By Deb Vietor
Recently, we visited a place where magic happens daily in Del Mar: The San Diego Fertility Center, where terms such as IVF and IUI are tossed around freely. Meet Dr. Brooke Friedman, A Princeton graduate who attended University of California-San Francisco, medical school. In addition, Dr. Friedman attended Stanford for her residency in Obstetrics and Gynecology and fellowship in Reproductive Endocrinology and Infertility. Having been recognized by her patients with a Patients Choice Award and Top 10 Physicians certification, her credentials are impressive. Even more impressive is what she does daily along with a staff of physicians for infertile couples, who number 1 in 8 in the U.S. today.
With state of the art medical equipment and a center which is growing for the fertility needs of couples, Dr. Friedman explained the process regarding the treatment of infertility: “Cryotanks are stored in the surgical center next to the medical facility,” she says. “Through IVF, eggs, once retrieved; are injected with sperm. The fertilized eggs, or embryos, are grown in the lab and a biopsy can be done in order to determine if they are genetically healthy. Healthy embryos are implanted and the rest are frozen.”
In 1978, Louise Brown was the first person born through the IVF procedure. Since then, technology has come a long way. Dr. Friedman mentioned that there are medical protocol rules and although no two patients are the same, they are each supported in a unique way. The clinic respects and appreciates the struggle and stress level of couples and individuals experiencing fertility challenges.
With more than 70 years of collective experience diagnosing and treating infertility, SDFC is a leading fertility provider in San Diego. The Center specializes in helping patients map out a strategy and fertility treatment plan which fits their individual goals, schedule and values.
We asked Dr. Friedman some other questions regarding the center and fertility.
L’CHAIM Magazine: Do you receive referrals from other physicians?
Dr. Brooke Friedman: Doctors refer patients, or patients hear about us through word of mouth and refer themselves.
L’CHAIM: Do you often have patients who request multiple births?
B.F.: Years ago, we often implanted multiple embryos whereas today it is more common to implant one. With our improved lab techniques, including genetic testing, we can feel more confident with Elective Single Embryo Transfer (ESET), in which a single embryo is implanted.
L’CHAIM: Do people want the sex of their baby identified?
B.F.: The ratio is about half and half.
L’CHAIM: What is your rate of success and could you please describe the process for new patients with regards to fertility issues, the available procedures and options.
B.F.: If a woman under 35 years old has tried to conceive for over a year, or if a woman over 35 years old has tried to conceive for over 6 months, it is recommended that the couple undergo a fertility evaluation. For a new patient, the first step is scheduling an appointment at our facility. During the initial consultation, we review the patient’s history, previous evaluation, (if any) and perform a pelvic ultrasound. We than determine what tests need to be performed to determine the cause of infertility. The results of the evaluation guide us regarding next steps.
Often, a first step in fertility treatment is an intrauterine insemination (IUI), also known as artificial insemination. During this procedure, sperm are washed, concentrated and placed directly inside a woman’s uterus, in order to increase the number of sperm in the fallopian tubes where fertilization takes place. IUI is most successful when it is combined with fertility drugs that recruit more than one egg to be released in a given month.
In-Vitro Fertilization (IVF) is a technology in which a woman takes injections to recruit multiple eggs. Her eggs are then removed with a procedure and then fertilized with sperm in our IVF laboratory. The fertilized eggs, or embryos, are grown in our IVF laboratory, and later reintroduced to the uterus. IVF also allows for the genetic testing of embryos prior to transfer.
There are egg donors and surrogacy options for people from all over the world.
L’CHAIM: Is there an age that you consider to be too late for a pregnancy?
B.F.: There are many different paths to building a family. It becomes more difficult to conceive when a woman reaches her 40s and it is unlikely that a woman will be able to conceive with her own eggs after the age of 44. Another wonderful option, however is becoming pregnant through egg donation and this can be performed up to the age of 50 as long as the mother is in good health.
L’CHAIM: What is the average time for a pregnancy to take place once treatment has started?
B.F.: Each case is different. Sometimes a couple will conceive with their first month of artificial insemination. For other couples pursuing IVF, it may take 3 months or longer until a pregnancy occurs. We continue to work with patients until we achieve success and help them build their family.
L’CHAIM: You are currently constructing a new facility. How will the new building assist the organization in providing services to patients and how many new patients per year can be helped due to the additional space?
B.F.: The new building is designed with transparency in mind. We wanted to demystify the IVF process and allow patients to see through the glass window into our IVF lab where the embryologists are working. We also wanted to create a very tranquil and peaceful environment in which all patients could feel welcome and feel comfortable during their treatment.
L’CHAIM: What do you believe sets your organization apart from others?
B.F.: After your first visit, and after our front office staff has had the opportunity to meet you, you are now a part of the SDFC family. Upon arrival to your next visit, you are greeted by name. People are always amazed at how our front office remembers everyone’s name. It gives our patients a warm feeling and proves to them that they are not just a patient. [at subsequent visits, they get a hug and we let them know they are not a stranger. We hug, we cry and we get excited at positive pregnancies and heartbeats. We are on this journey with each other and every one of our patients. We are not a cookie cutter practice and believe that we are on the team that can make miracles happen! The road is not always straight or smooth, but with our combined efforts of cutting-edge treatment and compassionate care, we are committed to helping each patient achieve success.
L’CHAIM: What is one of your favorite things about your job as a physician? What is the most challenging?
B.F.: When choosing to specialize in infertility, I knew going in that it was not going to be easy. It is a very scary and challenging time for the patients and this is where my job begins. One of my favorite things about being a reproductive endocrinologist is when I get to call the patient and tell them that we have a positive pregnancy result. The bond that is created throughout this journey is close and personal. As a physician, this is when I take a moment to be grateful for having the ability to help others.
The most challenging aspect of my job is when a patient has gone through treatment without success. At times it’s hard for the patient to understand why this is happening to them. It is a very emotional and frustrating time. My goal is to help the patient understand that although we have not succeeded this round, we have learned a lot about how their body responds to the given protocol and we will make adjustments and try again. It doesn’t always happen the first time and sometimes not the second, but the good news is if patients are persistent, the majority will experience success. If there is a will, there is a way. Patients have options and there are many different paths available to building a family.
Dr. Friedman shared that SDFC works with agencies to facilitate donors from Israel who come to donate their eggs and with Jewish couples this is very important. Jewish couples are also tested for many genetic disorders, such as Taysachs disease, which are more commonly found in Ashkenazi Jews. Both parents need to be carriers for a child to be at risk of being affected by the disease. We learned that embryos can also be tested for the BRCA gene which is a gene carrying an increased risk of breast and ovarian cancer. Other genetic disorders can be tested for as well. Patients are educated about potential complications and doctors are up front and honest through each step of the fertility process.
At the San Diego Fertility Center, the belief is “High tech and high touch.” Areas of focus for infertility include: Intrauterine insemination, In vitro fertilization, (IV), egg freezing, egg donation, surrogacy, preimplantation genetic screening, and fertility financing. There are many qualified doctors at the San Diego Fertility Center available to help patients. People come from all over the world to receive help for infertility issues and assistance is provided for single individuals and for gay and lesbian couples as well.
For more information on the San Diego Fertility Center, call (858) 794-6363 or visit the website at www.sdfertility.com. The San Diego Fertility Center is located at 11425 El Camino Real, San Diego, CA 92130.