Archive for the ‘male infertility’ tag
By Tracey Minella
September 4th, 2015 at 6:15 pm
Tagged with Bina Benisch, Fertility, gay parenting, GLBT fertility, Infertility, infertility information, Infertility Support, LGBT fertility, Long Island IVF, male infertility, PFLAG and fertility, PFLAG Long Island, same sex parenting, Trying to Conceive
Dr. David Kreiner, reproductive endocrinologist and co-founder of Long Island IVF…the infertility practice responsible for bringing Long Island its first IVF baby… is excited and honored to be the guest speaker at the upcoming Long Island PFLAG chapter’s September 20th meeting in Commack. His presentation will be on “Fertility Options for Same Sex Couples”.
Since its inception in 1988, Long Island IVF has been committed to the belief that all people have the right to have a family. We have a proud history of supporting LGBT family-building in a way that is sensitive to the unique needs of the community. We go beyond LGBT-friendly…several of our staff members are part of the community. And our experienced psychologist, Bina Benisch, MS, RN, is also the caring and sensitive mother of an adult transgender child. So, we’ve got you covered.
If you are a member of the LGBT community…or a parent or loved one of a member…please come down and meet Dr. Kreiner. He will address all of your questions regarding the many fertility preservation and family-building options for the LGBT community.
Date: Sunday, September 20, 2015
Time: 2:00 pm
Place: Suffolk Y JCC
74 Hauppauge Rd. Commack, New York
For more information, call PFLAG at 631-462-9800
If you can’t wait until then to meet Dr. Kreiner, you can also attend Long Island IVF’s upcoming event, “An Evening of Holistic Approaches to Fertility”, on September 15th at our Melville office. Details are available on our website here: http://www.longislandivf.com/view_event.cfm?id=191
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Do you have any questions for Dr. Kreiner in advance of the PFLAG presentation?
By David Kreiner MD
July 7th, 2015 at 3:01 pm
Fatherhood comes in many different varieties that as a reproductive endocrinologist specializing in family building I see on a regular basis. Whether the man is involved in a traditional heterosexual relationship or is attempting to build a family with his male partner or by himself, man… like woman… feels a biologic drive to parent. As such, although adoption is a wonderful way to create a family, surrogacy and egg donation is appealing to male-only prospective parents because it affords them the opportunity to have a biological connection to their baby.
There are two types of surrogates: traditional and gestational. A traditional surrogate supplies her own eggs and carries the baby to term. Gestational carriers do not supply their own eggs and therefore a separate egg donor is utilized. Unlike donated sperm, donated eggs require the in vitro fertilization (“IVF”) process involving hormonal stimulation of the female egg donor, monitoring during the 2 weeks of stimulation, and transvaginal egg retrieval which is performed under anesthesia. Typically, the intended male father supplies the sperm and the fertilized eggs or embryos are placed into the uterus of the gestational surrogate. Surrogates carry the pregnancy to term then surrender the baby and their parental rights to the father or male couple. The process involves the use of assisted reproduction attorneys, and/or a donor/surrogacy agency. The entire process including IVF with egg donation, surrogacy, and obstetrical care has a cost that can be insurmountable for many men desiring to start a family, estimated to cost between $125-150,000.
There have been a few ways some men have successfully cut this expense. First of all, the fee agencies charge to supply the donated eggs and the surrogates ranges from $10,000-$40,000 independent of the fee the reproductive attorney charges or the cost of psychological screening. Some IVF programs will supply these services at a much lower cost. In addition, these IVF programs have relationships with lesbian partners who may be interested in becoming surrogates after they have completed their own families. Also, some income-based grants exist for male couples in need of surrogates.
Whatever your situation, Long Island IVF has the history, the means, the skills, and the desire to assist you in your family building journey. We can assist you in finding the best agencies/donors/surrogates, reproductive attorneys and counselors to insure that you have the greatest chance of achieving your goal for the family of your dreams.
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How important is it to you to have a biological child and what is the greatest obstacle to you’re facing/faced in achieving that dream?
By Tracey Minella
June 19th, 2015 at 10:03 am
Forget “Men are from Mars; Women are from Venus”. On days like Mother’s and Father’s Day, it’s more like “Fertile folks are from… Uranus”.
What? I meant they’re cold and distant and full of gas, of course!
Well no matter what planet they’re from, most infertile folks would rather be light years away from them on such difficult days. But since you can’t strap a rocket on their backs and send them into the stratosphere, how can you stop fertile folks from making Father’s Day even harder?
First, recognize that there is some truth to the Men/Mars and Women/Venus thing. We are different. At the risk of being accused of sexism here, what pushes women’s emotional and hormonal buttons may not have the same reaction in most men. Women in groups often talk about kids and babies and family stuff—things that are like daggers in the heart to infertile women. However, men have been known to retreat to their “man caves” to talk about “manly” things like sports or business or landscaping—things far removed from baby talk. Men seemingly let more roll off their backs. That said men may also hold their pain in.
So while your hearts in the right place with that secret plan to isolate him on Father’s Day, consider that he may actually enjoy being with the right group of guys, throwing back a cold one and flipping burgers on the grill. Or having a game of wiffle ball. Or watching a ballgame. Or fishing. So you need to really ask him what he wants to do. He may want to be alone with you, or really alone– without you. Remember how you wanted your wishes respected on Mother’s Day? Well, try to understand his now. And here’s the hard part: You may get stuck in the ladies’ chat room in order to give him what he needs on Sunday.
But either way, you should spend some time alone together on Sunday night to make sure he knows he can let his feelings out to you. And to celebrate having gotten through the day. Maybe even to look up at the night sky and make a wish…on Uranus.
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What are you doing on Father’s Day this year? Share your plans to help others who aren’t decided.
By Tracey Minella
May 9th, 2015 at 2:05 pm
Tagged with childless on mother's day, coping with infertility, Fertility, infertile on mother's day, Infertility, Infertility Support, Long Island IVF, male infertility, Mother's Day, Tracey Minella, Trying to Conceive
I want to help and inspire you this Sunday. To mend the raw and broken heart that simply is infertility. To distract you from the emptiness that is Mother’s Day. And from the pain of losses suffered and prayers still unanswered.
But the words don’t come.
I lived it, too, for very many years. The memories are crystal clear. And still the words won’t come to make the worst day of the year any easier. So I’m going to ramble and share some thoughts from the heart.
This journey you’re on, that consumes your life and sucks you dry, will end someday. Yes, it will… even though it feels like it’s been this way forever and that it never will end. But it has to, if you take the time to think about it. And for many it will end with a family. One built in the way you hoped, or in another way that through your evolution on your journey you will have come to accept. And it will feel like it was meant to be and the heavens will literally feel like they opened up and shone down on you just like in the movies.
But you won’t get these years back. I call the infertility years, “the hole”. It’s nearly a decade that I let some form of family-building consume me. When I look back, it’s an effort to remember the good times because I simply couldn’t allow myself to be happy or force myself to have fun. I let infertility rob me of more than it already had. It stole a decade of my life. Don’t let it do that to you. Trust that you’ll be a parent someday. Believe it. Because if it comes true, which it often does, you will have been able to find some happiness during the waiting years. And if it doesn’t come true, you are no worse off.
Celebrate your own mom on Mother’s Day because she won’t be here forever. Trust me, I know. I lost my mom before I got pregnant and could make her a grandmother. Same with my dad. Put the focus on her on Sunday. If it’s too hard, then see her today. Don’t get so lost in your own desire to be a mom that you forget to somehow celebrate the woman who is your mother.
Want a bit of a distraction? Do this project: Fill a mason jar with memories of your mom. Colorful tiny strips of paper with stories and traditions and qualities that you admire about her. And give it to her. What a priceless gift. Not feeling that? Then make one for yourself (or start a journal) with a list of all your plans and the qualities you hope to have as a mom. Baby names, nursery colors, favorite movies and books you’ll share. Activities you’ll encourage. Traditions you’ll start or continue. Add tidbits about this journey you’re on and how you’re feeling. These are therapeutic projects.
Follow your heart Sunday and do what you need to do to get through the day. Avoid places with children if that’s too hard to bear. Stay up late tonight and sleep extra late (cut that day in half!). Treat yourself in some way.
And listen to that heart as well. It’s telling you more than the grief and fear and frustration is letting you hear. There’s a voice whispering deep inside that makes you get out of bed each and every day, including tomorrow.
If you listen…really listen…it’s telling you that you are a mom-in-waiting. Hear it.
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What are you doing to get through the day? What/who are you dreading most?
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Long Island “Brew For the Family” Event- June 4, 2015
Would winning a FREE IVF Cycle door prize help you or a loved one build a family?
Join us on Thursday, June 4th, 2015 from 7:30-10PM at the Long Island Brew for the Family event hosted in partnership with the Tinina Q. Cade Foundation.
We have come together to spread the message that infertility can be overcome! Enjoy a night out and forget the stress of infertility as we sample craft beers at one of Long Island’s premier microbreweries, The Great South Bay Brewery. The evening will include a sampling of 6 beers, guided brewery tours with a master brewer, great food, music, and a silent auction.
Each admission ticket will include one entry into the drawing for a FREE IVF CYCLE* door prize. Be sure to invite your family and friends for even more chances to win, as the prize is transferrable.
To purchase tickets and learn more about this event please visit: www.librewforthefamily.eventbrite.com.
Long Island IVF-WINNER: Best in Vitro Fertility Practice 2015
It is with humble yet excited hearts that we announce that Long Island IVF was voted the Best In Vitro Fertility Practice in the Best Of Long Island 2015 contest.
The doctors, nurses, embryologists, and the rest of the Long Island IVF staff are so proud of this honor and so thankful to every one of you who took the time to vote. From the moms juggling LIIVF babies… to the dads coaching LIIVF teens…to the parents sending LIIVF adults off to college or down the aisles… to the LIIVF patients still on their journeys to parenthood who are confident in the care they’re receiving…we thank you all.
We love what we’ve gotten to do every day more than 27 years…build families. If you are having trouble conceiving, please call us. Many of our nurses and staff were also our patients, so we really do understand what you’re going through. And we’d like to help.
Photo credit: http://www.freedigitalphotos.net/images/Gestures_g185-Depressed_Woman_Sitting_On_Floor__p99322.html
By David Kreiner MD
January 24th, 2015 at 8:13 am
Tagged with coping with infertility, David Kreiner MD, Dr. David Kreiner, Fertility, Infertility, Infertility Support, Infertility Treatment, IVF, IVF specimen production, Long Island IVF, male infertility, man's role in IVF, pregnancy, specimen production for IVF, stress of infertility
Many husbands complain that they feel left out of the whole IVF process as all the attention and care is apparently directed towards the woman. If anything they may feel that at best they can show up for the retrieval at which time they are expected to donate their sperm on demand. If you should fail at this then all the money, time, hope and efforts were wasted all because you choked when you could not even perform this one “simple” step.
I have not witnessed the terror and horrors of war but I have seen the devastation resulting from an IVF cycle failed as a result of a husband’s inability to collect a specimen. Relationships often do not survive in the wake of such a disappointment. Talk about performing under pressure, there is more at stake in the collection room than pitching in the World Series.
Husbands and male partners view IVF from a different perspective than their wives. They are not the ones being injected with hormones; commuting to the physician’s office frequently over a two week span for blood tests and vaginal ultrasounds and undergoing a transvaginal needle aspiration procedure. At least women are involved in the entire process, speak with and see the IVF staff regularly and understand what they are doing and are deeply invested emotionally and physically in this experience. So what is a husband to do?
Those couples that appear to deal best with the stress of IVF are ones that do it together.
Many husbands learn to give their wives the injections. It helps involve them in the efforts and give them some degree of control over the process. They can relate better to what their wives are doing and take pride that they are contributing towards the common goal of achieving the baby.
When possible, husbands should accompany their wives to the doctor visits. They can interact with the staff, get questions answered and obtain a better understanding of what is going on. This not only makes women feel like their husbands are supportive but is helpful in getting accurate information and directions. Both of these things are so important that in a husband’s absence I would recommend that a surrogate such as a friend, sister, or mother be there if he cannot be. Support from him and others help diminish the level of stress and especially if it comes from the husband helps to solidify their relationship.
Husbands should accompany their wives to the embryo transfer. This can be a highly emotional procedure. Your embryo/s is being placed in the womb and at least in that moment many women feel as if they are pregnant. Life may be starting here and it is wonderful for a husband to share this moment with his wife. Perhaps he may keep the Petri dish as a keepsake as the “baby’s first crib”. It is an experience a couple is not likely to forget as their first time together as a family.
With regards to the pressure of performing to provide the specimen at the time of the retrieval, I would recommend that a husband freeze a specimen collected on a previous day when he does not have the intense pressure of having to produce at that moment or else. Having the insurance of a back-up frozen specimen takes much of the pressure off at the time of retrieval making it that much easier to produce a fresh specimen. There are strategies that can be planned for special circumstances including arranging for assistance from your wife and using collection condoms so that the specimen can be collected during intercourse. Depending on the program these alternatives may be available.
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If you did IVF, was your partner involved? How did it go? Any funny or sweet stories to share?
If your partner wasn’t involved, are you happy about that decision, and if so, why was it the right decision for you?
By Tracey Minella
November 4th, 2014 at 6:57 pm
Tagged with Fertility, GLBT, GLBT Expo, GLBT fertility assistance, GLBT fertility treatment, GLBT infertility help, Infertility, IUI, IVF, IVF Long island, LI-IVF, Long Island GLBT Expo, Long Island IVF, male infertility, Surrogacy, Trying to Conceive
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: http://bestof.longislandpress.com/voting-open/
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Will we be seeing you at the expo on Sunday?
Photo credit: David Castillo Dominici/freedigitalphotos.net http://www.freedigitalphotos.net/images/latin-mother-with-daughter-and-aunt-photo-p200021
By Steven Brenner MD
October 18th, 2014 at 10:52 am
Tagged with blocked tubes, coping with infertility, facing infertility, Fertility, Fibroids, HSG, Infertility, infertility basics, Infertility Treatment, IVF Long island, Long Island IVF, male infertility, MD, ovulatory dysfunction, prolactin, Reproductive Endocrinologist, Stephen Brenner, Trying to Conceive
“Thinking the worst” is a very common reaction for individuals experiencing adversity.
This is especially true for people experiencing infertility. Concerns regarding the question of establishing the family someone has dreamed of since they were young is daunting and can leave a person with significant anxiety and doubt regarding her/his future.
In this context it is important to go back to basics regarding fertility and understand that many people suffering from this disorder will be successfully treated with relatively simple techniques and therapies. For the more severe abnormalities, it is comforting to know current available therapies can address these issues with great success.
Establishing a pregnancy without infertility treatment requires a healthy egg, functioning sperm and an anatomic path that allows sperm to ascend the genital tract and an egg to travel into a fallopian tube where fertilization takes place. The anatomic path needs to allow the fertilized egg to travel into the uterine cavity. A receptive uterine lining is then required for the pregnancy to implant and grow. To make things more challenging, sperm and egg have a very small window of time to find each for fertilization to take place.
Many couples have experienced infertility as a result of improperly timed intercourse. This often results from the couple not being aware of the timing of ovulation and the short duration of egg viability. The “fix” for something like this is very simple, requiring merely an understanding of the basic physiology. Sexual dysfunction can plague a relationship, but it is often not until fertility is compromised that couples seek treatment. The simple fix for fertility may involve nothing more than inseminations timed to natural ovulation. Much more in depth therapies may be required to overcome the other, additional concerns associated with sexual dysfunction.
Ovulatory dysfunction, while a very complex issue, is often very easily addressed with simple treatments. Weight loss or gain may be all that is needed to establish regular ovulatory cycles. Correction of hormonal abnormalities leading to problems with ovulation can often be treated with medications that do not require the intense monitoring of injectable fertility medications associated with in vitro fertilization procedures. Sluggish thyroid activity and elevations in a hormone named prolactin are such issues that readily respond to oral medications.
A receptive uterine lining to allow for implantation of an embryo that formed in the fallopian tube is needed to allow a pregnancy to be established in the uterus. Although a scarred endometrium or one that is distorted from fibroids may require surgical repair, other disorders of the lining can be treated with local hormonal supplementation. The endometrium, the uterine lining, may not develop appropriately after ovulation secondary to hormonal abnormalities. This may reflect an abnormality in egg production and the hormones associated with ovulation.
Therapies directed at improving ovulation or directly supporting the lining of the uterus with vaginal application of the hormone progesterone may be all that is needed to correct this problem.
Anatomic problems such as scarring of the fallopian tubes may require surgical correction. However, blocked tubes may be opened by minimally invasive procedures at the time of a hysterosalpingogram (HSG). In such procedures, a tube blocked where it inserts into the uterus is opened with a catheter in a setting that does not require general anesthesia.
Many patients will be successfully treated with simple techniques and procedures that are not associated with the expense and invasiveness of the therapies that most people think they will require.
For each infertile person a plan of evaluation and therapy needs to be developed, beginning with the basics. It does not necessarily lead to those treatments that are more detailed and invasive.
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Did you put off an infertility evaluation out of fear of needing expensive, invasive fertility treatments?
Photo credit: http://www.wpclipart.com/phps.php?q=ostrich
By Tracey Minella
August 27th, 2014 at 5:45 pm
On Saturday night, Long Island IVF and the Cade Foundation hosted a fabulous infertility fundraiser…Dancing for the Family… at the breathtaking Dance With Me studio in Glen Head, NY—home of Dancing with the Stars® champion dancers.
There was music and dancing with all attendees enjoying professional dance lessons. Food and drinks and desserts for all. A silent auction. All for only $65. And perhaps the best part: a fabulous door prize of a free IVF cycle, valued at approximately $10,000 to help one infertile couple start or build their family. To have a baby through a treatment they otherwise may not be able to afford.
This free IVF cycle was transferable, meaning that someone could win it for someone else. So friends and family could come down and not only have a fun night, but could possibly become some couple’s hero by winning the prize for them. So many people who are open about their infertility struggle have loved ones who want to help them and this was the perfect opportunity.
And that’s what happened on Saturday night. Someone won it for her friend. What a gift! Can you imagine what happened between them when she shared the news?
Plenty of folks were out there on the dance floor, taking advantage of this fabulous opportunity to win the chance for themselves or their friends to have a baby. They all enjoyed a fun evening while also raising money for the Cade Foundation to continue to fund infertility and adoption grants and educational programs in our area and throughout the country. But…there was room for more. The night had it all: music, dance lessons, food, drinks, dessert and the best door prize imaginable. And everyone who came felt the magic in the air.
So…where were you?
Seriously, we want to know what kept those of you we missed from attending. Because we want you there the next time. Would you take a moment to let us know?
Did you not hear about the event in time? Was the ticket too costly? Did you stay away for privacy concerns? Was the location inconvenient? Was the dance night theme unappealing? Was the date inconvenient or did it conflict with other vacation plans? Was it something else?
Help us help you. Let us know what kept you and your friends from being part of this fabulous event. Your suggestions may help us plan our next amazing event.
And for those who were there…thank you for making it such a special night. We know that not winning the door prize hurts. A lot. That’s the hard part for us, too. But we encourage you all to research the grant options available through Long Island IVF and the Cade Foundation on our respective websites. And keep following us for any future special events.
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What did you think of the event if you went? And if you missed it, let us know why.
By Tracey Minella
June 14th, 2014 at 7:18 am
Just as Mother’s Day is the hardest day of the year for infertile women, Father’s Day is roughest on the infertile men. And society’s expectations of men make it even harder.
Men are “supposed” to be so many things. Tough guys. Knights in shining armor. Passionate lovers. Good providers.
But the harsh reality of infertility flies in the face of all that. Real men cry. Timed sex is no fun. (Ditto for specimen cups.) Ten thousand dollar bills don’t grow on trees. You can’t “just look at her” and get her pregnant. And this Sunday is yet another day…and another year… without a crayon-colored card and painted rock paperweight present.
Our guys are there to pick us up each month as we face another disappointment and to hold us after yet another a failed cycle. Some hold back their tears so we can let ours flow freely while others join in. (Either way, they hurt, too.) They lose sleep worrying about how to finance the next fertility treatment. And if the cause is male factor, they often shoulder unbearable guilt as well, no matter how much we reassure them.
Face it. Society isn’t even sympathetic to us on Mother’s Day even though the depth of the maternal instinct is universally accepted. So the support, empathy, and understanding our men need needs to come from somewhere else.
It needs to come from us. So what can we do to help our partners this Sunday?
Here are 7 tips to help get him through Father’s Day:
Cater to him: Get inside his head and go for the best diversion for him. Do whatever it is he likes…preferably where there won’t be children (if being around them is hard). In fact, set up a whole day of his favorite things, starting with breakfast in bed.
Surprise him: Has he been begging you to share a new experience with him, like fishing or hiking…or any other positively mortifying thing? Has he hinted about a concert or sporting event that you would rather die than attend? Well…surprise him with those tickets or grab the tackle box and go for it with a smile on your face. That simple gesture will speak volumes. (Tomorrow you can tell him it was a one-day only thing!)
Solo time with Dad: Instead of having to endure a barbeque with the whole family…including the wise-cracking fertile siblings and the 22 grandchildren they’ve already provided…plan to spend solo time with Dad. Consider breakfast on Sunday morning or dinner on Saturday night instead.
Daddy-in-Waiting card: He’s already a father in his heart. He’s just waiting. Don’t make him wait to get a card (or a gift for that matter). Write him a heartfelt note telling him how much he means to you and how he’s helped you on this journey. Tell him what wonderful traits he has that you hope your children will one day have and why he’d make a great dad. (Then get the tissues ready.)
Adopt a kid: If you can handle it emotionally and you’re close to someone with a child who no longer has a father in the picture, consider doing something with that child on Sunday. Toss a ball in a park, see a movie, get an ice-cream. It may be an awkward or difficult day for the child and his mom, but you could make a difference… and do your heart some good, too.
Get physical: Relieve some of the stress of infertility with physical activity. Take a walk or run on the beach. Take a trip to the gym. Have a roll in the hay. Or not.
Sow your seed: There’s something cathartic about getting your hands dirty with nature. About sowing seed or planting a tree that will live for generations. About fertility and making something grow. So while you are waiting for that baby, consider planting a Father’s Day tree or garden…something to watch grow over the coming years. A tree next to which you might take annual photos with your future child every Father’s Day as they both grow.
Remind him that this journey will end someday and that IVF success rates and technology continue to improve daily so there’s no better time to be trying to conceive.
Hopefully, the reality of that painted rock paperweight is only a stone’s throw away.
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What are you planning to do on Father’s Day this year?
By David Kreiner MD
May 9th, 2014 at 9:15 am
Tagged with Assisted Hatching, blastocyst, coping with infertility, Cryopreservation, David Kreiner MD, Embryo Glue, Fertility, Fertility Medications, ICSI, Infertility, Infertility Treatment, IVF, Long Island IVF, male infertility, Old Eggs, PGD, PGS, pregnancy, reproduction hormones, Trying to Conceive
If you’re not pregnant yet and you’re wondering what to do, this post may shed some light on infertility diagnoses and treatments. Yes, there’s a lot to learn. Yes, it can be overwhelming. But the good news is that you can go to the head of the class by the time you finish reading this post.
Dr. David Kreiner of Long Island IVF gives you the low-down and the lingo. It’s everything you need to know, from A to… well… P. And what better letter to stop at? “P” is for pregnant:
“Why me? My wife never had any infections, surgery or any other problem? I have no difficulty ejaculating and there’s plenty to work with so why can my friends and neighbors and coworkers get pregnant and we can’t?”
I hear these questions daily and understand the frustrations, anger and stress felt by my patients expressing these feelings through such questions. There are many reasons why couples do not conceive. An infertility workup will identify some of these. A semen analysis will pick up a male factor in 50-60% of cases. A hysterosalpingogram will locate tubal disease in about 20% of cases. Another 20-30% of women do not ovulate or ovulate dysfunctionally. A post coital test may identify that the problem is that the sperm is not reaching the egg. It may not be able to swim up the cervical canal into the womb and up the tubes where it should normally find an egg to fertilize. When these tests are normal a laparoscopy may be performed to identify the 20-25% of infertile women with endometriosis. However, even when this is normal and there is no test that logically explains the lack of success in achieving a pregnancy; an IVF procedure may both identify the cause and treat it successfully.
What is IVF?
In Vitro Fertilization, IVF, is the process of fertilizing a woman’s eggs outside the body in a Petri dish. Typically, a woman’s ovaries are stimulated to superovulate multiple eggs with gonadotropin hormones, the same hormones that normally make a woman ovulate every month. Injections of these hormones are usually performed by either the husband or wife subcutaneously in the skin of the lower belly with a very tiny needle. It takes 9-14 days for the eggs to mature. She will then take an HCG injection which triggers the final stage of maturation 35-36 hours prior to the egg retrieval. This is performed in an operating room, usually with some anesthetic. The eggs are inseminated in the lab and 3-5 days later, embryos are transferred into the uterus with a catheter placed transvaginally through the cervix into the womb.
What is ICSI?
Some times even in the presence of a normal semen analysis, and normal results on all the infertility tests, fertilization may not occur without microsurgically injecting the sperm directly into the egg. This procedure is called Intracytoplasmic Sperm Injection or ICSI and may achieve fertilization in almost all circumstances where there is otherwise a sperm cause for lack of fertilization.
If it looks like a sperm and swims like a sperm, why doesn’t it work like a sperm?
A South African gynecologist, Thinus Kruger, discovered that small differences in the appearance of sperm affected the sperm’s ability to fertilize an egg. In 1987, Thinus demonstrated that when we used the very strict Kruger criteria for identifying a normal sperm, we were able to identify most men who had normal semen analyses and were yet unable to fertilize their wife’s eggs. Most of these couples suffered from unexplained infertility except now utilizing the Kruger criteria for sperm morphology we were able to identify the problem. Today, these couples are successfully treated with the ICSI procedure.
As women age, the percentage of genetically abnormal eggs increases. These older eggs are less likely to fertilize, divide normally into healthy embryos or result in a pregnancy. When older women do conceive they are more likely to miscarry then when they were younger. Aging of eggs begins in the 20’s but accelerates after age 35. This is why a woman’s fertility drops as she gets older. The age at which it becomes significant for a woman varies. Some women in their 30’s have significant aging of their egg. Others less so and may have a good number of healthy eggs into their 40’s.
ABC’s of IVF
Assisted Hatching is when the embryologist makes a hole in the shell around the embryo called the zona pellucidum. This is performed minutes prior to embryo transfer and may be performed chemically with acid tyrodes, mechanically with a micropipette or with a laser. It is commonly believed that older eggs may lead to embryos with a thicker or harder shell that may prevent the natural hatching of an embryo that must occur prior to the embryo implanting into a woman’s lining of her womb.
Blastocyt embryo transfers occur on day 5 or 6 after the egg retrieval. This is the embryonic stage when an embryo normally implants into the womb. These embryos have been selected to be healthier by virtue of the fact that they have made it to this stage. Statistically, the pregnancy rates for women who have had blastocysts transferred is higher than when the same number is transferred on day 3 using “cleaved” embryos of 4-10 cells. As the advantage of the blastocyst transfer may be only a matter of selection, it is thought that there may be no advantage if the embryologist is able to select just as well the best embryos to transfer on day 3 which is typically the case when there are not excess numbers of high quality embryos which will vary according to the patient and be dependent on the age of the patient.
Bravelle – Brand of FSH, follicle stimulating hormone which is a gonadotropin used to stimulate a woman’s ovaries to superovulate and make multiple eggs mature during the IVF cycle.
Cetrotide – Brand of Gonadotropin Releasing Hormone Antagonist that prevents a woman’s pituitary gland from producing LH, luteinizing hormone. LH increases can trigger premature ovulation and stimulate testosterone and progesterone production which can be harmful to a woman’s egg production and prematurely mature the lining of womb potentially affecting implantation.
Co-culture of a woman’s endometrial cells from the uterine lining or granulosa cells from aspirated ovarian follicles along with the embryos in the same culture dish is thought to provide growth factors for the embryos which may improve the health and growth of the embryos.
Cleavage Stage Embryos are 2-10 cell embryos transferred on day 2 or 3. They are often graded by their lack of fragmentation and granularity of the inside of the cell cytoplasm; A to D or 1to 5 with A or 1 being the best grade.
Cryopreservation or freezing can be performed on individual eggs where it may serve as a way to preserve a woman’s fertility either due to aging or in preparation for surgery, chemotherapy or radiation which may affect future access to a woman’s eggs. It may be performed on cleaved embryos or blastocyst embryos that are already fertilized either because they are in excess of the desired number of embryos to be transferred fresh or to bank for a future PGS/PGD or to improve implantation by delaying transfer to a subsequent unstimulated cycle.
Embryo Glue is a protein supplement to the transfer media prepared minutes prior to transfer to make the embryo more likely to stick to the lining of the womb. It is believed that some embryos may not implant since they are not adhering to the lining and do not get an opportunity to burrow into the endometrium.
Estradiol is produced by the granulosa cells of the follicle which surround the egg in the ovary. As follicles are stimulated and grow they produce more estradiol. We measure estradiol to monitor development of the follicles. It also helps to prepare the lining of the womb for implantation.
Follistim – Brand of FSH, follicle stimulating hormone which is a gonadotropin used to stimulate a woman’s ovaries to superovulate and make multiple eggs mature during the IVF cycle.
Ganirelix – Brand of Gonadotropin Releasing Hormone Antagonist that prevents a woman’s pituitary gland from producing LH, luteinizing hormone. LH increases can trigger premature ovulation and stimulate testosterone and progesterone production which can be harmful to a woman’s egg production and prematurely mature the lining of womb potentially affecting implantation
Gonal F – Brand of FSH, follicle stimulating hormone which is a gonadotropin used to stimulate a woman’s ovaries to superovulate and make multiple eggs mature during the IVF cycle.
Gonadotropins – FSH, follicle stimulating hormone and LH, luteinizing hormone stimulate the follicles in the ovary to mature and produce ovarian hormones, estradiol, testosterone and progesterone. It also is used to stimulate a woman’s ovaries to superovulate and make multiple eggs mature during the IVF cycle. We adjust the ratio of FSH and LH to achieve goals of optimal follicular development and maturation while trying to minimize the risk of hyperstimulation. Typically we administer the gonadotropins to the woman for 8-14 days before giving her HCG 35-36 hours prior to the egg retrieval
HCG is human chorionic gonadotropin, the pregnancy hormone we measure to see if your wife is pregnant. We follow the numbers to monitor the growth and health of the pregnancy. HCG has the same biological effect as LH and therefore can be used to mature the egg in the same way as if it were getting ready to ovulate. We therefore administer HCG to women 35-36 hours prior to the egg retrieval. Brand names for HCG include Pregnyl and Ovidrel. HCG is occasionally used in place of HMG (Menopur, see below) with similar effects.
HMG – Human Menopausal Gonadotropins are purified from the urine of menopausal women since they have high levels of FSH and LH. Menopur is the brand of HMG used in IVF stimulations containing a 1:1 ratio of FSH to LH. We adjust the ratio of FSH and LH to achieve goals of optimal follicular development and maturation while trying to minimize the risk of hyperstimulation. Adding pure FSH, i.e. Bravelle, Follistim or Gonal F will increase the ratio of FSH to LH which may be desirable especially early in a stimulation. Some patients may not need any supplemental LH and are stimulated with FSH only. HMG is sometimes added towards the end of a stimulation to minimize the risk of hyperstimulation syndrome.
Hyperstimulation syndrome is a condition which occurs approximately 3% of the time as a result of superovulation of a woman’s ovaries with gonadotropins. A woman’s ovaries become enlarged and cystic, fluid accumulates in her belly, and occasionally around her lungs. When it becomes excessive, it may make it uncomfortable to breathe. We remove this excess fluid with a needle. Women can also become dehydrated and put them at risk of developing blood clots. We therefore recommend fluids high in salt content like V 8 and Campbell’s chicken soup. We give patients baby aspirin to prevent clot formation and a medication called cabergoline which helps prevent the development of Hyperstimulation. It may also be recommended to freeze all the embryos and postpone the transfer to a later cycle as pregnancy can significantly exacerbate Hyperstimulation syndrome as well as potentially be more likely to implant in a subsequent cycle.
ICSI – Some times even in the presence of a normal semen analysis, and normal results on all the infertility tests, fertilization may not occur without microsurgically injecting the sperm directly into the egg. This procedure is called Intracytoplasmic Sperm Injection or ICSI and may achieve fertilization in almost all circumstances where there is otherwise a sperm cause for lack of fertilization
Lupron is a Gonadotropin Releasing Hormone Agonist that must be administered after a woman ovulates or concurrent with progesterone or oral contraceptive pills to effectively suppress gonadotropins. Lupron prevents a woman’s pituitary gland from producing LH, luteinizing hormone. LH increases can trigger premature ovulation and stimulate testosterone and progesterone production which can be harmful to a woman’s egg production and prematurely mature the lining of womb potentially affecting implantation
Monitoring of a woman’s stimulation with gonadotropins is performed by transvaginal ultrasound examination of her ovarian follicles and blood hormone levels. The gonadotropin doses can be adjusted according to the results of the monitoring. The timing of the HCG and subsequent egg retrieval are likewise based on the monitoring. Typically, a woman need not be monitored more frequent than every 3 days initially but may need daily monitoring as she approaches follicular maturation to determine timing of the HCG injection and retrieval.
Morula is the stage between the cleavage stage embryo and blastocyst. It is when the embryo is a ball of cells and is usually achieved by the 4th day after insemination.
Oral contraceptive pills are often given prior to the stimulation to help time stimulation starts and bring a woman’s reproductive system to a baseline state from which the stimulation may be initiated.
PGD/PGS is preembryo genetic diagnosis and screening. PGD refers to diagnosing the presence of a single gene disorder in the embryo. Typically, patients with a prior history of producing a child with this disorder or where both partners are known carriers for a genetic disease are candidates for PGD. Alternatively, patients could make the diagnosis in pregnancy by chorionic villus sampling or amnioscentesis. PGS is screening for chromosomal abnormalities and has been used to improve success after embryo banking, to prevent chromosomally caused recurrent miscarriages, to improve success with older patients’ IVF cycles and for family balancing/gender selection. Embryos are biopsied 3 days after retrieval in the cleaved state or 5 or 6 days after retrieval in the blastocyst state.
Progesterone is an ovarian hormone that prepares the lining of the womb for implantation. We measure it during stimulation to check if the lining is getting prematurely stimulated. We add it to the woman after the retrieval to better prepare the lining and continue it as needed to help sustain the implanted embryo until the placenta takes over production of its own progesterone. It may be administered as an intramuscular injection in which it is placed in various oil media to facilitate absorption. It may also be administered as vaginal suppositories or tablets either as compounded micronized progesterone or in the commercially prepared brands; Endometrin and Crinone.
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