#NIAW: Reproductive Endocrinologist Dr. Laura Meyer on Fertility Treatment During COVID-19 and Her Happiest Clinic Moments

As one of the first stops when a woman suspects something isn’t quite right with her reproductive health, Dr. Laura Meyer often plays a significant role in the trajectory of a woman’s fertility journey. As a Reproductive Endocrinologist at Greenwich Fertility, she’s there for the bad news days, the good news days, the really great news days. For National Infertility Awareness Week, we sat down with Dr. Meyer to chat about her work, the synergy between medicine and alternative support, and the challenges that COVID-19 has put on couples pursuing fertility treatment. 

Find Dr.Meyer @greenwichfertility and here.

What was your training like to become a Reproductive Endocrinologist?

After graduating from medical school at NYU, I did a 4 year residency in Obstetrics and Gynecology at Cornell, and then continued my subspecialty training there with a 3 year fellowship in Reproductive Endocrinology and Infertility.

At one point in their trying-to-conceive journey does someone (or a couple) usually end up in your office? 

If they don’t have any pre-existing risk factors, couples will typically see me after about a year of trying if the female partner is under 35, or after 6 months if she is 35 or older.  If they have any known risk factors for infertility (such as irregular periods, concern for a sperm issue, or a history of prior chemotherapy treatment in either partner), then they should come in sooner.

What does an initial appointment look like with you?

During the initial consultation, I start off by speaking with the patient in my office.  My new patient visits are an hour long, so that we have plenty of time to extensively discuss her history, address all questions and concerns, and then talk about next steps.  Usually the first step is to do some diagnostic testing, and if the patient is ready to move forward, often we can do a pelvic ultrasound and some blood tests during that first visit.

What are the options you have for someone struggling to conceive, and what’s the typical first line of treatment?

The treatment is always individualized to each person, so it depends on a patient’s history, testing results, and personal goals.  After we complete a work-up, I meet with the patient to explain the results, answer all questions, and then discuss treatment options. Typically, if medically appropriate, we will start with less invasive treatments first.  For example, in a young patient with open fallopian tubes whose partner has a normal sperm count, usually the initial treatment would be an oral medication such as clomid or letrozole in conjunction with an intrauterine insemination (IUI).  This treatment optimizes a woman’s chances of conceiving that month, while allowing fertilization and implantation to happen unassisted in the body.

For women who ultimately do not become pregnant through IUI, or who are not IUI candidates for other reasons (for example blocked fallopian tubes or a very low sperm count), another treatment option is in vitro fertilization (IVF).  During an IVF cycle, a woman takes injectable medications to stimulate the ovaries so that multiple eggs mature at the same time.  She then has a minor surgical procedure called an egg retrieval to remove the eggs from the ovaries.  Once the eggs are retrieved, they can be fertilized with sperm in the lab to create embryos, and an embryo can then be transferred into the uterus to create a pregnancy.

We also have other types of treatments for patients who need additional help to get pregnant.  Women who cannot conceive with their own eggs may use an egg donor.  Others may become pregnant through the use of donor sperm.  And those who cannot carry a pregnancy can have a child with the help of a gestational carrier (surrogate).

Have you seen a rise or fall in the number of people who are seeking fertility support over the years? And what do you attribute this change to?

There has been an increase in the number of people seeking fertility care over the past several years.  Some of this has to do with the fact that on average, women are waiting longer to start their families, and infertility becomes more common as women get older.  On a positive note, another reason is that access to fertility care has significantly improved in recent years, and more women have insurance coverage for infertility treatment.  I practice in CT and NY, and both states now have insurance mandates for fertility coverage, which is great for patients.  These laws have enabled many more people to be able to seek help in starting their families when they are struggling to conceive.

What types of support do you find that most women (and couples) are looking for to complement the medical care they get from your office?

I think it is so important for people to feel well-supported on their fertility journeys. Fortunately there are many different resources out there, which is helpful in meeting patients’ diverse needs.  Some consult with nutritionists, acupuncturists, fitness instructors or health coaches.  Others meet with counselors or reproductive psychologists, or may find it helpful to connect with other women going through similar situations through online or in-person support groups.

What questions should someone ask when determining if a fertility specialist is the right fit for them?

Seeking fertility care can be a very sensitive and personal experience, so it’s incredibly important to feel understood by and comfortable with your doctor.  Make sure to ask any questions that you have about your potential plan so that you have a full understanding of what to expect during your treatment cycle.  I would also recommend confirming that the fertility clinic is a member of SART (Society for Assisted Reproductive Technology).  SART is a non-profit organization that provides oversight for fertility clinics and sets national standards for fertility care, and its member clinics conform to specific ethical and practice standards.

In light of the current reality, how has your practice handled those patients who were just starting treatment or mid-cycle? 

During the COVID-19 pandemic, we have abided by the American Society for Reproductive Medicine (ASRM) guidelines and have temporarily suspended the initiation of new treatment cycles since the recommendations were announced in mid-March.  Patients who were already in the midst of treatment and wished to continue were able to finish their cycles.  As we wait for the situation to improve both locally and nationally, we are doing mostly telemedicine visits at this time.  We look forward to helping our patients to build their families as soon as we can safely do so.

What emotions are your patients feeling right now?

The COVID-19 pandemic has been a challenging time for many patients who are eager to build their families but have had to put plans on hold.  It is so hard to face additional uncertainty during what is already a very stressful time.  My heart goes out to everyone who is dealing with these difficult issues while longing to grow their family.    The health, safety and wellbeing of my patients is my top priority during this unprecedented time.  I am hopeful that the situation will improve soon to the point that we can re-start treatments and continue to help our patients on their path to parenthood.

You have practices in NY State where Andrew Cuomo recently announced that fertility treatment is an “essential service” and that the physicians and patients should work together to determine the best course of action to ensure everyone’s safety. Can you speak to how you’ve counseled your patients about the future of fertility care?

I appreciate that Andrew Cuomo recognized in an official capacity that fertility treatment is not elective.  In my field we feel very strongly that infertility is a disease and its treatment is medically necessary.  During this unprecedented time patients across the country with many different types of serious medical conditions are experiencing delays in treatments that are non-emergent but necessary and important.  It is a challenge for patients and providers in many fields of medicine, including ours.  Decisions about exactly when to resume treatments are particularly complicated here in the tristate area where I practice, since it is a COVID-19 hotspot.  Fortunately, over the past several days there have been encouraging signs that the curve is flattening.   We are hoping that ultimately this pause in treatments will be brief and that we can safely resume fertility care soon.

What makes you happiest when you’re at the office?

There is nothing better than calling a patient with positive pregnancy test results- it never gets old!  As a fertility doctor, it is an honor to walk beside my patients during all of the ups and downs of their journey to pregnancy.   It is a wonderful and rewarding part of the job to see them have success and achieve their dreams.  I also love when they bring their babies back to visit!

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