Interview With Fertility Specialist & Author Robert Greene, MD, FACOG
October 30, 2008 by Kristen King
Filed under Women's Health
(www.livelywomen.com) — I had the pleasure of talking with hormonal health expert and reproductive endocrinologist Dr. Robert Green, medical director of SHER Institutes for Reproductive Medicine – Northern California (SIRM) and author of the recently released Perfect Hormone Balance for Fertility: The Ultimate Guide to Getting Pregnant
Dr. Greene’s daughter just turned 1.
Kristen, Lively Women: Dr. Greene, your new book Perfect Hormone Balance for Fertility: The Ultimate Guide to Getting Pregnant
Robert Greene, MD, FACOG: With each of my books, I’ve always used real patient anecdotes throughout. In this book, once my editor found out [about my personal experience with infertility treatment], my editor asked if we would be willing to talk about our own experience. Some of the things you’ll find throughout the book is there will be different parts called Robert’s Story and Morgan’s Story: his and her side of the story. [My wife, Morgan] is a nurse and IVF [in vitro fertilization] coordinator. That was part of the irony of the whole thing. She and I hated the way we were treated as patients. We just really hated it. That was a big part of our motivation for this book. we want to give other people the info so they can take control of their treatment and not just be led around by their shirt collar.
We jumped into treatment right away because my wife was approaching 40 when we decided we wanted to have children. We didn’t originally want to have children. We were successful the first month we tried, but very shortly after that the first success turned into a miscarriage. The very sad thing about that is that we couldn’t even talk about the miscarriage with anyone because we didn’t tell anyone we were trying to get pregnant. We weren’t able to process that with anybody but each other, which made it a lot more difficult. About a year and a half of minor treatments without success, then IVF and that wasn’t successful, and we were pushing almost 2 years into the process and we weren’t successful again.
What was the aha moment for you that prompted you to pursue the hormone balance technique?
Robert Greene, MD, FACOG: It was really after the failed IVF attempt because the way I tell patients all the time is that I view fertility treatment as a diagnostic process as well as therapeutic. Our goal is to create a pregnancy. but anytime we fail to create a pregnancy, my backup goal is to ask what can we do to change the approach and have a successful attempt.
I told them, “Here’s what I think should be done differently.” I’m telling you the truth, Kristen, they laughed at me. They said, “That’s never going to work,” and I said, “Fine, we’re out of here.”
And we went and did things that made sense to us and we lay it out in the book exactly what we did. Yoga, stress level, vegetarian diet… Instead of ramping up to the more involved, more high-tech treatment, we decided to go a little more back to the basics. And it worked and now we have our daughter.
You promote what you call a “symptoms matter” approach to conception. What exactly does this mean?
Robert Greene, MD, FACOG: One thing that’s very different about my practice. Besides being a fertility specialist, I also have 15 years of neuroendocrine research (hormone-brain connection) using modern imaging tools to measure what’s going on in the brain and correlating that with what’s going on in the body and what people are experiencing. The point I’m trying to get at is that the symptoms people experience are very often the best clues at to what may be going on, and very often people aren’t aware of [them].
Can you give an example?
Robert Greene, MD, FACOG: Most people aren’t aware that 90% ovulation is triggered by the brain between midnight and 5 in the morning. Nurses and flight attendants who are working night shifts are very likely to have irregular menstrual cycles and have issues with fertility.
It’s a highly individualized approach. By getting the patient involved, you can really get individualized care and target your treatment to what’s unique to that patient and that couple.
Because we’ve used PET [positron emission tomography] scanning and functional MRI [magnetic resonance imaging], it’s very, very scientific for anyone who wants to look at the science. I typically give 80-100 lectures a year, and most of the lectures I give are to doctors, most commonly neurologists or psychiatrists because there’s a tremendous amount of science that’s backing up everything I’m saying.
What kinds of things are symptoms that women may overlook?
Robert Greene, MD, FACOG: Unexplained weight gain or inability to lose weight, pain associated with intercourse, irregularity in menstrual cycle, changes in libido… It’s amazing how many of these symptoms a lot of people just completely don’t see as related.
What are the keys to overcoming the natural obstacles to fertility?
Robert Greene, MD, FACOG: That’s the real challenge there. When it comes to fertility, there are so may things that have to go right. In any one individual, there might be one major problem and two minor ones or no major ones and seven minor ones. Throw in another person’s physiology, and it’s complicated. [I try to] give people the knowledge that they can make as many changes as they want.
What should be first step for anyone who wants to conceive?
Robert Greene, MD, FACOG: I have absolutely no financial relationship to any of the products I recommend in my book and my office. I don’t invest, don’t get free samples, etc. One of the best first steps and this just became available last year it’s a home fertility test called Fertell. It measures things people can’t measure on their own — ovarian reserve, rough estimate of a man’s sperm — this is something people can get and check this out at home.
I even talk about this in my book. It’s something that if people find this information and find that their results are reassuring, then they might want to go through the book and clean up their habits and their lifestyle and do something things to optimize their changes. If they results aren’t reassuring, then they know that they might want to go see a fertility specialist and skip all the steps in between. It’s empowering; it gives people the opportunity to take a very active role.
In the privacy of their own home, there are a lot of things people can do. I’m not against fertility treatment, but often it’s not covered by insurance, and people get emotionally and financially tapped out before they even get to the office. [I like to] let them know what treatments they should just say no to. A great example is reversal of a tubal ligation. It’s one of my favorites, but I don’t do it anymore because there are other treatments that are much more successful and less expensive at the same time.
Like a lot of women in their 20s and 30s, I’ve been on birth control for years. What do I need to keep in mind when I’m ready to start a family? Will I have a harder time conceiving than an identical woman who has never used hormonal birth control?
Robert Greene, MD, FACOG: Just the opposite. There’s some good evidence — it’s not definite yet — but there are studies suggesting that the woman using birth control for many years may actually have a longer fertility window than woman who don’t [use birth control].
Another popular myth is that you need to be off birth control for six months to get pregnant. That concept is one that developed about 30 years ago and was disproved 13 years ago. It’s old advice that keeps getting repeated and it’s just terrible because it’s not true. The best change of getting pregnant is the first few months after they stop [birth control]. As a fertility specialist, we put patients ON birth control.
Are there other benefits of birth control?
Robert Greene, MD, FACOG: Birth control has been shown to reduce ovarian cancer 80%, uterine cancer 60%, colon cancer 40% to 60%… It doesn’t increase or decrease the risk of breast cancer, but the bottom line is that there’s a lot of benefit to birth control pills. I actually have put nuns on birth control because they’re at high risk of getting ovarian cancer because they never get pregnant. I call it “hormonal regulation” instead of oral contraception.
Is there anything you’d like to add about reproductive health?
Robert Greene, MD, FACOG: [My goal is] empowering [patients] with knowledge so they can decide on the treatment that makes the most sense to them, helping them understand what their options are. I don’t think people should settle for anything less, and the beauty of the field of fertility is that there is so much competition that you don’t have to. If I’m not meeting your need, you should not continue to see me. I’d appreciate it if you at least told me, though.
Dr. Greene’s book Perfect Hormone Balance for Fertility: The Ultimate Guide to Getting Pregnant
Contents © Copyright 2008 Kristen King
