Pregnancy on Pause: Dr. Anate Brauer talks about infertility treatment & coronavirus

Dr. Anate Aelion Brauer A. Brauer, M.D., FACOG and Shady Grove Fertility - New York’s IVF Director

I never anticipated that we would be having the conversations that we are having now about the implications of a worldwide pandemic on infertility and fertility treatment. I often wonder what the world will look like in the (hopefully) not so distant future once we get past this pandemic; locally, nationally and globally.

What I have noted in these past few weeks is that humanity can be beautiful when we come together. Community empowers us to set aside our own fears and anxiety in support of one another and those on the front line. To support the mental health of other infertility warriors on hold with kindness and simply checking in, to feed hungry children who relied on getting a meal each day at a school which is now closed, to protect and nourish our healthcare workers with personal protective equipment (which is is dire shortage) and feed them healthy food to fuel their immunity during extensive shifts so that they can continue to save lives.

What you may not know is that in certain places around the country including NYC, our fertility doctors are also being asked to volunteer to be on the front line to fight against Covid-19. The same doctors that you know help create life are now being asked to sustain it. I had the opportunity to catch up recently with Dr. Anate Brauer, one of our healthcare heroes who is ready to the answer the call if it comes.

I cannot wait for a nation no longer on pause, to see Dr. Brauer live and thank her for her empathy as well as lending her support and expertise to both infertility and in relation to a cause that none of us saw coming.

Dr. Brauer, what does your work day look like now versus two weeks ago?

AB: Wow. Where to begin. Two-three weeks ago my office was bustling with patients excited to embark on their journeys to parenthood.  My day was filled with in-person consults, retrievals, embryo transfers and other procedures aimed at achieving the ultimate goal, PREGNANCY.  Over the past couple of weeks, following state local and national guidelines, we have quickly shifted to remote practice of medicine.  SGF (Shady Grove Fertility), as an organization, quickly developed and adopted an efficient telemedicine protocol which has been absolutely crucial in our continued delivery of care. Currently, my days are spent mostly on video consults as well as many calls and emails surrounding specifics of Coronavirus as it relates to fertility and pregnancy. As IVF Director of the New York region, I am also on SGF’s Coronavirus task force, which meets almost daily as situations change.  

What has changed about patient protocol and office visits since ASRM released its view on treatments?  

AB: Shady Grove Fertility - New York is now fully operational as a remote practice. It has been pretty incredible to see how quickly we made this happen. A patient calls to schedule a new patient or follow up visit, is registered into our secure portal where he or she will receive instructions on how to set up a link to a video consult.  That link is then placed in to my daily schedule. We both simply click on the link and we are connected on a HIPPA compliant platform on our phone, tablet or computer. The patient can also upload our patient questionnaire and any records into the portal with help of our patient coordinators so that I am able to review prior to our consult. We are not currently doing any non-urgent testing or treatment, however are working on abilities for remote testing.  We are continuing necessary in person care of our medical fertility preservation (for cancer) patients and our pregnant patients, and have very specific screening and social distancing protocols in the office. 

Is testing included in your screening for patients that may have been exposed to Covid-19?

AB: We are not currently offering coronavirus testing in our office. If patients have been exposed, they are directed to contact their primary care physician. 

What is SGF's view on pregnancy right now? How long does the medical community anticipate that it will take to understand any potential implications of pregnancy?

AB: The first reported cases of Coronavirus came out of China in November of 2019.  Since this is a novel virus, there is little data about its effects on pregnancy. Data existing about other Coronavirus is reassuring, however. This is why the American College of Obstetrics and Gynecology and the Society for Maternal Fetal Medicine have NOT come out with statements that women should avoid pregnancy.  

Does a pregnant patient have the potential to become more ill from the virus and could it affect a developing a fetus?

AB: We do not have any reason to believe that a pregnant patient will become more ill from the virus. We also have no data to suggest that the virus can affect a developing fetus. It is important to note that any virus that causes high fevers, such as the flu for example, can cause pregnancy complications. Coronavirus is no different. 

Is SGF still planning to continue with new egg freezing, retrievals and transfers?

AB: SGF - NY is no longer initiating new, non-urgent fertility treatments. We are, however, very committed to taking care of our patients who require time sensitive fertility preservation, and therefore, will remain fully operational for those specific cases. 

Will there be any impact to the embryo if mom tests positive during the cycle?

AB: Not that we know of. 

Will SGF- NY proceed with treatment situations that require immunosuppressants?  

AB: We do not generally use immunosuppressants as part of our protocols as they are not evidence based, and in the current environment, likely cause more harm than good. 

What happens if someone had to cancel a treatment mid-cycle? Can their financial investment be recouped?

AB: There are clinical protocols in place of what to do medically if you must stop in mid cycle. These protocols revolve around decreasing risks of OHSS in the setting of no retrieval.

Financial investment is a whole different issue. Just as in the case of cancelled cycles for other reasons most clinics will only charge for what had been done thus far and therefore patients should be able to recoup the bulk of the cost that comes from the retrieval itself. Another option is crediting part of their current cancelled cycle to their resumed cycle after the virus is under control.

Anything else you would like the (in)fertility community to know?

AB: This is a very difficult time. As IVF director of a large center in the heart of NYC, I am faced with new challenges daily during these unprecedented times. Remember, we, as an IVF community have to not only protect our current patients, but protect our precious eggs and embryos in our freezers during a time of crisis and possible shut downs. We know and understand that infertility in and of itself is an extremely anxiety provoking state which makes the current situation even more unfathomable.

We are right there with you. We are a team that now more than ever needs to (and are) working together to find the safest and most practical solution(s).

This. Will. End.  You will build your family. And when you do, you will cherish it in a way the world has never experienced. That’s what crisis does. It makes you stronger and opens your eyes to new appreciations for everything around you. 

Dr. Anate Aelion Brauer A. Brauer, M.D., FACOG, is a board-certified reproductive endocrinologist with extensive experience in treating all medical and surgical aspects of infertility. She serves as Shady Grove Fertility - New York’s IVF Director. Learn more about Shady Grove Fertility - New York here, and Dr. Brauer on IG: @dranatebrauer

*Note: Clinics may be operating slightly differently based on ASRM guidelines and where they are located in conjunction with the epicenter (NYC) and other US hot zones.

More About Dr. Brauer. Dr. Brauer earned her medical degree from the George Washington University School of Medicine, where she was elected to the prestigious Alpha Omega Alpha medical honor society. She completed her residency in Obstetrics and Gynecology at New York Presbyterian Hospital-Weill Cornell Medical Center. Dr. Brauer subsequently completed her fellowship training in Reproductive Endocrinology and Infertility at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine and Infertility-Weill Cornell Medical College. Prior to joining Shady Grove Fertility, Dr. Brauer was an Assistant Clinical Professor at NYU School of Medicine.

Dr. Brauer has expertise in ovulation induction, in vitro fertilization (IVF), egg freezing, pre-implantation genetic testing and third-party reproduction including donor egg, donor sperm, donor embryo, and gestational surrogacy. She applies the latest clinical data, state-of-the-art technology, and extensive clinical experience to optimize pregnancy rates while minimizing patient stress with her supportive approach to care.

Dr. Brauer has published and presented at numerous national meetings on the topics of optimizing fertility treatments in patients with diminished ovarian reserve, polycystic ovarian syndrome (PCOS), or those using a gestational surrogate; fertility preservation; and complementary therapies in infertility. She is especially passionate about helping young patients with cancer build families, which has led her to serve on the Advisory Board of the Young Survivors Coalition. Dr. Brauer is a regular contributor on a variety of women’s health topics to local and national media such as Parents, Reader’s Digest, Refinery 29, Woman’s Health Magazine, Byrdie and Shape, to name a few. For Shape, she serves on their expert Brain Trust.

She is a fellow of the American Congress of Obstetrics and Gynecology and an active member of the American Society for Reproductive Medicine and the Fertility Preservation Special Interest Group.

Dr. Brauer enjoys spending time with her husband and their three children. She also enjoys cooking and running or spinning for exercise in her free time.

Dr. Brauer, who is also fluent in Hebrew, joined SGF in 2019, and sees patients at SGF's New York office, located in the heart of Manhattan.

NIAW Feature: Faces of (In)fertility

Photo by Alexis Mera. Shirt design by Erin Halper.

At first glance it would be hard to detect that Stephanie Rapp is a fertility warrior. Stephanie is young, beautiful, vivacious and currently pregnant. And while Stephanie is entirely transparent about her story and the challenges on her path to building her family, you would probably assume that she sneezed and got pregnant. During our interview, Stephanie shares how (in)fertility has many faces and also affects young women. Read on to find out why we should never judge a book by its cover.

Stephanie’s story

My story began when I went on the pill at age 15, and was on it for the next 10 years. Fast forward to high school and college, where I struggled to maintain 100 lbs and hard a hard time putting on weight. After UPenn, I went into finance, working at Goldman Sachs in Fixed Income sales & trading, (through the financial crisis) for eight years. Soon after starting at Goldman Sachs, I was working 14 to 20 hour days and feeling the immense stress and pressure of the job and culture, (which were exacerbated by the climate of the time), and I stopped getting my period. My OBGYN, who I saw at the GS health center, reassured me that it was normal to not get a period while on the pill. After witnessing fertility struggles of people close to me, I decided to take my health into my own hands.

I went searching for a good OBGYN, I started making changes to try and get a cycle back and I went off of the pill. A year after going off of the pill, my situation was still the same. I was still very slender, still working intensely in a highly stressful environment, still working out regularly, still going out often. And still without a period.

I was sent for ultrasounds, CAT scans, MRIs, rounds, and rounds of blood work and more, to no avail. My hobby and passion is nutrition so I enrolled in nutrition school in hopes that I could also find out how to get my body functioning. I changed the way that I ate (bone marrow and collagen, ghee and egg yolks, kombu and kefir, grass fed steaks and cheese), and the way I worked out (yoga and walks, pilates and rest days). I added in acupuncture and supplements. And I started to notice positive changes in the right direction. But when my husband and I got married and started to try for a baby, I never, not once, in many months had a positive ovulation test.

I felt called to share my journey with other women who, surprisingly (had experiences which) were not dissimilar. So many of my colleagues also were experiencing amenorrhea or had suffered infertility. One day, after opening up about my struggles, a friend suggested that I see her fertility specialist. My then OBGYN told me to try for a year because I was so young before proceeding down any alternate paths. I had little to lose so I went to the specialist (that my friend recommended), and within an hour she had honed in on my issue and created a path towards pregnancy.

Patches, pills, shots and six weeks later, I was pregnant with Olivia (now four years old)! Seven months after having Olivia, I went back to my fertility specialist. Four weeks later I was pregnant with Cullen (now almost three years old)! Fast forward again, I went back for number three. A few cycles in I was pregnant again, but at eight weeks had a miscarriage. I elected for a DNC days after the diagnosis which ended up being a lifesaving decision because my pathology determined that I had a molar pregnancy, placental tumor.

Had I waited to miscarry naturally, I likely would have had to have a much more invasive procedure followed by a year or more of chemo(therapy). Instead, I suffered through a long and scary six months of constant blood work to ensure the tumor was not growing back coupled with the most intense fatigue, fog, exhaustion, lack of fervor and joy. Total depletion. I was desperate to feel like me again, but was grasping at straws. Again, I went for blood work and tests and labs; to find nothing. I treated myself with alternate therapies, supplements and nutrients, rest and support, eventually coming out of the hole I was living in after six months. I'm now pregnant with number three, due early July! 

I started a wellness company, EMBODY Wellness Company just over four years ago. We are a holistic wellness and lifestyle concierge, who create customized wellness programs for our individual and corporate clients. Our goal is to clear through the clutter and help our clients accomplish (more than) their goals in a sustainable and lasting way. We specialize in fertility, pre and post-natal and getting your body back after baby, as well as weight-loss, gut repair, clean home and beauty makeovers, corporate workshops, events, talks and more! We also do wellness business consulting for budding companies and practitioners. I am inspired by my work and our clients and love being able to help others on their journey to embody wellness!

Your high?

Each positive pregnancy test and then the highest high, holding my healthy babies! 

Your low?

The molar pregnancy rocked me to my core. It was emotionally sad and taxing, and it physically crushed me too. Feeling joy was too exhausting. I struggled to stay in the moment and enjoy the happiness around me. Even laughter was a strain. And my two kids are so funny! I felt despair and helplessness and uncertainty that the future would clear up. The road ahead seemed rocky and unreliable. My medical bills were crazy. (My insurance covered zero percent. Not even my DNC and all of the prescription hormones that I was on for well over a year.) I felt horrible physically and mentally, and felt even worse about that emotionally. I felt guilty about not being "me" for my kids and husband who needed my support and help, and I was just so so tired all of the time. 

Do you have a silver lining? 

This is a tough question. I think I'll be able to answer that more genuinely when I hold baby number three and see that he is healthy and here! A friend recently told me the timing is great because my older two are at ages where they are so excited for baby and cannot wait to be big siblings. They are thrilled to have responsibilities and teach their little brother their favorite songs, how to eat food, pick out his diapers and clothes. They will both be in preschool so I'll have good 1:1 time with the little guy. 

I truly believe I’m an optimist but I think that some parts of infertility are not lined in silver. I didn't need to have a placental tumor (to learn a lesson or appreciate something else). I don't want anyone else to go through that. I'd much prefer every woman have a linear path to motherhood. In the end, my third healthy child will be the silver lining. That's the most important outcome. 

Do you have any words of wisdom?

There are many ways of becoming a mother. Sometimes, ways we don't plan for or expect. But trust that you will hold your baby one day, maybe after an easy and natural conception, maybe through IVF, or even surrogacy or adoption. But, If you want to be a mom, you will be. 

I also want to add that most importantly that this is your journey and your life. Allow yourself to feel however you fee; mad, frustrated, sad, defeated, joyous, excited, hopeful. Whatever your emotions, they are real and don't need to be explained or justified. Give yourself the time and space to feel and heal how you need. And you don't have to do it alone! seek help from friends, professionals, (this growing) community, family, a journal, whatever you need. Reach out and let others in! You are not expected to be the expert on everything, and you are not failing.

Stephanie, her husband and two (soon to be three!) children live in NYC. If Stephanie isn’t creating meals from her farmers market finds for her family, friends or EMBODY Wellness clients, you can find her dancing and singing along with her kids as they rehearse the complete soundtrack to Frozen. To learn more about Stephanie, please visit EMBODY Wellness or follow @embodywellnesscompany on Instagram.