Ep. 210: What to Look for in an Endometriosis Surgeon for a "One and Done" Surgery, with Dr. Patrick Yeung

New research says that 50% of women who have infertility but no painful periods have endometriosis. Those with painful periods and infertility are *90%* likely to have it. But diagnosis isn't always the hardest part. Many physicians will say they can treat it, but very few have the specialization needed to provide a "one and done" surgery, leaving many women with only temporary symptom relief, years of endo suppression medications, and the need for repeat surgeries. Is there a different way? YES. Dr. Patrick Yeung shares the key things to look for in an endometriosis specialist to help you find someone who can provide you with high quality care that doesn't require IVF for pregnancy or suppression medications for pain. 

NOTE: This episode is appropriate for most audiences and does use the term sexual functioning.

GUEST BIO: Dr. Patrick Yeung Jr. is Fellowship-trained in Minimally Invasive Gynecologic Surgery and spent most of his career in academics - at Duke University and still as Adjunct Professor at Saint Louis University, for 15 years, almost 4,000 cases, with multiple landmark publications. He founded the RESTORE Center for Endometriosis to pay forward what benefitted his own wife in relieving debilitating pain and leading to recurring natural fertility, and to enter the conversation among Centers of Endometriosis as the only Center dedicated to removing endometriosis and optimizing the anatomy that does not rely on IVF or post-operative hormonal suppression

SHOW NOTES: 

Journal article: https://rrmjournal.org/index.php/jrrm/article/view/13/17

Ep. 10: Endometriosis 101

Ep. 139: Preventing scarring, adhesions, and repeat endometriosis surgery, with Dr. Naomi Whittaker

Ep. 190: Unblocking Fallopian Tubes for Natural Conception with Dr. Naomi Whittaker

Transcript

Caitlin Estes (00:25)
Welcome back to the Woven Well podcast. I absolutely love providing you with the information you need in order to advocate for yourself and get the best reproductive care possible. At Woven Natural Fertility Care, we believe that every woman deserves to be treated with dignity and respect in the doctor's office. And that includes how her reproductive health concerns are treated. Sometimes the most excellent care is actually guidance in diet and lifestyle changes.

Other times it may include supplements, bioidentical hormones, or medications, and sometimes surgery is the best option. But not all surgeons are the same, and neither are their approaches. There's a lot of talk about restorative reproductive medicine these days, and for good reason. Physicians and surgeons trained in restorative reproductive medicine have different approaches, different techniques, and different outcomes. So how can you know if it's the right choice for you?

Well, we've invited Dr. Patrick Yeung to help you answer that question. he is fellowship trained in minimally invasive gynecologic surgery and spent most of his career in academics at Duke University and still as adjunct professor at St. Louis University for 15 years, almost 4,000 cases with multiple landmark publications. He founded the Restore Center for Endometriosis to pay forward what benefited his own wife in relieving debilitating pain and leading to recurring natural fertility, and to enter the conversation among centers of endometriosis as the only center dedicated to removing endometriosis and optimizing the anatomy that does not rely on IVF or post-operative hormonal suppression. Dr. Yeung, welcome to the show.

Patrick Yeung Jr. MD (02:05)
Well said. Thank you so much for having me on. It's pleasure and a privilege to be here. yes, restorative medicine and surgery is really having its day. I strongly believe and I love your show. I say often, women with endometriosis deserve better.

Caitlin Estes (02:23)
Absolutely, absolutely. The category is broad, you know, of all the women who deserve to be treated with respect. It includes everyone, absolutely. Well, last year you published a paper discussing the unique approach of surgeons specializing in restorative reproductive medicine, and it was really helpful. And I'll certainly have a link to that paper. It was in the Journal of Restorative Reproductive Medicine. I'll put that in the show notes for anyone who'd like to read it for themselves, but can you help us understand what the major differences are between surgeries done by a specialist trained in restorative reproductive medicine versus those who may not have had that type of training?

Patrick Yeung Jr. MD (03:02)
Well, so at Restore Center for Endometriosis offer what we're calling is kind of a root cause treatment for the disease of endometriosis and for optimizing the pelvic fertility. It's in direct contrast to call the status quo or the usual, which is I call it band-aid therapy for pain.

So medications that induce a type of chemical pregnancy like birth control pills, or now the newer FDA approved medications are causing really a state of chemical menopause. Or for fertility, the status quo is IVF which is kind of a bypass therapy. Or even this idea that once you start to have surgery for endometriosis, you're going to have to have surgery every couple of years for the rest of your life.

This status quo approach to women's health and infertility is not satisfactory to most women. So again, we're talking removing the disease, for the hope of one and done surgery, which no one thinks is possible, but we're showing as possible. And that was one of the biggest findings of a recent landmark publication that we can talk about. They showed the possibility of one and done surgery, which no one thinks is possible.

Caitlin Estes (04:18)
Absolutely, because I have had many clients who have come in over the years and start working with us at Woven and they will say, ⁓ I've had two or three surgeries for endometriosis. So the idea of a one and done surgery for that is going to be appealing to many. Why can you offer a one and done surgery, whereas other surgeons may not be able to offer that same promise?

Patrick Yeung Jr. MD (04:42)
So first off, before I answer that, let me talk briefly about how common this disease is, endometriosis. There's a Ted talk called the most common disease you've never heard of. I love that title. Everybody knows somebody with endometriosis. And this hashtag one in 10, the rate of endometriosis. That maybe is true for the entire female population, most of whom have symptoms.

But with patients who have even without pain, it's at least 50%. Patients who have significant pelvic pain that do not feel better with hormonal suppression, it's over 80%. And from our 10 year study, the rate of finding endometriosis in patients who had both significant pelvic pain and infertility, the rate of finding endometriosis was over 90%.

And most of these women are being told they have unexplained infertility, which having gone through it with my wife and I, that's a slap in the face. The woman knows that her body is designed to get pregnant. And if it's not happening, there should be a reason why. And to be told you don't, we don't know why. The woman herself knows this is not satisfactory. So it's so common. And, to answer your question about, you know, why does a reproductive or restorative surgeon make a difference? I'd like to say, you know, in the world of surgery for endometriosis, first off, most GYNs treat the disease by trying to destroy these implants with energy. Nothing is removed from the body. The problem with that approach is if it's a widespread surface patch, it's like trying to paint the wall with a pencil tip. If it goes deeper, you're literally trying the tip of the iceberg and people will not, nor should they, trying to burn if the endo is found near a vital structure. So by cutting it out, cutting under it, under the roots, we can get the whole thing out and we're treating in places where others do not. Like on or near bowel, vessels, ureter, fallopian tube are all places we would treat where others would not. So when they say it's gonna keep coming, I'm doing air quotes for those who don't see the video. They're probably looking back, It's come back, but they're really seeing the same disease over and over again if you think about it.

So the published rate after the usual burning, which is what most people do, up to 60, 80 % in one to two years. But again, they're not getting at all. Our rate of repeat surgery under 5 % in 10 years. So it was very difficult to publish this. We finally did And I recognize redmit there is no cure. Nobody's perfect. There are no guarantees that you can't need to have surgery again. again, this was a landmark study in showing 10 year data, that one and done surgery is possible in many, if not most patients and without the need for long-term suppression. one and done surgery should at least be the goal of what centers focused on treating endo should be striving for. I feel like most surgeons have given up or at least don't feel the need to have to remove it all. I don't get they're gonna recommend what everybody recommends, which is to put them on suppression after surgery should suppress what they don't get. In fact, it's a big red flag to me when the patient says, my doctor said they could, but by the way, is recommend after surgery. That tells me they know they didn't get it all and they're trying to use suppression to suppress what they didn't get. Or pass the pelvis and quickly refer to IVF, the status quo. They don't have to optimize the patient's own anatomy or just come back and do it again in two years.

That's a very different, I would say on behalf of the surgeon and I think we've shown a very different surgical result for the patient. Lastly and maybe most think the way to get to the hope of one and done surgery is not even just remove it all. So we call this optimal excision defined as cutting out whatever is suspicious for endo in whatever form and wherever found. Very few can achieve that result.

Enhanced endo it takes a team. it has to be recognized to be removed by somebody who's able to recognize the subtle and atypical forms of endo to remove it for best results.

But even if you can achieve optimal excision, cutting it all out, that's still not enough. You have to still prevent adhesions where things can stick after certain scar tissue. That's the other half And preventing adhesions was very important in our story. In our story, my wife had painful periods her whole life, thought it was normal. We tried to get pregnant from said, maybe I have endometriosis. I said, no way. She had bad or severe endometriosis. Surgery to remove the endo and then multiple surgeries for adhesions.

We're trying to pay that forward. But you have to combine the best of cutting it all out and preventing adhesions. There are some people in adhesion world who are very focused on cutting it all out, but then do little to nothing to prevent adhesions. Other people are very focused on preventing adhesions. but they don't necessarily remove it all because they're afraid to promote adhesion.

I really think one should not compromise the other. And I think that's how we're such great outcomes.

Caitlin Estes (10:28)
And, you know, as you're describing the intentionality that goes into this approach, it just makes me think this is not a situation where you can, as a patient, advocate for yourself enough with just your local surgeon. I mean, you can't say, hey, I want this done or I want that done because it sounds like they're not given the same type of training. And I know I looked into your background a little bit and you've pursued a lot of additional specialized trainings and fellowships to get to the point where you are today. But am I correct in that? There's nothing you can say to your local doctor that can help enough if they don't have these same types of trainings.

Patrick Yeung Jr. MD (11:10)
I did do two residencies and two fellowships to do what I do. But now I love it.

Patrick Yeung Jr. MD (11:16)
I like to steal a phrase from my wife who, you know, she says it has eternal value to help somebody get their life back, better quality of life, better sexual functioning, over 90 % or please God to get pregnant. That has eternal value. There's nothing better. So I love what I do. But I decided early on to be good at this. You kind of have to focus on.

I couldn't do it part time. couldn't like every now and again, I couldn't be up at night delivering babies and trying to do good surgery during the day. So this is all I've done now for 17 years, almost 4,000 cases. And we know that volume matters. So I would just say it's important to find somebody that committed to this type of surgery and has a good commitment to it or experience and volume with this type of surgery. Because it takes that kind of commitment to optimize the anatomy. The bowel surgeon that I work with, know, some people are committed to cutting out the endo, but they don't have a good bowel surgeon to work with. I feel very blessed to have worked with the same bowel surgeon for over 10 years. We do stage four advanced bowel endo cases every Thursday, week in, week out.

I think over the years he's done some of the most bowel cases in the country. But I joke, you know, I say that, you know, when you graduate residency, they roast you. When he graduated residency, they gave him the OCD award. But that is the guy you want for endo surgery. I've been told I'm a little OCD as well, but just somebody who's really committed to doing what is needed to optimize the anatomy.

Caitlin Estes (13:00)
That's right. And it's not always going to be easy to find a surgeon or travel to the surgeon that you want to work with, who is going to be as committed as you're describing. But obviously the outcomes and the quality of life improvement is worth it. You know, it may not be local, it may not be covered by insurance, you may have to travel. There are those things that go into it, into consideration, but as you just mentioned earlier, that one and done option, and I would imagine the overall change in a woman's experience from living with those horribly painful periods for the majority of her life to being pain free and not having to be on any sort of medication to maintain that pain free existence. It's worth the effort.

Patrick Yeung Jr. MD (13:58)
Yes, so you my wife used to have really bad periods which debilitating or bad periods are not normal. After she got the endo removed, she was basically pain free with her periods. In fact, she got caught off guard a few times. That never used to happen. She didn't know that she was starting to have her period until she began to bleed. And then we've had recurring fertility, praise God.

You know, that's not always guaranteed. Going through infertility with her, you know, one thing I learned is it's not fair. Those who are trying to get pregnant are not, and those who don't want to get pregnant are the ones getting pregnant. It is not fair. At one point, she even said, I feel passed over.

But I'm here to say you are not passed over. There is a plan in some way, whether it be at least to feel better or to get some answers or both or adoption, which is a beautiful option, which we did as well. So there is some plan. You are not forgotten.

Caitlin Estes (14:57)
Thank you for saying that. And I'm sure that as women and couples are researching what to do and who to go to, knowing that there are surgeons who have that perspective as well and are focused on the details of the body, but also aware of the bigger picture of the human person there has to be very encouraging.

So let me ask you this to kind of close out our time for women who are exploring surgery for the first time. Maybe they're hearing this and realizing, wow, I have painful periods or I have loose bowel movements around my period or I have these other things that could be associated with endometriosis, infertility, as you mentioned. Where do they even start? Where would you recommend someone start as they're looking for the right resource for them?

Patrick Yeung Jr. MD (15:50)
So there are lists of kind of excision surgeons or restorative reproductive surgeons on different sites. Maybe we'll have to put that together for you to put that, to post that or whatever in the show notes, but you just really want somebody who...

I guess talks about this concept of restorative reproductive surgery. Again, is really trying to optimize the anatomy to avoid the need for post-operative suppression to lead to natural fertility and recurring natural fertility. That needs to be the focus. And nowadays, you know, we have telehealth. Nowadays, big cities are just a plane ride away.

So it is a different time. And for myself, know, the first half of my career was mostly academics. And I think now we have the data to show that what we're doing works and works well. And then the second half of my career with having a private practice now, my goal is to train others, to have a fellowship and to train others to do this type of surgery. Cause that's the bottleneck. That's what we don't have enough of, the surgeons that can do this.

We need more research, we need more training, and we need more awareness.

Caitlin Estes (17:04)
Absolutely. So even some of the key things that you just said, someone who has gone through the training, someone who is not saying, well, we'll do this and then send you to IVF to hopefully conceive, or we're going to rely on hormonal suppression to keep it from recurring. Those are, as you mentioned earlier, band-aid options when you think about actually taking the anatomy seriously in treating that underlying disease so that you don't have to live with endometriosis moving forward. So thank you so much Dr. Yeung for offering your time and your expertise to us today.

Patrick Yeung Jr. MD (17:44)
Thank you so much for all that you do. Again, I started with it. A women within fertility deserve better women with endometriosis deserve better and the status quo of band-aid therapy and bypass therapy is not the only way is not the best way to be able to have restorative reproductive medicine and surgery can lead to both wellness and fertility, and they go hand in hand. Thank you so much.

Caitlin Estes (18:15)
Thank you. Listeners, we have some other great episodes that will continue to provide helpful context around restorative reproductive medicine surgery, including Dr. Naomi Whitaker talking about the details of opening fallopian tubes that may be blocked and Dr. Christine Hemphill-Jones talking about ovarian wedge resection. So I'll link them in the show notes for you. Whether you're a regular listener or not, if this episode was helpful, we want to share it with others who may find it equally informative.

You can actually help us do that by taking five seconds to leave a review, whether you listen on Spotify, Apple Podcasts, or anywhere else. So from those who need to hear this, thank you. As always, thanks for listening as we continue to explore together what it means to be woven well.