 
|
||||||
              
|
  Local specialists try to balance high-tech aid, old-fashioned care By Gary Rotstein, Post-Gazette Staff Writer The choices are varied for those convinced their goal of parenthood is worth the stress and cost of undergoing high-tech laboratory treatment. Some opt to travel to nationally known fertility clinics that have reported higher success rates than local facilities. Those who choose a local clinic sometimes do so based on referral from their obstetrician-gynecologist, who determines that a patient needs more specialized care from a reproductive endocrinologist. Those specialists receive two to three years of fellowship training in infertility treatment. Patients spending $7,000 and up on a monthly cycle of in vitro fertilization might also pick a site based on a combination of factors: perceptions of a clinic's success, its doctors' reputations for personal care and proximity to the patients' homes, among them. The selection is just one more decision facing patients caught in the daunting maze of infertility treatment. University Womens Health Care Associates, staffed by five reproductive endocrinologists on the faculty of the University of Pittsburgh's School of Medicine, is the oldest and largest of the local programs. While affiliated with Magee-Womens Hospital, where it has offices, most procedures are actually done at a Monroeville location and patients are also seen at a South Hills Village office. The second biggest advanced reproductive program is at Allegheny General Hospital, overseen by Dr. Anthony Wakim, who describes himself as a former infertility patient. St. Clair Hospital began a smaller program in late 1996 headed by Dr. Miguel Marrero, who left The Western Pennsylvania Hospital after establishing an in vitro fertilization center there three years earlier. West Penn has not hired anyone to continue its program. UPMC Shadyside also operated an in vitro program from 1990 to 1993 before abandoning it when the doctor who ran it left. The newest source of high-tech treatment is the private practice in Franklin Park of Dr. Lori-Linell Hall, a reproductive endocrinologist formerly with University Womens Health Care Associates. She began performing in vitro this year using the laboratory of Galen Fertility Institute in Boardman, Ohio. Dr. Carolyn Kubik, director of the infertility program of University Womens Health Care Associates, said Pittsburghers seeking advanced treatment probably have more choices than counterparts in similar-size cities. "Competition is always good," said the former Air Force doctor, a reproductive endocrinologist since 1984. "It puts pressure on all of us to offer a lot more personal care." That issue of too little personal attention and excessive bureaucracy has been a concern for some patients using University Womens Health Care Associates, which initiated 244 advanced treatment cycles in 1995 and expects to do 300 this year. Patients have complained about the difficulty of scheduling appointments and getting answers to their concerns. Kubik said the practice has worked to solve such problems, which she attributed partly to past understaffing of physicians. Two reproductive endocrinologists have been added since last summer. She also said the group has improved its success rates since 1995, when its birth rate of 13 percent for most laboratory treatments was about two-thirds of the national average. The in vitro program, founded in 1982, installed a new laboratory director and equipment in Monroeville last summer. "The numbers indicated we had to evaluate things," Kubik acknowledged. "We had to make changes, and we made them." Success rates reported by AGH have not been much better, but Wakim said he is satisfied the program is offering patients the best care possible. He is skeptical of facilities around the country that report success rates of 40 percent or more in births from procedures. "I can't claim that -- more power to them," Wakim said. He said the three reproductive endocrinologists at AGH will probably perform 240 in vitro-related procedures this year compared to 60 or fewer in the early 1990s. He believes that number proves patients view the program favorably. Marrero moved with his laboratory staff intact from West Penn to St. Clair, pushing a doctrine that patients deserve more attention from their physicians. As St. Clair's only reproductive endocrinologist, he managed all 45 advanced treatment cycles there himself last year, and said he customarily spends two hours with a couple on initial consultation. Hall said, likewise, she entered individual practice seeking "a more hands-on" relationship with those in her care. She said financial incentives lead many physicians to place more emphasis on performing procedures than talking to patients. "The only thing [about infertility treatment] that's not better in this day and age is that with all the technology, we've lost touch with the patient," she said.
|
|||||
