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Archive for the ‘David Kreiner’ tag

A Eulogy to Robert Edwards

By David Kreiner, MD

April 13th, 2013 at 11:34 pm

 

image courtesy of: freedigitalphotos.net/credit: Photokanok

Robert Edwards, the British scientist responsible for developing the first successful In Vitro Fertilized baby in the world in 1978, died this week.  Since then over 5 million babies have been born as a result of the IVF technology he pioneered and eventually won him the Nobel Prize in 2010.  Today, 1-4 % of all babies born in Europe, North America and Australia are the result of this assisted reproductive technology started by Professor Robert Edwards.

 

For those of us affected by infertility or who dedicate our life’s work to IVF, we owe much to this brilliant man whose perseverance in the 1960′s and 1970′s in embryologic research made it possible for us to experience the miracles we now are fortunate to know as our children and the children of our patients, friends and relatives.

 

I had the good fortune to meet Professor Edwards in the 1990′s.  He astounded me with his intelligence, his humility and his humor.  I told him about our Long Island IVF softball team that we had at the time which made him laugh hysterically.  

 

It was ironic to him that IVF which had been his research project for decades as well as a world controversy had made it to the everyday mundane status of American softball.

 

We owe much to this great man and will forever hold his memories dear to our hearts.

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What would you have said to, or asked, Robert Edwards if your paths had ever crossed?

Photo credit: freedigitalphotos.net

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Infertility Podcast Series: Journey to the Crib: Chapter 5

By David Kreiner, MD

March 12th, 2013 at 8:39 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Five. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=39

Meet the Doctor

A woman’s desire to have children can be colossal, yet many are unable to take that first step to overcoming the impediments to their fertility.  Seeking assistance from a qualified reproductive endocrinologist whose sole focus and practice is on such issues will put affected individuals on the right path to achieving motherhood.

I have now, over my twenty seven years of infertility practice, experienced thousands of first encounters with infertility patients.  I know that those coming to see me have various degrees of past disappointments and frustrations and have suffered depression, anxiety and relationship problems because of it.  This presents quite a challenge to me as the physician encountering a patient in need for the first time.

I have several goals that I strive to achieve in this first visit.  First, and perhaps most important is to get to know my patients and form a bond.  This would assist us as we work through our plan of treatment.  Email is a wonderful way for patients to communicate with their physicians and I encourage patients to ask questions and vent frustrations before they become a problem.

As it may be difficult to hear everything a physician says during this appointment, I recommend that patients bring with them their partner or some supportive individual who can serve as a second set of ears.  Since no patient will retain everything that is said to them, we hand patients a written treatment plan, offer information on our website and blog, and repeat information at subsequent visits.  Again, email is always available for questions.

This first visit is a critical step for a woman to take when she encounters difficulty conceiving.  Choosing the right doctor for you will set you on the right path.  It is essential that you select a fellowship trained Reproductive endocrinologist with whom you can communicate your problems.

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If you’ve gone, what was YOUR first visit to the Reproductive Endocrinologist like? If not, what’s holding you back?

 

Please share your thoughts about this podcast here.

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Infertility Podcast Series: Journey to the Crib: Chapter 4

By David Kreiner MD

March 4th, 2013 at 9:59 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Four: Where Do You Go? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=34

 

Where Do You Go?

 

I try to help the reader understand the published statistics offered online by SART, the national organization of IVF programs that provides a registry of IVF programs who submit their data for audit by SART.  Rates are offered with a numerator and a denominator with the critical goal of a live baby per retrieval or transfer being the most crucial statistic.

 

The benefits and disadvantages of large programs are discussed basically offering that larger programs tend to have more experienced and often skilled personnel albeit with more waiting time for monitoring.  Some programs may provide more personalized care, some more psychological or emotional support and some offer adjunctive therapies such as acupuncture and mind body programs.

 

I emphasize the importance of the embryology lab as well as the skill of the physician performing the embryo transfer.  The technique of the transfer is described including factors that I believe may affect success rates.

 

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Please share your thoughts about this podcast here.

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Infertility Podcast Series: Journey to the Crib: Chapter 2

By David Kreiner, MD

February 19th, 2013 at 4:50 pm

Welcome to the Journey to the Crib Podcast. We will have a blog discussion each week with each chapter.

This podcast covers Chapter Two: The Pregnancy Test is Negative Again-What Do I Do? You, the viewer, are invited to ask questions and make comments.  You can access the podcast here:  http://podcast.longislandivf.com/?p=20

A negative pregnancy test is a reminder of all the feelings of emptiness, sadness and grief over the void created by infertility.  This chapter was written to arm the reader with infertility with a strategy to fight off the potentially damaging effects that this condition can do to the afflicted individual.

The first step in dealing with the emotional onslaught that infertility brings includes focusing on breathing, meditation and seeking support from a partner or friend.  Perspective through knowledge in the fact that fertile couples only conceive every five months means that the infertile couple is in good company with many future moms and dads.

The next step is seeking help from a trained professional, a reproductive endocrinologist, whose focus is on helping infertility patients.  He/she works with infertile couples to develop a plan based on diagnosis, age, years of infertility, motivation as well as financial and emotional means to support that therapy.

Therapy may be surgical or medical.  They may include intrauterine inseminations or IVF with minimal or full stimulation.  There may be diagnostic tests, yet undone that may prove to be of value in ascertaining a cause for the problem and facilitate treatment.

Complementary and adjuvant therapies may offer additional success potential and emotional support by improving the health and wellness of an individual.  The mind body programs and acupuncture are the most popular of these.

A strategy for dealing with the negative pregnancy test is offered with the intent of helping patients take control of their lives, improve their health and well being and increase the likelihood that the next test will be a positive one.

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Please share your thoughts on the podcast and ask Dr. Kreiner any questions.

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Negative Pregnancy Test Again! What Do I Do?

By David Kreiner MD, and Tracey Minella

January 30th, 2012 at 6:08 pm


Throwing the negative pee stick …or anything else … through the window isn’t going to help anything. So what’s a woman to do when faced with yet another horrible disappointment in the bathroom?

Fortunately, Dr. Kreiner of Long Island IVF has some helpful advice:

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 who 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 to get through the disappointment? (I’d give my own advice but, as a pee stick thrower, I’m not one to talk…)

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Happy Birthday, Dr. Kreiner!

By Tracey Minella and David Kreiner MD

November 28th, 2011 at 12:00 am

Today is Dr. Kreiner’s birthday. I always remember this day, not because he is my boss, not because he is my friend, but because he was my doctor.

Where would I be if he had not been born?

I might have had children, but they would not have been the exact ones I have now. They would not be the same ages or have come into my life in exactly the same way.

My journey was what it was because Dr. Kreiner was born. He decided to be an RE and to pioneer IVF on Long Island, precisely at the time that I needed him to be there. And there are hundreds, maybe thousands, of other couples who feel like me.

So, in honor of Dr. Kreiner’s birthday, I’m sharing one of his posts about a tender moment Grandpa Kreiner shared with his grandson about the wonderful work he does:

Last night I tucked my grandson Jayden into bed. “Saba,” which is Hebrew for grandfather, Jayden said, “What do you do at work?” I thought back to when I first talked to his dad, my son Dan, about the birds and the bees. Well, I thought, I help those in need make babies but how do I explain this to a three year old?

I need to explain that my patients are suffering, some so severely that it affects their marriage, their jobs and often their health. I’m responsible for alleviating their suffering. I share my compassion for their troubles, hoping I may start to develop a bond with them.

I meet with each couple to try to evaluate the presence of any relationship problems. Sometimes these problems are sexual in nature, often related to difficulties with communication and, unfortunately, sometimes include violent behavior on the part of one or both spouses. Working with a program that employs a highly-trained mental health professional and a mind-body team approach helps alleviate stress, works on relationships and helps improve the health of my patients through nutrition, acupuncture and massage, as well as support groups. A healthier, less stressed patient with proper flow of Qi is more likely to conceive with my most advanced scientific infertility treatments available to man.

So I say to Jayden, “Saba is a doctor who helps people become mommies and daddies.” Jayden was not sure he was satisfied. His face frowned. He shrugged his shoulders and raised his arms, palms turned up. “How Saba?” he asked.

“With G-d’s help and the help of all those good dedicated men and women who work with me in the office,” I replied. With that, I looked at my grandson with all the joy and love a grandparent can feel for his grandchild, to which Jayden added, “Can we play another game of Wii?”

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BE SURE TO CHECK IN TOMORROW FOR THE WINNER OF THE THANKFULNESS CONTEST!

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Yom Kippur, Infertility, and the Wrong Path Taken

By Tracey Minella and David Kreiner MD

October 7th, 2011 at 9:25 pm

Today is Yom Kippur, the holiest day of the year in the Jewish faith. It’s a day of atonement for Jews. A day when they look back on the choices they’ve made and the goals they’ve set and ponder things like what mistakes or wrong decisions they may have made that have led them down a path they did not intend to take.

Sometimes, mistakes may have landed patients on the path of infertility.

Dr. Kreiner, of East Coast Fertility examines a common situation he encounters where poor decisions…or indecision…on behalf of patients and their GYNs leads them down a path they certainly did not intend:

A friend of mine was complaining to me about the trouble he got into with his homeowner’s association because he did not hide his empty garbage cans in his garage but left them behind his cars in front of his house.  It was 20 feet from the curb, he claimed, still distraught that he should have been scolded for breaking the rule.  “I didn’t know”.  That phrase, “I didn’t know” clicked in my brain as a recurrent declaration from the frustrated patients who I see every day.

My infertility practice is filled with patients who spent years of their lives all the time assuming that their fertility would be there when they were ready.  Some even mentioned their failed attempts at conceiving to their gynecologist who may have reassured them or if it were a more aggressive clinician, he may have put them on clomid for 3 to 6 months.  Meanwhile these women got older, many over 40 not realizing that time was chipping away at their fertility.  “They didn’t know”.

A fertility screen is a good way to assess annually what is happening to your fertility independent of your age.  This is accomplished by getting day 2 or 3 FSH and estradiol levels as well as an ultrasonographic antral follicle count.  An AntiMullerian Hormone level can be checked at any point in the cycle and likewise reflect the relative number of eggs left giving some reassurance about a person’s remaining fertility.

What do I as a reproductive endocrinologist who sees the damage done by this benign neglect on a daily basis do to wake people up to the fact that fertility is a temporary state that needs to be taken advantage of when the time is right?  Recently there was a report of doctors taking ovarian tissue/eggs from a child to preserve her fertility.  It’s hard for me to imagine that this is the future solution for the masses.  However, egg freezing technology is shortly becoming acceptable therapy with ever increasing success and lack of problems being noted.

Patients who are not in a position to execute their reproductive rights while they are still fertile should consider egg freezing when they do not have a partner to share in conception.  With a willing and available partner, freezing embryos is the most viable option.

But without question, couples who are ready to start a family, should seek assistance from a reproductive endocrinologist who specializes in helping those such as yourselves build your families.  Even when not covered by insurance, there are affordable options such as minimal stimulation IVF ($3900 at East Coast Fertility), grants and studies that make the process within reach of most people in need.   So do not become another victim to “I didn’t know”.  Take action, see a reproductive endocrinologist and get on the right path to building that family of your dreams.

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My IVF Doc Can Take Your IVF Doc (With One Hand Behind His Back!)

By Tracey Minella and David Kreiner MD

April 26th, 2011 at 1:42 am


“Nyeh, Nyeh. My RE is better than your RE!”

“Is not!”

“Is TOO!”

“No way!”

“YES WAY!”

Well, the words may be more polished than the childish playground bullies use…or in some heated cases, maybe not… but the sentiment is the same. Some of us adore our RE’s. Others are indifferent, cautiously saving the kudos for when their pee stick evidence is in. And the unlucky ones have freakin horror stories to share from choosing the doc who graduated in the bottom of the class.

My RE graduated in the top of his class and learned beside the doctors who pioneered IVF in America. A real science geek. And it turns out that he can even string a few sentences together in a coherent fashion, having authored Journey to the Crib.

So, I dug out an old blog post he wrote last June to give all those who are coming here for the NIAW contest (or from ICLW) a glimpse into the funny, poignant family man, Dr. Kreiner really is, not the stiff academic his credentials would lead you to imagine.

So before I leave you with his words, I have one parting shot for anyone who thinks their RE is better: “You wanna step outside?!”

Dr. David Kreiner of East Coast Fertility and The Miracle on Old Country Road:

I was feeling depressed the other day.  It seemed that we had insurmountable computer issues, staff morale was down and my family was acting rebellious.  My kids were arguing with each other, with me and I found myself mindlessly walking out of my office down Old Country Road.

I came to a busy intersection and just stood there as cars sped by me.  Honestly, at that moment in time I was thinking, why am I here?  Why put up with all the hard work at the office trying to make the practice viable despite the pressures of the recession?  Insurance companies were denying claims and when they were paying claims, it was at lower reimbursements that threatened to not compensate for our expenses.  The government was planning to lower reimbursements even more.  Patients, also experiencing financial difficulties were either asking for more breaks in the fees or not paying.  I have to admit I gave thought to giving it all up as the pain and aggravations were not worth the efforts.

Suddenly, a white Audi convertible came to a screeching stop right next to me.  It was one of my patients in the passenger seat sporting a very pregnant belly and apparently blowing through what I assumed was a labor pain.  Her husband spoke.  “Dr. Kreiner, Lara went into labor early this morning and we are on our way to the hospital to have the baby…can you come with us?”  Speechless and shocked, I let myself into the cramped backseat and tried to comprehend what was happening as Lara’s husband took off.

We pulled into the emergency room five minutes later.  Lara and I were taken to the labor floor while her husband dealt with the paperwork at the desk.  Nurses barked orders, the doctor was called, and Lara started screaming during her pains and in this laboring frenzy I was awakened from my funk.  It has been awhile since I was involved in a delivery but this baby was not waiting for the doctor and I got back into obstetrical mode, checking the baby’s position and heart rate and getting the anesthesiologist to administer the epidural.  Lara’s husband was now at her side assisting her with her breathing.

“Push Lara, push”, I yelled as I saw the baby’s head crowning.  She and her husband acted as if they had trained all pregnancy for this moment, working together as a team, his arm around her shoulders, breathing with her and supporting her back as she pushed.

Well, the doctor got there just before the baby was delivering.  I stood on the side watching this miraculous event…Lara and her husband together pushing the baby out of the same womb that I had implanted nine months earlier.  I remembered the image of showing Lara and her husband the photograph of the embryo and then watching on ultrasound as I injected the drop of media and air bubble containing the microscopic embryo into her uterus.  I thought how sweet life was and I smiled.

Moments later, Lara put baby Adam to breast, her husband a proud new father was beaming as he gave out chocolate cigars to the doctor and nurses and then came to me with tears in his eyes and said, “Thank you, so much Dr. Kreiner.  We could never have done this without you.  This will be my first Father’s Day and I couldn’t be happier.”

What can I say?  It was as if my problems never existed.  I thought the only thing missing for me was to be with my family and appreciate what I have.  And what my wife and I have is truly amazing.  We have my two lovely daughters and two sons, one with a fantastic girlfriend who he just moved in with and another son who has the best wife and most gorgeous three children one can ever wish for.  Playing with them, having brunch and dinner with the family I love, I enjoyed a very Happy Father’s Day.

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How important is it to you to actually like your fertility doctor on a personal level instead of just a professional level? Should you put up with a good doctor with a lousy bedside manner…or are you entitled to more?

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What Does ECF and Hot, Sexy Firemen Have in Common?

By Tracey Minella

April 7th, 2011 at 12:00 am

Well…….both will have booths at the Long Island Women’s Expo this weekend!

Um, yep. That’s about it.

DISSED! (Oh, c’mon… you didn’t really expect me to call the doc who helped me conceive “hot and sexy”. That’d be like kissing your brother! Besides, we’re friends now…or we were friends…and it’s so much more fun to commit blog- writing career suicide.)

Well, let me get off the hot seat to tell you that you simply can’t miss this event this weekend, April 9th and 10th  at the Suffolk County Community College, Brentwood Campus. It’s still too cold to plant anything, so why not venture out to the Expo where things promise to be HOT, HOT, HOT.

Remember those hot firemen? They’re putting on a fashion show on Saturday for charity! Talk about melting…

But if you really want to get fired up, visit the East Coast Fertility Booth #119. Come over and say “hello”. There are free raffles each day for both Dr. Kreiner’s amazing book, Journey to the Crib, and Jodi Picoult’s new bestseller, Sing You Home. We’ll have representatives from different ECF departments there to answer your questions, or if you prefer not talking in public, you can sign up for our free e-newsletter.

All the info you need about the Expo, including a downloadable coupon for discounted admission, is available at http://www.longislandwomensexpo.com/exhibitors.html .

So grab a girlfriend and head on out for a day that’s all about the things that matter to women.

And to the ECF docs who felt dissed: Remember, any man can handle his hose, but it takes real brilliance and skill to handle a wand. And make magic.

Now, that’s HOT.

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Making IVF Affordable for Couples

By East Coast Fertility

December 19th, 2010 at 6:19 pm

Most people do not have insurance coverage for in vitro fertilization (IVF), forcing many patients to make treatment decisions based on their budget and not on best practices. Unfortunately, fertility clinics have not made care more affordable to assist their patients in making better decisions. Without good options, patients often resort to less expensive treatments including ovulation inducing hormones that stimulate multiple eggs to ovulate resulting in high risk, costly multiple pregnancies. IVF can avoid these multiple pregnancies by limiting the number of embryos transferred. In this way, affordable IVF saves money with less need for hospital beds, NICU beds and disability care. 
“It is my strong belief that every infertility center in the United States needs to restructure their costs in some way even if means making less money,” says David Kreiner, MD FACOG| Medical Director at East Coast Fertility (ECF). “Our clinic’s Single Embryo Transfer Program incentives transferring one embryo at a time so patients don’t have to feel they must hedge their bets and transfer more embryos to increase the chance of pregnancy.” 
A patient in the ECF program pays only for the initial fresh cycle. Thereafter, the cryopreservation of the embryos, the storage of the embryos and unlimited frozen embryo transfers are free. This eliminates the financial need for the patient to put all her eggs in one basket. 
ECF also offers a minimal stimulation program, MicroIVF, that not only is affordable ($3900) but eliminates the risk of hyperstimulation syndrome, uses fewer medications and minimizes the risk of developing a multiple pregnancy. MicroIVF is essentially the cost of IUI with ovulation inducing medications without the risk and better than twice the success. 
“I am so proud to work with a clinic who is a leader not just in reproductive care but in reproductive ethics,” says Pamela Madsen, founder of The American Fertility Association and The Fertility Advocate. “ECF offers income based sliding scale grants including the NYState DOH grant to patients doing IVF.” 
When combining an ECF grant with an IVF study, patients receive ICSI, cryo, unlimited frozen embryo transfers, medications, coculture and embryo glue for $6900. Some patients have a limited budget that they can apply to IVF treatment. For them a money back refund such as in ECF’s IVF Guarantee Program is ideal because in the absence of the birth of a live baby, the IVF fee minus the cost for medication and anesthesia is refunded 100%. 
“My wish is to assist all patients in need with creating that healthy family of their dreams without adding unnecessary risk,” says Kreiner. “Our programs help them in their quest. Until the government and insurance companies step up with coverage, it is up to the IVF programs themselves to help patients get the IVF that they need to build their families.”

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