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Melanie Cole (Host): Welcome. If you are a couple trying to have a baby, you know how heartbreaking it can be if you’ve been told that you are infertile for one reason or another. But there are so many options out there today, so many tools in the toolbox of reproductive endocrinologists that there is always hope. My guest today, is Dr. Daniel Griffin. He’s a Reproductive Endocrinologist Boston IVF at the Women’s Hospital. Dr. Griffin, before we begin about fertility treatments, tell us a little bit about the partnership between Boston IVF and Deaconess, The Women’s Hospital.

Daniel Griffin, MD, FACOG (Guest): Boston IVF is one of the largest fertility practices in the country and they partnered with the Deaconess Women’s Hospital six years ago in order to provide great access to fertility care in patients in this area.

Host: What a great partnership. So, let’s talk about fertility then. When is a woman most fertile? Women have this question all the time, they’re not sure when during their cycle, they are most fertile.

Dr. Griffin: If a woman is ovulatory, meaning that she’s having regular menstrual cycles; her most fertile time would be 12 days to 14 days after her period has started if she has a 28 day cycle or about two weeks before the onset of her next menses.

Host: That’s so interesting. When I was trying to get pregnant with my first child Dr. Griffin, it took a while and I was told relax, have sex, just relax and it will happen. I am sure that you’ve heard this before and people have told you this. How long do we do that? How long do we relax before we see a fertility specialist?

Dr. Griffin: Sure, the chances of achieving a pregnancy even in women who are under the age of 30 per month is somewhere between 20 to maybe 25%. And the majority of those pregnancies will occur within the first six months and so if you have a patient who is under the age of 35 and they have been trying to get pregnant for 12 months or longer; they should seek out an evaluation by a reproductive endocrinologist. If they are over 35; they should seek out an evaluation in six months. If they are over 40; they should seek an evaluation right away.

Host: Wow, that’s great advice. I was definitely over 35 so, you seek an evaluation. What is that like? What is that initial visit like with you and how does that discussion go about how far a couple is willing to go in their pursuit of fertility?

Dr. Griffin: The first appointment is really getting to know the couple, discussing their medical history, if they’ve done any prior fertility treatment, or had an evaluation prior to seeing us and then we would develop an evaluation or a diagnostic plan at that first visit and fertility is just like anything else in medicine. You would gear your treatment to whatever it is that you would find in that evaluation.

Host: So, both the couple come in. Both partners, both people in the relationship come in to see you. How do you determine who is the one with maybe some issues that might affect fertility?

Dr. Griffin: So, what I always tell people when they first come in here is the cause of infertility, it does not discriminate between the sexes. So, about 40% of the time we will find something in the female, 40% of the time we will find something in the male. Sometimes there may be overlap where you would find something in both partners and 20% of the time, you may not find an explanation at all.

For the male side of things, it’s a very simple semen analysis test. On the female side of things, we would do tests to evaluate if a woman is ovulating or releasing an egg in a given cycle and then they may also have an evaluation of their anatomy to make sure that there is nothing with the uterus or the ovaries or the fallopian tubes that would prevent pregnancy.

Host: Dr. Griffin, as I said in my intro, it can be heartbreaking for a couple to find out there is any issues at all. What expectations do you tell them to have when they start this process?

Dr. Griffin: I think when they would come here, the first thing I would tell them to expect is that we’re going to listen to them and hopefully answer their questions to the best of our ability and like I said, it’s not uncommon to not find a cause of infertility. I tell patients in terms of treatment, that we tend to start with the simplest thing and then sort of work your way up from there. And most of the patients that we treat will have success. And so, we always try to keep hope alive, if you will, in terms of navigating this process.

Host: That’s excellent information. Tell us what they can expect from your team. How many providers? What kinds of providers are involved and if they did take a test, is it a long wait to find out? Do they have to come in again to get their test results? Tell a little bit about how the process works.

Dr. Griffin: Sure. For the initial visit, they would either meet with me. They may meet with one of my partners from Boston IVF. We also have a nurse practitioner; her name is Valerie Topper who may meet with the couple initially. That first visit is really to get a medical history and then also go over any diagnostic testing which would be done. Occasionally if those tests have been done; we would discuss a treatment plan at that first visit.

Then they would meet with one of the nurses after they have met with someone from our team to discuss in more detail how to schedule any tests that would be needed and then maybe also go through a cycle calendar to discuss their treatment.

The final part during that first visit would be to meet with a financial counselor to discuss insurance benefits and any other financial questions that patients would have regarding treatment. Typically, the first menstrual cycle if you will, after they had seen one of us would be to do the testing and then hopefully, with that next cycle, they would then be able to start doing fertility treatment.

Host: Wow, that’s very comprehensive. What are the facilities like? Tell us some of the cool technology you have available.

Dr. Griffin: Correct, so we are able here, to provide fertility services for anything that a couple would need in regards to treatment. So, we are able to do semen analyses here. We can run hormonal tests here. We have the ability to do intrauterine insemination and then of course any procedure that would need to be done in regards to IVF. So, in terms of something called intracytoplasmic sperm injection or genetic testing of embryos, embryo freezing. And this facility was opened in 2013 and we have continued to make upgrades in order to provide patients with the best care.

Host: Do you also treat male infertility Doctor?

Dr. Griffin: Yes, we do. Male infertility is responsible for at least 40% of cases and so men would have a semen analysis. They may also need to have hormonal testing and they may need to see a urologist during their evaluation, but in terms of treating male fertility; that can be done out of this office.

Host: Wow that’s cool. Now tell us a little bit briefly about some of the techniques that you might try, the first line of defense whether it’s clomid which many women have heard of; really what these treatments are intended to do. Just give us a brief overview.

Dr. Griffin: Yeah so, like I was mentioning earlier, the treatment is geared toward the evaluation and so sometimes the treatment may be surgery. Sometimes it may be to treat with an oral medication like clomid. Clomid is a pill which if you give it to a patient who doesn’t have regular menstrual cycles; it may cause them to ovulate at a more regular time. In women who have regular menstrual cycles, it may help to boost ovulation. If there was an issue with the sperm; then sometimes you would use a fertility procedure called an intrauterine insemination and then in those cases where either they have failed treatment or if there is a specific indication to proceed directly to IVF; then those patients could undergo invitro fertilization.

Host: So many options as you say and so much hope out there for fertility treatments today. Wrap it up for us Dr. Griffin, with your best advice and information what you would like couples to know that are trying to have children, may feel frustrated and what would you like them to know about coming in to see you and the services that you can offer?

Dr. Griffin: I would like any couple to know that they are not alone in their struggles with infertility. Infertility affects as many as one in six couples and the hardest part for infertility is to make that first appointment. I think if they come and they learn about it and they can evaluate what different treatment options that they would have; what hopefully they will find is that there are things that are available to them that would provide them with a better chance of success.

Host: It’s great information. You’re an excellent educator. Thank you so much Dr. Griffin, for being on with us today and sharing your expertise, explaining to couples some of the options that are out there and what you can do for them at the Women’s Hospital. Thank you again. This is The Women’s Hospital—A Place for All Your Life. For more information, please visit www.deaconess.com.bivf, that’s www.deacpness.com/bivf, or call to schedule an appointment. You can always do that at 812-842-4530. This is Melanie Cole. Thanks for tuning in.