Sweet’s Rules: Four simple rules I use each day to guide me as I diagnose and treat my infertile patients

During National Infertility Awareness Week, I’d like to share my four patient care rules. I made them up rather spontaneously nearly 22 years ago and I still use them each and every day when I am uncertain of what to tell a patient or how we should proceed.

Before the rules are invoked, it is most important to first understand what brings patients to my clinic. By understanding the causes of their infertility, I will better be able to tailor a treatment plan specific to their needs. Some patients feel this is a waste of time and want to proceed immediately to treatment, but I strongly recommend understanding the issues first before proceeding forward.

So, once the evaluation is complete, my Sweet’s Rules are used to guide us forward-

1. Get my patients pregnant as fast as I can

Time can be an enemy and patients are not necessarily patient. We need to complete the evaluation quickly and move forward as most of my patients wanted to be pregnant many yesterdays ago. Some will call this a “duh!” rule, but it is still a good one to keep me moving forward as the patient desires.

2. Achieve success in the most cost-effective manner possible

We always want to choose the least costly conception method. This might even mean sending the patients on a date to try natural means for a tad bit longer. Hopefully, the successful patient potentially saves a bundle by my guiding them away from costly alternatives. Sometimes, adoption is also the best option and I’ll send them down this new road, if it is needed, even if the practice loses a patient. My cardinal rule is to treat the patients like family and tell them what I would tell someone close to me, regardless of the gain or loss to the practice. Practicing this way has always served may patients well.

3. Minimize complications (i.e., no litters)

I took an oath to do no harm and I take that oath very, very seriously. A multiple pregnancy can be a million dollar pregnancy with complications too long to list here. Always pull back, no matter how much pressure from the patient, if I fear a complication is likely.

4. Minimize the use of procedures with minimal chances of success

This may be the most important rule. I do not like being a “Gynechiatrist” (borrowed from the movie “Knocked Up”) by performing procedures that are unlikely to work. While some patients need to try a procedure destined for probable failure, to have closure and the inner knowledge that they gave it a shot, I prefer to move quickly through these treatments and get the patient to understand what will truly bring them to their goal.

I tell patients these rules when I am trying to guide them through their treatment plan. I believe it helps them to understand why I am telling them something, especially when they don’t necessarily want to hear it. Understanding my motivations, I believe, helps them to appreciate that I truly have their best interests at heart. By following these simple four rules, I will always keep my patients’ needs first and foremost.

While I may not be successful with all my patients, I will always try my best, give them the best information I can and provide options that simply make sense. Interestingly, these rules help me keep on the path, as much as they simultaneously guide my patients, as we make decisions and travel the infertility to fertility journey together.

By: Dr. Craig R. Sweet

Medical Director & Founder

Your FAQs Answered

Earlier this week, I asked readers to submit their questions about fertility care. To recap, I was asked about whether pineapple helps make the embryos stick during IVF and about whether Pre seed helps with producing cervical fluid during ovulation.

Regarding pineapple – that is a new one for me. I checked the National Library of Medicine database and found curious information.

First, pineapple contains the enzyme bromelain, which supposedly breaks down enzymes that inhibit implantation. I found an old study from the 1970's that examined if this enzyme could induce an abortion in rats. It was not found to be useful.

There hasn't been any reproductive research on this enzyme over the past 10 years. I did find a 25-year-old study wherein the enzyme was used to breakdown cervical mucous in the laboratory. This worked but further study has never been done and I certainly do not recommend that pineapple be placed in the vagina!

This enzyme is apparently used to tenderize meats.

So, to summarize, this enzyme breaks down proteins (meat), has been studied to potentially cause an abortion (doubtful) and can be useful in the laboratory to break down cervical mucous (Please do not try this in the vagina!). It doesn't seem to have any specificity so the breakdown of yet-to-be-discovered proteins that inhibit implantation is a real stretch of the imagination.

I like the idea of fruits and vegetables added to a sensible diet but I will have to place the “pineapple pregnancy” supplement into old wives' tales probably propagated by the pineapple industry itself!

Happy eating!

In our next issue of our e-newsletter, “Sweet Concepts,” I’ll sort “Fact from ‘Phallicy?’” A little humor and play on words! Don't be shy! Ask any question! Submit it below or email me directly at fertility@dreamABaby.com. Please indicate if you want us to use your name or e-mail. If you’re not already signed up for our newsletter you can subscribe at http://dreamababy.com/e-mail-list.htm

Question of the week: Is it true that eating pineapple during IVF helps the embryos stick?!

If you are trying to conceive, then you are likely familiar with some of the common myths of achieving pregnancy. For example, the “hips up theory” – is it the best position for achieving pregnancy? Send in your questions and I’ll sort out fertility fact from fertility fiction.