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Archive for the ‘egg freezing’ tag

When Should I Freeze My Eggs?

By Dr. Michael Zinger

August 4th, 2016 at 3:43 pm

 

image credit: stockimages/freedigitalphotos.net


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

 

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

 

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

 

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

 

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

 

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

 

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

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Social Media and the IVF Experience

By Tracey Minella

March 20th, 2016 at 10:11 pm

 

image courtesy of bplanet/ freedigitalphotos.net


Snapchat® your IVF retrieval day story? Instagram® your embryo’s first picture*? Live tweet your transfer on Twitter®?

It’s true. In Vitro Fertilization (IVF) is boldly going where social media has never gone before. Farther than just sharing the positive pregnancy test on Facebook®. And celebrities are leading the way.

Celebrities have often shared their infertility stories on social media after-the-fact, either during or after the resulting pregnancy. Chrissy Teigen caused a stir in the “twitterverse” when she recently came out during her pregnancy about doing IVF (and selecting a girl embryo to transfer) while shooting the Sports Illustrated® swimsuit issue. And there are countless others who speak out later.

But “real-time” social media updating has entered the IVF scene. One example is the Snapchat® retrieval day story of E!News host, Maria Menounos, as reported by intouchweekly.com., so check it out. The star was also quoted on her reported previous egg-freezing experience and shares her thoughts on the cutting edge fertility-preservation technology.

The benefits of “real-time” social sharing are many:

  • It’s your Coming Out Infertile Day. With one click, you can indirectly “come out” about your infertility struggles to your family and friends on social media.**
  • Remove the stigma and increase awareness of infertility and emotional support by putting a real face to infertility.
  • Embrace the Coolness Factor. We all know the drawbacks, but what makes IVF family-building unique in a good way? Being able to document in photos and videos the literal creation of your baby…and share it all live… is exhilarating, emotional, and, yes even cool. Not everyone can do it, so in a twisted sense, it is a privilege. (And these photos and videos are priceless keepsakes to share with your eventual children, too.)

But there’s an obvious down-side to real-time social sharing. Unforeseen and unfortunate developments sometimes happen that you may not be prepared to experience… much less share on the spot… such as fewer eggs retrieved than hoped for, poor fertilization, or a negative pregnancy test. Once you share the start of the story, you create an expectation for the ending. And while it’s often happy, there can be no guarantees.

Maybe these real-time infertility stories are the inevitable and natural answer to the never-ending flood of pregnancy posts and baby pictures on social media. What do you think?

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Would you/did you share your treatment in real-time on social media? If so, how? Would you/did you share your experience after-the-fact?

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*Many fertility practices, including Long Island IVF, do not provide embryo photos.

**Long Island IVF, sponsor of Coming Out Infertile Day, invites you to visit the Coming Out Infertile Day Facebook page for a helpful graphic and easy instructions to help you come out any day and start getting the support you need.

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Long Island IVF-WINNER: Best in Vitro Fertility Practice 2015 AND 2016

It is with humble yet excited hearts that we announce that Long Island IVF was voted the Best In Vitro Fertility Practice in the Best Of Long Island 2015 and 2016 contest…two years in a row!

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

We love what we’ve gotten to do every day more than 28 years…build families. If you are having trouble conceiving, please call us. Many of our nurses and staff were also our patients, so we really do understand what you’re going through. And we’d like to help. 631-752-0606.

 

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Start the New Year with an Annual Fertility Screening

By David Kreiner MD

December 13th, 2015 at 12:31 pm

Photo Credit: George Hodan/ publicdomainphotos.net


As the year winds down and you reflect on the past, and make resolution for the future, it pays to consider an annual fertility screening.

Some of you may be well into treatment already, but others may just be starting out with their family-building plans…or may be putting off starting a family or adding to their family.

It may be wise to have a baseline or annual fertility screening done, just to help rule out identifiable and underlying fertility problems you may already have and are unaware of. Armed with the knowledge a screening gives you, you can make a more informed decision about how long you may want to wait before beginning or resuming your family building plan.

Dr. Kreiner explains what a fertility screening usually means:

Fertility screening starts with a blood test to check the levels of FSH (follicle stimulating hormone), estradiol and AMH (antimullerian hormone). The FSH and estradiol must be measured on the second or third day of your period. The granulosa cells of the ovarian follicles produce estradiol and AMH. The fewer the follicles there are in the ovaries the lower the AMH level. It will also mean that less estradiol is produced as well as a protein called inhibin. Both inhibin and estradiol decrease FSH production. The lower the inhibin and estradiol the higher the FSH as is seen in diminished ovarian reserve. The higher the estradiol or inhibin levels are then the lower the FSH. Estradiol may be elevated especially in the presence of an ovarian cyst even with failing ovaries that are only able to produce minimal inhibin. However, the high estradiol reduces the FSH to deceptively normal appearing levels. If not for the cyst generating excess estradiol, the FSH would be high in failing ovaries due to low inhibin production. This is why it is important to get an estradiol level at the same time as the FSH and early in the cycle when it is likely that the estradiol level is low in order to get an accurate reading of FSH.

The next step is a vaginal ultrasound to count the number of antral follicles in both ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least a total of eight antral follicles for the two ovaries. Between nine and twelve might be considered a borderline antral follicle count.
As you start to screen annually for your fertility, what you and your doctor are looking for is a dramatic shift in values from one year to the next.

What Does the Screen Indicate?

A positive screen showing evidence of potentially diminishing fertility is an alarm that should produce a call to action. When a woman is aware that she may be running out of time to reproduce she can take the family-planning reins and make informed decisions. The goal of fertility screening is to help you and every woman of childbearing years make the choices that can help protect and optimize your fertility.

Due to advancements in assisted reproductive technologies, younger women who may not be ready to start their families yet for social, financial or other reasons, can now freeze their eggs for future use if needed. This technology is available at Long Island IVF. If you are interested in egg-freezing for your own use or for donating to another woman, please contact our Program Coordinator, Vicky Loveland, RN in the Melville office.

Although none of these tests is in and of themselves an absolute predictor of your ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny. That’s when it makes sense to have a discussion with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out.

It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as a history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order.

Regardless of the nature or severity of the problems, today, with Assisted Reproductive Technology there is a highly effective treatment available for you.

 

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Did you put off a fertility screening… and end up regretting it? If so, what advice do you have for other women who may be doing the same thing?

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ASRM 2015: Looking Back and Moving Ahead “We Could Always Do More and Do Better”

By David Kreiner MD

October 18th, 2015 at 12:58 pm

It was fitting that this year’s national infertility meeting, the ASRM was held in Baltimore, the city where the recently deceased Dr. Howard W. Jones Jr. first trained and rose to prominence in the field of reproductive medicine.  In the 1950′s and during his career at Johns Hopkins, he was involved in the controversial biopsy of cervical cancer patient, Henrietta Lacks, which led to the most widely utilized and researched cell line of all time.  Thereafter, he became an expert in genetic disorders and reproductive developmental issues that led to his opening the first transgender surgery clinic.  Remarkably, however, “Dr. Howard” (as we students called him) is best known for work he performed after his retirement from Hopkins when he moved to Norfolk and started the first IVF clinic in the Western Hemisphere resulting in the birth of the country’s first IVF baby, Elizabeth Carr, in 1981.

 

My first ASRM (called the American Fertility Society at the time) meeting in 1983 was a showcase of this brand new technology of IVF despite a success of 10% in the best clinics. Reproductive surgery was still more successful than IVF so there were presentations by the premier microsurgeons, laparoscopists and hysteroscopists who were demonstrating the latest advances that were becoming available as instrumentation had improved and laser had become a tool of the reproductive surgeon.  IVF was performed laparoscopically and ovarian stimulations were being performed with some variation of human menopausal gonadotropin, Pergonol, derived from the urine of menopausal women and Clomid.

 

In 2015, we reviewed the impact of social media in the opening presidential lecture urging members of the Reproductive Science community to spread the word about reproductive technology advances and utilize social media tools to educate the public.

 

In this meeting, it was now recognized that the LGBT community needed to become a special interest group within the ASRM with focus on alternative family-building that was available not just to lesbian couples but to gay male couples and transgenders.

 

With the successful fertilization and subsequent pregnancies achieved through egg freezing, fertility preservation for women undergoing cancer treatment, gender reassignment or aging prior to a time when they are ready for motherhood is now available. The technology of egg freezing thrusts upon women important new options to be considered (often on an urgent basis) when preparing for chemotherapy, radiation, hormone therapy or surgery… or simply before aging does irreversible damage to one’s fertility.

 

There was an Acupuncture symposium that presented research demonstrating improved success with IVF when utilized twice a week for at least 4-5 weeks prior to retrieval, before and after transfer.  The use of the mild male hormone, DHEA, was discussed in yet another symposium as a potential benefit to patients with diminished ovarian reserve to optimize number of eggs and embryos and improve pregnancy rates.

 

Elective freezing of embryos to transfer in a non-stimulated cycle and embryo-banking combined with complete genomic sequencing of the embryos to selectively transfer only healthy embryos has demonstrated improved success of IVF. And aside from the increased cost and time involved, it appears to be the ideal approach to IVF today.

 

I think Dr. Howard would be happy with these developments in the field and the direction the society is going both towards a more efficient and safer treatment and to widening its scope to be inclusive of the LGBT community.  Though typical of Dr. Howard, he always thought we could do more and better.  Weeks before his death, he called my friend and former fellow, “Richard S”.  He complemented him on his great work but complained to Richard that he wasn’t measuring some hormone or factor that Dr. Howard thought needed to be checked in Richard’s research…

We have come a long way in the 32 years that I have been active in ASRM. I’m proud that Long Island IVF has always been on the cutting edge of reproductive medical technology with programs and practices already existing for this year’s most popular ASRM topics, including social media, LGBT-focused and friendly alternative family-building, egg-freezing, complete genomic sequencing aka PGS (pre-embryo genetic screening), and acupuncture. Let it never be said that the work is done and that we are satisfied with the status quo.  As Dr. Howard would say, “we could always do more and do better”.

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Have you considered using any of these latest technologies or programs in your family-building plans?

 

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Infertility and the Wrong Path Taken

By David Kreiner MD

September 22nd, 2015 at 12:41 pm

Image credit: wpclipart.com


A day of atonement is when people reflect 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 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?  Today, doctors can take ovarian tissue/eggs from a child or adult to preserve her fertility prior to fertility-robbing cancer treatments.  In fact, egg freezing technology is now here for the healthy women who want to preserve their fertility. It’s become acceptable therapy with ever increasing success and lack of problems being noted. Ask your Long Island IVF doctor about egg freezing.

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 another 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, 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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Have you considered egg freezing? Do you wish you had?

 

Photo credit: http://www.wpclipart.com/travel/more_road_signs/road_signs_2/crossroads_sign.jpg

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The Fertility Awareness Opportunities Angelina Jolie Missed

By Tracey Minella

March 27th, 2015 at 11:57 am

 

 

credit: Paul Sherman/ wpclipart


Actress, director, humanitarian, ambassador, mom of twins, adoptive mom, wife of Brad Pitt. And she’s gorgeous.

What’s not to hate?

Oh, I’m just sort of  kidding. No, really. But despite all the good she does, there will always be haters. People who want her money, her talent, her babies, or her man. Jealousy can do that.

I don’t necessarily admire many celebrities… and that’s fine, because their only job is to entertain me, not impress me. But I am impressed with Angelina Jolie. She’s charitable with her time and money and seems pretty grounded for a megastar. And she uses her celebrity for good.

It’s been only two years since Jolie made headlines for undergoing a preventative double mastectomy after testing positive for the BRCA gene mutation… a mutation that significantly increases the lifetime risk of getting breast cancer. At that time, she was open about her decision and used her celebrity to increase breast cancer awareness.

Now Angelina revealed that she took those preventative measures to the next level. This time, she had both of her ovaries and fallopian tubes removed in the hope of avoiding ovarian cancer…another deadly cancer linked to the same gene mutation. Jolie lost her mom to ovarian cancer and said in a recent New York Times Op Ed piece that she doesn’t want her children to experience the same loss. Her openness is raising awareness of ovarian cancer.

But there is another untold story here, too…a fertility awareness story…and it needs to be heard.

Unless you’ve been hiding under a rock, you know Jolie has six children. She adopted three children internationally and gave birth to a singleton and a pair of twins. Practically eliminating her risk of getting ovarian cancer is not the only result of her surgery.

The media is reporting that she can no longer have biological children. And Jolie acknowledged how hard her decision would be for a woman who has not completed her family-building. Perhaps because of the size of her family, this point seemed lost on the general public. But it’s not lost on you, is it? This surgery is a big deal. And before others who may not be done with their family-building journeys emulate Jolie and follow her path, some crucial missing information needs to be shared.

In fact, there are three opportunities here to increase fertility awareness and educate the public about advances in the field of reproductive technologies, namely PGD, Egg donation, and Egg-freezing.

First, there’s pre-implantation genetic diagnosis (“PGD”). PGD enables couples who are concerned about passing a life-threatening genetic disease on to their children to have their embryos pre-screened for gene mutations. This screening can only be done in conjunction with an in-vitro fertilization (IVF) procedure, where eggs are retrieved and fertilized in a lab and the resulting embryos can be tested. Then, only those embryos that did not test positive for the mutated gene would be transferred into the uterus…virtually eliminating the chance of passing on that hereditary disease. BRCA is one of the many genes that can be screened through PGD. Long Island IVF offers PGD.

Second, there’s egg donation. If a woman has her ovaries and tubes removed, she cannot thereafter have a biological child…one created using her own eggs… however she may still experience childbirth. If she still has a healthy uterus, it may be possible for her, through IVF, to use eggs from an egg donor and the sperm of her partner or a donor, and have the resulting embryos transferred into her uterus where a pregnancy can implant and grow to term. Long Island IVF’s Donor Egg Program brought Long Island its First donor egg baby decades ago.

Finally, there’s the latest breakthrough in women’s fertility preservation technology: egg freezing. Egg-freezing offers an exception to the egg donor statement above. If… prior to removing her ovaries… a woman undergoes IVF for the purpose of either freezing her retrieved eggs (or freezing the embryos resulting from the fertilization of her retrieved eggs), then instead of needing donor eggs, she would be able to later have her own frozen eggs (or embryos) thawed and transferred into her uterus in the hope of becoming pregnant with her own biological child. Or if her uterus was unsuitable or absent, she could still have a biological child by having someone else carry a pregnancy for her. (Note: Surrogacy and gestational carrier laws vary from state to state.) Long Island IVF has an Egg Freezing Program.

These three fertility awareness opportunities, when coupled with Jolie’s breast cancer and ovarian cancer awareness, will further empower women everywhere to make better medical choices and take charge of their fertility and general health.

Shame on the haters. It’s wonderful that Jolie is open about her health in a way that raises awareness for others. She is a just a mom. A selfless mom who just wants to be there to see her children and future grandchildren grow up.

Is there something wrong with being proactive after tests show you carry a gene that could one day take your life, like it took your mother’s? Are the haters just jealous of her? Is she a hero?

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What do you think? What would you do?

 

 

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Reasons to Consider Annual Fertility Screening

By David Kreiner MD

December 19th, 2014 at 8:01 pm

 

credit: akeeris/ freedigitalphotos.net


What Is Fertility Screening?

Fertility screening starts with a blood test to check the levels of FSH (follicle stimulating hormone), estradiol and AMH (antimullerian hormone). The FSH and estradiol must be measured on the second or third day of your period. The granulosa cells of the ovarian follicles produce estradiol and AMH. The fewer the follicles there are in the ovaries the lower the AMH level. It will also mean that less estradiol is produced as well as a protein called inhibin. Both inhibin and estradiol decrease FSH production. The lower the inhibin and estradiol the higher the FSH as is seen in diminished ovarian reserve. The higher the estradiol or inhibin levels are then the lower the FSH. Estradiol may be elevated especially in the presence of an ovarian cyst even with failing ovaries that are only able to produce minimal inhibin. However, the high estradiol reduces the FSH to deceptively normal appearing levels. If not for the cyst generating excess estradiol, the FSH would be high in failing ovaries due to low inhibin production. This is why it is important to get an estradiol level at the same time as the FSH and early in the cycle when it is likely that the estradiol level is low in order to get an accurate reading of FSH.

The next step is a vaginal ultrasound to count the number of antral follicles in both ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least a total of eight antral follicles for the two ovaries. Between nine and twelve might be considered a borderline antral follicle count.
As you start to screen annually for your fertility, what you and your doctor are looking for is a dramatic shift in values from one year to the next.

What Does the Screen Indicate?

A positive screen showing evidence of potentially diminishing fertility is an alarm that should produce a call to action. When a woman is aware that she may be running out of time to reproduce she can take the family-planning reins and make informed decisions. The goal of fertility screening is to help you and every woman of childbearing years make the choices that can help protect and optimize your fertility.

Although none of these tests is in and of themselves an absolute predictor of your ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny. That’s when it makes sense to have a discussion with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out. It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as a history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order.

Regardless of the nature or severity of the problems, today, with Assisted Reproductive Technology and the latest Egg-freezing technology, there is a highly effective treatment available for you.

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Have you had a fertility screening yet? Did you find it helpful? Do you have any questions for Dr. Kreiner?

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An Infertile Woman’s Advice to the New Grad

By Tracey A. Minella

June 21st, 2014 at 6:19 am

 

credit: david castillo dominici/freedigitalphotos.net

How innocent you look there in your cap and gown, your broad smile gleaming in the sun. Another educational milestone met. Another diploma for the wall.

You’ve got grand plans for your bright future. Another advanced degree, or maybe your first big job, waits. Visions of the good life fill your mind. Having it all. The career with its promotions, the marriage with romantic vacations. The first house. And then…eventually… the baby. The one you’ve decided will arrive in May of some yet undetermined year. Right on schedule. Exactly as planned.

Today, your foot is poised on the ladder to success.

And as I see you, my mind screams “Put it in the stirrups!”

I was you, long ago. Innocent, with no reason to suspect my life’s lofty goals would not turn out exactly as planned. And as it turns out, I’d trade all my degrees, romantic vacations and big empty house in a heartbeat just to have some of that time back. Just to have thought to start trying to conceive sooner. Or to have budgeted money better. And sadly, I’m in good company feeling this way.

I never thought I’d be married 13 years before I finally conceived. Or that my journey to the crib would take 6 years and 6 IVF cycles and then another IVF four years later. Or that the costs…financial and emotional… would be so great and still have an impact on my life for so many years.

There’s something about graduations that brings out the cynic in me.  It’s that innocent optimism of the grad and the sense that they have all the time in the world before having a family that makes me want warn them that a rude awakening may await them. But who am I to shatter their dreams?

So the best advice I can give new grads is to look ahead optimistically, but keep one eye on the mirror and keep your ear on the biological clock because time moves faster than you think. Whether you have a partner or not, see an RE periodically for a complete fertility evaluation as your eggs may be older than you think. Rule out or treat any issues found early…before you’re ready to conceive.  Consider egg freezing, if indicated. A simple semen analysis is an inexpensive test that yields a lot of information. These exams will let you know if you should consider changing your original family-building timing.

Being book smart is great, but there’s more. Be smart about your body and your fertility. Know your options because knowledge is power.

Now, go out and conquer the world.

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What, if anything, would you do differently in terms of timing your education, career, and family planning?

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ASRM Retrospective 30 Years Later

By David Kreiner MD

October 17th, 2013 at 1:48 pm

image courtesy of renjith krishnan/freedigital photos.net

 

Flying into Boston this week it occurred to me that this was the 30 year anniversary of the first ASRM meeting I ever attended.  In 1983, the American Fertility Society “AFS” meeting (as it was called then) was held in San Francisco and I attended as a third year ob-gyn resident. I was in awe attending this huge conference of about 3-5,000 held at the Hyatt Hotel as I recall.


Though I was required to man the Ovcon 35 birth control pill exhibit (since Ovcon’s manufacturer was paying my way), I was drawn to the microsurgery and in vitro fertilization exhibits and presentations.  

In the ballroom, the presenters presided over a few thousand of us eager to hear about the most recent successes in IVF.  Already, Norfolk had achieved dozens of births through this new scientific process which brought gynecological surgeons (laparoscopists) together with embryo biologists, endocrinologists, andrologists and numerous nurses, technicians and office staff.  For me, hearing Dr. Howard Jones, American IVF pioneer, and others speak about their experiences with this life creating technique was exhilarating.

Years later, as a Jones Institute reproductive endocrinology fellow, I would hear Dr. Howard proclaim that a chain is only as strong as its weakest link.  IVF required every link to maintain its integrity for the process to work.

In 1985, I presented my own paper at the AFS meeting in Phoenix, Arizona.  My wife and two sons joined me.  My presentation on endometrial immunofluorescence in front of hundreds of experts and specialists in the field remains one of the strongest memories in my life.

Today, the ASRM must be held in mega convention centers like the one in Boston where it could accommodate tens of thousands of attendees.  One presentation estimated the number of IVF births worldwide at over five million. Interestingly, per capita, the US performs one fifth the number of IVFs as Europe–where IVF is much more accessible and typically covered by government insurance.

Today, success in the US is better than fifty per cent for most people, thereby making single embryo transfer (“SET”) for good prognosis patients a viable option to avoid the risk of multiple pregnancy. Minimal stimulation IVF (“Micro-IVF”) is a viable alternative for many patients, offering a lower cost and lower risk option.  Egg freezing offers a means of fertility preservation, especially valuable to women anticipating cancer therapy.  Pre-embryo genetic screening (“PGS”) is an option that allows patients to screen for and eliminate genetically undesirable embryos that may otherwise lead to miscarriage or termination.

Looking back at the past thirty years, I am amazed at the progress and achievements made by my colleagues in IVF and happy that I was able to participate in this most rewarding field that has brought so much joy to millions of people.

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photo credit: renjith krishnan http://www.freedigitalphotos.net/images/agree-terms.php?id=10058384

 

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Fertility Preservation, IVF, and a Race Against Time

By David Kreiner MD

June 9th, 2013 at 10:28 pm

I attended a beautiful First Communion party for the cutest seven year-old boy, Michael.  We were dancing and feasting and making merry in celebration of this very special boy’s religious achievement.

His mom, Sylvanna, made a speech that left not a dry eye in the catering hall.  She told her story… one that most in the room were previously unaware of.

Michael was the blessed product of IVF using her then-dying husband’s frozen sperm. 

She explained that one day her son Nicky came home from school crying for a baby brother.  Unfortunately, Sylvanna’s husband, Kenny, was undergoing yet another chemotherapy treatment for advanced colon cancer that had spread throughout Kenny’s body, forcing him to be bedridden much of the time.

She told Kenny about Nicky’s desire for a sibling and Kenny’s reaction was that Sylvanna was crazy to consider it. Aside from his not being able to help raise a child, he thought he would not be able to contribute as he no longer made any sperm.   But Sylvanna loved her son and her husband so much that she was determined to make this happen.

Fortunately, Kenny had frozen sperm prior to his treatment when he was initially diagnosed so there did exist sperm in the bank.  With no more than hopes and prayers, Sylvanna presented to my office begging that we could assist her in her attempt to grow her family despite her husband’s illness.

The challenge was not just the limited available sperm… since only that which was frozen was going to be available… but Sylvanna was already past her 40th birthday, not to add that it was unclear how much time Kenny had left.

Sylvanna’s dad, a resident in Sicily came to support her during her IVF cycle and implored me to do everything possible to make his daughter’s dream of expanding her family a reality.  To do so by any means other than using Kenny’s sperm and her eggs was not a consideration for them.

Sylvanna stimulated well for her age and we retrieved eggs that fertilized with the cryopreserved sperm.  Two weeks later, I called Sylvanna with the news that would change her life and eventually lead to this celebration that we were now enjoying.

Months after Michael was born, Kenny did pass away but not until he got to know his second son, who lives on in his father’s memory, loved and supported by his dedicated mom, Sylvanna, his older brother Nicky, and a new family which includes her new husband, also named Kenny and his two children.

* * * * * * ** * * * * **

Did you know that fertility preservation…freezing eggs, sperm, or embryos… prior to commencing cancer treatment, if time permits,  can often enable men and women to have biological children after their cancer crisis has been resolved?

photo credit: vera kratochivil http://www.publicdomainpictures.net/view-image.php?image=16861&picture=baby-and-dad-sleeping

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