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Archive for the ‘RE’ tag

BFN! Negative Pregnancy Test Again! Now What?

By David Kreiner MD

February 5th, 2013 at 6:30 pm

image courtesy of david castillo dominici/freedigital

Women confronted with a negative result from a pregnancy test are always disappointed, sometimes devastated. Many admit to becoming depressed and finding it hard to associate with people and go places where there are pregnant women or babies, making social situations extremely uncomfortable. A negative test is a reminder of all those feelings of emptiness, sadness and grief over the void infertility creates.

We don’t have control over these feelings and emotions. They affect our whole being and, unchecked, will continue until they have caused a complete state of depression. This article can arm you with a strategy to fight the potentially damaging effects that infertility threatens to do to you and your life.

First, upon seeing or hearing that gut-wrenching news, breathe.
Meditation — by controlling and focusing on your breathing — can help you gain control of your emotions and calm your body, slow down your heart rate and let you focus rationally on the issues. It’s best to have your partner or a special someone by your side that can help you to calm down and regain control.

Second, put this trauma into perspective.
It doesn’t always help to hear that someone else is suffering worse — whether it’s earthquake or cancer victims — but knowledge that fertile couples only conceive 20% of the time every month means that you are in good company with plenty of future moms and dads.

Third, seek help from a specialist, a reproductive endocrinologist (RE).
An RE has seven years of post-graduate training with much of it spent helping patients with the same problem you have. An RE will seek to establish a diagnosis and offer you an option of treatments. He will work with you to develop a plan to support your therapy based on your diagnosis, age, years of infertility, motivation, as well your financial and emotional means. If you are already under an RE’s care, the third step becomes developing a plan with your RE or evaluating your current plan.

Understand your odds of success per cycle are important for your treatment regimen. You want to establish why a past cycle may not have worked. It is the RE’s job to offer recommendations either for continuing the present course of therapy — explaining the odds of success, cost and risks — or for alternative more aggressive and successful treatments (again offering his opinion regarding the success, costs and risks of the other therapies).

Therapies may be surgical, such as laparoscopy or hysteroscopy to remove endometriosis, scar tissue, repair fallopian tubes or remove fibroids. They may be medical, such as using ovulation inducing agents like clomid or gonadotropin injections. They may include intrauterine insemination (IUI) with or without medications. They also may include minimal stimulation IVF or full-stimulated IVF. Age, duration of infertility, your diagnosis, ovarian condition, and financial and emotional means play a large role in determining this plan that the RE must make with your input.

There may be further diagnostic tests that may prove value in ascertaining your diagnosis and facilitate your treatment. These include a hysteroscopy or hydrosonogram to evaluate the uterine cavity, as well as the HSG (hysterosalpingogram) to evaluate the patency of the fallopian tubes as well as the uterine cavity.

Complementary therapies offer additional success potential by improving the health and wellness of an individual and, therefore, her fertility as well. These therapies — acupuncture, massage, nutrition, psychological mind and body programs, hypnotherapy –
have been associated with improved pregnancy rates seen when used as an adjunct to assisted reproductive technologies.

A negative pregnancy test can throw you off balance, out of your routine and depress you. Use my plan here to take control and not just improve your mood and life but increase the likelihood that your next test will be a positive one.

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What have you done…or what tips can you add… to get through the disappointment?


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What’s a Fertility Doc’s Job?

By David Kreiner, Md

June 16th, 2011 at 12:32 am

Last night I tucked my grandson Jayden into bed. “Saba,” which is Hebrew for grandfather, Jayden said, “What do you do at work?” I thought back to when I first talked to his dad, my son Dan, about the birds and the bees. Well, I thought, I help those in need make babies but how do I explain this to a three year old?

I need to explain that my patients are suffering, some so severely that it affects their marriage, their jobs and often their health. I’m responsible for alleviating their suffering. I share my compassion for their troubles, hoping I may start to develop a bond with them.

I meet with each couple to try to evaluate the presence of any relationship problems. Sometimes these problems are sexual in nature, often related to difficulties with communication and, unfortunately, sometimes include violent behavior on the part of one or both spouses. Working with a program that employs a highly-trained mental health professional and a mind-body team approach helps alleviate stress, works on relationships and helps improve the health of my patients through nutrition, acupuncture and massage, as well as support groups. A healthier, less stressed patient with proper flow of Qi is more likely to conceive with my most advanced scientific infertility treatments available to man.

So I say to Jayden, “Saba is a doctor who helps people become mommies and daddies.” Jayden was not sure he was satisfied. His face frowned. He shrugged his shoulders and raised his arms, palms turned up. “How Saba?” he asked.

“With G-d’s help and the help of all those good dedicated men and women who work with me in the office,” I replied. With that, I looked at my grandson with all the joy and love a grandparent can feel for his grandchild, to which Jayden added, “Can we play another game of Wii?”

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Choosing an Infertility Doctor: Guy or Gal?

By Tracey Minella

May 13th, 2011 at 12:00 am

Would recommendations, credentials, and insurance participation take a backseat to the doctor’s sex? How much does the sex of your doctor matter to you? For many, it doesn’t matter at all. Others make it the primary consideration.

When it comes to OB/GYN’s or RE’s, it’s a pretty, well, intimate relationship. In a sterile setting. A woman doesn’t get much more vulnerable… clinically…than when she exposes herself to the very private, personal prodding done by an infertility doctor.

Understandably, many women have a definite preference for a doctor of a particular sex. And they feel so strongly that they won’t compromise that position. I’ve noticed this often over the years. The overwhelming majority who do have a preference seem to want a woman doctor over a man.

When questioned, the most common response given is that a woman knows exactly what it feels like to be examined and would therefore be gentler. This is followed quickly by reason #2: women feel less uncomfortable and less vulnerable being naked and/or touched in their most private areas when a woman is doing the exam. They also feel that it’s easier to talk about their issues and/or feelings with another woman. This is widely true of heterosexual women, but is especially true for the majority of lesbian women.

In the other camp, you have the women like me, who prefer a male doctor. We’re less outspoken about our preference and are more open than the other group to seeing a doctor of the sex we don’t prefer. While I can see the argument about a woman knowing how something feels, there are certainly male doctors who are perhaps extra gentle specifically because they don’t know how it feels and are being super careful not to cause discomfort.

And while no exam is a picnic…or could be classified as sexual in any way…most women who prefer male doctors say they are less uncomfortable being touched in their most private areas by a man. For them, that seems more natural than a woman’s touch. Maybe it’s easier to accept help getting pregnant from a male doctor since we’ve grown up thinking we need a man’s help to get pregnant. Of course a small percentage of women in this group may prefer a male doctor because they see him as their white knight and may even have a little crush on him.

I would hope that when choosing a doctor, a patient would look for credentials first and heavily weigh recommendations, before looking in to which sex they preferred. It’s so important to have the right chemistry with your chosen doctor, but without the right credentials, you may not end up with the outcome you so desperately want.

Choose wisely.

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Do you feel strongly about the sex of your doctor? Was it a factor in your decision to choose him/her?

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My IVF Doc Can Take Your IVF Doc (With One Hand Behind His Back!)

By Tracey Minella and David Kreiner MD

April 26th, 2011 at 1:42 am

“Nyeh, Nyeh. My RE is better than your RE!”

“Is not!”

“Is TOO!”

“No way!”


Well, the words may be more polished than the childish playground bullies use…or in some heated cases, maybe not… but the sentiment is the same. Some of us adore our RE’s. Others are indifferent, cautiously saving the kudos for when their pee stick evidence is in. And the unlucky ones have freakin horror stories to share from choosing the doc who graduated in the bottom of the class.

My RE graduated in the top of his class and learned beside the doctors who pioneered IVF in America. A real science geek. And it turns out that he can even string a few sentences together in a coherent fashion, having authored Journey to the Crib.

So, I dug out an old blog post he wrote last June to give all those who are coming here for the NIAW contest (or from ICLW) a glimpse into the funny, poignant family man, Dr. Kreiner really is, not the stiff academic his credentials would lead you to imagine.

So before I leave you with his words, I have one parting shot for anyone who thinks their RE is better: “You wanna step outside?!”

Dr. David Kreiner of East Coast Fertility and The Miracle on Old Country Road:

I was feeling depressed the other day.  It seemed that we had insurmountable computer issues, staff morale was down and my family was acting rebellious.  My kids were arguing with each other, with me and I found myself mindlessly walking out of my office down Old Country Road.

I came to a busy intersection and just stood there as cars sped by me.  Honestly, at that moment in time I was thinking, why am I here?  Why put up with all the hard work at the office trying to make the practice viable despite the pressures of the recession?  Insurance companies were denying claims and when they were paying claims, it was at lower reimbursements that threatened to not compensate for our expenses.  The government was planning to lower reimbursements even more.  Patients, also experiencing financial difficulties were either asking for more breaks in the fees or not paying.  I have to admit I gave thought to giving it all up as the pain and aggravations were not worth the efforts.

Suddenly, a white Audi convertible came to a screeching stop right next to me.  It was one of my patients in the passenger seat sporting a very pregnant belly and apparently blowing through what I assumed was a labor pain.  Her husband spoke.  “Dr. Kreiner, Lara went into labor early this morning and we are on our way to the hospital to have the baby…can you come with us?”  Speechless and shocked, I let myself into the cramped backseat and tried to comprehend what was happening as Lara’s husband took off.

We pulled into the emergency room five minutes later.  Lara and I were taken to the labor floor while her husband dealt with the paperwork at the desk.  Nurses barked orders, the doctor was called, and Lara started screaming during her pains and in this laboring frenzy I was awakened from my funk.  It has been awhile since I was involved in a delivery but this baby was not waiting for the doctor and I got back into obstetrical mode, checking the baby’s position and heart rate and getting the anesthesiologist to administer the epidural.  Lara’s husband was now at her side assisting her with her breathing.

“Push Lara, push”, I yelled as I saw the baby’s head crowning.  She and her husband acted as if they had trained all pregnancy for this moment, working together as a team, his arm around her shoulders, breathing with her and supporting her back as she pushed.

Well, the doctor got there just before the baby was delivering.  I stood on the side watching this miraculous event…Lara and her husband together pushing the baby out of the same womb that I had implanted nine months earlier.  I remembered the image of showing Lara and her husband the photograph of the embryo and then watching on ultrasound as I injected the drop of media and air bubble containing the microscopic embryo into her uterus.  I thought how sweet life was and I smiled.

Moments later, Lara put baby Adam to breast, her husband a proud new father was beaming as he gave out chocolate cigars to the doctor and nurses and then came to me with tears in his eyes and said, “Thank you, so much Dr. Kreiner.  We could never have done this without you.  This will be my first Father’s Day and I couldn’t be happier.”

What can I say?  It was as if my problems never existed.  I thought the only thing missing for me was to be with my family and appreciate what I have.  And what my wife and I have is truly amazing.  We have my two lovely daughters and two sons, one with a fantastic girlfriend who he just moved in with and another son who has the best wife and most gorgeous three children one can ever wish for.  Playing with them, having brunch and dinner with the family I love, I enjoyed a very Happy Father’s Day.

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How important is it to you to actually like your fertility doctor on a personal level instead of just a professional level? Should you put up with a good doctor with a lousy bedside manner…or are you entitled to more?

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Infertility Dream Team: The GYNO and the RE

By Tracey Minella

January 31st, 2011 at 12:00 am

You’ve heard the guidelines on how long you should be trying to conceive before you see a gynecologist for help. One year if you’re under 35. Six months if you’re over.

Sure, those guidelines are fine for the fertile world, because contrary to what we were all scared into thinking as hormone-crazed teens, it’s not that easy to get pregnant each month. Doctors don’t want stampedes of patients seeking testing after TTC for only one or two months. It is perfectly normal for it to take a few months.

But to a thirty-something (or older) woman who continues to ache for a baby, those guidelines are just a freakin waste of time. Precious time. Just suffer through the disappointment of 12 negative pregnancy tests and unwanted periods before investigating the reason? Seriously?  I know tons of desperate women who lied about how long they’d been TTC so they’d fit into the guidelines and not get sent home to try some more. Hell, I was one of them.

So, now that you’re there, how long do you give the GYNO to diagnose and solve your problem? Where are those guidelines?

How many tests, procedures or surgeries should you let the GYNO perform before switching over to the stirrups of a RE? Do you trust him enough to decide when to refer you to an RE? Are you sure that her heartfelt desire to get you pregnant, or her ego, won’t delay her referring you on for advanced treatment? Those are loaded questions.

I’m a firm believer in listening to that voice in your head. If there are factors, suspicions, or nagging fears about something in your medical or social history…and your heart is telling you that you’re going to need special help to have a baby…listen to it and get specialized help earlier. Especially if your age is a factor.

Here’s how I see it. If your face lost a battle with a windshield, would you want the ER doctor to sew your face back together, or would you want a plastic surgeon? Both doctors can close you up just fine. But only one is a specialist in making you look good. One has different talents, special training, knowledge and skills that the other doesn’t… all of which are designed to give you a better chance at the best possible outcome. And you have to face the mirror and live with the consequences of that decision for the rest of your life. It’s sorta the same thing with your fertility.

I’m not saying to by-pass the GYNO, just to keep the communication lines open about any concerns and expectations you have about the cost, pace and scope of your treatment. Consider your age. Also, keep your finances and emotional strength in mind when deciding how long to wait before moving on to an RE. It’s hard to leave your comfort zone. But sometimes it’s necessary.

Don’t wait to switch over until you and your partner are so emotionally and financially drained that you don’t have anything left to put into the more intense assisted reproductive technologies, like IVF, if it’s needed.

Remember, you won’t be leaving your beloved GYNO forever. The RE specializes in getting you pregnant. After that, you’re referred back to the specialist best equipped to monitor your pregnancy and deliver the baby you’ve worked so hard to conceive…your beloved OB.

When you have the best of both specialties…an Infertility Dream Team… and they each work their magic, there’s no telling what they, or you, can deliver.

Do you think you waited too long before seeing a gynecologist about your inability to conceive? Did you stay too long with the gynecologist before moving on to a reproductive endocrinologist? Do you have a story to share?

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