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Medical Update: A Family Practice That Builds Families

Education Update (EdUp): What brought you to the field of fertility medicine?

Dr. George Kofinas (GK): I was lucky in my curiosity to be guided to this field. When I was finishing medical school in the 1970s, there was no such thing as fertility medicine. It began to form as a sub-specialty within obstetrics and gynecology after the first successful in vitro fertilization (IVF) birth in 1978; around the time I came to the US. And I jumped right in. The emerging science and the surgery were so exciting to me. With that, you could say that I've lived the entire history of fertility medicine - I was there at its conception, I've evolved with the field every step of the way, and I've also had the opportunity to conduct significant research over the decades which has helped us secure better outcomes for patients. It's the most beautiful field in medicine.

Dr. Jason Kofinas (JK): I decided to specialize in fertility medicine because I love helping create human life for people who can't. Every day, I feel like I'm making a difference in someone's life in a very positive and personal way, and through this process, I also get to know my patients very well because we spend so much time together. For me, while the medicine is important, it's not just about tests and procedures. The emotional side to fertility treatment is tremendously important and taking the time to know and support my patients establishes a connection that goes beyond any specific treatment. Also, growing up with my father in this field and with my mother who worked in neonatology was a wonderful introduction, though neither of them ever pressured me to go into medicine or into the fertility field, more specifically.

EdUp: What do you think has been the key to your success?

GK:Well, there are a lot of factors that have contributed to our success. For one, it's our comprehensive approach, which is to always investigate every aspect of a patient's infertility challenges first. It's only after this in-depth investigation that we move forward with a treatment plan. This initial discovery process can be a tedious and time-consuming process that many fertility practitioners don't spend as much time on anymore before proceeding with fertility treatment, but we think it's absolutely essential to optimizing the patient for success from the very beginning. Of course, once you know the source of the problem, you then need the expertise and skillset to address it, and we have the surgical expertise and resources to correct the anatomical problems that cause infertility, such as fibroids and endometriosis. In both these cases, surgery can be complex, and we often see and successfully treat cases that other physicians aren't willing to operate on.

EdUp: What's endometriosis and how does it affect fertility?

JK: Endometriosis is a condition where endometrial tissue is found outside the uterus.  It's a condition that unfortunately goes undiagnosed by many physicians and which many avoid operating on because the surgery is complex and requires a high level of expertise. But this condition is a fertility killer. Many clinics will go right to IVF, but we ask very specific questions that are associated with this condition. We go deep into their history, and if we suspect it, we'll perform a diagnostic, minimally-invasive laparoscopy and remove any lesions we find. We believe that diagnosing and treating endometriosis before IVF is beneficial to the overall success rate of the patient, and this approach has allowed us to have higher fertility success without fertility treatment once the endometriosis is treated.

EdUp: Designing and building this new facility from scratch must have been a huge commitment and undertaking. Why make this investment?

GK: MRSC was built with one important purpose in mind: to enhance every aspect of a patient's surgical experience and optimize her reproductive health. And so, in addition to the convenience of offering patients the full range of advanced fertility treatment capabilities under one roof - including lab testing, examinations, and surgery - we strongly believe that this centralized approach to fertility care will significantly improve patient outcomes beyond what we are already delivering, including shorter post-surgical recovery periods and extremely low infection rates due to the facility's advanced sterilization techniques. It will also be the first standalone reproductive ambulatory surgery center in New York State dedicated to the treatment of patients who suffer from a wide scope of gynecological conditions, including fibroids, endometriosis, pelvic pain, congenital abnormalities of the uterus, and infertility. 

JK: Everything in this facility has been designed around improving patient outcomes and optimizing our ability to serve our patients. This facility has been five years in the planning and building and has been informed by decades of experience. We calculated the space we need and designed it to support the way we work as a team. For example, we designed the operating rooms and the laboratory so that they don't get in the way of each other, but so that we can also work together through pass-through windows. This feature, which doesn't exist at hospitals, is absolutely essential because it will minimize the time that an embryo is outside of the incubator down to around thirty seconds. On top of that, everyone in the facility - from the surgeons to anesthesiologist to nurses to administrative staff - is dedicated to fertility medicine. We all work together every day and operate as a cohesive team.

EdUp: For people considering fertility treatment, what's the most important thing you want them to know?

GK: For any woman who is interested in building a family at some point in her life, I would say the following: consider a family as early as possible to ensure that your eggs are healthy. And if that's not possible now, I'd recommend that they consider freezing their eggs at an earlier age. We've now reached a point with our technology where frozen eggs have the same success rate as fresh eggs, so the benefit of taking action early on and preserving this option is tremendous. Along with advances in technology, which have taken more than twenty years to perfect, the cost of this procedure has also come down considerably, so it is often much more affordable than many women realize.

JK: I think it's important that people see the fertility process as a journey. It can sometimes take time to diagnose and treat an infertility problem, which can be quite frustrating. However, if they are committed to the process, we will eventually know what the cause of their infertility is. This is very important, because understanding what the problem is and why you have to undergo fertility treatment helps people find the strength and patience to go through the process. I spend a lot of time with my patients helping them to understand this because I think it's so important.  

EdUp: What is the biggest misconception that women who are looking to conceive have about the fertility treatment process?

GK: Many women believe that no matter what their age, they can get pregnant, but this isn't true. It is all about the quality of eggs a woman produces, and this quality naturally decreases with age. Again, that's why I recommend, to any woman who wants to have children at some point in her life but who isn't ready yet to freeze her eggs when she is younger to preserve this option.

JK: Many people believe that IVF is a year-long process. I've had some patients go through the whole process in months and others who take a slower approach. So much depends on the individual. Another misconception is that IVF is cost-prohibitive. The cost has come down significantly, even from ten years ago, and the fact is that a lot of insurance companies will now cover a significant portion of the cost, so it's good to investigate what your benefits are before concluding that it's beyond your financial reach. #

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