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Welcome to Westchester
Fertility and Reproductive Endocrinology
About The Practice:
Westchester Fertility offers a full range of services for
testing, diagnosis, and clinical applications associated with infertility
treatments.
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Egg Freezing Fertility Treatment
NEW "EGG FREEZING" FERTILITY TREATMENT NOW AVAILABLE -- ADDRESSES THE "BIOLOGICAL CLOCK" AND ENABLES WOMEN WITH CANCER TO CONCEIVE A CHILD USING THEIR OWN EGGS
Westchester Fertility and Reproductive Endocrinology is proud to be the first facility in the region to offer complimentary egg freezing to women with cancer!
Egg freezing is a new option for those who want to achieve pregnancy, but cannot or choose not to at a given time. It addresses the issue of the “biological clock.”
Egg freezing also opens up possibilities that were previously unimagined for women living with cancer. It is the first viable fertility treatment option for women living with cancer, which can empower them to be in control of their future as parents. Women undergoing cancer treatment now have the opportunity to preserve their fertility prior to treatment by freezing an egg for later use prior to her undergoing chemotherapy or radiation as those treatments often cause permanent destruction of the reproductive function.
Hear Dr. Blotner's Interview On Conceive On Air!
Dr. Blotner was a recent guest on Conceive Magazine's popular podcast, Conceive On Air. Listen to Dr. Blotner's exciting interview with highlights of his announcement about our first-ever complimentary egg freezing program for women newly diagnosed with cancer.
9/17/08 - Egg Freezing for Cancer Patients
Cancer—it’s the word no one wants to hear. But, there’s at least inspiring news for women who have been diagnosed and still want to have a child after undergoing treatment. Tune in as Host Kim Hahn speaks with Michael Blotner, MD, founder and director of Westchester Fertility & Reproductive Endocrinology in White Plains, New York, about egg freezing, the innovative procedure that preserves good quality eggs for use at a later time.
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Suggestions Prior to Initial Consultation:
Patient Packet:
All new patients are required to fill out a form which enables our physician
and staff to more efficiently address the patient's personal needs and options.
By clicking on this link you can obtain a copy of
our
registration form, which
can also be obtained upon arrival at our facility.
By clicking on the link below, you can obtain the
Insurance procedures as well as other
information and policies:
The material of this
packet includes:
Patient's personal information
Patient's insurance information
A copy of our financial policy
A consent to use and disclose Health information
An assisted Reproductive technologies insurance verification worksheet,
which outlines what questions to ask your insurance company when verifying
fertility coverage as well as a general overview of insurance procedures
An additional copy of the directions sheet to the office
Medical Information:
Referrals from prior gynecologists or fertility doctors is highly
recommended before your initial visit as it enables our physician to asses
your personal case history as well as evaluate your personal information
before your visit.
The referrals can be faxed to the office through this number: 914 949 5758
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The Insurance Companies With
Whom We Participate:
Oxford Health Plans
Empire Blue Cross Blue Shield
Pomco
United Health Care
United Health Care- Empire Plan
Healthnet
Healthnet- Federal Services
Cigna
Great West
Guardian
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Fertility Evaluation and Consultation
This meeting includes a 60 minute personal evaluation with
the Physician concerning your personal health history and medical records,
your status relative to reproduction, and outlines possible procedures and
treatment options.
The initial meeting establishes you as a patient at Westchester Fertility
and gives you the opportunity to personally meet with the physician and
address any questions or concerns that you may have.
Following the initial consultation the physician usually prescribes a
series of tests which are designed to further elucidate the options as
well as expedite treatment.
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A
Brief Overview of Some of the Treatments Used to Optimize Pregnancy:
Ovulation Induction:
This process involves use of fertility medications to stimulate the
ovaries to produce more than one mature egg per cycle. Careful monitoring
of the patient utilizing blood tests and pelvic ultrasound optimizes the
medication dosing and timing of sperm exposure. Increasing the number of
mature eggs per cycle, in essence "targets" for the sperm, often will
increase the chance of pregnancy each month.
Intrauterine Insemination (IUI):
When necessary, the semen is prepared in the laboratory by separating the
sperm cells from the seminal fluid, placing the sperm in a sterile
nutrient solution that is inserted directly into the uterus. This
procedure is implemented when the cervical mucus impedes the sperm's
progress, or when the sperm quantity and or quality is suboptimal. The IUI
is also frequently employed in cases of unexplained infertility prior to
proceeding to more advanced reproductive procedures. The timing of the IUI
is enhanced by the concurrent use of the fertility medications.
In Vitro Fertilization (IVF):
While IVF was originally designed to bypass blocked or damaged fallopian
tubes, its application has been extended to male factor infertility,
unexplained infertility, or failure of conventional treatment such as
ovulation induction with intrauterine insemination. The process involves
stimulation of the ovaries to obtain multiple egg development and removing
those eggs by ultrasound guided needle aspiration. The patient is given
anesthesia for the procedure which takes fifteen to twenty minutes. After
the eggs are isolated in the laboratory and the partner's sperm is
prepared, the eggs are either inseminated or injected with the sperm. The
resulting embryos are cultured in the incubator and evaluated daily. The
embryos are returned to the uterus in three to five days by a thin soft
catheter. Blastocysts are embryos in a more advanced state of development
and commonly developed by the fifth day in culture. Blastocysts are often
the heartiest embryos and are more likely to be of good quality.
For more
information click on this link to obtain an in depth packet on IVF.
Intracytoplasmic sperm injection (ICSI):
During in vitro fertilization it is sometimes necessary to select a normal
appearing live sperm and inject it into the egg. This process is preformed
with special micro-pipettes under microscopic control. This enhances
fertilization in cases of very low sperm count, poor motility or with high
percentage of abnormal sperm.
Preimplantation Genetic
Diagnosis (PDG):
Selected embryos are sometimes evaluated for specific genetic diseases or
abnormalities prior to transfer.
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An Overview and Explanation of Some of
the Tests and Procedures Encountered During Treatment
The
post coital test
Laparoscopy
Horm onal
studies
Hysterosalpingogram (HSG)
Endometrial biopsy
Semen analysis
The postcoital test:
The post coital test evaluates the interaction between the sperm and the
cervical mucus at a time near ovulation. About halfway through the
menstrual cycle, there is a clear vaginal discharge. This is "fertile"
mucus, produced by the cervix near the time of ovulation (release an egg
from the ovary). The sperm must penetrate and swim through this mucus,
then travel through the reproductive tract to reach the egg. Sometimes
there is an incompatibility between the sperm and the cervical mucus, and
the sperm become immobile or die. The reason this happens is not clear-
the quality of the mucus may not enable the sperm to move well, or it
could be attributed to infections, or antibodies in the mucus may kill the
sperm, There also may be a problem with the sperm. The doctor will examine
the quality of the mucus and the interaction of the sperm with the mucus
to determine if an incompatibility exists.
The post coital test must be performed near the time of ovulation, so the
doctor will need to estimate when ovulation will take place. This is
often difficult to do, especially if one's cycle is irregular. The best
way to know when ovulation will occur is to use an ovulation prediction
kit that one can buy in a drugstore. The ovulation prediction kit measures
the LH (luitinizing hormone) in the urine. A rise in the LH also called an
LH surge means that one will probably ovulate within the next 24 to 36
hours. When an LH surge occurs, one will need to schedule an
appointment with the doctor for the next day. Plan to have sexual
intercourse any time that day Before your appointment. The post coital
test is painless and takes only a few minutes.
The doctor will collect a sample of your cervical mucus and examine it
under a microscope to see the quality of the mucus and and if the sperm
are active or still.
Q: How soon before the test should we have sexual relations?
A: one may have intercourse anytime after the LH surge. It is best to have
intercourse within 12 hours before the test. The doctor or nurse will give
you more specific instructions.
Q: Is it ok to bathe or shower before the test?
A: It is ok to shower but do not take a tub bath. Also, do not douche or
put anything in the vagina.
Q: A couple that I know told me this test was stressful. Is that true for
most couples?
A: Most couples feel this way for infertility testing in general. However
this test puts a lot of pressure on couples to have sexual relations at a
specific time. The added stress often makes it difficult for men to
perform and it not uncommon for couples to have to wait and try again
during this cycle or the next one.
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Laparoscopy:
Laparoscopy is a surgical procedure the doctor uses in order to look at
the uterus, ovaries and fallopian tubes. If any problems are diagnosed the
doctor can usually correct them in this procedure.
Laparoscopy can diagnose fibroids, scar tissue, endometriosis, and blocked
fallopian tubes, all of which can cause infertility. Using a narrow fiber
optic telescope, inserted through a tiny incision near the navel, the
doctor can examine the ovaries, fallopian tubes, and the outside of the
uterus.
Laparoscopy is a short surgical procedure preformed under general
anesthesia, so it is usually done in a hospital or surgery center. Once
one is under anesthesia the doctor will insert a needle and inject a
harmless gas into the abdomen. The gas raises the abdomen wall so that the
doctor will be able to see the reproductive organs more clearly. The
needle is removed and a laparoscope is inserted through a tiny incision.
Another small incision is made in the lower abdomen so that the doctor can
insert a probe. The probe is used to move or lift the organs to see
certain hidden areas. Also a dye may be injected through the cervix into
the uterus and fallopian tubes to see if they are blocked.
Common Questions and Answers
Q: How
soon can I go home after the procedure?
A: One stays in the recovery room for about 3 to 4 hours after the
procedure. One should plan to have someone with them for 24 hours
following the procedure. In some cases an overnight hospital stay might be
required.
Q: How will I feel for the next few days after the procedure?
A: Expect to feel sore and tired. Your may feel pains in the shoulders or
diaphragm. The pains are caused by gas bubbles from the procedure, and
should disappear in a day or two. Taking pain medication and walking or
moving around should relieve this pain. You should plan to take a few days
off from work.
Q: How many scars will I have and how large will they be?
A: Most patients will have 2 or 3 scars the one near the navel will be
about 1/2 and inch wide. The other scars in the abdomen will be about a
1/4 of an inch wide.
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Hormonal Studies
Hormonal studies help identify hormonal imbalances that may impair one's
fertility.
Hormones control every step in achieving pregnancy – from stimulating the
development of an egg, to ovulation and implantation of the fertilized egg
in the uterus. Each hormone that plays a role in the conception must be
produced in a specific amount at a precise time in the menstrual cycle.
Hormonal studies measure the level of certain hormones produced by you
body during one's cycle. It is likely to have a series of simple blood
tests at various points in your cycle. The tests the physician orders may
help determine the diagnosis as well as identify the best treatment
options.
Hormones that control ovulation and implantation of the eggs:
Estradiol
Stimulates the growth of follicles and production of fertile mucus from
the cervix, and prepares the uterine lining for implantation of the
fertilized egg.
Follicle stimulating hormones (FSH)
Stimulates the development of the egg.
Luteinizing hormone (LH)
Stimulates the release of the egg from the follicles (ovulation).
Progesterone
Stabilizes the uterine lining for implantation of the fertilized egg and
supports early pregnancy.
Other Hormones that can interfere with ovulation:
Androgens
Normally small amounts of andogents – testosterone and DHEAS
(dihydroepiandrosterone sulfate) – are produced in women. Excess
production may interfere with the development of the follicles, ovulation,
and cervical mucus production.
Prolactin
Stimulates milk production, blood levels may be higher than the normal
certain disorders or if you are taking certain medications.
Thyroid
An under active thyroid (hypothyroidism) can result in high prolactin
levels.
Common Questions and Answers
Q. Do I need to fast before I have my blood test?
A. Food does not usually affect you blood tests for hormonal studies so
its okay to eat. However, you may be told to fast before having a
prolactin blood test. Speak with you doctor if you are unsure about eating
before this test.
Q. Do these blood tests have to be done on certain days of my menstrual
cycle?
A. Yes. Your hormone levels change throughout your cycle and have to be
measured at a specific times to diagnose an imbalance. Your doctor or
nurse will tell you exactly when to have each test done.
Q. What is a normal level for each hormone?
A. The “normal” levels vary by laboratory so you’ll have to discuss these
values and your results with your nurse or doctor.
Q. When will I get the results of the blood test?
A. Some test results are available the same day others take up to a week.
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Hysterosalpingogram (HSG)
Having a blocked fallopian tube or growth in the uterus can reduce
chances of pregnancy. If the fallopian tubes are blocked the sperm can’t
reach the egg. A hysterosalpingogram (HSG) is a test that uses
x-rays and a special dye to detect scar tissue, tubes or preventing a
fertilized egg from implanting properly in the uterus. Another test is
called a sonohysterogram. It uses ultra sound and a special solution to
detect abnormalities inside the uterus. However, the sonohysterogram
cannot be used to detect blocked fallopian tubes.
What to expect during the HSG
The HSG is usually done in a radiology lab and takes between 10 to 30
minutes. The doctor will insert a speculum into the vagina, and then place
a thin plastic tube inside the cervix that will lead to the uterus and
fallopian tubes. A special dye will be injected through the plastic tube.
The dye should fill the uterus and fallopian tubes, and spill out of each
fallopian tube. Next x-rays will be taken, and the doctor can evaluate the
uterus and fallopian tubes.
Common Questions and Answers
Q. A friend of mine had a HSG and she said I was painful is that true?
A. Many women feel some cramping, especially when the dye is injected.
Women who have a blocked fallopian tube may feel intense pain.
Over-the-counter pain medicines such as ibuprofen can help relieve this
pain or discomfort. Speak to your doctor about taking a pain medicine 30
to 60 minutes before the procedure to prevent or reduce pain during the
test.
Q. Is it ok to drive home by myself after the test?
A. Many women have no pain after the HSG, but you may feel cramps or achy
after the procedure, so it’s a good idea to have someone else drive you
home.
Q. What are the risks of a hysterosalpingogram
A. The risks of a HSG include pain or discomfort, injection, and vaginal
spotting or bleeding. Contact you doctor if you develop a fever or
continue to feel pain for a few more days.
Q. When is the best time during my cycle during my cycle to schedule the
HSG
A. The test should be scheduled after your period ends, but before you are
expected to ovulate, usually between 6 to 10 days of your menstrual cycle.
To figure out the days of your cycle, count day 1 as the day your period
begins.
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Endometrial biopsy:
Around the time of ovulation, the endometrium (inside lining
of the uterus) grows thick with blood vessels, glands, and stored
nutrients to allow a fertilized egg to implant and grow. If fertilization
does not occur, the endometrial tissue sheds as menstrual flow to mark the
beginning of the next cycle. Progesterone and estrogen control the growth
and stabilization of the endometrial tissue. If one doesn’t produce enough
of these hormones, the uterus may not maintain a pregnancy. An endometrial
biopsy is taken by the doctor and then sent to a pathologist who will
examine the sample of the endometrial tissue under a microscope. The
doctor can thereby tell if the body is producing enough of these hormones
by the thickness and pattern. If the body is not producing enough
hormones, medications may be prescribes to regulate them.
Common Questions and Answers
Q. What can I expect after the procedure?
A. You may have mild cramps an hour or so after the procedure and you may
also have vaginal spotting. Light bleeding and spotting can last until you
have your period.
Q. When will I the results of this test?
A. It may take as long as 7 to 10 days to prepare and interpret the
biopsy.
Q. Does this test have it be done on a specific day of my cycle?
A. Yes. This test us done 1 to 3 days before you expect your period. Your
endometrium should be very thick at this time in your menstrual cycle. You
will need doctor know when your period actually begins. You doctor will
compare the date of your period actually started the day you have started,
based on thickness and patter of the tissue sample. If there is a big
difference between these dates, it may mean that your endometrium is not
sufficient to support pregnancy.
Q. What are the risks of this procedure?
A. There is a slight chance that the biopsy may disrupt an early pregnancy
if you happen to be pregnant when the test is preformed. To avoid this
potential problem, your doctor may want you to avoid pregnancy during the
month you are taking the test. You may also have to take a pregnancy test
before you have a biopsy to make sure you’re not pregnant
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Semen Analysis
There are many reasons why couples have trouble achieving pregnancy. A
semen analysis is one of the tests the doctor will use to evaluate the
problem. The test results will tell the doctor the number of sperm
in the semen (the sperm count), whether they are normal (morphology),
and how well they swim (motility). A low sperm count may be caused by
certain medications or medical problems such as a blocked duct low
testosterone level, or a condition in which sperm back up into the
bladder. Fever can also reduce sperm count. Some men may have enough
sperm, but their sperm may not swim well enough to reach the egg. Also,
sperm that are not normal in shape may not be able to penetrate and
fertilize the egg. The physician is able to treat many of these problems
Semen collection
The doctor will need a semen sample. The sample is
collected by masturbation at the doctor’s office in a private comfortable
room. The semen is collected in a sterile specimen cup.
Another option is to collect the semen at home during intercourse in a
special condom that one can get from the doctor. The
sample must be delivered to the doctors office within 45 to 60 minutes after collecting it.
Speak to your doctor about instructions for transporting the sample to the
office. Test results often vary, so one may need to do this
procedure more than once.
Common Questions and Answers
Q. What does low sperm count mean?
A. A low sperm count is fewer than 20 million per milliliter ejaculated.
The normal range is between 40 and 300 million sperm per milliliter of
ejaculation
Q. What does low motility mean?
A. Motility describes the movement of the sperm. Low motility may reduce
your chances to conceive especially if your sperm count is also low. In a
normal semen sample at least half of the sperm have appropriate movement.
Q. What does abnormal morphology mean?
A. A normal sperm has an oval head, slender midsection and a tail that
moves in a wave like motion. Sperm that do not have this normal shape may
not be able to swim effectively or penetrate the egg.
Q. How long must I abstain from sex before the analysis?
A. You should abstain from sex for at least 3 days before the analysis,
but not longer than a week. Check with you doctor to see if there are any
other recommendation specific to you
Q. How long does it take to get the results?
A. The test results are generally available within a few days.
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