Dr. Fady Sharara: From Boutique Care to AI Embryos: How VCRM Puts Patients First

Episode Transcript

SPEAKER_00 (00:00):
My name is Fadi Sharara.

(00:01):
I'm a fertility doctor, and myoffice is called Virginia Center
for Reproductive Medicine.
It's in Reston, Virginia, andwe've been open for twenty-thers
now.

SPEAKER_01 (00:16):
Wow, that's amazing.
You've been around for a whilenow.

SPEAKER_00 (00:19):
Right.

SPEAKER_01 (00:20):
So now take me back to how you got started in all of
this.
Tell me how you got to where youare today.

SPEAKER_00 (00:27):
So in med school, I wasn't sure what I wanted to do.
I was between OBGYN andcardiology.
And so I came to Georgetown in1985 and spent four months
taking electrose.
So I took cardiology first and Isaid, okay, maybe this is not
what I wanted to do.

(00:48):
And then I did a month ofhigh-risk obstetrics, and I
liked the OB part, but not tomake it a career.
And then reproductive endocrineor infertility was a brand new
specialty.
The first pregnancy in the worldwas in 1979.
The first pregnancy in the USwas 1981.
So it was still brand new.
And the first day I starteddoing that elective, I knew this

(01:12):
was my calling.

SPEAKER_01 (01:14):
Wow.

SPEAKER_00 (01:14):
And so I spent two months doing this, then went
back, finished my MD, then wentinto OBGYN residency at GW, and
then went to the NIH for athree-year fellowship.
And I've been, I spent eightyears in six years in academics,
and then said I need to do myown thing.
And this is when I opened mypractice.

SPEAKER_01 (01:36):
Wow.
You were definitely a banner onthe walk.
You knew it was definitely foryou.
That's awesome.
So you said that helping couplesachieve parenthood is one of the
most meaningful callings inmedicine.
What core values drive your workevery day?

SPEAKER_00 (01:51):
Every day is new.
Every patient, every couple isnew, every couple is different.
No two people have the sameissue.
And people struggle with this.
And infertility has become moreand more and more prevalent for
multiple reasons.
The biggest one is women waitinglonger to have children, waiting
longer to get married.
Even people who get married intheir 20s usually say, Oh, I

(02:14):
want to wait a little bit.
My career is first.
I need and the big thing thatmost women don't understand is
they have a finite number ofeggs.
They're born with about 1.2million eggs.
By the time they get their firstperiod, they're down to about
450,000.

(02:34):
And these eggs are lost everysingle month at a rate of about
a thousand every month, whetheryou're pregnant, asleep,
traveling, you lose these eggs.
By about age 37, you start theloss becomes even more
accelerated.
You lose about 1,500 eggs aboutage 37.

(02:54):
So that's why women go throughsomething called menopause when
they don't have any eggs left.
But this attrition of eggs isvery different from woman to
woman.
Not every woman lose at the samerate.
Some of them lose at a fasterrate than others.
And things like smoking, drugs,drinking, genetics make a huge

(03:16):
difference in terms of thisacceleration and this loss of
eggs.

SPEAKER_01 (03:23):
Awesome.
Seems like a lot of factorsreally go into it.
Things we don't even think aboutfrom day to day.
For sure.
What does compassionate,patient-centered fertility care
look like at Virginia Center forReproductive Medicine?

SPEAKER_00 (03:39):
As I said, every couple is unique.
And this is the only field inmedicine where you just don't
worry about one person, you'retreating a couple.
So if you have high cholesterol,you go to the doc and you
address this.
If you have, if your knee ishurting, you see an orthopedic
and you do this.
This is very different.

(03:59):
You go as a couple.
Because it's if you take 100,000couples, about the problem is
the man in about 40%, it's thefemale in about 40%, and the
combination of factors from bothin about 20%.
So it takes two to tango.
And if you could be in perfectshape, but if your partner has

(04:20):
no sperm or very poor sperm,then your chances of getting
pregnant are obviously extremelylow.
So you have to do what's calledthe infertility investigation.
And this is why every couple isdifferent.
You have to do the testing, andthen depends on what the problem
is, you treat that problem.
So people come in the first atthe first appointment thinking

(04:42):
that, oh, I'm just going to lookat them and it's like, okay,
this is what's wrong with you,and this is what we're going to
do.
But no, people have to undergothis fertility workup to make
sure there are no otherproblems.
Many couples have what's calledunexplained infertility, and
that's about 10 to 20% of caseswhere it could be endometriosis,

(05:04):
it could be other things.
You do the workup and you reallydon't find anything majorly
wrong.
But you know something is notright because they're not able
to get pregnant.
So you treat them as such.
So 15, 20 years ago, we used todo a laparoscopy on every woman
to try to look for somethingcalled endometriosis.
And we used to findendometriosis in about 40% of

(05:26):
women.
But now we just don't do thatanymore.
Even if they have what's calledendometriomas or chocolate cysts
in the ovaries, we try not tooperate on these women and then
move forward with treatment.
The big thing with operation iswhen they remove these
endometriomas or chocolatecysts, many women lose

(05:47):
significant ovarian reserve.
So that's that's why treatingcouples is very, very different.
So the way at VCRM we look atthis is completely unique.
Every couple is different.
I tell them don't look at yourfriends because they may have a
completely different issue.
What there's one of you, everywoman is unique, every man is

(06:10):
unique, and their situation isalso unique.

SPEAKER_01 (06:14):
Right.
Everybody's just a littledifferent.
Everybody's different.
I like the point you made aboutwhen people ask their friends or
this is very common.

SPEAKER_00 (06:21):
I hear I hear this all the time.
I tell them, please don't askyour friends, don't go on the
internet.
The internet is a double-edgedsword.
The biggest disaster is for anon-medical person go on Google
to get medical informationbecause they don't understand
what this means and say, oh, Iread this on Google, or I read
this on Reddit, or this coupleon Reddit was saying this is

(06:43):
their problem.
That more than likely has nobearing on your situation.

SPEAKER_01 (06:50):
Exactly.
Sad.
Founding VCRM was a majormilestone.
What vision did you have for thecenter when you started it?
And how has it evolved over theyears?

SPEAKER_00 (07:01):
That's an excellent question.
So I opened the center to treatif I was the patient, what would
I be looking for?
Because now medicine has becomecompletely corporate.
You go to see your dog, you maynot even see your doctor now.
You may see a nursepractitioner, you may see
somebody, or you may go to apractice where there are 25, 30

(07:25):
different docs and you don'thave a physician.
Every time you go, it's somebodyelse.
Sadly, this is the situation ofmedicine, not just in
infertility, but probably acrossmany medical specialties at this
point.
So this personal care has or isdisappearing.
And some people say what Ipractice is I'm like a dinosaur,

(07:47):
but it's not.
Infertility is such a personalproblem.
And unlike other things, youdon't go, if you have a
headache, you go to the storeand you buy Tylenol or Advil and
you'll be fine.
This is completely different.
The diagnosis of infertility forsome couples is like somebody
telling them you have cancer.
This is how bad they reallythink.

(08:07):
And they struggle with this,especially the women.
For many men, they don'tunderstand that women have
what's called a biologicalclock.
They hear it loud and clear.
And for most men, they'recompletely oblivious to what's
going on.
But women do understand thisissue.
So they feel they have thiswindow whereby they need to come

(08:29):
in and try to have children.
Sadly, the mean age of mypatients is 40 and a half.
So I don't see women in their20s.
They just don't come.
One, most of them are notmarried.
Two, if they're married, they'renot interested in having
children right now.
I see a lot of women in theirlate 30s, early, mid, late 40s.

(08:49):
And for many of those, it's gameover.
They need to look at otheralternatives.
So by the the chance of gettingpregnant from IVF at 44 is 1%.
Having a child.
By 45, it's practically zero.
46, 47.
If you're calling our practice,we tell you if you're not coming

(09:11):
to do egg donation, we're notgoing to see you because your
chance is zero on your own atthis point.
That said, unless you've hadfive, seven, ten children
before, by the if you've neverhad children and you're 46,
you're looking at probably anegg donation at that point.
So time is critical.
Do not wait.

(09:32):
And one of the things we were,one of the first program in the
DC area to open an egg freezingclinic in 2003.
And I knew this was going to behuge because women are waiting.
And thank God now there's enoughawareness about this egg
freezing thing.
So you're young, you're notmarried, you don't have a

(09:54):
significant other, you'restarting to become 32, 33.
It's something I think thateveryone needs to consider.
The biggest mistake that mypatients tell me is not freezing
their eggs before.
They come in at 41, 42, it'sjust too late.
The quality, what happens inwomen, the quality of the eggs

(10:14):
deteriorates markedly as youage.

So look at it this way (10:18):
100 years ago, if you go talk to
your grandmother, for example,she's going to tell you she had
her kids at 18, 19, early 20s.
By the time they were in theirlate 20s, they're done having
children.
Extremely unlikely for somebodyin your grandparents' generation
to tell you they had kids at 34,35.

(10:39):
This didn't happen.
A hundred years ago, most of usused to be dead by the time
we're 40.
Now we're living much longer.
Women are spending at least athird of their lives after
menopause.
If you're not ready to havechildren and you're in your late
20s, early 30s, you really needto start thinking seriously

(11:00):
about freezing your eggs.
You may never use them, but Ipredict that, I mean, now about
14% of people who freeze theireggs come to use them, and this
number will only increase.

SPEAKER_01 (11:12):
So what you're saying is it's definitely a good
thing to put some thought towhen you're young.

SPEAKER_00 (11:16):
Correct.
Yeah.
But we tell patients this is notan insurance policy because
freezing eggs does not mean thesame thing as freezing embryos.
For example, you need 24 matureeggs that are frozen to have
about a 94% chance at having atleast one child.
So this is not a small number.
So if you have diminishedovarian reserve and you only

(11:39):
make five, six eggs that arefrozen, you really need to
freeze much more because I'vehad many patients that only
froze six or ten eggs, and theysome many of them do not even
make a single embryo to be eventested.
So the more you have, the betterit is.

SPEAKER_01 (11:57):
That's really interesting.
How do you foster collaborationbetween physicians,
embryologists, and staff toensure every patient receives
seamless care?

SPEAKER_00 (12:06):
Excellent.
So it starts with yourphilosophy for the center.
Okay.
So we are a boutique practice.
We handhold our patients.
When patients come in, they weknow them by their names.
Uh they come in, they feel it'slike cheers.
You walk in the bar and then,hey Norm, everybody knows your
name.
Okay.
Uh this is how it is for us.

(12:27):
Um, so that philosophytranslates into very close
collaboration between thephysician, the embryologist, the
nurses, the staff.
So we're a small practice for areason, and everybody
communicates constantlythroughout the day.
So nothing falls through thecracks.

(12:47):
The nurses know who the patientsare, the staff knows who the
patients are, the embryologistsknow who the patients are.
So this is really, reallycritical.
So it's not, even for theembryologists, it's not this,
okay, you know, this person,they have no idea who that
person is.
They review the records, theyknow what's going on, the
stimulation cycle, or if theyneed to have, like, for example,

(13:09):
insemination, they know what'sgoing on.
So it's continuouscollaboration.
And that's the way to make surethat nothing falls through the
cracks and no mistakes happen.

SPEAKER_01 (13:22):
Teamwork makes the dream work, right?

SPEAKER_00 (13:24):
That's the whole thing.
I mean, we, you know, our mottois making dreams a reality.
And when patients come in, wewant them to trust us with their
care.
And we want them to listen towhat we're telling them because
we have their interest at heart.
We're not here about the money.
We're not here.
We, you know, we are here tohelp you have a child.

SPEAKER_01 (13:47):
That's wonderful.
Fertility treatment can bedeeply emotional.
How do you and your team createan environment of hope and trust
for your patients?

SPEAKER_00 (13:57):
Excellent question.
This is, as I told you before,for some women, they feel this
is a cancer diagnosis.
So we're here to, and I tellthem, we're your cheerleaders.
You're not on your own in thisjourney, okay?
Because many women feel alone.
As I told you, the men sometimesjust don't get how emotional
this whole thing is.
And we tell them, we're on thisroller coaster with you.

(14:19):
We have our highs, we have ourlows.
When things don't work, they'redown.
And the key is to keep themoptimistic, keep them positive.
There's always something that wecan do to get them to where they
need to go.
So we obviously offer thememotional support, we offer them
moral support.
There are there, and if theyneed something more, there are

(14:42):
professional people we referthem to that they can discuss
this issue with that can helpthem through this journey.
I mean, this is not an easyjourney.
And when people do this, weactually strongly recommend that
the husband also gets involvedwith this.
There's uh uh there's one calledOrganic Conceptions, we refer

(15:02):
our patients to.
And it's a multi-step programthat couples have to go through.
And I really think it helps themtremendously to go through this
pretty difficult journey.
But the end of the journey isamazing.
When it works and they have achild, they forget all the bad

(15:23):
things that they've gonethrough.
It's an amazing thing.
I mean, it's uh when patientshave a kid, it's totally
different than going to yourdermatologist and they tell you,
okay, you know, take that creamand you're gonna look better and
feel better.
Afterwards, you're not gonna go,you're not gonna hug them,
you're not gonna feel you owethem something.
This is an amazing thing becauseyou are helping them have

(15:44):
something that they areliterally dying to have.
It's extremely rewarding when itworks.
And and for me, this is thehappiest moment when they
patients come in and they bringtheir children.

SPEAKER_01 (15:58):
Such a magical moment to be able to see it come
full circle.

SPEAKER_00 (16:01):
If you come around Christmas, you see the whole
office filled with Christmascards from babies that that
we've had.
And it's for me, this is thehappiest time of year.

SPEAKER_01 (16:12):
I love that.
What are some of the mostexciting advancements in
assisted reproductive technologythat you believe will transform
patient care in the comingyears?

SPEAKER_00 (16:24):
So it has already transformed substantially over
the past 20 years.
So early on, I remember when thesuccess rates used to be in the
20s, 20%, 25%.
And we were putting three, four,five embryos routinely into
people and just with the hopethat patients would get

(16:45):
pregnant.
Some of these would get pregnantand then have a miscarriage
afterwards.
In my opinion, the biggestadvancement has been the
introduction of genetic testingof the embryos over the past,
let's say, it's been aroundsince 1991, but PGS, PGTA.3, so
PGS3.
So their latest advancement overthe past probably 10 years now

(17:08):
have made a humongousdifference.
We're at a point where, becausemost of my patients are older,
so when they get pregnant, theyhave at least anywhere between
15 and 30% chance at losing thatpregnancy.
And most of these pregnanciesare lost because they're
genetically not normal.
So now we have the ability totest the embryos before we

(17:31):
transfer back into the woman.
And we transfer one for 97% ofour patients at this point.
And we check, so if it's anormal boy, normal girl, and
some patients come in to dogender selection.
We can talk about this a littlebit later.
But the fact that we cantransfer a single tested embryo

(17:51):
substantially decreases thechances of a miscarriage and
increase the chance of themtaking home a baby.
Patients want to get pregnantfrom the first attempt if they
can.
The biggest thing that I startednoticing about seven, eight
years ago, patients are comingin and their biggest fear is a
miscarriage.

(18:11):
So they don't want to miscarry.
It's such a traumatic event thatnobody wants to go through.
So that by testing the embryosand transferring a genetically
tested embryo, we significantlydiminish the chance of a
pregnancy loss happening.
So this is a huge, hugeadvancement.
There are other things we're allwaiting.

(18:33):
So the chance of a pregnancywhen you transfer a single
tested embryo could be as highas about 70%.
Okay.
But that means even when you'retransferring a single, perfectly
normal embryo, the chance of apregnancy not happening is still
about 30% at least.
This is what we still don'tunderstand.
This last big box.

(18:53):
You're transferring agenetically normal embryo into
what's supposed to be a niceendometrium, a nice uterus, and
the pregnancy still doesn'thappen.
We just tell patient, stay thecourse.
Okay.
So we're introducing now AI intothis.
So AI is obviously the sexiestthing.
Everybody talks about this.

(19:14):
So we're in the process actuallyon uh tomorrow, they're coming
in to install a brand new,what's called time-lapse to
allow the embryos to grow undercontinuous observation.
So there's a camera on top ofwhere the embryos grow that
takes pictures every fiveminutes.
And this, and then it's linkedto an AI software that gives us

(19:39):
the ability to differentiateeven between two perfectly
looking normal embryos, whichone to transfer first.
So we're into the age of AI, andwe're joining the age of AI
tomorrow.
So this is something that I amextremely excited about.

(19:59):
I really think this is going tomake a difference and hopefully
may increase that you know 70%chance to even a little bit
higher.
It's just uh it's just thelogical thing to go to.
Technology is at this point.
There are new advancements.
Hopefully, in about maybe fiveto ten years, we can grow eggs
for women who are in menopauseor don't have enough eggs.

(20:22):
For men who don't have sperm,maybe grow sperm for them.
So at this point, this is allexperimental, but do I see this
a reality in about maybe another10-15 years?
Very possibly.
So at that point, because nowfor these women who are older,
they need to get eggs from anegg donor before.

(20:44):
And so maybe now they don't haveto do this anymore.
So we'll see.
That's definitely an excitingthing down the road.

SPEAKER_01 (20:51):
Got it.
That's so fascinating.
Just the advancements intechnology today and what they
can do.

SPEAKER_00 (20:56):
Incredible.
I mean, thank God for the recentadvancements in IT and other
things.
So these ultimately trickle downinto what we do.
For ultrasounds are better now,the imaging is better, but this
is the advancement in the lab.
There may be, you know, totallywhat's called automated labs for

(21:17):
IVF, where you go in, you don'tneed to have two, three people
manning your IVF lab.
You can do it with just oneperson where robots would go and
they do the procedures, they getthe eggs, they actually get to
the point of freezing the eggs,and all you have to do is or the
embryos, and then you just dropthem in liquid nitrogen.

(21:46):
Do I see this becoming a realityin another 10 years?
Very possibly.

SPEAKER_01 (21:51):
That is super interesting.
When patients think of theVirginia Center for Reproductive
Medicine, what's the one thingyou want them to remember about
their experience?

SPEAKER_00 (22:03):
Personalized care.
We're a boutique practice for areason.
If they want to go to Walmart,you want to go to Walmart, or
you want to go to Neiman Marcus,for example, or Sachs.
This is what we try todifferentiate ourselves from.
If you want to go to a dog whoreally knows what's happening
with you, or you want to go to acenter where you're just it's a

(22:25):
factory and you're just likeeverybody else in this factory.
If people don't know any better,they assume that all centers are
this way.
Sadly, patients find me afterthey fail.
So we tell them do your researchbeforehand.
I mean, the internet isavailable for everybody.
Go look before you jump.

(22:46):
Even if you have a your doctoris recommending one center
versus another, still do yourhomework.
Go to the one where you feelcomfortable.
You may like and be perfectlyfine with the with the factory
approach.
There's nothing wrong with that.
The factory does a good job.
But if you are a patient thatneeds more attention, that have

(23:07):
a problem that's a little bittrickier, that you need answers
to, that you want to sit downand talk to your doctor and try
to understand what's reallyhappening with you, then look
more.
Do your research.
So we are a boutique practicefor a reason.
Because we think we do a betterjob at taking care of our

(23:29):
patients.

SPEAKER_01 (23:30):
And just kind of getting that unique personalized
experience.

SPEAKER_00 (23:33):
So we've been practicing personalized
medicine.
So the sexy thing has been foryears, over the past maybe five
to ten, personalized medicine,personalized medicine.
We've been practicing this fromday one at VCRM.
Everybody is different and theircase is different, and how we
approach them is different, howwe handle them is different.

(23:55):
Most of our patients are, bycoming from other centers, are
amazed at when they come at howeverything is so different than
their prior experience.
They think everybody is like thefirst experience they had, and
it's not.

SPEAKER_01 (24:12):
That's amazing.
So as we wrap up, is thereanything you'd like to add that
I haven't touched on today?

SPEAKER_00 (24:20):
I think you've you've addressed a lot of
things, but I will tell womenout there, do not wait.
Don't, you know, many OBGYNsthat they see are so busy, they
don't have the time to sit downand talk to them about things.
If you're a 27-year-old andsomething is not right, you feel
your periods are off, you'rejust not getting the answers

(24:42):
from your OBGYN, come and seeus.
There may be something moreserious going on.
I've seen women in their early20s start to lose their ovarian
reserve.
I've seen many people,especially over the past three,
four years, I'm seeing moreyoung women coming in with
diminished ovarian reserve.

(25:02):
We don't know why this ishappening.
We're actually, you know,looking at data now, try to
figure out uh what's going on.
But this is a real phenomenon.
We are seeing it right now.
So don't assume because you're29 years old that everything is
perfectly fine.
You can come in, you can do atest, and that will tell you if

(25:22):
you're fine or not.
That at least would, you know,if you're fine, you can take a
deep breath and say, okay, youknow what?
I can wait a year or two orthree, and if I'm not married, I
can come and freeze my eggsthen.
But women lose this ovarianreserve at different speeds.
So if you're fine at 29, itdoesn't mean you're going to be

(25:44):
fine at 35.
So don't, you know, do the test.
If you're fine, you can wait alittle bit.
If the test is not great, youmay want to think very seriously
about freezing your eggs earlierthan you think.

SPEAKER_01 (25:58):
Got it.
So take early action.

SPEAKER_00 (26:00):
Early action.
You are your own advocate.
Don't wait for your OBJN or yourprimary care doc or your friend
to be your advocate.
If you're not going to advocatefor yourself, we have a problem.

SPEAKER_01 (26:13):
Perfect.
I'd like to thank you so muchfor joining me on the podcast
today.
It was a pleasure hearing yourstory.
Thank you.
And having you.

SPEAKER_00 (26:22):
Pleasure it was mine.

SPEAKER_01 (26:23):
Thank you.