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Archive for the ‘Obesity and fertility’ tag

Too Fat for Fertility Treatment?

By David Kreiner, MD

March 11th, 2016 at 12:39 pm

 

image credit: OhMega1982 at freedigitalphotos.net


The most shocking thing I’ve experienced in my 30+ year career in Reproductive Endocrinology has been the consistent “resistance” among specialists to treat women with obesity. This “resistance” has felt at times to both me and many patients to be more like a prejudice. I have heard other REI specialists say that it is harder for women to conceive until they shed their excess weight. “Come back to my office when you have lost 20, 30 or more pounds,” is a typical remark heard by many at their REI’s office. “It’s not healthy to be pregnant at your weight and you risk your health and the health of the baby.” Closing the door to fertility treatment is what most women in this condition experience.

An article in Medical News Today, “Obese Women Undergoing Infertility Treatment Advised Not To Attempt Rapid Weight Loss”, once suggested that weight loss just prior to conception may have adverse effects on the pregnancy, either by disrupting normal physiology or by releasing environmental pollutants stored in the fat. The article pointed out what is obvious to many who share the lifelong struggle to maintain a reasonable Body Mass Index (BMI): Weight loss is difficult to achieve. Few people adhere to lifestyle intervention and diets which may have no benefit in improving pregnancy in subfertile obese women.

The bias in the field is so strong that when I submitted a research paper demonstrating equivalent IVF pregnancy rates for women with excessive BMIs greater than 35 to the ASRM for presentation, it was rejected based on the notion that there was clear evidence to the contrary. Here’s the point I was trying to prove: IVF care must be customized to optimize the potential for this group.

Women with high BMI need a higher dose of medication. Those with PCOS benefit from treatment with Metformin. Their ultrasounds and retrievals need to be performed by the most experienced personnel. Often their follicles will be larger than in women of lower weight. Strategies to retrieve follicles in high BMI women include using a suture in the cervix to manipulate the uterus and an abdominal hand to push the ovaries into view.

Most importantly, a two-stage embryo transfer with the cervical suture can insure in utero placement of the transfer catheter and embryos without contamination caused by inadvertent touching of the catheter to the vaginal wall before insertion through the cervical canal. Visualization of the cervix is facilitated by pulling on the cervical suture, straightening the canal and allowing for easier passage of the catheter. The technique calls for placement of one catheter into the cervix through which a separate catheter, loaded with the patient’s embryo, is inserted.

Using this strategy, IVF with high BMI patients is extremely successful. With regard to the health of the high BMI woman and her fetus, it’s critical to counsel patients just as it is when dealing with women who live with diabetes or any other chronic situation that adds risk.

We refuse to share in the prejudice that is nearly universal in this field. It’s horrible and hypocritical to refuse these patients treatment. Clearly, with close attention to the needs of this population, their success is like any others.

Women who have time and motivation to lose significant weight prior to fertility therapy are encouraged to do so and I try to support their efforts. Unfortunately, many have tried and are unable to significantly reduce prior to conception.

What right do we have to deny these women the right to build their families?

It can be hard to deal with obesity and even more so when combined with infertility. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. I advise you to ask your doctor about support groups and for treatment that can help you including fertility treatment. Long Island IVF has a complete Mind-Body program with counselors for men and women suffering from infertility and we welcome those who are not yet our patients. See http://www.longislandivf.com/mind_body.cfm

Remember, though this condition can be annoying, aggravating and even depressing, seek an REI who is interested in supporting you and helping you build your family and reject those who simply tell you to return after you have lost sufficient weight.

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

Have you been turned away from an RE because you’re overweight or obese? Do you think that’s fair?

* * * * * * * * * **  * **

Photo credit: Ohmega 1982 at freedigitalphotos.net  http://www.freedigitalphotos.net/images/Other_health_and_bea_g278-Female_Hand_Touching_Stomach_Fat_p86222.html

 

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

 

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 contest…two 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 28 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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Age and Fertility

By David Kreiner MD

February 2nd, 2015 at 4:23 pm

 

credit: photostock/free digital photos.net


You’ve heard the “Reproductive Bell” toll and may question “Is it real?”…

You see celebrities getting pregnant well into their 40’s and think “Then why can’t I?” So, is your reproductive clock as critical as modern doctors say?

I have come across fertility advice from non-physician practitioners, such as acupuncturists and Chinese herbalists, who encourage their patients to “question the Western dogma” when it comes to age and fertility. They claim the effect of aging and fertility is “exaggerated by the Medical profession and can be overcome with a shift in an individual’s health and lifestyle”.

Unfortunately, this advice comes without any cited research or statistics in support of it.  According to the Society of Assisted Reproductive Technology, as published on SART.org, a review of the 2012 national statistics, those most recently published of IVF cycles started, the age breakdown for IVF live birth rates are the following:

 

Age <35= 40.2%

 

Age 35-37=31.3%

 

Age 38-40=22.2%

 

Age 41-42=11.8%

 

Age >42=3.2%

 

It is true that a woman’s health and physiology gets worse as she gets older.  Some of these non- physician practitioners argue that perhaps if this can be improved then the diminishing fertility commonly seen with aging can be reversed. But though improving a woman’s general health may help it is not sufficient in most cases.  Fertility rates decrease with increasing age in large part because there is an increase in genetic abnormalities found in gametes (eggs and sperm) as patients (women in particular) age.  This is the result of long-term environmental exposure to toxins, in addition to the increased likelihood of genetic damage over time.  Miscarriage rates increase with age for the same reason in large part due to the greater likelihood of embryos having chromosomal abnormalities.

Many women as they age also will experience a significant drop in their ovarian activity, referred to as diminished ovarian reserve.  This activity can be assessed by your physician with a blood level of Anti Mullerian Hormone (AMH) and day 3 FSH and estradiol levels.  Women with lower AMH levels and elevated FSH in the presence of a normal low estradiol have fewer ovarian follicles, and hence eggs, that will respond to ovarian stimulation.  Since the likelihood of these eggs being genetically normal is less, then fertility is reduced and the probability of IVF and other fertility treatments resulting in a live birth becomes significantly lower.

The challenge to any practitioner dealing with an aging patient attempting to conceive is to optimize their patient’s chance to have a healthy baby which optimally would include an integration of multiple modalities.  Therefore, ideally a physician specially trained in the fertility process (a Reproductive Endocrinologist), should implement state-of-the-art Western therapies with a complementary holistic approach that aims to shift their patient’s health and fertility.  These holistic approaches include diet and lifestyle changes as well as fertility-directed acupuncture and herbal therapy treatments.

Lifestyle changes that may improve fertility primarily include those that reduce stress and improve diet and activity.  Stress at work, at home, and with family and friends can create pathology from both Eastern and Western perspectives.  Diets that do not support adequate blood production or create Eastern patterns of cold or heat can affect fertility.  Excesses or deficiencies of particular foods…such as dairy, fat, or grains… can create imbalances or pathology that may affect fertility or result in obesity or malnutrition which also impact reproduction.

Inactivity may impair fertility. Therefore some level of exercise, combined with an improved diet directed at improving fertility, stress reduction techniques, acupuncture, and supplements (which may include Chinese Herbs as well as Western supplements) will optimize your chances of successfully building your family.

The first step is to seek help from a reproductive endocrinologist skilled in state-of-the-art fertility therapies who can coordinate a program which is ideal for you. But if you are hearing the “Reproductive Bell” tolling, it is important to take that first step soon, because, while these many complementary approaches can optimize your fertility, they may not be enough to overcome the reality of the negative effect of advanced age in fertility.

Long Island IVF offers complementary holistic approaches to achieving pregnancy (See our Mind-Body Program http://www.longislandivf.com/mind_body.cfm ) as well as a well-respected Donor Egg Program http://www.longislandivf.com/donor_programs.cfm  with no wait for pre-screened, multi-ethnic donor eggs, or Donor Embryos.

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

Has the increased visibility of older celebrity moms getting pregnant made you think you have more time? Have you considered combining Western and Eastern medicine in your family-building treatment?

 

 

http://www.freedigitalphotos.net/images/Younger_Women_g57-Young_Woman_Holding_Clock_p49428.html

 

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Too Fat for Fertility Treatment?

By David Kreiner MD

January 2nd, 2015 at 9:01 am

credit: Ohmega1982/ freedigitalphotos.net

The most shocking thing I’ve experienced in my 30+ year career in Reproductive Endocrinology has been the consistent “resistance” among specialists to treat women with obesity. This “resistance” has felt at times to both me and many patients to be more like a prejudice. I have heard other REI specialists say that it is harder for women to conceive until they shed their excess weight. “Come back to my office when you have lost 20, 30 or more pounds,” is a typical remark heard by many at their REI’s office. “It’s not healthy to be pregnant at your weight and you risk your health and the health of the baby.” Closing the door to fertility treatment is what most women in this condition experience.

An article in Medical News Today, “Obese Women Undergoing Infertility Treatment Advised Not To Attempt Rapid Weight Loss”, once suggested that weight loss just prior to conception may have adverse effects on the pregnancy, either by disrupting normal physiology or by releasing environmental pollutants stored in the fat. The article pointed out what is obvious to many who share the lifelong struggle to maintain a reasonable Body Mass Index (BMI): Weight loss is difficult to achieve. Few people adhere to lifestyle intervention and diets which may have no benefit in improving pregnancy in subfertile obese women.

The bias in the field is so strong that when I submitted a research paper demonstrating equivalent IVF pregnancy rates for women with excessive BMIs greater than 35 to the ASRM for presentation, it was rejected based on the notion that there was clear evidence to the contrary. Here’s the point I was trying to prove: IVF care must be customized to optimize the potential for this group.

Women with high BMI need a higher dose of medication. Those with PCOS benefit from treatment with Metformin. Their ultrasounds and retrievals need to be performed by the most experienced personnel. Often their follicles will be larger than in women of lower weight. Strategies to retrieve follicles in high BMI women include using a suture in the cervix to manipulate the uterus and an abdominal hand to push the ovaries into view.

Most importantly, a two-stage embryo transfer with the cervical suture can insure in utero placement of the transfer catheter and embryos without contamination caused by inadvertent touching of the catheter to the vaginal wall before insertion through the cervical canal. Visualization of the cervix is facilitated by pulling on the cervical suture, straightening the canal and allowing for easier passage of the catheter. The technique calls for placement of one catheter into the cervix through which a separate catheter, loaded with the patient’s embryo, is inserted.

Using this strategy, IVF with high BMI patients is extremely successful. With regard to the health of the high BMI woman and her fetus, it’s critical to counsel patients just as it is when dealing with women who live with diabetes or any other chronic situation that adds risk.

We refuse to share in the prejudice that is nearly universal in this field. It’s horrible and hypocritical to refuse these patients treatment. Clearly, with close attention to the needs of this population, their success is like any others.

Women who have time and motivation to lose significant weight prior to fertility therapy are encouraged to do so and I try to support their efforts. Unfortunately, many have tried and are unable to significantly reduce prior to conception.

What right do we have to deny these women the right to build their families?

It can be hard to deal with obesity and even more so when combined with infertility. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. I advise you to ask your doctor about support groups and for treatment that can help you including fertility treatment. Long Island IVF has a complete Mind-Body program with counselors for men and women suffering from infertility and we welcome those who are not yet our patients. See http://www.longislandivf.com/mind_body.cfm

Remember, though this condition can be annoying, aggravating and even depressing, seek an REI who is interested in supporting you and helping you build your family and reject those who simply tell you to return after you have lost sufficient weight.

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

Have you been turned away from an RE because you’re overweight or obese? Do you think that’s fair?

 

Photo credit: Ohmega 1982 http://www.freedigitalphotos.net/images/agree-terms.php?id=10073481

 

 

 

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“Yo Mama’s So Fat…” and Other Reasons Infertile, Overweight Women Kill

By Tracey Minella and David Kreiner MD

January 5th, 2012 at 6:21 pm

Didn’t these jeans fit me three weeks ago?

#@#*&%!!

Raise your hand if you made a resolution to lose weight this year…again. Or were you like me and just thought it but didn’t say it out loud… to avoid the snickering? C’mon, get that hand up, sister.

Tell me I’m not the only one out there who chomped down too many Christmas cookies, finished off too many fried latkes and zeppoles, and got hammered on gallons of eggnog. Really, I’m not the only one pulling out the “fat” clothes again, am I?

To a woman TTC, nothing is worse than being told you can’t have a baby without medical intervention…unless you’re then told you’re too overweight to have the treatments. That can hurt even more than those terrible fat jokes.

For me, depression and overeating Oreos went hand in…well… mouth. And the longer my infertility journey took… with the sorrows of miscarriage, failed IVFs, and an ovarian torsion to drown… the bigger the gap got in the back of my hospital gowns.

In a perfect world, we’d all be a healthy weight. None of us would be infertile, or have thyroid issues or diabetes, or PCOS, or just plain-old, depression-induced obesity to fill the void where our baby is supposed to be.

But the world is not perfect.

Fortunately, there are compassionate RE’s out there who are willing to give overweight patients the respect and the treatment they deserve. They’re just not easy to find. Maybe they even felt the sting of the public’s disdain for the obese on a personal level. Whatever their motivation, it’s worth the extra effort to find this kind of support on your infertility journey.

You need a doctor who is willing to potentially sacrifice his program’s IVF stats to make you a mom, because he believes he can do it…today…not after sending you home to lose those 20-30 pounds of extra weight first. Today.

Even if you are morbidly obese or have other health issues related to morbid obesity… and your treatment needs to be deferred for safety reasons until some of that weight is taken off…  there’s no reason to have to scale down to Cover Girl stickness in order to be treated. You can get a bun in your oven… and have some junk in your trunk!

Dr. Kreiner brings this prejudice and injustice to the forefront in his thoughtful, compassionate post:

The most shocking thing I’ve experienced in my 30 year career in Reproductive Endocrinology has been the consistent “resistance” among specialists to treat women with obesity. This “resistance” has felt at times to both me and many patients to be more like a prejudice. I have heard other REI specialists say that it is harder for women to conceive until they shed their excess weight. “Come back to my office when you have lost 20, 30 or more pounds,” is a typical remark heard by many at their REI’s office. “It’s not healthy to be pregnant at your weight and you risk your health and the health of the baby.” Closing the door to fertility treatment is what most women in this condition experience.

An article in Medical News Today, “Obese Women Undergoing Infertility Treatment Advised Not To Attempt Rapid Weight Loss”, suggested that weight loss just prior to conception may have adverse effects on the pregnancy, either by disrupting normal physiology or by releasing environmental pollutants stored in the fat. The article points out what is obvious to many who share the lifelong struggle to maintain a reasonable Body Mass Index (BMI): Weight loss is difficult to achieve. Few people adhere to lifestyle intervention and diets which may have no benefit in improving pregnancy in subfertile obese women.

The bias in the field is so strong that when I submitted a research paper demonstrating equivalent IVF pregnancy rates for women with excessive BMIs greater than 35 to the ASRM for presentation, it was rejected based on the notion that there was clear evidence to the contrary. Here’s the point I was trying to prove: IVF care must be customized to optimize the potential for this group.

Women with high BMI need a higher dose of medication. Those with PCOS benefit from treatment with Metformin. Their ultrasounds and retrievals need to be performed by the most experienced personnel. Often their follicles will be larger than in women of lower weight. Strategies to retrieve follicles in high BMI women include using a suture in the cervix to manipulate the uterus and an abdominal hand to push the ovaries into view.

Most importantly, a two-stage embryo transfer with the cervical suture can insure in utero placement of the transfer catheter and embryos without contamination caused by inadvertent touching of the catheter to the vaginal wall before insertion through the cervical canal. Visualization of the cervix is facilitated by pulling on the cervical suture, straightening the canal and allowing for easier passage of the catheter. The technique calls for placement of one catheter into the cervix through which a separate catheter, loaded with the patient’s embryo, is inserted.

Using this strategy, IVF with high BMI patients is extremely successful. With regard to the health of the high BMI woman and her fetus, it’s critical to counsel patients just as it is when dealing with women who live with diabetes or any other chronic situation that adds risk.

We refuse to share in the prejudice that is nearly universal in this field. It’s horrible and hypocritical to refuse these patients treatment. Clearly, with close attention to the needs of this population, their success is like any others.

Women who have time and motivation to lose significant weight prior to fertility therapy are encouraged to do so and I try to support their efforts. Unfortunately, many have tried and are unable to significantly reduce prior to conception.

What right do we have to deny these women the right to build their families?

It can be hard to deal with obesity and even more so when combined with infertility. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. I advise you to ask your doctor about support groups and for treatment that can help you including fertility treatment.

Remember, though this condition can be annoying, aggravating and even depressing, seek an REI who is interested in supporting you and helping you build your family and reject those who simply tell you to return after you have lost sufficient weight.

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

Have you been turned away from an RE because you’re overweight or obese? Do you think that’s fair?

no comments

“Yo Mama’s So Fat…” and Other Reasons Infertile, Overweight Women Kill

By Tracey Minella and David Kreiner MD

April 21st, 2011 at 12:00 am

Maybe murder is a bit extreme, but then again…

To a woman TTC, nothing is worse than being told you can’t have a baby without medical intervention…unless you’re then told you’re too overweight to have the treatments. That can hurt even more than those terrible fat jokes.

For me, depression and overeating Oreos went hand in…well… mouth. And the longer my infertility journey took… with the sorrows of miscarriage, failed IVFs, and an ovarian torsion to drown… the bigger the gap got in the back of my hospital gowns.

In a perfect world, we’d all be a healthy weight. None of us would be infertile, or have thyroid issues or diabetes, or PCOS, or just plain-old, depression-induced obesity to fill the void where our baby is supposed to be.

But the world is not perfect.

Fortunately, there are compassionate RE’s out there who are willing to give overweight patients the respect and the treatment they deserve. They’re just not easy to find. Maybe they even felt the sting of the public’s distain for the obese on a personal level. Whatever their motivation, it’s worth the extra effort to find this kind of support on your infertility journey.

You need a doctor who is willing to potentially sacrifice the program’s IVF stats to make you a mom, because he does believe he can do it…today…not after sending you home to lose loads of weight first. Today.

Dr. Kreiner of East Coast Fertility brings this prejudice and injustice to the forefront in his thoughtful, compassionate post:

The most shocking thing I’ve experienced in my 30 year career in Reproductive Endocrinology has been the consistent “resistance” among specialists to treat women with obesity. This “resistance” has felt at times to both me and many patients to be more like a prejudice. I have heard other REI specialists say that it is harder for women to conceive until they shed their excess weight. “Come back to my office when you have lost 20, 30 or more pounds,” is a typical remark heard by many at their REI’s office. “It’s not healthy to be pregnant at your weight and you risk your health and the health of the baby.” Closing the door to fertility treatment is what most women in this condition experience.

An article in Medical News Today, “Obese Women Undergoing Infertility Treatment Advised Not To Attempt Rapid Weight Loss”, suggested that weight loss just prior to conception may have adverse effects on the pregnancy, either by disrupting normal physiology or by releasing environmental pollutants stored in the fat. The article points out what is obvious to many who share the lifelong struggle to maintain a reasonable Body Mass Index (BMI): Weight loss is difficult to achieve. Few people adhere to lifestyle intervention and diets which may have no benefit in improving pregnancy in subfertile obese women.

The bias in the field is so strong that when I submitted a research paper demonstrating equivalent IVF pregnancy rates for women with excessive BMIs greater than 35 to the ASRM for presentation, it was rejected based on the notion that there was clear evidence to the contrary. Here’s the point I was trying to prove: IVF care must be customized to optimize the potential for this group.

Women with high BMI need a higher dose of medication. Those with PCOS benefit from treatment with Metformin. Their ultrasounds and retrievals need to be performed by the most experienced personnel. Often their follicles will be larger than in women of lower weight. Strategies to retrieve follicles in high BMI women include using a suture in the cervix to manipulate the uterus and an abdominal hand to push the ovaries into view.

Most importantly, a two-stage embryo transfer with the cervical suture can insure in utero placement of the transfer catheter and embryos without contamination caused by inadvertent touching of the catheter to the vaginal wall before insertion through the cervical canal. Visualization of the cervix is facilitated by pulling on the cervical suture, straightening the canal and allowing for easier passage of the catheter. The technique calls for placement of one catheter into the cervix through which a separate catheter, loaded with the patient’s embryo, is inserted.

Using this strategy, IVF with high BMI patients is extremely successful. With regard to the health of the high BMI woman and her fetus, it’s critical to counsel patients just as it is when dealing with women who live with diabetes or any other chronic situation that adds risk.

We refuse to share in the prejudice that is nearly universal in this field. It’s horrible and hypocritical to refuse these patients treatment. Clearly, with close attention to the needs of this population, their success is like any others.

Women who have time and motivation to lose significant weight prior to fertility therapy are encouraged to do so and I try to support their efforts. Unfortunately, many have tried and are unable to significantly reduce prior to conception.

What right do we have to deny these women the right to build their families?

It can be hard to deal with obesity and even more so when combined with infertility. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. I advise you to ask your doctor about support groups and for treatment that can help you including fertility treatment.

Remember, though this condition can be annoying, aggravating and even depressing, seek an REI who is interested in supporting you and helping you build your family and reject those who simply tell you to return after you have lost sufficient weight.

* * * * * *

Have you felt prejudiced along your journey because of your weight? Do you feel that obese women should have to lose weight before TTC with IVF?

no comments


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