Separating Fact From Fiction
By Randy S. Morris, M.D.
Board Certified Reproductive
Endocrinology and Infertility
Fact #1 This Fact #2 What
is a First Some Definitions
You Are Not Alone Doctors Treat
Big Industry It is estimated that as many as one in seven
couples may suffer from infertility. Some
Obstetrics: is the branch of medicine
have never had a pregnancy (Primary infer- concerned with the care and treatment of
tility) but a larger percentage have been women during pregnancy, childbirth and the
pregnant at least once previously (second- ensuing period
In 1995, 1.2 million women visited a reproductive professional.
Gynecology: is the branch of medicine concerned with the care and
treatment of the female reproductive system and includes:
It is estimated that 2 billion dollars are spent annually on fertility • Family Planning and Contraception
diagnosis and treatment in the United States alone. • Cancer screening (PAP smears, mammograms)
• Menstrual problems
With that much money changing hands, there are going to be abuses. • Pelvic pain
Most abuses will not be obvious or flagrant but the charlatans and snake • Fertility
oil salesman are out there - so be wary. You, as a patient and a consumer • Menopause
need to be as well educated as possible in order to protect yourself.
Obstetrician/Gynecologist: has received training in all of the above. These
physicians have completed 4 years of college, 4 years of medical school and 4
years of a residency in obstetrics and gynecology. They are sometimes
referred to as general OB/Gyn's or simply as generalists.
Residency: is sort of an “on the job training program” where a recently
graduated physician works under the direction of experienced doctors and
assists in the care of patients. Most of the residency takes place in the hospi-
tal setting but can also occur in an office setting. Each year, the resident is
given an increasing amount of independence and responsibility for the care
of patients. By the time the resident is finished, he/she is supposed to be able
to practice in that area of medicine independently.
Fellowships: Once a doctor finishes residency, he/she may go on to setup a
practice or he may go on to further train in one particular area in obstetrics
and gynecology or subspecialty.
Most fellowships are three years in length. There are four types of
fellowships in obstetrics and gynecology:
• Gynecologic oncology
(Cancer of the uterus, ovaries)
(Handles high risk/complicated pregnancies)
• Gynecologic urology
(Treats problems involving the
the urinary system in women)
• Reproductive Endocrinology /Infertility
(Deals with hormonally related problems,
infertility and recurrent miscarriage)
Obstetrician /Gynecologists are typically the first doctors to see and treat
women with infertility. They will initiate some preliminary testing and, at
times, start some treatments. If pregnancy does not occur or it seems that a
problem has been discovered that is more complicated, they will refer the
couple to a reproductive endocrinologist for more advanced care.
Fact #3 Here is an excerpt from a medical
Understanding practice website Why is “Infertility” listed
(The name has been changed): separately?
Certifications We Care for Women, P.A. is The separate listing is meant to give
a medical practice specializing in the impression that they have
Obstetrics, Gynecology, and some special expertise in infertility
Infertility. We have 14 physicians,
11 of whom are Board Certified by treatment. It really doesn't make
the American Board of Obstetrics sense. For example, you never see
and Gynecology, who offer state-of- "Obstetrics, Gynecology and
the-art care to our patients at four Oncology" even though all OB/GYNs
locations in the Dallas area. do cancer screening.
What does “Board Certified” mean? What are reasons why
The system for assessing doctor credentials is very confusing. doctors might not be board
Let's try to clear it up.
• Some doctors never bother to take
When a student graduates from medical school, he earns the title “doctor” the test
and gets an M.D. after his name. However, since he has not yet • Some doctors have tried and failed
completed a residency, there isn't much he can do with that degree. to pass the test
After finishing residency, a doctor can set up a practice in his field.
However, there are no more initials that are added after his name. Can a doctor who is not
board certified still practice in the field?
A doctor can choose to become certified in his/her specialty by passing a
series of tests called “board exams”. They are called board exams because The answer is yes! There is no requirement to become board certified. For
they are administered by a governing body or board setup by each specialty. example, many insurance companies do not require board certification for a
For example the American Board of Obstetrics and Gynecology (ABOG) doctor to care for its patients.
is the governing body that administers exams for general obstetrics and
gynecology and all of the subspecialties.
Why does everyone want to become a fertility “specialist”?
The board exams are separated into written and oral tests.
• Infertility is a highly desirable medical practice
After completion of the residency, a general • Usually involves young, healthy patients
OB/GYN must first take and pass the general ob • Doctor's offices often don't deal with insurance
gyn written exam. Then he must work for a year • Malpractice premiums are lower than for those doctors who deliver babies
taking care of patients. He must record all of the • Infertility is an exciting, rapidly developing field
patients he sees in that year and submit it to the
board for approval. If the board believes that Take home point:
variety of patients is sufficient, then the doctor
may take the oral examination. If he passes the
oral examination, he is then said to be board If your OB/GYN sends you to see a “fertility specialist”
certified in obstetrics and gynecology. Make sure that he is board certified in
A reproductive endocrinologist who wants to
become board certified must first finish the Some doctors will try to fool patients by stating they are board certified but
fellowship and then pass his written and oral exam not specify what specialty they are board certified in. Others will try to imply
for general obstetrics and gynecology and then he they have special certification by listing their membership in various societies.
must take and pass a written and oral examination
in reproductive endocrinology!
Board certification is the highest level of
distinction possible in the field. Doctors who
are board certified must recertify every ten years.
Fact #4 Fact #5
Unfortunately, many couples do not
Understanding Understanding investigate their doctor’s credentials and
In some cases, membership in a medical Pregnancy instead focus on pregnancy rates. Of
Medical society can tell you about the qualifications course pregnancy rates are important
Societies of a doctor. In other cases, it tells you Rates measures of success, however, the average
nothing. Here are some examples from patient has almost no ability to determine
the infertility field: the accuracy of pregnancy rates or to use
them to compare different fertility
Does NOT tell you about doctor qualifications What's more, the snake oil salesman are
experts at manipulating the numbers to make themselves appear to be better.
ASRM- American Society for Reproductive Medicine Take this example:
• Membership open to physicians and non-physicians Pregnancy Rate
• Membership is immediate upon receipt of the application fee Dr. A 20%
• The largest and most active of the fertility related societies Dr. B 40%
• Sponsors educational events and issues guidelines for practice Which doctor has a higher pregnancy rate? Most people would say Dr. B.
CARE- Chicago Association of Reproductive Endocrinologists Lets look a bit closer.
• Amazingly you Don't have to be a reproductive Pregnancy Rate Number of patients
endocrinologist or even an ob/gyn to be a member Dr. A 20% 200/1000
• Membership immediate upon receipt of application fee Dr. B 40% 4/10
• Sponsors a monthly dinner educational meeting With a little more information, we see that Dr. B only saw 10 patients, a
SART- Society for Assisted Reproductive Technologies number much too small to be able to determine a pregnancy rate accurately.
• Society dedicated to the more advanced fertility treatments Pregnancy Rate Number of patients Entry requirements
such as in vitro fertilization Dr. A 20% 200/1000 Any age
• Membership open to physicians and non-physicians Dr. B 40% 4/10 Under age 35 only
• Membership is immediate upon receipt of the application fee
• In the past, was responsible for collecting data from in vitro Now we find out that Dr. B restricts his practice to only younger women. We
fertilization programs to send to the Center for Disease Control. know from hundreds of medical studies that older women do not get pregnant as
As of 2005, they lost that responsibility to another agency often as younger women. By restricting his practice, Dr. B can inflate his preg-
• The largest and most active in vitro fertilization related society nancy rates and make it seem as though he has a better treatment program.
• Sponsors educational events and issues guidelines for practice
DOES tell you about doctor qualifications Across is a list of a few of the factors found to influence pregnancy rate.
SREI-Society for Reproductive Endocrinology and Infertility These factors can have a dramatic impact on pregnancy rates. How a
• SREI Membership requires certification by the American Board of pregnancy rate is reported is also important. One must compare apples to
Obstetrics and Gynecology in both Obstetrics and Gynecology apples. Lets take an example of a fertility treatment called Treatment X
and the subspecialty of Reproductive Endocrinology Number of patients who start treatment 100
• Sponsors educational events and issues guidelines for practice Number of patients who complete treatment 70
Number of patients with a positive pregnancy test 20
Number of patients with a pregnancy seen on ultrasound 15
Number of patients who deliver a baby 10
Dr A. Reports a pregnancy rate of 10%. Dr. B reports a pregnancy rate of 28.6%
Factors That Influence Pregnancy Rate
Factor Variable associated with lower success Who is correct?
Answer. They both are. Dr A reported the number of patients who delivered a
Female age Older baby divided by the number who started treatment. A more conservative
Female body weight Heavier method of reporting. Dr. B reported the number with a positive pregnancy
Type of treatment Some are worse than others test divided by the number who completed their treatment. Which one is
Geographic location Certain problems may be endemic more misleading?
Season Variation has been shown in studies
Length of infertility before seeking treatment Longer Unfortunately, for most treatments, there are no rules for how these rates are
Number of previous failed treatments More previous failures reported. If you were a patient who was trying to decide between Dr A and
Results of pre-treatment testing Abnormal ovarian function Dr B based on pregnancy rates, it would be impossible to realistically com-
pare the two. There simply is never enough information given to make an
(in vitro fertilization)
IVF is one of the most expensive A TALE OF 2 PROGRAMS
Pregnancy Rates and invasive treatments that fertility
specialists offer and so it deserves
some special discussion. Lets try to compare the results from
two actual in vitro fertilization
The simplified steps involved in programs for women who are under
in-vitro fertilization are as follows: age 35. (Program A and Program B)
Since we have no idea about the
1. Woman takes fertility medications patient populations of these two
2. She hopefully produces a number of eggs in her ovaries programs its impossible to say by the
3. The eggs are removed (egg retrieval) pregnancy rates whether one is better.
4. Attempt is made to fertilize the eggs in the laboratory
5. If eggs became fertilized, the embryos are grown in the laboratory However, Program A puts in more
6. Some embryos are placed into the uterus (embryo transfer) embryos on average than Program B.
By doing this, they have now placed
their patients and their babies at
How IVF Programs Can Mislead Patients greater risk.
1. Not all programs report results Think about it, about one in every ten
IVF programs in the United States are supposed to report the results of IVF pregnancies in program A is a triplet,
cycles to the Center for Disease Control. Unfortunately, not all do and the quadruplet, quintuplet or higher!
enforcement is lax. Even these reported pregnancy rates are subject to con- That only happened to Program B in
siderable problems. The CDC puts a disclaimer that these numbers should about one in a hundred patients.
not be used for comparisons between programs.
2. The Number of Embryos Implanted
In addition to the factors listed above, there are other ways to mislead
patients about IVF pregnancy rates. One of the most important is the
number of embryos that are placed into the uterus. Putting more embryos
into the uterus can increase the number of pregnancies up to a point.
However, it also increases the risks of multiple pregnancy and we are not Program A Program B
just talking about twins here.
Number of cycles 332 192
Comment: Both programs have a good number of patients
Avg. number of embryos transferred 3.1 2.1
Comment: B puts in less of embryos
% of cycles resulting In pregnancy 31.9% 39.1%
Comment: B has a higher rate
% of pregnancies with twins 33% 25.3%
Comment: B has less
% of pregnancies with triplets or more 9.4% 1.3%
Comment: A has almost 10 fold higher risk of triplets or more
% of live births with multiples 34.7% 26.6%
Comment: B has less With multiples
Fact #7 Fact #8
Almost all of our fertility treatments use First you must understand one thing
Understanding fertility medications. The use of these Snake Oil Salesmen about yourself. regardless of the
medications can to various extents And How To amount of education you have had,
Multiple increase the chances for a multiple
pregnancy. Most couples do not pay Protect yourself
Pregnancy sufficient attention to this risk. In fact, YOU ARE AN EASY MARK
most couples with infertility state they FOR THE SNAKE OIL
would prefer to have a twin pregnancy.
By far and way, the greatest risk to the use
of any of these fertility treatments is the risk of a multiple pregnancy. WHY Are You an EASY Mark?
It is important to know that all multiple pregnancies, including twins, have • You are very vulnerable. The couples we see are often desperate to have a
a greater rate of complications. Women with a multiple pregnancy have a child and will do almost anything to get one.
greater chance for complications like: • You want to believe what they are saying.
If some one tells you they have cure that no one else has, we are more
inclined to believe than to disbelieve.
Multiple Pregnancy Potential Complications • Patients always prefer to do “something” vs. “nothing” even if there are no
differences between the two. If someone gives you the option of trying a
I. Preterm labor and delivery. treatment versus not doing anything, most people will try the treatment
• 50% of twin pregnancies are delivered prematurely even if it is unlikely to really work.
• 90% of triplet pregnancies are delivered prematurely • Most of you lack the skills scientifically to determine what is true and what
II. Some of the complications of prematurity is not. This can be true of doctors as well.
• Cerebral palsy
• Blindness Some Guidelines When Evaluating “Miracle” Treatments”
• Bleeding into the brain
• Respiratory distress (breathing difficulty due to immature If It Sounds Too Good To Be True, It Probably Is
lungs) The website below claims to be able to unblock fallopian tubes and remove
• Can result in lifelong disability for the babies adhesions from the pelvis simply by a few massage treatments.
III. Gestational diabetes. Their claim: “High success rates without surgery or medication”
• This is a form of diabetes that occurs during pregnancy. They talk about a 75% success rate which if true would make it the most
• Related to an increase risk of birth defects effective fertility treatment ever discovered.
• Often requires insulin injections
• Can cause babies to grow too large or too small
IV. Pre-eclampsia. A problem of high blood pressure that occurs
during pregnancy. Associated with other complications such as:
• Stroke & Seizures
• Poor growth of the babies
• Death of the babies in uterus
• Death of the woman carrying the pregnancy
• Increased risk for cesarean section
• Increased risk for babies with birth defects
• Increased risk for miscarriage
• Increased risk for babies that die
V. Twins are seven times more likely to die in the first month of life
VI. Triplets are twenty times more likely to die in the first month of life
Doctors should carefully counsel patients about the risk of multiple preg-
nancy associated with their age, infertility condition and treatment being
used. When performing in vitro fertilization, doctors should
strive to transfer the minimum number of embryos possible.
Gone are the days when a 30 year old woman has four
embryos placed into her uterus!
Some Guidelines When Evaluating If you are contemplating Conclusions
“Miracle” Treatments” treatment with IVF and your
doctor tells you that four
Beware The Testimonial embryos are necessary to get
Consider this actual unaltered testimonial taken from a web site of a local doctor: you pregnant, then you should
“If you are struggling with miscarriage and need help, Dr. X is the
only Doctor who can help you. Trust me, I know!!! This Doctor has seek a second opinion!!!
the talent of Michael Jordan, the intelligence of Bill Gates, and the
love for people in need like Mother Teresa. I say this because he is
the first person in our lives (other than our parents) that cared enough
about us and wanted to really help us. Dr. X is what a Doctor should be
like. God bless you Dr. X.” In the last few decades, the treatment of infertility has become
more effective. It has also become more complicated, more
expensive and has greater risks. More “practitioners” are trying
Beware Doctors Who Claim To Be Misunderstood Or to “get in on the gold rush” by offering ineffective treatments
Persecuted By The “Medical Establishment” or using accepted treatments in an overly risky manner.
Consider this actual unaltered excerpt from a web site
“Dr. Y has spent his entire academic life analyzing the impact of the
immune system on infertility and the success or failure of a pregnancy. You must educate yourself as much as
He has dedicated his professional life to analyzing couples with possible to protect yourself from these
infertility, IVF or implantation failures and recurrent pregnancy losses types of practices.
who have been told by the medical community that their problem was
due to bad luck or that there were no proven therapies for their problem.”
Don't Draw Unsupported Conclusions.
This is the sequence of events:
1) I had infertility
2) Doctor Z waved his magic wand over me
3) The next month I was pregnant
Conclusion: Dr Z's magic wand must have cured my infertility
This is a popular scheme seen on internet bulletin boards. There is a problem with
this logic. With every malady known to man, some people get better by doing
nothing or by using a treatment that has no effect.This is known as the placebo
effect. The best way to determine if a treatment really works is to have two groups.
One group receives the treatment being studied. The other group receives a placebo
or dummy treatment. Ideally, neither the doctor nor the patients should know who
got what until after the study is completed.This is the only way that a true treatment
effect can be proven.
Although we are best known known for our Male Fertility Tests
In Vitro Fertilization - IVF - and We are also proud of our male fertility
preimplantation genetic diagnosis - PGD - testing. Our advanced semen analysis
programs, you will find that we offer much,
uses sophisticated imaging and
computerized analysis to get highly IVF1 and Infertility
accurate and repeat able results for sperm
Acupuncture in infertility counts, sperm motility, and sperm
morphology. Office Locations
Acupuncture in IVF
IVF - In Vitro Fertilization
In vitro Fertilization - IVF is an
Insurance Coverage for increasingly popular infertility treatment.
Infertility Our philosophy is to obtain the highest
Your first interaction with our office will IVF ( in-vitro fertilization ) pregnancy Chicago, Illinois
trigger our infertility insurance specialists rates with the lowest risk for multiple
to contact your insurance company to pre pregnancy. To accomplish this, we IVF1 and Infertility Office
determine your infertility insurance maintain the highest and strictest 900 North Michigan Avenue
coverage. By the time of your first standards for our IVF laboratory and
appointment, we will be able to counsel utilize the most advanced IVF techniques 15th Floor
you about your IVF in vitro fertilization such as intracytoplasmic sperm injection
insurance, and insurance coverage for (ICSI), preimplantation genetic diagnosis Chicago, IL 60611
infertility diagnostic tests and (PGD) and blastocyst transfer. Phone: 312-440-5055
With years of data that now indicate that
Fantastic Office Staff blastocyst transfer can reduce the risk of
Our past and current patients rave about multiple pregnancy while increasing the
our friendly and supportive office staff. chance for IVF - in vitro fertilization -
From the front reception desk to our success, it is amazing that we are still one
highly trained nursing staff. of the few programs the use blastocyst
transfer on a regular basis. Naperville Illinois
Infertility Testing IVF1 and Infertility Office
We offer a wide variety of infertility testing Other Fertility Treatments
services including: Of course, we offer all fertility treatments 636 Raymond Drive
Assessment of ovarian reserve using the here including intrauterine insemination Suite 303
clomid challenge test and transvaginal (IUI), ovulation induction with Clomid
ultrasound for determination of ovarian (clomiphene Serophene), letrozole, Naperville, IL 60563
volume and antral follicle counts. glucophage, actos, avandia and
gonadotropins such as Gonal F and Phone: 630-357-6540
The HSG (Hysterosalpingogram)is an Follistim.
infertility procedure used to diagnose
uterine cavity problems (like fibroids and Laparoscopy, Hysteroscopy and
polyps) and fallopian tube obstruction. Reproductive Surgery
Our gentle techniques allow a nearly
pain free HSG. Using tubal
catherization techniques like selective
salpingography and wire guide
Dr. Morris is an expert laparoscopic
surgeon and performs laparoscopy for
infertility problems such as
endometriosis, pelvic adhesions,
canalization, we can open blocked fallopian tube blockage,
fallopian tubes and have helped many and uterine fibroids. He also frequently
women avoid more invasive surgery. performs surgery inside the uterus
(hysteroscopy) for polyps, fibroids and