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I’m excited to share my recent interview with Dr. Rahi Victory with you. He is a Canadian trained OBGYN, who attended Wayne State University in Detroit for his fellowship training in reproductive endocrinology and infertility. He now provides the best, most transparent, honest fertility care out of Toronto, Canada.
Dr. Aimee: Dr. Victory, thank you for joining us on today’s show. Tell us a little bit more about yourself and your practice.
Dr. Rahi Victory: Thank you for having me. It’s a pleasure to be here. We have a practice in Toronto and then we also have a practice in Windsor, and we run labs at both sites. We are opening satellite clinics soon as well.
Our model is a little bit different than the traditional model. We’re very patient-focused and we really try to give patients options and choices rather than pushing through one treatment.
Dr. Aimee: That’s exactly why I invited you on today’s show, to talk about how to make sure your journey is your doctor’s priority, and it’s your journey, not your doctor’s journey.
Dr. Rahi Victory: Absolutely, for sure. We want to facilitate that journey for our patients.
Dr. Aimee: For those of you who are listening right now and want to learn more about how you can be Dr. Victory’s patient, it’s easy. Go to DrVictory.com. You also take care of international patients, including my patients from California. Is that right?
Dr. Rahi Victory: That’s correct. We have patients from Europe, Japan, Russia, Israel, and we’ve been in contact with many patients from California and all throughout the US.
Dr. Aimee: I love it. You’re all about transparency and honesty. How do you start your relationship with your patients?
Dr. Rahi Victory: Our initial discussion is just a deep dive into their history. I need to know everything about the individual, or if they’re a couple, about the couple. We want to know about their journey getting up to the point where they’ve met us.
We do a lot of second opinion work, so if that’s the case, I need to know about what they’ve done before and where they’re coming from. You really want to know about what their expectations are from the process. Are they looking to use their own eggs? Are they looking to use somebody else’s eggs and/or sperm? Is it same sex or a heterosexual couple? All of these are critical elements.
Then we really do a lot of in depth evaluation of their psychological perspectives, their emotional perspectives, what are they aiming for with all of this. And what’s their own history, do they smoke, do they drink, are their diets appropriate, are they getting exercise, how high is their stress level.
We really take a very wholistic approach to the patient, because I think it’s important that you address each and every one of those points rather than just look at them and say, “Your tubes are blocked, you need IVF.” It’s not just about needing IVF, it’s about where that patient is coming from and where they’re trying to get to.
Dr. Aimee: Wonderful. I imagine there are a lot of tests that you’re doing for your patients as well. What is your philosophy about testing your patients?
Dr. Rahi Victory: We really like to be very comprehensive in our testing. We try to focus on addressing all of the major categories that we can in the testing, to make sure that we’re addressing what we’re going to need to know in order to give them advice as to what approaches would be appropriate or indicated.
From a male perspective, obviously we’re looking at all of the blood work, we’re looking at their STD screen. We do check male hormones. Obviously, an in depth semen analysis. More and more, we are taking on DNA fragmentation as an important part of our screening for men.
Certainly, if it’s more complicated, where you’re dealing with very poor sperm quality, there are additional tests we’ll look at. Including whether it’s chemical exposures, or vitamin deficiencies, whether you need an ultrasound, and so on. Genetic testing where it’s indicated for azoospermia cases as well.
For women, it’s a little bit more complicated. We explore a whole month of monitoring with them with natural cycle monitoring, as we call it, to see how many eggs they have, what is their uterine lining looking like throughout the course of the cycle, are their eggs developing at a reasonable rate, is it taking 35 days to go through a cycle or 28 days or 40.
Then we look at the tubal status and the cavity of the uterus, so I do a saline infusion sonohysterogram (SIS) for everyone. We do it extremely gently. There’s a lot of fear out there about the SIS, but I’ve literally never had a single patient complain about our SIS procedure, so we’re very gentle and delicate while we do them.
Then we try our best to explore egg quality, which we all know is not the easiest thing to figure out. We do our best with surrogate markers, with hormones, AMH. Again, we explore vitamin levels. I check vitamin D and ferritin on every single patient, because we know that those can be quite important in terms of their success rates.
Certainly for the patients where they have “unexplained infertility,” and I know most of us don’t necessarily believe there is such a thing as unexplained infertility, I make sure that they don’t have a history that is going to lead to a diagnosis of endometriosis, or adenomyosis, or tubal disease.
We try our best to really dot every I and cross every T, so patients are not left after waiting a month for the answer with, “I’m sorry, I don’t have an answer.” We want to try and answer it as much as possible for every couple.
Dr. Aimee: How do you communicate test results to your patients?
Dr. Rahi Victory: I think that’s probably the most important part of our job, to be honest. It’s what we call in our practice an I-1, it’s the first visit that the patient is having after they’ve had a diagnosis of infertility. We spend a lot of time at that discussion.
First, just explaining every single thing that the patients have found. We go through the numbers, I explain what each hormone does, I explain what the number they had was, and then we actually say what that signifies, what that represents. We go through vitamin levels. We talk about the sperm performance. I break it up into its component parts, so I’ll tell them about their volume, their count, their motility, the progression, and so on.
So, we really dive deeply into the data that we’ve received from all of the testing that we’ve done. We show patients pictures of the uterus. We share the screening of the sperm and so on. Once we’ve done all of that, we really have educated the patients, or at least I set it as my goal to educate the patients, so that they never leave me saying, “He didn’t tell us what was wrong.”
I want every patient to leave saying, “We know exactly what was wrong. He explained it to us. We understand what was going on so far and now we know what we need to do moving forward.” That’s really the goal of that first discussion. I feel at that point like I’m not really necessarily a doctor as much as I am a teacher, because it’s my role to educate the patients about what’s going on with them.
Dr. Aimee: How do you counsel your patients about their different options once you have all of the test results available to you?
Dr. Rahi Victory: I think that’s the part where transparency and honesty is really important. Obviously, a lot of clinics can favor one treatment over another. If you’re a satellite, you want to probably promote doing insemination, because that’s probably what you’re doing there. If you’re a lab, you want to offer IVF.
For us, I just want to get the patients through their specific journey. My priority is helping the patients achieve their priority, so we really lay out all of the options. I start by saying that you can do nothing, because doing nothing is an option. There’s even data that supports doing nothing in some cases.
We really explain to patients they can start with doing nothing. Maybe they just need to change some of their psychosocial habits, like smoking, drinking, drug use, marijuana, maybe they need to change their vitamins, maybe they need a naturopath or traditional Chinese medicine. Then you start getting into the treatment modalities that we use, which are things like insemination and IVF. I do a lot of minimally invasive surgery, so if I feel that surgery is indicated then we’ll talk about the potential need for surgery.
We very much want our patients to understand that we feel that infertility is a loss of control for our patients, and we want to restore that control back to them. It’s hard to feel like you have autonomy over your medical care without feeling like you have control to make your own decisions. We really try to educate patients, give them the information they need, and then really explore with them what those choices are, and let them make the choice as to which one is best for them.
I always tell people no one wants me in the bedroom with them, so they really need to be able to make their own decisions about what’s right and wrong for them. They don’t need me there in the middle of it.
Dr. Aimee: I tell people that my office is not as sexy as your bedroom. Let’s say that they’ve gone through treatment and you’ve done everything you possibly can as a medical doctor and a human being to help your patients, and the treatment isn’t successful. What do you do then?
Dr. Rahi Victory: We always go back over everything we’ve done from start to finish. We’ll go back over their history, make sure we haven’t missed anything along the way. We’ll go through what they’ve done with us so far. Did we miss endometriosis? Would it be worth considering surgery in some cases? Did they have a fibroid that we thought was not an issue but maybe now is? Are there other components of this that we haven’t caught so far? Maybe the partner is smoking and isn’t telling anyone, or something like that.
We really do a fine-tooth comb review of everything that we’ve done. Then we sit down and explain to patients that there are three components to the whole fertility process; that is the passage, the passenger, and the destination.
Specifically, if we’re doing IVF, we start talking to them about the passenger, which is the embryo. Was it a good quality embryo? Was it genetically normal? Do we think it was energy efficient? Did it have all of the tools and pieces and parts that it needed to function and to stick, attach, and grow?
Then we talk about the passage, which is us. Did we do a good embryo transfer? Was the transfer gentle? Did the patient have cramping, was there bleeding, did I clean the mucus? If it’s a difficult embryo transfer, one of the things that we’ve really focused on, and I’d like to say really honed down on now is doing transvaginal ultrasound guided embryo transfers. If the uterus us retroverted, we all know those are very difficult to see on transabdominal ultrasound, so we do it with a transvaginal and you get beautiful visualization, you still get that same quality of view that you would with a normally positioned uterus.
Then we talk about the destination, which is often the complex part of it. Was the lining okay? Did you have compression of the lining after you started the progesterone? Were there contractions there? Do we think it was synchronous (if you believe in that)? Do we think that there was a problem with the patient’s immune system or a problem with the blood flow and so on? We address as much of that as we possibly can.
I really firmly believe that there doesn’t necessarily need to be an end to a patient’s journey. There’s almost always something more we can do or investigate to help find answers for them. It doesn’t necessarily even mean that they have to do more treatment. I owe it to them as their doctor to at least give them an answer, and I’m willing to fight for that, no matter what it takes.
Dr. Aimee: I love it. We need to make a t-shirt that says that and then have #Dr.Victory. I imagine that it’s so hard for patients to leave your practice. What do you tell them? How do you equip them for the next part of their pregnancy journey so that they are as educated as possible about what they need to know?
Dr. Rahi Victory: I appreciate you saying that, first of all. I certainly want to be the kind of physician where it’s hard to leave us. I think it’s really important for patients to feel educated and to feel like they need to advocate for themselves.
At the same time, I always argue online that patients shouldn’t have to advocate for themselves, but I do want them to be prepared to do that, because I can’t vouch for every physician out there. Certainly, there are physicians that feel that they need to align their priorities with the patient’s priorities, and there are physicians out there that feel that the patients should just listen to them. I think patients have to be prepared to know what questions to ask and know how to navigate their journey with whoever they’re with.
We do focus a lot on making sure that our patients understand what they’ve gone through, understand the journey moving forward. I frequently during these second opinions will say to patients, “Make sure you’re finding a physician who is willing to listen, who is willing to offer you options, who is willing to not impose their will on you but rather listen to you and hear you, and then see what they can do to facilitate what you’re trying to achieve.”
I think it’s really important to find physicians that can align themselves with your priorities, rather than finding someone who just wants to put you through the cookie cutter medicine, because that’s never going to work. We always ay that we’re making babies, not cookies, so cookie cutter medicine does not work in fertility.
Dr. Aimee: I love it. You’re making babies, not cookies. You guys heard it here with Dr. Victory. This is awesome. I hate to see you go, like your patients, and I would love to talk to you all day long, and I certainly could. I want to ask you one last question…
What is the one thing you would tell a fertility patient today who was starting their fertility journey, what’s the most important thing that you would want them to do or know?
Dr. Rahi Victory: I think patients starting their fertility journey need to have tremendous hope, because there are solutions for you. I don’t want you to go into it afraid, ashamed, or worried that you’re not going to get help. There are lots of answers out there.
I think you need to find a physician or a team of physicians that are going to help you find those answers. Don’t go somewhere where the goal is money or the goal is just grinding you through the IVF machine. Go somewhere where your priority is their priority. I think that’s the most important part. Find a physician that is honest, transparent, and really values you as a person, not you as a dollar sign.
Dr. Aimee: Awesome. Thank you. Victory Reproductive Care, the website is DrVictory.com. Thank you, Dr. Victory, for coming on today’s show and sharing all your wisdom with us.
Dr. Rahi Victory: Thank you so much for having me. It’s been a real pleasure.Catch more of me and topics like this through The Egg Whisperer Show. Episodes are live-streamed on YouTube, Facebook, Twitter, IGTV and Apple Podcasts . Sign up to get my newsletter. Tune in to The Egg Whisperer Show on YouTube. and Sign up for The Egg Whisperer School.