Transcription of Dr. Benjamin Lannon for the show Fertility, #85
Dr. Lisa: Spring is the time of the year when things are growing, plants and flowers and little animals. We’re thinking about fertility and growth. We’re talking today with Dr. Benjamin Lannon. He’s a Reproductive Endocrinologist with the Main Center of Boston IVF. Thanks for coming in and talking to us today.
Dr. Ben: Thanks for having me.
Dr. Lisa: Ben, you grew up in New Hampshire. You have a presence here in Maine and you have a presence in Boston. What was it about growing up in New Hampshire that caused you to decide, “You know what, I want to come back here. I want to raise my kids. I like this part of the world.”?
Dr. Ben: My wife and I both grew up near the ocean. It was a really important formative part of our childhoods. I really appreciated just being able to get to the beach easily and the beauty of the coast of New Hampshire and also the coast of Maine and even Massachusetts were really a part of my formative years.
For both of us, it was important to include that in our ongoing lives and also the lives of our children. Being in touch with that aspect of nature is really important for us.
Dr. Lisa: You also received your education largely in New England. You have a very extensive education.
Dr. Ben: I’ve been mostly around New England either in Northern New Hampshire or down in Rhode Island and also in Boston. Haven’t really escaped too far from the New England region which again is part of my identity.
Dr. Lisa: Did you always want to be a doctor?
Dr. Ben: I was in fourth grade and went to career day as a doctor. My father was a doctor. My grandfather was a doctor. Probably that had a major impact. Although my father was very much encouraging me to explore things outside of medicine. Knowing that many children are to follow in the path of their parents without fully thinking of where they want to go.
I went through a long period of time planning to go onto medicine. Then later in college, tried to find other things besides medicine to do but ended up coming back. It’s always been another part of my identity.
Dr. Lisa: What makes it part of your identity? What drew you back?
Dr. Ben: The interaction with using aspects of science and technology but really being able to apply them directly to humans and individuals. I’ve spent some time in the biotech world trying to explore just the pure science of things. Ultimately, it’s the human connection that was important to me and being able to use a wealth of knowledge that physicians acquire but being able to use that in ways that can really help and benefit individual people.
Even I’ve spent some time in the public health world as well and it really didn’t speak to me as much. It’s just that one-on-one interaction with people. That’s what gets me through every day right now.
Dr. Lisa: You do have an extensive education. You have an undergraduate degree from Dartmouth, a medical degree from Brown, master’s in evaluative clinical science again from Dartmouth, did a residency in obstetrics and gynecology at Beth Israel and Harvard and then a fellowship in reproductive endocrinology and infertility at Beth Israel Deaconess.
That’s a lot of investment of time and energy and resources likely to come back around to do something that ends up impacting your life in a big way. Has it been worth it?
Dr. Ben: It’s been worth it so far. I am just coming off of the final phase of my training which has been board certification in reproductive endocrinology. It’s been a time to reflect back at times on exhausting education process. My wife who started in business school when I started in medical school, many of her friends are contemplating down, stepping down in their careers and I feel I just got my first job.
The process along the way is part of a journey. You can’t just wait to get through training to start things. It’s been a really rewarding process so far. I’m looking forward to the next days, which are more of the independent part as supposed to the training.
Most doctors are always in the process of learning or training. It’s what you sign up for when you entered this career.
Dr. Lisa: When you look at your education, you kept narrowing it down and narrowing it down and narrowing it down. Now your focus really is helping bring life into the world. That is absolutely your focus at this point. It’s a challenging focus because people who come to see you are challenged. Talk to me about why you would go into such a field.
Dr. Ben: When I was in medical school and trying to figure out what I wanted to do, I really found myself drawn to this profession. I ultimately went in to my residency anticipating going into further training in infertility medicine.
Again, it’s that nice interplay with there’s a lot of basic science and a very detailed understanding of the molecular aspects of reproduction. The people that are sitting in the room across to me don’t necessarily care about that. They just want to have a baby.
Being able to use the skill and the knowledge that I’ve acquired and really being able to help people. Probably one of the most valuable aspects of their life is really a privilege and it’s rewarding every day whether it works or it not. Helping people get through the process has been the thing that when I look at … with every doctor they have to figure out what’s going to get them up every day. In many profession, that’s true but in particular medicine; what’s the thing that’s going to get you through the whole process?
For me it’s that, the reward of that interaction and the satisfaction when the patients are successful or even if they’re not successful that they come through the process with the feeling of some closure.
Dr. Lisa: Fertility has become a really important field. It’s grown, leaps and bounds. Boston IVF has a lot of different locations including this one in Maine that you work for. Why is that true? Why are we having issues with fertility in our culture today? Conversely, how we’ve been able to come to a place where we can now help this problem more?
Dr. Ben: There’s been not necessarily an explosion but a really constant improvement in the technologies that exist to help couples that are trying to get pregnant. When we look back roughly 35 years ago, the first IVF procedure was performed. The amount of progress that’s occurred in the 35 years since then has been incredible. It’s been made available to a much wider group of people.
Any time you have more technology that’s available to help people, more and more people get access to that treatment. You’ll start to see it become more prevalent in the society.
There are a lot of different things that are occurring in our society that we don’t really know how they’re impacting our fertility. A lot of chemical substances and things called endocrine disruptors that may or may not be having an impact in all of our lives, not just reproduction but lots of studies looking at changes in the time of menarche and the first signs of puberty that girls are having whether they’re changes in semen or sperm parameters that men have over the last 30, 50 years.
It’s unclear exactly what impact those are having and whether we’re experiencing a mild epidemic of infertility. A lot of it has to do with just changes in our society. People are really much more comfortable talking about these things whereas the previous generation are to really suffered in violence around a lot of these issues. That’s one of the biggest factors.
Then also just the changing dynamics socially of when people are having children. As more and more couples and particularly women are making more proactive decisions about reproduction, we see a difference in the time that people are having children compared to one or two generations ago.
There are many more women, about 20% of women are having children after 35 for their first child which one or two generations ago would have been much less common.
Dr. Lisa: What are some of the actual causes of infertility? You’re talking more of global reasons for infertility. What are some of the more common diagnoses that occur?
Dr. Ben: One of the things to appreciate is that infertility really affects couples. It can affect both men and women. It’s not always just even though our specialty comes from women’s health and obstetrics and gynecology, roughly half of the time there is a known factor. It’s either male or female.
There are things that can impact sperm production or the release of sperm that may impact a couple’s fertility. For women, there are a host of problems that can impact ovulations. Either something called Polycystic Ovarian Syndrome where women have an imbalance in the hormonal relationship between their brain and their ovaries and ovulate on less frequent paces or maybe not at all.
As well as other hormone interactions again between the brain and the ovary and those signals that are important in regular ovulation cycles that can reduce the likelihood that women ovulate.
That’s in addition to some of the more structural issues such as having a blockage in the fallopian tubes which is the passage that the egg has to travel as well as the sperm in order to meet each other. Those can be results of either infection or inflammation that’s occurred much before somebody has tried to get pregnant.
One of the differences with fertility or infertility and many other diseases is that it’s mostly asymptomatic. People don’t necessarily know that they have a problem. The definition of infertility itself is really based on the lack of ability to get pregnant over a certain amount of time of trying.
It’s different than having a bladder infection where you feel a symptom and you know that something is different. Therefore you go and have a specific test. Here, it’s really based on what is normal within a population and where you’re deviating.
Dr. Lisa: What are some of the technologies? You’ve talked about IVF, In Vitro Fertilization. What are some of the other things that have recently come about that are helping couples to conceive?
Dr. Ben: The range of treatments can be very simple to being more focused on the timing of intercourse and when couples are trying to get pregnant. Increasing the number of eggs that are produced in a given cycle maybe increase the likelihood of success. As well as a procedure called insemination or intrauterine insemination where sperm is placed rather than in the vagina, directly into the cervix and into the upper part of the reproductive tract.
Those are technologies that have been around for a long time. The more simple end of things, the more advanced aspects involving In Vitro Fertilization as well as something called Intracytoplasmic Sperm Injection or ICSI where a very small amount of sperm can be used to fertilize eggs.
Some of the newer technologies that are emerging are our ability to do genetic testing or chromosomal screening on embryos before they go back into the uterine cavity so that for couples that have either unknown genetic disorder or are trying to screen for chromosomal imbalances such as Down Syndrome.
That testing can be done on an embryo even before it’s implanted in the uterus. That’s made a lot of improvement for couples that are facing some of the not necessarily fertility-related issues but just the genetic complications that come along with reproduction.
Dr. Lisa: Judging by the fact that there are now requirements in some States that insurance companies actually pay for fertility treatments, it seems as though we are finally accepting the fact that this is an important medical diagnosis trying to help people conceive. It’s not an optional thing. It’s not as though some people just because they are fortunate enough to have everything in place.
They have the right to have children. For everybody else, it’s too bad for them. Does that help in some way to move this field along?
Dr. Ben: It has helped. The great underlying question in our society is whether infertility is a medical condition or really a misfortune as you said that we say, “We’re sorry that you can’t get pregnant.” We don’t deem it worthy of other medical conditions that insurance will treat.
It’s very interesting on a State-by-State basis how this is decided. In several States, I won’t say many maybe 10 or 11 States there has some coverage for infertility diagnosis and treatment. While in other States there really isn’t any treatment coverage.
It makes a major difference for many couples because we said, this can be quite an extensive process. When you’re paying for that out of pocket, it comes at a significant expense for the rest of your life. .
Massachusetts has a very comprehensive insurance coverage for infertility whereas Maine is quite limited. In many senses dictate what treatment people do if that all or how far they can get. Price ranges for treatment might range from on a low-end could be in the 500 to a thousand range but it can get upwards of 15 to $20,000 depending on how complicated things get.
For a process that theoretically could be free for most people, it’s a significant amount of money.
Dr. Lisa: Back to the idea of what medicine truly is for, is it for curing an individual’s, cleaning out their arteries so they won’t have another heart attack or is it for looking at things from an eagle eye view? We’re looking at the continuation of a species. If we’re saying that the only people who can reproduce are the people who can do it “naturally”. Then we’re not really looking at the health of the population at large.
Dr. Ben: There are a lot of conditions that are associated with infertility, depression, anxiety as well as other gynecologic or medical conditions that get treated but somehow the infertility diagnosis itself for many people is not considered a medical necessity.
I respect people’s opinion that our society should in some way determine what is considered a medical issue versus not. Anybody who’s struggled with infertility or known somebody who struggled with infertility recognizes that this is the same, meets all the criteria of any disease that we consider in the rest of our population. It’s really unfortunate that many insurance companies or many States don’t require coverage for this.
Dr. Lisa: Ben, you and your wife, Jean have two children, Oliver and Gretchen. How has the work that you’ve done in the field of infertility changed the way that you’ve looked at you own ability to have a family or vice-versa?
Dr. Ben: I have a picture of my family in my office. I put it off to the side. Many times you go to a doctor’s office and there are lots of pictures of their family and their children. I want it to be there for me to know and for my patients to know that I understand what they’re working towards. It’s important not to have it be too much in the face of my patients who are having all these other constant reminders of people’s families.
Anybody who had a family without much difficulty should recognize the challenges that some people have. Anytime that we can successfully form our own families that it’s a blessing for all of us. Many times we take our own families or children for granted sometimes. Many people when they’re talking to somebody who is trying to get pregnant and they say, “I just want to have children.” People will say, “Oh, you can have mine.” They’re driving me crazy.
That speaks to this imbalance of perspective that we all have where it’s a great fortune to be able to have children whether your children were created with minimal amount of complication or significant amount. Everybody has the right to be able to do that if they want.
Dr. Lisa: The type of work that you do requires not only the high tech and the knowledge and all the education that we spoke of when we first began the interview but also significant sensitivity and compassion and empathy. Do you feel as though medical education today is heading us in the direction of being able to marry those two, the high tech and the high touch?
Dr. Ben: It’s very person-specific. There are always going to be people that are gravitate to the high tech. There are always going to be people that gravitate to the high touch. Some of it you can teach but a lot of it is inherited in the personalities of the people that ultimately decide to go into medicine or any of the really the healthcare professions.
There are many doctors who the last thing they would want to do is deal with my patient population. That’s part of the selection process of all of us when we choose a profession. There are big differences between radiologists and internal medicine doctors and my profession for example.
It’s always important for all of us in whatever we do but particularly in medicine to figure out which things they’re good at and how you can apply those to whatever specialty you end up going into.
Dr. Lisa: Do you think that doctors might not want to deal with your patient population because it does require the high touch and the sensitivity and the compassion and that’s not always easy?
Dr. Ben: It’s a very needy has the connotation but it’s a very demanding population in terms of the amount of time and energy that goes into this process. It’s not, “I’ll see you once for your annual exam and come back in a year,” or ask you for this broken arm or whatever process that you’re dealing with. It evolves over for many of my patients months to years before we achieve the goal. That’s a very unique aspect of this type of medicine that you have to prepare for.
Dr. Lisa: There is also the possibility that the goal that you achieve is finally realizing that you may not be able to carry a biological child and that you may need to explore other options.
Dr. Ben: That’s one of the hardest things that we all face in this profession is helping couples find closure or transition to a different pathway than they had originally intended such as going through adoption or moving on without children or even for many people using donated gametes either sperm or eggs to help them assist in their goal.
That’s again one of the challenges that we all work towards is helping throughout that journey is really helping people get perspective on where they are now and where things are going or maybe going. There are always going to be people that aren’t achieving their exact goal. It doesn’t mean that they aren’t successful.
Dr. Lisa: Ben, you’ll be speaking at the free fertility seminar which is coming up on April 30th from 5:30 to 8:00 at the Maine Medical Center. People can hear more about what you’ve been talking about there at the seminar. Also, people can find out about you through the website for the Maine Center of Boston IVF. Tell us what that website is.
Dr. Ben: You can look us up if you go to Boston IVF or bostonivf.com. That would be the easiest access point. There are a number of fertility groups that are available. We’re certainly one option for many people. Our goal is to make sure that people are aware of this issue and can get access to somebody to provide help. As I said, we’re always happy to tell people or help people make that next step into the process.
Dr. Lisa: We’ve been speaking with Dr. Benjamin Lannon who is a Reproductive Endocrinologist with the Maine Center of Boston IVF. We’re quite privileged to have you in here today. Thank you for the work that you’re doing to bring life into the world.
Dr. Ben: Thanks very much.