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Archive for the ‘Dr. Joseph Pena’ tag

Another Long Island IVF Doctor Named to the Super Docs List!

By Tracey Minella

May 28th, 2017 at 3:05 pm

 

 

Happy to share some great news: The New York Times Magazine’s annual “Super Docs” list for 2017 was published and another one of our doctors has now joined two of our other doctors on the list!

 

Long Island IVF co-founder, Dr. Daniel Kenigsberg, along with doctors, Dr. Joseph Pena and Dr. Michael Zinger, were named as New York “Super Doctors” in the field of Reproductive Endocrinology, securing three spots on the elite list. This is the fourth straight year for Drs. Pena and Zinger.

 

You can’t buy your way onto the list through paid advertising, or get on it by generating the most “likes” in a social media campaign (but feel free to come over and “like” us on Facebook anyway at http://www.facebook.com/longislandivf!) What is special about this honor is that Super Docs are chosen by their peers. It’s doctors recognizing other doctors’ talent and ability.

 

We know of many other top notch doctors…both on the Long Island IVF team and in other fields who are not included on the Super Doctors list… and are humbled by this recognition. Thanks to all the physicians who voted for Drs. Kenigsberg, Pena, and Zinger for this honor.

 

Thanks also to our wonderful patients, who so often sing the praises of their LIIVF doctors. It’s possible that some of the doctors who nominated our physicians as Super Docs may have first heard about them from you! You are the reason we all love what we do every day.

 

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Have you ever told another doctor about your LIIVF experience or recommended your LIIVF doctor?


 

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5 Popular Misconceptions Regarding Polycystic Ovary Syndrome (PCOS)

By Dr. Joseph Pena

June 22nd, 2015 at 11:23 am

 

via WikipediaCommons pubdomain”]

By Schomynv [CCo


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

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

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

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

—  Nonclassical congenital adrenal hyperplasia (Nonclassical CAH)

—  Androgen-secreting tumor (ovary, adrenal gland)

—  Exogenous androgens

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

—  Central nervous system tumors/disorders

—  Primary ovarian failure

—  Cushing syndrome

—  Insulin-receptor defects

 

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

 

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

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

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

 

Myth #3 – PCOS is an ovarian cystic problem.

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

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

—  Increased ovarian volume > 10 cm3

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

—  Presence of one PCO is sufficient for diagnosis

 

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

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

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

 

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

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

FEATURES OF POLYCYSTIC OVARY SYNDROME

PREVALENCE

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

 

 

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

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

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

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

 

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

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Long Island IVF Doctors Are Recognized as “Super Doctors” Again!

By admin

May 15th, 2015 at 10:39 am

 

 

Dr. Pena


Did you catch the big news? New York Times Magazine named this year’s “Super Docs” list on Sunday and you might just recognize a name or two!

Long Island IVF doctors, Dr. Joseph Pena and Dr. Michael Zinger, were named as New York “Super Doctors” in the field of Reproductive Endocrinology, securing two of only about a dozen spots on the elite list, which only includes two doctors on Long Island, and the remaining in the NYC area.

What makes this exciting and humbling is that “Super Docs” honorees are chosen by their peers. You can’t buy your way onto the list through paid advertising, or get on it by generating the most “likes” in a social media campaign (but feel free to come over and “like” us on Facebook anyway at http://www.facebook.com/longislandivf!) It is doctors recognizing other doctors’ talent and ability.

Dr. Zinger

We know of many other top notch doctors…both on the Long Island IVF team and in other fields who are not included on the Super Doctors list… and are humbled by this recognition. Thanks to all the physicians who voted for Drs. Pena and Zinger for this honor.

And of course, we’d like to thank our wonderful patients, who so often sing the praises of their LIIVF doctors… because it’s possible many of the doctors who nominate our physicians for these honors may have first heard about them from you! You are the reason we all love what we do every day.

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Have you ever told another doctor about your LIIVF experience or recommended your LIIVF doctor?

 

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Long Island IVF WINS “Best In Vitro Fertility Practice” in Best of Long Island 2015!

By admin

January 20th, 2015 at 2:28 pm

 

It is with humble yet excited hearts that we announce that Long Island IVF was voted the Best In Vitro Fertility Practice in the Best Of Long Island 2015 contest. Unlike prior years, for the 10th anniversary of the BOLI contest, there could only be one winner per category with no runners-up.

We just received word that we won. Thanks to all of you!

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

We love what we get to do every day…build families. And that’s all the thanks we really need. But your endorsement of us to your friends, families, and the public (by voting for us) means so much and will enable us to help even more infertile couples fulfill their dreams of building a family.

As we usher in 2015…our 27th year…we will continue to offer our unique blend of cutting-edge medical technologies and holistic, personal support… wrapped in the comfort of a private, non-hospital setting.

Thanks again. Happy New Year to all.

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Long Island IVF’s 25th Anniversary Reunion Recap

By Tracey Minella

May 17th, 2013 at 9:14 pm

 

The only thing more perfect than the beautiful spring weather for Long Island IVF’s 25th Anniversary reunion party yesterday was the smiles on the faces of all of our babies and their grateful parents!

Every spring, Long Island IVF celebrates the births of our most recent IVF arrivals with a picnic for that year’s newborns and their parents. But this year…for our big anniversary…we opened it up to all 5,000+ couples whose families we’ve helped build over the past quarter century! Please “like” us on Facebook and check out some more reunion pictures there.

For those who don’t know, Long Island IVF was the practice to bring Long Island its first IVF baby, first FET/cryo baby, and first donor egg baby. The same doctors who co-founded Long Island IVF twenty-five years ago are still partners today.

We cherish every little life we’ve helped create, from the college grads to those being conceived today. But it was especially exciting to reunite with some of our oldest babies, now all grown-up, including the second baby born to Long Island IVF’s program, Alyssa.

Alyssa is the beautiful 24 year-old blonde in the picture with Dr. Kreiner. She and her mother came (her 21 year-old younger brother couldn’t make it) and they were instant “celebrities” as word spread throughout the crowd that Baby #2 was “in the house”. They each addressed the crowd, recalling how important Long Island IVF was in their lives, in a very emotional moment of the day that really helped bring home the magnitude of what Long Island IVF has meant to so many couples for 25 years and counting.

Other beautiful older babies were there. Some reiterated the same sentiment as they spoke about their lives…lives that would not have been possible without Long Island IVF. It was a humbling and gratifying experience for the whole Long Island IVF staff. As always, the fresh crop of adorable newborns and toddlers, decked out in their finest, were a joy to meet and gush over!

Everyone at Long Island IVF would like to thank all of the parents and children who came out to celebrate this very important milestone with us…and all those who were there in spirit, but were not able to come.

You and your families are beautiful. You all inspire us each day to do the work we love…building families. Thank you from the bottom of our hearts for allowing us the privilege of building yours.

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Were you at the party? Please share your thoughts and feel free to upload a photo on our Facebook page.

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Femvue: The HSG Alternative Test

By David Kreiner MD

May 6th, 2013 at 8:40 pm

 

image courtesy of OhMega 1982/free digital photos.net

Fear can be an awesome motivator. 

Unfortunately, when it leads to avoiding a vital medical test such as investigating the patency of fallopian tubes it can prevent a physician from discovering the cause of a couple’s infertility. 

The hysterosalpingogram (HSG) is an x-ray of the fallopian tubes after radio-opaque contrast is injected transvaginally through the cervix.  Contrast can be visualized filling the fallopian tubes and spilling through patent fallopian tubes into the pelvis.

The HSG is performed using a metal instrument clamped on the lip of the cervix while a tube is placed through the cervix and contrast injected into the uterine cavity under pressure.  Patients have complained that this procedure is too painful for them to endure and either refuse to undergo the procedure or go for a surgical laparoscopy under general anesthesia.

Today, a new procedure, known as the Femvue, is available whereby a physician inserts a catheter similar to that used at insemination into the cervix.  The physician observes by transvaginal ultrasound the flow of air bubbles through the tubes and into the pelvis.  This can be accomplished in the office with typically minimal discomfort to the patient. 

Sometimes, it may be difficult to get reliable results with Femvue in obese patients. In cases where the results of Femvue are abnormal, a traditional HSG may be done to confirm results.

With the Femvue, the fear of pain experienced by some patients from the HSG is no longer an obstacle to the infertility workup.

Femvue is currently being performed at Long Island IVF by Doctors Kreiner, Pena, and Zinger.

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If you have had an HSG, was it painful? If you’ve had Femvue, how did it go?

Have you avoided an HSG because of fear?

 

Photo credit: http://www.freedigitalphotos.net/images/Diseases_and_Other_M_g287-Woman_With_Abdominal_Pain_p76296.html

 

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Long Island IVF’s Extreme Family Building Makeover Free Micro-IVF Winner is…

By Tracey Minella

September 4th, 2012 at 7:19 am

I can’t sleep tonight. It’s 1:00 a.m. now and I know that many of the eligible winners are tossing in their sleep, too. 

I am torn between extreme sadness for the wonderful entries that weren’t chosen as the Grand Prize winner this year…and the extreme happiness I feel for the entrant who was chosen as this year’s Grand Prize winner . She will be getting a knock on her front door in about 5 hours. It turns out that this year, the winner is a local woman. In the past, we’ve had local and out-of-state winners. We’ve had winners for videos and winners for essays. This year, we have a secondary infertility winner for the first time. 

I soooo wish I could be there for the moment the prize is awarded, but I can tell you what I expect will happen. I’ll paint you a picture of it. I won’t post this until I know she’s been told though, so it’ll be after8:00I bet. 

Dr. Pena and some of the Long Island IVF staff, and a video crew have synchronized their watches and will sneak up the front lawn of the winner’s home at precisely 7:00 am. They will have balloons and probably a giant “free micro-IVF” certificate (like the fake “checks” lottery winners are presented) in hand. Maybe a local news reporter will even drop by. 

Ding. Dong. Will she be awake? Asleep? Presentable? 

 HOME?! 

Of course, she’ll be home. I hope she is surprised. I hope winning makes it easier for her to drive by the bus stops tomorrow. I hope she smiles for a month. Or two. Or nine. 

Congratulations to Jessica for “We’ll NEVER Stop Hoping”, for winning the Grand Prize free micro-IVF cycle! View…and share… her AMAZING winning video here: http://www.youtube.com/watch?v=2HzTjikZFbY 

Thank you to all who entered the contest this year. We were touched by your infertility stories and grateful that you chose to share them. Please do not give up on your dream. This year’s winner, Jessica, did not win last year’s contest, but she came back and tried again this year. She even entered both an essay and a video! Though you may understandably be disappointed, we hope you join us at Long Island IVF in wishing Jessica and Rob good luck as they embark on the next step in their family-building journey. And we hope that if you haven’t conceived before the next contest, that you will enter again next year. 

Please stay tuned for upcoming contests, raffles and give-aways, plus news on grant programs, studies, and other financially-friendly programs for family-building at Long Island IVF. The best way not to miss them is to bookmark this blog or like us on Facebook. 

Become a regular contributor here and get to know us; let us get to know you and tell us what you need so we can do our best to provide it. One of our Facebook fans made a great suggestion and we’re working on a new contest based on it. So talk to us… and to each other. This is your space.

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If you could pick the next contest, what would it be and what would the prize(s) be?

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LIIVF’s “Every Baby’ s Beautiful” Pageant Parade Video

By Tracey Minella

June 19th, 2012 at 10:08 pm

When I was doing IVF, one of the things I focused on when I’d get discouraged was the annual Long Island IVF reunion. It was my dream to get to that picnic with my little miracle. Some day, I vowed, I’m gonna get there.

In the summer of 1998, I got my chance and it was every bit as exciting as I’d imagined it’d be. Back then, all babies were still invited. It was a barely manageable crowd due to the years of successful baby-making. They used to bring in a crane or cherry-picker fire truck just to be able to get a photo of the crowd of families.

These days, they unfortunately have to limit the reunion to the most recent “class” of babies born through the program. So they decided to make it an exciting outing for the little attendees.

Check out the footage of LIIVF’s littlest wonders and their beaming parents at the recent reunion luncheon: http://www.youtube.com/watch?v=4ODaCHJsypk&feature=youtu.be

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Have you been to a reunion yet? If so, how was it? If not, does the thought of it keep you going in rough times?

Photo credit: http://www.publicdomainpictures.net/hledej.php?hleda=driving+away

 

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