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Archive for the ‘OHSS’ tag

September is PCOS Awareness Month

By David Kreiner MD

September 12th, 2014 at 2:30 pm

 

credit: anankkml and free digital photos.net


PCOS is the most common hormonal disorder of reproductive age women, occurring in over 7% of women at some point in their lifetime.  It usually develops during the teen years.  Treatment can assist women attempting to conceive, help control the symptoms and prevent long term health problems.

The most common cause of PCOS is glucose intolerance resulting in abnormally high insulin levels.  If a woman does not respond normally to insulin her blood sugar levels rise, triggering the body to produce more insulin.  The insulin stimulates your ovaries to produce male sex hormones called androgens.  Testosterone is a common androgen and is often elevated in women with PCOS.  These androgens block the development and maturation of a woman’s ovarian follicles, preventing ovulation resulting in irregular menses and infertility.  Androgens may also trigger development of acne and extra facial and body hair.  It will increase lipids in the blood.  The elevated blood sugar from insulin resistance can develop into diabetes.

Symptoms may vary but the most common are acne, weight gain, extra hair on the face and body, thinning of hair on the scalp, irregular periods and infertility.

Ovaries develop numerous small follicles that look like cysts hence the name polycystic ovary syndrome.  These cysts themselves are not harmful but in response to fertility treatment can result in a condition known as Ovarian Hyperstimulation syndrome, or OHSS.

Hyperstimulation syndrome involves ovarian swelling, fluid accumulating in the belly and occasionally around the lungs.  A woman with Hyperstimulation syndrome may become dehydrated increasing her risk of developing blood clots.  Becoming pregnant adds to the stimulation and exacerbates the condition leading many specialists to cancel cycles in which a woman is at high risk of developing Hyperstimulation.  They may also prescribe aspirin to prevent clot formation.

These cysts may lead to many eggs maturing in response to fertility treatment also placing patients at a high risk of developing a high order multiple pregnancy.  Due to this unique risk it may be advantageous to avoid aggressive stimulation of the ovaries unless the eggs are removed as part of an in vitro fertilization procedure.

A diagnosis of PCOS may be made by history and physical examination including an ultrasound of the ovaries.  A glucose tolerance test is most useful to determine the presence of glucose intolerance and diabetes.  Hormone assays will also be helpful in making a differential diagnosis.

Treatment starts with regular exercise and a diet including healthy foods with a controlled carbohydrate intake.  This can help lower blood pressure and cholesterol and reduce the risk of diabetes.  It can also help you lose weight if you need to.

Quitting smoking will help reduce androgen levels and reduce the risk for heart disease.  Birth control pills help regulate periods and reduce excess facial hair and acne.  Laser hair removal has also been used successfully to reduce excess hair.

A diabetes medicine called metformin can help control insulin and blood sugar levels.  This can help lower androgen levels, regulate menstrual cycles and improve fertility.  Fertility medications, in particular clomiphene are often needed in addition to metformin to get a woman to ovulate and will assist many women to conceive.

The use of gonadotropin hormone injections without egg removal as performed as part of an IVF procedure may result in Hyperstimulation syndrome and/or multiple pregnancies and therefore one must be extremely cautious in its use.  In vitro fertilization has been very successful and offers a means for a woman with PCOS to conceive without a significant risk for developing a multiple pregnancy especially when associated with a single embryo transfer.   Since IVF is much more successful than insemination or intercourse with gonadotropin stimulation, IVF will reduce the number of potential exposures a patient must have to Hyperstimulation syndrome before conceiving.

It can be hard to deal with having PCOS.  If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition.  Ask your doctor about support groups and for treatment that can help you with your symptoms.  Remember, PCOS can be annoying, aggravating even depressing but it is fortunately a very treatable disorder.

* * * * * * ** *

Do you suffer from PCOS? Do you have any advice to share for other “cysters”?

 

 

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Don’t Jostle Your Ovaries

By Tracey Minella

February 10th, 2013 at 12:58 pm

It takes a strong woman to go through infertility treatment. And sometimes, in our headstrong, full-speed-ahead-with-blinders-on mode, we feel we’re unstoppable. Invincible, even. But we are not.

With some areas of Long Island blanketed in over two feet of snow, there is a potential danger to infertile women in treatment… snow shoveling. You are not invincible. Do not shovel snow if you are currently in a treatment cycle, have just completed a cycle, are in the two-week waiting period for results, or are pregnant. You must be gentle to and mindful of your ovaries.

When you take injectable medications for IVF (or ovulation induction) to stimulate your ovaries to produce multiple follicles… instead of the single monthly follicle you may otherwise have produced… one of the reasons the doctors monitor you so closely with blood work and sonograms is to reduce the risk of ovarian hyper-stimulation syndrome, or “OHSS”.

When you stimulate the ovaries, they temporarily swell a bit in response, which is expected. OHSS in its mild form can be uncomfortable, but usually resolves on its own. Fortunately, severe OHSS cases are incredibly rare. But in the 1-2% of those cases, patients may experience symptoms including rapid weight gain, abdominal pain, vomiting, and shortness of breath. Pregnancy hormones can worsen OHSS. So, it is important to report any of the above symptoms to your RE as soon as possible, before or after your retrieval or transfer (or IUI). For more info on OHSS, see http://mayocl.in/Xv5NsP

Most women know not to do anything that could be harmful to a developing baby, but they don’t often realize the potential risk certain activities can pose to their stimulated, or recently retrieved, ovaries. Play it safe. Don’t jostle your ovaries.

So put the snow shovel down, ladies. And, leave the vacuum alone while you’re at it, too.

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

Have you ever done anything strenuous while stimulating? Have you ever experienced OHSS?

 

Photo credit: Peter Griffin @ http://www.publicdomainpictures.net/view-image.php?image=29815&picture=shovel-snow

 

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Infertility Support Through Blogging

By Tracey Minella

January 10th, 2013 at 10:53 pm

credit: adamr/freedigitalphotos.net

RESOLVE, the National Infertility Association, is a great source of information and resources for those suffering from infertility. One popular feature it offers is the annual “Bloggers Unite Program”. During National Infertility Awareness Week in April each year, there is a theme for infertility bloggers to blog about. In 2012, the theme was “Don’t Ignore Infertility”.

Infertility blogs are as different as their authors’ individual infertility experiences and personalities. They may be written by newbies or seasoned IVF veterans, by those who had easy success or those who suffered terrible losses. By those who adopted, who had multiples, or who chose to live child-free. By those who are frank, sarcastic, funny, reserved, or serious. In short, there is something for everyone.

These are the blogs featured in RESOLVE’s 2012 “Bloggers Unite Program”: http://bit.ly/UP0vcR Consider checking some out.

My blog post from April 25, 2012 on Long Island IVF’s blog, The Fertility Daily, is number 35 on page three of the list. Here is that blog, in full, below:

Don’t Ignore Infertility Support Available

There’s something wrong with me. I see infertile people.

As an infertility blogger and an IVF mom, my mission is to support the women still on their fertility journeys. To listen to them and, when the time is right, to share my own stories to give them strength to go on…or to let go.

And to remind them that their infertility journeys will come to an end. Some day. It may be the day a baby is born or adopted, or with an eventual decision to live child-free. But someday, all this stuff…the charting, injections, inseminations, blood work, retrievals, transfers, miscarriages, stillbirths, and two week waits…all the stuff that now makes up every moment of every day… will end. “Really”, I tell them. “Trust me”…

But I lied.

True, the infertility journey will end. But the infertility itself never goes away.

Most people don’t know that.

After six years… three IUIs, six fresh IVFs, a twin loss, OHSS, ovarian torsion, and countless other obstacles to happiness, then a seventh IVF, for two problematic, bed-rest, preterm labor, gestational diabetic pregnancies which each delivered 6 weeks early…I was sure I’d put infertility behind me. Shop’s closed. Time to let that little smokin’ piece of charcoal I call “my remaining ovary” rest in peace.

But infertility remains.

It’s like in those movies where people see dead people. Except I see infertile people.

It’s there in the faces of young married couples who have the careers, the houses, and the “fur babies”, but have no obvious reason not to have had children yet. The woman awkwardly avoids eye contact when someone unknowingly brings up children. Those of us who’ve been there see it. It is blindingly obvious—like infertile radar.

It’s there in our faces, too. It’s in the little nagging worries about whether the countless vials of injectable medications are going to come back to bite you some day, some way. Or in the resentment we feel about having children later…possibly a decade later…than fertile folks did– and the fear of having less energy to parent them the way they deserve, or of living long enough to see them settled.

I’ve seen division in the infertility world. Among the childless, you have the rookies and the veterans defined by the number of failed IVF cycles they’ve endured. Then you have the secondary infertility patients, often claiming to be resented by the childless for being “greedy” enough to come back for another child. Finally, you have the newly pregnant or newborn success stories– the envy of all. Harsh, but often true. The world can be ugly, and the infertile world is no exception.

When a patient passes into the success story group, something wonderful happens to them. But something sad happens, too. They get the boot. Like some kind of graduation rite, the new moms get ejected from the ranks of the infertile. Their infertile former friends think they’re different now. They think they’re just like all the other fertile folks.

You have a baby now. You no longer understand us.

Are you reading this and saying “So what? Bring it on. Just let me get pregnant and kick me out! I can’t wait until infertility is over!”

It’s not so easy to be a woman without a country. You don’t fit in with your old infertile friends who are still trying to conceive, but you also don’t fit in with the fertile people who, by their words and actions, often take the ease with which they conceived for granted.

Enter one of the best kept secrets of the infertility world… the survivor’s guilt.

Infertility will always be part of you. Even as you push your child on a park swing, you’ll be acutely aware of the sad, detached woman on the bench. You’ll always remember the date of your long-awaited positive pregnancy test and will often think of the waiting room and the people still waiting there. You may find you are far too overprotective of the child you worked so hard to have. That infertile radar is always on.  And your heart hurts for those still struggling…even if they’ve forgotten you.

I blog about infertility for the doctors who didn’t give up on me when I wasn’t an easy case, or an easy patient, or truth be told, much help to their success stats. I blog for the doctors who built my family. For today’s patients and the patients yet to come. Some of the drug names have changed, but the stories are all relevant and the support is heartfelt.  It didn’t feel right to just go on with my life after my journey ended.

Sadly, many IF bloggers gravitate only to blogs by women currently on their journeys. Of course, they are wonderful sources of support. But to overlook the value of informative commercial blogs or blogs by those whose journeys have ended is to overlook another source of support.

So, don’t ignore the infertility support that is available from those who’ve walked a mile in your stirrups. Don’t shun us because you think we don’t understand you anymore. Don’t lump us in with the fertile people just because our journey has ended. Take advantage of the fact that we want to focus only on you.

We are here to help and support you. We will never forget. Don’t ignore us.

* * * * * * ** * **

Do you read other infertility blogs? If so, which ones?

 

 

photo credit: http://www.freedigitalphotos.net/images/search.php?search=computer&cat=

 

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Journey On: My Journey, My Advice

By Tracey Minella

January 3rd, 2013 at 2:38 pm

credit: tung photo/freedigitalphotos.net

I want to share my story today because I want to inspire you to go on when you think you can’t possibly do so any longer. I hope you will listen even though I personally know… and will always remember…how much it hurts to hear of someone else’s IVF success.

Fifteen years ago today,  my infertility journey took a turn down a new path. My daughter was born. Allow me to follow that with a big fat “Finally!”

She arrived six weeks early amid chaos in a delivery room crowded with NICU team members. I’d spent a week before Christmas in the hospital trying to stave off early labor and to get the hang of insulin injections for gestational diabetes. But there was no putting her off any longer. I won’t lie to you: my life truly began that day.

Nothing on the road to motherhood was easy for me, including the pregnancy itself. Some people are lucky to have IVF success right off the bat, but not me. But here’s one of the life lessons I learned from what felt like the world’s longest infertility journey ever: The longer the wait, the happier the ending.

The happiest “happy endings” come after struggle and loss. They come from a place of profound gratitude. From a place where hope barely hangs on. They often come after the heart-wrenching ups and downs of “No you can’t have it”…“Wait for it”… “It’s possible”…“It’s negative, again”…“Ok, we can do this”…” “See the heartbeats?”… “No, I’m so sorry”… “Let’s try this”… “Good news”… “You’re being admitted”…“There’s been a complication”…

But they do come:

“Congratulations. It’s a girl.”

If you’ve suffered long, may you find some consolation in the idea that you may be building a happier ending.

I usually share my story for new readers in January and June, on the anniversaries of the day I became a mother and the day I started working at Long Island IVF.

Oddly enough, I started working as a medical assistant at Long Island IVF on the day of my first pregnancy test after my 6th fresh IVF cycle. What the heck were we all thinking? It was a big gamble for the doctors… hiring not only a patient, but a very challenging one nearly ready to crawl out on the ledge. But it was a life-changing day for me on many levels.

I made it my purpose then to help others on their journeys. There is something to be said about “misery loves company.” As I drew their blood and they’d talk of quitting, I’d share my stories of perseverance in the face of my early 1990’s IVF challenges like hyperstimulation, poor fertilization, repeated failed implantation, ovarian torsion and its removal, high order multiple pregnancy, and pregnancy loss. I’d never push them to go on, but many chose to.

I help today’s patients through blogging. I pass along the latest information about advances in the field (like the PGS/PGD study we are currently recruiting patients for), share some stories, educate and entertain, and provide a laugh or a virtual shoulder to cry on. Some of the drug names have changed…and some of the needles have gotten smaller…but the emotions and most of the experiences are the same. Happily, the success rates are much higher.

As this New Year begins with possible thoughts of stopping your own infertility journey, please remember this when you’re weighing your options: Just because it doesn’t work out for you the first, second, third, fourth, or fifth time, it doesn’t necessarily mean it isn’t meant to be. We all may need financial and emotional breaks and we each take different roads along the way. Just realize that not succeeding quickly doesn’t necessarily mean you never will. I proved many people wrong.

I hope you all find your way over the worst bumps and turns in your own infertility road, sooner rather than later. In the meantime, you can vent here. Real life and online friendships have started here. Join us this year.

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

Where are you along your infertility journey? Where do you find support?

 

 

photo credit: http://www.freedigitalphotos.net/images/search.php?search=crossroads&cat=

 

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PCOS: The Unwanted Pearl Necklace

By David Kreiner MD, and Tracey Minella

September 6th, 2012 at 7:49 pm

credit: maggiesmith/freedigitalphotos.net

There’s nothing at all sexy about PCOS, or Polycystic Ovarian Syndrome. In fact, some women who suffer from PCOS are not only fertility-challenged (by tiny ovarian cysts appearing like a string of pearls on an ovarian sonogram), but may be cursed with any number of other annoyances, including facial hair and acne and extra poundage. How lovely.

Dr. Kreiner, of Long Island IVF explains PCOS, its affect on your ability to conceive, and the way it can be managed:

PCOS is the most common hormonal disorder of reproductive age women, occurring in over 7% of women at some point in their lifetime.  It usually develops during the teen years.  Treatment can assist women attempting to conceive, help control the symptoms and prevent long term health problems.

The most common cause of PCOS is glucose intolerance resulting in abnormally high insulin levels.  If a woman does not respond normally to insulin her blood sugar levels rise, triggering the body to produce more insulin.  The insulin stimulates your ovaries to produce male sex hormones called androgens.  Testosterone is a common androgen and is often elevated in women with PCOS.  These androgens block the development and maturation of a woman’s ovarian follicles, preventing ovulation resulting in irregular menses and infertility.  Androgens may also trigger development of acne and extra facial and body hair.  It will increase lipids in the blood.  The elevated blood sugar from insulin resistance can develop into diabetes.

Symptoms may vary but the most common are acne, weight gain, extra hair on the face and body, thinning of hair on the scalp, irregular periods and infertility.

Ovaries develop numerous small follicles that look like cysts hence the name polycystic ovary syndrome.  These cysts themselves are not harmful but in response to fertility treatment can result in a condition known as  Ovarian Hyperstimulation syndrome, or OHSS.

Hyperstimulation syndrome involves ovarian swelling, fluid accumulating in the belly and occasionally around the lungs.  A woman with Hyperstimulation syndrome may become dehydrated increasing her risk of developing blood clots.  Becoming pregnant adds to the stimulation and exacerbates the condition leading many specialists to cancel cycles in which a woman is at high risk of developing Hyperstimulation.  They may also prescribe aspirin to prevent clot formation.

These cysts may lead to many eggs maturing in response to fertility treatment also placing patients at a high risk of developing a high order multiple pregnancy.  Due to this unique risk it may be advantageous to avoid aggressive stimulation of the ovaries unless the eggs are removed as part of an in vitro fertilization procedure.

A diagnosis of PCOS may be made by history and physical examination including an ultrasound of the ovaries.  A glucose tolerance test is most useful to determine the presence of glucose intolerance and diabetes.  Hormone assays will also be helpful in making a differential diagnosis.

Treatment starts with regular exercise and a diet including healthy foods with a controlled carbohydrate intake.  This can help lower blood pressure and cholesterol and reduce the risk of diabetes.  It can also help you lose weight if you need to.

Quitting smoking will help reduce androgen levels and reduce the risk for heart disease.  Birth control pills help regulate periods and reduce excess facial hair and acne.  Laser hair removal has also been used successfully to reduce excess hair.

A diabetes medicine called metformin can help control insulin and blood sugar levels.  This can help lower androgen levels, regulate menstrual cycles and improve fertility.  Fertility medications, in particular clomiphene are often needed in addition to metformin to get a woman to ovulate and will assist many women to conceive.

The use of gonadotropin hormone injections without egg removal as performed as part of an IVF procedure may result in Hyperstimulation syndrome and/or multiple pregnancies and therefore one must be extremely cautious in its use.  In vitro fertilization has been very successful and offers a means for a woman with PCOS to conceive without a significant risk for developing a multiple pregnancy especially when associated with a single embryo transfer.   Since IVF is much more successful than insemination or intercourse with gonadotropin stimulation, IVF will reduce the number of potential exposures a patient must have to Hyperstimulation syndrome before conceiving.

It can be hard to deal with having PCOS.  If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition.  Ask your doctor about support groups and for treatment that can help you with your symptoms.  Remember, PCOS can be annoying, aggravating even depressing but it is fortunately a very treatable disorder.

* * * * * * ** *

Do you suffer from PCOS?

 

 

no comments

Micro-IVF Can Further Reduce Rare Risk of Ovarian Hyperstimulation Syndrome

By David Kreiner MD

July 17th, 2012 at 6:29 pm

Recent media attention* regarding the risk of ovarian hyperstimulation syndrome (OHSS) in in-vitro fertilization (IVF) cases– estimated by most sources at three percent (3%) for patients undergoing traditional IVF — has increased interest in minimal stimulation IVF, also known as Micro-IVF or Mini-IVF.  

Long Island IVF’s Micro-IVF program is five (5) years old and is registered with the Society of Assisted Reproductive Technology separately as East Coast Fertility under the medical directorship of Dr. David Kreiner and embryology directorship of Dr. John Moschella, who have a combined fifty years of IVF experience.

Since the merger of East Coast Fertility with Long Island IVF in October, 2011, the pregnancy rate for women under 35 years of age exceeds 50% per transfer with MicroIVF.  

Using clomid and two days of lowest dose gonadotropin hormones, this minimal stimulation has a 0% incidence of OHSS at Long Island IVF.  

Furthermore, a Micro-IVF procedure costs $3,900.00 plus the cost of the medications, and $500.00 for optional anesthesia.  

In tune with the safer minimal stimulation IVF, Long Island IVF also offers their Single Embryo Transfer (SET) Program to motivate patients to select the very safest procedure by avoiding the increased risk of multiple pregnancyassociated with a multiple embryo transfer.  Patients electing SET for traditional IVF or Micro-IVF pay nothing to freeze excess embryos and store them up to a year.

Certainly those concerned about OHSS, or those looking for a less costly alternative to traditional IVF should inquire about whether Micro-IVF–successfully performed by Long Island IVF’s doctors for five years—might be for them.

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

Long Island IVF is holding its annual “Extreme Family-Building Makeover” contest to award a Free basic Micro-IVF cycle, valued at $3,900.00, to a woman without (or who has exhausted) infertility insurance coverage. You do not have to be a LIIVF patient or even a New York resident. Contest ends August 26, 2012. For details, rules, and to enter, click here: http://bit.ly/LHbmQR

Have you experienced severe OHSS during traditional IVF that required hospitalization? If so, did it stop you from pursuing traditional IVF again? Would you consider Micro-IVF?

*This letter was prompted in response to today’s New York Times article, entitled “High Doses of Hormones Faulted in Fertility Care”, by Jacqueline Mroz. See the full article here: http://nyti.ms/OJT4yu

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