Buyan Pan ’15, Dominion Fertility

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.