Endless POFibilities -- July 2001

Interview with Dr. Rebar
by Amy Daniels

Dr. Rebar is an advisor to the IPOFA support group and is scheduled to speak at the IPOFA conference this September. His informative “POF FAQ’s” are posted on the IPOFA website. He agreed to take time out of his very busy schedule in order to do the following interview with me at the end of April.

Robert W. Rebar, M.D. is Associate Executive Director of the American Society for Reproductive Medicine in Birmingham, Alabama, and Professor in the Department of Obstetrics and Gynecology at the University of Cincinnati College of Medicine in Cincinnati, Ohio. Dr. Rebar is certified by the
American Board of Obstetrics and Gynecology in obstetrics and gynecology and in reproductive endocrinology and infertility. Dr. Rebar has contributed to many books, as well as authored over 100 aticles on menopause, fertility, and reproductive endocrinology in peer review journals.

Question 1: What is your current position at the American Society for Reproductive Medicine in Birmingham, Alabama?

I am currently an administrator only, and do not practice medicine. I also
still hold a volunteer appointment at The University of Cincinnati College of Medicine.

Question 2: How did you become interested in doing research on premature ovarian failure?

When I was a fellow in the early to mid ‘70’s I saw about 20 patients with multi-glandular autoimmune failure including POF.

Question 3: What are the latest findings regarding POF?

The latest findings have to do with the genetic research being done on POF. It is clear that at least a proportion of POF patients have a genetic basis for their POF. It has been found that some Finnish women have a mutation of the gene for the FSH receptor so it cannot act normally. This finding has
been confined to Finland and the same mutations have NOT been seen in America. So current research will probably focus on looking for genetic causes of POF. It is possible that in some individuals, POF may be caused by 4-5 spontaneous genetic mutations.

Question 4: To what do you attribute the increased incidence of POF?

Actually, there is NOT necessarily an increased incidence of POF. Rather, there is an increased identification of POF. You have to remember that until the 1960’s we could not measure reproductive hormones. Advances in this type of testing have led to an increased identification of POF. Similarly, there are more and more women who are surviving cancer therapy due to medical advances, and some of these woman are left with POF as a result of the chemotherapy.

Question 5: What advice can you offer us POFers?

After diagnosis, if child bearing is desired, donor egg is the treatment of choice. Seventy-Eight percent of women who wanted a child ended up with a baby after undergoing donor egg treatments (Remember, it may take more than one try at donor egg treatment and this takes lots of money, of course.) Also, 7% of women with POF will spontaneously become pregnant on their own, and 25% of women will ovulate again after the POF diagnosis is made.

Question 6: Do you see the costs of the IVF and donor egg procedure decreasing in the future as the technology becomes more advanced?

Not at all! In fact, I see the costs increasing, especially as the FDA becomes more involved with regulating genetic and infertility treatments. For example the FDA now requires every IVF facility that deals with frozen tissues get a license. This will lead to extra costs. There are also more regulations in the works regarding mandatory testing of donors for cystic fibrosis. This is a positive thing, but will also lead to extra costs for the patient.

Question 7: Do you foresee more insurance companies covering these types of infertility treatments?

Not with the current government administration!

Question 8: Do you know what you are going to speak about at the IPOFA conference in September?

I am planning on speaking about the different ways POF presents itself and the associated causes. I will give a general overview of POF, and what the data are regarding the clinical characteristics of the disorder. In fact I just gave a similar talk at the Mayo Clinic.

Question 9: Do you recommend any herbal or natural “alternative” treatments for POF?

Almost any drug we use comes from herbs or plants. There are some herbs that are known to have beneficial therapeutic effects like soy for relieving menopausal symptoms, and ginger to prevent nausea and vomiting. However, there are currently no drugs or herbs known to induce ovulation in the POF
patient. You also have to keep in mind that until we test an herb by grounding it up, measuring it out, and testing it in a placebo-controlled trial, we don’t know for sure what the active ingredient in an herbal remedy is, and if it really works.

Question 10: Do you have anything else you would like to add?

Probably the biggest thing that we haven’t talked about yet is educating doctors about this disorder and increasing the support network for POF patients. Although these issues are better now than they were ten years ago, there are still a lot of patients who come to me and are angry that their doctors haven’t told them enough information about what is going on. I believe we really need to help the individual woman understand what is going on and how to deal with it emotionally. I feel strongly that the POF
diagnosis is a traumatic and dramatic event. I have seen many different reactions to this diagnosis in my office. I know that this diagnosis can make a woman feel isolated, and we need to educate doctors to provide counseling and be empathetic to the individual. Most importantly, if you are not getting a satisfactory response with your practitioner, go to someone else with whom you can connect. Support groups are also very important! Although they are not for everyone, there are many women who do
benefit from them, and they have done a lot for this disorder.

Have questions for Dr. Rebar? Interested in hearing more from him? Join us at the 2001 IPOFA Conference, “POF: Preparing Our Future”, in Alexandria, Virginia, September 28-30, 2001. Dr. Rebar will be our keynote speaker.

IPOFA Support Group Conference 2001