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Archive for the ‘PCOS and infertility’ tag

September is PCOS Awareness Month

By David Kreiner MD

September 1st, 2017 at 9:05 am

, via Wikimedia Commons”]

By Anne Mousse (Own work) [CC0

Polycystic Ovarian Syndrome, or “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”?

 

Photo credit:

By Anne Mousse (Own work) [CC0], via Wikimedia Commons

https://commons.wikimedia.org/wiki/File%3AEchographie_pelvienne%2C_aplio_toshiba_ssa_700_5_2004_03_detail.jpg

 

 

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September is PCOS Awareness Month

By David Kreiner MD

September 1st, 2015 at 6:09 pm

 

Teal ribbons in September signify PCOS Awareness Month.

PCOS (formally known as Polycystic Ovary Syndrome)  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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5 Popular Misconceptions Regarding Polycystic Ovary Syndrome (PCOS)

By Dr. Joseph Pena

June 22nd, 2015 at 11:23 am

 

via WikipediaCommons pubdomain”]

By Schomynv [CCo


Myth #1 – “If I have irregular periods, I have PCOS”.

Women with irregular menstrual periods are often unaware of the reason for their menstrual irregularity.  Many women are placed on hormonal contraceptives (i.e. birth control pills) by their gynecologist to regulate their menstrual periods and prevent an overgrowth of the lining of the uterus that may lead to cancer if left unchecked.  Some women are told they have PCOS as this is the most common etiology for irregular menstrual periods (4-7% of women of reproductive age, ~60-85% of anovulatory women), while others are not given a specific reason for their irregular menstrual periods.

While there is no universally accepted definition for PCOS, there are a few expert groups which have generated diagnostic criteria.  The Rotterdam Consensus Criteria (2006) requires two of the three signs/symptoms of PCOS (hyperandrogenism, irregular menstrual periods, polycystic-appearing ovaries on pelvic ultrasound) to be present for the diagnosis to be made.  The Androgen Excess Society (2006) requires hyperandrogenism plus one of the other two signs/symptoms (irregular menstrual periods, polycystic-appearing ovaries on pelvic ultrasound).  The hyperandrogenism criteria may be satisfied by either the presence of hirsutism (excessive hair growth) or elevated androgen levels, such as testosterone.  However, both criteria recommend excluding other possible causes of these signs and symptoms.  The differential diagnosis of someone with irregular menstrual periods and/or hirsutism is listed in the table below.

Differential Diagnosis of Polycystic Ovary Syndrome (PCOS)
—  Thyroid disease (hypothyroidism, hyperthyroidism)—  Prolactin/Pituitary disorders

—  Nonclassical congenital adrenal hyperplasia (Nonclassical CAH)

—  Androgen-secreting tumor (ovary, adrenal gland)

—  Exogenous androgens

—  Primary hypothalamic amenorrhea (stress-related, exercise-related, eating disorders, low body weight)

—  Central nervous system tumors/disorders

—  Primary ovarian failure

—  Cushing syndrome

—  Insulin-receptor defects

 

The proper evaluation of a woman with irregular menstrual periods and confirmation of PCOS is important because this affects treatment (e.g. combined hormonal contraceptives for PCOS, thyroid hormone replacement for hypothyroidism, corticosteroid replacement for nonclassical congenital adrenal hyperplasia, surgery for androgen-secreting tumor, etc.), as well as determining future fertility treatment (e.g. clomiphene citrate for PCOS, dopamine agonist for hyperprolactinemia, in vitro fertilization using donor oocytes for ovarian failure, etc.).  Thus, it is important for women to ask their physicians for a diagnosis for their irregular menstrual cycles.

 

Myth #2 – “Regular menstrual periods means I’m ovulating”.

The menstrual bleeding that occurs in a woman with inconsistent or absent ovulation is more likely due to breakthrough bleeding rather than post-ovulation withdrawal bleeding.  Thus, vaginal bleeding cannot be assumed to be an indication of ovulation in these women.

In addition, while many women and some clinicians use a history of regular menstrual cycles as a predictor of normal ovulatory function, ~40% of normally-menstruating women who exhibit hirsutism (excessive hair growth) are, actually, not ovulating and may be classified as having PCOS or other diagnosis associated with hyperandrogenism.

 

Myth #3 – PCOS is an ovarian cystic problem.

PCOS is an endocrine disorder of androgen excess with defined diagnostic criteria as noted above in Myth #1.  The determination of “the polycystic ovary (PCO)” (in contrast to the syndrome, PCOS) is defined in the table below.

Determination of polycystic appearing ovary (PCO)
—  In one or both ovaries, either:—  >12 follicles measuring 2-9mm in diameter

—  Increased ovarian volume > 10 cm3

—  If there is a follicle > 10mm in diameter, scan should be repeated at a time of ovarian quiescence in order to calculate volume/area

—  Presence of one PCO is sufficient for diagnosis

 

From the table above, it can be seen that PCO does not refer to and is very different from clinical ovarian cysts, both physiologic (e.g. corpus luteum) and pathologic (e.g. endometrioma, dermoid tumor), which tend to be larger in size.

The characteristic PCO emerges when a state of anovulation (lack of ovulatory cycles) persists for any length of time.  ~75% of anovulatory women will have PCO.  Since there are many causes of anovulation, there are many causes of PCO (e.g. PCOS, congenital adrenal hyperplasia, hyperprolactinemia, hyperandrogenism, type 2 diabetes mellitus, eating disorders, etc.).   PCO is the result of a problem with the normal functioning of the ovaries, and not necessarily from a specific individual cause.

Last but not least, PCO is not necessarily a pathologic abnormality.  Up to 25% of women who menstruate and ovulate normally will demonstrate PCO on ultrasound.

 

Myth #4 – “PCOS does not occur in thin or normal-weight women, or in women without excessive hair growth”.

While obesity and hirsutism (excessive hair growth) are relatively common in women with PCOS, with a prevalence of 20-60% and 30-80%, respectively, there are many women with PCOS with neither feature.  Again, referring to the diagnostic criteria for PCOS (see above in Myth #1), the presence of obesity is not necessary.  Hirsutism is just one manifestation of hyperandrogenism.  The other is biochemical, such as elevated androgen levels in the blood.  Certain ethnic backgrounds (e.g. Asians) may genetically not manifest hirsutism despite elevated androgen levels.  Thus, being thin or of normal weight and showing no signs of excessive hair growth does not necessarily eliminate PCOS as a diagnostic possibility.  Other common (but not necessarily required) features of PCOS are listed in the table below.

FEATURES OF POLYCYSTIC OVARY SYNDROME

PREVALENCE

CLINICAL
     Hirsutism (excessive hair growth) 30-80% (depends on ethnicity)
     Acne 15-20%
     Androgenic alopecia 5-10%
     Obesity 20-60%
     Anovulation 90-100% (depending on definition)
     Oligo/amenorrhea (irregular/absent menses) 50-70%
OVARIAN
     Polycystic appearing ovaries 70-80%
BIOCHEMICAL
     ­ LH/FSH 35-95%
     ­ free testosterone 60-80%
     ­ total testosterone 30-50%
     ­ DHEAS 25-70%
METABOLIC
     hyperinsulinemia 25-60%

 

 

Myth #5 – “Irregular menstrual periods due to PCOS is only a problem when trying to conceive.”

Obesity, irregular menstrual periods, and elevated insulin levels are common features of PCOS and significant risk factors for the development of an overgrowth of the lining of the uterus (endometrial hyperplasia), which may lead to cancer, if left unchecked.  It is not surprising then that women with PCOS are at an increased lifetime risk for developing endometrial hyperplasia and cancer of the lining of the uterus.  Thus, it is essential for a woman with PCOS who is currently not interested in conceiving, to discuss with her gynecologist the best option for her to decrease her risk for developing endometrial hyperplasia/cancer.   Options that might be considered include the use of [low-dose combined] hormonal contraceptives (e.g. the pill, transdermal patch, vaginal ring), progesterone-only pill, progestin IUD, and/or withdrawing with progesterone at regular intervals.

Women with PCOS are also thought to be at increased lifetime risk for developing type 2 diabetes mellitus and cardiovascular disease (abnormal cholesterol and other lipids, high blood pressure).  Regular screening for pre-diabetes or diabetes (with a 2-hour glucose tolerance test or fasting glucose level), body mass index, fasting lipid profile, and metabolic syndrome risk factors is essential to possibly help improve mortality and morbidity in such individuals.  Early intervention with lifestyle modification (diet, exercise, weight loss) and pharmacological treatment if needed (e.g. insulin-sensitizing agents, statins) may help to accomplish this.

Thus, PCOS is more than simply a problem of infertility.  It is a condition which should be discussed with one’s physician (gynecologist, primary physician, endocrinologist) even when one is not actively trying to conceive.

 

By Schomynv (Own work) [CC0], via Wikimedia Commons

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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”?

 

 

no comments

September is PCOS Awareness Month

By David Kreiner, MD

September 19th, 2013 at 8:10 pm

image courtesy of arztsamui/free digital photos.com

 

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”?

 

photo credit: artzsamui/http://www.freedigitalphotos.net/images/agree-terms.php?id=100156295

 

 

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Long Island IVF’s National Infertility Awareness Week Events

By Tracey Minella

April 15th, 2013 at 3:47 pm

 

Long Island IVF is pleased to offer an exciting series of seminars for National Infertility Awareness Week 2013. The five (5) seminars in our “Evenings of Education” series will be packed with information on many areas of interest to those trying to conceive. Each event will be led by a different expert at Long Island IVF.

All seminars, which will run for approximately two hours, will take place at our beautiful, centrally-located Melville offices at 8 Corporate Center Drive, Suite 101, Melville, New York and start at 6:30 pm. (Please note the one exception is “The Complete IVF Donor Egg Program” which starts at 7:00 pm). Refreshments will be served at all events. Pre-registration is encouraged.

These seminars are designed to answer all the questions you may have no matter where you are along your journey to parenthood. Maybe you know… or suspect… that you’re suffering from PCOS and worry about its impact on your fertility. Or maybe you’ve been trying to conceive and have been unable to get pregnant, or have suffered from recurrent miscarriages, and think it might be time to move on to an infertility specialist. Maybe you need help dealing with the stress of infertility itself, as well as the financial stress it can bring. Maybe you’re considering getting a second opinion or are questioning the whether the fit is right with your current reproductive endocrinologist.

Take the next step. Come to one…or all…of our seminars. Get a feel for the personal touch we bring to infertility treatment and see what makes our program different from those hospital-based programs that treat you like a number.

Long Island IVF …celebrating our 25th anniversary this year…is the first successful IVF program on Long Island. We brought Long Island its first IVF baby, its first FET baby, and its first donor egg baby. Come meet us during National Infertility Awareness Week. We’ll be looking forward to seeing you.

Here is the Seminar Schedule:

Tuesday, April 16, 2013 at 7:00 p.m.: “The Complete IVF Donor Egg Program”  

Kicking off NIAW early is the first of five seminars in our “Evenings of Education Series”. Presented by a panel of Long Island IVF doctors and staff (Donor Egg Program Director, Dr. Steven Brenner, Donor Egg Clinical Nurse Coordinator, Vicky Loveland, R.N., and Aviva Zigelman, LCSW) this educational seminar, including a slide show, will discuss why a woman may need donor eggs to conceive. The psychological aspects of being an egg donor or recipient will also be discussed. The entire donor egg program and its various processes will be reviewed, including what sets Long Island IVF’s donor egg program apart from others. The discussion will feature a previously successful recipient who used the donor egg program, as a guest speaker. There is no waiting list for egg donors at Long Island IVF. To register for this FREE seminar, Email: victorial@longislandivf.com or call 877-838-BABY or 631-752-0606. Location: Long Island IVF, 8 Corporate Center Dr., Suite 101, Melville, NY 11747

 

Monday, April 22, 2013 at 6:30 p.m.: “Trying to Conceive: The Complete Fertility Workup”   The second of five seminars in our NIAW “Evenings of Education” Series. Presented by Long Island IVF’s Dr. David Kreiner, this educational seminar will help interested people determine when it’s time to see a Reproductive Endocrinologist for assistance in conceiving. Dr. Kreiner will also explain the tests and procedures they may expect as part of a complete fertility evaluation and the full range of available treatment options to maximize the chances for conception. Dr. Kreiner will hold a Q&A session afterwards where attendees may ask him public, or private, questions. Pick the brain of Long Island’s IVF “pioneer” reproductive endocrinologist at the practice that brought Long Island its first IVF baby, first FET baby, and first donor egg baby. Refreshments will be served. To register for this FREE seminar or any of the others we are offering nightly this week, Email: lmontello@liivf.com or call 877-838-BABY or 631-752-0606. Location: Long Island IVF, 8 Corporate Center Dr., Suite 101, Melville, NY 11747

Tuesday, April 23, 2013 6:30 pm: “The Mind-Body Program: Use Your Mind to Help You Conceive” Presented by Long Island IVF’s Bina Benisch, R.N., this third seminar in our series will explain how stress hormones, anxiety, and depression physiologically affect the body and how it is crucial to break this cycle to increase your chance to conceive. Relaxation strategies of the Mind-Body program are taught in small, intimate group settings and include breath work, meditation, progressive muscle relaxation, focused mindfulness, and more. Once learned, you can use these coping strategies daily at home. Meet Bina and see if becoming part of this sacred circle of support is right for you.  Refreshments will be served. To register for this FREE seminar or any of the others we are offering nightly this week, Email: lmontello@liivf.com or call 877-838-BABY or 631-752-0606. Location: Long Island IVF, 8 Corporate Center Dr., Suite 101, Melville, NY 11747

Wednesday, April 24, 2013 6:30 pm: “Conceiving With PCOS” Presented by Long Island IVF’s Dr. Michael Zinger, this educational seminar, the fourth in our NIAW “Evenings of Education” series will address the most common hormonal disorders of reproductive age women: Polycystic Ovary Syndrome. PCOS symptoms 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. The most common cause of PCOS is glucose intolerance. Dr. Zinger will discuss the treatment options for PCOS which can not only assist women attempting to conceive, but can help control their symptoms and may prevent long-term health problems. If you are one of the 7% of all women who suffer from this hormonal disorder, you won’t want to miss this seminar. Refreshments will be served. To register for this FREE seminar or any of the others we are offering nightly this week, Email: lmontello@liivf.com or call 877-838-BABY or 631-752-0606. Location: Long Island IVF, 8 Corporate Center Dr., Suite 101, Melville, NY 11747

Thursday, April 25, 2013 6:30 pm: “Fertility and Financial Options” Presented by Long Island IVF’s financial counselor, Chris Graffeo, this educational seminar, the fifth in our NIAW “Evenings of Education” series, will help you navigate the maze of health insurance and infertility treatment. You’ll learn how to find out what, if any, insurance benefits you may have for fertility treatment and how to find a participating reproductive endocrinologist. Chris will also discuss how to apply for Department of Health (DOH) IVF grants, how an IVF Refund Program works, and how a case rate plan can help make fertility treatment more affordable to self-pay patients. If the financial aspect of fertility care has you confused, this night is for you.  Refreshments will be served. To register for this FREE seminar or any of the others we are offering nightly this week, Email: lmontello@liivf.com or call 877-838-BABY or 631-752-0606. Location: Long Island IVF, 8 Corporate Center Dr., Suite 101, Melville, NY 11747

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

Which of these do YOU plan to attend? If there is a topic you’d like covered that you’re not sure fits in to one of the planned discussions, please comment below, or email lmontello@liivf.com with your question and we will forward it to one of the doctors. Or just come to one of the seminars and ask the doctor privately.

 

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Overweight and Infertile

By Dr. David Kreiner and Tracey Minella

January 15th, 2013 at 10:23 pm

credit: imagerymajestic/freedigitalphotos.net

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.

For some, infertility and depression go hand-in-hand with overeating. And the longer the infertility journey takes, the bigger the gap can get in the back of one’s hospital gown.

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 Reproductive Endocrinologists 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 loads of weight first. Today.

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.

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Have you been told you’re too overweight for infertility treatment? What did you do? If you have a success story, please share it to support others.

 

Photo credit: http://www.freedigitalphotos.net/images/search.php?search=obese+woman&cat=&page=4&gid_search=&photogid=0

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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.

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Do you suffer from PCOS?

 

 

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