USF Health en Español Series

Entrevista con el Dr. Celso Silva en Español. 11 minutos.

At the University of South Florida, fertility experts are involved in a daily race against time and in many patient cases, enemy number one is the woman’s biological clock. More and more women may be postponing pregnancy until their 30’s and 40’s, and more men may be fathering children well into retirement age but a woman’s biological clock remains unchanged! Like it or not, and despite modern medicine, there is a finite window of time when the female reproductive system can achieve pregnancy. For Hispanic patients, in particular, this race against time can be dramatically cut by language and cultural differences.

“Being afraid of not being understood, not speaking the English language, that’s all very real to them,” says Celso Silva, MD, fertility specialist at USF IVF. Even in cases of bilingual patients, he notes that many prefer to speak in their native tongue when it comes time to discuss deeply personal topics like sex, reproduction and family. The result: patients remain in limbo, continously searching for a specialist they feel more comfortable with, unable to overcome feelings of awkwardness during doctor visits. “That will delay treatment! And in our field, after a certain age and depending on the diagnosis, this is critical…the delay may completely change a couple’s chance of achieving their goal,” says Silva who speaks three languages, Portugese, English and Spanish.

Patient’s perspective…
40 year old Ana Barrios and her husband Alejandro are examples of that delay in treatment caused by language and cultural differences. The couple has been living in the Tampa Bay area for three years and has been trying to get pregnant for approximately 8 years. Over time, they’ve visited a cadre of doctors, but admit they never got very far in the process because of the language barrier. “A few months ago, I had this wonderful ‘Anglo’ doctor,” says Ana, a realtor in Tampa. “…but I just didn’t feel comfortable because I always had to have an interpreter with me to help translate.” The doctor’s medical explanations were, at times, beyond the scope of Ana’s command of the English language she later explained and also admitted she and her husband found it ‘emotionally’ difficult to talk about their sex life and reproduction in English, no matter how pertinent the information was to her case.

She found Silva in January 2008 thanks to a Colombian compatriot working at Tampa General Hospital. He recommended she try the doctors at USF IVF. She did and says that her hopes for the future have been restored. “I am so happy now,” says Barrios in rapid fire Spanish. “I am in love with this man! Well, I mean medically speaking,” she says with a nervous laugh. Embarrassed by her choice of words Ana explains, “He’s a professional in every sense of the word. He’s very respectful, but at the same time he’s very warm & friendly and I like that!”

Language barrier just the tip of the iceberg…
For Silva it is an interesting choice of words. Being ‘professional’ for one group of patients may be considered cold or indifferent by another. The language barrier is just the ‘tip of the iceberg’, so to speak. The Brazilian born physician says cultural differences can have significant impact too, noting the differences in the way patients receive medical information. In a significant number of his cases, for example, the non-Hispanic patient prefers to hear prognosis and details of care alone vs. the Hispanic patient who prefers to receive the information accompanied by relatives.“It’s very interesting and absolutely true,” says Silva. “I’ve had Hispanic couples come to their appointment with extended family members – not just the husband and wife, but the future grandmother too.” Not allowing a patient to bring extended family or encouraging them to do so can result in injured sensitivities for either group.

“For me, it’s not just the language. When a patient comes in, it’s not just for me to address the physiological aspects of her inability to conceive. There are also emotional, sociological aspects of the case to be addressed,” says Silva, explaining that his intent is not to fuel stereotypes, but rather share patterns he’s experienced with patients over the years. “In the Latin culture, many couples feel pressured by society – their relatives, friends – to have children. They are constantly bombarded with nagging questions like ‘What’s wrong with you?’ and ‘Why don’t you have children?’ That one act of not having a child, in this culture, can come with some negative connotations,” says Silva.

Silva’s cultural sensitivities also extend to his explanations of success rates and data. “We use our success rates, percentages, disease-free intervals, but sometimes a ‘matter of fact’ tone can be viewed as a lack of connection or empathy,” says Silva. Not paying attention to details like these can hurt patients’ sensitivities, he says, navigating in a patient care system that is definitely not a ‘one-size-fits-all’.

USF IVF above the national average…
Given USF IVF’s results, the data is impressive no matter what style it’s communicated in. The specialty practice has a clinical pregnancy rate above the national average. Since the start of USF IVF in September 2006 thru December 2007, the team treated 89 patients with In Vitro Fertilization (IVF) cycles that included egg retrieval and sperm collection. To date, the USF IVF clinical pregnancy rate stands above the national average, with a rate of 50 percent vs. the national average of 40 percent for women under the age of 35.

Clinician and Researcher…
When he’s not talking babies, bebes & nenems with patients, Silva is conducting research in the laboratory, studying the impact of aging on fertility. Specifically, he investigates the ability of stem cells to generate oocytes – the eggs which decrease dramatically in numbers and/or quality among older patients. From the laboratory to the clinic, Silva focuses on this issue of aging & fertility determined to give everyone a fighting chance to achieve pregnancy. The clinician and researcher is a recent arrival to USF IVF, having completed his residency in obstetrics and gynecology at Brown University and his fellowship in Reproductive Endocrinology & Infertility at the University of Pennsylvania.

“I guess it would make for a better story if I were to say ‘Yes, we (he & wife) went through this and I decided to know more about it.’ but no, it did’t happen that way. I developed an interest in this field even before we went through infertility as a couple. I have always been very technology oriented…and IVF was a relatively new field then, very cutting edge.”

‘I have been there’…
Silva and his wife are established fertility experts from Brazil. His wife, Vanessa Silva, is an embryologist. Ironically, when it came time to start their own family, they battled infertility. They arrived in the U.S. twelve years ago, and thanks to modern medicine are the proud parents of three children – 9 year old twin boys and 8 year old daughter. “We lived through this in a very significant way,” says Silva. “We went through all the basic treatments and none of them worked for us. Ultimately, we had to do In Vitro Fertilization. That gave me the opportunity to see what happens across the desk,” says Silva pointing to the patient chair facing him. “It’s very different when you have been on the other side. When patients ask me ‘How difficult is it going to be for me to go through this cycle…all the injections, the medications, the monitoring, how is that going to be for me?’ When you can say ‘You can do it. I have been there. ’ it’s something powerful. When you’ve gone through this with your own wife – the injections, everything – it gives you a different perspective… a level of understanding that is hard to explain in words,” say Silva.

OTHER LINKS:
Dr. Celso Silva Credentials
Welcome to USF IVF
USF IVF in Sarasota
USF Psychiatry in Español
USF Pediatrics in Español

Story by Lissette Campos, USF Health Communications
Photography by Eric Younghans, USF Health Media Center