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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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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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IVF: The Chances of Success

By Dr. David Kreiner

November 19th, 2010 at 10:44 am

What everyone wants to know when they decide to look into invitro ferilization (IVF) as a treatment option is "what is my chance for success?"  It’s a complicated question and the answer varies from  patient to patient. But let me try to break down a little bit for you.

In 2002 about 28% of cycles in the United States in which women underwent IVF and embryo transfer with their own eggs resulted in the live birth of at least one infant. This rate has been improving slowly but steadily over the years.  Patients should be aware, however, that some clinics define "success" as any positive pregnancy test or any pregnancy, even if miscarried or ectopic. These "successes" are irrelevant to patients desiring a baby. To put these figures into perspective, studies have shown that the rate of pregnancy in couples with proven fertility in the past is only about 20% per cycle. Therefore, although a figure of 28% may sound low, it is greater than the chance that a fertile couple will conceive in any given cycle.

Success varies with many factors. The age of the woman is the most important factor, when women are using their own eggs. Success rates decline as women age, and success rates drop off even more dramatically after about age 37. Part of this decline is due to a lower chance of getting pregnant from ART, and part is due to a higher risk of miscarriage with increasing age, especially over age 40. There is, however, no evidence that the risk of birth defects or chromosome abnormalities (such as Down’s syndrome) is any different with ART than with natural conception.

Success rates vary with the number of embryos transferred. However, transferring more embryos at one time not only increases the chance of success with that transfer, but will also increase the risk of a multiple pregnancy, which are much more complicated than a singleton pregnancy. The impact of the number of embryos that are transferred on success rates also varies with the age of the woman.

Pregnancy complications, such as premature birth and low birth weight, tend to be higher with ART pregnancies, primarily because of the much higher rate of multiple pregnancies. Nationally, in 2002-2003 about 30% of ART deliveries were twin deliveries, versus 1-2% of spontaneous pregnancies. The risk of pregnancy containing triplets or more was 6% in 2003.

As women get older, the likelihood of a successful response to ovarian stimulation and progression to egg retrieval decreases. These cycles in older women that have progressed to egg retrieval are also slightly less likely to reach transfer.  The percentage of cycles that progress from transfer to pregnancy significantly decreases as women get older.  As women get older, cycles that have progressed to pregnancy are less likely to result in a live birth because the risk for miscarriage is greater.  This age related decrease in success accelerates after age 35 and even more so after age 40.  Overall, 37% of cycles started in 2003 among women younger than 35 resulted in live births. This percentage decreased to 30% among women 35–37 years of age, 20% among women 38–40, 11% among women 41–42, and 4% among women older than 42.  The proportion of cycles that resulted in singleton live births is even lower for each age group.

The success rates vary in different programs in part because of quality, skill and experience but also based on the above factors of age, number of embryos transferred and patient population.  Patients may also differ by diagnosis and intrinsic fertility which may relate to the number of eggs a patient may be able to stimulate reflected by baseline FSH and antral follicle count as well as the genetics of their gametes.  These differences make it impossible to compare programs.

Another factor often overlooked when considering one’s odds of conceiving and having a healthy baby from an IVF procedure is the success with cryopreserved embryos.

Thus, a program which may have a lower success rate with a fresh transfer but much higher success with a frozen embryo transfer will result in a better chance of conceiving with only a single IVF stimulation and retrieval.  Success with frozen embryos transferred in a subsequent cycle also allows the program to transfer fewer embryos in the fresh cycle minimizing the risk of a riskier multiple pregnancy.  It may be more revealing to examine a program’s success with a combination of the fresh embryo transfer and frozen embryo transfers resulting from a single IVF stimulation and transfer.  For example, at East Coast Fertility, the combined number of fresh and frozen embryo transfers that resulted in pregnancies for women under 35.from January 1, 2002 to December 2008 was 396.  The number of retrievals during that time was 821.  The success rate combining the fresh and frozen pregnancies divided by the number of retrievals was 61%.  The high frozen embryo transfer pregnancy rate allowed us to transfer fewer embryos so that there were 0 triplets from fresh transfers during this time.

What can I do to increase my odds?

Patients often ask if there are any additional procedures we can do in the lab that may improve the odds of conception.  Assisted hatching is the oldest and most commonly added procedure aimed at improving an embryo’s ability to implant.  Embryos must break out or hatch from their shell that has enclosed them since fertilization prior to implanting into the uterine lining.  This can be performed mechanically, chemically and most recently by utilizing a laser microscopically aimed at the zona pellucidum, the shell surrounding the embryo.  Assisted hatching appears to benefit patients who are older than 38 years of age and those with thick zonae.

Recently a protein additive called “Embryo glue” was shown to improve implantation rates in some patients whose embryos were transferred in media containing “Embryo glue”.  Time will tell if the adhesive effect of this supplement is truly increasing success rates and warrants wide scale use in IVF programs.

Embryo co culture is the growth of developing embryos is the same Petri dish as another cell line.  Programs utilize either the woman’s endometrial cells obtained from a previous endometrial biopsy or granulosa cells obtained at the time of the egg retrieval from the same follicles aspirated as the eggs.  Growth factors produced by these endometrial and granulosa cell lines diffuse to the developing embryo and are thought to aid in the growth and development of the embryo.  It appears to help patients who have had previous IVF failures and poor embryo development.

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Understanding Fibroids

By David Kreiner, Md

October 29th, 2010 at 2:11 am

Fertility is dependent upon so many things!

We must have healthy gametes (eggs and sperm) capable of fertilizing and implanting in a uterus with a normal endometrial lining unimpeded by any uterine or endometrial pathology. The sperm need be in sufficient number and capable of swimming up through a cervix which is not inflamed and provides a mucous medium that promotes sperm motility. The eggs need to ovulate and be picked up by normal healthy fimbriated ends (finger like projections) of the fallopian tubes. The tubes need to be covered with normal micro hairs called cilia that help transport the egg one third of the way down the tube where one of the sperm will fertilize it.

The united egg and sperm (the “conceptus”) then needs to undergo cell division, growth and development as it traverses the tube and makes its way to the uterine cavity by the embryo’s fifth day of life at which point it is a blastocyst. The blastocyst hatches out of its shell (“zona pellucidum”) and implants into the endometrial lining requiring adequate blood flow.

And you wonder why getting pregnant is so hard?

All too often patients, in some groups as many as 30% of women, are told that they have fibroids that may be contributing to their infertility. Fibroids or leiomyomata are non malignant smooth muscle tumors of the uterus. They can vary in number, size and location in the uterus including; the outside facing the pelvic cavity (subserosal), the inside facing the uterine cavity (submucosal) and in between inside the uterine wall (intramural). Fortunately, most fibroids have minimal or no effect on fertility and may be ignored.

The subserosal myoma will rarely cause fertility issues. If it were distorting the tubo- ovarian anatomy so that eggs could not get picked up by the fimbria then it can cause infertility. Otherwise, the subserosal fibroid does not cause problems conceiving.

Occasionally, an intramural myoma may obstruct adequate blood flow to the endometrial lining. The likelihood of this being significant increases with the number and size of the fibroids. The more space occupied by the fibroids, the greater the likelihood of intruding on blood vessels traveling to the endometrium. Diminished blood flow to the uterine lining can prevent implantation or increase the risk of miscarriage. Surgery may be recommended when it is feared that the number and size of fibroids is great enough to have such an impact.
However, it is the submucosal myoma, inside the uterine cavity, that can irritate the endometrium and have the greatest effect on the implanting embryo.

To determine if your fertility is being hindered by these growths you may have a hydrosonogram. A hydrosonogram is a procedure where your doctor or a radiologist injects water through your cervix while performing a transvaginal ultrasound of your uterus. On the ultrasound, the water shows up as black against a white endometrial border. A defect in the smooth edges of the uterine cavity caused by an endometrial polyp or fibroid may be easily seen.

Submucosal as well as intramural myomata can also cause abnormal vaginal bleeding and occasionally cramping. Intramural myomata will usually cause heavy but regular menses that can create fairly severe anemias. Submucosal myomata can cause bleeding throughout the cycle.

Though these submucosal fibroids are almost always benign they need to be removed to allow implantation. A submucosal myoma may be removed by hysteroscopy through cutting, chopping or vaporizing the tissue. A hysteroscopy is performed vaginally, while a patient is asleep under anesthesia. A scope is placed through the cervix into the uterus in order to look inside the uterine cavity. This procedure can be performed as an outpatient in an ambulatory or office based surgery unit. The risk of bleeding, infection or injury to the uterus or pelvic organs is small.

Resection of the submucosal myoma can be difficult especially when the fibroid is large and can sometimes take longer than is safe to be performed in a single procedure. It is not uncommon that when the fibroid is large, it will take multiple procedures in order to remove the fibroid in its entirety. It will be necessary to repeat the hydrosonogram after the fibroid resection to make sure the cavity is satisfactory for implantation.

The good news is, when no other causes of infertility are found, removal of a submucosal fibroid is often successful in allowing conception to occur naturally or at least with assisted reproduction.

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Should Doctors Talk About Money?

By David Kreiner, MD

September 29th, 2010 at 7:14 am

One of the most distressing things I face in practice is when I get negative feedback from a referring physician.  Fortunately, it happens rarely but recently I was shocked about the complaint.  Apparently, his patient was offended that I discussed the finances involved with her treatment.  Her Ob Gyn agreed with her that it was inappropriate for me to discuss the cost of her options.  He told me, “I like you and think East Coast Fertility is an excellent program but I never talk about money directly to patients!  It’s not – I don’t know…seemly!”   “Money issues are discussed with the business office, the doctor only discusses the medicine”.

Perhaps it’s unfortunate that fertility doctors have to be so concerned about their patient’s pocket books unlike other fields of medicine that are usually covered by some measure of insurance.  But in the case of infertility with only a handful of states having some kind of mandated coverage – not everybody in the United States -  mandate or no mandate for infertility  -even has health insurance!  Many fertility patients are in some form or another “cash pay” patients.  One of the most popular places that patients visit when they go to any fertility clinic’s website is the finance page.  This is simply a fact of life.

For this reason I have developed many programs that will create access to fertility care for as many people as possible.  But here is the catch! One program does not fit all. These are simply not over sized tee shirts – each of these programs represent a certain course of  medical care – and each individual and couple needs the assistance of a caring doctor to help them choose the right program that will fit their own particular medical history.  In addition to the NY State DOH Grant Program and our own East Coast Fertility Grant Program, we have the Micro-IVF Program, The Money Back Guarantee Program,  and The Single Embryo Transfer Program.  The most effective treatment and the most efficient is always a full stimulation IVF. However, if someone has insurance coverage for IUI and meds but not IVF then they may prefer to do IUI. If they do not have coverage for IUI either then it may be more cost effective to do the Micro-IVF Program or minimal stimulation IVF at 2-3 x the success of IUI with less risk than gonadotropin IUI and less cost per pregnancy. Yet at a price of $3900 it may be more attractive than a full stimulated IVF. There is also The Single Embryo Transfer Program where we reward patients transferring one embryo at a time by making their cryo, embryo storage and unlimited frozen embryo transfers for free.  Others prefer the insurance of The Money Back Guarantee Program where patients are offered six IVF retrievals and frozen embryo transfers for a fixed fee that is refunded if they do not result in a live birth.   In order to inform patients about our success and programs that make IVF more available to them we offer free consultations.

In today’s world of fertility care – a good doctor will help a patient find not only the right treatment but how to access that care.  In order to do that – a doctor may have to do what some may think is unseemly – and that is to talk about money.

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