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A Heart-Stopping Tale: The Old Friend, A Fertility Doc, and The Subway Series

By David Kreiner MD

May 31st, 2013 at 9:05 pm

 

image courtesy of freedigital photos.net

“How do I feel?…The Mets won!” he exclaimed. And with those words exuding from his mouth, Marty’s whole face smiled from ear-to-ear.  “How do I feel?…Weak, but I don’t think I need a fertility doctor.”

Marty was on a roll, his joking relaxed me…his light-hearted mood and focus on his love for the Mets gladdened my heart as I was slowly realizing that Marty was back.

This 76 year-old semi-crippled athlete who loved to play tennis despite his obvious orthopedic infirmities of late struggled to walk, much less compete athletically, but clearly competitive sport was a great love of his.

This is how I knew Marty was back as he joked about his Mets winning the Subway Series.

His wife was now by his side, grasping for rational thought clouded by the sight of seeing her life’s soul mate lying apparently helpless on the floor, having just returned from a temporary state of cardiorespiratory arrest.  She was shaking, yet uncertain about Marty’s fate.

Karina, Dr. Karina I learned… our hero… was a 40-something gastroenterologist who initiated chest compressions moments before I arrived to the lobby of the restaurant but seconds after Marty was seen clutching at his chest, collapsing to the ground. He stopped breathing… his heart stopped beating…and he turned blue.

I confirmed there was no heartbeat nor respirations, as Dr. Karina continued chest compressions.  I looked at Marty and thought about all the fuss he had made over the years regarding road safety in our community…his involvement in tennis and the men’s club, as well attempts to bring others into the fold.

I respected Marty as a role model who I wished to emulate 19 years hence.  He was active, athletic, and responsible for the welfare of the community.

I was determined to breathe life back into this man who in my eyes had plenty more tennis matches to play, Mets games to cheer for, and kids to warn to slow down their cars.  With the will of God I exhaled my life’s breath, filling Marty’s lungs not once but twice.  In response to Dr. Karina’s chest compressions and my breaths, Marty started to perk up with a strong pulse.  His palms were now sweaty and his eyes were beginning to focus.

I dared to ask him, “Marty, do you know who I am”?

“Of course,” Marty said.  “You are the fertility doctor and the one who creates life”.

Later that evening, reflecting on the events at the restaurant, I finally felt that maybe there is some truth that Dr. Karina and I acted as agents of God and indeed did recreate life in the lobby of the restaurant that evening.

Photo credit: Victor Habbick/ http://www.freedigitalphotos.net/images/agree-terms.php?id=100100670

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Miracle on Old Country Road

By David Kreiner MD

December 22nd, 2011 at 11:09 pm

In this season of miracles, I decided to pull out my very favorite old post of Dr. Kreiner’s, edited for the current holiday. Any infertility patient fortunate enough to conceive will be jealous of this patient’s luck.

Here’s Dr. Kreiner’s story:

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.  Nurse’s 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.”

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 a newlywed with a fantastic wife 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 Hanukkah.

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

How do you feel about having to leave your fertility doctor once you get pregnant to go back to your OB/GYN? Do you wish your RE could deliver the baby?

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Happy Birthday, Dr. Kreiner!

By Tracey Minella and David Kreiner MD

November 28th, 2011 at 12:00 am

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

Where would I be if he had not been born?

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

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

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

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

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

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

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

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

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

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

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Are Your Eggs and Embryos Earthquake-Proof?

By Tracey Minella

August 24th, 2011 at 12:00 am

Long Island’s earthquake yesterday came as quite a shock. Of course, technically speaking it was really Virginia’s earthquake, but it shook our little island …and that makes it our quake, too.

Most of us probably haven’t had the ground fall out from under our feet since our infertility diagnoses were delivered. And frankly, that’s all the earth –shaking news anyone should ever have to bear.

Those of us who have kids may have panicked a bit if they weren’t with us when the quake hit. I admit to making a phone call to my daughter’s camp, sorta casually inquiring if the building was still standing. My son was safe with me away from the spinning chandelier.

But what about the embryos???

Images of embryologists John, Maria, and Sharlene diving over Petri dishes, firing up generators, hugging incubators, and throwing their bodies in front of freezers like the secret service agents protecting the president…flashed before my eyes. (Yep, I can be overdramatic.)

So I called the office just to check on the damages… for you guys, of course.

Dr. Kreiner assured me that there were no ill effects from the earthquake. “All eggs, embryos, incubators, freezers and generators are secure”. Then he rolled his eyes and laughed at me. Of course I didn’t actually see him do it, but I know he did.

So I am happy to report that your embryos and eggs are officially earthquake-proofed in the secure hands of East Coast Fertility. Just one more reason to sleep soundly tonight. At least until the after shocks…

* * * * * * * * *

So, where were you when it happened? Did you realize it? Did you think we were under attack like some people in Washington and NYC did? What did you do?

And have you entered our contest to win a romantic dinner or a free micro-IVF cycle yet? You have til 8/28! See the August 1st post for details!

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“This is Your Captain Speaking…”

By David Kreiner, MD

August 10th, 2011 at 8:30 am

"Scuza,scuza , Signore e signori we are experiencing technical difficulties…”

While I sit uncomfortably detained aboard an Al Italia jet on the tarmac at the Sicilian airport waiting for the mechanics to determine if they can repair the mechanical troubles, my mind drifts to the plight my patients experience while they go through their fertility treatments.

Frustrated, with no control over my situation I reflected upon what it must feel like for my patients who must place their trust in people more experienced than them who routinely deal with those issues that are so significantly impacting them.  

Like my pilots and their support staff, the fertility doctors, nurses and their staff have dealt with problems identical to or extremely similar to the ones my patients face on a daily basis. As such I felt that I should trust that the pilots and maintenance staff would only proceed with the flight once they were assured the problem was satisfactorily repaired and that the plane was safe.

However, I figured that if we were to be delayed for takeoff that I could take out my IPad and make myself more comfortable during the wait. Immediately, I heard from the flight attendant, in angry Italian, scolding me to turn off my electronics.  Actually, I did not understand but several other passengers quickly added in English to shut off my IPad.   Did I not hear the prior instruction to turn off the electronics?  

I did not understand the reasoning behind this as we were obviously delayed for takeoff. I was frustrated with my lack of control and understanding.  I would have felt more comfortable if I understood what was going on and even better if I were able to participate in the process in some way.  

I am sure that my patients must also have this great desire to understand and obtain some control.  I believe that many do… often by gaining more knowledge on the subject through the Internet, our orientation sessions, and directly through questioning the doctors and nurses.

The fact was for me I had no knowledge on our problem with the plane and was therefore utterly helpless other than to offer my complete cooperation.  My patients on the other hand do have opportunities to attain some control and an ability to assist on their own behalf achieving their goal of a pregnancy.

What can patients do to improve their success?  

Listening carefully to instructions and following them religiously such as obtaining and administering medications, regarding dosages and times is essential.  It is important to their ultimate success if they arrive to monitoring visits, retrievals and transfers at stated times.  Patients’ responses to medications vary over time and are considered when their doctors interpret their hormone levels.  The egg matures over the course of time passed from the Hcg shot but if this time is extended too long a patient may ovulate before the retrieval is performed and the egg is lost.

How else can patients improve their outcome?  

Studies have shown that stress reduction through support groups, mind body programs, massage and especially acupuncture improve success rates essentially by improving a body’s ability to respond in a healthy fashion to the fertility process.

As my reflections on the unique ability of my patients to impact their fertility were now complete and committed to paper (my IPad safely turned off and stowed away), over an hour later we finally pulled away from the gate and safely took flight.  One hour later we landed in Rome, excited to move on to the next leg of our trip. I thought as I reflected on my successful journey how I wished for my patients to be as successful in theirs.

Yet as we are about to deplane, I hear “Signore e signori I am very sorry…” the pilot announced that the bus transportation to the gate had not yet arrived and it would be another short while.

“I apologize for the inconvenience”.  Yes, this is very familiar.

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How to Explain the Fertility Doc’s Job to a Kid

By Tracey Minella and David Kreiner MD

August 2nd, 2011 at 8:36 am

Everyone knows that kids say …and ask…the darndest things. You never know when you’re going to find yourself on the “hot seat”, either explaining an embarrassing, innocently-made remark to a stranger or fielding a tough question from a wide-eyed curious kid.

I was speechless on Sunday at my son’s innocent comment upon meeting “Barry”, an overweight, gray-haired man claiming to be a lifeguard (“Hi Barry… with the round belly!”). I got whip-lash between the sheepish apologies to Barry and the silent, “how-could-you-say-that-I’m-so-freakin-embarrassed” motherly death stare to my son. Of course, he then repeated it. Twice. Ugh.

Fortunately, East Coast Fertility’s own Dr. Kreiner offers a good example of thinking on your feet when he fields a tricky question from his grandson:

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

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

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

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

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

* * * * * ** * * * *

Anyone have a story to share about either explaining to a younger child what going to the fertility doctor is about, OR just a "kids say the most embarrassing thing" tale?

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Stop the Infertility Insanity!

By Tracey Minella

February 17th, 2011 at 12:00 am


The definition of insanity is doing the same thing over and over and expecting a different result. Are you doing that with your infertility treatment? Are you gearing up for your 15th IUI?  If so, maybe it’s time to shake things up a bit. Maybe move on to a new approach or technique. Time to stop the insanity.

Listen, if any one is entitled to be crazy, it’s a woman struggling with infertility. The fear of possibly not being able to have a biological child and the frustration over the lack of control and the costs associated with infertility treatment is maddening. And let’s not even talk about the havoc the friggin drugs wreak…

Your infertility journey is a series of steps, each one moving you further along to the goal of a healthy pregnancy. The key is not to spend too much time on one level if you are not successful. Be willing to move forward. You must face that at some point, the basal thermometer and ovulation kit goes in the drawer. Clomid may give way to injectables. Repeated IUIs without success should lead to IVF. And repeated IVF failures should lead to changes in the IVF protocol. Stop doing the same thing over and over.

So, how do you know when to move on?

First, you need to educate yourself on the medical aspects of your infertility treatment. Listen to and understand your diagnosis. Ask questions and do some research. Know your options and your odds for success doing each type of possible procedure. Don’t be afraid to talk to your fertility doctor. I can’t tell you how many times I’ve heard patients say they freeze up or forget to ask their questions. Or that they just blindly do as they are told. You won’t offend the doctor by asking questions. And if you do, he’s the wrong doctor. Think things out, write down questions, and take notes when you meet with the doctor. Remember, you are a team.

Second, you should understand the financial aspects of infertility treatment. Learn about what your insurance plan will or will not cover as far as medication and treatment options. Ask your clinic about grants to help off-set expenses. Do this early as there may be a waiting list. Reputable clinics will have billing and grant specialists who can help you navigate this frustrating and stressful part of the process. And less stress is best. You don’t want to waste your entire infertility budget on 12 IUI’s and have nothing left for IVF, with its higher cost, but higher success rates. It’s easy to say “just one more cycle” and then lose track of how fast time and money has flown.

Next, have a heart to heart talk with your partner. Better yet, have many. Keep the communication lines open about what you both want as a couple. One of you may want to move at a faster pace than the other or may be against even doing certain procedures. Plus, feelings change from cycle to cycle, so keep talking to each other. The last thing you need is for you to run out of the emotional or financial stamina before even getting to IVF. Take advantage of your practice’s support groups.

Finally, you need decide if you’re even in the right infertility practice. That’s a tough one because it’s unbearably hard to face the fact that you may’ve chosen the wrong clinic to begin with. And to admit that you wasted precious time and money. But if you don’t face that hard truth, and you stay there, things will likely only get worse.

(Next week, I will address the things to consider when choosing the right infertility practice, so be sure to check back!)

Are you an active partner in your infertility plan? Do you have tips to share for fellow patients who are reluctant to speak up? Or do you think the doctor knows best and the patient should just listen?

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