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Archive for the ‘Long Island infertility doctors’ tag

Getting Pregnant with Clomid

By Tracey Minella and David Kreiner MD

February 9th, 2012 at 9:23 pm


If doing IVF compares to swimming the English Channel, then Clomid is like dipping your toe in the water. You’ve got to get your feet wet somewhere when moving on from conceiving naturally to conceiving with assisted reproductive technology, and Clomid is that first step for many women.

Dr. David Kreiner answers all your questions about Clomid therapy:

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.

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What was YOUR clomid experience like?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=4854&picture=blister-pack

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NWW Photo Caption Contest No. 6

By Tracey Minella

February 8th, 2012 at 12:14 am


Hey, love! Ready for the Nearly Wordless Wednesday Valentine’s photo challenge? It’s time for our weekly photo caption contest where anyone anywhere can enter to win by submitting a clever caption for the photo of the week. Try it and you’ll soon be addicted to the fun. And what infertile couple, or generally stressed out person, can’t use a fun distraction? Come on and play Nearly Wordless Wednesday!

Each week, the winner gets a gift card. It’s our little thank you for playing our game.

This week’s contest winner will get a McDonald’s gift card. Their hot chocolate or mocha frappes are great. And their fries are legendary. Who wouldn’t love a drive thru the golden arches right now? Win this contest and the gift card is yours!

But first let’s announce last week’s winner: Tiffany W! Congrats! First two-time winner!

Remember that old man with the football, leaping over a boy lying on the ground? Well, Tiffany’s caption: “Who’s your GRANDPA now?!” just won her Starbucks on us! Easy, right? (My caption would have been “Daddy never quits, son. Now get up. I didn’t spend all those years trying to have you for you NOT to play football with me!”)…Of course that’s part of the reason I can’t play along!

Tiffany, please email your address and the words “NWW Contest #5-Starbucks” to Lindsay at lmontello@liivf.com to claim your gift card.

Now, on to the Valentine’s week challenge. It is slightly different than usual.

You need to caption this photo with a “Roses are red, Violets are blue…” poem either FROM the guy in the photo to his valentine OR from YOU to HIM! This should be funny!

Give this photo a caption either below on this blog or on our Facebook page. NOTE: Please enter on Facebook this week if you have problems entering on the blog as we are changing blog platforms.

Best entry winner gets McDonald’s on us! It’s a fast, fun and free contest open to anyone, whether infertile or not, and whether a patient of our practice or not.

Bookmark our blog or like us on Facebook and check back next week to see if you won and we’ll mail you your gift card.

Plus, if you “LIKE” us on Facebook at https://www.facebook.com/longislandivf , we may be able to send you the prize as an e-gift right through Facebook, depending on what this week’s prize is, so you could be enjoying your winnings as early as on the day we choose the winner! (And as much as we’d love you to “LIKE” us on Facebook, it is absolutely not required to either enter or win our contests!… But did I mention we’d love it if you did ;-)

Enter today! Or at least before next Tuesday!

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Why not bookmark us so you remember to check back often…at least every Wednesday…so you don’t miss our NWW contests. And we also run bigger contests, too. And feel free to suggest other fun places we could get gift cards from that you’d like to win as prizes for these fun contests or topics you’d like to see discussed on the blog. Now go enter the contest!

Photo credit: http://www.funny-potato.com/blog/valentines-day-weekend

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Negative Pregnancy Test Again! What Do I Do?

By David Kreiner MD, and Tracey Minella

January 30th, 2012 at 6:08 pm


Throwing the negative pee stick …or anything else … through the window isn’t going to help anything. So what’s a woman to do when faced with yet another horrible disappointment in the bathroom?

Fortunately, Dr. Kreiner of Long Island IVF has some helpful advice:

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? (I’d give my own advice but, as a pee stick thrower, I’m not one to talk…)

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How Old is Too Old to Get Pregnant?

By David Kreiner MD, and Tracey Minella

January 17th, 2012 at 11:44 pm


I’m the first to admit it would’ve been easier on many levels if infertility hadn’t delayed motherhood for me. I’d have a kid in college instead of a third grader. Sure some days I feel like I’m aging in dog years… but on others I’m sure chasing him keeps me young.

I can make judgments about myself. We all do. But if someone else were to judge whether or not I was too old to become a mother…now that’s a whole different story!

We can probably all agree that, say 65, is too old. But is 60? Or even 55? As we slide that scale downward, we get into a gray area. But what’s a fertility doctor to do?

Read on for Dr. Kreiner’s thoughtful post on how he has handled this controversial issue:

When I saw that Maria de Carmen Bousada (the oldest mother to conceive at the time with donated eggs and the help of an IVF program) had died, my first thought was to extend my sincere condolences to her family and in particular to her two year twin boys. My heart truly went out to them. It is a great tragedy when a death occurs especially when it is the mother of such young children. I hope and pray that Maria’s family and friends find the strength to replace the love and nurturing typically given by a mother to her child. My second thought as a fertility doctor was that once again – the world of infertility was making the news because we continue to push the edges of what society views as acceptable.

This is one of the hardest things about being a doctor in a cutting edge field such as reproductive medicine. We are often put in the position of making decisions with our patients that have even bigger implications to society than the individual patient. I do my best to look at each patient, and each situation individually, but I do rely on my patients to treat me as honestly as I treat them. It is a two way street – and unfortunately, Maria lied to the clinic about her age, telling them she was only 53 years of age.

Questions are being raised regarding the responsibility of the IVF program to verify the veracity of information supplied to them by their patients in addition to confirming their health condition to carry a pregnancy.

Others add that beyond a certain age, it is unnatural to become a mother and it puts the family at risk that she may not be around to help raise the child as what occurred in this case, or even if she is perhaps she lacks the energy and stamina to raise the child properly.

At East Coast Fertility, we had a cutoff of age 50 which was admittedly random and that limit was often broken when faced with an energetic couple with a woman who passes her stress test, medical and high risk maternal fetal medicine clearances. We recently celebrated our latest 54 year old patient’s delivery of a healthy baby that was highly reported in the press.

As I said, it is a struggle to separate my own personal feelings about the proper age to have a child which may be inappropriate for others who have a completely different perspective. My responsibility as the physician offering assistance to patients in need of help with procreation is to the health of my patients, the well being of the child and for the good of society.

Many women in their 50’s have the health and energy to carry a pregnancy and bear a child with no more increased risk than many woman 10-20 years younger whose interest in achieving pregnancy we would never consider questioning. That being said what about the risk that the mother may not still be around to raise the child to maturity.

There is no question that a young healthy couple with sufficient financial support and emotional maturity is ideal for raising a family. But, happy, successful families can take on many different faces. Single parent families exist, survive and often thrive. One can never be certain that the condition of the couple at the time of conception will continue through the child’s birth or for that matter until the child has reached maturity. We do not know that a healthy woman of 30, 40 or 50 may not develop a lethal disease before a child has grown up. In addition, at least 50% of couples in the United States become divorced. One can argue that couples at risk of divorce should not get pregnant. I do not think that society is ready to conclude that any of these women should not be allowed to procreate.

So, what about the clinic’s responsibility regarding confirming that a patient is giving them truthful information? We have been deceived in the past that a couple who is requesting fertility assistance was unmarried when in fact at least one partner was married to someone else. This issue is especially acute as it can raise potential liability to the clinic. As in the case of Maria de Carmen Bousada, she lied about her age and perhaps was beyond the limit the doctors and society was comfortable assisting.

For me and for our program we have raised our bar to do the proper due diligence realizing that we will not be able to get the truth in all cases but minimize the risk that we missed picking up a crucial lie. But I don’t want to be “The Fertility Police”. I am a fertility doctor – and my job is to help people have families no matter how different those families may look to you and me.

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What’s your opinion? Should there be an age limit? Or should it be determined on a case-by-case basis?

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