Archive for the ‘Reproductive Endocrinologist’ tag
By David Kreiner MD
August 18th, 2016 at 9:50 am
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?
By Tracey Minella
February 23rd, 2015 at 11:23 am
Tagged with coping with infertility, Dr. Satu Kuokkanen, female infertility doctor, Fertility, Infertility, Infertility Treatment, IUI, IVF, IVF Long island, Long Island IVF, Reproductive Endocrinologist, TTC
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?
By David Kreiner MD
February 2nd, 2015 at 4:23 pm
Tagged with acupuncture, acupuncture and fertility, age and fertility, AMH levels, ASRM statistics, Biological Clock, David Kreiner MD, diet and fertility, diminished ovarian reserve, eastern medicine for fertility, egg age and miscarriage, Egg Donor, environment and fertility, IVF and Eastern Medicine, Long Island IVF, Miscarriage, Obesity and fertility, pregnant older celebrities, Reproductive Endocrinologist, Trying to Conceive
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%
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?
January 20th, 2015 at 2:28 pm
Tagged with Best in Vitro Fertility Practice Long island, Best Long Island Infertility Practice, Best of Long Island 2015 Winner, Best of Long Island Infertility Practice, BOLI 2015, BOLI Winner 2015, David Kreiner MD, Dr. Daniel Kenigsberg, Dr. Joseph Pena, Dr. Kathleen Droesch, Dr. Michael Zinger, Dr. Satu Kuokkanen, Dr. Steven Brenner, Fertility, Infertility, Infertility Treatment, IVF Long island, LI-IVF, Long Island IVF, Reproductive Endocrinologist, Trying to Conceive
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.
By David Kreiner MD
December 19th, 2014 at 8:01 pm
Tagged with AMH, David Kreiner MD, diminished ovarian reserve, egg freezing, estradiol level, Fertility, fertility screening, FSH level, Infertility, Infertility Treatment, Reproductive Endocrinologist, TTC
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?
By Tracey Minella
November 11th, 2014 at 4:26 pm
Tagged with Daniel Kenigsberg MD, David Kreiner MD, Fertility, Infertility, Infertility Treatment, IUI, IVF, IVF Long island, Joseph Pena MD, Kathleen Droesch MD, LI-IVF, Long Island IVF, Long Island IVF Family Reunion 2014, Michael Zinger MD, Reproductive Endocrinologist, Satu Kuokkanen MD, Steven Brenner MD, TTC
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:
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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?
By Steven Brenner MD
October 18th, 2014 at 10:52 am
Tagged with blocked tubes, coping with infertility, facing infertility, Fertility, Fibroids, HSG, Infertility, infertility basics, Infertility Treatment, IVF Long island, Long Island IVF, male infertility, MD, ovulatory dysfunction, prolactin, Reproductive Endocrinologist, Stephen Brenner, Trying to Conceive
“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
By Tracey Minella
October 17th, 2014 at 7:10 am
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 email@example.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
By Tracey Minella
May 23rd, 2014 at 12:52 pm
Did you catch the big news in Sunday’s New York Times Magazine?
Long Island IVF doctors, Dr. Joseph Pena and Dr. Michael Zinger, have been named as New York “Super Doctors” in the field of Reproductive Endocrinology, securing two of just 6 spots on the elite list for the combined Long Island and Brooklyn area.
What makes this exciting and humbling is that “Super Docs” honorees are chosen by their peers. You can’t buy your way onto the list through paid advertising (at least LIIVF’s doctors didn’t pay for advertising!), or get on it by generating the most “likes” in a social media campaign (but feel free to come over and “like” us on Facebook anyway at http://www.facebook.com/longislandivf! It is doctors recognizing other doctors’ talent and ability.
For a complete list of the SuperDoctors in Reproductive Endocrinology, click here: http://bit.ly/1hglvmu
We know of many other top notch doctors…both on the Long Island IVF team and in other fields who are not included on the Super Doctors list… and are humbled by this recognition. Thanks to all the physicians who voted for Drs. Pena and Zinger for this honor.
And of course, we’d like to thank our wonderful patients, who so often sing the praises of their LIIVF doctors… because it’s possible many of the doctors who nominate our physicians for these honors may have first heard about them from you! You are the reason we all love what we do every day.
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Have you ever told another doctor about your LIIVF experience or recommended your LIIVF doctor?
By David Kreiner MD
May 16th, 2014 at 11:55 am
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?