In the first episode of the “Fertility” miniseries, Dr. Fox welcomes Dr. Susan Lobel, a reproductive endocrinologist and founder of Metropolitan Reproductive Medicine in New York City. Dr. Lobel explains the most common reasons couples struggle to conceive, fertility treatments, IVF, and more.
“Infertility: Should I be Concerned?” – with Dr. Susan Lobel
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Dr. Susan Lobel joins Dr. Fox to discuss infertility. A reproductive endocrinologist, Dr. Lobel is the founder of Metropolitan Reproductive Medicine in New York City. She started this practice after directing a large IVF program and eventually deciding she would like to start a smaller practice. She explains that “fertility is a very personal issue, so I wanted to provide more personal care.” She further explains choosing your fertility practice similar to choosing which college to attend—for some, a large school is better, while others thrive at a small school. She says it’s simply up to personal preference and which setting the patient feels they benefit from most.
Dr. Lobel explains that for couples who don’t have any fertility issues, the chance of conceiving is about 20% from intercourse at the right time of the month. Like most reproductive endocrinologists, she recommends that couples try to get pregnant for about a year before they pursue fertility treatment, assuming that they are under 35, the woman’s cycle is regular, and they have no known issues that could affect fertility. Women over 35 are recommended to seek care after about six months. Dr. Fox adds that it’s possible for couples to seek fertility care sooner if they are anxious about it, but this isn’t really necessary, and insurance is unlikely to cover it.
The most common causes of infertility or difficulty conceiving, according to Dr. Lobel, are ovulating irregularly, problems with the uterus or fallopian tubes, and decreased sperm production.
In patients with an irregular cycle, Dr. Lobel explains that figuring out the cause for this irregularity is her first step. Common causes include polycystic ovary syndrome, hypothalamus issues, or thyroid problems. She says that “if a patient has a bleed every 28-30 days (plus or minus two), she’s likely ovulating normally.” However, irregular periods can mean either it’s difficult to predict when she’s ovulating or that she’s not ovulating at all. These problems can often be treated using medication or other methods.
Problems with the uterus can include a heart-shaped, or bicornuate, uterus, which more commonly causes miscarriage. Patients may also be found to have fibroids or polyps in the uterus, which Dr. Lobel explains act like an IUD and prevent implantation. The fallopian tubes can also be blocked due to congenital issues or other problems. Dr. Lobel explains that these could be opened surgically, but this increases the risk of a tubal or ectopic pregnancy, so she usually recommends IVF instead.
Finally, Dr. Lobel explains that there are many reasons why sperm production or quality can be compromised. She says that in some cases, problems with sperm can be caused by medication or habits like using saunas or hot tubs, which are easily remedied. However, other issues such as a dilated vein in the scrotum, are also possible and require more medical intervention to resolve. In these cases, she explains that she would refer patients to a urologist. Otherwise, Dr. Lobel recommends IVF for patients who don’t have suitable solutions for a low sperm count, as the process can be completed with only a few sperm.
In addition to common fertility concerns, Dr. Lobel explains that fertility gradually decreases over time. For most women, this occurs beginning in the late 30s or early 40s, but not every patient will experience the same loss in fertility at the same rate. She says that it’s most common to see issues at around 42, but this isn’t true for every patient.
Drs. Fox and Lobel also explain egg freezing. While the procedure is no longer considered “experimental,” Dr. Lobel says that unfortunately, the rate of becoming pregnant using frozen eggs isn’t as high as she wishes it was. She explains that egg freezing is “kind of like an insurance policy,” and that while there is little harm in doing so, there are no guarantees. However, she does recommend the procedure for patients undergoing cancer treatments or other situations that are likely to affect their eggs and fertility in the future.
Finally, Dr. Lobel explains that “most people will be successful” after fertility treatment, although it can take multiple IVF cycles before a couple has a child. She says that while it’s good that people feel more open sharing their personal stories, patients should remember that they’re not always hearing a full story from friends or family members, and “what I would not advise people to do is to get advice over the internet.” She instead recommends that patients ask their OB/GYN first, and that they don’t hesitate to ask for a second opinion.
Dr. Susan Lobel graduated summa cum laude from Princeton University and Harvard Medical School. She is a board certified OB/GYN and Reproductive Endocrinologist and has served on the faculty of Harvard Medical School. After developing and directing the IVF program at Genesis Fertility and Reproductive Medicine, she founded Metropolitan Reproductive Medicine.