David R. Meldrum, MD
From UCLA to RPMG
I have been asked many times why, after spending a dozen years on the full-time faculty at UCLA, being tenured as an associate professor and sure to reach full professor in short order, I would leave for private practice. At that time being a full-time faculty member involved research, clinical care, administrative duties, and teaching. If you factor in travel for speaking engagements and professional meetings, then doing everything well and having reasonable time left over for family and leisure time is simply impossible. I particularly enjoyed patient care and did not to want to delegate it to residents and fellows, even if that was possible with something as complex as IVF. Fortunately today, there is a clinical series which allows someone to concentrate on clinical care with less research and travel. It’s unfortunate that the university took so long to realize what was glaringly apparent to me. So, after much contemplation Claudia and I decided to make the leap off of the treadmill.
Fortunately the leap wasn’t so difficult since I had a 2 year waiting list of patients at the rate that UCLA was allotting me operating room space. At that stage in the development of IVF, egg retrieval required laparoscopic surgery because ultrasound guided retrieval was just getting underway. (Our UCLA program was actually ahead of the curve on non-surgical egg retrieval having established the first successful pregnancy in the U.S. by passing a needle under ultrasound guidance across the full bladder into the ovary to draw off the eggs). Again there Alan Trounson’s lessons led me to fill the bladder with culture medium to avoid any toxic effect of urine on the eggs, which was probably crucial to our early success (her name is Greta, here with her mom, Nancy, and her dad, Dick; Gretta now has her own two year-old). However, that technique was not sufficiently proven by achieving one pregnancy to abandon laparoscopic retrieval just yet). Fortunately my UCLA embryologist, Minda Hamilton, lived closer to the South Bay where my wife’s relatives lived and she accompanied me in setting up a program in Redondo Beach. Dr. Art Wisot, a local physician interested in infertility, also joined us and has been a treasured colleague ever since.
Our Redondo Beach program flourished and although Minda recently retired, a number of key people we recruited early on are still with us many years later. Lisa, who initially began as a lab tech measuring hormones is now the IVF lab director in La Jolla, and Diane, who initially joined us as a receptionist, manages our front office people working at multiple locations. Gabe Garzo worked with us in Redondo for a few years and now heads the UCSD RPMG Regional Fertility Center in La Jolla.
However, it was still a small “mom and pop” operation and I felt we could do much better with more people on the team. Dr. Bill Yee, who was running a successful IVF program in Long Beach, actually lived closer to Redondo. We began to talk and subsequently merged into what is now known as “Reproductive Partners Medical Group” that has grown to 7 physicians, and approaching 100 employees in 4 locations (Beverly Hills, Redondo Beach, Westminster, and La Jolla). I have always believed in the value of teamwork, and RPMG illustrates that so well. Due to our high success rates and our well-organized team of professionals we have steadily grown during the recent economic downturn while other programs have seen their volume drop as much as 30%.
Although I have retired from seeing patients, I have continued as scientific director of our La Jolla facility. We have made a major emphasis there on single embryo transfer. Infertile couples do not realize the very significant risks for mother and her infant due to multiple pregnancy. Even divorce is more common due to the stresses of caring for more than one newborn. As it turns out, because we can usually do full chromosome analysis on the embryos, our success rate is as good as if we had transferred two untested embryos.
Although your primary RPMG physician will be overseeing your care, for some daily visits and for some procedures you might see one of the other physicians. Be reassured they are all experienced and follow uniform protocols. Think of it as a built in second or third opinion. Four or six eyes are always better than two. If you find that you want to be followed by someone different from the physician you first saw for your new patient visit, simply ask the nurse and she will make that change. The physician will not be offended. We all want you to be as comfortable with your care as possible.
Above all keep in mind that the thing that will maximize your chance of success more than anything else is the number of treatments you have. Too many patients become discouraged and simply give up. It is well documented that in states or countries where IVF is fully covered, the major reason for failure is giving up. That is one of the reasons you may wish to have your embryos tested to be sure they have the correct complement of chromosomes (see quads). That will prevent you from going through transfers with embryos that are not capable of implanting or may miscarry. We know that couples have difficulty coping with multiple failures. Be sure also to take full advantage of groups such as Resolve, and stress reduction techniques such as yoga and mind/body to allow you to better cope with unsuccessful cycles.
After my many years seeing infertility patients in the South Bay, most times that Claudia and I go somewhere locally for a walk we see one of my successes. Be sure to stop me and say hello. I always like to see how you’re doing, and of course to see how your kid/s are doing. Or send pictures or stop by the office. All of our staff gets a great lift out of seeing the product of their labors and their former patients as parents.