Why I'm Expanding My Fertility Services: A Practice Evolution Three Decades in the Making

After more than three decades caring for women in Marin County, I've decided to formalize and expand fertility services at La Follette OB-GYN in partnership with Branch Care. This decision reflects both my clinical experience and my deep commitment to supporting patients through their complete reproductive journey.

The Problem I've Been Watching

Over the past three decades in my Greenbrae practice, I've had countless conversations with women facing fertility concerns. These aren't just clinical encounters; they're emotionally charged moments where patients share their deepest hopes and fears about building families. As someone who has been passionate about reproductive longevity research and women's reproductive choice, these conversations have always resonated deeply with me.

The inefficiency I witnessed in traditional fertility care pathways have also nagged at me. I would often initiate basic fertility workups in my office, following ACOG guidelines for infertility evaluation. When patients transitioned to reproductive endocrinologists, many of those same tests would be repeated. My patients were experiencing duplicate labs, repeat ultrasounds, and paying twice for the same information.

They sometimes left specialist consultations feeling pushed toward IVF when ovulation induction or IUI might be equally appropriate starting points. As their OB/GYN, I had established relationships with these women. I understood their medical histories, their concerns, and their goals. I wanted to support them through more of this journey.

Recognizing Our Existing Strengths

OB/GYNs already possess many clinical skills needed for initial fertility evaluation. Equally importantly, we have established relationships built on trust and continuity. Patients naturally turn to their OB/GYNs first with fertility concerns. We're often their primary contact for reproductive health questions. The infrastructure to formalize these services while maintaining rigorous clinical standards has been missing from most practices, making it difficult to deliver this care systematically.

Finding the Right Partnership

The most significant barrier I hear from colleagues who seek to support their patients’ fertility needs is about operational demands, not clinical competency. Fertility care requires extensive patient education, insurance verification, care coordination, and ongoing communication. These elements are essential but can easily overwhelm practice workflows.

Branch Care addressed this challenge through comprehensive support systems. Their dedicated fertility nurses handle the time-intensive components: patient education sessions, benefits verification, lab coordination, appointment scheduling, and ongoing patient support. This allows me to focus on clinical decision-making while ensuring patients receive thorough care coordination.

Every protocol we follow has been developed in collaboration with board-certified Reproductive Endocrinology and Infertility specialists (REIs). Every patient workup receives REI specialist review. When patients are ready for advanced treatments, they arrive at REI offices with complete, standardized documentation that specialists can immediately utilize.

Transforming Patient Experience

The transformation in patient experience has been remarkable. Instead of having patients experience a piecemeal array of tests between providers, I can now offer:

• Immediate initiation of care when patients express concerns, backed by a team of fertility nurses that can reduce uncompensated physician time
• Comprehensive diagnostic workups using our existing capabilities, with REI-approved protocols ensuring no tests need to be duplicated at patient handoff
• Continuity of care throughout their fertility journey, from initial evaluation through pregnancy and beyond
• Coordinated treatment for services within our scope, like ovulation induction and IUI, with seamless REI support when needed

Supporting Professional Collaboration

This model enhances collaboration rather than creating competition. REIs can dedicate their subspecialty expertise to complex cases requiring advanced intervention, while receiving better-prepared patients with complete workups.

For OB/GYNs, this enables us to support patients through earlier stages of their fertility journey with appropriate specialist oversight. Both provider types can practice at the top of their license while improving patient access and care coordination.

An Investment in Comprehensive Care

After three decades of practice, I've learned that the most rewarding work happens when we can support patients through their complete journey. Expanding fertility services has allowed me to be present for more of my patients' stories, from initial concerns through pregnancy and beyond.

"After three decades of practice, I've learned that the most rewarding work happens when we can support patients through their complete journey. Expanding fertility services has allowed me to be present for more of my patients' stories, from initial concerns through pregnancy and beyond."

For colleagues considering similar practice evolution, I'd encourage you to consider the conversations you're already having with patients. The clinical foundation exists within our training. The operational support systems now exist to make this expansion both clinically excellent and practically sustainable.

This partnership has been about returning to why I became a physician: to support women through all phases of their reproductive lives with expertise, compassion, and comprehensive care.

What questions do you have about expanding fertility services in your practice? I'd love to continue this conversation with colleagues who are considering similar practice evolution.