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Archive for the ‘Joseph Peña’ tag

Long Island IVF Celebrates National Doctor’s Day

By Tracey Minella

March 30th, 2017 at 8:48 pm

 

L-R Drs. Brenner, Pena, Kenigsberg, Kreiner


You’ve trusted them with more than just your medical care. You’ve trusted them with your future…with your dreams of having a family. They are your Long Island IVF doctors. And we celebrate them today on National Doctor’s Day. (Camera shy today are Drs. Zinger and Droesch!)

For almost 30 years, the doctors at Long Island IVF have been helping Long Islanders become parents through advanced assisted reproductive technologies like IUI and IVF. We were responsible for such milestones as Long Island’s first IVF baby, its first Donor Egg baby, and its first IVF baby from a cryopreserved embryo. We are often the first practice in the region to offer the newest technologies and treatments in family-building.

Whether you came to one of our doctors through a trusted recommendation from family or friends whose families we helped to build, or you found us through conducting your own research into Long Island IVF’s history, we are so glad you chose our doctors.

There is a beautiful transition that often happens between a patient and her doctor. What starts out as a queasy mix of hopefulness and fear at an initial consultation—where you lay your story and feelings there at the feet of an expert who is still a stranger—often develops into a partnership in care that leads to that sought-after pregnancy. Not always unfortunately, and that is devastating to both the patient and the doctor. The journey may be short for some, longer for others, and stressful for all.

Your doctors pour over your case and feel enormous responsibility to help you succeed because they know how much is on the line. They don’t really exhale until you are sent back to your ObGyn for pregnancy care with a healthy sono photo in your hand.

And nothing makes them happier than when they get to meet your little ones at the annual LIIVF family reunion– or any time you want to drop in for a visit.

If there is a special doctor at Long Island IVF that has touched your life, feel free to give a “shout-out” right here in the comments to let them know how much they mean to you. It will make their day! (Hey Dr. Kreiner, if you’re listening—thanks for the two miracles!)

Now it’s YOUR turn…

Shout out begins now!

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Who is your favorite LIIVF doctor?

 

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Long Island IVF-WINNER: Best in Vitro Fertility Practice 2015- 2016- 2017

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 and 2016 and 2017 contest…three years in a row!

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 29 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. 631-752-0606.

 

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Long Island IVF Doctors are “Top Docs” Again!

By Tracey Minella

August 9th, 2015 at 8:53 pm

 

(L-R) Dr. Brenner, Dr. Pena, Dr. Kenigsberg, Dr. Kreiner


Long Island IVF is proud to announce that several of its doctors have been included in the Top Doctors on Long Island Guide selected from the 2015 Castle Connolly Guide by Newsday.

Three of its physicians…Daniel Kenigsberg, MD, Steven Brenner, MD, and Joseph Pena, MD… have consistently appeared on the prestigious listing as Reproductive Endocrinologists and were recognized again this year.

All three doctors are consistently humbled by this honor. Doctors do not and cannot pay to appear on this list, but rather are nominated and selected through a peer recognition process, so being named to the Top Docs list is an honor that never gets old for these physicians.

Long Island IVF is proud of all of its physicians, embryologists, nurses and staff for their commitment to its patients and is grateful for the recognition given by Castle Connolly’s Top Doctors Guide honors. But the best reward for a job well done is the satisfaction we get from building families every day and seeing the very real impact our work has on the lives and happiness of our patients.

In an effort to give back to the Long Island community, Long Island IVF sponsors annual infertility fundraisers in which it donates a free IVF cycle as a door prize. Long Island IVF also offers a variety of grants which can provide financial assistance to those seeking infertility treatments, including NYS DOH’s Infertility Demonstration Grant as well as the new Jade Foundation IVF Grant which is exclusively available at Long Island IVF. For more information on grants, patients new to our practice should contact the Long Island New Patient Counselor at (631) 752-0606 and existing patients should speak with their LIIVF Financial Counselor.

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If you could say one thing to your LIIVF doctor OR to someone who was looking for an infertility specialist, what would you say?

 

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“What can I expect to feel like on fertility drugs? What are the side effects?” Part 2 (Injectable Gonadotropins)

By Joseph Peña, Md, Facog

August 5th, 2010 at 12:00 am

Side effects, risk, and complications of gonadotropins may include the following:

·         Ovarian hyperstimulation syndrome (OHSS)

o   OHSS occurs when the ovaries respond too well to the medication and produce too many eggs.  The ovaries rapidly swell to several times their size and leak fluid into the abdominal cavity.

o   If present, usually mild (10-30% of IVF cycles, less likely in intrauterine insemination (IUI) cycles) resulting in some discomfort (abdominal and pelvic bloating and discomfort) but almost always resolves without complications

o   Severe OHSS occurs ~1% of IVF cycles, increased in younger women, women with PCOS, and women who conceive.  Potential complications include:

§  Abdominal and chest fluid collections, blood clots, kidney problems, ovarian twisting

§  May occasionally require draining of fluid from the abdomen (paracentesis) to help alleviate symptoms (e.g. difficulty breathing, abdominal pain due to distention, decreased urine output)

§  May require hospitalization for close monitoring, but the condition is usually transient lasting about 1-2 weeks

o   The key is prevention.  A couple of options that may be considered in patients deemed to be at significant risk for OHSS (increased number of ovarian follicles on ultrasound, increased serum estradiol levels, PCOS) to decrease risk of manifesting severe OHSS include:

§  Cancelling IVF cycle (withholding hCG) and prevent ovulation

§  Cancelling embryo transfer with cryopreservation of the embryos for frozen embryo transfer in a subsequent menstrual cycle, in order to prevent conception during current cycle

·         Multiple pregnancy

o   Up to 20% risk of multiple pregnancy with use of gonadotropins in IUI cycles (majority are twins, but up 5% risk of triplets or greater), compared to baseline of 1-2% in the general population

o   Associated with increased risk of pregnancy loss, premature delivery, handicap due to the consequences of very premature delivery, pregnancy-induced hypertension, hemorrhage, and other maternal complications

·         Ectopic (tubal) pregnancies

o   Slightly increased risk from the 1-2% rate in the general population

o   Important for close monitoring in the early part of pregnancy to confirm that the pregnancy is located in the uterus

·         Adnexal torsion (ovarian twisting)

o   The enlarged, stimulated ovary can twist on itself, cutting off its own blood supply in < 1% of cycles

o   May require surgery to untwist or remove the ovary

·         Ovarian cancer?

o   Link between use of gonadotropins and the development of ovarian cancer is unknown and is the subject of ongoing research

Thus, while the use of the injectable gonadotropins is generally safe and the benefits outweigh the risks/side effects for many women undergoing fertility treatment, it is important that while taking any of these medications, it should be done under the close supervision of a physician who specializes in managing such treatment cycles.  And if one has any questions or concerns while taking any of these medications, it is best to consult one’s physician.

References:
-Clinical Gynecologic Endocrinology & Infertility.  Speroff.

-ASRM Patient’s Fact Sheet: Side Effects of Gonadotropins

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“What can I expect to feel like on fertility drugs? What are the side effects?” Part 1 (Clomiphene Citrate)

By Joseph Peña, Md, Facog

August 4th, 2010 at 9:10 am

“Fertility drugs” can refer to any number of medications used for fertility treatment.  The two most common of these are the oral medication clomiphene citrate (Clomid) and the injectable gonadotropins (e.g. Gonal F, Follistim, Bravelle, Menopur, Repronex, etc.).  Some side effects and complications are common to both, while others may be unique to each group.  A review of the side effects, risks, and complications of both groups is listed below.

Side effects, risks, and complications of clomiphene citrate (CC) may include the following:

·         Menopausal symptoms are not uncommon such as:

o   Hot flashes (~10%)

o   Irritability

o   Headaches (1.3%)

·         Abdominal distension, bloating, pain, or soreness (5.5%)

·         Ovarian cyst formation – not uncommon and temporary, resolving within in 1-2 menstrual cycles

·         Thickened cervical mucus

o   If present, it can be treated by bypassing the cervix with use of intrauterine insemination (IUI)

·         Breast discomfort (2%)

·         Nausea and vomiting (2%)

·         Visual disturbances (1.5%), such as blurring, spots or flashes, double vision, intolerance to light, decreased visual sharpness, loss of peripheral vision, and distortion of space

o   If present, should be cautious about driving a car or operating dangerous machinery

o   Notify your doctor immediately who may modify your treatment and/or recommend a complete evaluation by an eye specialist

o   Symptoms usually disappear within a few days of discontinuing the medication

·         Multiple pregnancy

o   5-8% risk of multiple pregnancy with use of CC (mostly twins, 1% risk of triplets), compared to baseline of 1-2% in the general population

·         Ovarian hyperstimulation syndrome

o   If present, usually mild (enlarged ovaries and abdominal discomfort)

o   Rarely, may be severe.  Potential complications may include

§  Massive ovarian enlargement, progressive weight gain, severe abdominal pain, nausea and vomiting, fluid in abdominal cavity, decreased urine output

·         Miscarriage risk?

o   Some studies have noted a slightly higher miscarriage rate.  However, it is not clear if this is due to an effect of the medication or related to preexisting conditions such as age or polycystic ovary syndrome (PCOS), which are found more often in women who take CC.

o   Other studies have not shown an increased risk of miscarriage.

o   No evidence that CC treatment increases overall risk of birth defects

·         Ovarian cancer?

o   No causal relationship between ovulation inducing drugs and ovarian cancer has been established

Thus, while the use of clomiphene citrate is generally safe and the benefits far outweigh the risks/side effects for a majority of women undergoing fertility treatment, it is important that while taking any of these medications, it should be done under the close supervision of a physician who is experienced in managing such treatment cycles.  And if one has any questions or concerns while taking any of these medications, it is best to consult one’s physician.  You can learn more about clomiphene citrate at:  http://www.eastcoastfertility.com/index.php?id=blogsingle&tx_ttnews[tt_news]=41&cHash=f6fa864a75e9c0f6e8982478ab2256db

References:
-ASRM Practice Committee: Use of clomiphene citrate in women
-Clinical Gynecologic Endocrinology & Infertility.  Speroff.
-WebMD: Infertility & Reproduction Health Center

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“Why do I need to have a hysterosalpingogram (HSG) – I heard that they hurt!” Part One

By Joseph Peña, Md, Facog

June 17th, 2010 at 6:00 pm

The best way to answer this question is to break down the HSG into the basics…

What is hysterosalpingography or hysterosalpingogram (HSG)?

            HSG is a radiology procedure usually done in the radiology department of a hospital or an outpatient radiology facility.  HSG is an x-ray examination of the inside of the uterus and fallopian tubes that uses fluoroscopy and a contrast material.  Fluoroscopy is a special x-ray that makes it possible to see internal organs in motion.  A water-soluble contrast dye is infused through the cervical canal with a catheter or cannula and is used in conjunction with fluoroscopy to fill the uterine cavity and fallopian tubes and appears bright white on the x-ray film.

What are indications for obtaining an HSG?

  • Infertility:  this diagnostic imaging study is often obtained for a woman who has trouble conceiving for a prolonged period of time (greater than one year, or 6 months if greater than 35 years old).  An HSG may be recommended if one has had a previous child or pregnancy and/or if one had a previous HSG in the past.  Health conditions may change with time.  If an HSG was done prior a cesarean-section delivery and now there are difficulties conceiving again, another HSG should be seriously considered.  It is not uncommon for abdominal and pelvic surgery (such as a cesarean section) to result in pelvic scarring that may distort and/or block the fallopian tubes.  Thus, it is important to consider tubal patency in the evaluation of one’s fertility, and the HSG is currently the most commonly used diagnostic study to accomplish this.
    • If tubal blockage is found, a natural pregnancy may be difficult if not impossible.  Fallopian tubes can result in blockage due to pelvic scarring from a previous pelvic infection (may be subclinical-unknown to woman), previous abdominal/pelvic surgery, or endometriosis.  Tubal blockage on HSG is suggested when the contrast dye is not able to fill the fallopian tube and/or spill into the pelvic cavity.
    • Irregularities in the uterine cavity such as endometrial polyps, submucous fibroids (benign muscle tumors), or scar tissue, may contribute to infertility as well, possibly by having a negative impact on implantation.  These pathological conditions may be noted on HSG as uterine cavity filling defects.
  • Recurrent pregnancy loss:  this diagnostic imaging study is also used to investigate repeated miscarriages by focusing on the intrauterine cavity portion of the test. 
    • A uterine septum, which is one form of congenital malformation of the uterus, is not an uncommon form of correctible cause for recurrent pregnancy loss.  Endometrial polyps, submucous fibroids (benign muscle tumors), or scar tissue may also contribute to early miscarriage in those with a history of recurrent pregnancy loss.

How to prepare for the HSG?

  • Schedule HSG for after menstruation and prior to ovulation.  This turns out to be usually between cycle days 7-10 for most women, but may vary depending on a woman’s menstrual cycles.  The study should be deferred if you might be pregnant to avoid radiation exposure during early pregnancy.
  • HSG should not be performed if one has a chronic pelvic infection or untreated sexually transmitted disease currently.  After appropriate treatment, HSG may then be considered after resolution of the infection.  Inform your physician if you suspect you have either condition.
  • You should inform your physician and the radiologist if you have any allergies, especially barium or iodinated contrast materials.
  • You should inform your physician if you have a history of kidney problems or if you are taking glucophage (Metformin).  Since the dye can potentially have a negative effect on kidney function, your physician may wish to assess your kidney function and/or withhold the glucophage prior to the HSG.
  • About 30 minutes prior to the procedure, you may take ibuprofen (e.g. Advil, Motrin, Aleve) if you are not allergic to help relax the uterus and decrease uterine cramping and/or discomfort during the procedure.
  • Depending upon your diagnosis, your physician may prescribe antibiotics (e.g. doxycycline) for prophylaxis against possible infection.

How is HSG performed?

  • HSG is usually done on an outpatient basis, either in a radiology facility or in the hospital.
  • Patient is positioned on her back on the exam table, with knees bent and feet in stirrups.  A speculum, similar to one used at a gynecologist office, is inserted into the vagina to visualize the cervix, which is then cleansed usually with betadine.  
  • A catheter (flexible tube) or cannula (stiff tube) is inserted through the cervix and the contrast dye is infused to fill the uterine cavity and fallopian tubes.  Patient may be asked to shift and change position at some point during the procedure to obtain different views.
  • X-ray pictures are taken just before the contrast dye is infused, during the infusion, and after the infusion.  Still images are stored on either film copy or electronically as a digital file.
  • After the test, the catheter or cannula is removed, followed by the speculum.  Patient is then allowed to get up and get dressed.
  • HSG procedure usually takes 15-30 minutes to complete.

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