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RE of the Month: Robert J. Stillman, M.D., F.A.C.O.G.
Robert J. Stillman, M.D., F.A.C.O.G.
- “You can have as many kids as you want, but preferably one at a time.”
Dr. Robert J. Stillman is not only an infertility specialist with an extremely busy practice at Shady Grove Fertility Center in Rockville, MD (part of the IntegraMed Fertility Network), he’s also an advocate for the health and well being of women and their babies.
“We have an ethical responsibility, not only to patient autonomy, but to the other major principle of beneficence,” he explains. This commitment to his patients and their future children drives his efforts to promote elective Single Embryo Transfer (eSET) in his practice and in his partnerships with RESOLVE: The National Infertility Association, and the Society for Assisted Reproductive Technology (SART). It’s why we’ve chosen Dr. Stillman as our RE of the Month.
Money and Multiples
Dr. Stillman never expected to one day be at the forefront of discussions about responsible embryo transfer practices. “There was no such thing as human IVF when I started,” he explains. “I finished my fellowship in 1979 and there was one birth – Baby Louise Brown.”
Louise Brown was born the year before and is known as the first “test tube” baby. As the industry grew, so did Dr. Stillman’s interest in the ethical aspects of assisted reproductive technology.
When IVF was less effective, it made sense for doctors to transfer multiple embryos to increase the chance of a successful pregnancy. But as science has improved, doctors are able to better gauge which embryos are stronger. In a study he led at Shady Grove, Dr. Stillman was able to prove that by choosing one good quality embryo, pregnancy rates remain high but the chance of twins – and the complications inherent to any multiple pregnancy – drop significantly. This practice is called Elective Single Embryo Transfer or eSET. For an industry used to thinking “more is more,” this more cautious approach has been a tough sell for many patients and for many of their doctors.
Informing and Empowering Patients
To help his patients understand the benefits of eSET, Dr. Stillman and his staff are working on a brochure titled, “But I Want Twins … What Are the Risks?” which outlines the hard realities of a more risky multiple pregnancy.
“My view is that if you’re having enough difficulty getting pregnant and you finally get pregnant, everything ought to be easy because you’ve already paid your dues,” he says. “To wind up with infants with complications or pregnancy loss at 24 weeks is that much more tragic and cruel.”
Dr. Stillman also helped create policies for his clinic that have been applauded in The Journal of Law, Medicine & Ethics.
Stillman’s clinic’s “Shared Risk Program” allows qualified patients to pay a flat fee for IVF cycles that’s refunded if they do not leave treatment with a baby in arms. In place since the mid-90s, the program acknowledges that patients who are less pressed financially are empowered to make choices that are more conservative in their treatment. This reality also drives Dr. Stillman’s efforts towards insurance reform, as policies rarely cover IVF.
"Insurance companies can be shortsighted and bureaucratic,” says Dr. Stillman. “They’re paying for pediatricians and intensive care nurseries for infants that are born as multiples because of fertility treatment. They’re not looking at the money they would be saving if we could avoid the complications in the first place.”
While Dr. Stillman believes strongly that decisions about treatment ultimately should lie with the informed consumer, he says fertility clinics need to be held accountable. To that end, he’s working with SART to develop a way to measure success rates that don’t reward clinics that transfer more embryos, rather gives clinics points for higher singleton births than for twins or triplets. These changes would give clinics higher success ratings as a reward for lower multiple birth rates.
It’s no wonder Dr. Stillman’s honors include the designation "Best Doctors for Women" from Good Housekeeping. A strong advocate for infertility patients everywhere, as well as their future babies, we applaud Dr. Stillman.