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OBGYN.net Conference CoverageFrom First Congress on Controversies in Obstetrics, Gynecology & Infertility Prague CZECH REPUBLIC - October, 1999
Dr. Hugo Verhoeven: "Good afternoon, my name is Hugo Verhoeven, and I'm a member of the Editorial Advisory Board of OBGYN.net. I'm very glad to have the chance to talk this afternoon with Dr. Mark Surrey from Los Angeles. I've known Mark a long time. In Europe, we are one of the leading teams in the field of in vitro fertilization, and our idea was to have the infertility diagnosis and treatment completely under one roof. I heard from Dr. Surrey that he is interested in having, in Los Angeles, the same idea that we implemented. Mark, what are you planning in Los Angeles?"
Dr. Mark Surrey: "We have constructed and have just opened a center that is not dissimilar from your center in Germany in so much as we have the capacity to do all diagnostic and therapeutic modalities for the infertile couple. This includes a complete evaluation and whatever therapies may be necessary. The therapies may include endoscopic surgery for either diagnostic or therapeutic procedures, as well as a full-service in-vitro fertilization laboratory that has been one of the leading labs on the West Coast in regard to the pregnancy rates that have been obtained. We're moving this lab from a hospital facility into a new clinic because we really don't believe that fertility is a problem or a disease of patients who require hospitalization. Our patients, as yours are, are basically young, healthy individuals who for a variety of reasons due to either endocrine problems, tubal problems, or endometriosis problems, have become infertile and require therapies and treatments. We want to provide for them not only an optimal environment to do this, but also an environment where the patients don't feel like they're ill, where they don't have to go to a hospital for their in-vitro and be in a recovery bed next to an elderly gentlemen recovering from cardiac catheterization. They can be in a setting with patients who have problems similar to theirs and expect to achieve the best care and the best results from that care."
Dr. Hugo Verhoeven: "You certainly know that in Germany, about 95% of all egg retrievals are performed outside of hospitals in an office set-up. It was always our wish that the patients coming to our centers do not feel ill, that they would come because they just wanted to become pregnant. I've always wondered why in the United States so many procedures are performed in the hospital, like hysteroscopy and laparoscopy. Do you think it will be accepted by the other doctors, your referring doctors, and the patients - that you're going to say, 'listen, we're doing everything in the office now, and we're not going into the O.R. anymore with the exception of major surgical procedures,' and do you think that you will convince the people that that is good quality, and that you will provide safety to the patients like the way it is accepted in Europe? What is your opinion about the status in the United States?"
Dr. Mark Surrey: "It's an evolving process and for a lot of different reasons we've actually been behind the time table of the European experience. Traditionally, as you know, with in vitro fertilization pick-ups where the egg was removed by laparoscopy, it was thought that laparoscopies require general anesthesia and, therefore, needed to be done in a hospital environment. As you know, egg retrievals are no longer done by laparoscopy, they're done by transvaginal ultrasound guidance. And they're done either without anesthetic at all or with intravenous sedation, as are many of the procedures that you do in Europe, including many endoscopic diagnostic procedures such as hysteroscopy or transvaginal hydrolaparoscopy. These procedures have been well-documented in regard to their safety by performing these procedures out of the hospital. In the United States, we have a particular problem with economics when these procedures are done in a hospital environment, and many of them are not covered by third-party carriers or insurance companies. As such, a clinic setting is able to provide these procedures at a much lower cost than a hospital can and, in addition, the comfort and the quality of care can be controlled much better than in a hospital. In a large hospital, as you're aware, the hospital administrators and staff have to be very sensitive to the acutely ill patients, primarily. Patients who come for elective procedures like fertility evaluation and therapy often aren't a priority of the hospital administration and the hospital staff and, as such, the ability to receive the best treatment may be compromised by a hospital environment. So in the United States, more and more of these centers are moving out of hospitals into private or outpatient settings, as this is, and all the transitions are very successful. The inevitable question, once the transition is made, is, 'why didn't we do this ten years ago?,' and so I think that it's a natural evolution."
Dr. Hugo Verhoeven: "So, what you're setting up now, in Los Angeles... is that something unique or is it available in other parts of the United States? I think our listeners would be interested to know exactly what you are offering differently from the other IVF teams?"
Dr. Mark Surrey: "In Los Angeles, it's a very unique setting because we provide not only facilities for the best in vitro fertilization, but also endoscopic procedures, and there is not such a facility that exists presently in our area. There are, however, similar models and similar facilities elsewhere. For example, in New York, New York University recently moved their hospital-based facility into a clinic setting very similar to ours, and this has been done at many major centers all over the country - in Chicago, in Atlanta, and in other cities. So it's not a unique model, but it is something, as I mentioned, that's evolving in the United States. In our geographic area, I think, we have a unique setting."
Dr. Hugo Verhoeven: "The United States is a country of unlimited possibilities, if you look at what we are doing in our center alone, about 3,000 egg retrievals a year are completely outpatient. We are treating our patients completely as outpatients - outside of the hospital. They do not have to go to the hospital for any procedure. Why shouldn't you do it in the United States?"
Dr. Mark Surrey: "Correct, exactly."
Dr. Hugo Verhoeven: "So there is good cooperation on the way?"
Dr. Mark Surrey: "Yes."
Dr. Hugo Verhoeven: "I thank you for the interview, and I wish you all the best."
Dr. Mark Surrey: "Thank you."