SPEAKER_00: 0:30

My name is Fadi Sharara. I'm a fertility doctor, and my office is called Virginia Center for Reproductive Medicine. It's in Reston, Virginia, and we've been open for twenty-thers now.

SPEAKER_01: 0:47

Wow, that's amazing. You've been around for a while now.

SPEAKER_00: 0:50

Right.

SPEAKER_01: 0:51

So now take me back to how you got started in all of this. Tell me how you got to where you are today.

SPEAKER_00: 0:58

So in med school, I wasn't sure what I wanted to do. I was between OBGYN and cardiology. And so I came to Georgetown in 1985 and spent four months taking electrose. So I took cardiology first and I said, okay, maybe this is not what I wanted to do. And then I did a month of high-risk obstetrics, and I liked the OB part, but not to make it a career. And then reproductive endocrine or infertility was a brand new specialty. The first pregnancy in the world was in 1979. The first pregnancy in the US was 1981. So it was still brand new. And the first day I started doing that elective, I knew this was my calling.

SPEAKER_01: 1:44

Wow.

SPEAKER_00: 1:45

And so I spent two months doing this, then went back, finished my MD, then went into OBGYN residency at GW, and then went to the NIH for a three-year fellowship. And I've been, I spent eight years in six years in academics, and then said I need to do my own thing. And this is when I opened my practice.

SPEAKER_01: 2:07

Wow. You were definitely a banner on the walk. You knew it was definitely for you. That's awesome. So you said that helping couples achieve parenthood is one of the most meaningful callings in medicine. What core values drive your work every day?

SPEAKER_00: 2:22

Every day is new. Every patient, every couple is new, every couple is different. No two people have the same issue. And people struggle with this. And infertility has become more and more and more prevalent for multiple reasons. The biggest one is women waiting longer to have children, waiting longer to get married. Even people who get married in their 20s usually say, Oh, I want to wait a little bit. My career is first. I need and the big thing that most women don't understand is they have a finite number of eggs. They're born with about 1.2 million eggs. By the time they get their first period, they're down to about 450,000. And these eggs are lost every single month at a rate of about a thousand every month, whether you're pregnant, asleep, traveling, you lose these eggs. By about age 37, you start the loss becomes even more accelerated. You lose about 1,500 eggs about age 37. So that's why women go through something called menopause when they don't have any eggs left. But this attrition of eggs is very different from woman to woman. Not every woman lose at the same rate. Some of them lose at a faster rate than others. And things like smoking, drugs, drinking, genetics make a huge difference in terms of this acceleration and this loss of eggs.

SPEAKER_01: 3:53

Awesome. Seems like a lot of factors really go into it. Things we don't even think about from day to day. For sure. What does compassionate, patient-centered fertility care look like at Virginia Center for Reproductive Medicine?

SPEAKER_00: 4:10

As I said, every couple is unique. And this is the only field in medicine where you just don't worry about one person, you're treating a couple. So if you have high cholesterol, you go to the doc and you address this. If you have, if your knee is hurting, you see an orthopedic and you do this. This is very different. You go as a couple. Because it's if you take 100,000 couples, about the problem is the man in about 40%, it's the female in about 40%, and the combination of factors from both in about 20%. So it takes two to tango. And if you could be in perfect shape, but if your partner has no sperm or very poor sperm, then your chances of getting pregnant are obviously extremely low. So you have to do what's called the infertility investigation. And this is why every couple is different. You have to do the testing, and then depends on what the problem is, you treat that problem. So people come in the first at the first appointment thinking that, oh, I'm just going to look at them and it's like, okay, this is what's wrong with you, and this is what we're going to do. But no, people have to undergo this fertility workup to make sure there are no other problems. Many couples have what's called unexplained infertility, and that's about 10 to 20% of cases where it could be endometriosis, it could be other things. You do the workup and you really don't find anything majorly wrong. But you know something is not right because they're not able to get pregnant. So you treat them as such. So 15, 20 years ago, we used to do a laparoscopy on every woman to try to look for something called endometriosis. And we used to find endometriosis in about 40% of women. But now we just don't do that anymore. Even if they have what's called endometriomas or chocolate cysts in the ovaries, we try not to operate on these women and then move forward with treatment. The big thing with operation is when they remove these endometriomas or chocolate cysts, many women lose significant ovarian reserve. So that's that's why treating couples is very, very different. So the way at VCRM we look at this is completely unique. Every couple is different. I tell them don't look at your friends because they may have a completely different issue. What there's one of you, every woman is unique, every man is unique, and their situation is also unique.

SPEAKER_01: 6:45

Right. Everybody's just a little different. Everybody's different. I like the point you made about when people ask their friends or this is very common.

SPEAKER_00: 6:52

I hear I hear this all the time. I tell them, please don't ask your friends, don't go on the internet. The internet is a double-edged sword. The biggest disaster is for a non-medical person go on Google to get medical information because they don't understand what this means and say, oh, I read this on Google, or I read this on Reddit, or this couple on Reddit was saying this is their problem. That more than likely has no bearing on your situation.

SPEAKER_01: 7:20

Exactly. Sad. Founding VCRM was a major milestone. What vision did you have for the center when you started it? And how has it evolved over the years?

SPEAKER_00: 7:32

That's an excellent question. So I opened the center to treat if I was the patient, what would I be looking for? Because now medicine has become completely corporate. You go to see your dog, you may not even see your doctor now. You may see a nurse practitioner, you may see somebody, or you may go to a practice where there are 25, 30 different docs and you don't have a physician. Every time you go, it's somebody else. Sadly, this is the situation of medicine, not just in infertility, but probably across many medical specialties at this point. So this personal care has or is disappearing. And some people say what I practice is I'm like a dinosaur, but it's not. Infertility is such a personal problem. And unlike other things, you don't go, if you have a headache, you go to the store and you buy Tylenol or Advil and you'll be fine. This is completely different. The diagnosis of infertility for some couples is like somebody telling them you have cancer. This is how bad they really think. And they struggle with this, especially the women. For many men, they don't understand that women have what's called a biological clock. They hear it loud and clear. And for most men, they're completely oblivious to what's going on. But women do understand this issue. So they feel they have this window whereby they need to come in and try to have children. Sadly, the mean age of my patients is 40 and a half. So I don't see women in their 20s. They just don't come. One, most of them are not married. Two, if they're married, they're not interested in having children right now. I see a lot of women in their late 30s, early, mid, late 40s. And for many of those, it's game over. They need to look at other alternatives. So by the the chance of getting pregnant from IVF at 44 is 1%. Having a child. By 45, it's practically zero. 46, 47. If you're calling our practice, we tell you if you're not coming to do egg donation, we're not going to see you because your chance is zero on your own at this point. That said, unless you've had five, seven, ten children before, by the if you've never had children and you're 46, you're looking at probably an egg donation at that point. So time is critical. Do not wait. And one of the things we were, one of the first program in the DC area to open an egg freezing clinic in 2003. And I knew this was going to be huge because women are waiting. And thank God now there's enough awareness about this egg freezing thing. So you're young, you're not married, you don't have a significant other, you're starting to become 32, 33. It's something I think that everyone needs to consider. The biggest mistake that my patients tell me is not freezing their eggs before. They come in at 41, 42, it's just too late. The quality, what happens in women, the quality of the eggs deteriorates markedly as you age. So look at it this way: 100 years ago, if you go talk to your grandmother, for example, she's going to tell you she had her kids at 18, 19, early 20s. By the time they were in their late 20s, they're done having children. Extremely unlikely for somebody in your grandparents' generation to tell you they had kids at 34, 35. This didn't happen. A hundred years ago, most of us used to be dead by the time we're 40. Now we're living much longer. Women are spending at least a third of their lives after menopause. If you're not ready to have children and you're in your late 20s, early 30s, you really need to start thinking seriously about freezing your eggs. You may never use them, but I predict that, I mean, now about 14% of people who freeze their eggs come to use them, and this number will only increase.

SPEAKER_01: 11:43

So what you're saying is it's definitely a good thing to put some thought to when you're young.

SPEAKER_00: 11:47

Correct. Yeah. But we tell patients this is not an insurance policy because freezing eggs does not mean the same thing as freezing embryos. For example, you need 24 mature eggs that are frozen to have about a 94% chance at having at least one child. So this is not a small number. So if you have diminished ovarian reserve and you only make five, six eggs that are frozen, you really need to freeze much more because I've had many patients that only froze six or ten eggs, and they some many of them do not even make a single embryo to be even tested. So the more you have, the better it is.

SPEAKER_01: 12:28

That's really interesting. How do you foster collaboration between physicians, embryologists, and staff to ensure every patient receives seamless care?

SPEAKER_00: 12:37

Excellent. So it starts with your philosophy for the center. Okay. So we are a boutique practice. We handhold our patients. When patients come in, they we know them by their names. Uh they come in, they feel it's like cheers. You walk in the bar and then, hey Norm, everybody knows your name. Okay. Uh this is how it is for us. Um, so that philosophy translates into very close collaboration between the physician, the embryologist, the nurses, the staff. So we're a small practice for a reason, and everybody communicates constantly throughout the day. So nothing falls through the cracks. The nurses know who the patients are, the staff knows who the patients are, the embryologists know who the patients are. So this is really, really critical. So it's not, even for the embryologists, it's not this, okay, you know, this person, they have no idea who that person is. They review the records, they know what's going on, the stimulation cycle, or if they need to have, like, for example, insemination, they know what's going on. So it's continuous collaboration. And that's the way to make sure that nothing falls through the cracks and no mistakes happen.

SPEAKER_01: 13:53

Teamwork makes the dream work, right?

SPEAKER_00: 13:55

That's the whole thing. I mean, we, you know, our motto is making dreams a reality. And when patients come in, we want them to trust us with their care. And we want them to listen to what we're telling them because we have their interest at heart. We're not here about the money. We're not here. We, you know, we are here to help you have a child.

SPEAKER_01: 14:18

That's wonderful. Fertility treatment can be deeply emotional. How do you and your team create an environment of hope and trust for your patients?

SPEAKER_00: 14:28

Excellent question. This is, as I told you before, for some women, they feel this is a cancer diagnosis. So we're here to, and I tell them, we're your cheerleaders. You're not on your own in this journey, okay? Because many women feel alone. As I told you, the men sometimes just don't get how emotional this whole thing is. And we tell them, we're on this roller coaster with you. We have our highs, we have our lows. When things don't work, they're down. And the key is to keep them optimistic, keep them positive. There's always something that we can do to get them to where they need to go. So we obviously offer them emotional support, we offer them moral support. There are there, and if they need something more, there are professional people we refer them to that they can discuss this issue with that can help them through this journey. I mean, this is not an easy journey. And when people do this, we actually strongly recommend that the husband also gets involved with this. There's uh uh there's one called Organic Conceptions, we refer our patients to. And it's a multi-step program that couples have to go through. And I really think it helps them tremendously to go through this pretty difficult journey. But the end of the journey is amazing. When it works and they have a child, they forget all the bad things that they've gone through. It's an amazing thing. I mean, it's uh when patients have a kid, it's totally different than going to your dermatologist and they tell you, okay, you know, take that cream and you're gonna look better and feel better. Afterwards, you're not gonna go, you're not gonna hug them, you're not gonna feel you owe them something. This is an amazing thing because you are helping them have something that they are literally dying to have. It's extremely rewarding when it works. And and for me, this is the happiest moment when they patients come in and they bring their children.

SPEAKER_01: 16:28

Such a magical moment to be able to see it come full circle.

SPEAKER_00: 16:32

If you come around Christmas, you see the whole office filled with Christmas cards from babies that that we've had. And it's for me, this is the happiest time of year.

SPEAKER_01: 16:43

I love that. What are some of the most exciting advancements in assisted reproductive technology that you believe will transform patient care in the coming years?

SPEAKER_00: 16:55

So it has already transformed substantially over the past 20 years. So early on, I remember when the success rates used to be in the 20s, 20%, 25%. And we were putting three, four, five embryos routinely into people and just with the hope that patients would get pregnant. Some of these would get pregnant and then have a miscarriage afterwards. In my opinion, the biggest advancement has been the introduction of genetic testing of the embryos over the past, let's say, it's been around since 1991, but PGS, PGTA.3, so PGS3. So their latest advancement over the past probably 10 years now have made a humongous difference. We're at a point where, because most of my patients are older, so when they get pregnant, they have at least anywhere between 15 and 30% chance at losing that pregnancy. And most of these pregnancies are lost because they're genetically not normal. So now we have the ability to test the embryos before we transfer back into the woman. And we transfer one for 97% of our patients at this point. And we check, so if it's a normal boy, normal girl, and some patients come in to do gender selection. We can talk about this a little bit later. But the fact that we can transfer a single tested embryo substantially decreases the chances of a miscarriage and increase the chance of them taking home a baby. Patients want to get pregnant from the first attempt if they can. The biggest thing that I started noticing about seven, eight years ago, patients are coming in and their biggest fear is a miscarriage. So they don't want to miscarry. It's such a traumatic event that nobody wants to go through. So that by testing the embryos and transferring a genetically tested embryo, we significantly diminish the chance of a pregnancy loss happening. So this is a huge, huge advancement. There are other things we're all waiting. So the chance of a pregnancy when you transfer a single tested embryo could be as high as about 70%. Okay. But that means even when you're transferring a single, perfectly normal embryo, the chance of a pregnancy not happening is still about 30% at least. This is what we still don't understand. This last big box. You're transferring a genetically normal embryo into what's supposed to be a nice endometrium, a nice uterus, and the pregnancy still doesn't happen. We just tell patient, stay the course. Okay. So we're introducing now AI into this. So AI is obviously the sexiest thing. Everybody talks about this. So we're in the process actually on uh tomorrow, they're coming in to install a brand new, what's called time-lapse to allow the embryos to grow under continuous observation. So there's a camera on top of where the embryos grow that takes pictures every five minutes. And this, and then it's linked to an AI software that gives us the ability to differentiate even between two perfectly looking normal embryos, which one to transfer first. So we're into the age of AI, and we're joining the age of AI tomorrow. So this is something that I am extremely excited about. I really think this is going to make a difference and hopefully may increase that you know 70% chance to even a little bit higher. It's just uh it's just the logical thing to go to. Technology is at this point. There are new advancements. Hopefully, in about maybe five to ten years, we can grow eggs for women who are in menopause or don't have enough eggs. For men who don't have sperm, maybe grow sperm for them. So at this point, this is all experimental, but do I see this a reality in about maybe another 10-15 years? Very possibly. So at that point, because now for these women who are older, they need to get eggs from an egg donor before. And so maybe now they don't have to do this anymore. So we'll see. That's definitely an exciting thing down the road.

SPEAKER_01: 21:22

Got it. That's so fascinating. Just the advancements in technology today and what they can do.

SPEAKER_00: 21:27

Incredible. I mean, thank God for the recent advancements in IT and other things. So these ultimately trickle down into what we do. For ultrasounds are better now, the imaging is better, but this is the advancement in the lab. There may be, you know, totally what's called automated labs for IVF, where you go in, you don't need to have two, three people manning your IVF lab. You can do it with just one person where robots would go and they do the procedures, they get the eggs, they actually get to the point of freezing the eggs, and all you have to do is or the embryos, and then you just drop them in liquid nitrogen. Do I see this becoming a reality in another 10 years? Very possibly.

SPEAKER_01: 22:22

That is super interesting. When patients think of the Virginia Center for Reproductive Medicine, what's the one thing you want them to remember about their experience?

SPEAKER_00: 22:34

Personalized care. We're a boutique practice for a reason. If they want to go to Walmart, you want to go to Walmart, or you want to go to Neiman Marcus, for example, or Sachs. This is what we try to differentiate ourselves from. If you want to go to a dog who really knows what's happening with you, or you want to go to a center where you're just it's a factory and you're just like everybody else in this factory. If people don't know any better, they assume that all centers are this way. Sadly, patients find me after they fail. So we tell them do your research beforehand. I mean, the internet is available for everybody. Go look before you jump. Even if you have a your doctor is recommending one center versus another, still do your homework. Go to the one where you feel comfortable. You may like and be perfectly fine with the with the factory approach. There's nothing wrong with that. The factory does a good job. But if you are a patient that needs more attention, that have a problem that's a little bit trickier, that you need answers to, that you want to sit down and talk to your doctor and try to understand what's really happening with you, then look more. Do your research. So we are a boutique practice for a reason. Because we think we do a better job at taking care of our patients.

SPEAKER_01: 24:01

And just kind of getting that unique personalized experience.

SPEAKER_00: 24:04

So we've been practicing personalized medicine. So the sexy thing has been for years, over the past maybe five to ten, personalized medicine, personalized medicine. We've been practicing this from day one at VCRM. Everybody is different and their case is different, and how we approach them is different, how we handle them is different. Most of our patients are, by coming from other centers, are amazed at when they come at how everything is so different than their prior experience. They think everybody is like the first experience they had, and it's not.

SPEAKER_01: 24:43

That's amazing. So as we wrap up, is there anything you'd like to add that I haven't touched on today?

SPEAKER_00: 24:51

I think you've you've addressed a lot of things, but I will tell women out there, do not wait. Don't, you know, many OBGYNs that they see are so busy, they don't have the time to sit down and talk to them about things. If you're a 27-year-old and something is not right, you feel your periods are off, you're just not getting the answers from your OBGYN, come and see us. There may be something more serious going on. I've seen women in their early 20s start to lose their ovarian reserve. I've seen many people, especially over the past three, four years, I'm seeing more young women coming in with diminished ovarian reserve. We don't know why this is happening. We're actually, you know, looking at data now, try to figure out uh what's going on. But this is a real phenomenon. We are seeing it right now. So don't assume because you're 29 years old that everything is perfectly fine. You can come in, you can do a test, and that will tell you if you're fine or not. That at least would, you know, if you're fine, you can take a deep breath and say, okay, you know what? I can wait a year or two or three, and if I'm not married, I can come and freeze my eggs then. But women lose this ovarian reserve at different speeds. So if you're fine at 29, it doesn't mean you're going to be fine at 35. So don't, you know, do the test. If you're fine, you can wait a little bit. If the test is not great, you may want to think very seriously about freezing your eggs earlier than you think.

SPEAKER_01: 26:29

Got it. So take early action.

SPEAKER_00: 26:31

Early action. You are your own advocate. Don't wait for your OBJN or your primary care doc or your friend to be your advocate. If you're not going to advocate for yourself, we have a problem.

SPEAKER_01: 26:44

Perfect. I'd like to thank you so much for joining me on the podcast today. It was a pleasure hearing your story. Thank you. And having you.

SPEAKER_00: 26:53

Pleasure it was mine.

SPEAKER_01: 26:54

Thank you.