CALL US AT: (877) 838.BABY


Archive for the ‘Jones Institute’ tag

Remembering My Mentor, Dr. Howard Jones

By David Kreiner MD

August 12th, 2015 at 1:01 pm

 

 

credit: Newsday


On July 31, 2015, we lost a great man who with his wife Dr. Georgeanna was responsible for so much in our field of IVF and infertility. Personally, for those of us who trained with Dr. Howard Jones Jr., our careers and lives were permanently and monumentally enhanced. We are who we are, we do what we do… and the way we do it… in large part because of Dr. Howard.

 

Dr. Howard was not just America’s IVF pioneer but he performed the first transgender surgeries in the U.S. This was his reasoning. “There was a lot of discussion of the appropriateness of doing it — if it would really solve the problem” of a person’s feeling uncomfortable as a man or woman and wanting to change, he said. But the questions about sex-change surgery were not moral or psychological ones, he said — “not what reaction it would have with the general public but, from a medical point of view, if it would really be helpful.”

 

In 1978, upon retiring to Norfolk to pursue their love of sailing it was reported that the first IVF baby had been born.  The Joneses hadn’t yet finished unpacking when journalists came to their home to interview them about this future Nobel Prize winning event.  Almost as an afterthought…Dr. Jones was asked if IVF could be performed in Norfolk.  In Dr. Howard’s pinpoint precision fashion and with his classic radio announcer voice, he proclaimed that with sufficient funds they could create a successful IVF program in Norfolk.  I have seen a video of this moment and it conjures up images of Babe Ruth promising to hit a home run for that sick boy in the hospital… then pointing to the fence just prior to him knocking one out of the park.

 

My personal history with Dr. Howard began with when I arrived in Norfolk to start my fellowship the day the Jones Institute moved to their new quarters in the summer of 1985.  By then the Institute had established itself through clinical success and teaching as the center of the IVF universe.  I was in awe of these giants in Reproductive Medicine who warmly welcomed me into the fold and graciously extended themselves to instruct me in the Jones Reproductive Medicine ways.  Dr. Howard was the most amazing role model as he could motivate and direct like a general leading his troops to battle.  He liked to say, “A chain is only as strong as its weakest link” and he did what he could to insure the integrity of each of those links.  Through his time, efforts and knowledge, Drs. Howard and Georgeanna, Dr. Rosenwaks and others at the Institute trained me and in so doing passed the baton of successful family building to open the first successful IVF program in Long Island.

 

no comments

ASRM Retrospective 30 Years Later

By David Kreiner MD

October 17th, 2013 at 1:48 pm

image courtesy of renjith krishnan/freedigital photos.net

 

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


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

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

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

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

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

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

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

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

 

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

 

no comments

Plastics, Infertility, Paleo and the ASRM 2013

By David Kreiner, MD

October 15th, 2013 at 4:01 pm

 

credit: stuart miles/freedigitalphotos.net

It’s a beautiful day in Boston today.  I am here not because of the Red Sox playoffs or Sunday’s Patriots game but rather to attend our annual ASRM national fertility meeting. 

I was delighted upon greeting some former colleagues of mine from my old stomping grounds, the Jones Institute, to hear compliments about how good I looked.  (Well, if you lose 55 lbs. of “baby fat” people tend to notice.)  I explained that my son, Dan, convinced me to try the Paleo Diet, modeled after the diet of Paleolithic man.

I am intrigued that so much is known about how man from the Paleolithic age ate.  I guess he left menus and recipes on the walls of his man caves.  Anyway, the focus… aside from elimination of dairy and gluten from his diet… is avoiding processed foods and chemical additives such as artificial sweeteners.

It was while eating my veggies and bun-less burger that I came upon one of the lead stories at the ASRM in the Wall Street Journal.  The chemical BPA, or Bisphenol A, found in plastic is tied to the risk of miscarriage.  BPAs can leach into the food that is heated on it such as in a microwave or in water stored in plastic and left out in the sun.  Additionally, it was recommended to limit the use of canned foods and avoid handling cash register receipts, which often are coated with resins that contains BPA.

I’m not sure “Paleo” man extended his life, avoided disease or lived any healthier with his “natural only” diet but we have some evidence of some benefits by doing so today.  Oh, and did I mention I can fit into those jeans from my college days?

For more information on the effects of BPAs on fertility as being discussed at the ASRM, see http://bit.ly/19Q28Bt

* * * * * * * * * * *

Did you know that plastics and other items made from BPAs may be harmful to your fertility or contribute to miscarriage? Do you use these products and if so, will you consider stopping now?

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=10054792/ Stuart Miles

 

 

no comments

How Long Island IVF Was Born: A Historical Retrospective Journey of 25 Years

By David Kreiner MD

April 8th, 2013 at 6:39 pm

Today, a woman I delivered into this world in 1982 came to me to help her conceive.   At the time, I was a resident in obstetrics and gynecology, a four year program that preceded my fellowship training in reproductive endocrinology and infertility (REI).

Seeing her triggered memories from then and how it happened that I am here today at Long Island IVF.  As an ob-gyn resident, my goal was to become an IVF expert and was the reason I came to Stony Brook to train with Dr. Zev Rosenwaks.  However, in 1983, he left to become the Director of IVF at the Jones Institute in Norfolk, Virginia, the American clinic that pioneered IVF.  Stony Brook then was without an REI specialist.

I attempted to learn as much I could through reading the latest studies which were directed primarily by Dr. Gary Hodgen at the National Institute of Health.  Of particular interest to me was a study performed 30 years ago that won the National Fertility Prize on what was termed, “Ovarian Stimulation in Medical Hypophysectomized Primates”.  The author of the study, a protégé of Gary Hodgen, was a young reproductive fellow, Dr. Daniel Kenigsberg.

Isn’t it ironic that as one expert left Stony Brook, the future of IVF on Long Island was formed by replacing Zev Rosenwaks with Daniel Kenigsberg?

Kenigsberg’s historic study became the foundation on which modern day IVF is practiced today.  In fact, Dr. Kenigsberg was the first to demonstrate the ability to stimulate ovaries using exogenous FSH (Follicle Stimulating Hormone) without the pituitary stimulation of both FSH and Luteinizing Hormone (LH).  Today infertility specialists throughout the world characteristically employ “the Kenigsberg switch” to turn off the pituitary when stimulating ovaries in preparation for IVF.

In 1985, motivated by the research success of Dr. Kenigsberg, my new mentor, I submitted research of my own on endometriosis that became a finalist for the National Fertility Prize.  Three years later, after my IVF training at the Jones Institute, I returned to start Long Island IVF with Dr. Kenigsberg where together we brought Long Island its first IVF baby, first baby from a cryopreserved embryo, and first donor egg baby.

Today… along with all of the Long Island IVF physicians, embryologists, nurses, and staff… we both look forward to celebrating our 25th anniversary of successfully assisting over 5000 Long Island couples with their family building needs.

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

If we’ve been a part of your family-building journey, we thank you for your faith and trust in us and would love to hear and see what you and your little miracles have been up to.

no comments

Long Island IVF Podcast: Journey to the Crib Ch.1: Welcome

By David Kreiner MD

February 11th, 2013 at 10:24 pm

Welcome to the Journey To the Crib Podcast.  We will have a blog discussion each week with each chapter.  You, the viewer, are invited to ask questions and make comments. You can access the podcast for this Chapter 1 here: http://podcast.longislandivf.com/?p=16

The first chapter introduces the reader to the writer, me, and my early experiences in the field of reproductive endocrinology, infertility and IVF.  This was during the early years of IVF and I was a new doctor driven by a passion for fertility; the science, the surgery and the new technology of in vitro fertilization.

I dedicated the book to my parents who were still alive when it was published.  They taught me the importance of family as it was the most precious commodity they owned.  My father recently passed but he was excited and proud of the work his son did even if he suggested making more revisions to my original drafts than I wanted to hear.  My mother, who suffered a ruptured cerebral aneurysm twenty five years ago and as a result has significant cognitive issues, remains my biggest fan.

It was with great anticipation that I sent to my mentor, Dr. Howard W. Jones Jr., this first chapter as much of it describes my impressions of him and his wife, Georgeanna Seegar Jones, the American pioneers in In vitro fertilization.  Today, he is 101 years old and remains the sharpest individual I have ever met.  I am proud to say that he was touched and impressed with my memories as I recorded them.

If you have not had the opportunity to hear him speak, please do yourself a favor and listen to any one of many videos recorded of him.  “Dr. Howard” describes how he initiated his efforts to develop the first IVF program in the U.S. on http://vimeo.com/asrm/howardjones .

I have a YouTube video discussing this pioneering couple at: http://www.youtube.com/watch?v=b790aiFLzJI&feature=related

If you have time, Dr. Howard gives an exceptional speech on the future of fertility on http://vimeo.com/17418251 .  He starts speaking about 19 minutes into the video.

The reproductive endocrinologist who had the greatest impact on my career was Dr. Zev Rosenwaks.  I unfortunately did not sufficiently credit him with the huge influence he had on my career and in shaping the physician that I have become.  As Zev was a fellow of both Joneses at Johns Hopkins and I was a fellow of his, it is this family of Reproductive Endocrinology from which my career was born.  There is not a thing that I do in practice today that cannot be traced back to Zev or Drs. Howard and Georgeanna or to any of the other fertility giants that were in Norfolk in those days including Suheil Muasher, Mason Andrews, Annibal Acosta, Gary Hodgen, Sergio Oehninger and Richard Scott.

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

Do you have any questions about this podcast? Dr. Kreiner would be happy to answer them. Please tune in weekly as we continue to cover Dr. Kreiner’s  book, Journey to the Crib, chapter by chapter. Back by popular demand.

no comments

IVF Today: One Baby at a Time

By Tracey Minella and David Kreiner MD

August 26th, 2011 at 12:00 am

Single embryo transfers. What a concept!

Back when I was doing IVF in the mid-90’s, transferring FOUR embryos was the norm! Sometimes even more, depending on the patient’s history! After a few failed IVFs, I did a GIFT/ET in 1994 with 4 eggs for the GIFT plus a 3ET. Technically, I could have been the “Septomom”, though prior history didn’t make that seem possible. I did get pregnant that cycle but later miscarried that twin pregnancy.

Also back then, my best friend was doing IVF at a clinic upstate. She had elected on medical advice to reduce a triplet pregnancy to a twin pregnancy, but miscarried after the selective reduction. A few years later, she got pregnant with triplets again. She did not reduce and, despite many complications, has healthy 12 year old triplets now.

It’s refreshing to see that technology at some of the finest fertility clinics now enables couples to choose single embryo transfers (SETs) and avoid the expense and potential complications a high order, high risk multiple pregnancy brings.

Dr. Kreiner of East Coast Fertility believes so strongly in the success rates and safety of SETs that his practice offers an amazing financial incentive to patients undergoing traditional IVF. Read on for details:

I entered the field of IVF in 1985 when the pregnancy rate at the Jones Institute, the most successful program in the country, was 15 percent. This rate was achieved by transferring six embryos at a time. As a consequence, we experienced many high order multiple pregnancies. Unfortunately, these were often complicated and did not always end well. Aside from pregnancy and neonatal complications, many of the marriages also suffered.

Thankfully, today IVF is so much more successful and we can attain pregnancies in greater than 60 percent of retrievals for women under 40. These rates are accomplished while transferring one, two, or at most three embryos at a time. Cryopreservation, or freezing embryos, has also improved our pregnancy rates per retrieval giving us multiple opportunities to get a patient to conceive from a single IVF stimulation and retrieval.

In an effort to encourage safer single embryo transfer and avoid risky multiple pregnancies, we introduced a program in 2007 at East Coast Fertility for patients who transferred one embryo at a time. For these patients we offered free cryopreservation, storage and frozen embryo transfers until a live baby was born.

Still, patients don’t commonly choose single embryo transfer.

From our experience, similar to others’, there was no significant difference in pregnancy rates between patients who chose to transfer one embryo vs. those who chose to transfer two embryos. There was a trend, however, towards higher rates for the two-embryo transfer group that was practically eliminated when frozen embryo transfers were added. These groups were age matched with no difference except for a 40 percent twin rate and one triplet in the two-embryo transfer group compared to the single-embryo transfer group in which no twins were created.

It is hoped that these results will encourage a higher percentage of good prognosis patients to transfer a single embryo, which is the safer option.

* * * * * * *  ** * * * * * *

Would incentives and stats like those above make you consider SET for yourself? Why or why not?

no comments

Cryopreservation: Peeking in the IVF Freezer

By Tracey Minella and David Kreiner MD

April 8th, 2011 at 12:00 am

Remember the Good Humor man? You’d hear that sound from blocks away and bolt out the door barefoot, shrieking “STAAAPPP!”, arms flailing like you were trying to get the bathroom pass from the teacher, and being joined by the rest of the block like rats to the Pied Piper. Remember the way the white square door with the chunky silver hinge on the back swung open and all that cold, smoky fog billowed out into the humid air?

Remember the frozen magic inside?

Well, East Coast Fertility has a magic freezer, too. Full of dreams. Full of potential. Full of embryos that may one day turn out to be rugrats running after the ice cream man. Below, Dr. Kreiner lets us take a peek inside ECF’s cryopreservation program:

In 1985, my mentors, Drs. Howard W. Jones Jr. and his wife Georgeanna Seegar Jones, the two pioneers of in-vitro fertilization in the USA and the entire western hemisphere, proposed the potential benefits of cryopreserving or freezing embryos following an IVF cycle. They predicted that cryopreserving embryos for future transfers would increase the overall success rate of IVF and make the procedure more efficient and cost effective. They also suggested that it would reduce the overall risks of IVF. For example, one fresh IVF cycle might yield many embryos which can be used in future frozen embryo transfer cycles, if necessary. This helps to limit the exposure to certain risks confronted only in a fresh IVF cycle such as the use of injectable stimulation hormones, the egg retrieval operation, and general anesthesia.

At East Coast Fertility, we are realizing the Jones’ dream of safer, more efficient and cost effective IVF. By utilizing the ability to cryopreserve embryos in 2007, 61.5% (118/192) of patients under 35 were successful in having a live birth as a result of only one egg stimulation and retrieval cycle! In addition, because of our outstanding Embryology Laboratory, we are usually able to transfer as few as 1 or 2 high quality embryos per cycle and avoid risky triplet pregnancies. In fact, since 2002, the only triplet pregnancies we have experienced have resulted from the successful implantation of two embryos, one of which goes on to split into identical twins (this is rare!). By cryopreserving embryos in certain high-risk circumstances, we are able to vastly reduce the risk of ovarian hyperstimulation syndrome requiring hospitalization. At East Coast Fertility, safety of our patients comes first. Fortunately, our success with frozen embryo transfers is equivalent to that of fresh embryo transfers, so that pregnancy rates are not compromised in the name of safety, nor are the babies.

Today, as reported in the Daily Science: “The results are good news as an increasing number of children, estimated to be 25% of assisted reproductive technology (ART) babies worldwide, are now born after freezing or vitrification” (a process similar to freezing that prevents the formation of ice crystals).

The study, led by Dr Ulla-Britt Wennerholm, an obstetrician at the Institute for Clinical Sciences, Sahlgrenska Academy (Goteborg, Sweden), reviewed the evidence from 21 controlled studies that reported on prenatal or child outcomes after freezing or vitrification.

She found that embryos that had been frozen shortly after they started to divide (early stage cleavage embryos) had a better, or at least as good, obstetric outcome (measured as preterm birth and low birth weight) as children born from fresh cycles of IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection). There were comparable malformation rates between the fresh and frozen cycles. There were limited data available for freezing of blastocysts (embryos that have developed for about five days) and for vitrification of early cleavage stage embryos, blastocysts and eggs.

‘Slow freezing of embryos has been used for 25 years and data concerning infant outcome seem reassuring with even higher birthweights and lower rates of preterm and low birthweights than children born after fresh IVF/ICSI. For the newly introduced technique of vitrification of blastocysts and oocytes, very limited data have been reported on obstetric and neonatal outcomes. This emphasises the urgent need for properly controlled follow-up studies of neonatal outcomes and a careful assessment of evidence currently available before these techniques are added to daily routines. In addition, long-term follow-up studies are needed for all cryopreservation techniques,’ concluded Dr Wennerholm.

The use of frozen embryos has become a common standard of care in most IVF Programs. At East Coast Fertility we are able to keep multiple pregnancy rates down – by only transferring one or two embryos at a time – while allowing patients to hold on to the additional embryos that they may have created during the fresh cycle. It is like creating an insurance plan for patients. We developed a unique financial incentive program using the technology of cryopreservation to encourage patients to transfer only one healthy embryo at a time. In order to ensure the best outcome for mother and child – these special pricing plans take the burden off the patient to pay for the additional transfers and the cryopreservation process. We have eliminated the cost of cryopreservation, storage and embryo transfer for patients in the single embryo transfer program. Thus, patients no longer have that financial pressure to put all their eggs in one basket! We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

no comments


The Fertility Daily Blog by Long Island IVF
© Copyright 2010-2012