Dr. Spencer Richlin Explains Why an Obstetrician Cares About Fertility Screening
Part of my job at Reproductive Medicine Associates of Connecticut (RMACT) is outreach to local Obstetricians/Gynecologists (OB/Gyn). The most pleasant way that is done is that I accompany one of our board certified reproductive endocrinologists (Dr's Mark Leondires, Spencer Richlin, Joshua Hurwitz, Cynthia Murdock and Shaun Williams) to a lunch at the office of an OB/Gyn.
Yesterday, it was Dr. Richlin and myself. I hadn't seen him in a while. I didn't forget how smart he is, really, I didn't. Listening to him explain the difference between PGD (pre-genetic diagnosis) and CCS (Comprehensive Chromosonal Screening) though, reminded me again how smart he is.
Be very clear, when you have two physicians talking about medical issues, as a lay person, I tend to get a bit lost. Less so these days then years ago. Also, they are kind and explain some of it as they go. Sometimes, like yesterday, they get so excited that the conversation just spirals away from me. It was fascinating listening to these men and women talk in such an animated way about their chosen fields of medicine and noticing where they intersect.
Why does an Obstetrician Care About CCS?
Why should an OB/Gyn care about CCS? Simple answer. One that I understood easily. Less pregnancy loss because there are almost no chromosomal abnormalities in the tested embryos (not zero, but less than 2% error rate). Given that almost 25% of all pregnancies result in miscarriage, that's important for an OB/Gyn to know. Pregnancy loss is hardest on the parents to be, without a doubt. I know. I had two of them. Pregnancy loss is also very challenging for a doctor's office to handle. There is the medical piece of it, which is often very straight forward, but not always. There is also the emotional piece of it, which is far less straight forward and needs to be handled on a patient by patient basis. There is often a lot of grief around a miscarriage even more potent when infertility was a struggle first. Our doctors and medical staff grieve with us when there's a loss.
Another reason that an OB/Gyn should care about CCS? Single pregnancies. When an embryo that has been found to be healthy is transferred back, the chances of pregnancy are much higher (and the risk of miscarriage much lower) and therefore allows for less embryos to be transferred back. Twin pregnancies frequently result in healthy babies and healthy moms. Often, though, there are more complications for both the babies and the mothers, even in a twin pregnancy. Certainly when we start to talk about higher order multiples (pregnancies of 3 or more), there will almost certainly be complications and probable compromises in the health and well being of the babies and the mother. An OB/Gyn would much prefer to see patients who are pregnant with one baby; they know that there is a much greater chance of a healthy baby and mom and much less chance of complications.
I got all this yesterday, again, while having the honor of hearing these physicians speak to one another. Yet another reason that I love my job! Fascinating conversations about women's health and family building, with doctors that really care. What's not to love?
Finding the miraculous in the familiar and ordinary. I’m about to go visit San Francisco. It will be the 48th visit there. Uh huh, at some point, I started to keep track, because, well, it started to be almost funny. We lived there for a year while my father did his fellowship; that was when I was in Kindergarten. Then family and close friends moved there and there was American Express Student Vouchers. Four times a year, I could fly round trip for $99. So I went to San Francisco four times a year for four years. It was like going to a second home.
Strange how my brain makes connections. Sorry to drag you along behind me on some of those voyages. I started writing because I’m sitting in the airport, on the only clear day of the week (so happy, no snow today!) and here’s where my brain went. To you. Yes, really.
Reproductive Medicine Associates of CT as a second home? I know what you’re thinking. I really do. The second home that you never wanted to be in, that you desperately want to be done with. I hear from you, though, over and over again, how hard it is to leave. How the RMACT team becomes family, offers support, help, medical information at almost any time, superb high tech protocols and more. How hard it is to leave pregnant, and not have the reassurance every few days that everything is ok, that the pregnancy is progressing well, thriving.
Monica Moore, our nurse practitioner extraordinaire, is taking this on. She is writing a blog for us, published soon, about transitioning to your Obstetrician (OB/Gyn). Lisa Tuttle, PhD, is tackling this as well, in both a blog here at some point as well as speaking directly to other doctors. In addition, RMACT is creating a presentation, being offered by Dr. Tuttle along with one of our wonderful nurses, which will help to ease the transition from our practice to your OB/Gyn. That presentation will be offered once a month to our patients that have had a positive pregnancy test or are ready to transition to their OB/Gyns.
I think this is where the familiar and the miraculous do meet up and get cozy. To an OB/gyn, they are familiar with pregnancy. It is part of their ordinary day. To you and I? It is a miracle. A miracle that we barely dared to hope for or believe was really true. And how do the familiar and ordinary meet the miraculous?
In an OB/Gyn’s office. Of course they are familiar with pregnancy. We want them to be. We want them to know all the in’s and out’s, and have this be so familiar that it’s almost ordinary. But talk to your OB’Gyn about the miracle that it is to you and you will find that it is for them as well. Being an OB/Gyn is not an easy road. Lots of time spent on call- having to be available in the middle of the night, for the whole night. Ob/Gyn’s don’t do what they do because of the great hours. And I won’t even mention malpractice rates. They do it because ultimately as familiar as birth and pregnancy are for them, they also understand it’s a miracle.
One more thing. On January 29th, from 11:45-12:45, I will be offering the first ever Fertile Yoga Pre-Natal class at 20 Glover Avenue in Norwalk! RMACT is very excited to be able to offer their space for this very special class. Details will be following in the coming week.
How to Choose a Top Fertility Doctor
How to pick a top fertility doctor
; course 101. You can get recommendations from everywhere, some places much more reputable, reliable and dependable than others. Doctors are pretty savvy these days. You will see advertisements on billboards, in the yellow pages, magazines, newspapers, all over the internet, on television. You will hear advertisements on the radio as well. In some ways, you can barely escape the marketing that swirls around. Here, there are three ways that are reliable, can work together and that are safer than picking a doctor from the yellow pages.
3 Tips for Choosing Top Fertility Doctors
1) Ask your primary physician for a direct referral.
Hopefully, you are talking to either your primary physician or Obstetrician/Gynecologist (OB/Gyn) if you are trying to conceive. Your OB/Gyn will generally know the specialists (reproductive endocrinologists) in the area, either through the hospitals where they attend meetings together, or from residency programs or even just from practicing medicine in the same area for a period of time. They will also hear things that perhaps a lay person would not; how well regarded the specialist is in the medical field. While your OB/Gyn may not share all the information that they have with you, rest assured it is part of why he/she is referring you to a specific physician. Sometimes your doctor will send you to the closest doctor in the area, sometimes they will send you to a doctor who they feel might be a better temperament for your personality. If you want to know why they are referring you to a specific doctor, ask them. Some OB/Gyn's are aware of pregnancy rates from a particular reproductive endocrinologists program or specific procedures that they feel you may need.
2) Learn more about a reproductive endocrinologist that you are considering seeing by visiting SART and CDC websites.
Both of these organizations give you specific data that is controlled and proven to be true. Neither website accepts advertising and the information that they release is not based simply on what a clinic says but on particular data that they check. The SART and CDC reports have become easier to read over the years and it is simple to compare two clinics in a close geographical area.
Careful about deciding on a reproductive endocrinologist simply on the pregnancy rate though, for a few reasons. One, the SART report is typically two years behind. Right now, they are reporting on 2008, so information is not up to date. Second, this is the disclaimer that SART puts at the bottom of each clinic summary, "Caution: Patient characteristics vary among programs; therefore, these data should not be used for comparing clinics." Of course, that's in the small type, running alone the bottom, barely noticeable. The treatment type on the summary clinic is IVF (in vitro fertilization) only; nothing is mentioned about other types of infertility treatment, such as IUI (intrauterine insemination). It's good to understand what "patient characteristics" mean though. Some clinics will routinely not treat patients with an FSH (follicle stimulating hormone) level above a certain number. Some clinics will not accept patients into their programs who have been unsuccessful for a certain amount of IVF cycles at another clinic. Maternal age (how old the woman is) also factors into a clinics decision about treatment. Third reason to avoid choosing a clinic solely on pregnancy rates is the still somewhat confusing information listed by SART. As they don't subdivide by diagnosis, simply choosing your age group does not give you an accurate idea of your individual chances of pregnancy.
Absolutely the SART report (I was not able to find a report more recent than 2006 on the CDC website so I am not going to discuss it here) has valuable information and is a good way to compare clinics for certain things. An invaluable and reliable resource, definitely.
3) Look at a prospective fertility doctor's website.
You'll find information about whether that doctor would be a good fit for you. What do they choose to say about themselves? Using what language? What treatment options do they offer?
What types of support programs are available? Do they have mental health professionals on staff? How much information do they actually disclose in terms of their credentials, certifications, degrees? Do they have educational materials on their website? One simple way to ascertain the level of training and proficiency is to check whether a doctor is a board certified reproductive endocrinologist.
A physician referral, the SART report, and what the doctors say about themselves are three methods to choosing a doctor. They are not exclusive of each other. When I choose a doctor, I use all three. I ask for a referral from a doctor that I already trust and respect, then I go see what else I can find out about them through medical organizations and their websites.
Coming into a consultation with a doctor that you all ready trust because of the research that you have done can bring a level of comfort that would not be there otherwise. That comfort can go a long way when you are worried about trying to conceive.
Take some of the worry out of the picture by choosing a doctor in a way that feels safe and comfortable for you. Please share other ways that have worked well for you, perhaps it will help someone else.