One of the most important parts of the infertility process is finding a reproductive endocrinologist you trust and who understands your specific case and needs. Today, we’re talking to Dr. Ellen Goldstein and asking her some questions about her own journey to medicine, when she recommends patients find a specialist and how you know you’ve found “The One” when it comes to your fertility doctor.
Did you always want to be a doctor?
DR. GOLDSTEIN: It was definitely an evolution. My father is a physician (he’s a pathologist), and I’ve loved biology and genetics since early in high school, but I kept my mind open and considered careers in biomedical research and genetic counseling as well.
A couple of things from my college years steered me to clinical medicine. Working in a genetics lab in undergrad was mind-numbingly boring for me, and the worst part was a project I did that required me to count how many fruit flies died every two hours in a 24-hour period—including staying up all night to count said dead flies!
I also took an incredible embryology class that merged hardcore laboratory science with social context, namely understanding the lives of individuals with disorders of sexual differentiation. This is a population of patients to whom, as a reproductive endocrinologist, I still provide care to this day. I pride myself on being able to explain and normalize their rare developmental differences to lessen stigma and shame. I realized that I far enjoyed the company of humans over fruit flies!
Was there a particular moment when you decided to specialize in gynecology and reproductive medicine?
DR. GOLDSTEIN: In the hospital, each specialty is really like a herd of animals. You have to fit in with the group, and each specialty attracts very different personalities. In my third year of medical school, the year that we rotate and “try out” different fields, I really felt that I had found my tribe when I rotated on OB-GYN. It was a surprise to me. I jumped out of bed every morning at 4 am to get to work. And when I tried to talk myself out of it, to go into an “easier” field, I felt completely unsettled and would keep coming back to OB-GYN.
What is one of the most frustrating fertility myths you hear?
DR. GOLDSTEIN: “I’m really healthy, therefore I won’t have any issues getting pregnant.”
When do you recommend people seek help from a fertility specialist? Are there any signs people trying to conceive should watch out for?
DR. GOLDSTEIN: You should see an REI (fertility specialist) when you’ve been trying for one year to conceive, or 6 months if you are 35 or over, or if there are any obvious things that concern you.
For any of the following obvious concerning factors, do NOT wait even one moment before scheduling a consultation:
- Irregular periods
- History of endometriosis
- History of pelvic infections, especially chlamydia or pelvic inflammatory disease
- History of pelvic surgeries
- History of chemotherapy or radiation
- Male erectile dysfunction
- Serious chronic illness in either partner
How can patients find the right fertility doctor for them?
DR. GOLDSTEIN: This is an intimate, emotional, arduous journey. You need to feel that your doctor is your partner in seeking the most successful, efficient, cost effective treatment for you. You should feel comfortable confiding all of your concerns.
You should trust your doctor as a wise mentor. It is a lot to ask! But we are highly trained and we should be able to offer you all of this and more. You deserve this kind of relationship. You can ask your doctor questions like, “How will you personalize this treatment for me? Who will do my ultrasounds and procedures—is it always you? How can I reach you for questions?”
What are some questions you usually ask your fertility patients at their first appointment?
DR. GOLDSTEIN: I get a complete medical history for both partners, including information about their careers and their families. I particularly focus on menstrual, gynecologic, and obstetric history as this gives lots of clues as to the etiology of the infertility. I try to get a sense of where they are in their fertility journey to guide how fast or slow to move forward. I might ask them to tell me about their visions for their future family.
On the challenging days, what keeps you going?
DR. GOLDSTEIN: I live and die by how my patients’ treatments are going. My inspiration comes from the strong women I care for who become like family to me. Like many doctors, I keep a folder of notes and baby pictures from dear patients over the years that I can leaf through on tough days. I also like to send emails to pregnant patients just to check in and hear how things are going!
How do you think patients can better advocate for themselves?
DR. GOLDSTEIN: I’m disappointed that we even have to discuss this question! I think patients should vote with their feet—get up and walk to a new practice if you are not happy with the care you are receiving. Ask your friends if they had a good experience with a particular doctor or clinic. Unfortunately, many women don’t speak openly about their fertility journeys, and this includes keeping quiet about both good and bad experiences with physicians.
If there was just one thing you could impart to people on their journey to parenthood, what would it be?
DR. GOLDSTEIN: Sometimes, when times are tough or if we think treatments won’t work, we have to take a step back and look at the big picture. Do you want to be a parent? We are going to get you there, one way or another, even if it’s plan B (an egg donor) or C (a surrogate) or D (adoption). Babies are just balls of love. They don’t know where their DNA came from. If you give them love, they will reflect it back a thousand times brighter.