What does it take to become a fertility specialist?
The short answer? Lots of years of medical training! The longer answer is that fertility specialists are sub-specialty trained OB/GYNs, which means that I first went through four years of undergrad schooling, then four years of medical school, another four years of OB/GYN residency and, finally, another three years of sub-specialty training in infertility. To put this in perspective, only 42 fertility subspecialists graduate in the U.S. each year.
What areas of medicine does a fertility specialist deal with?
We deal with all medical issues related to men’s and women’s fertility, including IVF (in-vitro fertilization) and non-IVF treatments, fertility surgeries and other disorders of female endocrinology, including issues related to puberty and menopause, and polycystic ovary syndrome (PCOS).
At what stage would you advise a married couple to seek fertility treatment?
A couple should see a fertility specialist if they have been trying unsuccessfully for 12 months to get pregnant. If the female partner is age 35 or older, go to the specialist after six months. However, there is no reason to wait any time at all if either member of the couple is worried and wants an evaluation, or if there is an obvious problem like irregular or absent periods, male sexual dysfunction or if the woman has been diagnosed with endometriosis.
What do you tell people who are uncomfortable with the idea of discussing such intimate matters, even with a medical professional?
This is what we spend our days doing; there’s nothing you can tell us that we haven’t heard before. And, on a personal level, statistics show that there’s a higher-than-average percentage of medical professionals who experience infertility (one in four doctors, versus the one in eight in the general population), likely due to the fact that doctors tend to push off childbearing until after their long years of medical training. And fertility specialists in particular often choose to go into the field because of a personal or family experience with infertility. So don’t worry—we understand what you’re going through, and we’re here to help.
What issues have you seen with regard to fertility treatment that are unique to the Orthodox community?
Great question! As a member of the Persian community (through marriage), I’ve been privileged to get to know this warm, welcoming community up close, and can comment on what I’ve noticed there. But to a certain extent my observations apply to other close-knit, family-oriented, highly traditional communities as well.
One of the beautiful things about our community is the strong family ties and high value placed on having children. However, I’ve noticed that fertility problems are not spoken about openly in our community. Part of that might result from an experience gap between the older and younger generations. Typically, our mothers and certainly our grandmothers [in the Persian community] married and had their first child while still in their teens. Fertility issues in the teenage years are quite rare, and even when they did come up, they weren’t talked about in those days. Today’s generation of women, however, are pushing off marriage and childbearing for the sake of their education and careers, and typically wait until their 30s to have their first child. Unfortunately, fertility issues are much more common for a woman in her 30s—and yet, there is still a sense in our community that this is something that “shouldn’t happen” and that “we don’t talk about.”
While the attitude may be well-meaning, what it does is foster a feeling of shame and stigma around fertility problems, which may prevent couples or single women from getting the help that they need.
What is the best way to combat this stigma?
In a word: education. It is crucial to educate people about these issues, which are so much more common than we might think. As I mentioned, American women today are postponing childbearing until their 30s or even later, and without commenting on the societal implications, the fertility implications are clear. More and more women will need medical intervention in order to have a baby. Therefore, in order to plan your family properly and get timely intervention, it’s crucial to educate yourself about the issues involved.
For example, did you know that the single greatest factor impacting a woman’s ability to have a baby is the age of her eggs? Egg quality starts to decline in the early 30s, and the decline speeds up after age 35 and again after age 40. So if you are a single woman in your 30s and hope to have a baby one day, it’s important to speak to a medical professional about fertility preservation, a.k.a. egg freezing, to explore whether this is a good option for you.
Recently, we’ve had a number of educational events in our L.A. Persian community on the topic of infertility, which have begun to combat the stigma attached to the subject. PUAH, one of the premiere fertility organizations in the Jewish world and the international leaders in the field of fertility and Jewish law, ran a big event at the Nessah Synagogue in Beverly Hills in March, which focused on genetics and fertility. It was an honor for me to be one of the featured speakers at this breakthrough event, which was the first time the topic of fertility had been addressed in our community in a public forum.
[PUAH also has an exciting fertility awareness event coming up for the Persian community in Great Neck on Sunday, June 23.]
Genetic diseases are sometimes thought to be an ‘Ashkenazi’ problem only. Is that a misconception?
Absolutely. Every ethnic group has its own genetic conditions (such as Tay Sachs and cystic fibrosis in the Ashkenazi population). Genetic screening tests can identify if both parents are carriers of the disease. In the case where they are, it is possible to prevent transmitting the condition to their children by means of Preimplantation Genetic Testing (PGT) and IVF. It’s important to note that some of the common genetic disorders found in certain Sephardic populations aren’t included in standard genetic screening tests. For example, the main genetic disease prevalent in the Persian population is Hereditary Inclusion Body Myopathy (HIBM). However, your typical genetic screening test that your doctor offers won’t include HIBM. It’s important to ask for it, especially if both partners are of Persian descent.
I’m very excited to be involved in these and other educational initiatives (such as a series of events Bayit LA recently ran for married couples), and based on the turnout, it’s clear that there’s a huge amount of interest in our community on the topic. However, while many women come over to me after these events and ask if they can make appointments to speak to me about their personal issues, I’ve noted that they rarely follow up. I think there’s still a lot of shame and ambivalence in our community surrounding the topic of infertility, and I would love to see that change. So many fertility issues are easily treatable; it’s a shame for couples to suffer in silence when they could instead be fulfilling their dreams of becoming parents.
For more information about the upcoming PUAH Benefit BBQ in Great Neck on June 23, or for any questions… contact PUAH at 718-336-0603.
By Gila Arnold
Dr. Ellen Goldstein is a double board-certified OB-GYN and reproductive endocrinologist and infertility physician. She has been helping hopeful families at the California-based Reproductive Fertility Center since 2016. Dr. Goldstein lives in Los Angeles with her two children and her husband, Houman David Hemmati, M.D., Ph.D., where she is a proud and active member of the L.A. Persian community.