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Fertility Doctor of the Month: John L. Frattarelli, M.D.
John L. Frattarelli, M.D., Medical Director and Laboratory Director, Fertility Institute of Hawaii
Dr. John Frattarelli’s role at Fertility Institute of Hawaii is unique. He is both the Medical Practice Director and Lab Director. “It allows me to have singular control over the whole process,” he says. “It allows me to individualize patient protocols and manage the patients clinically, but then also know exactly what’s going on in the laboratory at all times and manage the embryology side as well.” FertilityAuthority is pleased to recognize Dr. Frattarelli as Fertility Doctor of the Month.
Another unique aspect of Fertility Institute of Hawaii is the very diverse population: the fertility clinic sees a very large Asian patient population and the location draws many international patients from Korea, Japan, China, Australia and New Zealand.
The Asian population is a little bit more difficult to stimulate, Frattarelli says. Compared to Caucasians, fewer eggs are produced, the egg and embryo quality is a little less and the pregnancy rates are a little lower. “That definitely makes us stimulate patients differently and makes us treat our patients with a more individualized protocol depending on their ethnic background,” he says. “We use LH in pretty much every stimulation protocol, but in the Asian patients I find that they need a little more LH to balance out their egg quality and embryo quality.” Frattarelli says that research is ongoing, but to date no one has been able to identify why this is the case.
Other clinical developments include use of the embryoscope to monitor embryo development; increased use of frozen, rather than fresh, embryo transfer; genetic testing; and egg freezing for fertility preservation and egg donation. Three years ago, about 10 percent of all cycles at the clinic were frozen embryo transfers; today almost half the cycles are. “Anybody who we think is at risk for having progesterone elevation or a synchronicity issue for their uterus automatically undergo a frozen protocol. And we find our frozen success rates are so high it doesn’t make sense to put those patients into a fresh cycle,” Frattarelli explains.
He says that unfortunately, due to the cost of living in Hawaii, local patients generally don’t use genetic testing because of the added cost, but international patients do. “It allows them to do single embryo transfer and can prevent any chromosomal defects. Other than the financial aspect of it, there’s really no downside to it,” he says.
“We really work very hard at maintaining a very high level in our practice,” he says. They do approximately 400 cycles a year including egg freezing and all retrievals. “Our pregnancy rates have stayed in the top five percent consistently year to year, and I think that’s a credit to our team and the laboratory that we have. We’ve put together a very unique group here – some from Hawaii, some not from Hawaii – and they work very well together and do a very good job for our patients.”
As a father to 9-year-old twin boys and a 1-year-old daughter, all from IVF, Frattarelli says he identifies with his patients on a personal level. “Without the technology that I used personally to have a family, I wouldn’t be able to do that,” he says. “For every patient that goes through our practice I really take it personally when they don’t have success and I feel very happy personally when they do have success. I think pretty much all [reproductive endocrinologists] have that same compassion, but I think you feel it a different way when you’ve been through it personally as well.”
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