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Archive for the ‘Reproductive Endocrinologist’ tag

Long Island IVF Doctors Named to “Super Doctors” List

By Tracey Minella

May 23rd, 2014 at 12:52 pm

 

Dr. Pena

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

Dr. Zinger

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?

 

 

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BFN! Negative Pregnancy Test Again! Now What?

By David Kreiner MD

May 16th, 2014 at 11:55 am

 

credit: david castillo/freedigitalphotos.net

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?

Photo credit: http://www.freedigitalphotos.net/images/Gestures_g185-Depressed_Woman_Sitting_On_Floor__p99322.html

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Femvue: The HSG Alternative Test

By David Kreiner MD

April 9th, 2014 at 5:26 am

 

image courtesy of OhMega 1982/freedigitalphotos.net


Fear can be an awesome motivator. 

Unfortunately, when it leads to avoiding a vital medical test such as investigating the patency of fallopian tubes it can prevent a physician from discovering the cause of a couple’s infertility. 

The hysterosalpingogram (HSG) is an x-ray of the fallopian tubes after radio-opaque contrast is injected transvaginally through the cervix.  Contrast can be visualized filling the fallopian tubes and spilling through patent fallopian tubes into the pelvis.

The HSG is performed using a metal instrument clamped on the lip of the cervix while a tube is placed through the cervix and contrast injected into the uterine cavity under pressure.  Patients have complained that this procedure is too painful for them to endure and either refuse to undergo the procedure or go for a surgical laparoscopy under general anesthesia.

Today, a new procedure, known as the Femvue, is available whereby a physician inserts a catheter similar to that used at insemination into the cervix.  The physician observes by transvaginal ultrasound the flow of air bubbles through the tubes and into the pelvis.  This can be accomplished in the office with typically minimal discomfort to the patient. 

Sometimes, it may be difficult to get reliable results with Femvue in obese patients. In cases where the results of Femvue are abnormal, a traditional HSG may be done to confirm results.

With the Femvue, the fear of pain experienced by some patients from the HSG is no longer an obstacle to the infertility workup.

Femvue is currently being performed at Long Island IVF by Doctors Kreiner, Pena, and Zinger.

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If you have had an HSG, was it painful? If you’ve had Femvue, how did it go?

Have you avoided an HSG because of fear?

 

Photo credit: http://www.freedigitalphotos.net/images/Diseases_and_Other_M_g287-Woman_With_Abdominal_Pain_p76296.html

 

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Infertility and TCM (Part 5) Channels and Points: TCM’s Gross Anatomy Equivalent

By David Kreiner MD

March 31st, 2014 at 2:05 pm

 

image courtesy of stuart miles/freedigital photos.net

 

As a new student in Traditional Chinese Medicine (TCM) and acupuncture one of the first and most important classes we must take is called “Channels and Points”. This to a former medical student is the TCM version of Gross Anatomy. Gross anatomy in medical school was my exciting introduction to the human body, essential to the study of medicine.  I owned the classic Gray’s Anatomy text which today is popularized by the TV show of the same name.  The course requires strict memorization of all the bones, nerves, ligaments, vessels and organs in the body.

Likewise, “Channels and Points” requires the memorization of the precise location of 365 points and the corresponding channels of Qi which course throughout the body and can be utilized in the practice of acupuncture.  How these channels and points relate to each other and to the different organs is important as that will also determine their usefulness in different clinical situations.  

It is believed that the location of the channels of Qi and their surface access points was discovered through centuries of observation of the existence of tender spots on the body during the course of disease.  Furthermore, it was observed that symptoms were alleviated when those points were stimulated by massage or heat.  

When a number of points became known, they were linked into groups with common characteristics and effects and hence a pathway for a channel was identified.  Knowledge accumulated over hundreds of generations documented in several ancient texts.  As information regarding the channels and points accumulated, theories evolved and often resulted in modifications of prior beliefs as more experience clarified more accurate placement and function of these channels and points.  

The first document that unequivocally described the channels and points in an organized system of diagnosis and treatment recognizable as acupuncture is The Yellow Emperor’s Inner Classic, dating from about 100 BCE. The information was presented in the form of questions posed by the Emperor, Huang Ti, and replies from his minister, Ch’i-Pai. The source of the text of his answers was likely a compilation of traditions handed down over centuries, presented in terms of the prevailing Taoist philosophy, and is still cited today in support of particular therapeutic techniques. There is evidence that acupuncture utilizing bronze, gold and silver needles was practiced around this time as well as moxibustion.  

A more contemporary view of the concepts of channels in which Qi flowed that was documented through the precise anatomical locations of acupuncture points developed later.  During the Ming Dynasty (1368–1644), The Great Compendium of Acupuncture and Moxibustion was published, which forms the basis of modern acupuncture. It includes descriptions of the full set of 365 points that represent superficial access to the channels through which needles could be inserted to modify the flow of Qi energy.

Unlike the bones, tendons, nerves and vessels of Gross Anatomy, the channels and points utilized in acupuncture do not have corresponding visible or palpable anatomic structures that may be identified in an effort to memorize.  These channels of Qi are not visible structures nor can they be felt through touching or palpation.  So how does the acupuncturist know where the surface access point is to direct his needle?  

The trained acupuncturist utilizes the surface anatomy such as bones, joints and ligaments to locate these acupoints.  The points typically are found between the ligaments, in bony crevices or between bones. Additionally, the body is divided into units of measure based on an individual’s own bone size.  The most basic unit, cun, is defined as the width of the individual patient’s thumb.  Two cun is the distance from second most distal or middle joint of the forefinger to the tip.  Three cun is the width of the forefinger to the pinky measured at the point of the middle joint of the fingers.  The arms are 9 cun from axilla to the transverse crease of the elbow and 12 cun from the elbow crease to the wrist crease.  The number of cun for every portion of the body is delineated so that the location of the acupoints is based on locating according to the distance by cun units from an identifiable spot on the surface anatomy of the patient and usually are found in between ligaments, bones or in the bony crevices which are palpated by the acupuncturist upon needle placement.  

There are also some points that are identifiable based on particular placement of the fingers and hands of either or both the acupuncturist and patient.  For example, if the acupuncturist places his finger on a patient’s styloid process then has the patient internally rotate his/her hand, the point is located where the acupuncturist’s finger ends up.  This point, currently my favorite, is Small Intestine (SI) 6 with the English name of Support for the Aged because it treats symptoms such as blurry vision, lumbar pain, neck pain and other aches and pains that affect individuals as they get older.  

Another critically important point and therefore given the distinction of being a Command Point for the head and nape of the neck is Large Intestine (LI) 7.  It is located when the acupuncturist places his/her index finger on the dorsal side of the patient’s hand and thumb on the ventral side in between the patient’s thumb and forefinger.  The acupuncturist will locate the point where the tip of his forefinger meets a groove in the anterior portion of the patient’s radius bone.  

How deep to place the needle and in what direction and angle are further issues to be learned another day.

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Are you finding this educational journey into TCM fascinating? Do you have any questions for Dr. Kreiner about this or any other TCM topic he has covered so far?

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Acupuncture: What’s the Point?

By David Kreiner MD

March 12th, 2014 at 3:29 am

 

image courtesy of stuartmiles/freedigitalphotos.net

I have previously mentioned the conundrum facing a Western-trained physician embarking on the study of Traditional Chinese Medicine (TCM).  It is part of our nature after a lifetime of scientific training to explain natural phenomena such as health and illness in ways that have been documented with physical evidence. 

The basic physiology on which TCM is constructed has no corresponding physical support that can be seen or measured…a requirement that scientific thinkers rely on to reassure ourselves about the validity and rationale of a proposed theory or treatment.

Instead, it feels to me as I study TCM that I am memorizing random “facts” with corresponding syndromes and treatments.  For now, I must push myself to continue my studies unconcerned that these basics I am committing to memory are not supported by any physical evidence other than the stories of successful therapies.  It is premature for me to pass judgment for as they say, “the proof is in the pudding”. 

In fact, as a practicing reproductive endocrinologist I have seen patients with poor ovarian function or previous failed pregnancies succeed in their child-building endeavors after acupuncture intervention is added as an adjunct to their fertility treatments. 

For this reason, I persevere to learn as much as possible because despite my own admission that TCM is difficult for me to accept as “scientific truths” I believe that it offers potential advantage to my patients as they go through their Western fertility therapies.

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How important to you is the science…or measurable physical evidence…behind an infertility therapy? Can you take a leap of faith and hope “the proof is in the pudding”?

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Acupuncture: What’s the Point?

By David Kreiner MD

March 11th, 2014 at 8:22 pm

 

image courtesy of stuart miles/free digital photos.net

I have previously mentioned the conundrum facing a Western-trained physician embarking on the study of Traditional Chinese Medicine (TCM).  It is part of our nature after a lifetime of scientific training to explain natural phenomena such as health and illness in ways that have been documented with physical evidence. 

The basic physiology on which TCM is constructed has no corresponding physical support that can be seen or measured…a requirement that scientific thinkers rely on to reassure ourselves about the validity and rationale of a proposed theory or treatment.

Instead, it feels to me as I study TCM that I am memorizing random “facts” with corresponding syndromes and treatments.  For now, I must push myself to continue my studies unconcerned that these basics I am committing to memory are not supported by any physical evidence other than the stories of successful therapies.  It is premature for me to pass judgment for as they say, “the proof is in the pudding”. 

In fact, as a practicing reproductive endocrinologist I have seen patients with poor ovarian function or previous failed pregnancies succeed in their child-building endeavors after acupuncture intervention is added as an adjunct to their fertility treatments. 

For this reason, I persevere to learn as much as possible because despite my own admission that TCM is difficult for me to accept as “scientific truths” I believe that it offers potential advantage to my patients as they go through their Western fertility therapies.

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How important to you is the science…or measurable physical evidence…behind an infertility therapy? Can you take a leap of faith and hope “the proof is in the pudding”?

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Traditional Chinese Medicine (TCM) – Perspectives from a Western-Trained Physician-Part 2

By David Kreiner MD

February 18th, 2014 at 4:44 pm

 

credit: stuartmilesfreedigitalphotos.net



I am now four tests deep into my TCM training and have experienced some of the typical Spleen disharmony that comes with anxiety over my performance on the exams.  It was not bad enough to cause a clinical spleen Qi deficiency but I did have some stomach upset from rebellious stomach Qi and occasional weak knees.

I wonder at times if I could explain TCM fundamentals in Western terms.  It would be very satisfying to put TCM physiology in a language and system that was consistent with the science that as a physician I have learned and lived with for the past 30 years.  I am used to a medical construct based on organs and structures I can see and feel and metabolic processes that I can measure. TCM affords us none of this.

Instead, the physiology of TCM to me is based on faith and experience.  Hmmm… if there is experience supporting successful therapeutics whether they be herbal medicines or acupuncture then why do I say that TCM is based on faith.  From a scientific perspective, we cannot explain TCM fundamentals such as Qi or Essence nor the channels they travel in.  There is nothing we are able to see or touch to prove to ourselves their actual existence.

I am not saying that it is necessary to have a blind faith in TCM in order to either practice it or submit oneself to its treatment.  Once again, there is the experience to justify its practice.  However, it does make a Western-trained physician perplexed.  Perhaps our science is not yet at a level to explain TCM.  Maybe…if we were able to measure extremely minute changes in electrical charges, or levels of energy radiated in the body at a frequency or amplitude that we are currently unable to document… then we might be able to witness and even measure TCM phenomena related to Qi deficiency and other clinical syndromes.

In the meantime, I study so that I may be able to someday offer the TCM as an adjunct to my fertility practice.

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Would you be open to combining TCM principles with Western medicine in your fertility treatment plan?

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To Qi or not to Qi? That is the Question

By David Kreiner MD

February 1st, 2014 at 5:27 pm

 

credit: StuartMiles/freedigital photos.net

It has been a month since I started my studies in Traditional Chinese Medicine and Acupuncture at the New York College of Health Professions in Syosset, NY. 

Why does this 58 year old Reproductive Endocrinologist want to go back to school for an additional career after practicing for 27 years you may ask?  Is it because I am jealous of my younger daughter starting the University of Michigan this past fall and I want to enjoy the Greek life?  Eh…I cannot deny the coincidence is suspicious.

However, my interest in Traditional Chinese Medicine (TCM) dates back to my own college days. While I bought a copy of the “Barefoot Doctor’s Manual”, the thick red book sat on a shelf for years.  I never got past a few lines about “dampness in the lower burner” and treating “excess phlegm”.  After all, my goal was to become a physician and I liked wearing my clogs back then anyway.

TCM appears quite strange to a Western-trained physician.  The language is unique to TCM and bears little resemblance to the medical physiology that we are familiar with.  As I become more knowledgeable about the fundamentals of TCM, I am fascinated by the elaborate construct of ideas on which TCM is based. 

Unlike modern Western Medicine which is based on scientific study and experimentation, the wisdom of TCM was built upon hundreds of generations of experience by the wise healers of China.  Observations of thousands of cases led to the development of theories regarding disease, illness and healing.  To my physician friends who question the concept of treating pain and illness by impacting channels of Qi, a form of life energy, I ask them: Who are we to question the collective wisdom and experience of hundreds of generations of the wisest healers of China when Modern Medicine has been helping more people than it has been hurting only for the past 80 years or so?  I personally have seen many examples of accepted “Medical Truths” rejected and disproved since graduating medical school in 1981.

My goal is to help my patients any way I can.  Yes, I am a Western-trained physician but more than that I am my patients’ healer who is helping them in their journeys to build their families.  We have great tools in Western Medicine including gonadotropin medications, intrauterine insemination (IUI) and in particular In Vitro Fertilization.  But sometimes they may not be enough. 

I am reminded of the book and movie “Life of Pi”.  The protagonist, Piscine or Pi,tells his story about how he survived 227 days after a shipwreck while stranded on a lifeboat in the Pacific Ocean with a Bengal tiger named Richard Parker.  The official representatives investigating the incident reject his story as unbelievable and insist on hearing the “truth”.  Pi then offers them a second story in which he is adrift on a lifeboat not with zoo animals, but with the ship’s cook, a Taiwanese sailor with a broken leg, and his own mother. The cook amputates the sailor’s leg for use as fishing bait, then kills the sailor and Pi’s mother for food. Pi then kills the cook and dines on him. 

Pi points out that neither story can be proven and neither explains the cause of the shipwreck and in the end of each story the outcome is the same… that he still lost his family.  We are left without an answer as to which story is real. Why does it matter which story was true?  We are asked which story we preferred.

Similarly, with TCM, if we can achieve the desired outcome…in my specialty, the much sought after pregnancy and healthy baby, why does it matter if we do not fully understand the science or principles behind the therapy? The story we choose for that much desired baby…for our “journey to the crib”… can include TCM if it could help us to attain our goal. 

PLEASE FOLLOW MY TCM AND FERTILITY SERIES OF BLOGS AS I CONTINUE THIS JOURNEY.

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Do you think the blending of TCM and Western medicine principles could benefit infertility patients? Have you ever used or considered using TCM in your own fertility journey?

Photo credit: Stuart Miles http://www.freedigitalphotos.net/images/agree-terms.php?id=10055066

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Is Your Biological Clock Running Out?

By David Kreiner, MD

January 10th, 2014 at 10:35 pm

 

image courtesy of photo stock/freedigital photos.net

Tears start to course down the cheeks of my patient, her immediate response to the message I just conveyed to her. Minutes before, with great angst anticipating the depressing effect my words will have on her, I proceeded to explain how her FSH was slightly elevated and her antral follicle count was a disappointing 3-6 follicles. I was careful to say that though this is a screen that correlates with a woman’s fertility, sometimes a woman may be more fertile than suspected based on the hormone tests and ovarian ultrasound. I also said that even when the tests accurately show diminishing ovarian reserve (follicle number), we are often successful in achieving a pregnancy and obtaining a baby through in vitro fertilization especially when age is not a significant factor.

These encounters I have with patients are more frequent than they should be. Unfortunately, many women delay seeking help in their efforts to conceive until their age has become significant both because they have fewer healthy genetically normal eggs and because their ability to respond to fertility drugs with numerous mature eggs is depressed. Women often do not realize that fertility drops as they age starting in their 20s but at an increasing rate in their 30s and to a point that may often be barely treatable in their 40s.

A common reason women delay seeking help is the trend in society to have children at an older age. In the 1960’s it was much less common that women would go to college and seek a career as is typical of women today. The delayed childbearing increases the exposure of women to more sexual partners and a consequent increased risk of developing pelvic inflammatory disease with resulting fallopian tube adhesions.

When patients have endometriosis, delaying pregnancy allows the endometriosis to develop further and cause damage to a woman’s ovaries and fallopian tubes. They are more likely to develop diminished ovarian reserve at a younger age due to the destruction of normal ovarian tissue by the endometriosis.

Even more important is that aging results in natural depletion of the number of follicles and eggs with an increase in the percentage of these residual eggs that are unhealthy and/or genetically abnormal.

Diminished ovarian reserve is associated with decreased inhibin levels which decreases the negative feedback on the pituitary gland. FSH produced by the pituitary is elevated in response to the diminished ovarian reserve and inhibin levels unless a woman has a cyst producing high estradiol levels which also lowers FSH. This is why we assess estradiol levels at the same time as FSH. Anti-Mullerian Hormone (AMH) can be tested throughout a woman’s menstrual cycle and levels correlate with ovarian reserve. Early follicular ultrasound can be performed to evaluate a woman’s antral follicle count. The antral follicle count also correlates with ovarian reserve.

By screening women annually with hormone tests and ultrasounds a physician may assess whether a woman is at high risk of developing diminished ovarian reserve in the subsequent year. Alerting a woman to her individual fertility status would allow women to adjust their family planning to fit their individual needs.

Aggressive fertility therapy may be the best option when it appears that one is running out of time. Ovulation induction with intrauterine insemination, MicroIVF and IVF are all considerations that speed up the process and allow a patient to take advantage of her residual fertility.

With fertility screening of day 3 estradiol and FSH, AMH and early follicular ultrasound antral follicle counts, the biological clock may still be ticking but at least one may keep an eye on it and know what time it is and act accordingly.

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Did you realize that aging is not the only factor in the biological clock race? Did you know that certain conditions, like endometriosis, can play a part, too?

 

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=10049499

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Overweight and Infertile

By Dr. David Kreiner and Tracey Minella

January 3rd, 2014 at 1:41 pm

 

image courtesy of OhMega 1982/free digital photos.net

Raise your hand if you made a resolution to lose weight this year…again. C’mon, get that hand up, sister.

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.

Fortunately, there are compassionate RE’s out there who are willing to give overweight patients the respect and the treatment they deserve.

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 turned away from an RE because you’re overweight or obese? Do you think that’s fair?

 

Photo credit: Ohmega 1982 http://www.freedigitalphotos.net/images/agree-terms.php?id=10073481

 

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