Supporting fertility doctors and decreasing fertility treatment dropout rates with Alice Domar
BY: Alexandra Frost
Scientists can research the most cutting-edge IVF treatment plans. Businesses can market and sell, ideate and execute those options to families who need it the most. And yet, more than 1 in 5 women will drop out of fertility treatment plans within the first three months. That’s where Alice Domar, Chief Compassion Officer at Inception and the Director of the Inception Research Institute, comes in.
“Inception and its Prelude clinics are walking the walk in terms of putting the patient first but simultaneously prioritizing the mental and physical health of its employees,” she says. “And just for fun, we are building the largest reproductive infertility research institute in North America because, as I said at last year's Inception physician summit, the only way to improve patient care is through science.”
“my mother…finally got pregnant with my sister after seven years when someone prescribed the equivalent of valium. I clearly grew up with a bias that stress contributes to fertility.”
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And so, you’ll find her leading sensitivity trainings, pulling up doctors onto the stage at learning dinners, asking some of the toughest questions doctors will encounter through 14 common vignettes. This is because the doctor/patient relationship, and feeling heard and understood are key indicators of the success rate of a fertility treatment plan. You’ll find her meeting with patients, some of whom she’s counseled for more than a decade, because she doesn’t want to get too far into research and hypotheticals that she loses that connection to her why. “I’m one of the only psychologists in the U.S. who are half clinician and half researcher.” She has published eight books, numerous papers, and spoken around the world.
“Ali has relentless passion and energy for this field, and I mean that in a very positive way. Yeah, she cares deeply,” says Dr. Andrea Braverman, PhD, Clinical Professor of Obstetrics & Gynecology at Thomas Jefferson University in Philadelphia. “She is intellectually engaged, as well as, I think, emotionally engaged in the work that she does, and also investing back in the people we work with.”
Her journey to her life’s work — the connection of stress and successful conception and pregnancy — began with her own mother.
A conundrum: Staying calm to get pregnant
Domar watched her own mother struggle for a collective 12 years with infertility — seven years to have her sister, and five years to have her. “My entire childhood, my mother talked about it. How isolated she felt — because this was when everyone was having five kids — and how she was miserable and my father was no support. He was a busy economist,” she remembers. “She finally got pregnant with my sister after seven years when someone prescribed the equivalent of valium. I clearly grew up with a bias that stress contributes to fertility.”
Domar took notice.
From Candy Striper to Clinician
Growing up, Domar remembers they didn’t make doctor’s kits for girls — just nurse kits. That didn’t stop her. “I knew by the age of three I wanted to go into medicine,” she says. She’d rescue injured bugs, and was the on call family doctor, dealing with cuts and other injuries. “If I saw blood, I ran towards it, not away.”
At 13, she was a candy striper at the hospital, a comfortable place to her she knew inside and out. But when she went in for her own surgery, she was terrified. “I thought my career would be helping kids prepare for surgery.” She became an EMT her freshman year of college, helping with a gun shot victim her first day, on an ambulance for the city of Boston.
She ended up in a triple major, “never taking an elective,” in biology, psychology, and pre-med. Her father encouraged medical school, but she knew it didn’t feel quite right. “I cared much more how the child was reacting to what’s wrong with them than what was actually wrong with them.” So, she got a PhD in health psychology, specializing in OBGYN care.
“I have to research this”
In 1978, Louise Brown was born. She was the first baby conceived using IVF, and dubbed the first “test-tube baby.” Domar took notice. She was in college at the time. “I was way more interested in that than you would think I would be. I realized this is what I need to do.” Her Master’s thesis was developing a scale to assess how much anxiety a woman had before a pelvic exam. “I thought it’d be really helpful to gynecologists to know how stressed a woman was, and if it was psychological or physiological.” She did her dissertation on relaxation techniques before ambulatory surgery with Herb Benson, the “father of behavioral medicine,” she says. But it wasn’t until he gave a talk to OBGYNs about the role of the hypothalamus and infertility that the light bulb went off. “Oh my God I have to research this.”
She started the first mind-body program for infertility in 1987, teaching relaxation techniques, and “women just kept getting pregnant.” In the first group she ran, a third of the women got pregnant — a far cry above the 5% success rate associated with fertility treatments then. She knew she was onto something. She did multiple additional studies. Later, she did a randomized control trial comparing her mind-body program to a support group. The mind-body program had a 55% “take home baby rate,” compared to 52% with a support group, and 20% in the control group. “That’s incredible,” she says.
As any person who has been pregnant or tried to conceive can tell you, it’s quite difficult to “just relax,” creating a chicken and the egg scenario for relaxation and conception. So throughout her research, Domar says critics have “come for her” for perpetuating what they call a myth about stress causing infertility. But the proof is in the numbers, and she has plenty of them. She also notes her program isn’t about chilling in front of the TV — it’s a “rigorous” 10-week educational program that involves effort every single day. “It’s a very intense program.”
Years later, after putting her ideas into practice, Vogue and other publications dubbed her “the fertility goddess.”
“I honestly feel as if I have joined the dream team…T.J. Farnsworth has this vision of what patient care should and needs to be. It's all about the patient experience.”
Becoming a mother, the secret ingredients
When Domar herself got pregnant, she suffered from preeclampsia, miscarriage, and some of the challenges she counsels patients on. It hit different for patients when she was able to say she’d truly been there, going forward. One of her biggest fears is if her own daughters struggle with infertility. She pulled her research from her own struggles.
“My last book was staying calm during pregnancy. I wrote a book on self-nurturence because I had such a hard time self-nurturing myself. I wrote another on perfectionism, because I’m such a perfectionist,” she says.
Aside from parenting, researching, and writing, Domar loves to bake, especially a cake she and Braverman like to bake that they’ve dubbed “life-altering chocolate cake.” The secret ingredients are buttermilk, coffee, and a super dark chocolate icing, she reveals.
Domar also was never all work and no play — she used to arrange her fall schedule to ensure she never missed a Patriot’s game, based largely on her infatuation with Julian Edelman. “I used to call him my little boyfriend. Because he was just so cute!”
Bi-Directional Support
Domar can say firsthand just how stressful physical ailments can be. She tore her ACL at a work retreat, but you won’t find it stopping her — especially because she has to wait six months after a recent quadruple spinal infusion surgery, after which she developed meningitis. She’s been through retina issues, preeclampsia in pregnancy, and a miscarriage.
“It’s been a big challenge. But there were 14 members of my executive team and our CEO…I used to call the other executives ‘my boys’ when there were just one or two other women in the past,” she says. “But they’ve been so kind to me.”
She is kind back. “I think I care too much about the people that work with me,” she jokes. She’s the one to organize a baby shower when one of the acupuncturists on her team got pregnant, for example.
“Her leadership style is collaborative and empowering—she encourages innovation, and holds high standards grounded in both scientific integrity and human empathy,” says Elizabeth A. Grill, Psy.D. and Associate Professor of Psychology, Director of Psychological Services, The Center for Reproductive Medicine, Weill Cornell Medicine. She has worked with Domar for 25 years. “Alice fosters environments where people feel supported to contribute authentically, making her an exceptional mentor, clinician, and thought leader.” Needless to say, a torn ACL isn’t holding her up much.
Joining the Dream Team
T.J. Farnsworth, CEO of Inception, where Domar is currently the Chief Compassion Officer, tells Domar, age 66, not to say the R word, or even think about. “Retirement,” that is. “We were in Galveston riding in a cyber truck, and he gave me a ride but said if you use the R word, I’m going to have to push the eject button,” she laughs. She has no thoughts of retirement now until she’s fulfilled her life’s work.
“I honestly feel as if I have joined the dream team,” she says. “T.J. Farnsworth has this vision of what patient care should and needs to be. It's all about the patient experience. And he is not only letting me do everything I have ever wanted to do in terms of changing the way we care for patients, he is encouraging me to do even more.”
Since pregnant and soon-to-be pregnant moms sometimes misreport just how stressed they are or aren’t, she’s working with a Canadian company Auto, to make a device for a study they just finished, to wear around your waist and put an electrode in your hand and on your forehead. It measures 54 parameters of cardiovascular and Central Nervous System stress. She can’t release study results yet, but hints they are promising. And it’s “really tough” for the haters to argue with an EKG or an EEG, she notes. She’s excited to present the results and implications for fertility treatment. The next phase, “Auto 2,” will involve a bracelet and red, yellow, or green stress indicators, helping women reduce their stress as they go through IVF. “Once auto two is done and published, maybe I could stop working,” which she estimates to be two years out.
Yearly, a Cornell colleague and Domar teach a physician prevention burnout course on a ship. She’s excited at the prospect of integrating AI more to prevent burnout in the future. She’s also still an associate professor at Harvard Medical School, and is speaking in Australia soon.
As another colleague, Lauri Pasch, Professor, UCSF, Department of Psychiatry and Behavioral Sciences, says of Domar: “She has inspired a whole generation of fertility doctors to focus not only on the core goal of achieving pregnancy, but also on finding ways to make the process less traumatic, more supportive, and ultimately helping people stay in treatment long enough to get to their goal.”
Looking to Take Your Career to the Next Level?
Discover the Fastest-Growing Fertility Network in North America – Your Dream Job Awaits!
Are you ready to grow in a career that matters? Join Prelude, the fastest-growing fertility network, offering exciting opportunities in clinical, administrative, and REI roles with unmatched career growth and a fantastic employee experience.
Competitive salary & benefits
Growth potential and geographic flexibility
A supportive and dynamic team environment
Rewarding work that makes an impact
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