Posted on January 28th, 2021by RMANY

Ep 47: Catching Up on What Transpired in 2020 with Dr. Alan Copperman

Fertility Forward Episode 47:

Today on the Fertility Forward podcast we welcome back the Medical Director of RMA of New York, Dr. Alan Copperman. A lot has transpired, especially over the last nine months with COVID-19, and you’ll hear from Dr. Copperman to see how things have been professionally and personally. We talk about what we can look forward to in the future, in terms of clinic closures and what COVID-19 means for those trying to conceive, those who are pregnant, and more. Dr. Copperman sharing the hardest things, in his experience, in running a fertility clinic during the pandemic, and he does an excellent job explaining the mechanisms behind the coronavirus vaccinations and they role they play in pregnancy and fertility. We explore and elaborate on all the positives that have stemmed from the pandemic and how the power of positivity impacts our mindsets and dispositions, how we strive to empower patients to self-advocate and why, and so much more on today’s show. Tune in for all this, and more!

Transcript of Episode 47

Rena: Hi everyone, we are Rena and Dara and welcome to fertility forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power and you are your own best advocate.
Dara: Rena and I are so excited to jump right in. It's been just over a year since we started our podcast and now 47 episodes in, we are actually coming full circle. We have our boss and our medical director of RMA of New York, Dr. Alan Copperman back with us. And a lot has transpired, especially over the past nine months with COVID-19. And today we just want to have a chat with you to see how things have been professionally and also personally. So thanks for being here.
Dr. Copperman: Thanks Dara and thanks, Rena. Really an honor to be back and chatting with you both and talking about the different world that exists right now than the one that we started with a year ago.
Rena: Yes, we're so excited. And I didn't even think until you said that it has come full circle, having Dr. Copperman back in it quite a while ago, that you were on our first episode and it's crazy now that we've come through a global pandemic and we're still in it. I know our listeners will be really, really curious to hear your feedback about sort of what transpired and then what they can look to for the future. You know, I know all of us, I'm sure it dealt with our patients, having a lot of anxiety throughout the pandemic and potential clinic closures, what COVID may or may not mean for those trying to conceive, those that are pregnant. So I'd love to get your professional opinion and thoughts on all of the above, wherever you want to dive in.
Dr. Copperman: You know, yesterday I was performing an embryo transfer and somebody had their ear pods in. I said, what are you listening to? And they smiled and said it was Fertility Forward. That she just found that she was just picking up some techniques to help her with her relaxation or frame of mind and that she was choosing education to help lower her anxiety just like you told her to do. So, thanks to you both I think that that’s a proof that this is a worthwhile venture and that hopefully on an individual and a community level we’re making an impact.
Rena: I love that. Thank you for the feedback and sending lots of good vibes to the patient who had the transfer. So let’s go! That's awesome to hear. What would you say was the hardest thing about the past few months and running a fertility clinic throughout the pandemic? Let's start with that.
Dr. Copperman: so much has been said and written about 2020 the year that we'll just go down as really a very sad and challenging year, tremendous loss for civility, tremendous loss of life, tremendous loss of opportunity to be with loved ones. And I sit here today at the beginning of 2021 with vaccines around the pike for many, with us coming into a kinder, gentler place with hopefully spring coming in a couple of months. And I think of the positivity that we were able to get through this together with science and technology. I found myself reading more about virology and immunology and vaccine mechanisms of disease, occupational health safety, regulatory awareness. I found that this was this opportunity to take science and take the epidemiologists, make them into the rock stars that they are, and to translate that into better patient care in a safe environment for our team working. That's been the challenge this past year. How do we continue to help when patients need us so badly to be there, to do the egg retrieval, to do the embryo transfer, to preserve their fertility, their eggs and their sperm prior to chemotherapy and do it in a way that's safe and to stay open and to protect our staff. And so we face unprecedented challenges and we've been creative. It's not just masks. It's not just PPE. It's not just social distancing. It is this awareness symptom checking, respect, social distancing, and spree to core that's helped us come together to continue to deliver care. It has been challenging, but it's been so rewarding. And on my desk, you can see just alongside it, there are just hundreds and hundreds of holiday cards and thank you cards that really are a testament to the whole team and the whole field that got through together, the challenges and that developed a safer, more effective way of delivering care.
Dara: How nice is that? I feel like you also have been so great with communication, and I think that's a big part of it. It's one thing, as you mentioned, having all the safety measures and guidelines enforced in the clinic, but on top of that, the communication with staff, the communication with patients. I'm sure that's been a lot on your end, but I think it's a testament to how you've been able to adapt and evolve as a business and as a practice, you know, that really cares for the people.
Dr. Copperman: You know, the calculus scares people. Multi-variate calculus scares everybody, but it's simply based on these concepts. You've got to define the best possible outcome and then you've gotta define the worst possible outcome. And you draw lines that help you achieve the positives as often as possible while minimizing the negatives. So how do we deliver care, but not get our employees sick? How do we comply with guidelines in a way that allows us to continue to deliver care? How do we close if there's not enough PPE and ICU beds to take care of complicated situations and yet open up, even though this is a scary time to make sure we're doing the timely delivery of essential care that we need to. So, yeah, I think that it's learning and communicating and making these complex decisions along with this wonderful team of scientists, administrators, and the physician and the nurses and getting input from everybody. And that's, that's been the challenge with the rewards this past year. Again, we were learning science. I think that everybody now knows that there's a family of viruses called coronaviruses that SARS and MERS have been around for decades. And that ultimately they don't really interfere with fertility. And that COVID-19 is a variant of this. It’s an RNA virus. It's a small one. It only has a bunch of proteins that it codes for, but there's one nasty one, this spike, which can penetrate cells in the lungs and the kidneys because it really attaches to a receptor. And it's not easy for the body to clear. And it is very contagious when somebody who's infected with COVID-19 sneezes or coughs, these large droplets can get everywhere and there could be one person that's a super spreader. So we've got to stay away from these infectious environments. Now I knew none of that a year ago, but that really is something that we should all know right now. The other magic of this last year has been the speed at which we developed a new category of vaccinations. I'm going, maybe I'm jumping the gun and I'm sure you guys want to talk about this, but what is the Pfizer and the Moderna vaccine and how do we know it's safe? And should we take it? And should we not? Modern technology has never developed a vaccination in the history of modern science with the speed and yet that doesn't make it unsafe. So the theory that technology, the science behind this is pretty simple. We want the body in this case a muscle cell and the deltoid muscle in the arm, to present as if it's a virus so the body makes antibodies to it. So what you do is you take the MRNA, you take a simple message, you inject it right into the muscle and the cells then say, wow, there's a message. What do we do? The ribosomes make a protein. And the protein looks like that spike. So the cell pops, opens up and these spikes are floating around and the lymphocytes say, wow, we don't want a spike here and makes antibodies right in that lymph node in the armpit. What's amazing is that the only cells that are making the antibodies are right here so that the RNA and the particles of the RNA have dissolved, it stays localized within that arm, but the antibodies go throughout the body and they prevent cells around the body from being infected. So what we know is that the antibody responses is swift, it's specific to COVID-19, and within one dose of some of these vaccines, almost half of people are immune within two weeks and within two doses in a week after that 95% reduction in getting the disease. So what we know is that COVID-19 causes significant complications in pregnancy and preventing COVID should be one of the most important things that we do. But this vaccine really seems to protect against COVID-19 and can help us beat this pandemic. So once again, science and an understanding and forward-thinking and investment of pharma and government together has helped save the world.
Dara: Dr. Copperman, I love the way you explained it. I feel like it's great for the lay person, including myself, of how it works. And I think that's part of it. I think if we don't really understand how it works, it can be quite overwhelming and scary, but once we can get that understanding of how it reacts in our body and also the knowledge that getting a vaccine can be protective and actually has lower risk potentially than getting COVID when you're pregnant, that itself is reassuring.
Dr. Copperman: Saves your life, saves your family's lives, saves your loved ones lives, enables you to go back into the community and be productive. And it opens it up so maybe in a few months we're starting to travel again and go dining and having a handshake or even a high five without being petrified that we're actually going to be a victim of this horrible little virus.
Rena: I love your message of positivity and hope, and I think that's so needed right now. So I hope people are listening cause I know, you know, it's been hard. I think people went into 2021 trying to be hopeful but at least the sentiment I’m hearing from patients, people in my life, are they’re feeling a little dim and grim right now. So I think any message of hope is certainly well received.
Dr. Copperman: We're social creatures. We rely on each other. We go to movies to experience the full range of human emotions. Not all of them positive. And sometimes we just, by feeling sadness or grief, we feel, we live, we exist. I happen to like the positive messages. That's why I chose this field. It's not that we're afraid to give out bad news. It’s part of what we have to do, but I love the fact that we're able to share scientific advances. And I love the fact that we're achieving pregnancies, that people who are coming back in after being on the sidelines for three or six months in the spring or the summer, or afraid to or told not to leave their houses are coming back in and they're achieving their goals. Without a doubt, you know, spring is here. This is a time where we're getting back on track after just this unprecedented derailing.
Rena: Totally. You know I hear a lot a patients, you know I work a lot with sort of reframing and the power of positive thinking. And one of the pandemic positives as I call it that a lot of patients have said you know what? I actually feel like this is a great time to try to conceive because I'm not going into work. I don't have to deal with making up excuses for doctor's appointments. I don't have to deal with anyone seeing me so I don’t have to hide if I have a bloat or a bump. No one has any idea. So I actually kind of like being able to do this hidden at home. It's a great time and I’m actually able to do it.
Dr. Copperman: Yeah, there will be positives that have come out of this. And I look at telehealth and the number of times that somebody would spend an hour coming into an appointment, wait the 10 or 15 minutes from running late, spend a few minutes and then spend the time commuting home when it really was a quick question, but being able to sit here and communicate from the screen, cause a lot of what we do doesn't involve physical exams of ultrasounds. A lot of it does. I mean, we still have to bring patients in for scans or for blood tests and examinations, but a lot of what we can do, some of the prep works. This is a great time-saver for many people. And I would agree that this pandemic and people working remotely has given an opportunity for private conversations, for follow-ups that are meaningful and in a timely fashion delivered to patients without waiting months for a doctor's visit. It has been transformative.
Rena: Absolutely. And I don't know about you, but I've been able to see so many more patients and I’ve had so few cancellations. You know, before the pandemic people would cancel a lot coming into the office. They couldn't get out of work, you know, as you said, that commute time, et cetera. It would be a two hour ordeal which in the middle of the day is difficult for people. And now with the ease of tele-health and we have these HIPPA compliant platforms, people show up consistently.
Dr. Copperman: I know that I've given out both of your names as resources more times in the last six to nine months than I think in the year’s before that we’ve gotten to work together. And my goodness, Dara, you must be exploding in patients meeting because we've all gained the COVID 19. And Rena, we all, haven't seen a lot of sunlight and haven't had those gatherings with loved ones too. I mean the two of you must constantly be able to reach down for your own strength to be able to deliver these messages to our patients.
Dara: We have been busier than ever, but it's been great. I feel like, as Rena said, we have been able to connect to more people just for the mere fact that there's less cancellations. There's more opportunities to reach people from all over. And I mean, that's our job, which I'm speaking for Rena, but I'm sure she can agree that we're in this field to give back and to give compassion and to give support. And I feel like at least speaking for myself that I feel like the patients have also helped me in this journey as well. Rena has helped me in this journey as well. And I really do think that even this podcast has been such a great platform for us to do the work that we love and to give back to people, especially during this time when there is a lot of uncertainty and a little bit of added anxiety.
Dr. Copperman: Well I know, Dara, I’ve spent more time cooking over the last five months.
Rena: Oh yeah? Do you have a specialty?
Dr. Copperman: Well, in warmer weather I like to be grill master. And again, if you could name a food group, I can grill it. Just a balanced meal, a little bit of flavor and a little bit of color and texture differences. And just having a lot of fun innovating. I absolutely love the sport of cooking for family and small groups these days. It’s not like you’re throwing dinner parties and hopefully that’ll still come soon but I think that focusing on nutrition and focusing. And I think, Rena you said it best, cognitive reframing. The number of times that people must come in and saying, hey, this is the worst day ever. And you're helping to say well tell me something positive. These messages of positivity will definitely exponentially get out there as they take that same opportunity when they see their next person who tells them how sad they are saying, okay, tell me something positive. We’ve got to feel the sad, but we can also have that first story be one of hope and I think that that’s going to help pull us out.
Rena: Totally. I think you just touched upon it. You know, that we have to feel the sad. And I think, you know, something I do all the time in my job is validate people's feelings. You know, what we don't want to do is repress our feelings. And I certainly believe in the power of positivity and reframing. And sometimes I almost worry a little that people might think that, you know, like I have my head in the clouds and that do I not see what’s going on because I think I present, you know, these ideas and that things are okay and let's be positive. And that doesn't mean that I don't feel sad or that this isn't hard. It's been incredibly hard. I've gone through it the same as most people. I got very sick in March and this has been very difficult. So it doesn't mean that I haven't experienced that, but I'm really lucky that I've done a lot of work personally and professionally, and I have the tools to be able to cope with it. And so I feel really lucky that I can share that with other people and then see how this benefits them.
Dara: I love the idea also of reframing, which I feel like you are so great at and acknowledging, acknowledging that there are some moments that are more challenging than others, but that we can all find gratitude out there even while experiencing some tough moments.
Dr. Copperman: Resilience, getting back up to the plate after being knocked down and feeling these feelings are valid, the suffering and the loss, the delays, the loss of jobs, the cost of treatment, the burden of treatment. It doesn't make them not real, but finding some other pathway to achieve success or to be patient until you have the opportunity. That's part of our goals as healthcare deliverers is not just to give medication, but to help patients see see a clear pathway. Somebody recently sent over to Dara just to work on the BMI so that they can be in the right physical shape to achieve a pregnancy. Or to Rena who's having a relationship issue as people are fighting over their computer screens in a studio apartment, yelling over each other in meetings and try to help them with their relationship to find some boundaries and realize that nobody's being selfish. Everybody has to get their needs met in some way and just trying to set some guidelines to help. You guys as much as the medication is, part of the stories that are help us get through this.
Rena: Well that's why we love you Dr. Copperman and RMA because you believe in this collaborative, integrative approach to care and you, you know, brought me and Dara on as sort of this wellness team and you believe in this integrative approach, and I get questions all the time from patients, they say, I don't understand why is there not a mental health person and nutritionist in these other clinics? And I just say, well, you know, Dr. Copperman was on board, RMA was on board and they believe that this is so important to the process as you know, myself and Dara do. So we're really lucky to have, you know, someone like you share our vision and understand that approach because I think that really serves our patients.
Dr. Copperman: I think you guys also do a really good job of helping patients self advocate for themselves. And when a patient lets us know what they're going through, lets us know what their needs are then it makes it much easier to hit those needs. It's easy to be unaware. I mean, we can see a hundred patients in a day and we smile and we're nice to everybody and we measure their follicles and we make a medical decision. But when somebody says, you know, I've got a kid at home who's struggling, tell us about it. It turns out it might be genetic like, well, let's see our genetics counselor. Let's see if there's anything that we need to learn about your history, that humanist, just that conversation when they tell us that there's something else going on, aside from their follicle. And we should be asking as healthcare professionals, but you guys empower patients to tell us, and then it's up to us to hear what they're saying. And that's all part of delivery of great care.
Rena: I think it's interesting. And I was having this conversation with someone the other day who was really afraid to say anything to her doctor. You know, I think their relationship was one of deliver things and she accepted it. And we were just sort of having a more existential conversation that healthcare in general. And I think, you know, especially at RMA, that culture is changing and you want to hear from patients, you want to talk to them, have open dialogue. I think we all feel really lucky that our patient population is so smart and diverse and they are so invested in their care. And that makes I think a really interesting experience working with them. And one of the things I love and I know everyone at RMA is open to these conversations and loves when patient advocate and speak up.
Dr. Copperman: I love that we've got this digital platform that before the patient comes in, that they tell their whole story. So before I actually meet with the patient, I know what's important to them. I've read through this story, I’m prepared, I’ve reviewed their medical records. So when they sit there in the office, I can tell them, not what are you here for? But I get to talk about it. Well, how have you been handling this burden? I see so many pages of notes. That emotional costs to you has been tremendous. How are you handling them? I get to have a real human conversation rather than the simple says here that your AMH is, that's not a way to start off a dialogue. And so hopefully this has given us with information and with a little bit of awareness, we try to be more sensitive than maybe doctors of years ago.
Rena: Oh I think so I think that always comes across for sure. So what do you see? I mean, if anything, any sort of trends for 2021, where do you think this year is going to take us in terms of fertility care? Are you able to see anything this early on?
Dr. Copperman: I think that we're seeing opportunities to have more coverage for fertility treatment. New York's mandate has transformed the opportunity for many families. New York was of the I think the 12th or 13th? I know Resolve is a big part of your professional life, Rena. But Resolve has fought hard to get New Yorkers the right and access to healthcare. So we're seeing more people eligible. Employers are beginning to recognize that if they want to recruit and retain, especially female employees, then it's important to cover. So there are some employer sponsored benefits that are coming into play. The governor announced his family building act. The fact that New York will allow surrogacy. So we're starting our same sex male parenting program in February, where as two men can get married. Now, not only can they get married, but they could have a baby. And so we're building out our gestational surrogacy program. I think we’ll continued to see streamlined diagnostics and treatment. I think that the times of pregnancy will get shorter and shorter from the new patient until at the obstetrician with a healthy singleton pregnancy because we're not wasting a lot of time on diagnostic cycles. We're not spending months and months doing low tech treatments that don't work as well like clomid. We're not doing unnecessary surgeries like laparoscopies and hysteroscopy, unless they're really indicated to diagnose or treat pathology. And we're focusing on IVF with a single screened embryo transfer which is going to work on the first try more than half the time. So we're seeing the whole treatment journey condensed into a very short diagnostic and a patient focused treatment cycle. So with better coverage, more precise diagnostic, better sequencing technologies. I think we're going to see better outcomes in a more cost effective way.
Rena: I love to hear that. I think one of the major difficulties is the timeline, and the waiting, and the anticipation. So that’s super exciting that everything's going to be streamlined and condensed. That’s going to make a world of difference.
Dr. Copperman: Even the two-week wait is 8 days now. Now, after the embryo transfer we do a pregnancy test eight days later just to beat the famed internet.
Rena: Wow. I’m going to have to revise all my writing. Take out two-week wait. That's incredible. I hope that really brings a message of hope to people because that's incredible. You know I’ve seen a few companies out there that are working on a variety of things to streamline different processes and it’s quite incredible.
Dr. Copperman: And sequencing technologies will continue to get better and better because we're just, the sequencing of the genome is actually progressing at a super Moore's law rate and more information, shorter time period, less cost. So right now we're screeningwhen a couple wants to have a baby for 284 diseases. Within the next two months, the standard of care is going to be over 500 diseases. One tube of blood or one bit of saliva from a couple, whether they're at risk of not only cystic fibrosis and Tay-Sachs, but hundreds and hundreds of diseases because of streamline technology. And if a couple is at risk of having an affected baby, then the technology to test an embryo is getting cheaper and more accessible and without delays able to allow us to help them achieve not only a pregnancy, not only a singleton pregnancy, but a singleton pregnancy of a baby who isn't affected with a disease that might've been in their family or a gene that they didn't even know about.
Dara: Wow. So many areas of advancement and lots to be excited for. I feel like, you know, this is going to be a great year. I feel it in the, in terms of fertility and health and wellness, but I want to go back to you, Dr. Copperman. It's been, I'm sure a challenging year. I mean first all for us all, but I'm sure for you. I know in the past you've told us in your spare time that you like to spin and now we know you also like to cook. Is there anything else that you like to personally do to help feel good?
Dr. Copperman: So my spinning has changed from Soul Cycle to Peloton and that is one of the byproducts of the pandemic.
Rena: I won’t ask you to share your name on the leader boards but we’ll have to discuss our favorite instructors.
Dr. Copperman: And occasionally play the piano. I took lessons for a lot of years, mostly as a kid and just putting my classical music at the bottom and pulling out Billy Joel. I look forward to traveling again because that is a passion to go to new places. And hopefully when we're all vaccinated, when we've achieved her herd immunity, when we continue to develop safety standards, rapid testing, to make sure that we're in a safe environment, we can go back to all these things.
Rena: A-woman to that as we say on here.
Dara: So much to be excited about in this coming year. Any last words that you want to add?
Dr. Copperman: I think that what you're doing is important and congratulations on your 5,000th download by the time many of you are hearing that I know you're on the doubling curve, so it's going to be many, many more than that. I like the way you're framing it. It's like not all these are messages of hope. Sometimes these are discouraging times and we have to get through disappointments together and nobody's telling somebody who's unhappy to put on a happy face. But I think focusing on positive thinking, focusing on health and wellness and you both are, I mean, you live those mantras. Being there for each other, having a safe place for support, empowering the patient to ask the right questions and let their needs be known and finding the right doctor who's willing to listen to them and meet their needs and embracing science and technology to keep us safe and help us achieve ourreproductive dreams and beyond that, I think they're great ways to start off 2021.
Rena: I love that. We're so grateful to have you on today and I’m trying to think of the last time when I even saw you. Far too long. So, really wonderful to see you over zoom, which I guess is the new normal, but I'll take it. So I, you know, before we wrap up, we like to end with gratitude. So any additional gratitudes you want to share, anything you're grateful for?
Dr. Copperman: Friends, family, and the greatest co-workers anybody could ask for. It comes from my heart. We all put on our brave faces in March and April and May. We didn’t know how this virus would spread. We thought we were putting ourselves at risk and we did it because we believe it what were doing. And the people alongside me were very much a source of strength. So gratitude for the people I got to work with and the family that embraced me when I came home from work and this opportunity to help other people.
Rena: So lovely, really lovely. Dara?
Dara: Lots to be grateful for today. Grateful for my job, which I absolutely love. Grateful to our listeners. Unbelievable that we've had over 5,000 downloads. I wanted to piggyback on Dr. Copperman - I'm grateful for COVID period because I have been cooking. Ironically, you think I'd be cooking a lot already, but I've been cooking so much more so than I have in the past. And also just like you, I have really honed in on my piano skills. I also practiced piano when I was younger and stopped and just got back to it in the past year. And definitely Billy Joel, definitely Elton John, but it's really given me that passion that's really just for myself. And it's a great way to end my day, put my kids to sleep and practice piano. And it really brings me that like simple joy.
Rena: I love that. Well, first I'm going to say one of my first social events when this is all over is I'm going to vote for a little piano playing, grill party at Dr. Copperman’s. Now that I know I'm in the company of two piano grill-master chefs. But you know what, I'm really grateful for my job. You know, I think it was really interesting the pandemic, I felt closer than ever to the RMA family. And even though we weren't together in person just through technology and reaching out and being there for each other, I felt really, really connected to everybody. And I'm really grateful because my job gives me purpose. You know, it gives me a reason to get up in the morning. The messages people send me that tell me that I give them hope inspires me to keep going. And I recognize, especially now in this pandemic and as someone who found my career and my passion kind of later in life, just how lucky I am to have this. So I'm really grateful to have this podcast as a platform, to have my patients, and to have my job.
Dara: A-woman! Thanks for being here.
Dr. Copperman: Thank you for inviting me and good luck on this upcoming year and I know that your work is appreciated.
Dara: Thank you so much for listening today and always remember: practice gratitude, give a little love to someone else and yourself, and remember you are not alone. Find us on Instagram at fertility_forward. And if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.

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