Interview: Dr. Gary DeVane

Gary DeVane, M.D.  is board certified in obstetrics and gynecology as well as reproductive endocrinology and infertility. The founding partner of the Center for Reproductive Medicine in Orlando, Fl., Dr. DeVane developed the first in vitro fertilization (IVF) program in Central, FL in 1985. Now retired, Dr. DeVane focused on providing high quality in vitro fertilization (IVF) with special emphasis on cost-effective minimal approaches to ensure that all couples have access to this treatment.

Please read more about Dr. DeVane and his work here:
http://www.ivforlando.com/

For further information please visit www.ASRM.org a wonderful multidisciplinary organization dedicated to the advancement of the art, science, and practice of reproductive medicine.
 
A note: This was a very special interview for me to conduct, as Dr. DeVane was my RE when I went through treatments. He was not only incredibly knowledgeable, but so kind, caring and genuinely concerned about each of his patients. Speaking with him years later, he is the exact same individual, someone I am very fortunate to have had as my physician.
 
What motivated you to focus your career on fertility?
 
I attended a training center for my internship and residency that was strong in internal medicine. It was a rotating internship and I spent a lot of time in OB/GYN. At the time, they were doing more interesting, cutting edge, endocrine science and I just got caught up in what was happening. I gravitated toward GYN Endocrine and that dovetailed into infertility.
 
At what point would you suggest someone having trouble conceiving seek help?
 
The insurance companies set the guidelines to actively trying to conceive for one year. I think that's fine for females under 33. But, as you age, everything becomes more difficult. When you're 35 and older, maybe six months. When you're over 38 you should probably start being tested right away.
 
What factors should one consider when choosing a fertility specialist or a fertility center?
 
I've always felt that a good OB/GYN should be the first step. A lot of OB/GYN's are just not too interested in infertility, though. They'll give you some information, read this, read that. Sometimes they'll try a simple oral medication. If the doctors are going to refer you out to a specialist or you want to be self-referred, you need to go to a physician that is full-service so that you have all the options on the table. If they offer everything, it means they've got the depth and resources so that you can make informed decisions.
 
What should expect from first visiting a fertility clinic?
 
It can be intimidating. I always felt, as a physician, it was important to review everything you had done up until that point so you didn't have to waste your time trying to tell me what happened. We always allocated 45 minutes to an hour for a new patient appointment so it was an extended visit. Usually there's a comprehensive but limited exam. We’d always do an ultrasound and you can expect to probably have some blood studies drawn. Sometimes you have to have them drawn at certain times during a menstrual cycle. Some women don't have cycles, which makes the process a bit longer. The work up takes roughly six to eight weeks and then you should have a follow up visit for a plan. One of the things I always felt was difficult was the amount of visits. When people are working and with traffic and everything, it's really hard to coordinate your schedule. That's one of the reasons we decided to do satellite offices-to make it a little more convenient. But honestly, there's nothing convenient about doing studies and being poked and prodded and all of the other things that have to be done to decide if there's something that needs to be focused on to be treated.
 
What do you think you could tell someone dealing with infertility that might help put them at ease at the start of their treatment?
 
They're not alone. It's a pretty prevalent problem. There are a lot of things that can be done, so many options, high tech and low tech. Some people don't want to go high tech and I certainly understand that. It doesn't work every time. One of the things I tried to always explain is, not every egg is going to be a baby and not every month is going to be a good month. There's going to be built in disappointment. It's hard because everybody is sort of a perfectionist and they want everything to be immediate. That's just human nature I think. That's where you come in. Counseling helps a lot.
 
What are your thoughts on the mind/body connection regarding infertility?
 
I’ll be honest, I used to think, with IVF, we were sort of taking control of the situation. It wasn't until Alice Domar published a great study that I changed my opinion. She showed how the mind body approach could affect IVF outcome results, through stress release and other factors. It was just mind boggling. Everything is interconnected and towards the latter part of my career, the last five to ten years, I was really pushing yoga and meditation and, under certain circumstances, acupuncture. I totally believe that mind and body are interconnected and both need to be working right for things to work correctly. I've always been interested in hormones and endocrine studies but it's very clear that stress effects a lot of your endocrine system and it definitely effects your health.
 
Can you tell me anything about the current and most effective treatments for infertility or any advancements on the horizon in the field?
 
It's all about genetics and the ability to determine if an embryo is genetically normal. You can do certain enzyme studies to make sure that the energy part of the embryo is normal, the mitochondria. It's heading into high-tech techniques that improve outcome.
 
Is there something that you used to find yourself saying to most patients over and over?
 
I would always reassure them that it's going to happen, but it's going to take some time. When you have a long career, you saw that. Sometimes I'd also think a break from treatment was a good idea. Sometimes during the break, they'd get pregnant. In those cases, I knew it wasn't anything I did. It was meant to happen.
 
What does a success story look like to you?
 
The patients, and I remember them, who did everything recommended, and it still didn't work, yet had a good experience. They didn't say, “oh it was misery, the whole thing was misery,” even though it was misery at times. To me, that's a success. But in our little field, it's all about take home baby. That's the gold standard.
 
Are there any outcomes that have stuck with you or made you proud?
 
Every baby made me proud. Everybody wants a family, but when you work as hard as couples have to when they have to go through all that we make them go through, it means that these babies are really wanted.
 
What was your favorite thing about working with your patients?
 
It's all about the patients. I like the idea of life and helping couples achieve their life goals. It's all about the patients. I had delightful patients and it was just an honor. It was a pleasure to be in a position in dealing with people who were so highly motivated to achieve an outcome. If I asked people to stop extensively exercising, as much as they enjoyed the exercising, they usually did it.
Weight loss is very difficult but patients would do it. Weight gain is even more difficult. They would do that. Highly motivated, wonderful patients. Every day was almost a good day.
 
Why do you think that there's often secrecy surrounding infertility or miscarriage?
 
I think it's probably because it's private. I think that's part of the problem too. You want to internalize everything and keep it even from your parents but I've found that people who were more open about it seemed to do better. I think it's very private. It's a part of your marriage, your sexuality, all of these things. Some people just aren't comfortable sharing that with others.
 
Any advice you can offer to those that have experienced a miscarriage?
 
It's painful and the scientific, important factor is that one or even two miscarriages doesn't necessarily mean that you're going to have another miscarriage. As a matter of fact, it's something like 70% chance your next pregnancy will be successful. Miscarriage is always a loss. One of the things I would stress to couples is, you need to wait before you get pregnant again. Your body, your mind, everything isn't back to normal yet so I always thought you needed a little time to reflect on the loss and also to let your body return to normal.
 
Do you think that there's ever a point when enough is enough? What would your advice be then?
 
Yes, unfortunately. It's hard because you read about all these people that are getting pregnant at 47, movie stars and other famous people and you think, “why not me?” I had patients who did everything, donor egg, everything. There were factors that we couldn't control and the only real option, which is a very difficult option, it's expensive and it's not for everybody would be using a gestational carrier. Sometimes they would decide, “We're going to move on with our lives and we're going to stop doing all of this.” It's hard. That's a very hard discussion for sure.