Dr. Domar’s consultation, training, and teaching encompasses three components: patient care/education, staff care/education, and marketing/outreach to differentiate fertility centers from their competition with the Domar name, media attention, and patient-centered care branding.

Patient Care/Education: Research has shown that the emotional burden of care is enormous and is the primary reason why insured patients drop out of ART. Depression prior to a first cycle is also the largest contributor to treatment termination after only one cycle. The majority of women undergoing infertility treatment report clinical levels of depression and anxiety; this distress is equivalent to a cancer diagnosis. Infertility was cited as the top stressor by patients during the first surge of Covid and has remained so during the pandemic.

Insured patients who dropped out of treatment, when asked what could have been done to prevent that decision, cited the need for written stress management materials, the availability of mental health resources, and stress reduction classes. Research has shown that minimal psychological interventions are associated with huge reductions in treatment termination: in one study, a mailed stress management packet was associated with a 67% reduction in dropout behavior and in another study, patients who used a coping mobile app were twice as likely to return to treatment after a failed ART cycle.

The initiative would tackle this need in a variety of ways, with the creation of written stress management materials for every stage of the infertility journey, providing easy access to coping strategies, as well as inclusion in the offering of a variety of emotional health boosting activities, ideally offered remotely. There is also the potential for an organization to arrange an exclusive license with the FertiCalm Pro mobile app. There are limitless opportunities to apply my clinical expertise to the patients at clinics, including webinars, podcasts, live lectures, and seminars.

Staff care/education: Nursing retention has become a large problem in the REI field with nursing turnover currently happening after an average of two years, when it was previously four years. The majority of nurses surveyed by ASRM reported significant symptoms of burnout. Given that it is estimated that bringing on a new nurse in an REI clinic can approach $250,000, it seems obvious that nurses need more support and coping strategies to better be able to handle this very challenging patient population.

This initiative would include a three-pronged approach for all members of the REI care team, including physicians and support staff. Dr. Domar could easily provide all of this training, ideally in person but also with the possibility of remote education.

1. Education and orientation to the psychological aspects of infertility: so as to better understand where the patient is coming from, what may trigger challenging behavior, and why patients express such high levels of need.
2. Training in empathic communication: research shows that when medical staff communicate empathetically, patients perceive that the care is better, that the staff member has spent more time with them, and that they trust the recommendations given. Patients are far less likely to exhibit difficult behavior when spoken to in an empathetic manner.
3. Stress management for all of the health care team: working with REI patients is challenging and all members of the team can benefit from personal instruction. Specific training to recognize symptoms of burnout and methods to prevent/treat would be included.

Center Differentiation/Branding:  Dr. Domar is frequently referred to as one of the most well-known mental health professionals in the infertility space, both amongst patients as well as health care professionals. She has developed a reputation as a clinician, researcher, educator, and pioneer in the field. She speaks annually at ASRM and have spoken prior to the pandemic at ESHRE, UIT, and ASPIRE.  She routinely speaks globally to physician groups, providing research updates and clinical training. She is also a certified trainer for Empathetics as well as a clinician for the LBGTQ+ population.

Using the Domar name could differentiate centers from their competition. Patients are willing to sacrifice a 10% pregnancy rate drop in favor of a clinic which features patient-centered care, and with my contributions, centers could feature this patient care model.

Dr. Domar is an associate professor at Harvard Medical School, as long as she continues to provide 52 hours/year of teaching to the medical students/residents/fellows in ob/gyn.

Dr. Domar is uniquely qualified to enhance the quality of life for both patients and staff at centers with the potential to significantly increase patient retention and decrease team burnout and turnover and to make these centers known as THE place to go for patient centered care.