezing, estradiol level, Fertility, fertility screening, FSH level, Infertility, Infertility Treatment, Reproductive Endocrinologist, TTC
What Is Fertility Screening?
Fertility screening starts with a blood test to check the levels of FSH (follicle stimulating hormone), estradiol and AMH (antimullerian hormone). The FSH and estradiol must be measured on the second or third day of your period. The granulosa cells of the ovarian follicles produce estradiol and AMH. The fewer the follicles there are in the ovaries the lower the AMH level. It will also mean that less estradiol is produced as well as a protein called inhibin. Both inhibin and estradiol decrease FSH production. The lower the inhibin and estradiol the higher the FSH as is seen in diminished ovarian reserve. The higher the estradiol or inhibin levels are then the lower the FSH. Estradiol may be elevated especially in the presence of an ovarian cyst even with failing ovaries that are only able to produce minimal inhibin. However, the high estradiol reduces the FSH to deceptively normal appearing levels. If not for the cyst generating excess estradiol, the FSH would be high in failing ovaries due to low inhibin production. This is why it is important to get an estradiol level at the same time as the FSH and early in the cycle when it is likely that the estradiol level is low in order to get an accurate reading of FSH.
The next step is a vaginal ultrasound to count the number of antral follicles in both ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least a total of eight antral follicles for the two ovaries. Between nine and twelve might be considered a borderline antral follicle count.
As you start to screen annually for your fertility, what you and your doctor are looking for is a dramatic shift in values from one year to the next.
What Does the Screen Indicate?
A positive screen showing evidence of potentially diminishing fertility is an alarm that should produce a call to action. When a woman is aware that she may be running out of time to reproduce she can take the family-planning reins and make informed decisions. The goal of fertility screening is to help you and every woman of childbearing years make the choices that can help protect and optimize your fertility.
Although none of these tests is in and of themselves an absolute predictor of your ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny. That’s when it makes sense to have a discussion with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out. It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as a history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order.
Regardless of the nature or severity of the problems, today, with Assisted Reproductive Technology and the latest Egg-freezing technology, there is a highly effective treatment available for you.
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Have you had a fertility screening yet? Did you find it helpful? Do you have any questions for Dr. Kreiner?
By Tracey Minella
December 16th, 2014 at 3:56 pm
Many people suffering from infertility do so in silence. And this makes the struggle even harder. Did you just survive another holiday season dodging and lying to the baby-naggers and holding back tears as a mob of nieces and nephews opened presents? Are you wondering how you’ll face another New Year like this?
Despite the spike in infertility awareness and all the progress that’s made during April’s National Infertility Awareness Week (NIAW), by the time the holiday season approaches in December infertility awareness is off the public’s radar. With all the child-centered fun and the family gatherings where ignorant or insensitive baby pressure comments are made, December is particularly hard on the infertile. Especially the “closet” infertile who doesn’t have family support.
NIAW is specifically timed for late April, just before Mother’s Day…the indisputably most painful day of the year for infertile women. On the heels of NIAW is Advocacy Day in early May, when hundreds of infertiles and their supporters flock to Washington, D.C. to speak to elected officials about infertile-friendly issues and pending legislation. NIAW and Advocacy Day raise infertility awareness, educate the fertile public and legislators, and help reduce the ignorant and insensitive comments infertile couples are faced with. At least temporarily.
There is even a National Infertility Survival Day, on the first Sunday in May (also just before Mother’s Day) to “celebrate all the hard work and effort that infertile couples put towards trying to have a child. The day’s main emphasis is on self-care and celebration for what they do have. It’s also a day for friends and family to help lift the spirits of a loved one coping with infertility.” * This is a great idea for those who’ve already told their friends and families… or for couples to celebrate privately.
But wouldn’t it be wonderful if infertile people had a day…much like the GLBT community’s Coming-Out Day in October…when they could “come out” to their family and friends about their infertility? And wouldn’t it be great if that day was timed for right before Thanksgiving, the kick-off of the winter holiday season? I vote for November 11th. 11-11…easy to remember. Just like two lines on a test strip.
Participants in Infertility Coming-Out Day would release the burden of their silence, quiet the “baby-naggers”, and hopefully receive needed support and understanding. And even those who still remain silent might benefit from publicity surrounding such a day.
Who is with me?
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Do you think there should be such a day just before the winter holidays? If you are currently suffering in silence, would you find strength in numbers and find it easier to “come out” on such a day? If you’re struggling with wanting to tell, but not knowing how or when the time is right, would this help you?
If you have told your family, how and when did you do so…and how was the news received?
credit: stuart miles/freedigitalphotos.net Image ID: 10054806
By Tracey Minella
December 13th, 2014 at 9:23 am
Today is 12-13-14. It’s the last time the date will show consecutive sequential numbers in our lifetimes, unless you count the modified 1-2-34. And that’s 20 years away, too. Many people consider these kinds of unique dates to be lucky. No doubt couples will be purposely marrying today, especially since it is a weekend. And maybe planned births will choose today as well.
I remember when I used to think like that. I was going to get married on 10-10 (not 10-10-10 though…try the prior century!). And when I was first trying to conceive… clueless to the 7 year infertility battle that awaited me…I’d speculate on what month I’d choose to have my baby and think of potentially lucky due dates. (Boy, do I feel foolish admitting to that!)
Other people are superstitious about unique dates, like Friday the 13th, or September 11. They’re uncomfortable if their retrieval, transfer, IUI, or baby’s birth fall on those dates. I’ve shared my actual 9-11 story before…the one about the patient who was inseminated amidst all the news unfolding on 9-11 and ended up getting pregnant with twins. Beautiful miracles in the middle of such loss and horror.
As my own infertility journey continued longer than I expected, my dreams for a baby morphed from “Man, I really wanted to have a girl first in April at Hospital X !” to “I just want one healthy baby and don’t care if it’s born on Christmas Day in the garage!”
As infertiles, we are surrounded by significant numbers. Cycle days, follicles (the number and their sizes), blood levels, vials of medication, trigger shot date, IUI date, retrieval and transfer, number of embryos and their grades, the date we need to conceive by in order to have a baby before our next birthday/next holiday/next Mother’s Day. The list goes on. It’s enough to make your head spin. Many of us have committed to memory the number and grade of frozen embryos we have and the cycle(s) they came from. The numbers have taken over our lives.
AND SPEAKING OF NUMBERS there are only 2 days left…
LONG ISLAND IVF was nominated BEST IN VITRO FERTILITY PRACTICE in the Long Island Press’s “Best of Long Island 2015″ contest. If you’d like to vote to help us win, you can vote once per day through Dec 15 here: http://bestof.longislandpress.com/voting-open/
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So how about you? Are there any significant numbers in your baby-planning?
By Bina Benisch, MS, RN
December 10th, 2014 at 9:29 pm
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.
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Have you tried any of the supports available in the Long Island IVF Mind-Body program? If so, was it helpful?
Did you know you do not have to be a LIIVF patient to access this support?
By David Kreiner MD
December 7th, 2014 at 5:23 pm
Tagged with clomid, clomid alternative, clomid and cervical mucus, clomid and infertility, Clomid Side Effects, David Kreiner MD, endometriosis, getting pregnant with clomid, Infertility Treatment, IUI, IVF, limits on clomid cycles, Long Island IVF, Micro-IVF, success rates with clomid, Trying to Conceive
It has become commonplace for women who have been frustrated with repeated unsuccessful attempts to conceive naturally on their own to see their gynecologist who often times will try clomid therapy on them. Clomid, the traditional brand name for clomiphene citrate, is a competitive inhibitor of estrogen. It stimulates the pituitary gland to produce follicle stimulating hormone (FSH) which in turn will stimulate the ovaries to mature follicle(s) containing eggs. Estrogen normally has a negative effect on the pituitary: Clomid blocks estrogen and leads to pituitary FSH production and ovarian stimulation.
Infertility patients — those under 35 having one year and of unprotected intercourse without a resulting pregnancy and those over 35 having six months without pregnancy — have a two to five percent pregnancy rate each month trying on their own without treatment. Clomid therapy increases a couple’s fertility by increasing the number of eggs matured in a cycle and by producing a healthier egg and follicle. The pregnancy rate with clomid therapy alone is approximately ten percent per cycle and 12 -15 percent when combined with intrauterine insemination (IUI). Women who are unable to ovulate on their own experience a 20 percent pregnancy rate per cycle with clomid, the equivalent to that of a fertile couple trying on their own.
Clomid and Your Cervical Mucus
Women who are likely to conceive with clomid usually do so in the first three months of therapy, with very few conceiving after six months. As clomid has an anti-estrogen effect, the cervical mucus and endometrial lining may be adversely affected.
Cervical mucus is normally produced just prior to ovulation and may be noticed as a stringy egg white like discharge unique to the middle of a woman’s cycle just prior to and during ovulation. It provides the perfect environment for the sperm to swim through to gain access to a woman’s reproductive tract and find her egg. Unfortunately, clomid may thin out her cervical mucus, preventing the sperm’s entrance into her womb. IUI overcomes this issue through bypassing the cervical barrier and depositing the sperm directly into the uterus.
However, when the uterine lining or endometrium is affected by the anti-estrogic properties of clomid, an egg may be fertilized but implantation is unsuccessful due to the lack of secretory gland development in the uterus. The lining does not thicken as it normally would during the cycle. Attempts to overcome this problem with estrogen therapy are rarely successful.
Many women who take clomid experience no side effects. Others have complained of headache, mood changes, spots in front of their eyes, blurry vision, hot flashes and occasional cyst development (which normally resolves on its own). Most of these effects last no longer than the five or seven days that you take the clomid and have no permanent side effect. The incidence of twins is eight to ten percent with a one percent risk of triplet development.
Limit Your Clomid Cycles
Yet another deterrent to clomid use was a study performed years ago that suggested that women who used clomid for more than twelve cycles developed an increased incidence of ovarian tumors. It is therefore recommended by the American Society of Reproductive Medicine as well as the manufacturer of clomiphene that clomid be used for no more than six months after which it is recommended by both groups that patients proceed with treatment including gonadotropins (injectable hormones containing FSH and LH) to stimulate the ovaries in combination with intrauterine insemination or in vitro fertilization.
For patients who fail to ovulate, clomid is successful in achieving a pregnancy in nearly 70 percent of cases. All other patients average close to a 50 percent pregnancy rate if they attempt six cycles with clomid, especially when they combine it with IUI. After six months, the success is less than five percent per month.
In vitro fertilization (IVF) is a successful alternative therapy when other pelvic factors such as tubal disease, tubal ligation, adhesions or scar tissue and endometriosis exist or there is a deficient number, volume or motility of sperm. Success rates with IVF are age, exam and history dependent. The average pregnancy rate with a single fresh IVF cycle is greater than 50 percent. For women under 35, the pregnancy rate for women after a single stimulation and retrieval is greater than 70 percent with a greater than 60 percent live birth rate at Long Island IVF.
Young patients sometimes choose a minimal stimulation IVF or MicroIVF as an alternative to clomid/IUI cycles as a more successful and cost effective option as many of these patients experience a 40 percent pregnancy rate per retrieval at a cost today of about $3,900.
Today, with all these options available to patients, a woman desiring to build her family will usually succeed in becoming a mom.
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Do you have any other questions for Dr. Kreiner about Clomid?
By Tracey Minella
December 5th, 2014 at 11:19 pm
Hot on the heels of Black Friday and Cyber Monday was #GivingTuesday…a day to give back. We shared a list of some worthy infertility-related not-for-profits for anyone’s consideration.
But why should giving only be reserved for only one day? Especially since giving can be so therapeutic.
Holidays that involve having children are understandably particularly hard on us infertile folk. And there’s no way to really fill that void, but here are a few suggestions to help get through this month while you’re waiting for your own “dream present”:
Toys for Tots: Most communities have Toys for Tots campaigns and are in seeking unwrapped, new toys for underprivileged children. Some of these children do not have parents and the holidays are particularly hard for them, too. You can donate a toy at your local Toys R Us but if braving the toy store is too hard, you can donate money instead. For more information and for a list of other drop-off locations and volunteer opportunities see: http://www.toysfortots.org/donate/toys.aspx
Adopt-a-Family: Many local hospitals and houses of worship have programs where people can adopt-a-family for the holidays. The families chosen have fallen on hard times due to unemployment, military deployment, serious illnesses, death, homelessness, or other hardships. If not for this program, the children may not have food, warm clothes, or any presents for the holidays. Why not call and inquire about how you can help? The Salvation Army in Blue Point, NY (631-363-2136) and Soldier’s Angels http://soldiersangels.org/holiday-adopt-a-family-program/ and Toys of Hope http://www.toysofhope.org/adopt_family.html and The Retreat (for domestic violence victims) http://www.theretreatinc.org/ are just a few local adopt-a-family programs.
Soup Kitchen: Volunteering to feed the homeless and poor at a local soup kitchen is a great way to make a difference in someone’s life and make you feel good, too. Your local house of worship or Salvation Army can direct you to the nearest facility. Here is another list: http://www.homelessshelterdirectory.org/cgi-bin/id/countyfb.cgi?county=Suffolk-County&state=NY
Sick Children: You love children. Why not share your love with those who are suffering life threatening illnesses? You could volunteer with organizations like Make-A-Wish and be part of granting magical wishes http://suffolk.wish.org/ Or you could contact the social services department of your local hospital and ask if you can help brighten the mood of any of the children battling cancer who will be spending the holidays in the hospital and whose families might not be able to afford gifts.
It’s so easy to become a Grinch in December. Why not try one (or more) of these suggestions? I’ll bet your heart grows 3 sizes that day…
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What do you do to help get through the holidays? If you try any of these tips, please let us know how it goes! Or better yet, take a selfie doing one of these things and share it with us on Facebook, Twitter, or Instagram!