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Archive for the ‘High FSH’ tag

Is Your Biological Clock Running Out?

By David Kreiner MD

December 4th, 2012 at 8:25 pm

Tears start to course down the cheeks of my patient, her immediate response to the message I just conveyed to her. Minutes before, with great angst anticipating the depressing effect my words will have on her, I proceeded to explain how her FSH was slightly elevated and her antral follicle count was a disappointing 3-6 follicles. I was careful to say that though this is a screen that correlates with a woman’s fertility, sometimes a woman may be more fertile than suspected based on the hormone tests and ovarian ultrasound. I also said that even when the tests accurately show diminishing ovarian reserve (follicle number), we are often successful in achieving a pregnancy and obtaining a baby through in vitro fertilization especially when age is not a significant factor.

These encounters I have with patients are more frequent than they should be. Unfortunately, many women delay seeking help in their efforts to conceive until their age has become significant both because they have fewer healthy genetically normal eggs and because their ability to respond to fertility drugs with numerous mature eggs is depressed. Women often do not realize that fertility drops as they age starting in their 20s but at an increasing rate in their 30s and to a point that may often be barely treatable in their 40s.

A common reason women delay seeking help is the trend in society to have children at an older age. In the 1960’s it was much less common that women would go to college and seek a career as is typical of women today. The delayed childbearing increases the exposure of women to more sexual partners and a consequent increased risk of developing pelvic inflammatory disease with resulting fallopian tube adhesions. When patients have endometriosis, delaying pregnancy allows the endometriosis to develop further and cause damage to a woman’s ovaries and fallopian tubes. They are more likely to develop diminished ovarian reserve at a younger age due to the destruction of normal ovarian tissue by the endometriosis. Even more important is that aging results in natural depletion of the number of follicles and eggs with an increase in the percentage of these residual eggs that are unhealthy and/or genetically abnormal.

Diminished ovarian reserve is associated with decreased inhibin levels which decreases the negative feedback on the pituitary gland. FSH produced by the pituitary is elevated in response to the diminished ovarian reserve and inhibin levels unless a woman has a cyst producing high estradiol levels which also lowers FSH. This is why we assess estradiol levels at the same time as FSH. Anti-Mullerian Hormone (AMH) can be tested throughout a woman’s menstrual cycle and levels correlate with ovarian reserve. Early follicular ultrasound can be performed to evaluate a woman’s antral follicle count. The antral follicle count also correlates with ovarian reserve.

By screening women annually with hormone tests and ultrasounds a physician may assess whether a woman is at high risk of developing diminished ovarian reserve in the subsequent year. Alerting a woman to her individual fertility status would allow women to adjust their family planning to fit their individual needs.

Aggressive fertility therapy may be the best option when it appears that one is running out of time. Ovulation induction with intrauterine insemination, MicroIVF and IVF are all considerations that speed up the process and allow a patient to take advantage of her residual fertility.

With fertility screening of day 3 estradiol and FSH, AMH and early follicular ultrasound antral follicle counts, the biological clock may still be ticking but at least one may keep an eye on it and know what time it is and act accordingly.

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Do you wish you started trying to conceive earlier than you did? Do you wish you saw a reproductive endocrinologist sooner? Do you have any advice for others?

 

Photo credit: Peter Kratochvil http://www.publicdomainpictures.net/view-image.php?image=14919&picture=your-are-late

 

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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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Over 40, High FSH, and Infertile

By David Kreiner MD, Tracey Minella

August 16th, 2011 at 2:28 pm


Time flies when you’re having fun. Time also flies when you’re not really “having fun”, but are just busy plodding through life’s challenges. And then one day you turn around and ask yourself “Where did the time go?”…especially when you’re TTC.

Dr. Kreiner offers the following advice:

You have that dreaded infertility diagnosis, “Over 40 With High FSH Levels.” And there’s no cure or magic herb that will turn back the hands of time. You’re desperate so you are willing to try it all anyway, including acupuncture and some internet recommendations such as DHEA (dehydroepiendosterone).

You hear that you can lower your FSH with DHEA or estrogen. The fact is, however, elevated FSH levels do not cause a problem with conceiving. They are merely a marker of diminishing ovarian reserve, a depletion of ovarian follicles and eggs that, combined with increasing age, means you have very few genetically normal eggs available in your ovaries to achieve a healthy child.

Reproductive endocrinologists typically counsel “Over 40 With High FSH Levels” patients that their chance of successfully achieving a live birth using their own eggs is small and that by using a donated egg from a young, fertile woman they can increase their odds of giving birth to greater than 70 percent per donation. Unfortunately, this comes as a shocking disappointment to most women. It’s often a reason for them to drop out of a doctor’s practice or even quit trying to conceive.

So what do you do when faced with this situation? Your answer needs to be individualized, based on your emotional and financial resources, your motivation and your comfort with using a donated egg.

At our clinic, we try to come up with a strategy with our patients that includes counseling to begin the discussion about donor eggs, as opposed to trying with less chance for successful outcome using a patient’s own eggs, or stopping therapy completely and adopting or living child-free.

Perhaps you will choose a low tech option such as insemination with or without hormonal therapy. Sometimes, the plan will be to blast ahead with the big guns using IVF with full stimulation or with less medication and cost using Micro IVF or Minimal Stimulation IVF. Some patients respond better to different stimulations such as sensitizing with estrace or even DHEA prior to stimulation, using a lupron flare or even using clomid in combination with gonadotropins. Unfortunately, it is hard to predict what will be the optimal stimulation for you until we give it a shot.

The bottom line? There’s no right or wrong choice for you. Remember, a family can look many different ways and still be a healthy, loving unit. Your physician, nurses and counselors are available to assist you and support you with whatever decision you make.

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Remember tonight’s seminar at 6:30 pm!!! Learn all about IVF and meet Dr. Kreiner and the IVF team! Ask all your questions afterwards! At ECF’s Plainview office!

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Please Join Us Tonight: East Meets West Free Seminar!

By Tracey Minella

February 15th, 2011 at 12:00 am


There is something really radical going on in Plainview, New York tonight. It is called a free face-to-face, real live informational seminar on infertility. That’s right.   We’re talking personal connections here. Not a webinar. For free. (Did I mention the munchies?)

Tonight’s discussion is about combining Western and Eastern approaches in treating infertility. Like a one-two punch. Have you been trying to conceive without success? Maybe suffered one or more miscarriages? Is your day 3 FSH in the stratosphere? Have other programs told you to give up? Then this unique approach designed to increase pregnancy rates and possibly reduce miscarriage rates could be your answer. Imagine that!

The expert speakers are Dr. David Kreiner of East Coast Fertility and Acupuncturist Mike Berkley of the Berkley Center for Reproductive Wellness. Don’t you owe it to yourself to just check it out? When was the last time you could corner a RE or an acupuncturist and grill him ‘til you were satisfied? For free.

Still hesitant? Consider this scenario.

Picture two infertile friends and co-workers talking at the water cooler. One can’t get pregnant. The other can’t stay pregnant. One invites the other to a free seminar after work. It goes like this:

“But, I’m too tired after work. I just wanna go home.”

“Oh, c’mon. There’ll be munchies. It’s just two hours and maybe we’ll find the answers we’ve been looking for.”

“But, I hate those things. A conference room full of strangers. It’s probably just a big sales pitch about the same old, same old.”

“What if it’s not, though? I’ve never seen a seminar about combining these two approaches. I wouldn’t even know where else to look for an acupuncturist to talk to.  Maybe, just maybe, it can help us. It’s free. If I could avoid another failed IVF, it’s worth checking it out. Besides, we’ll be together.”

“Nah. I’m gonna pass, but you have fun. Sounds kinda hokey to me. Anyway, it’s freezing outside…”

Now let me ask you something. If you are the one left alone at the water cooler because your friend is on maternity leave, how are you going to feel about doing the easier thing tonight?

There will always be plenty of excuses not to go. Apathy, cold, tired, and depressed are powerful feelings to overcome. But remember, cutting edge opportunities in infertility treatment don’t present themselves every day. I promise you won’t have any regrets if you do go. Bring a friend.

Go on. Step away from your laptop. We’re waiting for you. (Hey, did I mention the munchies?)

Seminar begins tonight at 6:30 pm, until 8:30 pm, at:

East Coast Fertility, 245 Newtown Rd., Suite 300, Plainview, New York 11803

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