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Archive for the ‘Reproductive Endocrinologist’ tag

Remembering My Mentor, Dr. Howard W. Jones, Jr.

By David Kreiner, MD

August 4th, 2017 at 6:14 pm

 

I first met Howard W. Jones Jr, when I was 29 years old while still an obstetrics and gynecology resident in 1984.  It is now two years since his passing at the age of 104 and his legacy lives on ever greater with each passing year.

He interviewed me back then for a fellowship position in Reproductive Endocrinology/Infertility and IVF at the Jones Institute in Norfolk, Va., the first successful IVF center in the Western Hemisphere.  I was in awe of this 74-year-old statesman of the IVF/Infertility world.  He was after all famous in the field even before Elizabeth Carr was delivered on Dec. 28, 1981, that first IVF success that Howard W. Jones Jr. and his wife Georgeanna were responsible for in the United States.

In the 1950′s, it was HWJ Jr. who biopsied the cervical cancer of Henrietta Lacks who was made famous from the book and movie, “The Immortal Life of Henrietta Lacks”.  These cells from his biopsy were later utilized in nearly all scientific experiments for the next several decades.

In the 1960′s HWJ Jr. opened the first gender reassignment surgery clinic in the U.S. as well as performing pioneering work on ambiguous genitalia.

In 1965, he and Robert Edwards, the Nobel Prize winner for the world’s first successful IVF birth of Louise Brown, fertilized the first human egg.

In 1975, at the age of 65, Howard W. Jones Jr. was forced to retire from Johns Hopkins.  Ultimately, in 1978, Dr. Howard and Georgeanna retired to Norfolk, VA where he planned to work part-time as Emeritus Professor at the local medical school.  All this changed when Robert Edwards succeeded in creating the first successful IVF that resulted in Louise Brown.

Local journalists, aware of Dr. Jones’s reputation and past work with Prof. Edwards interviewed Howard.  At the conclusion of the interview the journalist asked Dr. Jones what it would take to perform IVF in Norfolk to which he simply replied “money”. The next day a former patient pledged that money and within 2 years the first successful IVF program west of the Atlantic was up and running and quickly became arguably the world’s most successful IVF program.

In his final decades Dr. Howard dedicated himself to promoting IVF as a successful medical treatment for those otherwise unable to conceive and to exploring bioethics in the field of reproduction.  Howard Jones never retired as he loved his work and recognized purpose and the satisfaction of achieving his life’s goals in his endeavors.

At a speech he gave during a celebration of his 100th birthday in a huge gathering of hundreds of professionals in the field, he quoted a professor of his at Amherst College from 80 years earlier, Robert Frost.  These seven lines, he said, exemplify, for him, the way to live:

My object in living is to unite 
My avocation and my vocation 
As my two eyes make one in sight. 
Only where love and need are one, 
And the work is play for mortal stakes,
Is the deed ever really done 
For Heaven and the future’s sakes.

I have aspired to live my life and career as Dr. Howard had taught me. When I am asked what I do for a living I smile and ramble on about feeling privileged to do what I love…helping those in need build families. By doing so I truly feel my endeavors perpetuate Dr. Howard’s standard of making a significant impact on the future of humanity.

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Long Island IVF’s Dr. Zinger is now in Lake Success and Brooklyn

By Tracey Minella

February 22nd, 2017 at 12:27 pm

We are happy to announce that Dr. Michael Zinger has joined Dr. Daniel Kenigsberg and Dr. Steven Brenner in seeing patients at Long Island IVF’s Lake Success location. Dr. Zinger will continue seeing patients in our Brooklyn office as well.

Dr. Zinger has been with Long Island IVF since 2008 as the reproductive endocrinologist who anchors our Brooklyn facility. He enjoys a loyal patient following and has just branched out a bit eastward to reach even more patients closer to where they live and work.

Uniquely-qualified with dual board certifications in Reproductive Endocrinology and Infertility as well as OBGYN, Dr. Zinger appreciates the difficulty frustrated patients face when choosing an infertility specialist as well as the trust it takes for OBGYNs to refer patients out to him for advanced infertility care.

Consistently ranked by his peers as a “SuperDoc” in the New York Times and selected for the Patient’s Choice and Compassionate Doctor awards on vitals.com, Dr. Zinger makes quality, compassionate patient care a priority. He’s one reason the public voted Long Island IVF the “Best In Vitro Fertility Practice” for three straight years– 2015, 2016, and 2017.

Prior to joining Long Island IVF, Dr. Zinger spent six years heading the IVF program at Edwards Hospital. A prolific author of medical textbook chapters and medical journal articles, as well as a presenter at numerous national and international medical meetings, Dr. Zinger was also the recipient of The Endocrine Society’s prestigious Senior Fellow’s Award for outstanding research. His complete bio can be viewed here.

If you are looking for a trustworthy and experienced infertility specialist in the Lake Success or Brooklyn area, you can book an appointment with Dr. Zinger by calling (718) 375-6400 for Brooklyn or (516) 358-6363 for Lake Success.

Long Island IVF has multiple offices throughout Long Island as well as in Brooklyn for your convenience.

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Reflecting on the Contribution of Clomid® Chemist, Frank Palopoli

By David Kreiner MD

August 18th, 2016 at 9:50 am

 

image credit: nenetus/freedigitalphotos.net


I was cooling off in my community pool and a former patient recognized me and proudly  showed off her 13 year old daughter…”just Clomid® right?”, I asked, a trite too brash.  “Yes, and insemination after a couple of failed attempts,” she replied.

I sometimes assume if a patient doesn’t have to do IVF to conceive that they have not sufficiently suffered the infertility rites of passage.  Shame on me…for someone facing the challenge of conceiving, the pain can be most severe and if solved with fertility pills—Clomid®–then it is just as miraculous a cure as the newer technologic marvel of IVF.

I have experienced in my 31 years as a reproductive endocrinologist specializing in fertility several hundred such successes and babies born from this highly successful fertility pill that was developed by a team in the 1950’s led by Frank Palopoli who died last week at the age of 94.

Clomiphene®, the generic form of the estrogen receptor inhibitor that came on the market in 1967, works by blocking the negative feedback of estrogen resulting in an increase of pituitary hormones, FSH and LH which in turn stimulates the ovaries to ovulate.

Clomid® may be used by itself or augmented with injections of LH and/or FSH as well as HCG used as a trigger for ovulation when the ovarian follicles stimulated by Clomid® have reached maturity.  The pills are usually taken in the beginning of the cycle for five days and the response carefully monitored with serum estradiol and LH levels as well as follicular ultrasounds.

As tens of millions of babies have been born since Mr. Palopoli developed Clomid® we in the field and those who have reaped the rewards of this medication owe him a tremendous debt of gratitude.

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Did Clomid® play a part in your fertility journey?

 

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Additional Extended Evening Office Hours at Long Island IVF

By Tracey Minella

February 23rd, 2015 at 11:23 am

 

Did you know that Long Island IVF offered evening office hours? Well not only have we offered extended hours in all of our offices for ages, we’ve added even more!

 

Infertility treatment can be stressful. And while some appointments and blood tests simply need to be done in the early morning hours, there are times when an evening appointment is feasible and might be more convenient. Especially for those who work full-time or who might be taking off certain mornings for less flexible monitoring appointments.

 

We’re pleased to announce that in an effort to be even more accessible to her patients, Dr. Satu Kuokkanen will be available on Wednesday evenings in the Lake Success office, starting in March.

 

The hours, nights, and doctors covering these evening appointments vary for each office so check with your doctor or LIIVF office for the specifics. Or if you are a new patient, contact the office you’re interested in for more information.

 

 

 

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Is the availability of evening doctor appointments an important factor in your decision to choose a reproductive endocrinologist?

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Age and Fertility

By David Kreiner MD

February 2nd, 2015 at 4:23 pm

 

credit: photostock/free digital photos.net


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

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

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

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

 

Age <35= 40.2%

 

Age 35-37=31.3%

 

Age 38-40=22.2%

 

Age 41-42=11.8%

 

Age >42=3.2%

 

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

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

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

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

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

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

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

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

 

 

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

 

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Long Island IVF WINS “Best In Vitro Fertility Practice” in Best of Long Island 2015!

By admin

January 20th, 2015 at 2:28 pm

 

It is with humble yet excited hearts that we announce that Long Island IVF was voted the Best In Vitro Fertility Practice in the Best Of Long Island 2015 contest. Unlike prior years, for the 10th anniversary of the BOLI contest, there could only be one winner per category with no runners-up.

We just received word that we won. Thanks to all of you!

The doctors, nurses, embryologists, and the rest of the Long Island IVF staff are so proud of this honor and so thankful to each and every one of you who took the time to cast a vote in our favor. From the moms juggling LIIVF toddlers… to the dads coaching LIIVF teens…to the parents sending LIIVF adults off to college or down the aisles… to the LIIVF patients still on their journeys to parenthood who are confident in the care they’re receiving…we thank you all.

We love what we get to do every day…build families. And that’s all the thanks we really need. But your endorsement of us to your friends, families, and the public (by voting for us) means so much and will enable us to help even more infertile couples fulfill their dreams of building a family.

As we usher in 2015…our 27th year…we will continue to offer our unique blend of cutting-edge medical technologies and holistic, personal support… wrapped in the comfort of a private, non-hospital setting.

Thanks again. Happy New Year to all.

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Reasons to Consider Annual Fertility Screening

By David Kreiner MD

December 19th, 2014 at 8:01 pm

 

credit: akeeris/ freedigitalphotos.net


What Is Fertility Screening?

Fertility screening starts with a blood test to check the levels of FSH (follicle stimulating hormone), estradiol and AMH (antimullerian hormone). The FSH and estradiol must be measured on the second or third day of your period. The granulosa cells of the ovarian follicles produce estradiol and AMH. The fewer the follicles there are in the ovaries the lower the AMH level. It will also mean that less estradiol is produced as well as a protein called inhibin. Both inhibin and estradiol decrease FSH production. The lower the inhibin and estradiol the higher the FSH as is seen in diminished ovarian reserve. The higher the estradiol or inhibin levels are then the lower the FSH. Estradiol may be elevated especially in the presence of an ovarian cyst even with failing ovaries that are only able to produce minimal inhibin. However, the high estradiol reduces the FSH to deceptively normal appearing levels. If not for the cyst generating excess estradiol, the FSH would be high in failing ovaries due to low inhibin production. This is why it is important to get an estradiol level at the same time as the FSH and early in the cycle when it is likely that the estradiol level is low in order to get an accurate reading of FSH.

The next step is a vaginal ultrasound to count the number of antral follicles in both ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least a total of eight antral follicles for the two ovaries. Between nine and twelve might be considered a borderline antral follicle count.
As you start to screen annually for your fertility, what you and your doctor are looking for is a dramatic shift in values from one year to the next.

What Does the Screen Indicate?

A positive screen showing evidence of potentially diminishing fertility is an alarm that should produce a call to action. When a woman is aware that she may be running out of time to reproduce she can take the family-planning reins and make informed decisions. The goal of fertility screening is to help you and every woman of childbearing years make the choices that can help protect and optimize your fertility.

Although none of these tests is in and of themselves an absolute predictor of your ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny. That’s when it makes sense to have a discussion with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out. It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as a history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order.

Regardless of the nature or severity of the problems, today, with Assisted Reproductive Technology and the latest Egg-freezing technology, there is a highly effective treatment available for you.

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Have you had a fertility screening yet? Did you find it helpful? Do you have any questions for Dr. Kreiner?

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Long Island IVF Family Reunion 2014 Memories

By Tracey Minella

November 11th, 2014 at 4:26 pm


Long Island IVF just celebrated its 26th Annual Family Reunion event. With schools closed and many people off from work, we were blessed with an exceptionally high turn-out of babies and new parents. And we couldn’t have been happier!

The family reunion is the highlight event of our year because it’s when the doctors and staff get to meet the newest crop of little miracles. The last time some of these babies were held, they were only a few cells in size! It’s such an emotional experience for doctors and patients alike. This year, 99 of the newest babies came out. Maybe we’re biased, but they were all gorgeous! And their parents were bursting with smiles and pride…happiness and gratitude replacing the worry and stress of the past. A photographer was capturing the little dickens in a fall-themed pumpkin patch.

It was remarked that if we’d had all of the babies we helped to create for the past 26 years, we’d have filled the Nassau Coliseum!

We were also so lucky to have the event covered by several media outlets, including CBS, Fox, FIOS, and News 12. Not only did that coverage expose our practice’s success to potential patients who may need our family-building services, but it enabled all of our patients, past and present, to share in the reunion experience. You could feel the happiness in the air.

Please check out some of the videos of that news coverage on our Facebook page or at these links and check back often as we will update them as they are available:

http://longisland.news12.com/news/long-island-ivf-celebrates-26-years-of-helping-families-1.9608352

http://newyork.cbslocal.com/video/10839273-proud-parents-reunite-with-doctors-to-celebrate-birth-of-little-miracles/

 

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Have you been to a LIIVF family reunion? If so, what was the best part? If not yet, what part do you imagine would be the most fulfilling?

 

 

 

 

 

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Infertility Care: Starting with the Basics

By Steven Brenner MD

October 18th, 2014 at 10:52 am

credit: wpclipart.com

“Thinking the worst” is a very common reaction for individuals experiencing adversity.

This is especially true for people experiencing infertility. Concerns regarding the question of establishing the family someone has dreamed of since they were young is daunting and can leave a person with significant anxiety and doubt regarding her/his future.

In this context it is important to go back to basics regarding fertility and understand that many people suffering from this disorder will be successfully treated with relatively simple techniques and therapies. For the more severe abnormalities, it is comforting to know current available therapies can address these issues with great success.

Establishing a pregnancy without infertility treatment requires a healthy egg, functioning sperm and an anatomic path that allows sperm to ascend the genital tract and an egg to travel into a fallopian tube where fertilization takes place. The anatomic path needs to allow the fertilized egg to travel into the uterine cavity. A receptive uterine lining is then required for the pregnancy to implant and grow. To make things more challenging, sperm and egg have a very small window of time to find each for fertilization to take place.

Many couples have experienced infertility as a result of improperly timed intercourse.  This often results from the couple not being aware of the timing of ovulation and the short duration of egg viability. The “fix” for something like this is very simple, requiring merely an understanding of the basic physiology.  Sexual dysfunction can plague a relationship, but it is often not until fertility is compromised that couples seek treatment. The simple fix for fertility may involve nothing more than inseminations timed to natural ovulation. Much more in depth therapies may be required to overcome the other, additional concerns associated with sexual dysfunction.

Ovulatory dysfunction, while a very complex issue, is often very easily addressed with simple treatments. Weight loss or gain may be all that is needed to establish regular ovulatory cycles. Correction of hormonal abnormalities leading to problems with ovulation can often be treated with medications that do not require the intense monitoring of injectable fertility medications associated with in vitro fertilization procedures.  Sluggish thyroid activity and elevations in a hormone named prolactin are such issues that readily respond to oral medications.

A receptive uterine lining to allow for implantation of an embryo that formed in the fallopian tube is needed to allow a pregnancy to be established in the uterus. Although a scarred endometrium or one that is distorted from fibroids may require surgical repair, other disorders of the lining can be treated with local hormonal supplementation. The endometrium, the uterine lining, may not develop appropriately after ovulation secondary to hormonal abnormalities. This may reflect an abnormality in egg production and the hormones associated with ovulation.

Therapies directed at improving ovulation or directly supporting the lining of the uterus with vaginal application of the hormone progesterone may be all that is needed to correct this problem.

Anatomic problems such as scarring of the fallopian tubes may require surgical correction. However, blocked tubes may be opened by minimally invasive procedures at the time of a hysterosalpingogram (HSG). In such procedures, a tube blocked where it inserts into the uterus is opened with a catheter in a setting that does not require general anesthesia.

Many patients will be successfully treated with simple techniques and procedures that are not associated with the expense and invasiveness of the therapies that most people think they will require.

For each infertile person a plan of evaluation and therapy needs to be developed, beginning with the basics. It does not necessarily lead to those treatments that are more detailed and invasive.

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Did you put off an infertility evaluation out of fear of needing expensive, invasive fertility treatments?

 

Photo credit: http://www.wpclipart.com/phps.php?q=ostrich

 

 

 

 

 

 

 

 

 

 

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Long Island IVF’s Annual Family Reunion is Coming!

By Tracey Minella

October 17th, 2014 at 7:10 am

 

credit: imagery majestic/ freedigitalphotos.net


With a feeling of thanksgiving in the autumn air, we’re eagerly preparing for LIIVF’s Annual Family Reunion…a celebration of the births of our newest batch of special babies.

I remember waiting a long, long time for my chance to attend this special celebration. I actually aspired to it. It was one of those things on my mental list of perks of getting pregnant. I’d heard talk of it in hushed tones among newly pregnant patients in the waiting room. My turn finally came on the LIIVF 10th Anniversary in 1998.

Back then, it was held outside the Long Island IVF office in Port Jefferson, behind Mather Hospital. And a huge fire truck…the kind with the bucket that soars amazingly high…would arrive to take a group photo of all the parents and their babies. Shortly thereafter, space limitations unfortunately necessitated limiting the attendees to the most recent crop of newborns.

If you haven’t experienced or heard of it, the reunion is a fun-filled, camera-clicking day where proud new parents show off their little miracles and our doctors and staff gets to meet the latest additions to the LIIVF family. (Just ask any “alumni” parents of our older babies if their infants’ reunion party was special.)

We know it may be hard to hear about this event if you’re still on your journey to parenthood. And we’re really sorry for that, and look forward to seeing you at a future reunion. But we want to be sure we haven’t missed any patient who is eligible to attend this year…

So… if your special little bundle was born between January 1, 2013 and today, please email Lindsay Montello at lmontello@liivf.com  so we can put you on the invitation list. (And if your baby’s older and you missed the last reunion…or you just really, really want to come this year, please email Lindsay anyway!)

This year’s event will be held on Tuesday, November 11, 2014 from noon until 2:30 pm, so save the date! More exciting details will come in your invitation.

We’re so looking forward to seeing you again and meeting your new little pumpkins!

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Have you been to a reunion? What’s the best part?

 

LONG ISLAND IVF was nominated BEST IN VITRO FERTILITY PRACTICE in the Long Island Press’s “Best of Long Island 2015″ contest. If you’d like to vote to help us win, you can vote once per day from now through Dec 15 here: http://bestof.longislandpress.com/voting-open/

 

Photo credit: freedigitalphotos.net and imagery majestic http://www.freedigitalphotos.net/images/agree-terms.php?id=100116728

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