Day 1

My host, Dr. John Gor­don ’85 picked me up in DC at 7:15 in the morn­ing to drive over to Domin­ion Fer­til­ity Clinic in Arling­ton, VA. He intro­duced me to the nurses and Dr. DiMat­tina, who founded the clinic. Early in the morn­ing, I watched Dr. G per­form vagi­nal ultra­sounds for sev­eral patients. It was really inter­est­ing to see how they were at dif­fer­ent stages of var­i­ous treat­ments: for some patients, Dr. G was look­ing at the thick­en­ing uterus lin­ing and how the ovaries were doing, and for one patient, we could already see 20 fol­li­cles in the ovaries from stim­u­lated growth, ready to be col­lected for IVF. The most fas­ci­nat­ing one was being able to see the embryo inside the uterus of one of the patients and hear its heartbeat.

Around 10:00, some patients came in for con­sul­ta­tion, which I got to watch Dr. G do in his office. It was insight­ful for me to learn how Dr. G inter­acted with the patients. He was frank and reas­sur­ing when giv­ing them advice, explain­ing all the dif­fer­ent options that were suit­able for each couple’s sit­u­a­tion, like stim­u­lated vs. nat­ural IVF, frozen embryo trans­fer vs. using fresh embryos, and the dif­fer­ent tests for a cou­ple who wanted to know where they stood in terms of fer­til­ity. It was almost over­whelm­ing that there were so many dif­fer­ent fac­tors to con­sider when a cou­ple was decid­ing on the right pro­ce­dure for them, like what would be best emo­tion­ally, finan­cially, health-wise, etc. I was sur­prised to learn that the cou­ples who come to the clinic are from dif­fer­ent parts of the coun­try, not nec­es­sar­ily all from Vir­ginia, because Domin­ion Fer­til­ity is the only clinic where the per­cent­age of IVFs per­formed are as high as 70% nat­ural cycle IVF as opposed to stim­u­lated cycle. Since nat­ural cycle pro­duces only one egg and hence one embryo, it makes the suc­cess­ful preg­nancy rates seem lower for a clinic, and that’s why not many of them are will­ing to offer the nat­ural. One final pro­ce­dure that Dr. G per­formed before lunch was assist­ing in the col­lec­tion of an egg. While Dr. G was with the patient, I went into the lab with Dr. Ning and saw the actual col­lected egg under the micro­scope, which was amaz­ing. Dr. Ning cleaned the sur­round­ing of the egg and stored it at the opti­mum tem­per­a­ture and con­cen­tra­tion of CO2.

After a quick lunch out, I had some cool con­ver­sa­tions with Dr. G about life at Prince­ton and about how he decided on repro­duc­tive endocrinol­ogy after hav­ing really enjoyed it dur­ing his residency.

When we got back, I fol­lowed Dr. Ning again and saw the same egg, this time being fer­til­ized by intra­cy­to­plas­mic sperm injec­tion (ICSI) and inserted back into the uterus of the patient.

I really felt what Dr. G meant when he said that there was a sense of grat­i­fi­ca­tion and accom­plish­ment, as I went through in my head all the patients that we had seen today: from cou­ples seek­ing the right treat­ment to those going through the pro­ce­dures, to the patient who con­firmed her preg­nancy and heard her baby’s heart­beat, and finally to the cou­ple who brought in their adorable twin babies. It’s a really won­der­ful thing to see both Dr. G and the cou­ple so happy when the treat­ments bear fruit.

Over­all, the day at the clinic was very busy, with con­stant patient inter­ac­tions, ultra­sounds, phone calls, fil­ing data, and all kinds of pro­ce­dures. But it was really help­ful to get expo­sure to this kind of work envi­ron­ment and see all the dif­fer­ent aspects of a typ­i­cal day in the clinic.

DAY 2

Buyan and Dr. Gordon

We started the day early this morn­ing at INOVA Fair­fax Hos­pi­tal, where Dr. G gave a lec­ture on pri­mary amen­or­rhea to the hospital’s res­i­dents and stu­dents at GW and VCU. He talked about the ques­tions that a doc­tor would ask a patient if she had delayed puberty and about the dif­fer­ent paths that would be taken in giv­ing her treat­ment. It was great to see the aca­d­e­mic side of things after get­ting to know the clin­i­cal set­ting yes­ter­day. Dr. G’s lec­ture was really inter­ac­tive and he asked a lot of ques­tions to engage his students.

After the lec­ture, we went to the clinic in Arling­ton. Dr. G had three patients whose eggs were ready for col­lec­tion, so while he was with his patients, I got to go into the lab again to watch Mark, one of the embry­ol­o­gists, go through the process of stor­ing the col­lected eggs. He let me look into the micro­scope and explained to me how a darker cumu­lus around an egg could be an indi­ca­tion of egg imma­tu­rity, how to ster­il­ize a pipette, how it’s used to trans­fer the egg into a medium for stor­age, how a des­ic­ca­tor is used to cre­ate the opti­mum envi­ron­ment for the eggs, and finally how they’re stored. The whole process was really com­plex and involved so much detail!

Around noon, we drove out to go to INOVA Fair Oaks Hos­pi­tal, where Domin­ion Fer­til­ity had an office. Dr. G per­formed ultra­sounds for a patient and did some con­sult­ing for another patient and her hus­band about treat­ments for ovar­ian cysts. On the drive back, Dr. G and I talked about the dif­fi­culty of iden­ti­fy­ing causes of cysts, espe­cially given all the dif­fer­ent types. We had some stim­u­lat­ing dis­cus­sions about the eth­i­cal con­sid­er­a­tions and med­ical dif­fi­cul­ties in pro­vid­ing can­cer and HIV patients with fer­til­ity treatments.

Back at the clinic in Arling­ton, Dr. G had a meet­ing so I went into the lab to see the eggs that were col­lected ear­lier go through the intra­cy­to­plas­mic sperm injec­tion (ICSI) process. I found it really fas­ci­nat­ing that there was so much dex­ter­ity involved in it. Mark and Jerry oper­ated the pipettes with a lot of accu­racy and care under the micro­scope, and I watched each moment a sperm was injected into an egg. It’s amaz­ing to think that such a del­i­cate process which pro­vided an alter­na­tive solu­tion to so many infer­tile cou­ples was dis­cov­ered by acci­dent by a Bel­gian sci­en­tist, as Dr. G had told me earlier.

DAY 3

We started the day off at the Fair Oaks office with some ultra­sounds and con­sult­ing for patients, and again it was really nice to see a cou­ple who suc­cess­fully had a baby from a pre­vi­ous treat­ment come back because they were ready for a sec­ond child. Back in Arling­ton, I got to see some more egg col­lec­tions and the whole process of stor­ing them in the lab. Then Dr. G went through the usual sched­ule of con­sult­ing, dis­cussing the dif­fer­ent treat­ment meth­ods — from least to most proac­tive — with each couple.

I learned so much over the course of my three days with Dr. G. I would def­i­nitely rec­om­mend this Princetern­ship to other stu­dents. It’s a really good place to explore your inter­ests if you’re look­ing at med­i­cine as a career. Repro­duc­tive endocrinol­ogy is a very spe­cial field too, and the clinic is a unique, sought-after place where so many dif­fer­ent patients go because of the avail­abil­ity of nat­ural cycle IVF which is rarely offered else­where. Because of that, you’ll get to meet all kinds of patients and see how the doc­tors and nurses inter­act with them. Also, Dr. G is out­go­ing, help­ful, and under­stand­ing, and on the way to dif­fer­ent places, we had really inter­est­ing con­ver­sa­tions about his expe­ri­ences at Prince­ton, career choices, the daily life of doc­tors, eth­i­cal or polit­i­cal issues that they face, and any ques­tions that I might have. I def­i­nitely had an inspir­ing Spring Break, and I’m really grate­ful to Dr. G and all the staff at Domin­ion Fer­til­ity for this won­der­ful opportunity.