Infertility and Patient-Focused Care

Dr. Christine Skiadas is a board-certified obstetrician and gynecologist and a subspecialist in reproductive endocrinology and infertility, or a reproductive endocrinologist. In her practice at Atrius Health in the Boston area, she works with a broad population of patients, many of whom are trying to get pregnant.

Pamela DeGregorio, a Women’s Health Writer at Ovia Health, spoke with Dr. Skiadas about some of the common concerns her patients have, assisting with the emotional struggles that come along with infertility, and how she prioritizes the patient experience in her care. Answers have been lightly edited for length and clarity.

While you work with a broad range of patients — from teens with irregular periods to young women dealing with premature menopause — the majority of patients you work with are couples who are trying to get pregnant. Among this patient population, what are some common questions and concerns patients come to you with?

The most common questions that I get from patients trying to get pregnant have to do with why pregnancy is not happening for them. For most couples, this is deeply upsetting and personal. Oftentimes there are few people they have been able to confide in, and it’s a time of life when many of their friends are getting pregnant and having babies, which can make infertility even more of a lonely struggle.

But many people deal with these struggles. People are waiting longer to have families for great reasons — more education, waiting to find the right partner, and professional opportunities — which can often translate into trying to get pregnant at an older age and then dealing with the impact of advanced maternal age. Thankfully, as fertility treatment has improved (both in terms of success rates and the ability to manage the risk of multiple pregnancies), it is getting to be less taboo.

The expense of treatment is also a big concern. I feel so fortunate to practice medicine in Massachusetts, which is one of the few states with a long history of an insurance mandate for insurers to cover fertility treatments — in Massachusetts we just celebrated 30 years — which provides access to so many patients pursuing care. Fertility treatment is expensive (due to expensive medications, frequent testing and state-of-the-art laboratory procedures), and if a large part of that treatment is covered by insurance, then it can take a huge burden off of couples. There is actually growing data that insurance coverage for IVF is cost-effective, as well, by encouraging single embryo transfers and trying to minimize the risk of multiple pregnancies, which often results in much higher costs later on in the pregnancy.

A lot of people who deal with infertility find the journey toward parenthood emotionally taxing. How do you address this aspect of a patient’s care?

This is such an important aspect of the patient experience, and we approach this as a team. Each couple has their physician, nurses, medical assistant, and support staff behind them helping them to reach their goals.

Our nurses are highly experienced in this field and provide a huge level of day-to-day emotional support. We also have psychologists and other behavioral health providers involved in our practice, who are wonderful resources for our patients. We even have the ability to email with patients through our electronic health record, to answer questions that may come up after a visit so that patients don’t need to wait until a next appointment to hear back from me.

Finally, we try to encourage patients to surround themselves with positive sources of energy and to avoid negative influences — which may mean minimizing reading the internet or social media posts, or even avoiding an acquaintance’s baby shower.

You’ve said that one of your major aims as a care provider is to prioritize the patient experience. What does this mean for patients who work with you?

It means that I try to focus on truly understanding my patients’ goals for care — not just the medical diagnosis, but their whole reproductive plan in terms of family building (i.e. ideal family size, spacing of children, and acceptability of different treatment options). We also discuss family history and genetic factors to customize a treatment plan to try to reach those goals. Sometimes, for example, a family history of a genetic disease leads people to pursue fertility treatments to try to reduce the risk of passing along a gene in their family through pre-implantation genetic diagnosis of embryos — even when they otherwise may not have fertility problems.

I know that the process of fertility treatment can be stressful and time-consuming, and our whole practice works to try to make it as seamless as possible. As part of that, I have the privilege of working with an outstanding team of nurses who provide amazing emotional support to our patients as they go through treatment.

We also try to work within the construct of other factors in our patients lives. Most fertility patients are trying to work and balance the rest of their lives, and not just fertility care. Whether it is a professional athlete with a crazy schedule, a busy executive with significant work travel, or a teacher hoping to time treatments to minimize their impact on work during the school year, we make every effort to try to respect the other demands that a person has in his or her life.

I love my job, and I have the amazing ability to be a part of couples growing into families and being able ultimately to meet their babies after they deliver. At this point, I have now had the pleasure of seeing couples for their first, second, and third babies — I even had one patient who had a surprise fourth baby after her first three were from fertility treatment. One of the most exciting aspects of my job is that it never gets boring. Decisions that are right for one couple may be completely wrong for another, and the very same couple may even feel differently when planning for their first child, as opposed to planning for their second.

I enjoy navigating through the different treatment options and finding a path that is best for my patients and then adjusting as needed along the way.

You can find Dr. Christine Skiadas at Atrius Health’s locations in Boston (Kenmore Square), Burlington, or Quincy and read part one of her interview here. For more articles like this, download Ovia Fertility from the App Store or Google Play!