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Archive for February, 2016

March is Endometriosis Awareness Month

By David Kreiner MD

February 29th, 2016 at 11:14 pm

 

image credit: ohmega1982/freedigitalphotos.net


I don’t have to tell you that endometriosis can be a very painful illness and that it can cause infertility. It is often a reproductive lifelong struggle in which tissue that normally lines the uterus migrates or implants into other parts of the body, most often in the pelvic lining and ovaries. This leads to pain and swelling and often times difficulty conceiving.

If you have endometriosis, you are not alone. Five to ten percent of all women have it. Though many of these women are not infertile, among patients who have infertility, about 30 percent have endometriosis.

Endometriosis can grow like a weed in a garden, irritating the local lining of the pelvic cavity and attaching itself to the ovaries and bowels. Scar tissue often forms where it grows, which can exacerbate the pain and increase the likelihood of infertility. The only way to be sure a woman has endometriosis is to perform a surgical procedure called laparoscopy which allows your physician to look inside the abdominal cavity with a narrow tubular scope. He may be suspicious that you have endometriosis based on your history of very painful menstrual cycles, painful intercourse, etc., or based on your physical examination or ultrasound findings. On an ultrasound, a cyst of endometriosis has a characteristic homogenous appearance showing echoes in the cyst that distinguish it from a normal ovarian follicle. Unlike the corpus luteum (ovulated follicle), its edges are round as opposed to collapsed and irregular in the corpus luteum and the cyst persists after a menses where corpora lutea will resolve each month.

Women with any stage of endometriosis (mild, moderate, or severe) can have severe lower abdominal and pelvic pain – or they might have no pain or symptoms whatsoever. Patients with mild endometriosis will not have a cyst and will have no physical findings on exam or ultrasound. It is thought that infertility caused by mild disease may be chemical in nature perhaps affecting sperm motility, fertilization, embryo development or even implantation perhaps mediated through an autoimmune response.

Moderate and severe endometriosis are, on the other hand, associated with ovarian cysts of endometriosis which contain old blood which turns brown and has the appearance of chocolate. These endometriomata (so called “chocolate cysts”) cause pelvic scarring and distortion of pelvic anatomy. The tubes can become damaged or blocked and the ovaries may become adherent to the uterus, bowel or pelvic side wall. Any of these anatomic distortions can result in infertility. In some cases the tissue including the eggs in the ovaries can be damaged, resulting in diminished ovarian reserve and reduced egg quantity and quality.

The treatment for endometriosis associated with infertility needs to be individualized for each woman. Surgery often provides temporary relief and can improve fertility but rarely is successful in permanently eliminating the endometriosis which typically returns one to two years after resection.

There are no easy answers, and treatment decisions depend on factors such as the severity of the disease and its location in the pelvis, the woman’s age, length of infertility, and the presence of pain or other symptoms.

Treatment for Mild Endometriosis

Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.
However, several well-controlled studies have shown that neither medical nor surgical treatment for mild endometriosis will improve pregnancy rates for infertile women as compared to expectant management (no treatment). For treatment of infertility associated with mild to moderate endometriosis, ovulation induction with intrauterine insemination (IUI) has a reasonable chance to result in pregnancy if no other infertility factors are present. If this is not effective after about three – six cycles (maximum), then I would recommend proceeding with in vitro fertilization (IVF).

Treatment for Severe Endometriosis

Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women. Some studies have shown that surgical treatment of severe endometriosis does improve the chances for pregnancy as compared to no treatment. However, the pregnancy rates remain low after surgery, perhaps no better than two percent per month.

Some physicians advocate medical suppression with a GnRH-agonist such as Lupron for up to six months after surgery for severe endometriosis before attempting conception. Although at least one published study found this to improve pregnancy rates as compared to surgery alone, other studies have shown it to be of no benefit. The older a patient is, the more problematic post surgical treatment with Lupron will be as it delays a woman’s attempt to conceive until she is even older and less fertile due to aging.

Unfortunately, the infertility in women with severe endometriosis is often resistant to treatment with ovarian stimulation plus IUI as the pelvic anatomy is very distorted. These women will often require IVF in order to conceive.

Recommendations

As endometriosis is a progressive destructive disorder that will lead to diminished ovarian reserve if left unchecked, it is vital to undergo a regular fertility screen annually and to consider moving up your plans to start a family before your ovaries become too egg depleted. When ready to conceive, I recommend that you proceed aggressively to the most effective and efficient therapy possible.

Women with endometriosis and infertility are unfortunately in a race to get pregnant before the endometriosis destroys too much ovarian tissue and achieving a pregnancy with their own eggs becomes impossible. However, if you are proactive and do not significantly delay in aggressively proceeding with your family building, then I have every expectation that you will be successful in your efforts to become a mom.

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Do you suffer from endometriosis? How has it impacted your fertility journey? Do you have any advice for others who are suffering?

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Oh, The Irony! It’s National Condom Week

By Tracey Minella

February 18th, 2016 at 8:24 am

 

photo credit: scottchan/ freedigitalphotos.net


 

Once upon a time, in a cruel twist of fate, a young, responsible couple that didn’t yet know they were infertile used condoms for birth control. Eventually, they gave them up to start a family long, long ago. A family they are still trying to conceive while the rest of the kingdom enjoys parenthood. So condoms are the furthest thing from their minds.

Sound familiar?

Ever wonder what’s happening in the condom world since you’ve been gone? Well, thanks to the internet and the site http://www.wheredidyouwearit.com/  people can anonymously check in online with their (protected) geographic location, gender, and relationship info and then share such details (through a drop down menu) as why they used a condom, where they used the condom, and finally, how they’d rank that particular sexual encounter.

For the love of Pete, is there nothing sacred anymore?

This is actually not something conceived by sex-obsessed college guys. It’s a campaign that’s part of a quest by Planned Parenthood® to reduce sexually-transmitted diseases (which may cause infertility) and promote safer sex through responsible condom use. It’s an awareness-raising initiative that’s making condom use cool– instead of lame or taboo– and it’s been around for awhile.

Feeling nostalgic? Considering buying a pack for old time’s sake?

Maybe you’re just a bit curious about the ranking system.  Well, the top “encounter” ranking is: “Ah-maz-ing–Rainbows exploded and mountains trembled”.

You go, Tiger.

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Do you think you would ever go back to using condoms??

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Gender Reveal Parties After Infertility

By Tracey Minella

February 16th, 2016 at 9:52 pm

Photo credit and cake by: Toni Doster Repko/Sweet Angel Cakes


You’ve waited forever for this baby…or babies.

After months… or years…of medical intervention, immeasurable stress, and possible losses or setbacks, your little miracle(s) is on the way. You’re cautiously optimistic about the pregnancy and glimpse the light at the end of the infertility tunnel.

With a leap of faith, you’re going to throw yourself into all the fun pregnancy-related things you’ve been denied all this time. Where do you start?

Of course, there is the fun of picking names, preparing nurseries, posing for maternity photo shoots, and registering for baby items for the baby shower your friends and family are likely dying to throw for you. (Shhh. It may be a surprise!)

But why wait for others to throw you a party when you can throw your own? If you’re one of those couples who want to know what you’re having now instead of being surprised in the delivery room, there is no better way to celebrate the moment than a big, fat gender reveal party!

A gender reveal party is, well, a party where a pregnant couple reveals the gender of the baby on the way to their family and friends. The baby’s sex is revealed to the entire room at the moment the couple cuts into a cake. If the slice is pink, it’s a girl. If it’s blue, it’s a boy. Only the baker knows in advance, so it’s a surprise to the parents as well as the crowd!

What a fabulous way to share your big news and celebrate with the people who stood by you throughout this long journey! Not everyone can be present at the birth…nor would you want that. But this allows you to share the moment you find out what you’re having with all of them while you’re sporting that pregnancy glow… instead of that open-backed hospital gown.

 

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What do you think of gender reveal parties? Would you/did you have one?

 

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Long Island IVF-WINNER: Best in Vitro Fertility Practice 2015 AND 2016

It is with humble yet excited hearts that we announce that Long Island IVF was voted the Best In Vitro Fertility Practice in the Best Of Long Island 2015 contest…two years in a row!

The doctors, nurses, embryologists, and the rest of the Long Island IVF staff are so proud of this honor and so thankful to every one of you who took the time to vote. From the moms juggling LIIVF babies… to the dads coaching LIIVF teens…to the parents sending LIIVF adults off to college or down the aisles… to the LIIVF patients still on their journeys to parenthood who are confident in the care they’re receiving…we thank you all.

We love what we’ve gotten to do every day more than 28 years…build families. If you are having trouble conceiving, please call us. Many of our nurses and staff were also our patients, so we really do understand what you’re going through. And we’d like to help. 631-752-0606.

 

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When Cupid’s Packing an IM Syringe

By Tracey Minella

February 14th, 2016 at 5:13 pm

photo credit: OZPhotography/ free digitalphotos.net

 

Is that a syringe in your pocket, or are you just happy to see me?

 

Seriously, there’s just no easy way to candy coat the reality of being infertile on Valentine’s Day.

 

If you are a rose-colored glasses kind of person and can enjoy the traditional festivities of chocolates and roses and red satin sheets, go for it. But if your infertility journey has you so down that even diamonds won’t cheer you up today… realize you’re not alone.

 

Usually, the ones who are down today are the ones without partners because of the unfair stigma associated with being alone on Valentine’s Day. But being a couple in love… and miserable… on Valentine’s Day is something society doesn’t really “get”. There’s no anthem for lovers and infertility. Nobody feels our pain.

 

We don’t want roses and perfume. We want a Valentine’s Day onesie and baby powder.

 

Infertility takes a toll. Foreplay left the building with the basal thermometer. And all the naughty words we used to describe spontaneous, carefree love-making quickly followed…reducing us to robots wielding specimen cups and whispering snappy sweet talk something like this: “Just roll over! We have to do it. Now!

 

While the fertile couples swap chocolates, cards, and flowers this morning, we’re dealing with blood work and sonos. Instead of laughing over champagne, and candlelight tonight, the only action we may be getting is a one-handed grope and a big two inch needle for a “quickie” of the unkindest kind.

 

So, I’m not here to tell you to have fun today if you really can’t get there emotionally because the only gift you both want to give or receive is the baby you can’t have (yet). You absolutely don’t have to buy into this Hallmark© holiday.

 

But I have an order for you that I promise will lighten your mood whether you’re down or not: At some point today make a list of the top three reasons why you love your partner. Just do it. I’ll even give you the first one. 1. Because he loves you enough to be by right by your side on this journey that has tested the strength of your love for each other. (I already feel you smiling.)

 

So why not reconnect and show your partner your love tonight? A heartfelt talk. A long walk (someplace warm) holding hands. A quiet dinner. Maybe even some long-forgotten naughtiness. Whatever feels right after you look at that list you created. If infertility has a choke-hold hold on your love life, break it tonight.

 

And if he comes at you with that big two inch tonight, take a deep breath and accept it as a sign of his love and commitment to you and the dream you have together. Just for tonight, think of it as Cupid’s arrow.

 

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If you have any stories or tips to share about how you get through Valentine’s Day, please share them here.

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In the “IVF Oscars”, the Nominee for Best Supporting Role is…

By David Kreiner MD

February 2nd, 2016 at 6:54 pm

 

image courtesy of wpclipart.com


Many husbands complain that they feel left out of the whole IVF process as all the attention and care is apparently directed towards the woman.

If anything they may feel that at best they can show up for the retrieval at which time they are expected to donate their sperm on demand. If you should fail at this then all the money, time, hope and efforts were wasted all because you choked when you could not even perform this one “simple” step.

I have not witnessed the terror and horrors of war but I have seen the devastation resulting from an IVF cycle failed as a result of a husband’s inability to collect a specimen. Relationships often do not survive in the wake of such a disappointment. Talk about performing under pressure, there is more at stake in the collection room than pitching in the World Series.

Husbands and male partners view IVF from a different perspective than their wives. They are not the ones being injected with hormones; commuting to the physician’s office frequently over a two week span for blood tests and vaginal ultrasounds and undergoing a transvaginal needle aspiration procedure. At least women are involved in the entire process, speak with and see the IVF staff regularly, understand what they are doing, and are deeply invested emotionally and physically in this experience.

So what is a husband to do?

 

Get Involved

Those couples that appear to deal best with the stress of IVF are ones that do it together. Many husbands learn to give their wives the injections. It helps involve them in the efforts and give them some degree of control over the process. They can relate better to what their wives are doing and take pride that they are contributing towards the common goal of achieving the baby.

When possible, husbands should accompany their wives to the doctor visits. They can interact with the staff, get questions answered and obtain a better understanding of what is going on. This not only makes women feel like their husbands are supportive but is helpful in getting accurate information and directions. Both of these things are so important that in a husband’s absence I would recommend that a surrogate such as a friend, sister, or mother be there if he cannot be. Support from him and others helps diminish the level of stress and especially if it comes from the husband helps to solidify their relationship.

Husbands should accompany their wives to the embryo transfer. This can be a highly emotional procedure. Your embryo/s is being placed in the womb and at least in that moment many women feel as if they are pregnant. Life may be starting here and it is wonderful for a husband to share this moment with his wife. Perhaps he may keep the Petri dish as a keepsake as the “baby’s first crib”.  It is an experience a couple is not likely to forget as their first time together as a family.

With regards to the pressure of performing to provide the specimen at the time of the retrieval, I would recommend that a husband freeze a specimen collected on a previous day when he does not have the intense pressure of having to produce at that moment or else. Having the insurance of a back-up frozen specimen takes much of the pressure off at the time of retrieval making it that much easier to produce a fresh specimen. There are strategies that can be planned for special circumstances including arranging for assistance from your wife and using collection condoms so that the specimen can be collected during intercourse. Depending on the program these alternatives may be available.

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

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