Cheryl Martin (Host): Advances in reproductive medicine bring much needed hope to those struggling to get pregnant. The Centers for Disease Control and Prevention, the CDC, reports that about one in five women have difficulty getting pregnant, and approximately one in 10 men have some form of infertility. Up next, we learn about the latest fertility options and how the team here at VCU Health empowers you to make informed decisions. Our guest is Dr. Erika New. She's an OB-GYN and reproductive endocrinologist. 

This is Healthy with VCU Health. I'm Cheryl Martin. Dr. New, I'm so delighted you're here to discuss this important topic.

Dr. Erika New: Hi. So happy to be here. Thank you for having me.

Host: First, tell us about your background and specialty.

Dr. Erika New: Yes, of course. I'm trained as both an OB-GYN and a reproductive endocrinologist and infertility specialist. So, that means I went to medical school and then did training in residency to become an OB-GYN. I did my training at University of South Florida in Tampa. And then you do an additional three-year fellowship specializing in infertility treatment. I also did that at University of South Florida. I'm so happy to be back home in Richmond, which is where I grew up, and actually I went to medical school at VCU. So, it's great to be back.

Host: That's wonderful. So, what advice would you give to people who are starting their fertility journey? For instance, are there lifestyle factors such as diet and exercise which affect fertility?

Dr. Erika New: That's a really great question, because I think most people go through their life not thinking at all about how hard it would be to become pregnant or think that they might have any issues getting pregnant. Most people don't talk about that. And so, if that happens, a lot of people can feel very isolated and not know what to do. 

So, for someone who's just starting the journey, I think one of the most important things is really knowing your menstrual cycle. Having a regular menstrual cycle where you can predict when your period is - that's a really good sign of healthy ovulation. It just gives you an idea of your general reproductive health and cycle.

In general, the things you would do just to stay healthy can also help your reproductive health. There’s not a specific diet we recommend. But in general, trying to eat a balanced diet, and low inflammatory foods. We usually want more protein, less carbohydrates. Obviously, if you're trying to get pregnant, we like to restrict smoking, restrict alcohol, that sort of thing. But in general, I would say the most important thing is to really get to know your body and your cycle to really help your best chances of getting pregnant.

Host: So, what are some common factors that can affect fertility in both men and women?

Dr. Erika New: I'm glad you bring up both men and women because it's not just one person or one part of the couple. In general, actually, in most couples, there can be both male and female factors involved. So, I would say some of the most common female factors that I see are related to not ovulating, which means you're not releasing an egg each month. And that can be seen in women who have a condition called PCOS or polycystic ovarian syndrome. 

And another factor I see a lot in women is a low ovarian reserve, which means a low egg count, and that can happen to anyone, but it's especially at higher risk in women who are older. So, a lot of women are putting off childbearing because they have busy careers and maybe it's taken longer to find the right partner. So, I would say those are two of the most common female factors. 

For the male partner, there are many, many possibilities. I would say one of the most common that we see is when the male partner takes exogenous testosterone, it can actually affect the sperm and reduce the sperm quantity significantly. So, I'll see some patients for that. And there can be other issues, but I would say those are the most common ones that we see.

Host: So, what steps should you take if you suspect you have infertility issues, and then when is it advisable to seek medical care?

Dr. Erika New: So, if you think that you have infertility, or you have a known reason. Maybe you have a history of endometriosis, or maybe you have had chemotherapy treatment in the past. Or, if you know there's an issue, then you really should try to get treatment right away, or at least come to be evaluated. We don't want you to waste time. If there's some intervention that we can do, we really want to help you as soon as we can. 

In patients who don't have any of those known concerns, then we really recommend usually after a year of trying to conceive, most patients or most couples will be pregnant. And so, if you are older than 35, we usually shorten that time period to six months and say, "Hey, we want to see you sooner, just so we can have an earlier intervention if needed." But without any known cause of infertility, and it's been about a year, that's when we say it's a really good time to come see someone like myself or another infertility doctor.

Host: And so, speaking of coming in, what infertility treatment options are available for people at VCU Health?

Dr. Erika New: So, we have the whole spectrum of treatment options. Some of the most common things that we do, we do medications to help people ovulate. We can do intrauterine inseminations, which are a procedure that can help if there's an issue with male infertility or sperm factor. Or for some other causes of infertility, even to the most advanced treatments, which are in vitro fertilization or IVF. We even do genetic testing. So, some patients, they come to get treatment just because they may have a known genetic condition that they don't want to pass along to their children. We also offer services for same-sex couples if they need to use donor eggs, donor sperm, if someone needs to use a gestational carrier. We have the whole range of fertility treatment options.

Host: So, the latest is available.

Dr. Erika New: Yes, definitely.

Host: Explain the advantages in terms of patient-centered care at VCU Health being part of an academic health system.

Dr. Erika New: I love that being part of the larger VCU system allows us to have really close relationships with our OB-GYN department for our patients. So, once you get pregnant or even just during this process, you have someone to take care of you in addition to us. If you have any medical complications, any other medical concerns, we have a whole team here of doctors, Maternal-Fetal Medicine specialists, cardiologists, neurologists, anything you can think of. And we really, I think, do a great job of having a patient-centered approach, especially at our clinic. We really love to get to know our patients. And we don't use ultra sonographers, for example, in our clinic. The doctor, myself, I'm doing your ultrasound. So, I get to see my patients and check in with them during their treatment cycles. We have really amazing nurses. A lot of our nurses have been here for years and developed close relationships with our patients too. So, I feel like that really helps make this journey a little bit easier because it's not an easy thing to go through. Infertility is really, really a tough diagnosis. And so, I think that helps make the journey a little bit easier.

Host: Now, we're hearing about more and more people, more and more women opting to freeze their eggs, and your clinic helps people who want to do that, who want to freeze their eggs or sperm. So, who's a good candidate for fertility preservation? And then, tell us about the process.

Dr. Erika New: I'm so glad you brought that up because I didn't even mention that as one of the things that we do. But we do, we freeze eggs and sperm. And it's a great option for anyone who is not ready to get pregnant currently, but really wants to leave that option open for the future. 

So, we see patients who are young, focused on their career, just not ready right now. But as we know, as women get older, the number of eggs you have decreases, the quality of those eggs decrease. So really, anyone who is thinking about having a family in the future would be a great candidate to come get more information about freezing your eggs so that you could have those for use in the future. And the same thing goes with sperm, that we can freeze sperm for the future. 

Another population that we offer this for is patients who are going to undergo treatment for cancer or some other chemotherapy or treatment that could affect your fertility. We also have patients who might be starting hormone therapy for gender-affirming therapy that could affect your future fertility. And so, those are really great candidates to try to help preserve your fertility now so that there's more security for the future.

Host: Is there an ideal age range for this?

Dr. Erika New: So really, the ideal age range is prior to age 40. It's not that you can't do treatment after that. You can still freeze eggs after that. It's just that the quality does decrease significantly. So, the outcomes are really best the younger you are.

Host: And do insurances cover this?

Dr. Erika New: It really depends. I have seen in my practice that there have been more insurances that have covered. And we actually advocate for state-mandated coverage. I advocate with RESOLVE, the national infertility organization, to try to get more coverage. Many local companies, I don't want to mention the list, but there are a lot that do provide coverage, including VCU Health, but it's not a universal thing that all insurance is.

So, I think it's really important, if you are looking at a new job or it's your time to renew your health insurance, to look and see and ask your employer, "Do I have coverage for fertility preservation? Do I have coverage for infertility?" And if you don't, we have options available. But to see if you do have that coverage or if you can get a policy that has it, it can really be helpful in the long run.

Host: You talked earlier about the patient-centered approach. So, what can a person expect at a new patient visit? And then, we also know that VCU Health has a strong mission to serve all people of Virginia and beyond. So, tell us about what that means when it comes to infertility.

Dr. Erika New: So, we take a very personalized approach. So, for a new patient visit, a lot of that is going to be directed at what your goals are, what testing or treatment you may have done before, what stage you're in. Are you just gathering information? You're not sure what you want to do next. Are you really looking into a specific treatment? So, we really base it on that. 

I would say, in general, what to expect with a new patient appointment is often we're first just taking a very good history; hearing about, you know, what's been going on. We do often do an ultrasound at the first visit so we can really look at the uterus and ovaries and get an assessment of your health. 

We have some patients that come by themselves. We have some that come as couples. We have some that bring us just a supportive friend or family member. But I would say that first visit is really just a chance for us to get to know you, to then gather some more information so we can really make a plan for you. 

And we really do want to serve our community. We have patients from all over the state that come here to Richmond. There are not that many fertility doctors out there. There's probably each year about 40 new doctors that graduate and become board-certified. So, it is a smaller field, and we really want to help as many patients as we can. And so, we try to do everything we can to help really our community to help conceive and help with whatever issues they're having. 

Host: So, after successful fertility treatment, explain the process for patient care at VCU Health. For instance, your team care for the patient during prenatal care through delivery.

Dr. Erika New: Yeah, that's something that's really a seamless transition here, because we have the full department of obstetrics and Gynecology, Maternal-Fetal Medicine. We have our beautiful Labor and Delivery suites at VCU Medical Center. So, we at our reproductive endocrinology clinic are following patients through the first trimester of pregnancy. And so, we're helping make sure everything is starting off to a great start. And then, we transition your care over to our OB-GYNs. So, I unfortunately am not going to be the one to deliver your baby. It's always very bittersweet when my patients graduate and I send them off to OB-GYN, but that means we've achieved our goal. And really, it's a nice, seamless transition into your prenatal care after graduating from our clinic.

Host: Do you find that there is just even excitement on your part when a patient goes through your treatments and the treatments are successful?

Dr. Erika New: It is the best part of my job. I even love when I see a patient and they end up getting pregnant on their own a month later. I still like to take credit. But that's why we do this and that's the best ever. We have patients send us photos. They send us updates. They'll stop by and bring their baby for us to see. That's really the most rewarding part of my job. That's why I love what I do.

Host: Anything else you'd like to add?

Dr. Erika New: I just would really encourage that if you are out there struggling with infertility, you're not alone. It's not something people talk about often, because it's just something that I think a lot of people are afraid to talk about or just don't know who to come to seek help for. So, I just really encourage that you reach out to us. We would love to help you, and I don't want you to feel alone.

Host: Dr. Erika New, thank you for bringing us up to date on the latest advances in fertility treatments. Very informative. Thank you.

Dr. Erika New: You're welcome. It was so great to be here.

Host: To make an appointment or to refer a patient, call 804-327-8820. Again, that's 804-327-8820. You can also send an email to reproductive medicine@vcuhealth.org. To listen to other podcasts from VCU Health, visit vcuhealth.org/podcast. This is Healthy with VCU Health. Thanks for listening.