Maria Sophocles, MD: Educating Patients on Conception

Most people first learn the beats of conception and pregnancy in middle school, but that shouldn’t deter a physician from refreshing patients on the details.

In an interview with MD Magazine®, Maria Sophocles, MD, director of Women’s Healthcare of Princeton, emphasized the importance of educating patients on fertility—especially for couples who have continuously tried to conceive without success, or for women who are only seeing an OB/GYN.

MD Mag: What should physicians be wary of in helping patients trying to conceive?

Sophocles: I think the important thing that we need to be worried about is not assuming the patient has an understanding of normal menstrual function and fertility in terms of fertile periods of the cycle. I have many, many women who don't actually know when they can get pregnant in their cycle. This might have been taught in middle school sex education class, but I'm not sure most of us were really listening or paying attention.

And now, we have ovulation predictor kits for sale in pharmacies, we have ovulated predictor apps. The public is more educated, but never presume as a clinician that your patient really understands when during her cycle she's most fertile. It’s very frustrating for patients or couples to come in and say, ‘We've been trying for 6 months, or 6 weeks, or 6 years, and we haven't conceived,’ and they've been having sex during the menstrual cycle, wondering why they weren't conceiving.

Also, it's important to educate patients as to the age-related decline in fertility. I think women understand that, and couples understand that. But we as clinicians, need to understand when does a quality go down, when is it appropriate to refer to a fertility specialist, when should you first start by saying, ‘Have you seen an OB/GYN, have you gone to your OB/GYN?’

Some women don't go to an OB/GYN regularly. Some women only go to an OB/GYN, and I think 25% of women, nationally, only use an OB/GYN. They don't have a primary care physician. But even those women should also be in the hands of a primary care physician. Do they have hypertension? Do they have other comorbidities that may impact their ability to conceive? This goes for their male partner as well.

But taking a good history is critical, in terms of who's your partner, has your partner fathered children before—trying to uncover red flags that might indicate either a male factor—which is responsible for 40% of infertility—or a female factor in infertility.

So these are just things as a clinician, if a patient comes saying ‘We're trying to conceive, we're having issues,’ a good history is critical. A good history could uncover some causes, but also a good basic understanding of ovarian function and how fertility relates to your age, your medical history, and when you and your partner are having sex.