Dr. Juan Alvarez works at Fertility Centers of Illinois. I chose to do a profile on Dr. Alvarez and highlight his work because of his unique perspective – as one of the few fertility specialists who is both Latino and openly gay. After his interview, I now consider Dr. Alvarez to be not just relevant and authentic – but an inspiration.
Q: Why medicine and specifically why reproductive medicine? What about this field excited or inspired you?
I went into the field of medicine because I always had an interest for science and biology that started when I was very young. As I grew up, my curiosity for the sciences only grew and led me to the path of becoming a physician. I went into the field of reproductive medicine because as a medical student I had the chance to shadow a reproductive endocrinologist who peaked my interest in the subspecialty. This is because reproductive endocrinology and infertility (REI) combines basic science and medicine in a unique way that other specialties do not. Knowing that my field continues to grow rapidly with new innovative treatments makes me excited to be part of the field of reproductive medicine.
Q: During your early days in this field, was there a moment where you realized you made the right decision choosing this specialty?
As a fellow, I saw a couple with long-standing infertility due to low ovarian reserve and endometriosis. As part of the consultation we performed a pelvic ultrasound, which showed that she had a mature size follicle that contained an egg. I set out her plan to trigger ovulation with a medication and for the couple to have timed intercourse. That patient ended up getting pregnant and carrying a full term baby. At this moment, I knew I picked the right specialty. I used my knowledge of reproductive physiology to formulate a treatment plan that changed their lives forever.
Q: You are a native of Columbia. What are some of the challenges this particular community faces when it comes to battling infertility?
There are two challenges that I’ve see in many of my Latino/Hispanic patients who are have infertility. The first challenge is overcoming the taboo of infertility. Some couples don’t like to talk about it, they don’t know any other couples in their community that are struggling with the same problem, and it’s not a common subject to talk about. Luckily, the taboo of infertility has diminished in general and more and more people are openly talking about their struggles with infertility. This is a challenge because many Latino/Hispanic patients delay seeking treatment, which can impact success. The second challenge is the high cost of treatments. This is due to social/economical disparities that are seen in the Latino/Hispanic community that impacts medical care, not just fertility care, and therefore, can delay or prohibit many from seeking treatment.
Q: You are open about being a member of the LGBT community. Do you feel that your personal experiences allow you to relate to patients in that community on a deeper level?
Yes, I do believe that being a gay physician helps me relate better with my LGBT patients. I understand and can relate to the fear of talking openly to a healthcare provider about sensitive medical and or personal problems. That is why I think many LGBT patients seek LGBT healthcare providers so they can feel comfortable and open to discuss important issues that impact their health.
Q: Are there any cases you can tell us about of an LGBT patient you worked that impacted you in some way?
During my training I saw a transgender man who was seeking to freeze his eggs to preserve his fertility. I remember this case was challenging because we don’t have a lot of research looking at fertility preservation in transgendered individuals who have already started the transition with hormone therapy. This really had an impact on me because I realized that much of the medical research that is being done may not be inclusive to the LGBT community – this is why I want to dedicate my time in seeing, treating and taking care of LGBT patients.
Q: What are the greatest challenges for people in the LGBT community who are trying to build their family through ART or surrogacy?
One of the biggest challenges for LGBT patients who are seeking assisted reproductive technology (ART) to build their family is cost. For lesbian couples, they have to purchase frozen sperm if using an anonymous donor. This can become costly after several rounds of artificial insemination, and if not pregnant, then the additional cost of IVF. For gay couples, they have to pay for an egg donor and a gestational carrier on top of having to finance a cycle of IVF, which can become very costly and potentially impede couples from using ART services. Another challenge is finding the right fertility clinic that is sensitive to the needs and/or challenges of LGBT patients.
Q: Has working in this field and helping patients with their struggles to build a family, prepared you for your own personal journey down this road one day in the future?
Working in the field has definitely given me a huge perspective of the process for LGBT patients. It is a difficult and long process, but having a healthcare professional that is aware of the challenges and potential pitfalls in the process is key. There are many components that need to come together and having a clinic and physician who are proficient in this process makes it less complicated. For these reasons, I am not discouraged to form a future family using ART.
Q: Your research studies have included miscarriage, PCOS, fertility potential and the impact of obesity on fertility. During your research did you have any revelations, surprises or unusual findings that you can share?
I’ve always known that obesity has an impact on future fertility. What was shocking to me during my research was how much obesity really impacts the potential of an egg. We mostly attribute obesity to a lack of ovulation and/or PCOS, however, obesity on its own causes many problems to the egg. Higher doses of fertility medication are required to improve chances of a higher egg yield during a retrieval. With obesity impacting egg quality, this can also result in fewer high quality embryos, longer time needed to conceive, a higher risk of miscarriage and obstetrical complications.
Q: What are you passionate and interested in right now in the field of reproductive endocrinology?
It is very exciting right now to be in the field of infertility as our knowledge of genetics increases. The biggest topic in our field is how genes impact fertility from the genetic component of an embryo to genes that are expressed in the lining of the uterus during the window of implantation. Understanding how our genes and environment interact during the window of fertility is a major topic that will have huge medical implications in the future in how we treat our patients.
Q: Are there any topics or issues you are seeing impact a growing number of your patients?
Insurance coverage for fertility treatments is the biggest issue that impacts all infertility patients. Many, but not all insurance companies have infertility benefits and if a patient does not have insurance coverage, treatment can be very costly.
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