Solving the Mysteries of Infertility
For individuals and families who need help welcoming new life into the world, RMA Marlton advises choosing a clinic that prioritizes safety, innovation, and “360-degree care.”
The majority of American families share the desire to start a family and experience the joy that comes from bringing a son or daughter into the world. For families and individuals who have spent months or even years struggling to realize this dream, however, such joyful moments seem far too elusive, if not impossible.
Some research suggests humankind may be in the midst of “an infertility crisis.” As many as 12 percent of American women of reproductive age have difficulty getting pregnant or carrying a pregnancy to term, according to the U.S. Centers for Disease Control and Prevention. In addition, approximately 9 percent of American men aged 25 to 44 years report seeking out a doctor for advice, testing, or treatment for infertility during their lifetime.
Jason M. Franasiak, M.D., FACOG, HCLD/ALD, has seen a marked increase in the number of individuals and families seeking out his particular area of expertise. As a reproductive endocrinologist who serves as the lead physician and laboratory director at RMA Marlton in South Jersey, Dr. Franasiak has helped hundreds, if not thousands, of individuals and families achieve the goal of starting or building a family.
Since opening its doors in April 2019, RMA Marlton has enabled residents of South Jersey and surrounding areas to stay close to home when seeking solutions to their infertility issues. In addition to IVF cycles, egg retrievals, and embryo transfers, the clinic’s in-house embryology and andrology laboratory provides preimplantation genetic testing of blastocysts—embryos aged five to six days after fertilization—to test embryos for specific genetic disorders, as well as screening to ensure the embryo has the correct number of chromosomes. The center also has the capability to perform male-related procedures, such as sperm retrieval for use in IVF treatment.
RMA Marlton, one of 10 fertility clinics that comprise RMA New Jersey, is part of IVI-RMA Network, a global organization whose reach extends across the country and around the world. In other words, every RMA clinic benefits from the resources of the collective, including the wisdom and expertise of a team of more than 500 physicians, embryologists, and researchers.
We recently spoke with Dr. Franasiak about how those who have had trouble conceiving can identify a capable provider to address their specific challenges. He shared his perspective on the questions patients should ask of prospective fertility clinics, the benchmarks they should consider when determining a clinic’s ability to deliver a positive result, and other criteria to keep in mind when trying to decide which fertility providers are most capable of helping them realize the dream of becoming parents.
Q&A
Tell me about the challenges patients who struggle with infertility go through and how those challenges may be overcome.
Historically, the human process of reproduction has been very inefficient. Normal fecundity, which is the clinical term for the chance of pregnancy per menstrual cycle, meaning when everything is working appropriately—egg, sperm, fallopian tubes, uterus, etc.—is only 20 percent. When someone comes to somewhere like RMA Marlton who meets the definition of infertility, fecundity is maybe 4 percent. There are various things we can do to improve that number. In vitro fertilization (IVF) is among them, but that, too, has had its share of inefficiency in the past. It’s an intense process, with patients having to undergo a fair amount of work—financially, emotionally, and physically—to get embryos ready for implantation. In the past, to overcome this inefficiency, clinics have transferred more than one embryo, and sometimes as many as three to five at a time. This increases the likelihood of having a pregnancy but also greatly increases the rate of multiple pregnancies which also increases the likelihood of other complications.
Tell me about the challenges patients who struggle with infertility go through and how those challenges may be overcome.
Historically, the human process of reproduction has been very inefficient. Normal fecundity, which is the clinical term for the chance of pregnancy per menstrual cycle, meaning when everything is working appropriately—egg, sperm, fallopian tubes, uterus, etc.—is only 20 percent. When someone comes to somewhere like RMA Marlton who meets the definition of infertility, fecundity is maybe 4 percent. There are various things we can do to improve that number. In vitro fertilization (IVF) is among them, but that, too, has had its share of inefficiency in the past. It’s an intense process, with patients having to undergo a fair amount of work—financially, emotionally, and physically—to get embryos ready for implantation. In the past, to overcome this inefficiency, clinics have transferred more than one embryo, and sometimes as many as three to five at a time. This increases the likelihood of having a pregnancy but also greatly increases the rate of multiple pregnancies which also increases the likelihood of other complications.
Because of the research, we’ve been doing and the expertise we have acquired throughout the years, IVF has gotten a lot better and more precise. We now have tools like the preimplantation genetic testing of embryos, enabling us to transfer far fewer embryos. Since 2021, we have transitioned to transferring only one embryo at a time, which has allowed for a much higher likelihood of a healthy singleton pregnancy. As a result of these kinds of advances, patients are seeing higher rates of full-term pregnancies, babies with normal birth weights, and a lower risk of babies needing long stays in the NICU (neonatal intensive care unit).
When people are considering a fertility clinic, what questions should they be asking when interviewing prospective clinics?
There are two important questions that need to be asked to glean the answers they need to make a decision. The first one is: “How successful is the clinic at achieving pregnancy?” Interestingly, the field of reproductive medicine is unique in that it is one of the few medical specialties required to report its outcomes. Those outcomes are available for patients to review through resources such as the Society for Assisted Reproductive Technology (SART). Patients can go on the SART website, www.sart.org, and see a clinic’s success rate in achieving pregnancy based on patient outcomes. The second question, which is not as intuitive, is: “How likely is the clinic to help me achieve my goal, meaning how likely is the clinic to help me have a safe, healthy, and full-term pregnancy?”
There are two important questions that need to be asked to glean the answers they need to make a decision. The first one is: “How successful is the clinic at achieving pregnancy?” Interestingly, the field of reproductive medicine is unique in that it is one of the few medical specialties required to report its outcomes. Those outcomes are available for patients to review through resources such as the Society for Assisted Reproductive Technology (SART). Patients can go on the SART website, www.sart.org, and see a clinic’s success rate in achieving pregnancy based on patient outcomes. The second question, which is not as intuitive, is: “How likely is the clinic to help me achieve my goal, meaning how likely is the clinic to help me have a safe, healthy, and full-term pregnancy?”
Metrics such as pre-term births and NICU rates may not necessarily be available through SART, but you can get information on a clinic’s percentage of singleton births. SART will also tell you the mean number of embryos transferred; it’s important to look for those that are close to one. SART will also tell you whether or not the clinic has a high reporting rate. It’s important to choose a clinic with a high SART rating; for example, RMA Marlton has a Platinum score for 90 percent or higher reporting. All that research is helpful when you’re checking the background of different clinics. Still, it’s important to ask good follow-up questions when you’re sitting down with a provider to find out if a particular clinic is capable of providing a good outcome safely.
You’ve specified safe outcomes. What kind of safety checks should individuals and families look for from a fertility clinic they might be considering?
Safety is everything, and it begins with adopting treatment measures based on evidence-based research. In terms of quality checks, we have several mechanisms in place, including those that utilize our EMR (electronic medical records) system, Artemis. We also have a patient portal where patients can provide feedback in real-time. Every time a patient has an interaction with someone on our team or our organization, they have the opportunity to provide feedback. That allows us to keep a finger on the pulse, so if there is any miscommunication along the way, we can work to amend the issue very quickly.
Safety is everything, and it begins with adopting treatment measures based on evidence-based research. In terms of quality checks, we have several mechanisms in place, including those that utilize our EMR (electronic medical records) system, Artemis. We also have a patient portal where patients can provide feedback in real-time. Every time a patient has an interaction with someone on our team or our organization, they have the opportunity to provide feedback. That allows us to keep a finger on the pulse, so if there is any miscommunication along the way, we can work to amend the issue very quickly.
What designations, achievements, and resources are important when vetting prospective clinics?
One of the things that’s important to understand is whether or not the clinic is tapped into an innovation pipeline. Is the clinic involved in ongoing research aimed at improving a patient’s chance of success and providing safe outcomes? Do they participate in clinical trials that are published in peer-reviewed journals to make sure the research they’re doing is vetted and worthy of publication? Are they presenting their research at national conferences?
RMA is very active in cutting-edge research, and it presents at multiple national conferences and international conferences every year. Many folks in our clinic are involved in various research studies aimed at male and female infertility. We also present every year at the American Society for Reproductive Medicine conference. We have had several trials published recently in peer-reviewed journals, including Fertility and Sterility, the leading journal in our field.
One of the things that’s important to understand is whether or not the clinic is tapped into an innovation pipeline. Is the clinic involved in ongoing research aimed at improving a patient’s chance of success and providing safe outcomes? Do they participate in clinical trials that are published in peer-reviewed journals to make sure the research they’re doing is vetted and worthy of publication? Are they presenting their research at national conferences?
RMA is very active in cutting-edge research, and it presents at multiple national conferences and international conferences every year. Many folks in our clinic are involved in various research studies aimed at male and female infertility. We also present every year at the American Society for Reproductive Medicine conference. We have had several trials published recently in peer-reviewed journals, including Fertility and Sterility, the leading journal in our field.
No one goes through infertility troubles alone. What should people look for in terms of supplemental resources and services to assist them in their journey?
A fertility journey is much more than just a medical diagnosis. That’s why we think it’s important to provide patients with an immense amount of support, not only from a clinical perspective but also to help them through other aspects of their journey. All patients have a provider team that consists of a physician, a nurse, and a financial coordinator, and that team remains with them throughout the process. Patients also have access to a patient navigator, a team member designed to guide patients through any questions about the next steps or if they need additional resources along the way. We know a patient’s overall health, including their mental and emotional health, can have an impact on success rates and outcomes. That’s why our patients have additional support from team members that include licensed counselors, registered dieticians, and acupuncturists.
A fertility journey is much more than just a medical diagnosis. That’s why we think it’s important to provide patients with an immense amount of support, not only from a clinical perspective but also to help them through other aspects of their journey. All patients have a provider team that consists of a physician, a nurse, and a financial coordinator, and that team remains with them throughout the process. Patients also have access to a patient navigator, a team member designed to guide patients through any questions about the next steps or if they need additional resources along the way. We know a patient’s overall health, including their mental and emotional health, can have an impact on success rates and outcomes. That’s why our patients have additional support from team members that include licensed counselors, registered dieticians, and acupuncturists.
We also help patients connect with other people who are in a similar situation through resources that extend beyond the walls of RMA. There’s a fairly significant support network in place, including FertiliFriends, a private Facebook group started by a former RMA patient, Resolve.org, and many other groups out there. Our goal is to provide 360-degree care because that’s what we think people need and deserve when they’re in the process of building a family.
For more information on RMA Marlton, visit rmanetwork.com or call (856) 267-8100.
Photograph by Alison Dunlap
Published (and copyrighted) in Suburban Life magazine, February 2022.
