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Archive for the ‘clomid’ tag

BFN! Negative Pregnancy Test Again! Now What?

By David Kreiner MD

February 5th, 2013 at 6:30 pm

image courtesy of david castillo dominici/freedigital photos.net

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

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

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

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

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

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

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

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

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

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

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

 

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

 

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Is Clomid for You?

By David Kreiner MD

January 17th, 2013 at 8:45 pm

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 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-estrogenic 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.

Side Effects

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.

Success rates

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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Did you start out with Clomid? Did you have success with it or did you move on to IVF?

 

 

 

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Discoveries Along Your Infertility Journey

By Tracey Minella

October 8th, 2012 at 2:12 pm

image courtesy of nuttakit/free digitalphotos.net

Today, celebrate the day Columbus discovered America.

Imagine starting out on a journey on uncharted waters… a handful of nervous strangers in the same boat. As you’re leaving shore, almost everyone on the dock thinks you’re crazy, or at a minimum, doesn’t understand your need to go on this adventure. Time passes with no end in sight as you plod along fighting bouts of nausea and depression. Then, the journey gets really long. Your patience grows thin. Mutiny crosses your mind.

Hey, I didn’t sign up for this!

Come to think of it, you don’t need to imagine this scenario…you’re in the same boat. Well, a similar boat. Sure, you don’t have to worry about scurvy (thanks, pre-natals!) but navigating those IM needles is no picnic. Walk the plank or take Clomid? Tough call.

When you’re diagnosed with infertility, your life veers off the path you thought it’d take. And a new journey begins. It could be relatively quick and inexpensive or it could steal years from your life and be so emotionally, physically, and financially challenging that you just want to jump overboard.

But there are discoveries along the way, though we don’t always realize the lessons until looking back years later. Those experiences shape us into who we are meant to be, and show us what we are made of. They test relationships and build friendships. Some people face unspeakable losses and others unimaginable joy.

And, like Columbus, we don’t always end up where we thought we would at the outset.

But the journey does end for all of us, whether it’s with a biological baby… a baby through donor egg, donor sperm, donor embryos… a baby through surrogacy or a gestational carrier… a baby through adoption… or even a decision to live child-free.

And the place you land is a place of new beginnings.

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Was/Is your infertility journey longer than you thought? What have you discovered as a result of your infertility journey?

 

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Infertility Podcast Series: Journey to the Crib: Chapter 30: The Gift of Life and Its Price

By David Kreiner MD

October 5th, 2012 at 1:24 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirty: The Gift of Life and Its Price. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=141

 The Gift of Life and Its Price

 IVF has been responsible for over 1 million babies born worldwide who otherwise without the benefit of IVF may never have been.  This gift of life comes with a steep price tag that according to a newspaper article in the New York Times in 2009 was $1 Billion per year for the cost of premature IVF babies.

 According to the CDC reported in the same NY Times issue, thousands of premature babies would be prevented resulting in a $1.1 Billion savings if elective single embryo transfer (SET) was performed on good prognosis patients. 

 The argument often given by a patient who wants to transfer multiple embryos is that to do SET would lessen their chances and to go for additional frozen embryo transfers is costly.

 In fact, if one considers the combined success rate of the fresh and frozen embryo transfers that are available from a single stimulation and retrieval, the success rate is at least as high if not higher in the cases of fresh single embryo transfers. 

At Long Island IVF, in an effort to eliminate the financial motivation for multiple embryo transfers, we offer free cryopreservation and embryo storage for a year to our single embryo transfer patients.  In addition, we offer them three (3) frozen embryo transfers for the price of one for up to a year after their retrieval.

IVF offered with single embryo transfer is safer, less costly and probably the most effective fertility treatment available for good prognosis patients.                     

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Was this helpful in answering your questions about single embryo transfers?  Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

 

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Choosing an Egg Donor or Sperm Donor

By Dr. David Kreiner and Tracey Minella

October 1st, 2012 at 8:28 pm

photo credit: jscreationzs/freedigitalphotos.net

No one grows up thinking about making this kind of a decision when they get older. We grow up thinking, no—assuming—we’ll get pregnant the old fashioned way. And even if we do entertain the thought that we might need some medical assistance, we likely figure a little Clomid will do the trick. Certainly nothing as emotionally charged as the decision to use donor eggs or donor sperm.

A couple years ago, I came upon a fellow attorney who’d been an egg donor back in law school. She was outwardly beautiful, and obviously intelligent. And a nanosecond after I thought about how generous she’d been I thought how lucky the recipients were to have her genetic traits in their children.

But that got me thinking about what my own “trait shopping” experience would have been like if I’d gone down that path to parenthood. Would I have tried to meticulously match the donor to my own traits, or my husband’s? Maybe I’d try to weed out an undesirable family trait…on his side, of course! What would I consider as the most important factors? Good health, first. But then what? Education? Athletics? A particular look or ethnicity?

Jeez, I can’t even decide between two options for dinner! 

I can’t imagine what a difficult, yet also exciting, experience choosing a sperm or egg donor must be. Oh, the possibilities…

Long Island IVF’s Dr. David Kreiner offers valuable insight into this choice:

Patients selecting donors whether for eggs or sperm often spend endless hours choosing the “best match”. On an episode of the T.V. show “Brothers and Sisters”, a couple was beyond themselves trying to decide and at one point, out of desperation toyed with the idea of choosing by posting the possible donors on a dart board and letting the dart decide.

People verbalize concern about both a physical and behavioral match. Patients assume that the child will resemble the donor. The likelihood that the child physically looks like the donor varies. The inheritance from a behavioral standpoint including personality and intelligence, drive and aspirations is less clear. There is a significant contribution that the environment plays and to the extent which factor will dominate, nature vs. nurture is not known.

I don’t have the answer to this question; it’s one I, myself, have spent much time considering. I’m one of five children and I have four children of my own and, so far, three grandchildren. Though the environment and the genetics of my siblings and my children does not appear to be so different, each of us has developed unique characteristics and personalities; some more so than others.

I think the nature vs. nurture question is like a Jackson Pollack painting. When you raise a child, different colors of nature and nurture are tossed randomly up in the air and what we call “life” dresses the canvas below. Sometimes the painting it creates is breathtakingly beautiful and other times, well… you wish you could throw out the old and start with a fresh canvas.

Now, if you are a conscientious parent, then you are most careful about how and what colors of nurture you toss. With nature however, there is no control over what features are inherited.

So, I tell my patients who are screening donors and are so concerned that their donor has a particular color hair, eye color or even personality type, that they are putting too much faith in just one can of paint that they get to choose to toss up in the air. People with blue eyes and blonde hair have other colors from ancestors that randomly did not appear on their body. But their gametes contain them and these cans of paint could potentially have more impact on the canvas than the blue eyes and blonde hair that the recipient is hoping for.

I prefer a recipient be concerned that the donor is healthy with good odds for successful conception and a generally appropriate match of physical and behavioral characteristics.

Then I pray for G-d’s blessing.

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What would your top considerations be in choosing a donor?

 

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Infertility Podcast Series: Journey to the Crib: Chapter 29: Why the Wyden Bill Does Not Support Fertility Patients

By David Kreiner, MD

September 28th, 2012 at 6:22 am

 Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twenty-Nine: Why the Wyden Bill Does Not Support Fertility Patients. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=138 

Why “The Wyden Bill” Does Not Support Infertility Patients 

IVF results subjected to government audit were mandated to be reported with the passage of the “Wyden bill”.   The intent of the CDC and national reproductive society (SART) was to assist infertility patients by informing them of the relative success of all IVF programs in the country.  

Unfortunately, what sometimes creates the best statistical results is not always in the best interest of the mother, child, family and society.  Now that prospective parents are comparing pregnancy rates between programs there is a competitive pressure on these programs to reports the best possible rates.   Sounds good…unfortunately it doesn’t always work out that way for the following reasons. 

Patients with diminished ovarian reserve, who are older or for any number of reasons have a reduced chance for success, have a hard time convincing some programs to let them go for a retrieval.  In 2008, we reported our success, 15% with patients who stimulated with three or fewer follicles.  Sounds low and in fact many of these patients were turned away by other IVF programs in our area.  However, for those families created as a result of their IVF, these “miracle” babies are a treasure that they otherwise… if not for our program giving them their chance… would never have been born. 

Another unfortunate circumstance of featuring live birth rate per transfer as the gold standard for comparison is that it pressures programs to transfer multiple embryos thereby increasing the number of high risk multiple pregnancies created.  This is not just a burden placed on the patient for their own medical and social reasons but these multiple pregnancies add additional financial costs that are covered by society by increasing costs of health insurance as well as the cost of raising an increased number of handicapped children. 

William Petok, the Chair of the American Fertility Association’s Education Committee reported on the alternative Single-Embryo Transfer (SET) “Single Embryo Transfer:  Why Not Put All of Your Eggs in One Basket?”.  He stated in November 2008, that although multiple rather than single-embryo transfer for IVF is less expensive in the short run, the risk of costly complications is much greater.  Universal adaptation of SET cost patients an extra $100 million to achieve the same pregnancy rates as multiple transfers, but this approach would save a total of $1 billion in healthcare costs.

We have offered SET since 2006 with the incentive of free cryopreservation, storage for a year and now a three for one deal for the frozen embryo transfers within the year in an effort to drive patients to the safer SET alternative.  

If we are going to report pregnancy rates with IVF as is required by the Wyden Bill, let us put all programs on the same playing field by enforcing the number of embryos to be transferred and even promoting minimal stimulation IVF for good prognosis patients.  The Wyden Bill without the teeth to regulate such things as the number of embryos transferred and reporting success per embryo transfer does more harm than good.  Let us promote safer alternatives and report in terms of live birth rate per stimulation and retrieval, including frozen embryo transfers, so that there is a better understanding of the success of a cycle without increasing risks and costs from multiples. 

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Was this helpful in answering your questions about the Wyden Bill, IVF success rates and reporting requirements, and SET?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

 

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Can Fertility Medications Cause Ovarian Cancer?

By David Kreiner MD, and Tracey Minella

September 17th, 2012 at 7:49 pm

image courtesy of david castillo dominici/freedigitalphotos.net

September is National Gynecological Cancer Awareness Month.

Admit it. If you’ve done IVF or stimulated IUI cycles, or even Clomid, the thought has crossed your mind. Will fertility drugs cause ovarian cancer later? Am I doing all this to become a mother, but I won’t be around to see my baby grow up? And the more cycles you do, the more you start to worry.

It’s natural to worry.

I worry… even though I know better. But to help keep my fears in check, I remind myself that infertility itself is a risk factor for ovarian cancer, so by defying it and becoming pregnant I may be helping my odds. I am also vigilant with my annual exams and I get an annual ovarian sonogram as well. By spacing the regular annual and the sonogram 6 months apart, I am examined every 6 months and like to think I’m boosting my odds of catching any problems that may arise early. [Fertile folks think I’m nuts going twice a year, but as we infertiles know, stirrups twice a year is a welcome change from stirrups every… stinkin... day.] If you are freaked out about cancer, you can follow my neurotic lead or listen to Dr. Kreiner.

Fortunately, Dr. Kreiner of Long Island IVF can put the fears of rational ladies like you to rest. Read on for some peace of mind:

I am often asked whether the medications we use in our fertility treatments can cause ovarian cancer. In the past, conflicting stories have been published mainly in the newspapers and non medical magazines. A scientific forum, Medscape Medical News, reviewed research on this topic and the good news is summarized below.

OnFebruary 10, 2009— It was concluded in the largest study of the subject to date that Fertility drugs do not increase the risk for ovarian cancer. There was no convincing association with ovarian cancer for any of the 4 different types of drugs used to treat infertile women — gonadotrophins (Bravelle, Menopur, Gonal F, Follistim), clomiphene citrate (Clomid, Serophene), human chorionic gonadotrophin (HCG,Novadrel, Ovidrel) and gonadotropin releasing hormone agonist/antagonist (Lupron, Ganirelix, Cetrotide).

Instead, the data suggest that factors related to the diagnosis of infertility (for example, genetic or biological factors) — and not the use of fertility drugs — increase the overall risk for ovarian cancer.

However, they also point out that there is a major limitation to this study — many of the participants have not yet reached the age at which the incidence of ovarian cancer peaks (early 60s).

The study, headed by Allen Jensen, PhD, assistant professor of cancer epidemiology at the Danish Cancer Society’s Institute of Cancer Epidemiology, in Copenhagen, Denmark, is reported online February 5, 2009 in BMJ(British Medical Journal).

These data are reassuring but cannot absolutely rule out a very small increase in ovarian cancer or one that occurs much later in life.

Main Limitation Is Age of Participants
A link between fertility drugs and increased risk for ovarian cancer was suggested by several studies in the early 1990s, and this has created concern for patients undergoing infertility treatment. However, many of the studies over the past 8 to 10 years have been very small and none were able to reject or confirm the hypothesis.

This study was the largest because it included 156 women with ovarian cancer, more than 3 times as many as any previous cohort.

The main limitation of the study, however, is the age of the participants. These were young women; they were first evaluated for infertility at a median age of 30 years. Despite a long follow-up, the median age of these women at the end of the follow-up period was 47 years. This is below the usual age at which women are diagnosed with ovarian cancer, which reaches a peak incidence in women in their early 60s. So there is a possibility that there could still be a spate of ovarian cancers diagnosed as these women age, which could alter the conclusions.

This is a question that nobody can answer yet, we should say that the data so far are reassuring with this observation period, and with this age of the cohort, we cannot see any association with an increase in the risk of ovarian cancer.

The researchers intend to revisit the data at regular points in the future to check on the progress of the study cohort with “passive surveillance.” The Danish system of personal identification numbers and nationwide health and cancer registries will allow them to track any new diagnosis of ovarian cancer.

Cannot Exclude Small Possibility
The Danish study investigated the records of 54,362 women with infertility problems, and compared 156 women who developed invasive epithelial ovarian cancer with 1241 controls.
However, although this study was much larger than previous investigations, it still could not exclude the possibility of a small increase in the risk for ovarian cancer in users of fertility drugs, The rate ratio for use of any fertility drug was 1.03, but the upper bound of the 95% confidence interval was 1.47.

Larger numbers of women will need to be studied to answer this question, and these will come with further follow-up of the cohort as they enter the age range where ovarian cancer is most common. Some women who take fertility drugs will inevitably develop ovarian cancer by chance alone, but current evidence suggests that women who use these drugs do not have an increased risk.

Clinical Context
Infertility has previously been associated with an increased risk for ovarian cancer. In an epidemiologic study of 3837 women treated for infertility, Rossing and colleagues demonstrated that infertility increased the risk for malignant ovarian tumors by a factor of 2.5 vs. the overall community prevalence of ovarian cancer. This study, which was published in theSeptember 22, 1994, issue of the New England Journal of Medicine, also suggested that the use of clomiphene in particular could increase the risk for ovarian cancer, particularly in women who had used the medication for more than 1 year.

The current study uses a large cohort of women to examine the effects of different fertility medications on the risk for ovarian cancer.

Study Highlights
• The study cohort consisted of women referred to Danish hospitals or infertility clinics between 1963 and 1998. A total of 54,362 women had data available for analysis.
• Cases of ovarian cancer were documented with use of 2 national registries: 176 women were diagnosed with epithelial ovarian cancer during a median follow-up of 16 years, and 156 women had data for analysis.
• The main outcome of the study was the relationship between fertility drugs and the risk for ovarian cancer. The 156 women with ovarian cancer were compared vs 1241 women from the infertile cohort who did not have ovarian cancer.
• The median year for entry into the infertility clinics was 1989, and the median age at the first evaluation for infertility was 30 years.
• The median time from entry into the cohort until the diagnosis of ovarian cancer was 14.5 years.
• Overall, the use of fertility drugs did not significantly affect the incidence of ovarian cancer. Fertility drugs were used by 49% and 50% of women with and without ovarian cancer, respectively.
• Clomiphene was the most widely used fertility drug, followed closely by human chorionic gonadotropins. Other gonadotropins and gonadotropin-releasing hormones were used less frequently.
• Nulliparity (No births) conferred an especially high risk for ovarian cancer in these women with infertility. The risk for ovarian cancer decreased with a higher number of births.
• The use of oral contraceptives and the cause of infertility did not significantly affect the risk for ovarian cancer.
• After adjustment for parity (Births), none of the individual fertility drugs were associated with a significant effect on the risk for ovarian cancer. The number of cycles used or the number of years since first use did not affect this conclusion.
• Similarly, combination treatment with multiple fertility drugs did not appear to increase the risk for ovarian cancer.
• Serous tumors were the most common histological type of ovarian cancer. Clomiphene use was associated with a higher risk for serous tumor vs. no use of fertility drugs but only in women who used clomiphene at least 15 years before the diagnosis of ovarian cancer.
• Previous research has found that infertility is associated with an increased risk for ovarian cancer, particularly in women who used clomiphene for more than 12 months.
• The current study suggests that fertility drugs do not significantly increase the risk for ovarian cancer.

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Do you worry about getting ovarian cancer from fertility drugs? Do you trust the results of studies like the ones referred to above?

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Micro-IVF Can Further Reduce Rare Risk of Ovarian Hyperstimulation Syndrome

By David Kreiner MD

July 17th, 2012 at 6:29 pm

Recent media attention* regarding the risk of ovarian hyperstimulation syndrome (OHSS) in in-vitro fertilization (IVF) cases– estimated by most sources at three percent (3%) for patients undergoing traditional IVF — has increased interest in minimal stimulation IVF, also known as Micro-IVF or Mini-IVF.  

Long Island IVF’s Micro-IVF program is five (5) years old and is registered with the Society of Assisted Reproductive Technology separately as East Coast Fertility under the medical directorship of Dr. David Kreiner and embryology directorship of Dr. John Moschella, who have a combined fifty years of IVF experience.

Since the merger of East Coast Fertility with Long Island IVF in October, 2011, the pregnancy rate for women under 35 years of age exceeds 50% per transfer with MicroIVF.  

Using clomid and two days of lowest dose gonadotropin hormones, this minimal stimulation has a 0% incidence of OHSS at Long Island IVF.  

Furthermore, a Micro-IVF procedure costs $3,900.00 plus the cost of the medications, and $500.00 for optional anesthesia.  

In tune with the safer minimal stimulation IVF, Long Island IVF also offers their Single Embryo Transfer (SET) Program to motivate patients to select the very safest procedure by avoiding the increased risk of multiple pregnancyassociated with a multiple embryo transfer.  Patients electing SET for traditional IVF or Micro-IVF pay nothing to freeze excess embryos and store them up to a year.

Certainly those concerned about OHSS, or those looking for a less costly alternative to traditional IVF should inquire about whether Micro-IVF–successfully performed by Long Island IVF’s doctors for five years—might be for them.

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Long Island IVF is holding its annual “Extreme Family-Building Makeover” contest to award a Free basic Micro-IVF cycle, valued at $3,900.00, to a woman without (or who has exhausted) infertility insurance coverage. You do not have to be a LIIVF patient or even a New York resident. Contest ends August 26, 2012. For details, rules, and to enter, click here: http://bit.ly/LHbmQR

Have you experienced severe OHSS during traditional IVF that required hospitalization? If so, did it stop you from pursuing traditional IVF again? Would you consider Micro-IVF?

*This letter was prompted in response to today’s New York Times article, entitled “High Doses of Hormones Faulted in Fertility Care”, by Jacqueline Mroz. See the full article here: http://nyti.ms/OJT4yu

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Forget the Bikini! Are You in Reproductive Shape?

By David Kreiner MD, and Tracey Minella

July 10th, 2012 at 9:00 am

It’s that time of year when your unused gym membership begs for renewal. I used to fall for that. Now I just scope out someone who looks worse than me to sit near on the beach. So lame, I know.

Alas…the trim, fit body of my youth is but a memory. I remember summers on the beach sporting the darkest tan and the smallest bikini I could get away with wearing when sneaking out to the ocean. I had no body issues back then. Way back then.

Then came the “freshman 15” from eating dorm food and doing midnight pizza runs. A pre-wedding diet wiped them away, only to find the same fifteen pounds creeping back during law school. Add a few more the summer of the bar exam. And BINGO… I was not in the best physical shape when we started TTC. Then, throw some more junk in my trunk from fertility meds and depression bingeing as each cycle failed. Suffice it to say, I didn’t give myself the best chance for fertility success.

You can learn from my mistakes.

Sure, being reasonably physically fit is important, but there’s so much more to making your baby dreams come true than being able to fit into that itsy bitsy teeny weenie yellow polka dot bikini.

Dr. Kreiner of Long Island IVF shares his tips for getting in fighting reproductive shape below:

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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So…are you in fighting reproductive shape? If not, what’s on your list to take care of next?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=16221&picture=girl-in-swimsuit

 

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7 Tips For Surviving the Fourth of July When Infertile

By Tracey Minella

July 3rd, 2012 at 2:59 pm

How exasperating is that title?

“Surviving”.

How awful that infertile folks live their lives in “survival mode” during the holidays. But it’s the sad truth. Infertility often takes the fun out of living and it certainly dampens the holidays.

For those perky types… who can handle their Clomid or Lupron, and still manage to wear a real smile to a picnic with 58 sparkler-toting toddlers… my hat’s off to you. Stop reading.

But the rest of you… who see the marshmallow stick not as a smores instrument, but rather as a weapon to take out your nagging, grandbaby-wishing mother-in-law… I have seven suggestions to get you through the festivities (be sure to read through to number seven):

  1. Put Yourself First. Give yourself permission NOT to go to any event you don’t really want to go to. And to NOT be around someone who twists you the wrong way. You come first. Their picnic will go on without you.
  2. Indulge. If your doctor is okay with it and you’re not cycling, consider allowing yourself to indulge in something that’s otherwise on your “off-limits” list…maybe a big ice cream sundae if you’ve been weight-watching, an extra jolt of caffeinated coffee, maybe even a small glass of wine. Haven’t you felt deprived enough?
  3. Pamper Yourself. Go get a massage or a kicky red, white and blue mani-pedi. Or whatever else you treat yourself with!
  4. Embrace the Solitude. Go for a walk alone (or with your partner) on the beach. There’s something about the water and the sand and the horizon that is calming and hopeful. And there’s lifeguards.
  5. Be Grateful. Find something in your life, no find three things, to be thankful for. Maybe your spouse, having a job, a home? Catch a parade and remember all the lives lost for our independence. Feeling grateful about something can actually help you feel slightly less depressed about what’s missing. And be grateful the holiday fell on a Wednesday, so you don’t have 3 straight days of barbeques to attend!
  6. Adjust the Focus. If you are going to be with folks who see you as the woman who doesn’t have/can’t have kids yet, show them another side of you. Bake and share a kickass apple pie from scratch and give them something else to talk about you over!
  7. Make a Wish. Your mission is to find a fireworks show. I don’t care if it’s your neighbor’s illegal cheesy display, a large, local professional extravaganza, or (my least favorite option) a televised fireworks show. Get thyself to something sparkly and explosive. Then make a quiet wish. Make it on the biggest boomer that lights up the night sky…or on a sparkler crackling in your hand. Let yourself believe it.

Here’s hoping your independence from infertility begins now… and that by this time next year you’ll behave yourself around the marshmallow sticks.

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What are your plans for the holiday?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=10460&picture=golden-fireworks

 

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