Q & A With Shahin Ghadir, M.D.:

How should someone evaluate whether a fertility doctor is right for them?
Dr. Ghadir: Trying to find a fertility doctor involves a lot of things. First of all, it involves how long you've had infertility issues. For patients under the age of 35 that have been trying for over one year, it's recommended that you see a fertility specialist. If you're over 35 and you've been trying for six months, it's recommended at that time that you proceed with finding an infertility specialist. Most people go to their OBGYNs first and get recommendations, but due to the fact that we're one of the largest IVF labs and IVF/fertility centers on the West Coast of the United States, and have a very good reputation, many people find us without even going through their OBGYNs.
Would you recommend someone come in and check out the lab itself as part of the process of evaluating?
Dr. Ghadir: This is something that most people don't think of at all. It's like going to a mechanic, but his only tool is a toothpick and a string to fix your car. Versus going to the best mechanic in the city who has all the tools available. Our IVF lab is the largest IVF lab on the West Coast. We have the newest equipment available in the world. We even have one of the newest technologies -- a camera that watches your embryos grow -- called an Embryoscope. These are things that make your IVF lab very important. The longevity of your IVF lab is also important. Our IVF lab has been working for over 20 years.
How has the Embryoscope been a game changer?
Dr. Ghadir: It's an incredibly expensive piece of machinery that allows up to 72 embryos to be placed in there ... It actually allows us to watch the embryos' structural well-being from the time the egg and sperm are put together -- all the way to the time when the embryo is going back inside for an embryo transfer into the uterus.
In terms of evaluating the equipment in a lab, are there any red flags someone should look for?
Dr. Ghadir: Patients never get to go to our IVF lab. Actually, I don't get to go to my IVF lab. So that's one thing. The security of our IVF lab is huge. And our building here is under 24-hour surveillance -- seven days a week with live security guards. All of our equipment is also on security devices at all times ... [Another possible red flag is] success rate. If you have a beautiful IVF lab with terrible success rates, there's something going wrong. And if you have really great success rates with a horrific IVF lab, then there's something shady in how [they're] presenting their data. The best way to acknowledge how well your IVF lab is doing is basically with the data of your success rates -- which is public information because you have to report your IVF lab success rates.
Is IVF the most popular way to have babies these days -- for those who can't do it naturally?
Dr. Ghadir: No. That completely depends on what the problem is and also your age. Most people who walk in here and who have been trying, the next step is generally simple medications that help you ovulate better. Either in the form of a pill, which usually is a starting point, and then daily injections, which help you make good eggs. Along with artificial insemination, which is also called intrauterine insemination. Usually people do three cycles of the pill with artificial insemination and if that doesn't work, they go to the daily injections with the artificial insemination for about three more cycles. And then generally if it's been unsuccessful for six months total, people progress to IVF.

Now, if there are issues where sperm is a major issue from the get-go, it's worthless to go to artificial insemination. It just will never get you pregnant. Where if there are issues that a patient has been trying for a super long time and has done other testing that has shown there are reasons that egg quality is diminishing rapidly, then it's not really worthwhile. The reason IVF is what people hear about is because it's the one that has the highest success rate out of all of the things we do for patients.
How does your team identify the healthiest embryos to use in in vitro fertilization?
Dr. Ghadir: There are multiple ways. The technique that we used to do originally was looking at the embryos and seeing on day five [how] they've been growing outside the body, the best looking embryos. Then came the technology to do genetic testing on embryos to make sure that the chromosomal analysis of the embryo is normal. Similar to an amniocentesis ... that tells you all 46 chromosomes of the child on the embryo itself ... before the embryo goes back inside.

Now it's that newest era of checking to see structurally if an embryo goes from one to two cell to four cell to eight cell and is dividing at a normal pattern until it gets to its maximum growth of an embryo, which is called the blastocyst. So we check it by its appearance, we check it by its growth pattern and we check it by its genetics.
What's been the biggest breakthrough in fertility science over the last 5 years?
Dr. Ghadir: I think the fact that we've been able to do the genetic analysis of the embryo to see which embryo is normal, and which is abnormal genetically -- the #1 cause of lack of implantation and #1 cause of miscarriage -- is probably the biggest finding that we have now.
Are people just delaying the process of having kids ... or aging out sooner?
Dr. Ghadir: The #1 cause of the increase in infertility in our population is that people are just waiting longer. That being said, there are a ton of environmental issues that affect fertility as well. We're not sure we can pinpoint exactly what they are, but we know it has to do with that as well.
Can you identify any of the environmental factors?
Dr. Ghadir: There are definitely some that we know for sure. Like smoking, the use of alcohol, the use of drugs, excessive heat, chemotherapy, certain medications...
What about with regards to nutrition?
Dr. Ghadir: There's been a lot of studies that have shown that your weight and your fertility are very much related, not necessarily in terms of the quality of food that you eat.
What could men be doing better to keep their sperm in tip-top shape?
Dr. Ghadir: The best thing to do is to make sure you're not overweight because excess fat converts to excess estrogen and excess estrogen is really bad for sperm quality. The other thing is that excessive amounts of heat to the testicular region is not a great idea.
No hot tubs?
Dr. Ghadir: You can do hot tubs, but anything in excess that can affect the sperm quality [is not good] -- because testicles are outside of the body for a reason, to stay cool and to stay in that environment for ideal growth.
What about the science with regards to people who keep their cell phones in that area?
Dr. Ghadir: I actually recommend for my patients not to -- not because there's any data but because we have absolutely no idea. And when someone's coming in here with no idea why they have poor sperm, and I see that their cell phone is sitting right there on their lap ... it's something avoidable. I also tell my patients not to keep a laptop on them without a special protector because you just don't know.
Is there anything you advise women to do to keep their eggs in good shape?
Dr. Ghadir: For women, being proactive and not waiting too long is the #1 thing they can do. If they know something in their life is going to keep them from conceiving earlier on, then they need to be proactive and preserve their fertility in the ways that are possible. Again, having a healthy lifestyle and a healthy diet and being in the normal weight category is also important. And just knowing that everything you do to your body can affect your eggs including alcohol, smoking and drugs.
Do you sense that the science that supports environmental factors causing boys and girls to develop sooner is contributing to the aging out process?
Dr. Ghadir: Just because you get puberty sooner does not necessarily mean that your fertility is going to decline sooner. Nor does it mean that if you're a patient that got their puberty later, you have the security of having your fertility prolonged for later. That's a myth.
When you evaluate the best candidates for IV treatment, is it always age based or is ethnicity a factor?
Dr. Ghadir: There are some categories of women, for example Asian women, where studies have shown that their fertility declines more rapidly than other populations. So when making decisions, we do look at patients and ... everything about their hormonal analysis and everything that relates to their well-being of their fertility and their fertility status at that time. Looking culturally other than for Asian women is not a big indication.
I heard you say in an interview that "The amount of things we don't know in our field is numerous." So I ask you: what discovery are you most looking forward to?
Dr. Ghadir: That's a great question. We still have a lot to learn about the uterus. Because sometimes we'll put a perfect embryo in, and there's still no implantation. So I think if we were able to learn more about the uterus and its receptivity ... that will allow us to get over some of the unexplained areas in our field.
Is there any research or science being done to make the age that women can conceive naturally ... older?
Dr. Ghadir: What happens to women as they age -- it's not that a switch turns off at 35 and again another at 45 -- but it's a natural progression and decline in their fertility. It's typically from the age of 27 or 28. Usually that natural progression is abnormal chromosomes that are passed on. That's why there's a higher risk of Down Syndrome and actually a million other abnormalities (Down Syndrome is the one of the very few that survives. The rest end in miscarriage or never have implantation.) So those are the ones that the majority of them are. The idea of being able to check chromosomally to make sure it's a healthy embryo is the one thing -- even if you're older but able to make that normal embryo -- that we can do for you to help you conceive.
I know egg fertilization isn't cheap. Do you foresee the price getting more reasonable or more expensive over time?
Dr. Ghadir: As the technologies improve, for example with the use of the Embryoscope, you can see how it would affect the price of in vitro fertilization going even higher. I think the better the technology, the more expensive and state-of-the-art it is -- for that reason, I don't see it going down. There is so much that goes on behind the scenes of making one perfect embryo that most patients are completely unaware of -- in terms of the cost of equipment, materials and everything else that's used, I think it's almost impossible to bring the cost down.
I know the live birth rate here (at Southern California Reproductive Center) is well above the national average, what do you attribute that to in a nutshell?
Dr. Ghadir: A state-of-the-art lab that is run amazingly and we have some of the top embryologists in the world working in there. And also the fact that when it comes to our IVF lab, we don't skimp on anything. Every single thing that is used in our IVF lab is the absolute best available in the world.
Dr. Shahin Ghadir of Southern California Reproductive Center Shahin Ghadir, M.D., is a reproductive endocrinologist and founding partner of Southern California Reproductive Center (SCRC), a state-of-the-art fertility lab in Beverly Hills, Calif., with over 10,000 live births and counting.

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