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Fertility Doctor of the Month: Robert K. Matteri, M.D.
Robert K. Matteri, M.D., Oregon Reproductive Medicine, Portland, OR
An outdoorsman who enjoys climbing and hiking and is involved with Friends of the Columbia Gorge, Dr. Matteri founded the Oregon fertility clinic in 1989 as Portland Center for Reproductive Medicine. The name was changed in 1999 when a new "clean room" for embryology was built.
"I think we built the first large scale embryology clean room in America in 1999," Dr. Matteri says. He took the leap during a time when people weren't sure how important the environment in embryology labs really was. "It was interesting because it was very expensive, and everyone gave us a hard time, but our pregnancy rates have been pretty much consistent since 1999. We had a 90 percent pregnancy rate (80 percent birth rate) with our egg donors, and it really hasn't changed. So that was really our claim to fame of what we did differently."!--break-->
Dr. Matteri is also very proud of the work his fertility clinic has done with fertility preservation. "We really support Fertile Hope and have been active in fertility preservation prior to cancer treatments, etc.," he says. "We had the first oocyte cryopreserved pregnancies in the NorthWest, I believe, several years ago, and egg vitrification has really opened the door in helping women who need cancer treatment."
A Different Path to Reproductive Endocrinology
Dr. Matteri always knew he wanted to be a doctor, and at one time wanted to be a cardiovascular surgeon. He received a bachelor's degree from Stanford University and then received his medical degree from Emory University School of Medicine. "I became fascinated with reproductive medicine and the menstrual cycle, which no one really understood," he explains. "In those days, reproductive medicine was almost all internal medicine (non surgical), so I decided to become an internist and went into reproductive endocrinology as an internist."
During his residency at the University of Tennessee College of Medicine, Louise Brown, the world's first "test tube" baby was born in Great Britain in 1978, with the technology developed by Dr. Patrick Steptoe and Dr. Robert Edwards. "Steptoe and Edwards came out with the first test tube baby, and then I realized: 'Who's going to come see me as their medical reproductive endocrinologist when I can't operate, and I'd have to send the patients off?' Because in those days you had to do laparoscopies to get eggs."
He completed a residency in internal medicine and a fellowship in medical endocrinology. Then, he switched fields and completed a second residency in obstetrics and gynecology at Oregon Health Sciences University and fellowship in reproductive endocrinology at the University of Southern California. He has four board certifications.
"The thing that I take away from that is I really learned how to provide good patient care," Dr. Matteri says. "The philosophy I learned at Emory, I've taken with me into reproductive medicine, and I think that's why my program was able to survive. We were one of the first private programs outside of a university setting. In those days, everyone went into academics. Now, 26 years later, almost every outstanding IVF program is in the private setting."
Advances in Reproductive Medicine
Oregon Reproductive Medicine has always stayed ahead of the curve in advanced reproductive technology. "We've been a blastocyst program, completely for five years, but almost completely for 10 years," says Dr. Matteri, referring to the transfer of an embryo on Day 5 or 6 vs. Day 3. "We were finally convinced about six or seven years ago that if our embryologist couldn't get the embyo to Day 5 in the lab, it's not going to happen inside you."
In addition, Dr. Matteri has seen significant growth in preimplantation genetic screening (PGS). "We actually call it Comprehensive Chromosomal Screening (CCS), where we do it for women who are of advanced reproductive age, women who didn't get pregnant the first time," he says. "We're not requiring people — if they are 39 — to do genetic screening, but we are offering it, and there a lot of patients who are taking us up on it. And the other people who are taking us up on it are those who have gone through IVF before, and they have come back, and they don't want two embryos transferred. They only want to have one embryo transferred, and they feel more comfortable doing that if it's a normal embryo."
CCS is performed on a Day 5 or 6 embryo that is subsequently frozen and then transferred in a frozen transfer cycle. "The other thing we have found is that if you freeze embryos, the ones that seem to thaw out are the normal genetic ones," Dr. Matteri says. "By looking at it, the ones that don't thaw out are the ones that are more likely to be abnormal."
Dr. Matteri certainly sees genetics as the wave of the future. "I think as soon as we come up with the 10 genes or five genes that cause autism, everybody in the country who wants to have one or two kids is going to want to do genetics," he says. "And it might not be autism, it might be something else just as drastic."
A Rewarding Field
Dr. Matteri's treatment philosophy has focused on the individual patient with a protocol designed for that patient. "We've always said you can provide the best care and the most compassionate care at the same time," he says. "That's always been the philosophy of our program — that if you will come here, people will know who you are and [provide] personal care. We're not a machine."
The physicians and staff at Oregon Reproductive Medicine work to try and limit the stress to the patient during an IVF cycle. "We've used things like acupuncture for over 10 to 12 years," he says. "We have a counselor on staff. A lot of the big programs lose people if they don't get pregnant the first cycle because it's so stressful to go through, and they don't feel like anyone is supporting them. But if someone drops out and they have the potential to get pregnant, that's someone we've lost. We try to keep that from happening."
The hardest part, of course, is IVF failure. "The failures, certainly those are the things I remember," he says. "Someone you've really tried to help, and they've done everything you've asked them to do — and even more — and then they don't get pregnant, or you realize that they don't have enough good eggs to get pregnant with their own eggs, or they keep having pregnancy loss. Those are the most difficult ones."
Still, the rewards are there. "There are lots and lots of rewarding parts of the practice," he says, "and of course that's why we keep doing this."
For his compassionate care on the leading edge of assisted reproductive technology, FertilityAuthority congratulates Dr. Robert Matteri.
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