LOUISVILLE Kelly Pagidas, MD, has worked every day for more than 20 years to bring miracles to couples who want a child. A specialist in reproductive endocrinology and infertility, Pagidas is the director of the University of Louisville Physicians – Fertility Center.
A native of Canada, Pagidas completed her residency and fellowship in Montreal. In the United States, she was a faculty member at Brown University and at Tufts Medical Center in Boston before arriving at U of L three years ago.
Genetic Testing Can Make A Difference for Couples
At the clinic, Pagidas helps hopeful couples with basic infertility evaluations, intra-uterine inseminations, in-vitro fertilization (IVF), third party reproduction (using donor egg and donor sperm), and preimplantation screening and diagnosis. The latter represents the cutting edge in assisted reproductive technology. “We can create an embryo through in-vitro and genetically screen it for specific disorders like sickle cell or cystic fibrosis,” says Pagidas.
“You have to know the disorder and map it out in advance,” explains Pagidas. “In some genetic disorders we don’t know where the gene is being affected, so we can’t screen for that, or it’s not something that will transfer down to the embryo. The classic ones we do know and can commonly test for are hemophilia, cystic fibrosis, and sickle cell disease,” says Pagidas.
“The idea is that if one embryo is affected, the hope is that you create enough embryos that you would have other presumed disease-free embryos, so you can reduce the risk. We can decrease the risk but not abolish it. Technology is not foolproof, but every couple of years, the technology advances, so we’re more specific and more accurate with improved outcomes, but not huge changes. The pre-implantation and diagnosis represents one significant innovation that has helped couples tremendously,” says Pagidas.
In-Vitro Fertilization Still Best Chance for Many Couples but Cost-Prohibitive
According to Pagidas, 20 years ago in the field of assistive reproductive technology, IVF was just in its infancy, but it has evolved to become the “single most important development in our field to help couples get to their dream of being parents. It can bypass any cause of infertility – even without good sperm quality you can still do IVF with someone else’s sperm or egg to carry the pregnancy,” she says.
While Pagidas emphasizes that technology will never be as perfect as human nature because we don’t know everything yet, it is highly effective for many couples. “I have no doubt that if couples have the biology to succeed, if they try enough rounds of IVF they will succeed,” she says.
Pagidas says the next real focus needs to be improving ways to select the best embryo to lower the risk of having multiples. “It’s really not healthy to have twins, triplets, quadruplets – it can complicate pregnancies. Hopefully in the next five years, we can develop better technologies to pick the best embryo.”
But for many of the diverse clients Pagidas sees, they cannot afford the costly infertility treatments they might need to conceive. While most patients are in their mid-30s, the fertility center has seen clients as young as 18 or as old as 49. Pagidas says it is a different demographic in Louisville than in her previous work in New England, with many ethnicities represented including Hispanic, African American, and Somali. “The sad part is most don’t have fertility coverage,” says Pagidas. “In fact, insurance coverage for fertility services is pretty uncommon. That means that while many patients can be evaluated for lower cost options, ultimately, many can’t afford services we could offer. It’s devastating for them, and for the staff, too,” she says.
“The key is identifying patients early on who are interested in getting pregnant and have a very low threshold.”— Kelly Padigas, MD
Provider Message to Hopeful Couples: Patiently Waiting May Not Be Best Plan
One message Pagidas wants to share with fellow providers about infertility issues is early intervention. “The key is identifying patients early on who are interested in getting pregnant and have a very low threshold to send them to specialty care. Often, people aren’t in the system for year and years, and they miss their biological window of succeeding. Tell patients not to delay if there are problems. Patiently waiting doesn’t help a lot of couples.”
What Pagidas finds most gratifying in her work with infertile couples may be a surprise. “The most obvious answer would be when couples succeed, but in our world, there are many that can’t achieve that dream, or can’t with their own biological children,” says Pagidas.
“It’s always wonderful when my patients get pregnant. But personally, for me as a provider, when we have a patient who says to me, ‘I know you did everything possible, but it just wasn’t meant to be,’ it puts tears in my eyes, but it’s gratifying. We played such a big role in their life and walked that journey, helping to put them in a new phase in their life even if they couldn’t have a child. But now they feel like they can have no regrets and they can move on.”