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Archive for the ‘Pre-Conception Health’ Category

September is PCOS Awareness Month

By David Kreiner MD

September 1st, 2017 at 9:05 am

, via Wikimedia Commons”]

By Anne Mousse (Own work) [CC0

Polycystic Ovarian Syndrome, or “PCOS”,  is the most common hormonal disorder of reproductive age women, occurring in over 7% of women at some point in their lifetime.  It usually develops during the teen years.  Treatment can assist women attempting to conceive, help control the symptoms and prevent long term health problems.

The most common cause of PCOS is glucose intolerance resulting in abnormally high insulin levels.  If a woman does not respond normally to insulin her blood sugar levels rise, triggering the body to produce more insulin.  The insulin stimulates your ovaries to produce male sex hormones called androgens.  Testosterone is a common androgen and is often elevated in women with PCOS.  These androgens block the development and maturation of a woman’s ovarian follicles, preventing ovulation resulting in irregular menses and infertility.  Androgens may also trigger development of acne and extra facial and body hair.  It will increase lipids in the blood.  The elevated blood sugar from insulin resistance can develop into diabetes.

Symptoms may vary but the most common are acne, weight gain, extra hair on the face and body, thinning of hair on the scalp, irregular periods and infertility.

Ovaries develop numerous small follicles that look like cysts hence the name polycystic ovary syndrome.  These cysts themselves are not harmful but in response to fertility treatment can result in a condition known as Ovarian Hyperstimulation syndrome, or OHSS.

Hyperstimulation syndrome involves ovarian swelling, fluid accumulating in the belly and occasionally around the lungs.  A woman with Hyperstimulation syndrome may become dehydrated increasing her risk of developing blood clots.  Becoming pregnant adds to the stimulation and exacerbates the condition leading many specialists to cancel cycles in which a woman is at high risk of developing Hyperstimulation.  They may also prescribe aspirin to prevent clot formation.

These cysts may lead to many eggs maturing in response to fertility treatment also placing patients at a high risk of developing a high order multiple pregnancy.  Due to this unique risk, it may be advantageous to avoid aggressive stimulation of the ovaries unless the eggs are removed as part of an in vitro fertilization procedure.

A diagnosis of PCOS may be made by history and physical examination including an ultrasound of the ovaries.  A glucose tolerance test is most useful to determine the presence of glucose intolerance and diabetes.  Hormone assays will also be helpful in making a differential diagnosis.

Treatment starts with regular exercise and a diet including healthy foods with a controlled carbohydrate intake.  This can help lower blood pressure and cholesterol and reduce the risk of diabetes.  It can also help you lose weight if you need to.

Quitting smoking will help reduce androgen levels and reduce the risk for heart disease.  Birth control pills help regulate periods and reduce excess facial hair and acne.  Laser hair removal has also been used successfully to reduce excess hair.

A diabetes medicine called metformin can help control insulin and blood sugar levels.  This can help lower androgen levels, regulate menstrual cycles and improve fertility.  Fertility medications, in particular clomiphene are often needed in addition to metformin to get a woman to ovulate and will assist many women to conceive.

The use of gonadotropin hormone injections without egg removal as performed as part of an IVF procedure may result in Hyperstimulation syndrome and/or multiple pregnancies and therefore one must be extremely cautious in its use.  In vitro fertilization has been very successful and offers a means for a woman with PCOS to conceive without a significant risk for developing a multiple pregnancy especially when associated with a single embryo transfer.   Since IVF is much more successful than insemination or intercourse with gonadotropin stimulation, IVF will reduce the number of potential exposures a patient must have to Hyperstimulation syndrome before conceiving.

It can be hard to deal with having PCOS.  If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition.  Ask your doctor about support groups and for treatment that can help you with your symptoms.  Remember, PCOS can be annoying, aggravating even depressing but it is fortunately a very treatable disorder.

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Do you suffer from PCOS? Do you have any advice to share for other “cysters”?

 

Photo credit:

By Anne Mousse (Own work) [CC0], via Wikimedia Commons

https://commons.wikimedia.org/wiki/File%3AEchographie_pelvienne%2C_aplio_toshiba_ssa_700_5_2004_03_detail.jpg

 

 

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Long Island IVF Fertility Acupuncture Seminar: What’s the Point?

By Tracey Minella

June 20th, 2017 at 7:35 am

So much about infertility is out of your control. In fact, next to the paralyzing fear and constant worry that you might never become parents, the lack of control over your body’s ability to reproduce when– and as often as– you want is probably the most maddening part of infertility.

So, when it comes to treatment options, it’s common to think a bit too aggressively and want things that deep down you know aren’t considered safe—like transferring back 8 embryos at once—just because you hope it’ll increase the odds of getting pregnant. Desperation can do that to you, especially if your journey is taking a long time.

Fortunately, there is a better and safer option. It’s fertility acupuncture. And it is available at Long Island IVF. Acupuncture is holistic—an ancient, trusted treatment—that might improve your chances of success with IVF. So, shouldn’t you learn more about it?

It gets better: This exclusive, yet very affordable, natural therapy might even help if you’ve had prior unsuccessful IVF cycles. And fertility acupuncture costs less than $200 per IVF cycle. Are you ready to learn more from the doctor who performs it and other local experts?

With so much riding on the outcome of an IVF cycle—emotionally and financially—many patients are looking closely at ways to “customize” their traditional IVF cycle. Depending on a patient’s particular case, customized “add-on” treatments might include such things as ICSI, PGS/PGD, and other cutting-edge Western medicine offerings.

Now, there is something from the East that shows promise, too… Acupuncture for fertility.

Long Island IVF is the first infertility practice with a Reproductive Endocrinologist who is also a Traditional Chinese Medicine (TCM) practitioner and a NYS certified medical acupuncturist.

Motivated by a desire to find complementary holistic approaches to enhance today’s best Western medical technologies, Long Island IVF co-founder and REI, Dr. David Kreiner, went back to school to study TCM after over 30 years of making babies.

Dr. Kreiner is now applying that acupuncture training in the IVF procedure room, both pre- and post-IVF transfer–exclusively to ALL interested Long Island IVF patients. IVF patients… especially those for whom Western medicine alone has not yet produced a baby…may benefit from adding this ancient therapy. Could this be the missing piece?

Long Island IVF’s Acupuncture Program is hosting a free seminar with Dr. Kreiner and a special guest–local acupuncturist James Vitale, M.S., LAc. — to discuss topics related to improving IVF success with acupuncture. You may also see a live demonstration of fertility acupuncture.

Don’t miss this special FREE program on Thursday, June 22, 2017 from 6:30 pm-8:30 pm at our Melville office at 8 Corporate Center Drive, Melville, New York. Seating is limited, so pre-registration is required. Register here now: http://bit.ly/2pt8c0K

We look forward to seeing you there. Please contact Lindsay Montello, Patient Services, at 631-752-0606 or LMontello@liivf.com with any questions.

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Are you coming to the Acupuncture Seminar?

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Reiki for Fertility Free Sessions at Long Island IVF

By Tracey Minella

June 1st, 2017 at 9:50 am

 

Are you ready for four weeks of free Reiki therapy to reduce the stress of infertility and possibly increase your chances of conceiving?

 

As anyone who has melted down monthly over negative pregnancy tests knows all too well, infertility is beyond stressful—as in constant, unrelentingly awful levels of stressful. But there are holistic ways to reduce stress and potentially increase the odds of conceiving that longed-for pregnancy.

 

The Mind-Body Medicine Program at Long Island IVF has long-offered specialized group and individual therapy sessions for infertiles, led by our infertility specialist and psychologist Bina Benisch, MS, RN. In addition to these wildly popular sessions, Bina also conducts occasional workshops on keeping the romance in lovemaking while trying to conceive, and on how to “come out” of the infertility closet to family and friends.

 

Bina is also an experienced Reiki Master and now, she’s offering something else that’s really exciting. Or should we say really relaxing?

 

It’s Reiki. Only at Long Island IVF. Open to all—you don’t have to be a patient of the practice. Get in on this 4-week free program while spots are available. Pre-registration is required so click here to sign up now.

 

Reiki is a “simple, natural and safe method of spiritual healing and self-improvement.” It’s a stress reduction and relaxation technique from Japan founded on the belief that a “life force energy” flows through the body and that our health is connected to its strength. If the energy is low, we may be stressed or sickly and raising it may make us feel happier or healthier. Meditative in nature, Reiki “feels like a wonderful glowing radiance that flows through and around you” and “treats the whole person including body, emotions, mind and spirit creating many beneficial effects that include relaxation and feelings of peace, security and wellbeing.”*

 

Whether you are trying to conceive naturally or are using assisted reproductive technology like IVF to conceive, the holistic Reiki therapy may enhance your efforts by helping you to relax.

 

In an effort to bring attention to Reiki therapy through Long Island IVF’s Mind-Body Medicine program, we are offering this limited-time, free four-week Reiki series. With such positive feedback from our innovative Acupuncture for Fertility program and our recent free Yoga for Fertility Night, patients seeking holistic alternatives to complement their Western medicine fertility treatment protocols have found all of these options under one roof.

 

Do something relaxing for yourself this summer and come down for Reiki with Bina.

 

The four (4) Reiki sessions will be held at Long Island IVF’s Melville office 8 Corporate Center Drive, Melville, New York on the following Monday nights from 6:30-7:30 pm:

 

  • Monday June 12
  • Monday June 19
  • Monday June 26
  • Monday July 10

 

Remember, the sessions are free but spots are limited, so pre-register now here.

 

Can’t wait to see you there. Please contact Lindsay Montello, Patient Services, at 631-752-0606 or LMontello@liivf.com with any questions.

 

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Are you coming to Reiki?

 

 

 

* http://www.reiki.org/faq/WhatIsReiki.html

 

 


 

 

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March is Endometriosis Awareness Month

By David Kreiner MD

March 1st, 2017 at 12:20 pm

 

photo: Ryan McGuire/gratisography.com


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?

 

 

Photo credit: Ryan McGuire at http://www.gratisography.com/

 

 

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Cupping for Competition—and Conception

By David Kreiner MD

August 11th, 2016 at 1:41 am

 

image credit: GraphicsMouse/freedigital photos.net


What treatment might Olympic athletes and fertility-challenged women have in common?

Evidence of Cupping on many competing in the Olympics, especially the swimmers, has made quite a splash…but what is cupping and why the purplish circular marks on the skin?


Cupping is a form of traditional medicine found in many cultures throughout the world. This treatment involves placing cups containing a negative pressure which exerts suction onto the skin that if left on long enough breaks small blood vessels or capillaries resulting in a bruise in the affected area. This sounds painful, but it isn’t.

Cupping is a popular form of Traditional Chinese Medicine (TCM) that works to unblock “Qi”, a form of life energy. Once unblocked, the energy can flow smoothly throughout the meridians or pathways in the body.

With cupping, TCM practitioners, commonly called acupuncturists, help to remove congestion and stagnation (stagnant blood and lymph) from the body and to improve the flow of “Qi” throughout the body.  It also will increase the blood flow to the area upon which the cup is applied.

Musculoskeletal disorders are aided by increasing the flow of blood and “Qi” to the muscles underlying the applied cups.  Hence, Michael Phelps and other Olympians have been going for cupping treatment to alleviate their sore muscles.  Some TCM practitioners will also use cupping to treat breathing problems or respiratory conditions such as a cold, bronchitis or pneumonia.

Cupping may also be utilized to improve fertility in conjunction with acupuncture, moxibustion (heat applied to acupuncture point through burning herbs) and/or herbal therapy.  From a TCM perspective, improving the flow of “Qi” at specific points or meridians may correct an imbalance that is preventing conception.  From a Western scientific view, cupping and acupuncture cause the body to release endorphins.  The endorphin system consists of chemicals that regulate the activity of a group of nerve cells in the brain that relax muscles, dull pain, and reduce panic and anxiety.

It is believed that these therapies may also trigger the release of more hormones, including serotoninSerotonin is a brain chemical that has a calming effect resulting in a serenity that aids the fertility process.  Cupping, like acupuncture, reduces inflammation which could also benefit fertility.  Whether it be the challenge of an Olympic trial or a battle against infertility cupping may be a valuable addition to one’s program.

 

 

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When Should I Freeze My Eggs?

By Dr. Michael Zinger

August 4th, 2016 at 3:43 pm

 

image credit: stockimages/freedigitalphotos.net


Every woman is born with a limited supply of eggs.  As this supply ages, the likelihood of each remaining egg to have the capability to become a baby diminishes.  However, this loss of potential is not spread evenly over the years, rather it is a shallow decline that usually continues into the mid-30’s, followed by a steeper loss that typically happens from the late 30’s into the early 40’s.  Over a matter of 5 years, the odds of one egg having the potential to make a baby decreases by about 80%.  Of course, not every woman is typical and the age at which this transition starts can vary quite a bit.

 

The only way to effectively protect the potential of eggs over time is cryopreservation, also known as egg freezing.  Once frozen, the capacity of the eggs to create a successful pregnancy is maintained through the years.

 

Gynecologists often ask me at which age to refer their single patients to me to discuss egg freezing.  The answer is not simple.  Certainly we do not want to put a patient through this process if it is likely that she will meet the right partner and form a family without ever using those eggs.  It would have been an unnecessary medical procedure with associated expense and lost time and effort.

 

On the other hand, we have to weigh the risk that the steeper decline in the eggs’ potential will happen before the woman has met her future partner and completed her family.  If we could predict when that decline will happen in each woman then this question would be much easier.  Unfortunately, our testing is only accurate in identifying this steeper decline when it is already occurring, at which point we have already missed the opportunity to freeze high-potential eggs.

 

Most of my egg-freeze patients are in their mid-30’s.  On average, at this point, only subtle changes in the potential of eggs have occurred, whereas within a few years, more drastic changes usually start.   Therefore, this timing does make sense for most women, but not everyone.

 

A concern about waiting until the mid 30’s is the possibility of an earlier decrease in egg potential.  While that is unusual, it tends to also be unpredictable.  Factors that contribute may include a history of smoking, a history of ovarian surgery or conditions that may lead to such surgery (e.g. endometriosis), or having a mother or older sister that experienced either an earlier menopause or infertility due to loss in egg potential.  Women with these factors should consider freezing eggs in their early 30’s or even late 20’s.    But, most often, if an early decrease occurs, it is without any predisposing factors and with no known cause.  Therefore, even without predisposing factors, cautious women, who want to minimize the risk of missing the opportunity, should also consider freezing their eggs in their early 30’s.

 

Of course, just as some women unpredictably have an earlier loss, some also have good potential that persists even past 40.  This can be determined at an initial visit with a fertility specialist through sonogram and blood tests.  So, for women who have not yet frozen eggs, even at 41 or 42 it makes sense to come in for evaluation and determine if this could still be worthwhile.

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The Difference Between Genetic Carrier Screening and Comprehensive Chromosome Screening

By Satu Kuokkanen, MD, PhD

June 6th, 2016 at 12:35 pm

image: cooldesign/ freedigitalphotos.net

Many infertility patients want to know the difference between genetic carrier screening and comprehensive chromosome screening (CCS), as well as why we perform these screening tests.

 

Genetic carrier screening refers to testing of one or both partners for a large scale genetic carrier status of select conditions that often result in severe early childhood diseases in their offspring. Some examples include cystic fibrosis, sickle cell anemia, and spinal muscular atrophy.  It is important to know that these devastating conditions are rare in the general population; however, some of them cluster in certain ethnic backgrounds or geographical regions.

 

Most diseases tested are inherited in recessive fashion, which essentially means that a person will need to have two mutated copies of the gene (one inherited from each parent) to actually get that disease. On the other hand, the carrier status by definition indicates that a person has only one mutated gene of the disease in their genome (DNA) and therefore will never contract the disease, but can pass this mutated gene to their offspring. This situation becomes particularly problematic if both partners are carriers for the same condition because, in such case, each of their offspring will have 1 in 4 or 25% risk of getting that disease. Thus, genetic carrier screening attempts to identify parental carrier status prior to pregnancy to avoid conception with a fetus with severe disease(s).

 

If both parents are carriers for the same genetic condition, the couple can proceed with in vitro fertilization (IVF) in combination with preimplantation genetic diagnosis (often referred as PGD) to essentially weed out affected embryos. Performed on the embryos created after fertilization, PGD tests the embryos for specific gene mutations, prior to transferring any embryos back to the woman’s uterus.  Theoretically, in such scenarios 1 in 4 of the embryos are affected and the rest should be unaffected for the tested condition. The unaffected embryos are transferred to the female partner’s uterus in the hope of establishing a healthy pregnancy.

 

On the other hand, Comprehensive chromosomal screening (CCS), also known as preimplantation genetic screening (PGS) refers to the testing of an embryo’s numeric chromosome component and can be done as part of IVF whether a couple is concerned about genetic diseases or not. Normal female chromosome component is 46, XX and male 46, XY.  Some conditions typically screened for through CCS are Down’s syndrome (extra chromosome 21) and Turner syndrome (missing chromosome X).

 

When CCS is elected, embryos are cultured to day 5, the blastocyst stage, allowing biopsy of a number of cells from each embryo.  The numeric chromosome component of each embryo is then analyzed, thus providing the selection of embryos with normal chromosome numbers for transfer. The improvement in pregnancy rates with CCS makes an elective single embryo transfer a feasible option for many patients, thereby avoiding multiple pregnancies and associated adverse maternal and fetal effects.

 

Importantly, the patients who need genetic carrier screening for specific gene mutations, such as cystic fibrosis, can have their embryos simultaneously analyzed for CCS from the same biopsy.

 

In addition, CCS includes the sex chromosomes: X and Y. When the chromosome screening results of the embryos are available, the information on sex chromosomes becomes optional for patients. Patients can either elect to transfer embryos of a particular gender or may decide not to know the gender of their embryos.

 

As the field of genomics continues to evolve, the ongoing research and clinical trials will provide more information on how and to what extent CCS and other tests can be applied to improve IVF outcomes and establish healthy pregnancies for our patients.

 

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Have you considered genetic carrier screening or comprehensive chromosome screening?

 

 

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Improving IVF Success With Acupuncture

By David Kreiner MD

March 3rd, 2016 at 11:08 am

image credit: Praisaeng/ Freedigitalphotos.net

I have been studying and practicing fertility treatment since 1985.  Over the past 31 years, I’ve witnessed first-hand the enormously improved success we have been able to achieve with advancements in in-vitro fertilization (“IVF”).  Every day now, people we previously thought could never be helped to conceive are having babies as a result of today’s state-of-the-art IVF technology.  However, successful as we have been, there are those who remain unhelped and still in need despite modern technology and medicine.  For those, I went back to school to study Traditional Chinese Medicine (“TCM”) and acupuncture.

 

TCM has been successfully used for nearly all health problems since before recorded history.  In fact, approximately 2400 years ago the ancient Chinese medical text, Yellow Emperor’s Canon of Internal Medicine, was written dealing with the relationships among the internal organs and with the concepts of yin and yang as applied to medicine.  In TCM, the yin and yang principle proposes that the bodily organs are interdependent and support each other in harmony.  Disease is defined as a loss of this state of balance within and among the organs.  Treatment with TCM is based on the restoration of the body’s natural harmony and rebalancing of all the organs.

 

Applying TCM to conventional Western medical diagnosis mixes different worlds without a common language.  The science of TCM is based on the flow of Qi (the body’s life energy) that connect the organs through channels and runs throughout the body.  Deficiencies and stagnations of this Qi arising from the different organs result in patterns of symptomatology– including the inability to conceive.  Treatment is individualized based on the unique patterns that are evident in each patient.  These symptoms and patterns are elucidated upon taking the patient’s history and performing a physical examination.

 

Integrating TCM with state-of-the-art Western medicine involves focusing on these patterns and  connections that help us filter each patient’s story and emerge with a clear map of how to use all the tools of medicine… including the most effective TCM and high-tech Western medicine.

 

Though the West was first introduced to acupuncture and TCM when President Nixon visited China, it was not until 2002 that the American Society for Reproductive Medicine (“ASRM”) took notice when a published article in Fertility and Sterility showed that pre- and post- transfer acupuncture increased pregnancy rates.

 

The Manheimer review published in Human Reproduction in June 2013 showed statistically improved success when acupuncture was used as adjunctive therapy in IVF programs that had lower pregnancy rates.  Recently, Dr. Shahar Lev-Ari from Tel Aviv University Sackler School of Medicine reported when combining IUI with TCM treatments, 65.5% of a test group of 29 women between ages 30 and 45 (average 39.4) were able to conceive, compared with 39.4% of the control group of 94 women between ages 28 and 46 (average 37.1) who received no herbal or acupuncture therapy.  The TCM treatment included weekly acupuncture and Chinese herbs.

 

At ASRM 2015, Dr. Paul Magarelli presented a study he performed from his program in Colorado demonstrating significantly higher pregnancy rates when acupuncture was initiated at least 6 weeks prior to embryo transfer and included pre- and post- transfer treatments.

 

How does acupuncture help fertility?  From a Western perspective, acupuncture’s successful treatment of stress is effective to improve fertility mostly by improving hormonal function.

There is evidence that acupuncture also increases blood flow to the reproductive organs and helps balance the endocrine system.

 

If we are to assume that combining TCM with modern reproductive medicine optimizes a patient’s success, then how can we best help our patients?  At Long Island IVF we work with some of the most qualified fertility acupuncturists on Long Island and, in addition, offer TCM and acupuncture on-site in the Melville office including pre- and post- transfer.

 

As a certified acupuncturist and reproductive endocrinologist with over 30 years of experience in IVF, I feel I am uniquely qualified to offer our patients the most effective fertility treatment that includes the best that Western medicine has to offer as well as TCM and acupuncture.

 

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Do you think adding acupuncture to your treatment plan could be beneficial?

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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 and 2016 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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5 Popular Misconceptions Regarding Polycystic Ovary Syndrome (PCOS)

By Dr. Joseph Pena

June 22nd, 2015 at 11:23 am

 

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By Schomynv [CCo


Myth #1 – “If I have irregular periods, I have PCOS”.

Women with irregular menstrual periods are often unaware of the reason for their menstrual irregularity.  Many women are placed on hormonal contraceptives (i.e. birth control pills) by their gynecologist to regulate their menstrual periods and prevent an overgrowth of the lining of the uterus that may lead to cancer if left unchecked.  Some women are told they have PCOS as this is the most common etiology for irregular menstrual periods (4-7% of women of reproductive age, ~60-85% of anovulatory women), while others are not given a specific reason for their irregular menstrual periods.

While there is no universally accepted definition for PCOS, there are a few expert groups which have generated diagnostic criteria.  The Rotterdam Consensus Criteria (2006) requires two of the three signs/symptoms of PCOS (hyperandrogenism, irregular menstrual periods, polycystic-appearing ovaries on pelvic ultrasound) to be present for the diagnosis to be made.  The Androgen Excess Society (2006) requires hyperandrogenism plus one of the other two signs/symptoms (irregular menstrual periods, polycystic-appearing ovaries on pelvic ultrasound).  The hyperandrogenism criteria may be satisfied by either the presence of hirsutism (excessive hair growth) or elevated androgen levels, such as testosterone.  However, both criteria recommend excluding other possible causes of these signs and symptoms.  The differential diagnosis of someone with irregular menstrual periods and/or hirsutism is listed in the table below.

Differential Diagnosis of Polycystic Ovary Syndrome (PCOS)
—  Thyroid disease (hypothyroidism, hyperthyroidism)—  Prolactin/Pituitary disorders

—  Nonclassical congenital adrenal hyperplasia (Nonclassical CAH)

—  Androgen-secreting tumor (ovary, adrenal gland)

—  Exogenous androgens

—  Primary hypothalamic amenorrhea (stress-related, exercise-related, eating disorders, low body weight)

—  Central nervous system tumors/disorders

—  Primary ovarian failure

—  Cushing syndrome

—  Insulin-receptor defects

 

The proper evaluation of a woman with irregular menstrual periods and confirmation of PCOS is important because this affects treatment (e.g. combined hormonal contraceptives for PCOS, thyroid hormone replacement for hypothyroidism, corticosteroid replacement for nonclassical congenital adrenal hyperplasia, surgery for androgen-secreting tumor, etc.), as well as determining future fertility treatment (e.g. clomiphene citrate for PCOS, dopamine agonist for hyperprolactinemia, in vitro fertilization using donor oocytes for ovarian failure, etc.).  Thus, it is important for women to ask their physicians for a diagnosis for their irregular menstrual cycles.

 

Myth #2 – “Regular menstrual periods means I’m ovulating”.

The menstrual bleeding that occurs in a woman with inconsistent or absent ovulation is more likely due to breakthrough bleeding rather than post-ovulation withdrawal bleeding.  Thus, vaginal bleeding cannot be assumed to be an indication of ovulation in these women.

In addition, while many women and some clinicians use a history of regular menstrual cycles as a predictor of normal ovulatory function, ~40% of normally-menstruating women who exhibit hirsutism (excessive hair growth) are, actually, not ovulating and may be classified as having PCOS or other diagnosis associated with hyperandrogenism.

 

Myth #3 – PCOS is an ovarian cystic problem.

PCOS is an endocrine disorder of androgen excess with defined diagnostic criteria as noted above in Myth #1.  The determination of “the polycystic ovary (PCO)” (in contrast to the syndrome, PCOS) is defined in the table below.

Determination of polycystic appearing ovary (PCO)
—  In one or both ovaries, either:—  >12 follicles measuring 2-9mm in diameter

—  Increased ovarian volume > 10 cm3

—  If there is a follicle > 10mm in diameter, scan should be repeated at a time of ovarian quiescence in order to calculate volume/area

—  Presence of one PCO is sufficient for diagnosis

 

From the table above, it can be seen that PCO does not refer to and is very different from clinical ovarian cysts, both physiologic (e.g. corpus luteum) and pathologic (e.g. endometrioma, dermoid tumor), which tend to be larger in size.

The characteristic PCO emerges when a state of anovulation (lack of ovulatory cycles) persists for any length of time.  ~75% of anovulatory women will have PCO.  Since there are many causes of anovulation, there are many causes of PCO (e.g. PCOS, congenital adrenal hyperplasia, hyperprolactinemia, hyperandrogenism, type 2 diabetes mellitus, eating disorders, etc.).   PCO is the result of a problem with the normal functioning of the ovaries, and not necessarily from a specific individual cause.

Last but not least, PCO is not necessarily a pathologic abnormality.  Up to 25% of women who menstruate and ovulate normally will demonstrate PCO on ultrasound.

 

Myth #4 – “PCOS does not occur in thin or normal-weight women, or in women without excessive hair growth”.

While obesity and hirsutism (excessive hair growth) are relatively common in women with PCOS, with a prevalence of 20-60% and 30-80%, respectively, there are many women with PCOS with neither feature.  Again, referring to the diagnostic criteria for PCOS (see above in Myth #1), the presence of obesity is not necessary.  Hirsutism is just one manifestation of hyperandrogenism.  The other is biochemical, such as elevated androgen levels in the blood.  Certain ethnic backgrounds (e.g. Asians) may genetically not manifest hirsutism despite elevated androgen levels.  Thus, being thin or of normal weight and showing no signs of excessive hair growth does not necessarily eliminate PCOS as a diagnostic possibility.  Other common (but not necessarily required) features of PCOS are listed in the table below.

FEATURES OF POLYCYSTIC OVARY SYNDROME

PREVALENCE

CLINICAL
     Hirsutism (excessive hair growth) 30-80% (depends on ethnicity)
     Acne 15-20%
     Androgenic alopecia 5-10%
     Obesity 20-60%
     Anovulation 90-100% (depending on definition)
     Oligo/amenorrhea (irregular/absent menses) 50-70%
OVARIAN
     Polycystic appearing ovaries 70-80%
BIOCHEMICAL
     ­ LH/FSH 35-95%
     ­ free testosterone 60-80%
     ­ total testosterone 30-50%
     ­ DHEAS 25-70%
METABOLIC
     hyperinsulinemia 25-60%

 

 

Myth #5 – “Irregular menstrual periods due to PCOS is only a problem when trying to conceive.”

Obesity, irregular menstrual periods, and elevated insulin levels are common features of PCOS and significant risk factors for the development of an overgrowth of the lining of the uterus (endometrial hyperplasia), which may lead to cancer, if left unchecked.  It is not surprising then that women with PCOS are at an increased lifetime risk for developing endometrial hyperplasia and cancer of the lining of the uterus.  Thus, it is essential for a woman with PCOS who is currently not interested in conceiving, to discuss with her gynecologist the best option for her to decrease her risk for developing endometrial hyperplasia/cancer.   Options that might be considered include the use of [low-dose combined] hormonal contraceptives (e.g. the pill, transdermal patch, vaginal ring), progesterone-only pill, progestin IUD, and/or withdrawing with progesterone at regular intervals.

Women with PCOS are also thought to be at increased lifetime risk for developing type 2 diabetes mellitus and cardiovascular disease (abnormal cholesterol and other lipids, high blood pressure).  Regular screening for pre-diabetes or diabetes (with a 2-hour glucose tolerance test or fasting glucose level), body mass index, fasting lipid profile, and metabolic syndrome risk factors is essential to possibly help improve mortality and morbidity in such individuals.  Early intervention with lifestyle modification (diet, exercise, weight loss) and pharmacological treatment if needed (e.g. insulin-sensitizing agents, statins) may help to accomplish this.

Thus, PCOS is more than simply a problem of infertility.  It is a condition which should be discussed with one’s physician (gynecologist, primary physician, endocrinologist) even when one is not actively trying to conceive.

 

By Schomynv (Own work) [CC0], via Wikimedia Commons

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NIAW Special Promo on Long Island IVF Event with Free IVF Door Prize!

By Tracey Minella

April 22nd, 2015 at 1:34 pm

In celebration of National Infertility Awareness Week, Long Island IVF is offering a special now through April 25, 2015…

During National Infertility Awareness Week, if you buy a regular admission ticket to the Brew for the Family event that we are hosting with The Tinina Q. Cade Foundation, you will receive two (2) entries into the drawing for the Free IVF cycle door prize instead of one!!! That’s two chances to win a Free IVF cycle for only a $55 admission ticket.

So on Thursday, June 4th,  from 7:30-10:00 pm you get a great night out at the Great South Bay Brewery which includes plenty of great food and music, plus beer sampling of several craft beers, a brewery tour, souvenir glass, silent auction for additional great prizes, and more.

Click here for more information http://bit.ly/1yvDBit.

To purchase tickets please visit: www.librewforthefamily.eventbrite.com. The promo is automatically applied so no code is required.

And if you’re into getting out during the week, join us for the last two fun NIAW events from 7-9 pm in our Melville office:

Fertile Yoga Night Tonight

Yoga with a Baby Goal! Created for both newbies and yoga devotes, this is your chance to participate in a yoga session specifically geared to potentially enhance your fertility. Bring your mat or a towel (and yoga pants or gym wear) and experience mediation, breathing and stretching designed to reduce stress, lessen muscle tension and increase blood flow to the pelvis. You’ll be guided by Lisa Pineda, an instructor experienced in yoga for fertility who will leave you relaxed and wanting more. Light refreshments.

 

Alternative Medicine & Holistic Approaches to Fertility Enhancement Night Tomorrow

This interactive evening will highlight Mind-Body and holistic medicine practices including meditation techniques, breath work, Reiki, massage therapy and a live demonstration of fertility-focused acupuncture. LIIVF’s own Dr. David Kreiner will discuss acupuncture and Bina Benisch, MS RN and other affiliated local practitioners will lead the other discussions/demos. Additionally, Rachel Liberatore, LMT, from Nu Touch Therapy will be providing free chair massages. Jim Vitale of Suffolk County Acupuncture will give a live demo of fertility-focused acupuncture, too. Don’t miss this chance to learn how to help yourself reduce stress and improve your own fertility. Light refreshments.

The events are FREE, but pre-registration is required. If you’ve been trying to conceive without success, please RSVP immediately to reserve your spot by contacting our Patient Services Coordinator, Lindsay Montello at 631-386-5509 or lmontello@liivf.com. You do not have to be a Long Island IVF patient to attend. Feel free to bring your partner or a friend.

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Are you coming?

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