Reproductive endocrinologists and other professionals in our field all have the same main goal: helping people build their families. But we all know that treatment is expensive, and the resulting revenue is how clinic owners get paid. In some cases, treatments can involve ‘extra’ services, resulting in additional revenue, but it may not always mean a better chance of success for the patient.
So when do clinics start to toe the ethical line when presenting options to their patients?
On this episode of Inside Reproductive Health, Griffin talks to Dr. Mark Trolice of Fertility CARE: The IVF Center in Winter Park, Florida. From his perspective as a former patient and as a provider of care in a non-mandated state, we look at fertility treatment “up-sells” such as egg freezing and PGT and the ethical implications of REs owning their own labs.
Mentioned in this episode:
Journal of the American Medical Association Article about biomarkers of ovarian reserve
Santiago Munné Paper from Fertility and Sterility about PGT
Learn more about Dr. Trolice by visiting https://TheIVFcenter.com, finding him on Twitter @drmarktrolice or on Instagram @myfertilitycare.
Purchase Dr. Trolice’s book The Fertility Doctor’s Guide to Overcoming Infertility here.
To get started on a marketing plan for your company, complete the Goal and Competitive Diagnostic at FertilityBridge.com.
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Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field.
Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.
JONES 1:03
Today on Inside Reproductive Health, I'm joined by Dr. Mark P. Trolice. Dr. Trolice is director of Fertility CARE: the IVF Center in Winter Park, Florida, which is outside of Orlando. He's a professor of OB/GYN at the University of Central Florida College of Medicine also in Orlando. He is responsible for the medical education of OB/GYN residents and med students there. He is a double certified position in REI and OB/GYN. He holds the unique distinction of being a fellow in all three American Colleges of OB/GYN, of Surgeons and of Endocrinology. He has received the Physicians’ Recognition Award from the AMA and awards for social responsibility, advocacy, and medical education. A lot of that is what we're going to be talking about today. He has a podcast called Fertility Health. And earlier this year, he released a book entitled The Fertility Doctor’s Guide to Overcoming Infertility: Discovering Your Reproductive Potential and Maximizing Your Odds of Having a Baby. Dr. Trolice, Mark, welcome to Inside Reproductive Health.
TROLICE 2:03
Thank you, Griff. It's my pleasure to be here and congratulations and thank you for all your advocacy. You're a voice for the fertility warriors and so I greatly appreciate that as a patient that I was, as well as a professional.
JONES 2:19
Well, I appreciate that and the reason I do it is I try to create as much content as possible so that I'm relevant because I think it's binary--either someone's relevant today or they're not. So I'm constantly advocating creating content. I usually don't ask people to write a book, but you went ahead and did that--without any you know, anything that has to do with me--but you created content and a book is a long form way of doing that. Was this something that had been brewing for a while? What made you decide to write the book?
TROLICE 2:56
I love writing and I have such a unique story of being a patient for 10 years, my wife and I struggled with infertility. And we went through everything, Griff, multiple, artificial insemination, IUI cycles, multiple--she's had surgery, I had surgery, a lot of IVF complications. It was just--it was daunting, overwhelming, it was surreal. It was suffocating. My patients would cry with--while I was a physician, my patient would cry to me during the day, and my wife would be crying at night. It was just inescapable. And time goes by like that, and it also stands still at the same moment. And you're in limbo. Your life is in limbo. So after the 10 years of significant disappointments and dramatic roller coasters, and all the upheavals, we designed our family and resigned ourselves to adoption. And we adopted our five little angels and I was older than I would have preferred to be originally, but nobody's life is the way we wanted it to be. And I think the key to life is adjusting to what is in front of you. You play the hand you're dealt as best as you can. And we did make lemons into lemonade because we absolutely adore our children. So that story was always a part of me wanting to share. And then I looked down the market and I did not see a real fertility guide that would help patients that was written by a reproductive endocrinology and infertility specialist. There's books out there by nutritionists or attorneys or people in science, but nothing by a clinician. So I saw that need and I just poured my heart into this book to share my journey to some degree, but also providing patients with evidence-based medicine. You know our field, Griff, is such a risk of exploitation, unfortunately, because of self pay, not enough insurance coverage, and the potential upcharges without real good evidence to support that. So I consider myself an advocate. And I made the book a way that whether you're interested in just thinking about getting pregnant right now, or you're along your journey and it hasn't happened, or you've really gone through and you're at a crossroads of do I do IVF, do I do adoption? This book was meant to be able to help you through this with coping strategies, stress reduction, science, real stories of other patients. And I just wanted to be there for the patient to have a resource that could help them through this.
JONES 5:52
Was that your intention in the book to help them explore some of the options in terms of things that you might not agree with? You mentioned certain services or certain add-ons, where there's less scientific evidence, very little scientific evidence, or still emerging evidence, was your intention to call out a few things specifically that are becoming more common in the field that you don't feel like are warranted yet?
TROLICE 6:19
I did this in a way that I, you know, after being in the field for 25 years, I've seen a lot and I review medical records of other practices and what patients are receiving for recommendations as well as procedures and treatment. And of course, you evolved in your field. You know, years ago, in fertility, and you do maybe a couple of cycles of IUI then you do a laparoscopy. Now the days of doing a diagnostic laparoscopy for infertility are long gone, like other procedures like post-coital testing, or just doing a whole plethora of hormone testing. Those are things that evidence has not supported. being used any longer. So things that are outdated, I call out to patients to say, look, you know, if your doctor is recommending these things, it's really important to ask why and to question. Always question, right? You know, respectfully, of course, but it's a mutual respect, your relationship with your physician. Physician has to respect the patient's needs. We're not there to tell a patient what to do. And I really get bothered when I hear patients say that Well, my doctor said I had to do this or I had to do that. Well, you know, the field of infertility, not necessarily reproductive endocrinology, but specifically infertility is, by itself, an elective, right? The patients choose. It's not urgent, per se, medically speaking, but it's a psychological urgency and a biologic need. But patients have options. I remember when I was taking my board examination, my oral exam on the infertility section, every question I answered was with options. And the examiner looked at me and says, “You know, you don't really answer questions do you?” I said, and I just panicked and said, “Tell me why you said that.” He says, “Well, every answer to every question I give you, you give me all the different options.” I said, “Well, I think that's our responsibility.” I said, you know, “Infertility is not 100% successful with one particular treatment option for a patient. Our obligation is to provide appropriate medically evidence-based treatment options.” First diagnose, of course, with appropriate procedures, and then you give them options, but talk about the statistics, likelihood, applying specifically to the patient, as well as cost. You know, in Florida it’s not mandated. But I'm working with advocacy groups to do that with also with physicians, but when it's not mandated, Griff, my gosh, the time that we spend on the cost of fertility treatment. You know, in states that are mandated, I would envision that you spend this much more than on cost and this much on the medical problem, right? Well with Florida, unfortunately, and other states that don't mandate, there's a lot of time with cost, because it becomes a numbers game. You know, well, what's the cost of three to four cycles of IUI? And how much does that equate with an IVF cycle? You know, it's just such a shame that patients have to beg, borrow, and steal sometimes for an IVF cycle, when it should be their right? Because the AMA, the American Society of Reproductive Medicine, the CDC--the World Health Organization, rather, all considered infertility disease. it's a disease and it should be covered.
JONES 9:29
So I've given some examples of some of things that are outdated that the patient should question, what are some of the things that are newer to the field that you don't feel that is warranted yet based on the scientific evidence that as a field, it might be marketed to the patient? Because as a marketer, we mostly work with clinics. We mostly market to help bring patients in the door and then there are things that we do to try to help convert patients along the treatment, but I can't say if somebody should just be doing ICSI only or if someone should be doing PGT or as a non-clinician, I stay away from that. What are some of the things that you think that I should know as a marketer that you feel, maybe, we should be slower to market right now?
TROLICE 10:24
Well, you know, I wasn't gonna mention this, but you put up ICSI right? Where you take the single sperm and inject it into the egg for severe male factor. Why do some clinics do more than 90% ICSI and other clinics doing 50%? You know, different patient populations, they may be charging for ICSI, unfortunately. We include it in the fee. It's a terrific question though. The two things that are out there that are potentially exploitative is egg freezing, and PGT. So there are commercial agencies that are really going after the younger patients, the 20 year olds and so on, that are using somewhat of scare tactics, I think, that are making them feel that, oh my God, you're going to have to freeze your eggs. When, if you look at actual medical evidence, success rates for fertility, even at 40, even at 40 years of age, 40 or 41, success rates after six months is about 50%. Okay? And then a little bit higher when you wait into the year. What I'm getting at is that natural fertility is not as abysmal as all of these commercial agencies are saying for patients that are younger that are delaying childbearing. And what's going on with the trend right now, right? Childbearing is being shifted, the older patients are getting pregnant. The fastest growing group of getting pregnant is above 35, and then about 40--37 I believe--and 40. So why is that happening? Well, not finding the right partner and delaying their fertility for career. So do they need to freeze their eggs? Well, I think there are certain indications, certainly cancer, right? I mean, that's the group that it was made for. And people are using anti-mullerian hormone or AMH as a guide to freeze their eggs when it was not meant to do that. There's only one thing that AMH does. He tells us indirectly, how many eggs that we will get for the egg retrieval and how to stimulate that patient. But that's it. If a patient has a low AMH, it’s not Oh, we better go freeze your eggs. Successful natural fertility is not based on your AMH. There was a study in the Journal of the American Medical Association about two years ago, they looked at patients ages 30 to 44 with low AMH versus normal AMH retrospectively, and they have the same pregnancy rate year to year. Age for age. So AMH isn't used for that. It's important to always give patients medical evidence and realistic expectations, particularly in our field, Griff. Why? Because it's so emotionally charged. You know women are devastated over the thought that they may not be a mother, okay? And so they could be unfortunately swayed if they're being given information that would make them think that they're risking their ability to have a child. So I think egg freezing is one. The other one is PGT. We don't do a lot of PGT. We do it if patients ask. I am a proponent of Dr. Paulson, Richard Paulson out in California, who has written several eloquent papers, analyzing the data from PGT. Now PGT for all the listeners that are for preimplantation genetic testing, this is where you do the embryo analysis, remove some cells from the day five embryo--day five, day six embryo--freeze the embryos, send those tissues off for analysis. What we get is chromosome testing. You can do it for single gene defects as well: cystic fibrosis, sickle cell, Tay Sachs, things like that. But for the chromosome testing, we're clearly not convinced in any way that we're definitively doing benefit. Okay, so there was a paper, Santiago Munné released in December in Fertility and Sterility Journal. With the intention to treat everybody that was randomized to PGT, then frozen embryo transfer, or just frozen embryo transfer based on how the embryo looks. And with the intention to treat analysis, they didn't have any difference in the pregnancy rate, whether you did PGT or not. Clearly in the less than 35. Now in the above 35, when they did a subanalysis of those that actually went through the treatment instead of just being assigned to a group that's intention to treat, but if they went through the treatment, above 35 did have a higher pregnancy rate. The issue is this Griff with PGT, are we really doing a service by analyzing a few cells and an embryo that's over 100 cells? Because we're testing the area that's the future placenta and the placenta can have some variations or mosaicism with two separate cell lines. Okay? So it's saying that the embryo is abnormal is not necessarily true, because there is evidence for self correction. Why do we know this? Because there are reports all over the world reporting that transferring abnormal embryos have resulted in a healthy child. Are we discarding embryos that are being told--that we're being told or abnormal when they would have resulted in implantation? That's the dangerous part. Now it seems as though if we're being told it's normal then it seems like those embryos are normal. We are not getting the cells from the actual future embryo which is the inner cell mass, we're getting it from outside. There is a little discrepancy of correlation or those studies are mixed on that. The point is that PGT is not for all and it clearly should be individually applied, but really I can't think of a good reason, it has to be really specific for one that is less than 35 and certainly not egg donors. So I think that that's an area that, unfortunately, is an upcharge, as it were. There are specific indications, but PGT has not been shown to even be valuable in patients with recurrent miscarriage. So, you know, once again, we have technology in our field, but it gets rapidly applied before we really have good indications.
JONES 16:33
If the listener at this point is wondering why I'm spending so much time on this because as I explained to Dr. Trolice before we started the interview, is I'm not a clinician. I allow different people, I allow different guests to express perspectives. If there's someone listening to this and saying Well, I don't agree, why didn't you challenge Dr. Trolice? Because I'm not a clinician! I'm allowing Dr. Trolice to explain his perspective. And so if there's somebody down the line that wants to say something different. They can come on, but I'm interested because I'm a marketer and two of the biggest things that we’re marketing in the field, one direct-to-consumer, which is egg freezing, so that, I have a lot more experience marketing. And then the second is PGT, which is not so direct-to-consumer in most cases. But certainly one of the biggest things that center-to-center within the field is being marketed. Those are really the two biggest things that Dr. T brought up. Egg freezing and PGT. So maybe--so I'm interested, because while I can't make specific recommendations, it does affect how I counsel people on marketing strategy. And so I wonder what you think of this Dr. Trolice because we've had a few clients that propose egg freezing. And it's sort of in line with just how I feel about marketing in general is I actually don't believe in putting too much emphasis on the baby, or in the case of egg freezing, on “stopping the biological clock” because there are far too many exceptions and then if someone doesn't have the result that they were expecting because of the advertisement they saw or the content that they read or the video they watched, then that can mean negative repercussions for the center at the end of the day because it's Hey, my expectation was this, you didn't give me this, and then come to find out the science is either questionable or another doctor I spoke to had a different opinion. So the way I approach all of this stuff, but especially egg freezing, is that I want to lay out everything. I want to break up the offering so we're not just talking about egg freezing but rather we're starting with you know, you some people call it a fertility snapshot of that people call it a fertility wellness check, marketing more of that as opposed to egg freezing being the end all and then I asked all of the partners of the group to talk about their feelings about egg freezing. Because within groups, the opinions often vary wildly from partner to partner. And in the case of a single doc, we would just say, Okay, let's start with the reasons why people shouldn't do egg freezing. And sometimes they might even outnumber the ones that people should. But at the very least, you allow people to self select at that point. It’s just more responsible than, let's say stopping the biological clock, that's not a slogan that would ever come out of my firm.
TROLICE 19:32
I'm not suggesting that people should not freeze their eggs. I am only concerned over the potential exploitation and unrealistic expectations. Because the caveats are this: it's expensive, it's about $10,000. The patient may never use those eggs, okay? And if they use those eggs, they may not get pregnant. Okay, so people say, Well, it's an insurance policy. Well, it's an insurance policy with an asterisk because it may not work, okay? So they need to know realistic expectations based on their age, the expected number of mature eggs that they would need for a reasonable chance for live birth. And I think that if they understand all of those things and say, Okay, got it, feel good about it, here's the risks of the procedure as well and risk of the medication so on so forth... if they have extensive informed consent, obviously, always the patient's decision, but I don't upcharge as it were. I don't bring this up. And I do it for the correct reasons, not just because of a low AMH or they're young and they don't know when they're going to be having children.
JONES 20:47
So for those listening to thinking of marketing their egg freezing program, this is why I put so much emphasis on strategy beforehand because you can actually use the asterisk that Dr. T is talking about as the forward message. You can use the asterisk as the message. It might be a question of volume after that. So I might be asking you to speculate, Mark, but I do think some of the groups, especially those in large coastal cities that are mainly for the purpose of egg freezing, do you think that their businesses being built to scale is not in the best interest based on the number of cases that they need to do? If that question makes sense. The number of egg freezes that they need to do to justify the business model is greater than those that might benefit from the asterisk?
TROLICE 21:43
Well, you know, that's an area that sort of rubs me the wrong way about a business model and how many that do egg freezing. I don't think a physician should be even considering that. I mean, if it's a commercial agency that is just doing that, maybe they need to look into that, but a physician's practice, I mean, I'm still in the business of medicine. That's my area. I talk patients out of egg freezing or in vitro fertilization, or at least give them the counter to let them know that I don't think that they absolutely need to do that at this point. So you're probably talking to the wrong person about numbers of cycles for an ROI. Because that's, I think that's counter to a physician with integrity.
JONES 22:36
I think that was the candid answer to the perspective that I was looking for. For PGT, do you think this is something where we're just early and you're not seeing based on what we're biopsying and right now, you don't think that PGT merits being an upsell to people do think is something that testing embryos before implantation will eventually become the state of the art. Where do you think we are in that?
TROLICE 23:06
Well, I don't know if my opinion is that important. But I would say that PGT is a robust technology that is very exciting. The ability to do pre-implantation testing of an embryo has enormous potential. But I don't think that we truly know right now to whom we should offer. I let all of my patients know that it is available. But I say, you know, my review of the medical literature is such that I don't think it's cost-effective at your age, if they're less than 35. If you're above 35, if they have severe ovarian aging, then you have to be concerned about it if you only have one or two embryos, do you just transfer them? Or do you do the testing? And if you do the testing and the both that normal, are you comfortable discarding those embryos and 100% convinced that they would never have implanted? Those are the things that we talk about. But I think PGT is here to stay. The technology, the platform of next-generation sequencing is the most powerful right now. But I still think we are learning on which patients to use it and you know, what, what are we truly gaining from the technology? The worst thing that would happen is discarding an embryo that would have otherwise implanted because what a woman goes through to get those eggs, and then we create embryos, and the physical, emotional, financial investment into all that, if we are not 100% proven that we're not discarding an embryo that would have otherwise implanted, then I think you have to have tremendous trepidation before you before you embrace this technology the way it's going now.
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JONES 26:33
And trepidation you have, which is why I'm focused on that, and for those listening, I have a copy of Dr. T's book. It's about a lot more than what we've just dealt with today. I'm painting the nexus between who you are as a business owner and a practice owner as an advocate for the community. And you believe in advocating this way because you went through infertility, you know how much it costs, the margin costs physically to retrieve those days, you know how much it costs financially, especially in a state like Florida, which 44-45 of them are similar and for so many people. And so two of the things that you're advocating for is to make sure that you are educated on these two things. And PGT and egg freezing are both things that are being widely promoted in the field right now and you're vocal about your reservations. You've even written a book, which and again, the book is about a lot more than that. Do you ever worry that you'll be a pariah?
TROLICE 27:37
If my business goes under because I'm not offering procedures that I don't believe in, I accept that. I will never do something for revenue. You know, when you cross the line once, then it's easy to stay on that other side, right? But once you do that, then you've lost your integrity. What's integrity? What's the best definition of integrity that I've seen, is doing the right thing, even when no one's looking. So you have to believe in yourself and I scour the medical literature intently to provide the best evidence for my patients because they don't know, right? I mean, if I take my car to a shop, and he says, Well, you need to fix the [inaudible] valve. Okay, you know, it sounds like you know what you’re doing, so just do that. They come to us without knowing. It's our responsibility, it's our ethic, it's our oath to be able to educate them as best as we know, as teachers--physicians as teachers--to give them enough information so that they could make informed consent. And that's what informed consent is. And they could just say, Okay, I got it, I still want to do this. And as long as there's no medical contraindication, then we go that route. And one of the chapters in the book is about me not being a good salesman. And that was about a patient who had gone to an awful lot with infertility. And she was at a crossroads. And she was looking at either one more cycle of IVF, or an egg donation, or adoption. And I felt, given her circumstance, how much she had gone through and the prognosis of trying with her eggs or an egg donor, I was leaning more toward adoption. And she said, Do you own an adoption agency? I says, you know, we did for a while, but it was really, really difficult to maintain because it was just a labor of love. You know, there was no cost involved to me, very, very minimal fees, and it was very hard to maintain that. She says, Why would you send me to an adoption agency when you wouldn't get any revenue from that? She says, You're not a good salesman. So I said, Right. I said, And I hope I never become one. So I paraphrase the chapter, but a physician should never have the conflict of interest. In a non-mandated state, particularly, IVF is a conflict of interest for a physician that owns his own lab. I mean, by definition, okay. Everything they do with IVF, they gain revenue from, right? Bloodwork, egg retrieval, embryology, that's a lot. And you can see how that could be enticing, potentially, right? Certainly from a business perspective, that's a fantastic arrangement. But as a physician, I will only recommend in vitro fertilization. Certainly, there's very few black and whites, Griff. I mean, no sperm in the ejaculate, tubes tied, you know, those are sort of black and white, but even those patients, okay, who come to me with a tubal ligation--a woman has her tubes tied, who says I'm here for IVF. I talk to them about tubal reversal. Now I don't do that procedure any longer. So I would have to refer that out. But I always will talk to them about a tubal reversal so that they never go through something and say, Gosh, I wish I had known about that other thing, because patients come to me after a tubal reversal was unsuccessful and I say Did they ever talk about IVF with you? I didn't even know what IVF was. Which is awful. Or if a man comes with no sperm in the ejaculate, and they are looking at testicular sperm retrieval, okay, now you're getting very, very costly, right? Because then you have the IVF--because they have to be IVF because the sperm are immature--you’ve got to do IVF with ICSI. I say look, you know, this is a big, big expense. I said we do this obviously, but unfortunately, you're both going to be getting a procedure and there is no guarantee. I said, I just want to let you know that for a lot less cost and minimally invasive for you, the woman, donor sperm IUI. Now I don't say that is Oh, it's just too donor sperm. I mean, I have been on the other side of the desk as a patient. My approach is with exquisite sensitivity. If I mentioned a donation or sperm donation, or a gestational carrier, you know, I do that with saying, Look, I know this is not what you originally wanted, but nobody's life is. And we could either lament that we can either be frustrated and angry, that is not the way we originally wanted it. Or we could sit back for a second, take a deep breath and say, Okay, what are my options?
JONES 32:53
And I know this to be the case when you say, “I'm a bad salesman”. I know that you're not pushing into IVF, because you and I have had business conversations and I know that to be the case now you're giving me a bit more context of why. Do you really feel that an REI practice owning their own IVF lab is a conflict of interest? That seems pretty strong worded.
TROLICE 33:23
Well, I think, yeah, I could see how that is being interpreted. What I'm saying is that there is, let's say more of a potential, okay? More of a potential conflict of interest.
JONES 33:34
To clarify, do you own your own lab?
TROLICE 33:36
Yes.
JONES 33:37
Okay.
TROLICE 33:38
Yes. I mean, I would say most REs do. And I'm not excusing that. I'm well aware that if I offer IVF to a patient that could sound like I'm pushing that. You know, when you're in the front line of talking with patients, they are exquisitely aware of the fact that this is a high revenue procedure. So I have patients coming to me for second opinions, you know, He was pushing IVF because of the money that they get. I'm very, very careful at ensuring that everything I offer is at the point of being appropriate. So a conflict of interest, I mean, I'm saying in the strictest of terms because there is revenue gained from that decision. But if you offer a patient say, Look, you know, you're 40 years of age, okay? There is medical evidence to support that when they looked at patients who did IUI for three months, or went straight to IVF--IUI for three months, then IVF or straight to IVF. The straight to IVF had a higher pregnancy rate. A faster time to pregnancy. You are welcome to do either option all the time. I just give you the information that's available right now. So once again, I don't want conflict. I don't want my colleagues or anybody to think that we all are subjective because, you know, in point of fact, anytime you do anything, you're billing for service. But the reason why I say there is the potential for that is because it is such a significant amount of expense by the patient and revenue for the practice to do that procedure of which the physician owns. So we have to obviously be very, very careful about not going down that slippery slope to make it a true conflict of interest.
JONES 35:33
So we talked about The Fertility Doctor’s Guide to Overcoming Infertility, and we talked about how that was informed by you being an infertility patient yourself. We talked about your role in advocacy and I just know in general that infertility has been a life-changing field for you professionally and personally. And so because the book is largely read by the patient community, our podcast is largely your colleagues, physicians, practice owners, some managers and other execs in the field, of the things that we've talked about about the book about patient advocacy about the ethics and business as you described it and your background as a patient, how would you want to conclude with our audience, Mark, knowing that most of them are your colleagues or other people that work in the field.
TROLICE 36:27
Well, I'm honored to be part of this show. And I have reached out to my colleagues across the country for a variety of reasons for medical care, for joining me with advocacy, for advice on career moves. So I'm very, very proud of the field that we're in. I'm primarily, and as a physician, we are, advocates for our patients. I fell in love with this field after just one week when I was in medical school. One week during medical school, I could not believe during my rotation of OB/GYN, the infertility practice. It just was literally overwhelming. It was the “aha” moment. The technology, the personal connection with patients, the surgery, the psychology, so many facets in REI, that I said, This is my life. This is exactly what my life is going to be. And to see what it has done in the last 25 years is amazing. We have the most impressive technology that's available for advancing the ability to help people that are trying to have a child. We also report our statistics. No other field does that. We have tremendous guidance from the American Society for Reproductive Medicine, so we're very, very evidence-based. And I respect many, many, many colleagues in our field in what they do. I'm on committees for ASRM, for SART and I'm very, very proud of those associations. I, as an advocate, have to call out if procedures are being done that are placing patients in a compromising position. And I know that many, many of my colleagues agree. Within our field, we know that there's always outliers. I mean, that's just the nature of every single business, right? But you get two standard deviations of the outliers. But the 95%, we have well-respected colleagues, who I am very proud to be associated in the same field.
JONES 38:54
Dr. Mark Trolice, thank you so much for coming on and sharing those concerns and the rest of your vision for advocacy on Inside Reproductive Health.
TROLICE 39:02
My pleasure, Griff, anytime and thank you for all the efforts that you do to increase awareness and your marketing. Thanks so much.
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You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.