Catholic doctor brings endometriosis specialty to St. Louis

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Right before he entered medical school, Dr. Patrick Yeung received a bit of eye-opening information from a friend.

He received a letter, and included with it was a brochure called, "Can a Catholic be an Obstetrician Gynecologist?" It was written by Dr. Thomas Hilgers, one of the pioneers behind Creighton Model FertilityCare System -- a Church approved method of natural fertility care -- and founder of the Pope Paul VI Institute for Human Reproduction in Omaha, Neb.

In the booklet, Hilgers explained that if Catholic medicine is true, "it should work and work well -- it should not be suboptimal medicine," Dr. Yeung recalled. It was advice that the young student, a cradle Catholic, needed to hear as he was about to embark upon a future in obstetrics and gynecology.

Today, Yeung is carrying on that example. Arriving in St. Louis last year, he is an OB/GYN who specializes in treating endometriosis, a condition in which cells, or implants, from the lining of the uterus grow in other areas of the body. Symptoms can include painful menstrual periods and infertility, among other issues.

As director of St. Louis University's new Center for Endometriosis at SSM St. Mary's Health Center in Richmond Heights, he is among just a handful of doctors across the country who treat endometriosis using a special, minimally invasive technique called excision, in which the endometriosis is cut from the body. He performs the technique using a non-contact carbon dioxide (CO2) laser.

He also describes birth control pills to treat endometriosis -- a common treatment in mainstream medicine -- as "Band-Aid therapy," adding that it only treats the pain associated with endometriosis, without addressing the underlying cause.

Yeung is among a growing number of Catholic OB/GYNs in the St. Louis area who, while following the teachings of the Church, are using special techniques -- both medicine and surgical -- to get to the bottom of what's causing a woman's gynecologic issues, which commonly can include menstrual irregularities, pain issues and infertility.

He said it isn't just that a treatment like the birth control pill goes against what the Church teaches about the unitive and procreative aspects of marriage -- but it also just doesn't make good medical sense, he said. It all falls in line with his belief that "good ethics is good medicine."

"I like to focus on the positive," Yeung said, "what I can offer patients instead."

Laser excision

According to the Endometriosis Foundation of America, roughly 176 million women worldwide suffer from endometriosis. Between 25 to 65 percent of women with endometriosis have fertility problems.Approximately 5 million U.S. teenagers are affected by the condition.

Several studies conducted in the United States, Europe and Brazil show that the average time from the onset of symptoms to the time of surgical treatment for endometriosis is 12 years, said Yeung.

"So for 12 years, women with pain are being told, 'Don't worry about it. Take some pain medication, birth control pills and come back when you want to get pregnant,'" he said.

Many gynecologists who surgically treat endometriosis use a technique called ablation, which means the implants found outside of the uterus are destroyed using energy. Yeung, however, said this kind of treatment only reaches the endometriosis at the surface, adding that the implants can invade at much deeper levels. Excision entirely cuts out the implants -- and because excision leaves a sample, it is sent for pathology testing to confirm the disease.

Yeung has completed two residencies -- one in family medicine at St. John's Mercy Medical Center (now Mercy Hospital St. Louis) and one in OB/GYN at Georgetown University. He also did two fellowships, one in minimally invasive gynecologic surgery at the University of Louisville, and another in laporoscopic excision of endometriosis using the carbon dioxide laser at the Center for Endometriosis Care in Atlanta. Before coming to SLU last summer, he founded Duke University's Center for Endometriosis Research and Treatment, which he directed for three years.

Yeung recently concluded a study that looked at complete excision in teenagers, performed by an expert -- that is "someone who knows all the different forms of endometriosis, and can find it and cut it out wherever it is found. We followed them for up to five years, two on average, and in that time frame, almost half of all patients had a second local laporoscopy -- zero had endometriosis. The published rate of occurrence after ablation is 50 percent in two years."

The study was presented at the annual conference of the Endometriosis Foundation of America, held in New York in March, and was published in the journal Fertility and Sterility, said Yeung.

The results, he said, pointed to the need to advocate for "early diagnosis, and complete excision as the best way to control pain and quality of life," he said. "The implication is perhaps it will preserve or restore fertility. If you go back and it's not there, then that means it cannot grow. That needs to be systematically studied, but that is a huge potential benefit."

Carrying on the work

Before he started his work at Duke, Yeung had several opportunities to work and publish with Hilgers, who has been regarded around the world as one of the leading pioneers in natural fertility health care for women, also commonly known as natural family planning. Hilgers founded the Pope Paul VI Institute for the Study of Human Reproduction in 1985; it was a direct response to Pope Paul VI's call to medical doctors in the 1968 encyclical, "Humanae Vitae," to "continue constant in their resolution always to support those lines of action which accord with faith and with right reason."

Hilgers began his work in natural ferility care at St. Mary's in Richmond Heights in the 1970s, when he joined with other medical professionals to create the Creighton Model FertilityCare system.

"It is amazing that I am now here," said Yeung. Also at St. Mary's is Dr. Cherie LeFevre, another Catholic OB/GYN who has a part-time practice that specializes in treating vulvar issues. Both LeFevre and Yeung are NaPro Technology medical consultants; Yeung is also a NaPro surgical consultant.

It was Hilgers who best explained that good medicine requires getting to the root of a medical issue and fixing it, "which is a basic approach to medicine that we have in every other field of medicine -- but somehow is lost in the world of OB/GYN," said Dr. Yeung. Instead, women's health issues often are treated with what he described as "suppressive or circumventive therapy."

In Hilgers' booklet, he spoke about working with a woman's natural cycles and trying to restore a woman's natural "ecosystem," said Yeung. "He had used words and phrases that I had never heard put in that way before. It was very positive, very in line with good medical principles and totally changed my worldview of medicine and Catholic medicine."

In 2004, Hilgers published "The Medical and Surgical Practice of NaPro Technology," a comprehensive reference book that Yeung called a "platform" for the practice medicine that works in cooperation with a woman's natural fertility.

"We can talk about (good medicine) based on the medicine and the facts, but it should be able to stand on its own, too," said Yeung. "It needs to be brought into the mainstream ... and to do that, there has to be research and we have to publish on it. And that's where I see my role."

"We are in a very exciting age where we have all the pieces in place," said Yeung. "Now it's just a matter of execution and making it accessible to people."

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