Latest / Becker’s Healthcare Podcast / The Future of Fertility Care with Dr. Jeff Deaton

Transcript

The Future of Fertility Care with Dr. Jeff Deaton · Becker’s Healthcare Podcast

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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - This is Scott Becker with the Beckers Health
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  - Care Podcast.
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  - We're thrilled today to be joined by a
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  - brilliant, brilliant leader. We're joined today by doctor
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  - Jeffrey Deaton.
• 1:01
  - Doctor Deaton's a reproductive
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  - endocrinologist
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  - at the Wake Forest University School of Medicine,
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  - a brilliant physician.
• 1:08
  - Doctor Deaton, can you tell us a little
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  - bit about yourself and what you do and
• 1:12
  - where you're most focused?
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  - Well, first, thanks so much for having me.
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  - I've been looking forward to talking to you
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  - today.
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  - Yeah. I came out of fellowship. When you
• 1:19
  - do fertility care, you do a fellowship after
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  - residency. And I came out of fellowship many
• 1:23
  - years ago, and I came straight to Wake
• 1:25
  - Forest. It was my first job.
• 1:27
  - And I have been the director of the
• 1:29
  - fertility program here
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  - for the last ten years. I did spend
• 1:32
  - ten years in private practice in the middle
• 1:34
  - of all this, and I came back to
• 1:35
  - Wake Forest. I'm kind of a bit of
• 1:37
  - a funny story. I was at Wake Forest.
• 1:40
  - I ran the division. I went out for
• 1:41
  - chiropractors, came back about ten years ago. And
• 1:44
  - so I just oversee the center for fertility
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  - and reproductive surgery at Wake Forest University. We
• 1:49
  - have a group of physicians and nurse practitioner,
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  - an incredible staff, and we, care for infertility,
• 1:56
  - patients and couples
• 1:58
  - in what we call the Piedmont Triad.
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  - Doctor Deaton, thank you so much for taking
• 2:02
  - the moment to introduce yourself. Before we dig
• 2:05
  - into trends, where you're focused, advice for leaders,
• 2:08
  - take a moment and tell us about your
• 2:10
  - latest book that you authored and and talk
• 2:12
  - about that if you don't mind.
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  - Well, thanks, Scott. I appreciate that.
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  - So I've been doing fertility care for a
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  - long time, and
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  - I've always liked to write. It's one of
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  - my ways
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  - to decompress and to get rid of some
• 2:25
  - stress in my life. I just like to
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  - write. And I've been writing stories for a
• 2:29
  - long time, and I decided to write some
• 2:31
  - favorite infertility stories. And I,
• 2:33
  - came up with about a dozen that were
• 2:35
  - just my some of my favorite of my
• 2:37
  - career.
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  - And then I had a publisher who wanted
• 2:39
  - to publish it, but then he said, you
• 2:40
  - know, you need some science in there too.
• 2:42
  - So then I added science. So the book
• 2:44
  - is called When Waiting Becomes Life,
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  - encouraging stories
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  - from the heart of an infertility doctor. And
• 2:51
  - it has a story,
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  - and then it has little advice. It's a
• 2:55
  - kinda doctor Deaton's prescription. What are you gonna
• 2:56
  - do with the story, the purpose of the
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  - story? And then then there's a chapter on
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  - science and to help you walk through the
• 3:03
  - infertility journey.
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  - And I've just gotten great feedback about it.
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  - I mean, first of all, I'm just
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  - really I'm really proud of it. And,
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  - I've just learned that shame
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  - is a very
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  - big part of what I face with my
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  - practice every day. You know, women
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  - often feel that way, and they shouldn't.
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  - Shame is when you feel like you don't
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  - measure up. And, of course, these women do
• 3:27
  - measure up, but they sometimes feel that way.
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  - And so I've just learned that when you
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  - feel shame about your journey,
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  - you kinda hide and you think you're the
• 3:35
  - only one going through it. And so these
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  - stories have a way of saying, look. You're
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  - not alone. This is what you're going through
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  - is common,
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  - and it kinda, I think, helps the women
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  - and the men,
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  - deal with what they're going through. So thank
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  - you very much. No. I I I love
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  - that. And and it's so true, though, that
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  - I remember our family going through fertility, and
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  - you've got all these issues. Is it you?
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  - Is it me? Who's the problem? What's the
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  - problem? It's the most stressful part of a
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  - young family's life because you're really trying to
• 4:01
  - have children. It's very important to both of
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  - you, and it's incredibly stressful. And there is
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  - a lot of this. Why are we having
• 4:07
  - this trouble when that person got pregnant? So
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  - is it this person or that person? So
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  - I did just love that. Let let me
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  - move you forward, doctor Keith, and I love
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  - that. And we'll ask you again at the
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  - end of the discussion to give us give
• 4:16
  - us one more time the title of the
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  - book. It's called when waiting becomes life
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  - and it's available on all the platforms, Amazon,
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  - When Waiting Becomes Life.
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  - Thank you. And talk to us a little
• 4:28
  - bit about what are some of the trends
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  - in fertility today?
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  - People get pregnant or start to have kids
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  - a little bit later. What are some of
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  - the trends that you're watching in fertility?
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  - What are some of the things you're watching?
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  - It's been really fun to be in this
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  - field because I came out
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  - almost
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  - at the time the first baby was conceived
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  - in this country. So I've kinda grown up
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  - with IVF, and I've noticed that every five
• 4:51
  - to ten years, something major happens. It just
• 4:53
  - changes the field and changes the world.
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  - And there are three things I'm seeing now
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  - that I think I ought to focus on.
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  - There's a lot of things I could talk
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  - about, but there are three trends that I'm
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  - watching right now.
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  - First,
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  - until about fifteen years ago,
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  - we only cared for women or couples who
• 5:11
  - were trying to get pregnant at the time.
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  - Now because of egg freezing, we can actually
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  - care for
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  - women and couples who wanna get pregnant ten
• 5:20
  - years from now, which is a whole new
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  - thought process.
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  - And so egg freezing has totally changed our
• 5:25
  - world and that now we are seeing people
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  - coming to us who wanna get pregnant ten
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  - years from now, and that never happened about
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  - ten years ago. And because of egg freezing,
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  - we're also seeing the LGBTQ
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  - plus population also come out in good numbers
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  - to freeze,
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  - their eggs for future families. So the egg
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  - freezing is one huge trend that is really
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  - changing our field. Now women can focus on
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  - careers,
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  - put eggs aside,
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  - and get to a point in their life
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  - where their careers are fairly stable or set,
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  - and then they can
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  - have their child then.
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  - So egg freezing's been a huge change. That's
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  - number one. Number two, we're seeing coverage by
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  - insurance companies get better every year. When I
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  - came out of fellowship and came to Wake
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  - Forest, there was only one company that covered
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  - in vitro, and that was Wake Forest.
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  - Well, now all these companies, especially the tech
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  - companies, Google, Facebook, they're all covering,
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  - infertility care. Now about 30 companies in our
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  - area cover it, and it gets better every
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  - year. And so coverage is getting better and
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  - better and better as it should.
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  - The final trend I'm seeing is a little
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  - bit futuristic, but,
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  - genetics
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  - is starting to take over our field a
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  - little bit. And so,
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  - we started doing embryo genetic testing
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  - about
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  - ten years ago, pretty widespread.
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  - And now we're learning
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  - more and more genes that cause diseases,
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  - and those can be tested for an embryos.
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  - And I think that's the trend that may
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  - bring
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  - fertile couples out for care because in the
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  - future, not right now, but in the future,
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  - we'll be able to test for all kinds
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  - of things. And then women who don't have
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  - trouble getting pregnant may still wanna come and
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  - have their embryos tested.
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  - So bottom line, because of these trends, you
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  - know,
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  - OB around the country is starting to actually
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  - drop. Our birth rate's dropping as you know.
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  - But infertility
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  - care is
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  - skyrocketing.
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  - And so if I were a health care
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  - system looking at these trends, I would kinda
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  - position my health care system in a way
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  - that we don't just focus on OB, which
• 7:28
  - is a way to kinda get families to
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  - come to the institution, but we focus on
• 7:31
  - before that, getting them pregnant and and make
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  - that a a prime area of our women's
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  - health care.
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  - Love that. And and thank you so much,
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  - doctor Deaton. Let's talk about those three things
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  - just for a moment. The coverage fertility moving
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  - in the right direction,
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  - more and more genetic genetic testing. And at
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  - some point, if genetic test comes out in
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  - a way that somebody doesn't like it to
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  - come out, which might give them concern about
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  - having a baby. At some point, there might
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  - be medicine to change that genetic outcome, not
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  - yet, but at some point, if I heard
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  - you correctly. And then the freezing of eggs,
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  - when people end up putting eggs back in
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  - that they froze five years ago, ten years
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  - ago, Does that create additional complications, or how
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  - does that work?
• 8:13
  - Yeah. Great question. So
• 8:15
  - the female system is fascinating. Of course, you
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  - expect me to say that because I'm a
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  - gynecologist,
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  - but the, the the uterus does not age.
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  - It's kind of amazing. It's an amazing organ.
• 8:25
  - So the uterus every month sheds and kinda
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  - starts over. And so your uterus can carry
• 8:30
  - as well as any uterus in your
• 8:32
  - probably late forties and fifties. It's the egg
• 8:35
  - that's the problem. So if you have a
• 8:36
  - 48 year old egg, your chance of getting
• 8:38
  - pregnant is virtually zero. If your egg was
• 8:40
  - frozen when you were 35 and now you're
• 8:42
  - 48, your pregnancy rate is as good as
• 8:44
  - if you're 35, and the uterus can carry
• 8:47
  - as well as any. Now having said that,
• 8:49
  - there are some things we worry a little
• 8:50
  - bit more about in older women with their
• 8:52
  - first pregnancy, but we haven't talked to our
• 8:55
  - maternal fetal medicine experts. But there are cardiac
• 8:58
  - issues we worry a little bit about. But
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  - I'll be honest, a healthy woman in her
• 9:02
  - mid to late forties that's healthy,
• 9:04
  - actually carries very well, and the uterus
• 9:07
  - doesn't age, like I said.
• 9:09
  - So, yeah, there are a few things to
• 9:10
  - think about, but it's a pretty good way
• 9:12
  - to to have a family later in life
• 9:14
  - if that's what you wanna do. If that's
• 9:15
  - your plan, that's that's that's a good way
• 9:17
  - to do it.
• 9:18
  - Let me ask you another question. It I
• 9:20
  - am told that there's a tremendous shortage of
• 9:22
  - fertility physicians in the in The United States.
• 9:25
  - Is that right? Is there a great shortage
• 9:26
  - of fertility physicians? Or what does that look
• 9:28
  - like?
• 9:29
  - That's correct, actually. And, the ACGME
• 9:32
  - is our organization that kinda oversees fellowship programs.
• 9:35
  - And, currently,
• 9:37
  - the numbers may be a little bit off,
• 9:38
  - so please don't quote me. But there are
• 9:41
  - somewhere between forty two and fifty fellowships in
• 9:44
  - the country.
• 9:45
  - So every year, only about 50 ish come
• 9:48
  - out. Again, my numbers may be a little
• 9:50
  - bit maybe a little bit off. And because
• 9:53
  - infertility is rising so much,
• 9:56
  - there's some ketchup going on. And so you're
• 9:58
  - seeing more fellowship programs being approved every year,
• 10:01
  - which is good. We need to get more
• 10:02
  - people out there trained.
• 10:04
  - In fact, we just started our fellowship this
• 10:05
  - year, one thing I'm really excited about.
• 10:07
  - But so, yeah, there is a shortage,
• 10:09
  - and I think it's going to get fixed,
• 10:11
  - but it's gonna take a while. The ACGME
• 10:13
  - doesn't move quickly with these numbers, and they
• 10:14
  - should not move quickly because, as you know,
• 10:17
  - the pendulum swings. But, yeah, that's the story
• 10:19
  - right now. And and then another question on
• 10:21
  - that, is there an is there a pathway
• 10:23
  - for a gynecologist
• 10:25
  - midwife
• 10:26
  - to become trained to do
• 10:29
  - endocrinology or IVF, or is that something that
• 10:31
  - they can't do if you're already a practicing
• 10:34
  - gynecologist? Or do you have to go back
• 10:35
  - and do a full fellowship?
• 10:37
  - You have to go back and do a
• 10:38
  - fellowship.
• 10:39
  - But a fellas but a person in their
• 10:42
  - mid career, if they decide they wanna do
• 10:44
  - a fellowship, they can. It's it's a hard
• 10:46
  - match, and the match is the you probably
• 10:48
  - know that term. It's a match where Of
• 10:50
  - course. And and it's a hard match if
• 10:52
  - you're in your career in your forties
• 10:55
  - because,
• 10:56
  - obviously, most programs look for those people coming
• 10:58
  - right out of residency. So it's not easy
• 10:59
  - to match.
• 11:00
  - We have a high no match rate in
• 11:02
  - our specialty because it's a very attractive field,
• 11:05
  - and so we get a lot of people
• 11:06
  - who apply.
• 11:07
  - And so you can do it. It's just
• 11:09
  - harder.
• 11:10
  - Talk for a second about so so the
• 11:12
  - three big trends you're watching, the, sort of
• 11:15
  - people getting pregnant a little bit later and
• 11:17
  - freezing eggs to do so, and they're able
• 11:18
  - to carry, god bless,
• 11:20
  - improved coverage, and fasting what you said about
• 11:23
  - Silicon Valley. I remember we had our children
• 11:25
  - through IVF and the the, you know, went
• 11:28
  - through five cycles to have two children, and
• 11:30
  - that was the last one that was covered.
• 11:31
  - So we're thrilled that we finally had children
• 11:33
  - after the the the two children after the
• 11:35
  - fifth cycle, and then the genetic testing. Talk
• 11:38
  - about what you yourself are most focused on
• 11:40
  - and excited about this next six months heading
• 11:42
  - into 2027.
• 11:44
  - Yeah. And I do wanna not correct myself.
• 11:46
  - I do wanna elaborate on a point. I
• 11:48
  - said we aren't doing genetic testing now for
• 11:50
  - diseases. That's not true. It's just only we
• 11:53
  - can only do so much.
• 11:54
  - But, like, for example, if a family has
• 11:56
  - cystic fibrosis or sickle cell, we can screen
• 11:59
  - embryos for that. So we're already doing it.
• 12:01
  - My only point about the genetics is that
• 12:03
  - we're gonna get better and better and better
• 12:05
  - at figuring out what genes cause what diseases.
• 12:08
  - And as we get better and better and
• 12:09
  - better, more people will come out of the
• 12:11
  - woodwork for that testing. But we're doing it
• 12:13
  - now, just to be clear about that.
• 12:15
  - Thank you. And talk about what you're most
• 12:17
  - focused on and excited about going into 2027.
• 12:19
  - Where are you most focused and excited?
• 12:22
  - Well, like, I've already tipped my head about
• 12:24
  - that, but, I was in private practice for
• 12:25
  - ten years, and I just missed the academic
• 12:29
  - environment. I mean, I'm I love academics. I
• 12:32
  - love teaching, and I missed it. And so
• 12:34
  - I came back ten years ago with one
• 12:36
  - goal in mind. Well, not one goal. I
• 12:38
  - had a lot of goals, but one big
• 12:40
  - goal that was to start a fellowship.
• 12:42
  - And it just takes a while. You know,
• 12:44
  - we had some change over in our staff
• 12:45
  - and but finally
• 12:47
  - finally, after many years of wanting this, our
• 12:51
  - first fellow started
• 12:52
  - last month. And so we're really excited about
• 12:54
  - that. So I'm focused on
• 12:57
  - growing these services here.
• 12:59
  - I do like to think about the future
• 13:00
  - and how to position our program for the
• 13:02
  - future, and I'm I'm focused on making our
• 13:04
  - division as good as I can make it
• 13:07
  - and also training the next generation of people.
• 13:10
  - That really excites me.
• 13:12
  - It's fantastic. And you've had this great leadership
• 13:14
  - career,
• 13:15
  - and and you're still very excited about what
• 13:17
  - you do, which is a real gift. Talk
• 13:19
  - a little bit about what advice you'd give
• 13:21
  - to emerging physicians, emerging leaders.
• 13:24
  - Oh, wow. That's a great question.
• 13:27
  - So, you know, first of all, what is
• 13:28
  - a leader? I mean, I think the first
• 13:30
  - thing is how do you define a leader?
• 13:31
  - Well, leaders have followers. And so if you're
• 13:33
  - if you don't have followers, you might wanna
• 13:35
  - be a leader and you might learn to
• 13:37
  - be a leader, but you're actually not a
• 13:38
  - leader. So, yeah, look at those people. I
• 13:40
  - have people following them. Those are the leaders
• 13:41
  - of the world. What I would say to
• 13:43
  - a young leader is,
• 13:45
  - number one, if you want your
• 13:48
  - staff, your people
• 13:50
  - to love and respect you and follow you,
• 13:53
  - you must first love and respect them.
• 13:56
  - Everything flows down from the top. So your
• 13:58
  - job as a leader is to create an
• 14:00
  - environment of of love and respect.
• 14:02
  - And if you do that,
• 14:04
  - they'll follow you.
• 14:05
  - Secondly,
• 14:06
  - always seek new vision.
• 14:08
  - Organizations
• 14:10
  - are either in an incline, a plateau, or
• 14:12
  - a decline.
• 14:13
  - People mistakenly think that when you're plateaued is
• 14:16
  - when you ought to put new vision into
• 14:18
  - your organization, that's actually too late. You wanna
• 14:20
  - put new vision in when you're actually on
• 14:22
  - the incline. So when things are going great,
• 14:23
  - things are happening, you're excited, that's when you
• 14:26
  - think about new vision. So always,
• 14:29
  - as a leader,
• 14:30
  - be trying to develop new vision.
• 14:33
  - Thirdly,
• 14:35
  - in my pretty strong opinion, great things in
• 14:38
  - this world happen because of
• 14:40
  - individuals, not because of committees.
• 14:43
  - Now you have to do the committee work.
• 14:44
  - You have to get people around you that
• 14:46
  - can help you,
• 14:48
  - carry out your vision. They can partner with
• 14:49
  - you.
• 14:50
  - But you're you know, everything rises and falls
• 14:53
  - on leadership. And if you're the leader of
• 14:55
  - an organization or a small group of people,
• 14:57
  - whatever it is, you know, it's important. What
• 15:00
  - you do will dictate how the organization or
• 15:02
  - your group of people go. So get the
• 15:05
  - right people around you to partner, but know
• 15:06
  - that you're
• 15:07
  - important. It'll rise and fall on you and
• 15:10
  - seek new vision.
• 15:11
  - And if I'm talking to a medical person,
• 15:14
  - I would also say, remember in medicine, we
• 15:16
  - have one north star. We don't have two
• 15:18
  - or three. We have one north star. You
• 15:20
  - do what's right for the patient
• 15:22
  - and let the chips fall where they will.
• 15:24
  - And then finally, one more quick thing. I
• 15:25
  - know I said a lot already about that.
• 15:27
  - One more quick thing.
• 15:28
  - Seek out mentors. They don't fall in your
• 15:31
  - lap, and you gotta go find them and
• 15:32
  - ask them to be a mentor. Seek out
• 15:34
  - mentors,
• 15:35
  - especially if you're developing your career
• 15:37
  - and you're younger in your leadership.
• 15:40
  - So just like I I love that, doctor
• 15:42
  - Deaton. And and and what I heard,
• 15:44
  - love, trust, partner, that you you have to
• 15:47
  - partner with people, thrive, thrive. As a leader,
• 15:49
  - you've got to love and trust, but you
• 15:52
  - also are ultimately responsible for the results. So
• 15:54
  - I have to hold people accountable. I I
• 15:56
  - love the point. And at the end of
• 15:57
  - the day, there's one North Star, what's right
• 16:00
  - for the what's right for the patient? What
• 16:02
  - what's right for the patient?
• 16:04
  - And I and I love that that there's
• 16:05
  - not multiple different choices. There's one North Star,
• 16:07
  - what's right for the patient, and finally to
• 16:09
  - seek mentors. I I I love that. We
• 16:12
  - we we love that all. Doctor Dieton, I
• 16:14
  - wanna thank you so much for joining us
• 16:15
  - on the Becker's health care podcast. What a
• 16:17
  - pleasure. What a fascinating field. Congratulations
• 16:20
  - on your role and what you do in
• 16:22
  - the Wake Forest School of Medicine. Just remarkable.
• 16:24
  - Thank you so much for joining us.
• 16:26
  - Well, thank you so much for having me,
• 16:28
  - Scott.