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Archive for the ‘IUI’ tag

Secondary Infertility and “Kindergarten Empty Nest”

By Tracey Minella

September 8th, 2015 at 9:03 am

 

credit: khunaspix/Freedigitalphotos.net


Maybe that first pregnancy came easy. Maybe it didn’t. But, boy did you want that baby.

Your first-born.

She made you a mom. Or a dad. He was the answer to prayers and the realization of dreams that began decades ago. You always expected to become a parent. If you struggled with infertility or losses beforehand, that angel’s birth was the sweet reward for your pain and perseverance.

But you wanted… more. And it hasn’t happened.

For years, you’ve wrestled with the thought of wanting a bigger family. Afraid to speak it aloud. Afraid to be judged ungrateful for the one child you do have. The one child you may’ve bargained with the Universe to have….the one you’d have sold your soul for. The single child that fertile folks and those struggling with infertility believe you should happily settle for.

But why can’t I have another, you often wondered as you savored every single minute of parenthood. Onesies and late-night feedings. First words and steps. Doctor visits. Bedtime stories and snuggles. Happy Mother’s Day and Father’s Day and happy every other holiday. Happy every single ordinary day, as well.

Until last week.

One minute you were at the bus-stop taking Facebook pictures and chatting up the other moms, as your firstborn …sporting a Minions backpack… giggled nervously with the other kids. The next minute a yellow bus whisked your baby away. And ran over your heart in the process.

How did this happen?

You returned to your empty house while the others pushed strollers home… your routine somehow disrupted. For the first time in five years, you may have all the time in the world. And hate it. What will you do to fill the 8 weeks hours until your baby comes home…or the 6 hours for those hovering “helicopter-parents” who covertly followed the bus?  How will you adjust to the new void in your life?

You suddenly realize that you really aren’t so different from the freshman college mom you pitied at Bed Bath & Beyond last month.

You’ve got kindergarten empty nest.

It is the price of secondary infertility. At best, it forces you to face the frustration over the ever-widening age gap between your first and potential second child. At worst, it makes you confront the possibility that what was supposed to be your firstborn may actually be your only child.

Kindergarten can also be tough on “lonely only-s”. Brace yourself for the inevitable plea, prompted by one of those early “All About Me” assignments: “When are you going to give me a little brother or sister?”

Just think…there are only 276 days until summer vacation. Not like anyone’s counting.

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Has anyone experienced Kindergarten Empty Nest? If so, what are your thoughts on coping with the adjustments it brings to you as parents and to your child? How have you handled it? Any tips?

 

 

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Infertility and the Irony of Birth Control

By Tracey Minella

August 18th, 2015 at 9:14 am

 

Photo credit: Ambro/ freedigitalphotos.net


What better day than National Birth Control Day to look back at the time when we used to use birth control? Can you even remember?

The embarrassment of buying condoms, the gynecologist visits for prescriptions. Oh, what we went through just to be sure we would not get pregnant. Because really, that would be the worst thing that could ever, ever happen.

Maybe you even experienced a time or two of sheer hysterical panic worry over a birth control “lapse”. Isn’t it amazing how totally opposite surviving that “two week wait” is from surviving today’s two week wait?

And the money wasted!!! Why, if we only knew then that we didn’t even need birth control because some sinister infertile force was lurking within, we could have dumped all that money into the future fertility treatment savings account instead. Heck, we could have steamed up all the car windows with reckless abandon.

When I think of the years on birth control, the irony kills me. I imagine the fertility gods laughing at me behind my back. Well, not really, but you know what I mean. I feel a little stupid, like life made a fool of me, and I resent feeling that way. Here I was the responsible one. We used birth control until we were ready to start a family. We had a plan.

Ha! A plan.

If we only knew.

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Do you ever feel resentful about the time and money you spent on birth control?

 

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Long Island IVF Announces Office Hours in the Hamptons

By Tracey Minella

July 22nd, 2015 at 9:41 am

Forget the beautiful beaches and trendy shops. There’s a bigger draw to the Hamptons. And it will last year ‘round.

Long Island IVF is happy to announce that two of its reproductive endocrinologists, Dr. Daniel Kenigsberg and Dr. Kathleen Droesch are seeing patients in the Hamptons. Until now, infertile couples in Eastern Suffolk County had to travel exceptionally long distances to reach us for fertility treatment. Now, those in the Hamptons area… for the summer and year round… will have the convenience of expert care closer to home!

For more information on the days and hours of doctor availability and to schedule an appointment with Dr. Kenigsberg or Dr. Droesch in the Hamptons, please contact our Stony Brook office at (631) 331-7575.

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How long do/would you travel for fertility care?

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Long Island IVF Hosts Seminar: “Family-Building the LGBT Way”

By Tracey Minella

June 15th, 2015 at 11:42 am

If you’d like information on family-building from a practice that’s been helping the LGBT community become parents for decades, we’ve got the event for you!

We’ve partnered up with the LGBT Network to bring you a very special seminar on June 25, 2015 from 7-9 pm at the LGBT Network Community Center in Woodbury, NY. http://lgbtnetwork.org/the-center

Long Island IVF’s “Family-Building the LGBT Way” seminar will answer everything you ever wanted to know about today’s LGBT Family-Building options. Two of our reproductive endocrinologists, Dr. Steven Brenner, and Dr. Satu Kuokkanen, along with other key LIIVF team members will introduce you to the fascinating world of assisted reproductive technology and how it’s used to help the LGBT community become parents. In addition, Vicky Loveland, our Donor Egg Coordinator and Melissa Brisman, Esq. owner and founder of Reproductive Possibilities http://www.reproductivepossibilities.com/ will be there. Ms. Brisman is a nationally known reproductive attorney.

LGBT family-building is different in many ways from so-called “traditional” family-building. As a practice made up of both LGBT and non-LGBT employees, we truly understand the nuances that make your family-building adventure unique to you.

Whether you met us briefly at LI Pridefest 2015 and you’d like to learn more about our LGBT Family Building program at Long Island IVF, or this is the first time you’ll be meeting us, we hope you’ll join us at the LGBT Network Community Center to learn about the many ways we can help you achieve your dream of parenthood.

Please pre-register for this free event by emailing lmontello@liivf.com. Light refreshments will be served.

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Will you be attending the “Family-Building the LGBT Way” seminar? Do you have any specific questions or particular topics you want to see covered?

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

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.

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 27 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.

 

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Is Clomid Right for You?

By David Kreiner MD

May 22nd, 2015 at 12:27 pm

 

Photo: imagery magestic/ freedigitalphotos.net


It has become commonplace for women who have been frustrated with repeated unsuccessful attempts to conceive naturally on their own to see their gynecologist who often times will try clomid therapy on them.

Clomid, the traditional brand name for clomiphene citrate, is a competitive inhibitor of estrogen. It stimulates the pituitary gland to produce follicle stimulating hormone (FSH) which in turn will stimulate the ovaries to mature follicle(s) containing eggs. Estrogen normally has a negative effect on the pituitary: Clomid blocks estrogen and leads to pituitary FSH production and ovarian stimulation.

Infertility patients — those under 35 having one year of unprotected intercourse without a resulting pregnancy and those over 35 having six months without pregnancy — have a two to five percent pregnancy rate each month trying on their own without treatment.

Clomid therapy increases a couple’s fertility by increasing the number of eggs matured in a cycle and by producing a healthier egg and follicle. The pregnancy rate with clomid therapy alone is approximately ten percent per cycle and 12 -15 percent when combined with intrauterine insemination (IUI). Women who are unable to ovulate on their own experience a 20 percent pregnancy rate per cycle with clomid, the equivalent to that of a fertile couple trying on their own.

Clomid and Your Cervical Mucus

Women who are likely to conceive with clomid usually do so in the first three months of therapy, with very few conceiving after six months. As clomid has an anti-estrogen effect, the cervical mucus and endometrial lining may be adversely affected.

Cervical mucus is normally produced just prior to ovulation and may be noticed as a stringy egg white-like discharge unique to the middle of a woman’s cycle just prior to and during ovulation. It provides the perfect environment for the sperm to swim through to gain access to a woman’s reproductive tract and find her egg. Unfortunately, clomid may thin out her cervical mucus, preventing the sperm’s entrance into her womb. IUI overcomes this issue through bypassing the cervical barrier and depositing the sperm directly into the uterus.

However, when the uterine lining or endometrium is affected by the anti-estrogenic properties of clomid, an egg may be fertilized but implantation is unsuccessful due to the lack of secretory gland development in the uterus. The lining does not thicken as it normally would during the cycle. Attempts to overcome this problem with estrogen therapy are rarely successful.

Side Effects

Many women who take clomid experience no side effects. Others have complained of headache, mood changes, spots in front of their eyes, blurry vision, hot flashes and occasional cyst development (which normally resolves on its own). Most of these effects last no longer than the five or seven days that you take the clomid and have no permanent side effect. The incidence of twins is eight to ten percent with a one percent risk of triplet development.

Limit Your Clomid Cycles

Yet another deterrent to clomid use was a study performed years ago that suggested that women who used clomid for more than twelve cycles developed an increased incidence of ovarian tumors. It is therefore recommended by the American Society of Reproductive Medicine as well as the manufacturer of clomiphene that clomid be used for no more than six months after which it is recommended by both groups that patients proceed with treatment including gonadotropins (injectable hormones containing FSH and LH) to stimulate the ovaries in combination with intrauterine insemination or in vitro fertilization.

Success rates

For patients who fail to ovulate, clomid is successful in achieving a pregnancy in nearly 70 percent of cases. All other patients average close to a 50 percent pregnancy rate if they attempt six cycles with clomid, especially when they combine it with IUI. After six months, the success is less than five percent per month.

In vitro fertilization (IVF) is a successful alternative therapy when other pelvic factors such as tubal disease, tubal ligation, adhesions or scar tissue and endometriosis exist or there is a deficient number, volume or motility of sperm. Success rates with IVF are age, exam and history dependent.

Young patients sometimes choose a minimal stimulation IVF or MicroIVF as an alternative to clomid/IUI cycles as a more successful and cost effective option as many of these patients experience a 40 percent pregnancy rate per retrieval at a cost today of about $3,900.

Today, with all these options available to patients, a woman desiring to build her family will usually succeed in becoming a mom.

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Did you start out with Clomid? Did you have success with it or did you move on to IVF?

 

photo credit: imagery majestic http://www.freedigitalphotos.net/images/Couplespartners_g216-Young_Romantic_Couple_p75136.html

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Additional Extended Evening Office Hours at Long Island IVF

By Tracey Minella

February 23rd, 2015 at 11:23 am

 

Did you know that Long Island IVF offered evening office hours? Well not only have we offered extended hours in all of our offices for ages, we’ve added even more!

 

Infertility treatment can be stressful. And while some appointments and blood tests simply need to be done in the early morning hours, there are times when an evening appointment is feasible and might be more convenient. Especially for those who work full-time or who might be taking off certain mornings for less flexible monitoring appointments.

 

We’re pleased to announce that in an effort to be even more accessible to her patients, Dr. Satu Kuokkanen will be available on Wednesday evenings in the Lake Success office, starting in March.

 

The hours, nights, and doctors covering these evening appointments vary for each office so check with your doctor or LIIVF office for the specifics. Or if you are a new patient, contact the office you’re interested in for more information.

 

 

 

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Is the availability of evening doctor appointments an important factor in your decision to choose a reproductive endocrinologist?

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To Single Embryo Transfer (or Not to)?: That is the Question

By Tracey Minella

February 11th, 2015 at 12:24 pm

 

Credit: stockimages/ freedigitalphotos.net


One of the hardest parts of undergoing in vitro fertilization is the difficult decision of how many embryos to transfer back…because each embryo transferred has the potential to implant and develop into a baby.

In the 1980s when IVF was new and success rates were understandably low, it was common to transfer as many as 6 embryos back. Even then, many women did not conceive. Others conceived multiple pregnancies. Still others conceived only one.

Happily, today the technology has been dramatically fine-tuned, resulting in much higher IVF success rates and, because fewer embryos are being transferred, fewer multiple pregnancies.

Some women can’t or don’t want to have a multiple pregnancy and are interested in a program that virtually eliminates the risk of more than a singleton pregnancy. Some of their reasons include possible health risks for the mother or babies, concerns over the higher costs of raising multiples, or the fear of being placed on bed rest and its potential financial impact.

On the other hand, because IVF can be expensive and often not covered by insurance, and because the couples attempting it may have already been trying to conceive for a long time with and without medical assistance and expense, it’s tempting to want to “put all your eggs in one basket”. These couples want to transfer a higher number of embryos back to maximize their chance of conceiving in that one cycle or because they can’t afford to do more cycles. Many couples think of the possibility of twins as a bonus. Two-for-one. Instant family. Dream come true.

But if the financial burden was lessened, and the odds of a live birth from transferring one embryo were nearly comparable to the odds for transferring more, would that make a difference to you? Would you opt for the statistically safer singleton pregnancy vs. the statistically riskier multiple pregnancy? Would you really prefer a multiple pregnancy or would you rather have a succession of singleton pregnancies, the way you originally planned before infertility entered your life?

Deep, emotionally-charged decision. No right answer. Just the right answer for you.

Some good news that may affect your decision is 20-year study of 92,000 patients from Denmark, Norway, Sweden, and Finland, recently published in the on-line Oxford Journal, Human Reproduction, on January 21, 2015. The Nordic study found that the health of children born from IVF has significantly improved and that the risks of pre-term or severely pre-term births have declined dramatically…and it’s primarily due to transferring just one embryo. In addition, the stillborn and infant death rate for singletons and twins born through IVF has declined. http://bit.ly/1Ejgg1o

For those interested, Long Island IVF has a well-established Elective Single Embryo Transfer Program with success rates comparable to traditional IVF in select patients. If you elect to transfer one embryo in your fresh cycle you get free cryopreservation of your embryos and free storage for six months or until a live birth occurs. As an additional incentive to motivate patients to make safer choices, we offer patients transferring a single embryo during their fresh stimulation cycle up to three frozen embryo transfers, within a year of their retrieval or until a live birth occurs, for the price of one. For more details and information on whether SET may be right for you, visit http://www.longislandivf.com/single_embryo_transfer.cfm or ask your LIIVF physician.

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What did/would you consider when deciding how many embryos to transfer? Is the elective SET program something you did/would consider? Why or why not?

 

 

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Free Fertility Treatment Awaits Grant Applicants

By Tracey A. Minella

January 11th, 2015 at 7:31 am

 

credit: imagery majestic/ freedigitalphotos.net


Chances are, if you are struggling with infertility, one of the biggest obstacles is the financial burden of the fertility treatments. A New Year often causes infertile couples without the benefit of infertility treatment insurance to revisit their family-building plans and reassess their options.

Some forgo the usual things like fine-dining, vacations, houses, new cars, and other luxuries of a typical life, putting the savings into their treatment. Many work over-time or take second jobs. Others max out credit cards, dip into retirement funds, or borrow from family. And some raise treatment money through on-line fundraising campaigns.

What if there was an easier way…a free way…to finance IVF (or fund an adoption)? You’d consider it, right?

Well, there is a grant opportunity you should consider pursuing that is offering grants of up to $10,000 to use toward your family-building goals. That’s money you don’t have to pay back. Enough to pay for all or a substantial portion of an IVF cycle or an adoption. But you need to act quickly because there is a February 1 deadline for the Spring Grant Cycle.

You may remember that Long Island IVF co-sponsored an exciting event last year…Dancing For the Family… with the Tinina Q. Cade Foundation. Not only did Long Island IVF donate a free IVF cycle as a door prize, but the event raised money that enables the Cade Foundation to fund these family-building grants. All you need to do now is apply.

Don’t like forms? Think you’ll never be chosen? Well, you’re in good company. Do you realize that so many people think like that, or are just beaten down by the stress of infertility, that there are often more funds than applicants for grants like these?! That’s right…grant money is often sitting there waiting for applicants to apply for it! And that’s a shame.

To apply, go here: http://www.cadefoundation.org/?page_id=10

Good Luck.

And keep your eyes open for upcoming news of this year’s Long Island IVF and Cade Foundation new and exciting event.

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Are you going to apply? If not, why not?

 

 

 

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TTC? Everything You Ever Wanted to Know About Clomid

By David Kreiner MD

December 7th, 2014 at 5:23 pm

credit: taoty/ freedigitalphotos.net

It has become commonplace for women who have been frustrated with repeated unsuccessful attempts to conceive naturally on their own to see their gynecologist who often times will try clomid therapy on them. Clomid, the traditional brand name for clomiphene citrate, is a competitive inhibitor of estrogen. It stimulates the pituitary gland to produce follicle stimulating hormone (FSH) which in turn will stimulate the ovaries to mature follicle(s) containing eggs. Estrogen normally has a negative effect on the pituitary: Clomid blocks estrogen and leads to pituitary FSH production and ovarian stimulation.

Infertility patients — those under 35 having one year and of unprotected intercourse without a resulting pregnancy and those over 35 having six months without pregnancy — have a two to five percent pregnancy rate each month trying on their own without treatment. Clomid therapy increases a couple’s fertility by increasing the number of eggs matured in a cycle and by producing a healthier egg and follicle. The pregnancy rate with clomid therapy alone is approximately ten percent per cycle and 12 -15 percent when combined with intrauterine insemination (IUI). Women who are unable to ovulate on their own experience a 20 percent pregnancy rate per cycle with clomid, the equivalent to that of a fertile couple trying on their own.

Clomid and Your Cervical Mucus

Women who are likely to conceive with clomid usually do so in the first three months of therapy, with very few conceiving after six months. As clomid has an anti-estrogen effect, the cervical mucus and endometrial lining may be adversely affected.

Cervical mucus is normally produced just prior to ovulation and may be noticed as a stringy egg white like discharge unique to the middle of a woman’s cycle just prior to and during ovulation. It provides the perfect environment for the sperm to swim through to gain access to a woman’s reproductive tract and find her egg. Unfortunately, clomid may thin out her cervical mucus, preventing the sperm’s entrance into her womb. IUI overcomes this issue through bypassing the cervical barrier and depositing the sperm directly into the uterus.

However, when the uterine lining or endometrium is affected by the anti-estrogic properties of clomid, an egg may be fertilized but implantation is unsuccessful due to the lack of secretory gland development in the uterus. The lining does not thicken as it normally would during the cycle. Attempts to overcome this problem with estrogen therapy are rarely successful.

Side Effects

Many women who take clomid experience no side effects. Others have complained of headache, mood changes, spots in front of their eyes, blurry vision, hot flashes and occasional cyst development (which normally resolves on its own). Most of these effects last no longer than the five or seven days that you take the clomid and have no permanent side effect. The incidence of twins is eight to ten percent with a one percent risk of triplet development.

Limit Your Clomid Cycles

Yet another deterrent to clomid use was a study performed years ago that suggested that women who used clomid for more than twelve cycles developed an increased incidence of ovarian tumors. It is therefore recommended by the American Society of Reproductive Medicine as well as the manufacturer of clomiphene that clomid be used for no more than six months after which it is recommended by both groups that patients proceed with treatment including gonadotropins (injectable hormones containing FSH and LH) to stimulate the ovaries in combination with intrauterine insemination or in vitro fertilization.

Success rates

For patients who fail to ovulate, clomid is successful in achieving a pregnancy in nearly 70 percent of cases. All other patients average close to a 50 percent pregnancy rate if they attempt six cycles with clomid, especially when they combine it with IUI. After six months, the success is less than five percent per month.

In vitro fertilization (IVF) is a successful alternative therapy when other pelvic factors such as tubal disease, tubal ligation, adhesions or scar tissue and endometriosis exist or there is a deficient number, volume or motility of sperm. Success rates with IVF are age, exam and history dependent. The average pregnancy rate with a single fresh IVF cycle is greater than 50 percent. For women under 35, the pregnancy rate for women after a single stimulation and retrieval is greater than 70 percent with a greater than 60 percent live birth rate at Long Island IVF.

Young patients sometimes choose a minimal stimulation IVF or MicroIVF as an alternative to clomid/IUI cycles as a more successful and cost effective option as many of these patients experience a 40 percent pregnancy rate per retrieval at a cost today of about $3,900.

Today, with all these options available to patients, a woman desiring to build her family will usually succeed in becoming a mom.

* * * * * * * * * * *

Do you have any other questions for Dr. Kreiner about Clomid?

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Negative Pregnancy Test Again! Now What?!

By David Kreiner MD

November 30th, 2014 at 9:51 am

 

credit: davidcastillodominici/ freedigitlaphotos.net


Women confronted with a negative result from a pregnancy test are always disappointed, sometimes devastated. Many admit to becoming depressed and finding it hard to associate with people and go places where there are pregnant women or babies, making social situations extremely uncomfortable. A negative test is a reminder of all those feelings of emptiness, sadness and grief over the void infertility creates.

We don’t have control over these feelings and emotions. They affect our whole being and, unchecked, will continue until they have caused a complete state of depression. This article can arm you with a strategy to fight the potentially damaging effects that infertility threatens to do to you and your life.

First, upon seeing or hearing that gut-wrenching news, breathe.
Meditation — by controlling and focusing on your breathing — can help you gain control of your emotions and calm your body, slow down your heart rate and let you focus rationally on the issues. It’s best to have your partner or a special someone by your side who can help you to calm down and regain control.

Second, put this trauma into perspective.
It doesn’t always help to hear that someone else is suffering worse — whether it’s earthquake or cancer victims — but knowledge that fertile couples only conceive 20% of the time every month means that you are in good company with plenty of future moms and dads.

Third, seek help from a specialist, a reproductive endocrinologist (RE).
An RE has seven years of post-graduate training with much of it spent helping patients with the same problem you have. An RE will seek to establish a diagnosis and offer you an option of treatments. He will work with you to develop a plan to support your therapy based on your diagnosis, age, years of infertility, motivation, as well your financial and emotional means. If you are already under an RE’s care, the third step becomes developing a plan with your RE or evaluating your current plan.

Understand your odds of success per cycle are important for your treatment regimen. You want to establish why a past cycle may not have worked. It is the RE’s job to offer recommendations either for continuing the present course of therapy — explaining the odds of success, cost and risks — or for alternative more aggressive and successful treatments (again offering his opinion regarding the success, costs and risks of the other therapies).

Therapies may be surgical, such as laparoscopy or hysteroscopy to remove endometriosis, scar tissue, repair fallopian tubes or remove fibroids. They may be medical, such as using ovulation inducing agents like clomid or gonadotropin injections. They may include intrauterine insemination (IUI) with or without medications. They also may include minimal stimulation IVF or full-stimulated IVF. Age, duration of infertility, your diagnosis, ovarian condition, and financial and emotional means play a large role in determining this plan that the RE must make with your input.

There may be further diagnostic tests that may prove value in ascertaining your diagnosis and facilitate your treatment. These include a hysteroscopy or hydrosonogram to evaluate the uterine cavity, as well as the HSG (hysterosalpingogram) to evaluate the patency of the fallopian tubes as well as the uterine cavity.

Complementary therapies offer additional success potential by improving the health and wellness of an individual and, therefore, her fertility as well. These therapies — acupuncture, massage, nutrition, psychological mind and body programs, hypnotherapy –
have been associated with improved pregnancy rates seen when used as an adjunct to assisted reproductive technologies.

A negative pregnancy test can throw you off balance, out of your routine and depress you. Use my plan here to take control and not just improve your mood and life but increase the likelihood that your next test will be a positive one.

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What have you done to get through the disappointment?

 

photo credit: http://www.freedigitalphotos.net/images/CouplesPartners_g216-Depressed_Young_Couple_p104407.html

 

 

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