PCOS & The Fertility Doctor's Guide to Overcoming Infertility [Podcast] - PCOS Diva
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PCOS & The Fertility Doctor’s Guide to Overcoming Infertility [Podcast]

PCOS Podcast 141-Overcoming Fertility - Dr Mark Trolice

“You are not defined by your fertility. That’s not a talent. That’s not anything that you’ve done. It’s like bragging that your right-handed… You’re defined by what type of person you are and how you contribute to this world and make it a better place… There is a lot of opportunity in life to find fulfillment and if, God forbid, it doesn’t happen the way that you originally wanted, there are things that you can do.”

– Dr. Mark Trolice, M.D.

The journey from infertility to fertility can be physically, emotionally, and financially draining. Dr. Mark Trolice, M.D. is the kind of knowledgeable and supportive doctor we all need. Double board certified in both OB/GYN and Reproductive Endocrinology and Infertility, he shares the wisdom he has gained in his years of research and practice with compassion and a gift for clearly communicating options. Listen in (or read the transcript) as we discuss:

  • The 4 issues that can impact your fertility
  • Managing the emotional toll
  • Possible impact of endocrine disruptors, caffeine, hot tubs, saunas, and cell phones
  • Things your partner should consider
  • The Type of doctor to see when you’ve been diagnosed with PCOS & you want to start trying to conceive
  • Financing options for fertility treatments

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Mentioned in this podcast:

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Complete Transcript:

Amy Medling:

On today’s PCOS Diva podcast, I’m welcoming back Dr. Mark Trolice. He is the Director of Fertility CARE at the IVF Center in Winter Park, Florida. He’s a double Board-certified doctor in reproductive endocrinology and fertility as well as in OB/GYN. He’s the author of a new book called The Fertility Doctor’s Guide to Overcoming Infertility. I love the tag line, “discovering your reproductive potential and maximizing your odds of having a baby.” I met Dr. Trolice at a PCOS Challenge Symposium weekend because he spends a lot of time advocating for women with PCOS on a national level as well as helping them to conceive and have healthy pregnancies. Welcome back on the podcast, Dr. Trolice.

Dr. Mark Trolice:

Oh, thank you. Congratulations to you for what you do for this podcast and giving the patients, empowering them with so much information that really helps them along their journey. Kudos to you.

Amy Medling:

Oh, thanks. Well, I absolutely love doing it. I get to talk to really interesting people like yourself. We had a great podcast together back … podcast episode 118, where we talked about “what you need to know about PCOS fertility and pregnancy.” I know you were working on your book at that point. I’m really pleased to have you back on where we can kind of dig in deeper into your book which was really excellent. I read it last night, and in addition to being a jazz singer which I found out from reading your book and a fantastic reproductive endocrinologist, you’re actually a really great writer, too.

Dr. Mark Trolice:

Well, thank you. I appreciate that, Amy. I remember when I was in college, I was so determined to learn how to write in prose that would engage the audience. I’ll never forget my professor at Columbia University. I was so stiff in my writing. She says, “You’ve just got to loosen up. You just got to forget the ground rules.” I’m paraphrasing it. “You’re too structured. Just let it come out and come from your heart and be passionate about it.” She gave me these essays to just talk about things that were visceral for me. Really very, very passionate. From then on, she changed my ability to write. I absolutely love writing.

Amy Medling:

Well, you did a great job. You really connected with the reader. If you are listening and you’re beginning your fertility journey or you’re in the middle of it, it’s really a great reference book to sort of take you through the whole journey. I highly recommend it after reading it. We’re going to touch on some of the chapters and topics in today’s podcast. First, I was hoping that you could share your story, your fertility journey, with us because it’s really quite powerful. I have found in doing these podcast interviews with various experts that those practitioners that, I think, have been through struggle and come out the other side, are often the most compassionate and empathetic. I’m going to quote you from your book. You say, “Our true character and integrity emerge when we face adversity and overcome our challenge to find fulfillment, not necessarily in the manner we originally intended.”

Speaking for myself, I never thought that I would, honestly, ever have this type of a platform helping women with PCOS years ago. It was because of my struggle and emerging from it that led me to this work. You have a similar epic story that I would love for you to share.

Dr. Mark Trolice:

Sure. My wife and I were … I was in my OB/GYN residency. After we had been married for a few years, I was in my third year of residency, and we said, “Hey, we think it’s time.” She goes off the birth control pill, and it doesn’t happen. Month after month. The first few months you sort of say like everybody, “Oh okay, just hasn’t happened.” When you get to after six months and then eight months, you start saying, “Hmm, what’s going on here?” 12 months was the alarm, of course. Being less than 35, you give it up to a year as long as you’re having regular menstrual cycles.

I fell in love with the field of infertility when I was a third year medical student. During my OB/GYN clerkship rotation, I spent one week on infertility and I said, “That was a real aha moment. This is my life now.”

Fast-forward, third year of OB/GYN residency, we’re having difficulty conceiving. My wife gets investigated and evaluated. I have to do my thing. Essentially, everything was good with her. They ended up doing a laparoscopy on her. There was a little bit of endometriosis. I have a little bit of a male factor. We started doing IUI cycles. Time goes by real fast, and it stops at the same time if you can even envision that. Your life is in limbo … it’s really a … it’s surreal. For me, as somebody who loves the field, then to be stricken, and I use that word deliberately because it’s a disease. To be stricken with this disease was so ironic and awakening and enlightening for me to be able to completely understand. I love the field. Then, to completely understand every nuance of my patients feelings. Their despair, their frustration, their anger, their regret, their intermarital conflict or interrelationship conflict. It’s such a myriad of emotions. You’re really on a roller coaster. That’s a cliché, but it really is every month.

We started doing treatment in New Jersey. Then, my fellowship in Connecticut, more treatment there. Then, we start doing IVF in Connecticut. Then, we went to Charlotte, more IVF. I felt angry. I was under Niagara Falls. I was literally suffocating. My wife is a very strong person. She kept persevering. I wanted to stop. I couldn’t take her being uncomfortable in any way. I mean, the surgery I was a wreck, and it was just a diagnostic surgery. It doesn’t even … you cannot believe that this is your life. This is it.

Then, we started getting into birthday party invitations that we skip out on family. Birth announcements that are crushing. Everything you all who are listening have felt, I’ve lived. I have grown to even further appreciate and understand the devastation. I was on medication for palpitations when I was in North Carolina. It was just tremendous stress to have my patients crying all day and my wife crying at night.

Eventually, we moved to Orlando. Had done another IVF cycle. In the middle of this, we had miscarriage. She’s admitted for ovarian hyperstimulation syndrome. They take all fluid from her abdomen. Then, we come to Orlando and the last IVF cycle results in ectopic pregnancy, so she has emergency surgery. I had surgery for the male factor … it was just, how many times can you say, “Can you believe this?” That this is what’s happening.

10 years, you fast-forward 10 years. Amy, 10 years is a long time. It goes by real fast, too. We resigned and resolved to say, “We’re going to build our family through adoption.” I, as a stubborn Italian from northern New Jersey, was very resistant. I didn’t know anybody who was adopted. It wasn’t in our family. Our family’s a huge family. I felt, initially, inappropriately embarrassed. I said, “They’re going to look at my children as different. They’re going to look at me as different. What in the world are we doing?”

I’ll tell you, my mom, rest her soul, just … oh God, the way both families treat our children is amazing because my children are just so full of love as well. We are just so blessed. I mean, when you adopt, you choose your child. We tell our children they were chosen. They knew they were adopted from the beginning. I mean, when we went to the playground and my children would find their friends and bring them over to us and say, “Hey dad, this is my new friend.” Then whisper to me, “Yeah, but he’s not adopted” which just said everything in that small little whisper.

I really encourage my patients … firstly, I say that 10 years is a long time. I would have waited another 10 years to get these children. Okay, but 10 years is too long out of your life. You want to be able to resolve this problem as soon as possible. Unfortunately, it doesn’t always happen the way you originally wanted. I say to my patients, “Don’t let this happen to you. Don’t do what I did” because it changes you, irrevocably. You’re not the same person after 10 years. You’re different. I mean, relationship gets strained. You question your masculinity. You question your femininity. You question your place. I have never forgotten what it was like to have my face pressed up against the windows of families or looking in the playground from the outside through the fence. I have never forgotten that.

When I’m in social circles and having conversations and people start talking invariably about children, and one person is not, I change the subject. I don’t know about their situation. I don’t know if they’re infertile or not. If they’re not contributing, that’s the first thing I think about. It was an enriching experience. I’m better for it. I’ve learned to love for the sake of love. I think adoption is sort of the purist form of love because there’s no biology. The talent that my children have, I could brag to the end about because it’s not about me. They got their talent because of them. It’s sort of a funny thing because you could just keep bragging about how gorgeous your children are, and it has nothing to do with you in a sense.

That’s my journey, and I share a lot of it with my patients. Indirectly and directly, they find out that I get it. I get where they are. For a physician who treats his patients with the disease that he had is a very unique but tremendous insight that you gain from feeling that. To this day, I read people and I feel what they feel. I just think about my wife. I said, “This is how she felt when she was talking to her doctor.” I see the man who can’t look at you because his sperm count’s abnormal and the head’s facing the door. That devastation … I take it personal. When I hear fertility doctors treating patients as numbers and impersonal … or there was a dropping the ball, as it were, and not making up for it. I take that personal because these patients are fragile, devastated and it’s unfair.

I’ll say this and I know you won’t want to get into the emotions of fertility and dealing with stress and so on, so forth. I really impress upon my patients that you are not defined by your fertility. You’re not defined by being able to procreate. That’s not a talent. That’s not anything that you’ve done. I mean, it’s like bragging that your right-handed. This is nature’s default that we can procreate. Those that have trouble, or anybody as a matter of fact, you’re defined by what type of person you are and how you contribute to this world and make it a better place. I don’t think it’s fair for somebody to base their worth, as it were, on their ability to procreate. That’s a hard thing to grasp because I hear so many things and I’m sure you have is that, “I wanted to be a mother since I was a little girl.” I completely get that. It breaks your heart. Yet, there is a lot of opportunity in life to find fulfillment and if, God forbid, it doesn’t happen the way that you originally wanted, there are things that you can do. That’s my advice.

Amy Medling:

Yeah. Your family is beautiful. I had the opportunity to meet them last September. You’re a blessed man. The empathy that you have for your patients comes across in this book. I’m not really sure where to begin. You’re talking a little bit about the emotional toll. It’s not your fault if you’re dealing with infertility. Maybe let’s start there. It is a very stressful journey. I know my husband and I have suffered with secondary infertility which you talk about in the book. How do you … you become sort of a counselor to your patients in terms of navigating that emotional toll. Maybe you could give our listeners some tips if they’re experiencing that right now.

Dr. Mark Trolice:

I don’t think that the average reproductive endocrinology infertility specialist, they call them REI, right? I don’t think that they typically go into the counseling that I do because I’ll tell you why. At the outset, I ask all my patients, “How are you feeling?” Invariably, they start crying. They said, “You know I’ve been to OB/GYNs; I’ve been to other fertility doctors. No one’s ever asked me how I feel.” You can’t separate the emotional investment from the physical investment. They go hand in hand. This is a fracturing disease.

Coping strategies and stress reduction could help with fertility, but it certainly helps the quality of your life. Are there things that we could do firstly, you said that you didn’t do this and it’s not fair to blame yourself? Of course. Are there things that you can do to abort? Before we went on the air, you talked about SWOT analysis. I came up with this. In business, anyone with a business degree or are in business, knows that when they’re making a business plan, they have a SWOT analysis. Strengths, weaknesses, opportunities, and threats, S-W-O-T.

I came up with this SWAT analysis, S-W-A-T because these four issues or points can impact your fertility, and are, in some way, preventable. In some way. S is for sexually transmitted infections if you have relations with unprotected intercourse and/or with someone that you’re not confident or know very, very well about their potential past or even if you did, there is the potential. A sexually transmitted infection, particularly gonorrhea and chlamydia, can cause damage to the tubes. Something called pelvic inflammatory disease and swollen tubes called hydrosalpinx. That really wreaks havoc. Avoiding sexually transmitted infections is key to realizing … because I call it the silent killer of tubes. Very, very important.

The other one … W, weight. Weight. A big problem with obesity in this country unfortunately, and obesity reduces fertility. Now, like everything, people would say, “Well, I know this woman and she’s very overweight, and she still had a baby.” Well, that’s like saying, “I know this person who smoked. He never got lung cancer.” It’s not 100%, but it doesn’t mean, it doesn’t exist. If you’re coming to see me, we’re going to talk about your weight if there’s an issue. Why, because you’re wasting, you’re not wasting, but you’re taking your time to come to see me. It’s my job to investigate every area that could possibly be contributing to your fertility.

Some women who are significantly overweight actually could get pregnant if they lost. If I could help you get pregnant naturally, you save the money and it’s a win-win. Weight increases miscarriage, reduces fertility up to 25% to 50%. Can cause pregnancy complications, hypertension, diabetes, even birth defects. We’ve got to talk about that. Proper diet and exercise. The Mediterranean Diet, fantastic diet, number one. Then, do your cardio five days a week for 30 minutes. Heart rate up for 30 minutes. You should be sweating after the cardio. Then, two days cross-train for weights that would reduce insulin resistance.

Third is the A. The A stands for age. All women know their biologic clock. I just recorded a presentation for a virtual health fair in the UK. It was all about, “How many eggs are in my basket?” The biologic clock is real. It’s not just for women. When you’re less than 30, your chance of having a pregnancy per month is about one in five. One in five chance on a monthly basis. After about a year, you’re dealing with 90%, 95%. When you’re over 40, your chance on a monthly basis could be in the five plus percent range. That’s a significant drop. Miscarriages increase and you’re dealing with a much more difficult time trying to conceive. After about a year in the early 40s, another 50% of patients will have conceived. It’s not over when you’re getting older, but it just takes longer and it’s a lower overall success. How do we affect the age? Well, years ago, we would try to get pregnant earlier.

Today, if you really know you’re going to delay fertility whether you haven’t found a partner or you’re in school or your career, you can freeze your eggs. Before you take on that egg freezing, you really want to talk to your reproductive endocrinologist to talk about expectations, realistic expectations. What cost are we looking at? What are the success rates? What are the caveats? There’s commercial agencies that really, really push egg freezing. It’s important to know the pros and cons in very exhaustive detail before you take that significant investment because it’s possible you never get pregnant. It’s possible that you never use these eggs. You find a partner, and you get pregnant naturally. You have to think about all these different things.

The last T. The last T. When I was in North Carolina, this was the big T. Tobacco. Cigarette smoking is probably one of the worst things that you can do to stop your fertility. Tobacco use accelerates the loss of your eggs. Women go into menopause sooner. They have higher rates of miscarriage and ectopic pregnancy. If you don’t smoke, please don’t start. If you are smoking, try to remember this. When you’re holding that cigarette and you’re trying to get pregnant, ask yourself one question. What would you rather be holding?

Amy Medling:

That’s powerful.

Dr. Mark Trolice:

Yeah. Every time you reach for that … let me just add one more thing about men. For years, we thought that a man could procreate without any trouble late in their life, up until late in their life. We know, more recently, that men above 40 to 45, somewhere around there, they’re going to have declining fertility. Increasing rates of miscarriage, preterm labor and more. Increase in birth defects and a four to five full higher rate of autism and schizophrenia in the offspring. Men are not excused from the biologic clock, unfortunately. That’s my SWAT analysis.

Amy Medling:

Can I ask you about, when it comes to the T, with the rise of vaping products, would you categorize that in that T-

Dr. Mark Trolice:

Yes.

Absolutely. We just published an article earlier this month in Fertility and Sterility Dialog just about vaping and the hazardous effects on reproduction. Excellent point. Yes, vaping is included. Thank you.

Amy Medling:

The other thing, I remember attending an ASRM conference several years ago. A big study that everybody was talking about was caffeine and fertility. What’s your thoughts on caffeine for men and women that are trying to conceive?

Dr. Mark Trolice:

Yeah. Well, for years, there was a … we were all following the guideline that more than two equivalent cups of caffeine a day, I think that was about 200 milligrams or something like that, can increase the risk of miscarriage. Not fertility, but miscarriage. More recently, there was actually no evidence to support that whatsoever. I think one of the studies showed that it could actually improve. All of you out there who are getting a caffeine headache because you’re trying to stop due to fertility, I don’t have any medical evidence to support that stopping. There’s actually health benefits of caffeine as well. I would be in trouble if I had to stop.

Amy Medling:

Okay.

Dr. Mark Trolice:

I have a t-shirt that, “All I need is coffee and …”

Amy Medling:

Okay. Well, that’s great to clear that up. You mentioned about men and their age. I think that I hear from so many women with PCOS that are so concerned about their fertility. Getting on the PCOS Diva lifestyle in terms of your diet and exercise and all of those lifestyle factors that you had mentioned. What about their partners? Do their husbands need to kind of get on board, too, in terms of lifestyle change? Does that help affect their fertility in a positive way?

Dr. Mark Trolice:

Well, excellent question. I would say that if you have a female factor, like PCOS which is the number one ovulation disorder in women and number one ovulation problem of fertility. PCOS doesn’t excuse the possibility of a sperm analysis problem, male factor, or a tubal problem. I think it was estimated that somewhere around five to 10% of the time you’ll find problems with the fallopian tube and/or sperm. If we see a patient who comes to us for fertility purposes and they have PCOS, we recommend also checking the tubes with a hysterosalpingogram, or HSG, as well as sperm analysis.

Now, sperm analysis is not the best measure of a man’s fertility, but it’s the best thing that we have, I mean, if I just give you a very, very small tutorial about sperm analysis. The World Health Organization changed the criteria in 2010, the fifth edition. There are still clinics that actually use the third edition which are higher value cutoffs and make men think that there’s a problem when there aren’t, so that’s unfortunate. If you’re not seeing a fifth edition sperm analysis from a reproductive lab, you might want to look into another.

The numbers that are somewhat cutoffs, if you will, are not really cutoffs. The way they came up with the sperm analysis is say, for example, you get 100 men who impregnated their partner within the year. They look to the sperm analysis on these men, and 95% of them had numbers at the cutoffs or above. That’s where most men would be with fertility. The lower numbers, the five percent, still impregnated, but, obviously, lesser did that. Lower percentage. Having a lower sperm analysis from count, motion, and shape which is density, motility, and morphology. That doesn’t mean, “Oh my God, I need a sperm donor.” It does show that you’re going to have a lower fertilization potential. When we see a analagous sperm analysis, we send them right to our reproductive specialist who’s a urologist, fellowship trained in andrology.

The man should always … I mean, it’s a partner. If you are in a heterosexual relationship, it’s always a partner evaluation. Lifestyle issues for the man. Well, if he’s smoking, that has been shown to impair fertilization potential as well. Men who are very overweight have lower sperm counts. Men who are hypertensive on a medication called a calcium channel blocker, that reduces significantly fertilization potential.

There are environmental issues that we were talking about before we went on the air. These plastics, the phthalates, these endocrine disrupters that have an impact on male and female hormone resistance. They are ubiquitous. They’re everywhere. It’s unfortunate. Now, because of COVID, people are using more plastics again because of the disposable issues. They’re, unfortunately, everywhere. You just have to be very environmentally conscious as you’re going through these issues.

Of course, the typical men with extremely restricted undergarments are at potential risk of reducing their sperm. Their intensity and motility as well as morphology just because they’re increasing the temperature around the testes. The testes are outside the body. They’re outside with temperature control. When it’s cold, the scrotum contracts and brings it up into the abdomen. When it’s warmer, the scrotal sac hangs a little bit lower, so it doesn’t get too hot. Whereas a woman’s ovaries are a constant temperature intra-abdominally, so the body temperature.

Amy Medling:

You had an interesting call out in your book when you were talking about the environmental factors for men. You mentioned hot tubs, saunas, and cell phones. Maybe you could just expound on that.

Dr. Mark Trolice:

Yeah. I mean, the cell phone and the laptops have always been looked at as potential causes of that. You’ve got your radiation issues as well as the heat from a laptop. I think we have to be guarded in having … there’s definitely potential concern there. Extended sauna and being with tight undergarments and the heat of Jacuzzis and saunas, that definitely can have or can cause issues with the sperm. I tell my male patients when they ask me. I say, “well, how often are you doing it?” “Well, I’m an hour a day.” “Well, that’s probably not a good thing that you’re doing that much heat to the testes for an hour a day.” You really want to limit it. I mean, I think that … I’m sure papers would say the number that would be the cutoff to maybe, but I would just really be infrequent for that.

Then, you talk about alcohol. Excessive alcohol use can impair male and female fertility. Male, we don’t know to the degree. For the female, there was a study in the New England Journal of Medicine that suggested any alcohol could impair fertility. The thing I say to my patients is that, “Well, you could probably have a drink while you’re trying to conceive because probably most children were born through alcohol.” I mean, obviously, not everyone. A little bit of a glass of wine, I think that should be fine. After ovulation, I would hold off on that because you want to avoid alcohol exposure, particularly in early embryo genesis. Any amount of alcohol in pregnancy for the woman is … there is no amount that is safe to risk the, God forbid, fetal alcohol syndrome which is mental retardation and other things.

Amy Medling:

I’ve been getting a lot of questions lately on the PCOS Diva Facebook groups. Specifically, my private Facebook community. There’s a lot of confusion as to who you should go see when you’ve been diagnosed with PCOS and you want to start trying to conceive. Do you stick with your OB/GYN? Do you go see an endocrinologist? You are a reproductive endocrinologist. When do you start thinking about making an appointment with a reproductive endocrinologist? Is it a year after trying to conceive? Maybe you could give us some information.

Dr. Mark Trolice:

The cutoffs on less than 35, we give up to a year. Now, this is as long as there’s no predisposing risk factors. Obviously, if you’ve had chemotherapy or radiation, you’ve had tubal surgery, you had male genital surgery, anything that has the potential impact on fertility, you’re probably going to want to get investigated sooner. In general, I work with regular menstrual cycles and no predisposing risk factors, less than 35, we give it up to a year. 35 to 39, six months. Above 39, three months. Now, that’s not to say that if you keep on going it’s never going to happen. That’s a reasonable guide to wanting an evaluation. With that, the patient who goes to the specialist sooner than later has been shown to have higher and faster success of fertility. This is supported in the medical literature. When should you go see a reproductive endocrinology and fertility specialist? As soon as you hit those marks. Can you go to your OB/GYN first? Sure. In general, based on the OB/GYN, in general, though you are going to have a longer time for evaluation and probably lack of medical evidence based treatment. All right.

Clomiphene citrate or letrozole, these are ovulation inducing medications. The OB/GYN doesn’t have access to IUI in treating intrauterine insemination where you take the sperm and inseminate into the woman. They don’t have access to IUI. They just give the clomiphene citrate and the letrozole out. The problem is that, in the woman who ovulates, that clomiphene or letrozole is fine unmonitored meaning no ultrasounds during the cycle. Ultrasounds at the start of the cycle, yes. During the cycle, unmonitored to that respect, yeah. If you’re not ovulating, use this medicine to ovulate. If you are ovulating, there is no evidence that using this medication is of any value unless you do IUI. In other words, without IUI, your success rate with using clomiphene or letrozole is the same as having…

Amy Medling:

Oh, I didn’t know that.

Dr. Mark Trolice:

Yeah.

Amy Medling:

That’s a good point.

Dr. Mark Trolice:

Right. Yeah. The things is, is that if you are reaching those milestones, a year, six months, three months, be your own advocate. You don’t have to go through your OB/GYN to see a fertility doctor. Who’s the fertility doctor? A Board-certified specialist in reproductive endocrinology and fertility. They have passed all the rigorous testing to ensure that they have the highest confidence in the field of reproductive medicine. That’s what I would advise the patients. To go directly to them, be your own advocate. Direct your own care, and be empowered. Great website for you all is reproductivefacts.org. Reproductivefacts.org. You can get it on the ASRM … a lot about the ASRM, that’s one of the options, ASRM.org, but you need the facts.

Another great website is SART, S-A-R-T.org for patients who are looking into doing in vitro fertilization because they even have a calculator. It’s amazing. They have a calculator that you put your age, you put your weight, you put your pregnancies, your diagnosis, and it gives you your chance of conception based on all the data of the countries pooled. The average statistics after one IVF cycle and all the subsequent embryo transfers from that one cycle or cumulatively with the second cycle or cumulatively with the third. It’s really great. I do it with almost all my patients.

Amy Medling:

Oh, that is fascinating. We’re not going to get into specific fertility treatments for PCOS in this podcast because we covered all of that in episode 118, so check that out. I just wanted to talk a little bit more about your book. I highly recommend it because you really … if you have questions about IVF, if you’re wondering what type of testing, genetic testing, different types of fertility medications, so that you’re just more aware when you go and talk to the doctor that you kind of can speak the same language. I highly recommend this book. The other thing that I really loved about it. I had no idea that there are so many different financing options for fertility treatments. We know that they’re really expensive and insurance doesn’t cover them all the time. You, I think, listed, I don’t know, 18 to 20 different options in your book. Maybe you could just kind of give folks an overview of what is available out there?

Dr. Mark Trolice:

Yeah. Sure. Well, I listed websites where patients can find ways to finance. There are those that have very, very low interest. There’s those that offer packages essentially. In other words, we’ve gotten involved with ARC Fertility where they offer packages of IVF with a percentage refund if not successful. There’s also grants out there for patients. I mean, PCOS Challenge is one of them. Bundle of Joy is another one. I tried to list the sites that are fertility-friendly, that provide you with low-interest loans and that are usually more accepted for fertility patients. I hope that’s of value. When you talk about the financing, it speaks to the injustice of having to self-pay infertility. It’s truly an injustice.

I am working with other advocacy groups in Florida to try to get coverage here. It should be across the country. Patients should not have to beg, borrow, and steal for infertility treatment. It’s a disease like other diseases. I mean, the World Health Organization, the American Medical Association, the American Society of Reproductive Medicine classify it as a disease. Why are we still, in 2020, having patients have to pay $15, $20, $30 for … I mean, it’s just outrageous that this has to be. It’s the worst part of my day when patients ask me how much does this cost? When you’re practicing in a state that doesn’t have mandated infertility coverage, you spend a lot of time, more time often, on the financial aspect of this.

Then, of course, fertility, is in general, even if it was covered, there’s always some investment. Fertility is a physically, emotional, and financial investment. When you’re in a non-mandated state, that financial is huge. I have a lot of problem. I have a lot of problem telling patients that they have to do IVF. If your doctor tells you that you need IVF or you have to do IVF, you really should start thinking about a second opinion because there’s no need and have to. There are always options. Of course, suppose both of your tubes are tied. You need IVF. Well, you can get your tubes reversed. If you have no tubes, yes, IVF is an option, but it’s not 100%. Patients need to know as much as when the treatment is readily available. The fact that you have no tubes, IVF is not a guarantee. What’s another option? Another option is adoption. No matter what the prognosis is, I always talk about options even if it’s not something that the patient originally wanted to talk about or knew about.

I think of infertility as taking the control away from a patient or a couple that should normally have had. The last thing I want to do is tell them what to do on anything.

I’ll never forget when I was doing my Board examination, I was answering the questions on infertility in my oral exam. Then, finally the examiner says, “You don’t normally answer questions, do you?” I went white. I think the blood just rushed out of my head and I was going to pass out. I said, “I’m sorry. I don’t understand.” He said, “Well, every answer I give you, you give me options.” I said, “Yes.” I said, “Because there’s no 100% with fertility treatment.” I mean, it was black and white. I mean, the woman has ovarian failure or, no ovaries or no uterus, or the man has no sperm in the ejaculate. Those are more definite options that you could offer.

I always give options because you want to empower people who feel that they’ve had their control taken from them. Patients will ask me, “What would you do?” I said, “All I can tell you are the statistics of these options and the cost. Then, you have to pray about what’s most comfortable for you and your family.”

Amy Medling:

Well, I think your book is just fantastic because it really educates people before they go into the doctor’s office about what those options are so they can really be able to ask the questions.

Dr. Mark Trolice:

Well, yeah. I think it’s the patient who’s thinking about having a child is the patient who has gone through cycles already, doesn’t know if they want to do IVF or they have gone through this and they’re getting spent emotionally and, unfortunately, financially. I try to cover everything that’s available in reproductive medicine as well as some future technology with genetics. It was done to empower.

Amy Medling:

Exactly.

Dr. Mark Trolice:

The fertility warriors, as they call them. Also, we talk about the third-party reproduction with LGBTQ population using a sperm donation even gestational carrier. Everything that can be available to help loving people and couples build a family is addressed in the book. It’s in a way that is not scientific. I try to really just have a conversation as like I’m talking to my patients while they’re reading it. I just want to make it very non-threatening, easy to understand, and empowering.

Amy Medling:

Just to let everybody know that Dr. Mark Trolice’s book, The Fertility Doctor’s Guide to Overcoming Infertility is available anywhere books are sold- Amazon, Barnes & Noble. Then, Dr. Trolice is also, if you’re looking for somebody to help guide you in your fertility journey and looking for a reproductive endocrinologist, he sees patients all around the world through telemedicine. That is great to know. Maybe you could tell us a little bit more of how to get in contact with you and reach out to you.

Dr. Mark Trolice:

Well, thanks about that, Amy. I appreciate that. Yeah. I’ve been doing telehealth consultations for years. I’m doing them all day on the weekends as well. The website would be theivfcenter.com. You can look at the book and get an appointment there. You don’t have to be an established patient. You don’t have to have a referral. I can do second opinions to review your medical records to be able to do that as a convenience for you and pricing is on the site as well.

I just feel that patients need to hear from credible sources about what’s going on. Very important caveats that we include in the books is to avoid exploitation. I mention that in caveat because unfortunately when you have a non-mandated cash paying patients, there is the potential risk of offering services that are not so evidence based. You have to really be careful about the costs of these. Always second guess your … I don’t want to say second guess. Always question your doctor to be able to understand why you’re doing the things that you’re doing. It should always make sense to you. If not, it’s not your fault. It’s just not being explained properly. If the student’s not doing well, you don’t blame the student. You have to say maybe the student requires a different method of teaching. Well, our responsibility as physicians is to help you understand. If you don’t, then question. If it gets to be difficult for you, then you have to consider another opinion.

Amy Medling:

That’s a great point. Well, I hope that everybody learned a little something from Dr. Trolice today. Again, just definitely check out his podcast number 118 for more specific information as it relates to PCOS and fertility. Thank you so much for coming back onto the PCOS Diva podcast.

Dr. Mark Trolice:

My pleasure, Amy. Any time you want me and need me, I’m always here.

Amy Medling:

Great. Well, thank you everyone for listening. I look forward to being with you again soon. Bye-bye.

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