Conceive Egg Freezing

Conceive IVF 101

On The Cutting Edge

Emotional_Response_Miscarriage_ChartLast month a survey was published in Obstetrics and Gynecology, the Green Journal. This publication is serves as the primary resource of academic research for practicing OB/GYNs. The survey addressed the issue of public perceptions of miscarriage. I thought it pertinent to highlight this particular article because of its frequency in the fertility world.

The questionnaire was administered to 1084 individuals between ages 18-69 across the United States. Respondents were 45% male and 55% female. Here are there responses. While 15% of respondents reported that they or their partner had  experienced at least one miscarriage, 55% of respondents thought the miscarriage occurred in 5% or less of all pregnancies.

Respondents believed that the following were common causes of miscarriage

When asked about their emotional response after a miscarriage, respondents indicated the following experiences

These responses were generally similar across all socio-economic classes of women from those with a high school education to those with a graduate degree. They both suggest that there are still large misperceptions about the causes of miscarriage and the need for emotional support after they occur.

Miscarriage_Beliefs_ChartHere are some of the realities of miscarriage. Miscarriage is the most common complication of pregnancy in the United States. It occurs in 15-20% of clinically recognized pregnancies, but can occur in up to 40% of pregnancies in women over the age of 40. This translates into 750,000-1,000,000 cases annually. The majority of miscarriage occurs because of genetic abnormality (aneuploidy). This is a failure of the sperm or egg to deliver the correct DNA to embryo formation, or can occur as the embryo itself is dividing in early pregnancy. This is known to be an increasing issue as women age. Other established causes of miscarriage include structural abnormalities in the uterus (such as fibroids or a uterine septum), blood clotting disorders (such as antiphospholipid syndrome), endocrine disorders (such as thyroid disease), and autoimmune disorders (such as antithyroid antibodies).

The emotional impact of miscarriage can be devastating resulting in further delay in conceiving and therefore increased risk in future miscarriage. As a result, early utilization of services such as support groups or therapy can be critical to maintaining your chances for future pregnancy. In addition, it has been demonstrated that women who understand the cause of their miscarriage experience a shorter length of increased anxiety around their miscarriage. Given that the largest cause of miscarriage is genetic abnormality, remember to request this testing if possible should you experience a miscarriage.

For further recommendations on miscarriage go to: http://tinyurl.com/opzr7ft

To read this article in full, go to: http://tinyurl.com/q9d9l3x

Best

Signature

Dinner For Two

By : Jabir Ponce

LIME CELANTRO SKIRT STEAK

SHOPPING LIST

1.5 Lbs of Skirt Steak
2 Bunches of cilantro chopped
½ C Lime Juice
1 Tsp Salt
1 Tsp Pepper

  • Cut meat into 2 inch pieces with the grain. Place in bowl with cilantro lime juice and salt and pepper. Mix together. Let marinade for 30 minutes. Turn the steak over and let marinade for another 30 Minutes.
  • It can be grilled for 3 minutes on each side for a medium rare; or cook in a sauté pan on medium heat for 4 minutes on each side. Let meat rest for 5 minutes then slice, with grain, into ¼ inch pieces.

SAFFRON RICE

SHOPPING LIST

1 C Jasmine Rice
2 C Chicken broths
1 liberal pinch of Saffron

  • Place in sauce pan, bring to a boil, cover pan then turn heat to low and cook for 20 minutes.
  • Remove from burner let sit for 2 minutes and serve.

GREEN BEANS

SHOPPING LIST

1 Lb Green beans
1 Steamer

  • Bring water to a boil in pot place green beans in steamer, wait 3 minutes.
  • Turn off burner and let beans sit in steamer for another 3 minutes. Remove and serve

 

ABOUT THE AUTHOR

Jabir Ponce, Private Chef. Jabir Ponce’s first passion is food and its preparation. While working in the pastry line and bake shop at the Ritz Carlton Manalapan, Mr. Ponce received his culinary degree in 1993 from the Florida Culinary Institute. After returning to San Francisco Mr. Ponce helped to open several small restaurants while running his own catering company. He served as the Lead Concierge for the Archbishop’s Mansion until its closing. Since July 2009, he has worked in San Francisco as a private chef. His email is jabirponce@sbcglobal.net

How To Keep Love Alive

In the Midst of Infertility Treatment

By: Qin Fan, PSY.D

When sex goes from being fun to being work, it can play havoc with your relationship. Infertility treatment is often experienced as an emotional rollercoaster, typically becoming an ordeal that either makes or breaks a couple. How can you support and deepen your love for one another in the face of emotional and relational adversity?

1. Understand that the fertility challenge affects every aspect of life. No one can entirely escape from challenges affecting their self-image, intimacy with partner, and sexual lives.

2. Remember that you are in this together. Inform yourselves and learn about what you’re up against so that you can face it together. The more you practice this together, the stronger you’ll become as a couple. Be considerate and tender toward your partner.

3. Recognize that you and your partner may keep a different pace on the fertility journey, and be understanding about it. Keep up the communication and give each other the chance to say what is on his/her mind. Remind yourself that the main thing is your common goal of making a family together.

4. Talk openly with your partner: Sounds easy, right? Yet, so often couples are cocooned in their own emotional anguish, or uncertain about what to say to each other when encountering infertility, that they literally become “speechless,” or shut down. Moreover, infertility can stir up a host of other personal or psychological reactions, including depression and anxiety. It is critical to discuss common reactions such as disappointment, shock, fear, envy, guilty, and rage.

5. Balance the need for privacy & support: What to say to family and friends, if anything at all? It is indeed a delicate dance. Research shows that isolation can be detrimental for couple relationship in the middle of infertility treatment. What is the right amount of disclosure so that the couple may benefit from support from family and friends? Each couple will have to negotiate and determine what is acceptable to them. No matter what you decide to say to others, the main thing is that you two are on the same page. The ability to open up to family and friends can not only ease some of the pressure and isolation but also boost the couple’s morale and overall wellbeing.

6. Redefine intimacy to include conversation at the dinner table, cuddling under a blanket, watching a favorite movie, and a hearty hug. Tell your partner when you need that hug and when you are feeling a little deprived. Go out to dinner at your favorite spot and do not talk about fertility for even one second. Reminisce about how you met and why you made a commitment to be life partners.

7. Plan to have sex, and then anticipate it, just like in the early days of your relationship.

8. Take care of yourself and each other: A healthy mind resides in a healthy body. Infertility treatment can be stressful and strain the relationship. Research suggests that setting time aside regularly, say once a week, to take walks, bike, treat yourselves with a couples massage, take yoga or dancing classes together, can help reduce stress and rejuvenate. Physical activities will not only help you boost your overall energy, but also facilitate a better outcome for your infertility treatment.

9. Seek additional emotional support: Infertility is a shared experience. Individual psychotherapy, couples counseling, and support groups can serve as a safe space for you to explore topics that might be otherwise difficult to discuss.

Qin Fan, Psy.D. 870 Market St., Ste. 659, San Francisco, CA 94102
Phone: 415.545.8606 www.drqinfan.com

ABOUT THE AUTHOR

Qin Fan, PSY.D. A licensed clinical psychologist and a member of the American Society for Reproductive Medicine, I support the family building efforts of all clients, including single women and men and same sex couples. Starting a family can be an exhilarating time for many, yet for some it can be an emotional roller coaster. To help you navigating through the fertility treatment maze, I offer psychological psychotherapy for individuals and couples dealing with infertility or fertility preservation; consultation for intended parents and recipients of egg, sperm, and embryo donation; psychological evaluation for your donor or gestational carrier. For more information or schedule a consult, please visit us at www.drqinfan.com

Preparing For Your Initial Consult

By: Kyra Lumpkin

So you have taken the plunge. You have called and scheduled your initial consultation! You are hoping that this visit will change your trajectory for having a baby. Now what? Every clinic is a little different, but the general forms that we describe below review the types of information that you should expect to provide at any new patient visit.

How to Prepare For Your Initial Visit

As the old adage goes, “you can’t tell where you are going unless you know where you’ve been”. Prior to coming to the office for your new patient consultation, we strongly urge you to prepare. Ensure that you have completed all of the forms in the New Patient Packet provided to you. This packet typically will include a Health and Physical History form for you to summarize your past medical history. Additionally, you will receive consents explaining our office policies, practice statement, and notice of practice privacy. Last, we have included a form to retrieve any pertinent medical records. These items are very important for us to receive prior to your appointment. After all, our goal is to optimize your fertility experience, and our physicians and clinical team need this information in advance to prepare for your visit.

Preparing For Cost

A benefit check is done before you come in for your initial consultation to better prepare you for any monies that you may have to pay. After scheduling your appointment, take a moment to snap a picture of your insurance card, front and back, and then forward it to your clinic. After your picture is received, the billing department will run a benefits check against the insurance information you provided to assess what will or will not be covered. The results are then emailed to you with an explanation of the findings. You will then be equipped with everything you will need to know about the costs of your appointment. If your clinic doesn’t do this routinely, be proactive and ask for this information or call your insurance company yourself. Most fertility patients are healthy individuals who have had little reason to use their insurance for more than a $20.00 office visit co-pay or a $10.00 prescription. This experience will be different for most patients.

What to bring

When you arrive at your initial consultation, please have a valid form of identification, any fees you will have to pay, and your insurance card ready.

What to Expect At Your First Appointment

The New Patient exam lasts approximately 60-90 minutes, and your partner is encouraged to come with you. During this appointment, the physician will perform an antral follicle count (AFC) using a transvaginal ultrasound. Afterwards, you, your partner and your physician will discuss your medical history in detail. This is the perfect time to ask any questions or present any concerns you may have. This visit is for you, so the physician is listening intently to understand what your fertility and family goals are.

A few examples of good questions to ask are:

  • What are your success rates?
  • I am still young, why do I need fertility treatment or Pre-Implantation Genetic screening (PGS)?
  • What are my chances of success if I don’t do PGS?
  • On average, how long does a full cycle take, from initial consult to transferring my embryos?

Taking control of your fertility challenge is a huge step. It takes bravery and patience. To aide in your own success, do not be afraid to ask as many questions as you feel you need.

Experience Excellence

At Lane Fertility Institute we are a team. A team dedicated to giving our very best at all times. A team that will do all that we can to assist you in achieving success on your journey to parenthood. We pride ourselves on providing the optimal experience from your very first phone call. Whatever clinic you decide to work with should have a similar attitude. If you don’t feel that the fertility team is in line with your needs, never be afraid to make a change. Fertility is already taxing on your emotions and resources, you should have an expectation of excellence every step of the way!

Good luck on your fertility journey!!

ABOUT THE AUTHOR

Kyra Lumpkin. Kyra Lumpkin is the Administrative Coordinator for Lane Fertility Institute. Kyra has been in the Administrative field for over 7 years. She commits herself to patient satisfaction and outstanding patient service. She has a strong belief that one’s business is only as good as the treatment provided to its patrons. Being a parent herself, Ms. Lumpkin is passionate about her ability to aide and prepare patients for their journey to parenthood. Her email is kmlumpkin@lanefertility.com

Let’s Get Started

By: Danielle E. Lane, M.D.

Summer has come and is almost gone. We are now into the early days of fall and that means…open enrollment! But before open enrollment, employers re-negotiate their benefits packages with their carriers. Around the Bay Area, competitive benefits packages are a way of life. The better the package the more attractive the company is to work for. As a result, an increasing number of companies are offering fertility benefits that include in vitro fertilization (IVF) coverage.

Some of the biggest employers for our area are Google and Salesforce, and both offer IVF coverage. But while both entities cover fertility services to include in vitro fertilization, that’s where the similarities end.

an increasing number of companies are offering fertility benefits that include in vitro fertilization (IVF) coverage

Through the 2015 year, Google’s healthcare benefits have been administrated by Blue Cross. Their package offers each employee a lifetime maximum of $20,000.00 to be used for fertility services. The savvy patient will find a contracted provider and have 2-3 cycles of care available from that amount due to contracted rates which drop the cost of each cycle to somewhere in the $6000-$8000 price range. At Google, fertility medications are also covered and are NOT part of the $20,000.00 lifetime maximum. As a result, patients are typically only out of pocket the cost of very specialized optional services such as their embryo biopsy.

Salesforce, alternatively, chose Aetna for their administrator. Patients have coverage for 50% of six insemination cycles and 50% of three in vitro fertilization cycles. But wait, first you have to call the company to register with the Fertility group at Aetna. Then you have to submit current laboratory test results, two semen analyses and await authorization which can take up to thirty days. Oh and this only applies if you have had unprotected intercourse for up to six cycles. So single women and same sex couples… beware. Further, once the Aetna fertility nurse agrees with your physician that you need fertility treatment, Aetna (not you or your physician) gets to determine your first step. They still believe in the concept of lesser before greater (ie. Insemination before IVF). That is great if it is in line with what you want to do, but no good if you want to bank embryos (or freeze eggs) for future use. This is also a problem if you wish to perform embryo biopsy to ensure that a good quality embryo is implanted and avoid complications like miscarriage which typically further delay you by months on end.

Google and Facebook continue to lead the way and have gone a step further. Last year, these companies report spending over $9 million in expenses related to high order multiples and fertility complications. Enough! They have carved out the fertility benefits from their respective Blue Cross and Aetna administrators and moved them over to a new PPO that only works with fertility benefits. Therefore, as of January 2016, no more silly hoops to jump. These PPO’s are working with providers to ensure that the packages offered to patients actually make sense. They are including the technology that has pushed our field forward in 2015 such as embryo biopsy and preventative banking of eggs and embryos.

Finally, a plan that makes sense! Kudos to Google and Facebook for seeing the light and here’s to hoping that the other Bay Area corporations catch up in offering plans that truly benefit their employees.

In the rest of this issue, you will find a guideline to preparing for your first fertility appointment, a savory end of summer recipe, some advice of keeping your relationship intact during your fertility journey, and the findings of a recent survey on how patients experience miscarriage. We hope you will find the answers to some of your questions.

Enjoy!
ABOUT THE AUTHOR

Danielle E Lane, MD, Reproductive Endocrinology and Infertility specialist. Dr. Lane attended McGill University before completing her medical training at the University of Pittsburgh school of medicine, her residency at Yale-New Haven Hospital and her fellowship at the University of California, San Francisco. She opened the Center for Reproductive Health at Kaiser Permanente in Napa-Sola-no in 2005. In 2009 she founded Lane Fertility Institute. The Institute has grown to a four physician, multi location practice with a state of the art embryology laboratory. She is committed to providing education for women about preservation of their fertility and developing lower cost models to improve access to care.

Team Member Feature

Ms. Doris Cheung, MPA, PA-C. 

In July 2015, Doris a native to the Bay Area, joins Lane Fertility Institute. After completing her undergraduate studies at the University of California at Santa Barbara, she returned home to the East Bay. While working for Pacific Fertility Center as a new patient coordinator, she was inspired to pursue her Masters in Physician Assistant Studies. She received her MPA from Samuel Merritt University. In addition, she worked as a research assistant running several clinical drug trials. Board-certified by the National

Commission on Certification of Physician Assistants, she is also a member of the American Society of Reproductive Medicine. As a Physician Assistant, she has worked for the past two years at the East Bay Center for Digestive Health in Oakland California before returning to her passion in the field of fertility.

Doris lives in Berkeley with her husband and two pups, a simple coyote and a much smaller terrier mix who runs the show. In her free time she enjoys travel, cooking, photography, and exploring new trails and restaurants in the Bay Area. With a background in Exercise and Health Science, her interpretation of medicine combines a passion for yoga, running and healthy living.

Team Member Feature

Ms. Tulay Gaines, RN, MSN, FNP-C, In May 2015, Lane Fertility Institute (LFI) welcomes Ms. Tulay Gaines. Tulay completed her undergraduate degree in Biological Sciences at UC Davis. She went on to complete both her Bachelor’s of Science in Nursing and Masters of Science in Nursing at Columbia University. In addition, she is a nationally certified Family Nurse Practitioner. She has worked at Reproductive Medical Associates, one of the top fertility practices in New York City, both as an IVF Nurse and later as a Nurse Practitioner in the Ovum Donation Department.

Prior to joining LFI, Tulay worked at JumpstartMD, a Bay Area medical weight loss clinic. Her focus was helping overweight & obese patients reach their wellness goals. Finally, Tulay holds national certifications as a facilitator for Open Airways for Schools, Freedom From Smoking, Not-On-Tobacco, and the Better Breathers  Club. Tulay will be monitoring and caring for our  fertility patients in the San Francisco location.

On The Cutting Edge

Father’s Day is just around the corner, and although you may still be on your fertility journey, it is an opportunity to celebrate the father-to-be in your life. Remember why you partnered with him to build a life together. Find the activity or relaxation technique that gives him the most joy, and create a time to do that with him.

Our next issue will feature a segment by a fertility psychologist on keeping your relationship healthy during your fertility treatment. We will also highlight additional insurance updates. We will have an article on the predictors of fertility success. Our patient story will feature a couple who has struggled with weight on their fertility journey. We will also feature the latest information on the benefits of vitamin D and DHEA as supplements to your fertility treatment.

As always, we are eager for your feedback. Please use our Facebook page or email contact to make suggestions and let us know how we are doing.

Best

Signature