Many fertility researchers consult Dr. Google for facts, but they can come away with bias, opinion & confusion if they’re not careful.
Almost everyone at this point has come across friends posting or sharing articles or opinions regarding medical care. Of course, the most common concerns are those related to COVID-19. Since this virus is novel and the impact so strong, people have naturally been using the internet and social media to try and help answer questions that they have.
Not only does this help to educate themselves, it also allows someone to add some sense of control over the situation. This same situation arises with trying to be a fertility researcher.
To a lesser extent I feel like those who have been working through fertility can almost look at those now furiously pounding the internet pavement for research and tell them, “Hold my eggs!” And while I truly believe that our fertility warriors are generally more sophisticated in their reading selection than the general population, I think that now is a good time to review some basic tenets of reading online as a fertility researcher.
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Fertility researchers should know: reading ≠ research
Many patients come into my office having done reading on in vitro fertilization (IVF) or other fertility treatments. This is fantastic! I love it when my patients are fertility researchers, coming in with a general sense of a fertility workup and possible treatments.
Fertility research is its own world and it is complicated. Any reading that a patient can do over time to slowly absorb and learn the new framework they find themselves in will help. However, the one thing that needs to be emphasized is that reading does not equal research. Research is a skill that requires instruction and expertise, and not everyone can be a fertility researcher.
The art of medical research
Healthcare providers spend years studying how to critique studies. It is an essential part of our training and it starts in the first year of medical school where most will take epidemiology. Doctors will spend an average of nine years training including residency and fellowship. All the doctors at RSC spent 11 years.
Besides the ridiculously rigorous studying and on the job training and testing during those 11 years, I had to review 3-4 studies a month and listen to a presentation, or present once every month or in structured reviews. This is not something that a nonprofessional fertility researcher, no matter how smart, can pick up in a few focused months.
Please do not get me wrong, though. Reading is great! Be informed! Just remember that fertility, like life, is not perfect and can be messy and conflicting. If you really want to learn how to look at a paper or research article properly, start with this guide to medical literature taken from the University of Washington, which borrowed from the University of California San Francisco based upon guidelines from the Journal of the American Medical Association.
Check your sources for the fertility facts you find
Every time you read a paper or article or blog, you need to know who wrote it, what their credentials are, and try to get an idea of WHY they wrote it. Social media and politics have essentially eliminated the walls between facts and conspiracy as far as COVID-19 is concerned.
What prompted me to write this review was the small group of politically funded doctors speaking out about COVID-19 that generated a lot of buzz in late July of this year. Each piece of information that you read or view deserves to stand on its own, but knowing more about who said it will give you a better idea of their motivation. In the case of these individuals, the impartial fact-based narrative fell away very quickly.
When doctors read studies that are funded by pharmaceuticals or device companies, we automatically flag it in our minds too! We then read how the study was conducted, who was included in the trial, and what was the endpoint of the study. We can then uncover other studies that that group has produced and who sponsored those.
The same goes for blogs and opinion pieces online. Some write from their own experiences, which is fine but it is very limited in scope and experience. Others have a readership that they need to sustain and the more “traffic” they create, the more income they get. Some work directly with companies or have their own product that they are trying to sell. Everyone needs to have a bit of skepticism when reading online and I recommend that you should always go 1-2 more articles or sources deeper than that first hit.
Got bias – confirmation bias?
Using that now infamous press conference as an example, those doctors were wearing their motivation and biases on their sleeves on that bright sunny day, and yet many people only saw truth. Why? One reason is because of something called confirmation bias. This refers to someone already having a theory and looking to confirm it instead of asking, “Does this treatment work?”
Dr. Google is great at finding evidence, but you need to look for the bias
Let us think about someone who is having trouble with infertility or embryo implantation and starts to wonder if immunotherapy may help. If you start off your searches looking for evidence that it works, then you will find some. Google is GREAT that way. Whatever you want to find, you can. However, confirmation bias tends to make people stop once they find what they are looking for. They don’t see the entire field of research that shows there is no proven benefit for this in all but the most very special and specific medical situations.
Related Reading: Recurrent Implantation Failure
Look, EVERYONE has biases. I know I do. In the past I have been wary of industry sponsored research for what I believe are very legit reasons. Specifically, there have been examples of medicines prescribed that were found to be hazardous a few years later. But I also know that I have been a little slower to embrace legitimate surgical methods or fertility testing methods because of this distrust, even when the science is there. Everyone has experiences that bias their thinking.
So how to recognize and combat this as a fertility researcher? Go through your reading with a critical eye having an idea of biases that you and the author might have. To help get you more informed and in tune with yourself, here is a listing of cognitive biases and research biases.
Your story is not the whole story
Personal stories that fertility patients post on Reddit or in Facebook groups are very important to share for several reasons. I do think it allows for a sense of community and allows for a quick survey of different treatment options and medications that are used by fertility clinics. I even go on them from time to time to get a quick overview of what’s popular or how patients may feel about their protocols or treatments.
But this type of reading is not research. It is an individual story. It is not that uncommon for me to have patients explain that they expect a similar outcome that their friend had. I take that inquiry seriously in order to create a partnership with the patient’s care direction. Many times, it turns out that it was someone on a social media thread, and very few details are known about that particular person.
What works well for one person may not work well with another patient. This is one of the reasons trying to be a fertility researcher is tricky. Those online discussions could be considered a starting point for finding studies looking at those protocols or medicines. Then, using the points I’ve outlined above, you may be able to come to a conclusion.
Related Reading: RSC Patient Success Stories
Trust me fertility researcher, not Instagram
Doctors are not perfect. Studies are not perfect. My wife once told me that the field of fertility is humans helping make humans. This means that there is not always an obviously correct path forward.
Whenever patients ask me about a different treatment option or medicine that they had read about or a friend had used, I like to address it fully and not with a simple yes or no. I not only give my advice, I explain how I came to that decision so that my patients fully understand my process and hopefully trust my judgment. This dialogue is really the only way to build that trust that will serve as the foundation of a patient’s success.
Reading is good. Learning how to read studies and evaluate sources is good. Gaining insight into both your bias and the author’s bias is smart too. This will help you learn and gain some sense of control and anticipation for the possible steps to come. But never forget that you are never alone in your fertility journey. We are your guides. This is why we became reproductive specialists in the first place.
WE LOVE THIS JOB!
And I love providing the insight and context that you can only get with experience and a strong grounding in research and facts. The world is a little nuts right now, and if you are dealing with fertility, it is even that much harder. I hope that reading the thoughts above will help provide some guidance and clarity for you.