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Is Clomid Right for You?

By David Kreiner MD

May 22nd, 2015 at 12:27 pm


Photo: imagery magestic/

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

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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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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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Will You Conceive in the Chinese Year of the Sheep, Um, Goat?

By Tracey Minella

February 19th, 2015 at 8:40 pm

credit: Feelart/ free

You don’t have to be Chinese to appreciate the richness of that culture’s traditions and the mystique of the Chinese methods of enhancing fertility.


The Chinese zodiac consists of a cycle of 12 years, with each year being named for a different animal, and supposedly bestowing upon those born in that year certain characteristics which are similar to the traits of the featured animal.


It’s the celebration of Chinese New Year. The 2014 Year of the Horse is ending. Each year, the passage of one animal year to the next is clear and routine. Except for the year that follows the year of the Horse. This year. Why?


An apparent ambiguity in the interpretation of the term “yang” has led to a difference of opinion among Chinese people on whether the year after the horse is the year of the ram, sheep, or goat. But the Chinese zodiac symbol recognizes it as the year of the Goat, so we’re going with that.


Children born in the Year of the Goat will be among other things “gentle, mild-mannered, shy, stable, sympathetic, amicable, and brimming with a strong sense of kindheartedness and justice”. * How wonderful!


But despite these great Goat qualities, many Chinese people try hard to avoid having children born during the year of the Goat. This is due in part to a popular Chinese folk saying ‘Only one out of ten people born in a year of the Goat finds happiness’ (十羊九不全). While this may seem to be a silly superstition to many…especially to infertile couples who usually wouldn’t care what day or year their baby was born…there is a real concern among many Chinese that Goat babies will be followers, not leaders, and may be destined for failed marriages, unhappy families, and bad luck.*


So, in the spirit of seeking all the good luck we can get when trying to conceive, I offer these four tips taken from Chinese New Year traditions.


Make Dumplings: On New Year’s Eve, the Chinese often celebrate by eating dumplings called “jiaozi”, which translates literally to “sleep together and have sons” according to If you’re not “culinarily-challenged”, consider making these challenging dumplings.


Sweep Away the Bad Luck: Then, sweep out the house from top to bottom with a broom and give it a good cleaning. It symbolizes the sweeping away of all the bad luck of the past year so the good luck can enter. I do this religiously every single year. It feels authentic. You must try it.


Wear Red: Wear something red. It’s the color of good luck and symbolic of wealth. The Chinese elders often give young ones red envelopes with money inside on Chinese New Year. Maybe you can start a new tradition and break out a red envelope and get your relatives to contribute to the IVF fund.


Hide the Knives: Put away the knives…this is good advice for hormonal women anyway. Using knives and scissors at this time symbolizes the “cutting off” of the good luck and is an omen of bad luck in the year to come. Remember this one at mealtime.


You don’t have to be Chinese to embrace some of the Chinese culture

and have some fun with Chinese New Year traditions. Wear red. If you’re feeling adventurous, try making a batch of jiaozi from an internet recipe. Or just buy some wonton soup! Try your hand at chopsticks. Surround yourself with the richness of red and gold. Sweep out that old bad luck and embrace the New Year that awaits.


Basically, do whatever floats your goat.


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Do you celebrate Chinese New Year or follow any other cultural traditions with fertility-related traditions? Would the characteristics associated with children born in a particular year of the Chinese zodiac impact your family-building plans in any way?




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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/

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.

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 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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The IVF Transfer

By Tracey Minella

February 7th, 2015 at 9:24 am


photo credit: marin/freedigital

In vitro fertilization (IVF) is a long process. The transfer is at the end of the line.

When people do IVF, they endure weeks of daily hormone injections and blood work and ultrasounds designed to make the woman produce more than the one egg she would otherwise likely produce. When the time is right, an injection is given that leads to the final maturation of the eggs and the egg retrieval is scheduled for about 34 hours thereafter, so that the eggs will not be ovulated and the cycle lost.

Once the eggs are retrieved, they are placed in a petri dish with the partner’s sperm, and in some cases, Intra-Cytoplasmic Sperm Injection (ICSI) is performed. With ICSI, a single sperm is isolated and injected into a single egg to increase the odds of fertilization, usually in cases where sperm count or quality is an issue. Then, you wait a day for a fertilization report.

If there is fertilization, the resulting embryos are continually monitored and graded based on how they grow and develop. An agreed upon number of Day 3 embryos (or Day 5 blastocysts) get transferred back to the woman’s uterus via catheter. Each embryo or blastocyst has the potential to develop into a baby, or in rare cases, may even split into twins. Excess embryos are usually cryopreserved (frozen) for future use.

In order to make it to Transfer Day, a couple must survive all the prior phases: cycle suppression, ovarian/follicle stimulation with blood work that corresponds to the number and size of the follicles, a uterine lining that is thick enough for embryo implantation, retrieval of quality eggs, fertilization of eggs, development and growth of quality-grade embryos. Then, the transfer.

Optimists may relax more as each hurdle is cleared. Worry-warts hold their breath ‘til the end. And even then, they beg to lay there for the next two weeks with their hips elevated by pillows or they slam their partners’ driving with every bump on the ride home.

The transfer is a magical moment. It’s not only the end of the treatment cycle, but for many it’s the closest they may ever have been to getting pregnant.

The beauty of IVF comes in the knowledge that you did create embryos…they are real and you can literally see them. If you get pregnant you have breathtakingly beautiful photos of your child from the earliest moments of conception. You know the exact date of conception. You even see the glow of the embryos in the uterus after transfer.

There is nothing quite like the feeling of hope on transfer day. You can bask in the literal moment you may be becoming a mom. Visualize implantation happening. Will it to happen. Allow yourself to believe it because you never know what the effect of positive thinking could be.

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What was your transfer day like? What do you most remember about it?

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

By admin

January 20th, 2015 at 2:28 pm


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

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

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

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

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

Thanks again. Happy New Year to all.

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You Have to See the Baby… at Long Island IVF

By Tracey Minella

January 16th, 2015 at 10:04 am


You Have to See the Baby!

When you’re struggling to conceive, it can be frustrating to hear the ever-present nagging of your friends and family who’ve become new parents. “You have to see the baby!” It’s like being trapped in a Seinfeld episode. Except no one’s laughing.

But “You have to see the baby” can be a good thing, too. Whether you’ve completed your journey to the crib or are still on the way, Long Island IVF has given this phrase new meaning.

Anyone who’s needed medical intervention to build their family knows that while there are ups and downs along the way, the one thing to never lose is hope. Hope sees you through the rough times.

So, we’ve created something wonderful at Long Island IVF: “” Take a peek here . Potential new patients who would like information about Long Island IVF are encouraged to complete the blue contact form on the  page for more information.

The page is a beautiful testimonial of hope, a snapshot of lives in progress, a mosaic of stories of what Long Island IVF’s miracle babies are doing today, up to a quarter century later. Some are in college or getting married. Others are performing at Carnegie Hall and having Sweet Sixteens. Many are enjoying first soccer games and dance recitals. And tons are celebrating milestones like walking, talking, and sleeping through the night.

YouHaveToSeeTheBaby is by you and for you.

We invite our patients to submit your own Long Island IVF children for inclusion. The instructions for submitting are attached at the bottom of this post, so read through to the end.   And if you are still on your journey to parenthood, we hope you will visit YHTSTB and be inspired by the sight of so many lives created by LIIVF. And that your hope is renewed by the vision of your own future addition.

Here are the instructions: Easy Upload Instructions:

If you’d like to submit your child(ren) for inclusion in our photo and profile montage, easy submission instructions are below.

By submitting your child(ren)’s names, photos, and stories you expressly consent to Long Island IVF and its agents using, displaying, and sharing same on its website and social media platforms without providing compensation of any kind.   You realize that submitting these materials for inclusion on our website and social media may result in your child(ren) being recognized as being created through the use of assisted reproductive technologies with the assistance of Long Island IVF and you indemnify Long Island IVF and its agents from any and all claims whatsoever with respect thereto. Submitted content may be edited at the discretion of Long Island IVF, for space or other considerations. Submission of content does not guarantee placement or use on the website or elsewhere. Photos may be removed at any time by Long Island IVF for any reason.

Photos should be non-professional and not subject to copyright (or must be accompanied by a written release by the photographer for this intended use). We are not able to give photo credit to photographers. Photos may only include the featured Long Island IVF child(ren) and should be clear and high definition jpeg photos.

  • To submit your child(ren) for consideration, please provide the following by email or regular mail to :
  • One clear high definition photo of your child(ren) in jpeg format (or if by mail then not to exceed 5×7 size)
  • Your Child(ren)’s name(s):
  • A Short paragraph on your experience with LIIVF (subject to editing)
  • A Short statement about a recent milestone of your child(ren) (subject to editing)
  • Your Full Name(s)
  • Your Signature (or if by email, you must reply to this email consenting to it’s terms)
  • Your contact info (phone number or email or preferably both)


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Have you uploaded your story yet?



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Long Island IVF Family Reunion 2014 Memories

By Tracey Minella

November 11th, 2014 at 4:26 pm

Long Island IVF just celebrated its 26th Annual Family Reunion event. With schools closed and many people off from work, we were blessed with an exceptionally high turn-out of babies and new parents. And we couldn’t have been happier!

The family reunion is the highlight event of our year because it’s when the doctors and staff get to meet the newest crop of little miracles. The last time some of these babies were held, they were only a few cells in size! It’s such an emotional experience for doctors and patients alike. This year, 99 of the newest babies came out. Maybe we’re biased, but they were all gorgeous! And their parents were bursting with smiles and pride…happiness and gratitude replacing the worry and stress of the past. A photographer was capturing the little dickens in a fall-themed pumpkin patch.

It was remarked that if we’d had all of the babies we helped to create for the past 26 years, we’d have filled the Nassau Coliseum!

We were also so lucky to have the event covered by several media outlets, including CBS, Fox, FIOS, and News 12. Not only did that coverage expose our practice’s success to potential patients who may need our family-building services, but it enabled all of our patients, past and present, to share in the reunion experience. You could feel the happiness in the air.

Please check out some of the videos of that news coverage on our Facebook page or at these links and check back often as we will update them as they are available:


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Have you been to a LIIVF family reunion? If so, what was the best part? If not yet, what part do you imagine would be the most fulfilling?






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Long Island IVF Builds Families for GLBT Community

By Tracey Minella

November 4th, 2014 at 6:57 pm


credit: david castillo dominici/free digital

Long Island IVF is so excited to return to the Long Island GLBT Expo this weekend on Sunday, November 9, 2014 at the Long Island Hilton in Melville, New York. We’ll have a raffle again, too, so be sure to stop by.

Long-committed to helping the GLBT community build their families, we love being able to reach out in person in a supportive environment like the expo. It gives you a chance to get a feel for us in a casual, rather than clinical, atmosphere. Some of our staff belongs to the GLBT community, so we understand what you’re feeling. Choosing a fertility practice is one of the biggest decisions you’ll ever make, so come over to our booth and say hello and ask us some questions.

Here’s a true story: Last year, a couple of guys (let’s call them “Max” and “Larry”~ not their real names) came by our booth at the expo. We talked. We bonded. And today, Max and Larry are a couple of proud new dads!  Their beautiful baby’s birth announcement just recently arrived. And it all started with a conversation at this expo.

There are so many options available and amazing new advances in assisted reproductive technologies that can help resolve your unique family-building challenge. We offer the most cutting edge technologies, including PGS (Pre-implantation Genetic Screening), and EEVA (Early Embryo Viability Assessment), many of which are only available at a handful of fertility centers in the country. We have pre-screened, multi-ethnic anonymous donors ready to help you, if needed. And we offer personal financial representatives to help navigate insurance issues and explain our many grant programs and flexible payment options.

We look forward to welcoming you into our family as we help you build yours.


LONG ISLAND IVF was nominated BEST IN VITRO FERTILITY PRACTICE in the Long Island Press’s “Best of Long Island 2015″ contest. If you’d like to vote to help us win, you can vote once per day from now through Dec 15 here:


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Will we be seeing you at the expo on Sunday?


Photo credit: David Castillo Dominici/




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