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Fertility Doctor of the Month: Sarah L. Berga, M.D.

Sarah L. Berga, M.D., Professor and Chair of the Department of Obstetrics and Gynecology, Vice President for Women’s Health Services, Wake Forest University Center for Reproductive Medicine

July 2013

Dr. Sarah Berga was destined to be a reproductive endocrinologist. In the fifth grade, as an avid reader of biographies, she chose to read about Freud and cognitive behavior influencing biology. As early as elementary school she was interested in the relationship between hormones and behavior. Later, as an undergraduate honor student at University of Virginia, her thesis addressed “Physiological Dimorphism and Gender Asymmetry.”

Today Dr. Berga is a fertility doctor with Wake Forest University Center for Reproductive Medicine and Professor and Chair of the Department of Ob/Gyn. She is a researcher who has had funding from the National Institutes of Health (NIH) for the past 27 years; she pioneered the use of cognitive behavior therapy for stress-induced infertility; and she has published approximately 200 papers. She is smart, philosophical, and very thoughtful. FertilityAuthority is pleased to recognize Dr. Berga as Doctor of the Month.

Through research, Dr. Berga and her team determined cognitive therapy could restore ovarian function in women with functional hypothalamic amenorrhea (FHA). Most recently she led a secondary study on the relationship, and determined that the cognitive approach would also improve neuroendocrine and metabolic function in women with FHA.

Berga says we could do well to understand the role of stressors, which she says “lurk in the background” and put “brakes on the system.” She cites attitudes that cause stress including unrealistic expectations, too much happening in a day, and perfectionism. Nutritional and exercise factors exacerbate the problem.

“The most prevalent form of infertility I see is unexplained infertility,” she says, often related to age or stress or both. Patients with stress-induced infertility are often anxious, driven and goal oriented, she says. If you can get stressors under control you could reduce cortisol levels, she says -- high cortisol levels are linked to low levels of reproductive hormones and to amenorrhea. Cognitive behavior therapy is one pathway to bring cortisol levels down.

For that reason she plants the idea of cognitive therapy as a companion to standard infertility therapy in her patients. It’s empowering for patients to be able to take back some control.

It’s taken Berga a long time to get here. Early on in her career, people didn’t believe that stress was real, that it had a negative footprint and led to endocrine alteration. But the perspective has slowly changed, particularly because today we can correctly specify mechanisms by which stress impacts reproductive function.

This has led to Berga’s rationale adopting a holistic perspective to patient care.

“The human experience of helping patients is a much bigger part of being a doctor,” than the technical aspect is. And that surprised Berga.

“My biggest goals are to help people to have better control of their lives in terms of health. Families will be healthier because parents are healthier.” People need to understand that the way we think has health consequences, she says. Health hygiene comes in as infertility sometimes. But there are lessons beyond infertility. Stress can cause heart disease, stroke, hypertension, diabetes and preterm labor; and stress accelerates aging.”

“Reproduction is just the tip of iceberg,” she says. “The lessons we are learning are applicable to all syndromes.”

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