Deborah Howell (Host): The journey to parenthood is deeply personal, and for one in six who struggle with infertility, it can be a complex and challenging path. In this episode of the Time to Talk Fertility podcast, Dr. Edward Nguyen, a Minimally Invasive Gynecologic Surgeon, or MIGS, and Reproductive Endocrinologist with FCI, shares how his dual specialty enhances patient outcomes, offering unique insights into the cutting edge techniques he employs to support individuals and couples on their path to parenthood. Dr. Nguyen, it's so nice to have you with us today.

Edward Nguyen, MD, PhD: Well, thanks for having me and it's a pleasure to be here.

Host: Can you explain to us what minimally invasive gynecologic surgery, or MIGS, involves?

Edward Nguyen, MD, PhD: Yeah, so basically what the minimally invasive portion of what that means is utilizing really small incisions, usually less than five millimeters or a quarter inch, or sometimes no incisions at all to do some basic procedures, whether it be diagnostic procedure or even surgeries.

Host: Wow, I hadn't realized there was a no incision option. That's incredible. Give me an example an operation that has no incision.

Edward Nguyen, MD, PhD: I guess a lot of people would do what's called a hysteroscopy, where we actually go through a natural orifice like the cervix itself. So we put a small camera, go up inside the uterus and then say if there's a fibroid or a uterine septum or something that basically doesn't belong there or maybe kind of like impairing chances of conception or fertility, we can use that approach to do a very minimal surgery.

Host: What drew you to specialize in both MIGS and reproductive endocrinology, if I could ask?

Edward Nguyen, MD, PhD: So I've always wanted to become a REI or a Reproductive Endocrinologist and Infertility Specialist, ever since graduate school. But as I went through residency, not only did I know that I liked REI as a field, but also kind of fell in love with surgery in general and being very hands on, and actually do complex surgeries as well.

Host: And what do you find most rewarding about your work as a MIGS surgeon and reproductive endocrinologist?

Edward Nguyen, MD, PhD: Basically that I'm able to offer more than your typical person. There's a lot of great REIs out there, but oftentimes, especially nowadays, they will have to refer them out to MIGS surgeons to do some complex surgeries. And vice versa, sometimes patients are seeing minimally invasive gynecologic surgeons for like other symptoms that are like fibroids.

And they may also want to preserve fertility or optimize fertility, so they refer them back to the REI instead. So I'm kind of like, basically best of both worlds, where I can have an overall, like scope of what's going on, and multiple ways to treat a person, not only for fertility, but also for any other gynecologic care.

Host: Yeah. The one two punch.

Edward Nguyen, MD, PhD: Also, I get bored easily, too. So it's fun to do a lot of different things at once. So whether it be IVF and those, and also I love doing surgeries, just there's nothing like it. So it's so much fun.

Host: Keep yourself interested. Doctor, could you share some examples of conditions or issues that MIGS can effectively address?

Edward Nguyen, MD, PhD: Yeah. A lot of different conditions that MIGS can address, usually in the benign world, meaning non cancerous. So things like endometriosis, which can cause a lot of like chronic pelvic pain, but there's also a big association with endometriosis on fertility. As well as other conditions such as uterine fibroids, which can cause bulk symptoms or bleeding, which can also affect fertility as well, and basically anything that requires any surgery within the abdomen.

Host: And how does your expertise in MIGS enhance the services offered at the Fertility Centers of Illinois?

Edward Nguyen, MD, PhD: Well, as everyone has experienced at some point within the medical system, sometimes the process can be very drawn out and long, especially if you have to refer someone for surgery who may not be within FCI itself. So oftentimes you have to refer back to a person to do surgery, which can take months, and then once the surgery is done, then they go back to FCI for further treatment. That back and forth can be very cumbersome and my goal here at FCI is to help reduce the wait times, as well as be able to offer comprehensive care for our patients all under one roof.

Host: That's so important for the patient. The waiting and then the schlepping around to different places and trying to park and it's all very stressful. So if you can just do it in one place, it's such an advantage.

Edward Nguyen, MD, PhD: Yeah, and so much easier to communicate between me and my colleagues here at FCI rather than then going back and forth between people at different institutions or practices. Basically like there's less room for things to get lost in the details or lost in the shuffle.

Host: You can use the same chart online and all that stuff, right?

Edward Nguyen, MD, PhD: Exactly. And I also have everyone's cell phone numbers, so I can just directly call them up and tell them what I see.

Host: So what are the main benefits of choosing minimally invasive procedures over traditional surgical methods?

Edward Nguyen, MD, PhD: There's lots of different advantages. Well, since the name itself is being minimally invasive, people oftentimes recover a lot faster because we're using such small incisions. But also, because of the smaller incisions, you have faster recovery times.

Traditional laparotomy, or a big fancy word for bigger incisions; people can often be out four to six weeks, or if not longer, during the recovery phase. With these smaller incisions, most people were actually feeling pretty back to normal within a week or two. But we still recommend them taking maybe four weeks off just to be safe. It's always easier to go back early to work rather than try to ask more time off. Other benefits of doing the minimally invasive approach are there's less blood loss, less pain and a lot of people within the reproductive age, care about the appearance of their abdomen to make sure there's no big scars.

So I'm using much smaller incisions or things that can be hidden, like an incision inside the belly button where you never knew there was an incision there. And these are all also outpatient procedures. So there's no overnight admissions or stay in the hospitals. So people can just go back home after and recover in the comfort of their own home.

Host: How do you work with patients who are anxious about undergoing surgery?

Edward Nguyen, MD, PhD: My general approach to like kind of everything in medicine, is I always want to make sure, that the patient knows and advocates for themselves and that they are basically always the boss. So I never want to talk a patient into doing something that they're not comfortable with. And just because you meet with me for a consultation doesn't mean you have to go through surgery itself.

But after our discussion, I want you to fully understand the rationale and the reasons why we're recommending surgery, or any alternative procedures, other than surgery. I want to make sure that they feel fully comfortable and know exactly what's going to happen.

Host: We touched on this before, but I think it's an important point, so I'm going to ask again. In what ways do minimally invasive surgeries impact recovery times for patients?

Edward Nguyen, MD, PhD: Because we're using such small incisions, people are going to recover a lot faster. So probably in one to two weeks before they're feeling mostly back to normal, versus longer recovery times with bigger incisions, which can be as long as four to six weeks. And also because of the small incisions, there's like less pain, less blood loss, less scarring basically too, because we're using such small incisions.

Host: Do surgeries affect fertility treatment timelines?

Edward Nguyen, MD, PhD: They can, depending on the type of surgery. If, say, we're doing a myomectomy or removal of a fibroid, and depending on its location and size, sometimes we recommend waiting as long as six months before actually trying to conceive. That's to allow time for the actual scar tissue, and the strength of the uterine wall to kind of heal back fully, before becoming pregnant again. Because our ultimate goal is to get you pregnant, but we want to make sure that you have the best and safest outcomes afterward.

That time of six months might seem kind of long, but it's really to make sure there's no complications during delivery, things like that.

Host: Well worth the wait. Can you describe a typical patient journey from diagnosis to recovery in your practice?

Edward Nguyen, MD, PhD: In my own personal practice of a patient who is not referred to me for surgery, oftentimes I'll just go through their basic medical history and main reasons why they're seeing m; which more often than not is due to, like, infertility. But if they give me some warning signs, then I always ask questions related to possible endometriosis, such as painful periods. Basically, anything that kind of sets off alarm bells in my head that might be a more physical or more obvious cause of infertility that can be addressed surgically.

I make sure I fish out those type of symptoms during our initial consultation. But then as we go through our evaluations with ultrasounds and other diagnostic tests like saline sonograms or hysterosalpingograms, which is the x-ray dye test, I'll look for more different signs of any physical or structural issues that might be contributing to infertility.

And once we get all the different factors and lab tests and all the results back together, I meet with the patient and kind of go over all my findings. And if I see that there's a role for surgery at all that may improve their chances of conception, you kind of talk about that as the next step.

 Also depends on the context of what they're trying to go, but we'll decide whether surgery is needed or other fertility treatments first before surgery.

Host: Let's talk about any advancements in MIGS that have had a significant impact on fertility treatments. Any come to mind?

Edward Nguyen, MD, PhD: There's lots of things that are probably on the horizon. But I think we're still kind of in the investigational stages of outcomes. For example, there is a super minimally invasive approach to treating fibroids called Sonata, which is basically using ultrasound waves to quote unquote cook the fibroid or help it shrink down in size.

And it came out in like 2018, it's a really cool technology and it's really been shown to improve outcomes for patients with fibroids who experience heavy menstrual bleeding. Although it's, not technically FDA approved for women seeking pregnancy afterward; there has been probably close to a hundred different documented pregnancies after that and all of them have been very promising with no adverse outcomes.

Host: That's truly good news for women. How do you envision the future of minimally invasive gynecologic surgery in the context of reproductive endocrinology and fertility care?

Edward Nguyen, MD, PhD: Probably I'm one of the more rarer people nowadays to be dual trained in both specialties. There is kind of a push for training more people like me, but the vast majority of people are going to be strictly REIs or strictly MIGS surgeons. So I definitely see there is going to be a partnership between the two sub specialties in treating fertility care.

Host: Well, thank you for being with us today to share your insights and expertise. We really appreciate it.

Edward Nguyen, MD, PhD: Thanks for having me.

Host: And you can schedule an appointment to talk to a fertility specialist at 877-324-4483 or visit fcionline.com for more info. And if you enjoyed this podcast, you can find more like it in our podcast library and make sure to give us a like and a follow if you do. That's all for this time. I'm Deborah Howell.

Have yourself a terrific day.