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Archive for the ‘PCOS’ tag

PCOS Awareness

By David Kreiner, MD

September 2nd, 2016 at 11:12 am

 

LIIVF Melville staff wearing teal


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”?

 

 

no comments

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”?

 

 

no comments

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

Nutrition, BMI, and Infertility

By Tracey Minella

March 28th, 2014 at 5:38 am

 

credit: surachaifreedigitalphotos.net


The practice of eating well while you’re pregnant is pretty common.  Most women know that, in addition to taking prenatal vitamins, eating the right foods during pregnancy can have a positive impact on their baby’s development. Even women who didn’t have stellar eating habits before conceiving often make healthier choices once they learn they are eating for two.

But did you know that proper nutrition and reaching a healthy weight for your height (also known as having a healthy body mass index, or “BMI”) prior to conceiving may help boost your chances of conception, whether naturally or through assisted reproductive technologies like IVF?

According to the American Society for Reproductive Medicine*, a BMI outside the normal range of 19-24 can impact the fertility of men and women. Obesity can contribute to low sperm count and motility in men and can cause irregular ovulation and irregular cycles in women. Underweight women may also experience irregular cycles or stop having periods altogether. In addition, there are several conditions that can impact achieving or maintaining a pregnancy… including PCOS, thyroid disease, gestational diabetes, and preeclampsia… which are often obesity-related.

To help you get to your nutritional peak and optimum fertility BMI, Long Island IVF offers nutrition counseling and safe, effective weight loss planning. If you are overweight, we can help you reach a healthy weight in a quick but safe way through the Take Shape for Life/Medifast program. In addition to medically- supervised weight loss, clients in the program learn lifestyle and behavior changes that support maintaining their weight loss success and improved health. If you are underweight, we offer nutritional counseling and life style change suggestions as well. If interested in either of these programs, please contact Mary Ann Vuolo, RN in the Melville office.

If you’d like to learn how fun eating fertility-friendly foods can be, join Long Island IVF for “Fun in the Fertile Kitchen”, a live cooking demonstration and multi-course dinner event on April 24, 2014, in celebration of National Infertility Awareness Awareness Week. For more details on this exciting, limited seating event, please see our website, our Facebook, or the previous blog post. To RSVP, contact our patient advocate, Bina Benisch at binabenisch@gmail.com

* * * * * *** * **

Do you struggle with maintaining a healthy BMI? What tips have you tried, or foods have you eaten, to improve your BMI or overall nutrition?

 

*https://www.asrm.org/Weight_and_Fertility_factsheet/

 

 

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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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Infertility Podcast Series: Journey to the Crib: Chapter 9 Polycystic Ovarian Disease

By David Kreiner, MD

April 17th, 2013 at 10:42 pm

Welcome to the Journey to the Crib Podcast. We will have a blog discussion each week with each chapter. This podcast covers Chapter Nine: Polycystic Ovarian Disease. You, the listener, are invited to ask questions and make comments. You can access the podcast here: http://podcast.longislandivf.com/?p=59

Polycystic Ovarian Disease

Polycystic Ovarian Disease (PCOS) is a syndrome, not truly a disease, in which a woman’s hormones are out of balance associated with a failure to ovulate regularly, irregular cycles and sometimes elevated male sex hormones resulting in hair growth on the face, chest or abdomen as well as acne. It can also be part of a “metabolic syndrome” which may include diabetes, hyperlipidemia and hypertension.

PCOS occurs in over 7% of women and usually develops during the teen years. It may be caused by a variety of factors, is often hereditary, the most common being glucose intolerance resulting in abnormally high insulin levels. Insulin stimulates male sex hormone production in the ovaries which blocks the development and maturation of ovarian follicles preventing ovulation which leads to irregular menses and infertility. The ovaries develop numerous small follicles that look like cysts hence the name Polycystic Ovaries.

A diagnosis of PCOS may be made by history and physical examination including an ultrasound of the ovaries. A glucose tolerance test is useful to determine the presence of glucose intolerance and diabetes. Typically patients have an elevated LH/FSH ratio.

Treatment starts with regular exercise and a diet including a controlled carbohydrate intake to reduce insulin production. A diabetes medicine, metformin, can help reduce insulin levels as well. Fertility medications are often needed to get a woman to ovulate and will successfully get 50% of women with PCOS to conceive. The use of gonadotropin hormones without follicular aspiration and egg removal as is performed as part of an IVF procedure may result in Hyperstimulation syndrome and/or multiple pregnancies. However, IVF has been quite successful and offers a means for a woman with PCOS to conceive without a significant risk for developing a multiple pregnancy as she can limit the number of embryos transferred with a single embryo transfer (SET).

Though PCOS can be annoying, aggravating and even depressing it is fortunately a very treatable condition that, with the help of a reproductive endocrinologist, patients can have their families and prevent the health problems often seen with the “metabolic syndrome”.

* * * * * * ** * * * *
Was this helpful in answering your questions about PCOS and its effects on a woman’s fertility?

Please share your thoughts about this podcast here. And ask any questions. Better yet, come to our PCOS seminar next week. See the blog or Facebook for more details.

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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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Infertility and Body Weight

By Tracey Minella

January 25th, 2013 at 9:31 pm

credit: stock images/free digital photos.net

What better time than Healthy Weight Week to examine whether your weight may be affecting your fertility?

January is synonymous with New Year’s resolutions of weight loss or getting healthier. As we approach the end of the month, some will be on their way to a fitter, healthier self. Others may be struggling to follow through with their plan.

Here’s reason to forge ahead on the path to a healthier, fertility-friendly weight.

While being just a couple of pounds over the ideal weight for your height and bone structure should not derail your baby-making plan, being grossly overweight…or even significantly underweight… can stop your plan in its tracks. Why?

Weight issues can cause imbalances in hormone levels which play a part in pregnancy, including estrogen. Very heavy women may produce too much estrogen; very thin women may produce too little. Sometimes, being very overweight or underweight can interfere with ovulation and cause women to have irregular or absent periods. These hormonal and/or ovulatory problems can be barriers to conceiving without either medical intervention or a correction of the underlying weight issue. Sometimes, an overweight woman may be suffering from PCOS, or Polycystic Ovarian Syndrome, a common cause of infertility. http://bit.ly/WWA7xL.

Long Island IVF physicians sympathize with and make every effort to provide treatment to overweight patients, so long as it is medically advisable. Many reproductive endocrinologists refuse to even consider grossly overweight patients for IVF until they lose a recommended amount of weight. Perhaps they fear their IVF success rates/stats will suffer.

Having a healthy BMI, or body-mass index, is important in maintaining optimum fertility. If you feel your weight could be a factor in your inability to conceive, ask your doctor for an evaluation. Consider a nutritionist and/or a personal trainer to help you gain or lose the recommended amount of weight and to get your body in top fertility shape.

Sometimes, a moderate weight adjustment may be all you need to conceive naturally. And even if you still need some medical assistance to get pregnant, each pound you did conquer can only increase your chances for a healthier pregnancy.

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

Is your weight a factor in your infertility? What tips do you have to get in fighting reproductive shape?

 

photo credit: http://www.freedigitalphotos.net/images/Healthy_Living_g284-African_Lady_Holding_Weighing_Scale_p92773.html

 

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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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