Lancaster Physician Summer 2021 - 31

SUMMER 2021
A good doctor will acknowledge the
emotional components of fertility issues
and can provide both medical advice and
understanding, Butts said.
" It's an opportunity for a medical provider
to meet people at a tough time of life and
help them, " she said. " I am deeply invested in
the success of my patients because it's really,
really important for them. It's a trusted,
sacred thing. "
UPMC PINNACLE
dr. KARA
NGUYEN
While many people
assume pregnancy is a natural
process that can be
easily accomplished, the fact
is that about one in eight
couples has trouble getting
pregnant, said Dr. Kara Nguyen, medical
director of reproductive endocrinology and
infertility at UPMC Pinnacle and a practicing
physician with Shady Grove Fertility, a private
practice that partners with UPMC Pinnacle
to provide fertility services.
A lack of understanding about the incidence
of infertility can make someone struggling
to become pregnant feel very much alone.
" No one comes to see us because they
want to, " Nguyen said. " They make the
appointment because they desperately want
a baby and trying on their own has either
not worked, or they already know they will
need assistance to conceive. Either way, when
they arrive, they're often feeling broken and
isolated because they think they're the only
one with this problem. But it's a lot more
common than people think. "
Tests and examinations reveal clues to what
is causing problems in about 90 percent of all
cases, according to Nguyen, who is one of the
few physicians in the nation who is tripled
board certified in obstetrics and gynecology,
reproductive endocrinology and infertility,
and medical genetics.
In about one-third of cases the cause is
attributed to the woman, in one-third of
cases to the man, and in one-third of cases
to both partners. About 10 percent of cases
remain unexplained.
Once a cause for the problem has been
identified, it can be addressed in a number
of different ways, always with the patients
making their own decisions regarding care.
" I tell them they are in control, because
they normally are feeling very out of control, "
said Nguyen. " I want to be very flexible with
giving options to patients. "
Recognizing the high cost of fertility
treatment and the fact that insurance often
does not cover it, Shady Grove works with
patients to accommodate their financial
needs and offers guarantees that patients will
have a baby or their money will be refunded.
Costs have increased as the specialty
has become more complex and treatments
more expensive.
For example, Nguyen explained, 20 years
ago a single woman might have located a
donor and had sperm inseminated. Today,
the sperm donor is tested for genetic purposes,
the sperm must be quarantined before
use, and the patient must receive counseling.
Legal issues concerning identity also must
be addressed.
" This all adds to the complexity and cost
of what we do, " Nguyen said.
Still, as increasing numbers of people,
including those in the LGBTQ community,
seek fertility treatment, Nguyen is grateful
to pioneers such as Robert Edwards and Dr.
Patrick Steptoe, who researched and developed
IVF and delivered Louise Brown, the
world's first IVF baby, in England in 1978.
Steptoe died in 1988, but Edwards in 2010
was awarded the Nobel prize in Medicine
for his work.
" That acknowledged the fact that IVF
has become such an important way for
people to build their families, " Nguyen
said. " Those pioneers were the inspiration
for Shady Grove. "
As the fertility treatment field continues
to advance, staff at Shady Grove works hard
to keep up with what is happening. With
LANCASTER 31 PHYSICIAN
Continued on page 32
dr. VASILIKI A.
MORAGIANNI
five clinics in Pennsylvania and others in
Colorado, Florida, Georgia, Maryland,
New York, Virginia, and Washington, D.C.,
Shady Grove often gets the chance to try
out new medications and equipment as
they are introduced.
" We are all very actively educating
ourselves, both as individuals and team
members, " Nguyen said. " And that's all for
the good of our patients. The more options
we can offer them, the better the chances
are of them finding the treatment that is
best for them. "
PENN MEDICINE
LANCASTER
GENERAL HEALTH
Dr. Vasiliki A. Moragianni
may be equally excited about
advances in fertility care that
have already been accomplished,
and those currently in development.
" The field of infertility diagnosis and
treatment is relatively young, but the speed
and complexity of technological advances
have been spectacular, " Moragianni wrote
in an email. " And with those, there are
some exciting new advances that are being
developed right now. "
A reproductive endocrinologist and
infertility specialist at Penn Fertility Care
- Lancaster General Health, Moragianni
cited improvements in freezing and thawing
techniques for eggs, sperm, and embryos
as major accomplishments during the past
decade. The advancements are especially
significant for embryos, she said, which used
to be transferred to patients without freezing.
The ability to transfer frozen embryos ensures
more controlled conditions and ultimately
better outcomes for patients.
The areas of embryo culture, biopsy, and
chromosomal testing also have seen great
strides, she said.
On the horizon, she noted advances
including non-invasive testing of embryos

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